BRATTLEBORO — When the Selectboard voted with little public notice or debate last spring for the municipality to take over emergency medical services from Windham County's largest and longest-serving agency, Rescue Inc., officials claimed the private nonprofit wasn't sharing enough information.
“The continued lack of transparency,” Selectboard Chair Ian Goodnow said April 19, “meant that I, as one board member, felt it was time to look for a different EMS provider.”
Goodnow and his four colleagues have stressed their collective belief in the concept of “transparency” at least 20 times in the months since, meeting transcripts show. But despite public calls for leaders to practice what they preach, the municipal government has yet to release a single document explaining the surprise switch, even when asked through the state's official public records process.
A series of VTDigger requests for information about why the town replaced Rescue with the municipal fire department after nearly 60 years of service has prompted leaders to declare they won't disclose any paperwork behind the decision.
“The law exempts from public inspection 'records relating specifically to negotiation of contracts,'” Town Attorney Robert Fisher wrote in a statement.
But the records request has unearthed a few clues for residents questioning why local leaders would pull the plug on Rescue before conducting a feasibility study to learn if the changes would save money and improve medical coverage.
“The fire department,” said a note with the town's denial of records, has “long expressed an interest in having a more robust role in EMS delivery in Brattleboro and this view came to be embraced by the former town manager.”
Octavian “Yoshi” Manale, who started as town manager in January, went on to draft undisclosed paperwork that preceded the Selectboard's approval of the change in April - eight weeks before he abruptly resigned.
Memo: 'flawed' by 'inartful drafting'
Under state statute, officials can - but aren't compelled to - withhold certain information as long as they identify what it is. In response, Brattleboro leaders said they are shielding three sets of documents:
1. A draft PowerPoint slideshow outlining how the town would replace Rescue with the fire department after a transition year of training with Golden Cross Ambulance of Claremont, N.H. - a presentation the town revised and shared with the public on April 18, the night before the Selectboard approved the change.
2. Two Excel spreadsheets drafted by Manale that “detail negotiation options” with Rescue and Golden Cross, dated March 8 and March 24 - six months after the former Town Manager Peter Elwell took the microphone at Rescue's 2021 annual meeting to say “the system is working.”
3. Manale's internal summary of proposed answers to potential questions, “although much of the same information is covered by TM Manale's memo,” the town said in reply to VTDigger's requests.
The town released the latter memo April 11 - and now acknowledges its content isn't fully accurate.
“The memo from 4/11/22 is flawed,” interim Town Manager Patrick Moreland wrote VTDigger as part of the public records process.
When asked to elaborate, Moreland limited his answer to “inartful drafting.”
The errors in Manale's memo start with the first sentence, which read “Rescue Inc. informed the Selectboard and town manager that [it] would no longer be providing emergency medical services for the Town of Brattleboro as of July 1” - something the provider never said.
Rescue had written municipal leaders to say the town's contract was set to expire June 30 and the agency was open to discussing an extension to continue coverage, a copy of the letter confirms.
The town's memo instead told the public that the fire department would have to fill an imminent void by taking over EMS duties through a transition plan with Golden Cross.
The memo went on to say that swapping Rescue's $285,600 annual contact with a lower-priced $75,000 transition-year agreement with Golden Cross would save taxpayers more than $200,000. Manale added that the switch eventually would let the town charge insurers for EMS services and reap an estimated $500,000 to $700,000 in annual revenue.
But since that time, the town has spent $75,000 on the Golden Cross contract, an estimated $52,000 for EMS staff raises, $27,000 in training costs for paramedics, $16,980 for medical consulting, and $13,721 more than originally budgeted for a feasibility study of the plan.
Those figures total $184,701 of the $237,580 the town would have paid Rescue. (Rescue's $285,600 annual fee would have been offset by the agency reimbursing the town $48,020 for its dispatch.)
Those calculations don't include yet-to-be-reported additional training costs at $1,000 each for emergency medical technicians and $1,200 to $1,400 each for advanced emergency medical technicians.
And the Selectboard is set to consider spending another $50,000 for use of a third Golden Cross ambulance it has tapped at least eight times in the first month of a 90-day trial.
If members approve that sum, total expenditures will match those budgeted for Rescue this fiscal year.
'One of the worst decisions ever made'
The increased spending isn't the only issue raising eyebrows. State EMS experts have questioned Brattleboro's claim that it will be able to reap as much as $700,000 in annual revenue by charging insurers for calls.
Vermont has a higher-than-average number of people covered by federal Medicare health insurance for older adults and Medicaid for anyone with low income, statistics show. This affects revenue, as Medicare pays only 80 percent of a bill, while Medicaid pays only about 64 percent.
“Every patient we see with Medicare or Medicaid is being reimbursed at least 20 percent less than the cost of delivery,” Rescue Chief of Operations Drew Hazelton said this spring at a public meeting where his agency explained the financial information the town claimed wasn't being shared.
Under the transition plan, Golden Cross is receiving Brattleboro EMS insurance revenue from July 1, 2022, through June 30, 2023. The town says the provider sent bills totaling $109,452 in its first six weeks and had collected $28,530 of that, although it cautioned that it was too early to calculate the percentage of charges being paid.
Before the town can take over EMS coverage fully, it will have to buy vehicles and equipment to replace what it's now accessing from Golden Cross. Local leaders won't know what that sum will be until a feasibility study is completed this fall.
But nearby Charlemont, Mass., just spent $350,000 for one new ambulance, while Manale's memo proposed Brattleboro buy the two or three it needs by seeking “refurbished” models at $110,000 each.
State officials worry Brattleboro leaders don't understand the challenge of juggling the billing imbalance and ongoing costs.
“Medicare and Medicaid don't pay enough, fuel is going up, payroll for employees is going up, everybody's strapped for finding certified people - it's not an easy business,” said Jim Finger, head of the Vermont Ambulance Association. “Anybody that does this should plan out way ahead for all the contingencies and make sure it makes financial sense.”
Outgoing Sen. Jeanette White, D-Windham, affirmed Finger's comments when she testified at a Vermont legislative committee meeting this spring that Brattleboro's pullout from Rescue was “one of the worst decisions ever made.”
Residents are asking their own questions. Many have expressed appreciation for the work of both Rescue and the fire department but said they don't understand why municipal leaders approved the change before studying the ramifications on medical coverage and costs.
Speaking at the Aug. 16 Selectboard meeting, Brattleboro physician Franz Reichsman pointed out the board's repeated use of the word “transparency.”
“As you said, transparency is very important,” Reichsman told members. “And there really hasn't been an open discussion of what happened and what we need to learn. I think there should be some kind of a comprehensive report that lets the people of the town know.”
The Selectboard unanimously rejected that suggestion.
Said member Elizabeth McLoughlin: “I really don't have any intention of rehashing that decision.”
And colleague Daniel Quipp: “I'm not interested in going back to the past.”
'This is a manufactured crisis'
That isn't deterring residents from seeking answers. Users of ibrattleboro.com have created “Your Handy Brattleboro Fire - EMS - Rescue Timeline” as a way to keep the public informed.
People with EMS experience are listening to and sharing local dispatch audio out of concern that the town's backup coverage plan is to turn first to Keene, N.H., and Greenfield, Mass. - each a half-hour away.
One recent audio of Brattleboro EMS activity Aug. 19 featured personnel asking questions about a call reporting a possible stroke and whether mutual aid was on its way. (The call ultimately was answered locally.)
Local lawyer William Kraham, who credits Rescue with saving him from sudden cardiac arrest, voiced his fear about long wait times in a May 11 letter to The Commons. He questioned the Selectboard's claims it was “forced” to change providers because of a perceived lack of information and “incendiary” comments in the Rescue correspondence Manale mischaracterized.
“This is a manufactured crisis,” Kraham wrote. “This is not a choice between using Uber or Lyft for your ride to the hospital [...] I have a sense of foreboding that our elected officers have chosen to gamble with people's lives.”
Town considers documents exempt from public records law
VTDigger filed its series of public records requests starting in July and continuing through the summer.
The first request asked for all information that led to leaders' April 11 statement, “After careful consideration of various options, the town will be shifting from a private provider to a joint fire/EMS service.”
In response, the town cited the “inartful drafting” of the original language, noting the Selectboard had voted only on a one-year transition plan rather than the long-term program.
“It is very clear that the Selectboard has yet to make such a [permanent] decision,” Moreland wrote. “Accordingly, the background materials for this decision have yet to be produced” and therefore can't be provided.
A revised second request asked for information behind the one-year transition plan and, specifically, Manale's words about “a careful internal analysis” and Selectboard Chair Goodnow's quote, “this decision is the result of deep reflection.”
In response, the town repeated that it had no records to share because “the memo from 4/11/22 is flawed.”
A third request dropped any mention of April 11 and simply asked for all records “involving any and all EMS issues” discussed by municipal leaders from Jan. 1 onward.
In response, the town said it had “just under 100 documents” and “roughly 6,800 emails” that would need to be reviewed before possible release - a task for which local leaders would charge an estimated $11,550.
A fourth request, which came after VTDigger reported its willingness to go to court to receive what's due under the law, led the town to acknowledge the three sets of undisclosed documents.
As the public and press seek information, local leaders are aiming to shape the story.
The draft Selectboard meeting minutes of June 21, for example, noted Brattleboro Fire Chief Leonard Howard said “he's not trying to hide anything, and neither is the board.” But the revised minutes that members approved removed the reference to “not trying to hide anything.”
Board member Tim Wessel has repeatedly chided the press for perceived “bias” and errors. He claimed, for example, that Manale received less than the $70,000 figure the media was reporting for a severance package - only to include contract information in his emailed complaint that proved the value of the settlement was actually more: $72,515.
As for the future, the Selectboard is set to decide how to proceed once it receives the results of its $38,721 feasibility study as soon as next month.
Meanwhile, Rescue Inc., which is still serving 14 surrounding communities in southern Vermont and neighboring New Hampshire, is launching the state's first EMS-specific training school in Newfane.
And Manale was just hired to be the new municipal manager in Claremont, New Hampshire, where the mayor who announced his hiring is Dale Girard - the owner of Golden Cross Ambulance who hasn't responded all summer to VTDigger requests for comment.