Sep 3, 2019 4 min read

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Fayette EMS administrative director Bob Topper thumbed through a thick packet with a grim expression. Each page listed patient bills in collection, adding up to $830,000 for thousands of unpaid ambulance trips.

“In most cases, they can’t pay it. They’re trying to make ends meet. They can’t pay $200 to get on the back of an ambulance,” Topper said.

Fayette EMS, along with other ambulance services throughout the country, is struggling to make ends meet so they can continue providing emergency medical services to their communities. The nonprofit service is owed $830,000, in addition to $430,000 in bad debt.

“There’s no easy solution to collect that,” he said.

Topper said most people with low-cost health insurance plans do not realize they will still have co-pays for ambulance services. EMS cannot collect advanced payments and transports patients even if they have thousands in unpaid bills.

“We’re not heartless in the least bit,” said Fayette EMS Chief Rick Adobato. “We’re in the poorest county in Pennsylvania. Most people don’t have (the money), and that’s sad. We have to find a way to keep the doors open.”

Pennsylvania’s Senate Resolution 6 Commission issued a 2018 final report saying EMS and fire services “are in a crisis” with EMS “woefully lacking in funding.”

Insurance covers a percentage of most $250 ambulance trips, Topper said. Unpaid $50 bills stack up to create a hefty burden for the ambulance service, which he said operates “as economically as possible.” Adobato said they “pinch pennies,” only getting fuel where Fayette EMS receives a discount amounting to 6 cents per gallon. Fuel accounts for $275,000 of Fayette EMS’ $7.5 million annual budget. Workers compensation makes up $140,000 of the budget, and $250,000 is budgeted for vehicle repairs, Topper said.

The service must soon find $600,000 to $650,000 to replace its decade-old cardiac monitors. Seventy percent of the budget goes toward employee wages and costs, with $3.75 million in payroll. Still, employees could make more at neighboring ambulance services.

“Our EMTs could probably go to Sheetz and make as much money, and that’s sad,” Adobato said.

Earlier this year, Fayette EMS was nearly forced to shut its mountain station in Wharton Township, which serves Wharton, Stewart and Henry Clay Townships and Ohiopyle and Markleysburg boroughs. Nemacolin Woodlands Resort and the Joe Hardy family provided a donation to keep the station open. Hardy donations kept the station running for 20 years. Markleysburg also provided a donation, and Wharton Township and Fayette County agreed to provide funding.

Adobato said the funding streams will make up a deficit for the next year, and they have tentative plans to keep the station open after the year has ended.

“We can’t keep going through this every year,” he said. “Fighting to protect the citizens should be a government responsibility. We’re providing the service.”

Topper said EMS needs a revenue stream from the government, whether it be imposed as a tax to property owners, surcharge or funding from gambling or tourism revenue streams.

“There just needs to be a monetary figure to provide the services,” he said.

He compared the challenge to volunteer fire services, which are also struggling for volunteers and funding. Firefighters spend much of their time volunteering to raise funds.

“Ours is all billing and begging for money. It’s tough. It’s been bad before, but never like this,” Adobato said.

He said a countywide system that receives tourism tax dollars could ease the financial burden. In the meantime, they are crunching numbers to keep emergency services running smoothly.

“The first responders are the safety net of the community when everything else fails,” Adobato said. “That can’t go away.”