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ISSUE #140: Call An AmbulANTs  4/2/2018

"Parties are only bad when a fight breaks out, when men fight over women or vice versa.  Someone takes a fall, an ambulance comes and the police arrive. If you can avoid these things, pretty much all behavior is acceptable. 

                          -- Bill Murray



Heard about the $7.5 million soon-to-be-built "Ambulance Barn" at the hospital?  Me neither, that is, since we approved a mill levy increase for the Aspen Ambulance District (AAD) in 2014.  The Red Ant advocated for this increase as a matter of public safety, especially to serve the needs of our growing (and aging) full- and part-time population.  What I did not advocate for was the AAD to operate in a dark vacuum since then, with little-to-no public outreach and, according to public records, nary a public meeting in the past three years! It's true, the government, including special districts, CAN build for the public without going through the standard reviews and processes, but this one is especially squirrelly.
Good question.  The AAD is the provider of ambulance services in Aspen.  It is a stand-alone taxing district within Pitkin County that was formed in 1982 with a mill levy of 0.82.  Over the years, due to the Taxpayers Bill of Rights (TABOR), as property values increased, the mill levy had been reduced to 0.22.  In 2014, voters within the AAD approved a property tax levy of up to 0.501 mills to ensure that AAD's facilities are adequate and that its revenue model can sustain the district beyond 2017.  
The AAD district boundaries include Aspen and unincorporated Pitkin County, from Watson Divide up to Aspen, but does not include Snowmass Village, the Snowmass Creek and Capitol Creek valleys, or the Crystal River Valley.  These areas are served by the Snowmass-Wildcat Fire Protection District, Basalt and Rural Fire Protection District and the Carbondale and Rural Fire Protection District, respectively.
And governance?  The AAD board is "coincidentally" Pitkin County's Board of County Commissioners (BOCC), who rarely discuss this little-known cash-flowing district.  In fact, two of the 5 commissioners live outside of the AAD boundaries, and should therefore be ineligible to vote on AAD matters if the county's other district board member qualifications are applied. (George Newman lives in Emma and Steve Child lives in Old Snowmass.) And that's not to mention that the BOCC folks are duly elected by citizens inside AND outside of the AAD boundaries, so yes, residents of Redstone and Old Snowmass technically get to vote on AAD representatives.  This group recently approved the issuance of Certificates of Participation (COP) to fund the AAD's proposed $7.3 million facility and a $250,000 new ambulance (recall that COPs do not require public approval) now that the district's new mill levies have kicked in and can service the debt.  This sidestep of the taxpaying public is a problematic practice, most recently seen in the City of Aspen's decision to use COPs to finance the Taj Mahal City Hall instead of going to the voters for bond approval.  It's the old "If you can get your sticky mitts on it, spend it" mentality... yet again.
The AAD contracts with Aspen Valley Hospital (AVH), so its 30+/- paramedics and EMTs are hospital employees, despite technically working for an outside entity.  The employees, equipment and responsibilities for the ambulances are "tasked" to the Aspen Valley Hospital district as part of an intergovernmental agreement.  The current ambulance barn is on AVH's property in the County.  The new 11,000+ sf barn will remain there, and the County is planning to name it "The Pitkin County Ambulance Building."  One problem: Pitkin County has nothing to do with ambulances, and the AAD does not serve the entire county.  Not even close.  The AAD boundary is nearly the same as that of the Aspen Fire Protection District (AFPD), served by the Aspen Volunteer Fire Department.  (Sure, Aspen Fire will absolutely assist Snowmass Village or frankly any jurisdiction that requests it under a code of "mutual aid," but these other districts have their own proprietary EMS operations as a first line.)
There is obviously a very cozy relationship (more like a tangled braid) between 3 government agencies:  Pitkin County, the Aspen Valley Hospital District and the Aspen Ambulance District.
NOTE:  In no way is this analysis any kind of judgment on the many fine professionals who work for the AAD.  We are incredibly fortunate to have such world-class care in our community.  And if you've ever been a "passenger" (as I have), you know just how good these folks truly are.  My beef is specifically with the governance,  the lack of transparency, the lack of fiscal oversight and  perhaps just some plain old archaic thinking.
The AAD is one strange unicorn.  To begin with, 96% of the country (USA, not the county) is served by fire-based Emergency Medical Service (EMS).  This includes our valley:  Snowmass Fire and EMS, Basalt Fire and EMS, Carbondale Fire and EMS, Glenwood Fire and EMS, and Rifle (Colorado River Fire and EMS).  But in Aspen, and Aspen specifically, fire and EMS are two different entities.  
It comes down to this: Does AAD really need a new $7+ million facility?  And should this facility be located on the west side of the Castle Creek Bridge at the hospital?  Does this location best serve the needs of our community?  What due diligence was done prior to the approval of this enormous taxpayer-funded expenditure?  Were there other alternatives?
The Red Ant has learned that it always helps to follow the money.  AAD has new-found purchasing power after the 2014 mill levy increase.  So much purchasing power, in fact, that the new barn continues to escalate in cost estimates each year, every time it is quietly mentioned, which isn't often.  And with AAD under the purview of AVH, the money owed AAD that is originally billed by AVH stays in the hands of AVH until it is reimbursed.  A slush fund if you will.  And who, especially a hospital, doesn't like a little slush fund?  
Pitkin County also sees some slush, as they collect the property taxes in the first place.  Sure, the AAD mills are indeed AAD dollars, but these hit the county coffers first, and are doled out at the discretion of the county administrators.  In the meantime, not at all unlike what the City of Aspen does with the Real Estate Transfer Tax (RETT) revenues, the county can use the cash on hand on a short term basis at its own discretion.  Who would know?  The power of the purse, so to speak.
There is also the mysterious question of whether or not Snowmass Village taxpayers are paying for their proprietary Fire/EMS services PLUS paying for the employees of Aspen's Ambulance District.  After all, Snowmass taxpayers pay into the Aspen Valley Hospital district, and Aspen's ambulance employees are paid by AVH.  The accounting is vague at best, so my best guess is that if not the salaries and expenses, it would appear that the benefits for AAD employees  just might be being paid in part by Snowmass Village taxpayers.  That just doesn't seem right.
It is a bit odd that our two entities are not combined, but that's just the way it is.  To The Red Ant, the reason seems like inertia.  The AAD has flown under the radar with an inherently conflicted board structure and little-to-no transparent governance since its inception.  But when it raises its own profile with a $7+ million taxpayer-funded HQ, the yellow warning lights begin flashing.  I'm sure it's convenient and tidy for the BOCC to meet sporadically on AAD business, despite the mill levy funds rolling in.  In fact, the only report I have heard about the BOCC's opinion on advocating for a stronger collaboration between the Aspen Ambulance District and the Aspen Fire Protection District is the overly simplistic question of how the fire district would handle ambulance billing were the two entities to become more closely aligned.  (One word: Software.)
But from a logistics standpoint, regardless of whether or not the two entities remain separate, there are some very real public safety considerations.  The concept of "best location" should absolutely drive the decision-making.  Where do the ambulance calls come from?  According to the AAD's call data, it's an even 50/50 split between the city and the county.  And when I say "county," I mean the portion of the county within the Aspen Fire Protection District boundary, not the entirety of Pitkin County.  Frankly, I found this curious.  It just didn't pass the smell test.  And I'm glad I asked further.  Did you know that ALL ski area ambulance pick-ups are "county calls"?  Yes, all of them, even the gondola drop-off driveway on Durant, Lift 1A AND the top of Spring Street between The Little Nell and the (former) Sky Hotel.  These pick-ups are counted as county pick-ups despite being located technically within the city limits.  They're designated "county calls" because ski area injuries occur on the ski areas which are in the county, not the city.  And AAD and the Pitkin County Sheriff consider all ski area emergencies to be in the county's jurisdiction.  So, in other words, the 50/50 count is grossly misleading. In fact, FAR more than 50% of ambulance calls are from what you and I consider to be "town," mere blocks from the Aspen fire station. But soon, all the ambulances will be forever stationed outside of town in the AAD's proprietary new $7+ million "Hilton at the Hospital."  
It seems to me that now would be a really good time to evaluate if this is truly the "best location" and get some much-needed public feedback - before the new HQ breaks ground.  The whole thing makes zero sense to me given our notorious traffic choke-point at the S-curves and Castle Creek Bridge, other than that the AAD suddenly now has a fat checkbook so it wants its very own clubhouse.  Besides, in the cozy relationship with AVH, AAD gets the land, and AVH can utilize AAD employees to supplement their workforce in the ER while on AAD duty.  Clearly, at the very least, the AAD needs some grown-up supervision!
Another logistic consideration is to avoid what's called "second call failure."  This is when, say, ambulance A is called to the gondola, and then 4 minutes later a second call comes in from elsewhere in the district.  It doesn't happen often, but it can, and given Aspen's ongoing flirtation with the laws of unintended consequences, it will.  Thus, a second ambulance, ambulance B, is always staffed and ready.  Is the best location for either or both ambulances really out at the hospital?
Oh, and let's not overlook the complete foolishness of having all the Aspen ambulances stationed out at the hospital.  They'll be sharing the driveway onto Castle Creek Road with AVH, the Health and Human Services building, and NUMEROUS condominiums.  And did I mention that this intersection with Castle Creek Road is mere feet from the insanely dense soon-to-be-built-across-the-street 488 Castle Creek Road subsidized housing project?!  (See Issue #139)  This bend on Castle Creek Road is going to get really ugly, really fast.  Is there a rational mind that thinks this is a good idea, when little-to-no-cost alternatives are available in town and in the western portion of the district, properly spread out to effectively service the population?
Fire stations are inherently located where they are most needed, so when the Aspen Fire Protection District totally rebuilt its downtown fire station for the Aspen Volunteer Fire Department, it included a bay for 1-2 ambulances as well as bunk rooms for the attendant AAD personnel.  (To this day, the space is underutilized.) 
Fire Chief Rick Balentine weighed in last year to Pitkin County leadership with his opinion and those of the Aspen Fire Protection District board on the AAD's plans, including an incredibly generous offer that was ignored by the AAN.  From a "space needs" perspective, the AFPD offered to house ambulances and crews at its existing stations (downtown and at the North 40) at little to no cost, with the goals of 1) enhanced public safety "by facilitating potentially quicker response times in the downtown core and other high density areas within our shared districts," 2) fiduciary responsibility  - "economies of scale to taxpayers," and 3) resource sharing - "integration and better cross-training and response protocols between members of both organizations."   Balentine is confident that "the currently built AFPD stations and crew quarters can adequately meet (AAD's) needs while allowing for future growth and development as both departments continue to evolve."  Furthermore, Balentine  highlighted that the North 40 station served as temporary quarters for AAD during the recent AVH construction.
This is not a specific call to combine the two entities, but it is most certainly a responsible call to do the proper due diligence and analysis before the AAD just hauls off and spends millions of taxpayer dollars unnecessarily simply because it can.  Balentine emphasizes "the potential cost savings and enhanced public safety that might be realized through a formulated cooperative resource-sharing plan of both our districts."  (This type of consideration is what happens when a special taxing district such as the AFPD demonstrates leadership and stewardship by meeting monthly and putting public safety at the forefront!)
The AAD desperately needs to be separated from the BOCC, obviously.  The question at hand is a good one - would the AAD be better suited under the purview of the AFPD or AVH?  (That is to be determined.) 
While a "combination" of the ambulance and fire districts may initially seem to make a lot of sense, there are additional considerations.  Culturally, for example.  The Aspen Volunteer Fire Department has been around since 1881.  That's 137 years.  It has a proud history with proven success, and that's not only in its full-service capabilities: fire suppression and prevention, swift water rescue, wild fire, hazardous materials mitigation, motor vehicle and aircraft accidents, technical rope rescue, as well as emergency medical and other emergencies. It also includes a track record of fiscal restraint and respect for the district's taxpayers.  For example, Aspen has the lowest fire protection property tax mill levy in Colorado, while also protecting well over $20 billion in property.  
As a volunteer organization, there is always the concern about becoming or being perceived as a "career" (paid) fire department, clearly not what AVFD would ever want.  But to have ambulances stationed in town at the fire station still makes infinite sense, particularly as it impacts response time.  Could anything be more obvious?
From Chief Balentine, there are certainly ways for the two districts to cooperate to better serve our community, even while remaining separate.  The first step is always cooperation.  From there, anything can happen.  The new barn is a huge step in the wrong direction.
In all likelihood, this train has left the station.  The AAD intends to break ground this spring.  But knowledge is power, and given that this project has intentionally been kept on the down-low, The Red Ant is not the only one irritated.  And concerned.  
There is an effort underway to Stop This Project.  I hope it can be done so that proper vetting can occur in the light of day.  And that includes new governance of the AAD so that they too conduct open meetings!
If you would like to share your opinion, please plan to attend the P&Z meeting on Tuesday, April 3 at 4:30pm in the Sister Cities Room in City Hall.
For questions and if you would like to get more involved, click  
And as always, feel free to submit your letters to the editors of our local newspapers, THE ASPEN TIMES and the ASPEN DAILY NEWS.
NOTE:  At press time, The Red Ant has learned that AAD staff is currently scrambling to "update" its facts and figures.  Clearly, someone is feeling the heat.  Let's turn it up!  



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