NAVAJO COUNTY — The long-standing dispute between the only two ambulance service providers for the Mountain shows no signs of settling down.
The players are the Timber Mesa Fire and Medical District (Timber Mesa) and Arrowhead Mobile Heathcare, Inc., (Arrowhead) which used to be called Show Low EMS. Under various laws and regulations, any provider of such services needs a Certificate of Necessity (CON) from the Arizona Department of Health Services (ADHS) — the CON is what the ADHS calls the permit that allows the provider to operate in a particular geographic area.
Timber Mesa, a governmental company funded in part by property taxes, had been doing business as Lakeside Fire District for years. Its permit was set to expire in November 2018, and they began the regulatory process of having it renewed. But Timber Mesa not only wanted to renew its old permit, it also wanted to expand its service area. Therein lies the problem because the expanded territory it applied for included the territory historically served by Show Low EMS/Arrowhead, a private company.
Rightfully sensing a threat to its business, Arrowhead “intervened” in Timber Mesa’s application process and opposed it. When that happens, the dispute goes to an Administrative Law Judge (ALJ) at ADHS who holds a hearing and makes a recommendation to the ADHS director, in this case, Dr. Cara Crist, to either approve or reject the application.
The ALJ in this case, one Thomas Shedden, recommended to the director of ADHS not to allow Timber Mesa’s expanded CON. He made over 400 findings of fact and conclusions of law, all of which supported Arrowhead.
But the director of ADHC makes the ultimate decision and in this case, Director Crist overruled the regulatory judge in May 2018 concluding that the judge was “not legally correct.” She rejected his recommendation and issued to Timber Mesa the expanded CON. It is noteworthy that Timber Mesa not only got its renewal, and the expanded territory it asked for, but also more territory that it had even asked for, making for a total service area of 167 square miles.
Arrowhead appealed Crist’s decision to the superior court asking for an injunction, and a restraining order to keep Timber Mesa out of its territory but lost the appeal.
That type of appeal is unusual because the decision Arrowhead complained about wasn’t in a lower court, it was not in a court at all. It was in a department of the state’s executive branch, overseen by Gov. Doug Ducey. This type of appeal, said the superior court judge, does not allow for injunctions or restraining orders. There is available a “stay” which would put Crist’s decision on hold but that judge said Arrowhead did not have the legal grounds for a stay.
Meantime, Timber Mesa has been servicing the new area under its CON, but the feud sparked up again when Timber Mesa notified the public that they have a choice of ambulance services even in an emergency.
Jim Broome, who describes himself as Arrowhead General Manager Ret. has since taken out newspaper ads claiming that Timber Mesa is “dangerous and reckless” by informing the public of the choice. Broome calls it “shameless” that Timber Mesa would tell the public that, and doing so “could cause serious harm or even death in critical, time-sensitive situation(s).”
In his ads, Broome said that Timber Mesa “may be the most expensive fire district per capita in Arizona.” That “property owners in Show Low, Linden and Lakeside are paying over $9 million a year in Timber Mesa taxes,” and that Timber Mesa ambulance patients “are billed $1424.89 plus $15.42 per mile” for service calls.
By contrast, he claims, patients of Arrowhead are billed directly by Arrowhead “of which 95% is paid for by Medicaid, AHCCCS, auto or health insurance.” Moreover, that despite the high rates Timber Mesa charges, “they reported half million dollars loss to ADHS from July 1, 2018 to June 30, 2019.”
Finally, Broome claimed that Timber Mesa only “has one staffed ambulance station in Show Low and one in Lakeside leaving most citizens underserved.”
That was about enough for Timber Mesa Chief Bryan Savage who recently contacted the Independent to “respond with clarity,” he says, to Broome’s claims. Savage calls the ads “literally fiction,” starting with Brooms’s status as Arrowhead General Manager Ret. In fact, said Savage, Broome is the “current owner and CEO of the company,” which is a for profit organization. Timber Mesa, said Savage, is a government entity with a publicly elected board, created by statute and not in the profit-making business.
“Dangerous and reckless,” says Savage doesn’t apply to Timber Mesa, it “applies directly to Mr. Broome and Arrowhead EMS.” Savage claims there have been “no less than 25 complaints filed (with ADHS) against Arrowhead...(about) equipment failures to response issues,” including one from an Arrowhead employee alleging dangerous working conditions, missing narcotics, misleading local building inspectors and a hostile working conditions including a supervisor who reportedly shot off a firearm in the station.
Regarding finances, Savage says that Timber Mesa is financed by property taxes, but none of that goes to the ambulance operation. That operation is financed though “locally supported funding,” and “healthcare reimbursement” and that Timber Mesa has earned recognition for its finances by the Government Financial Officers Association.
Savage explains that there was no “half million dollar loss” in the annual revenue report required to be filed every year with the ADHS. That from the perspective of a non-accountant, the report suggests that because of the pre-printed form the ADHS requires licensees to use. Savage says that certain expenses are not included in its operating budget and to account for them, certain costs are reflected in the addition and then the subtraction of certain figures, and that this accounting regimen has been explained to Broome “ad nauseum.” Savage says.
He also says the per-ride rate is lower than the $1,424 reported by Broome, and in fact, Timber Mesa’s charges are 20% lower than Arrowhead’s; actually the lowest among all fire districts and ambulance services in northeastern Arizona, he claims. What Broome didn’t say, claims Savage, is that Arrowhead has asked the ADHS for a 41% increase in Arrowhead’s current cost per ride up to $2,400. Finally, Savage said that Timber Mesa has added four ambulances to the area just since the director’s decision to expand its CON, and that the response time is equal to many urban areas.
But the back and forth continues.
Broome said that “We have served Show Low and the surrounding towns for 20 years with the best trained, most experienced paramedics and modern, well-equipped ambulances.”
Savage replied, “Mr. Broome wants to return to a loosely regulated monopoly where people don’t have a choice, where he can charge what he wants and has no competition and therefor no reason to improve services.”