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City Vows to Fill Potential Ambulance Void - NY


Mayor Michael Bloomberg said the city will add more ambulances if private hospitals decide to stop providing ambulance service because of a new fee the city plans to impose. But the mayor on Thursday predicted that the hospitals will pay up because they would stand to lose patients and revenue if they get out of the ambulance business.

The Fire Department handles roughly 63% of the ambulance tours in the five boroughs, while 25 private hospitals account for the remainder. Beginning in January 2012, the city plans to charge these hospitals as much as $1 million to participate in the city's 911 system.

Medical professionals said the new fee will create an enormous financial burden on already-struggling hospitals. Some officials predicted hospitals would no longer volunteer ambulance services.

But Bloomberg remained skeptical that private hospitals would stop providing ambulance service. "I don't think that's the case," he said Thursday in response to a question from The Journal. "But if we have that extra revenue and they go out of the ambulance business, we'll add more ambulances to the FDNY."

"The bottom line is that they like these ambulances to pick up patients because that's the way they fill the beds. And they generally don't pay themselves," he added. "They pass on the cost to insurance companies or to one of the federal programs."

The mayor suggested it's unfair for city taxpayers to pay 100% of the costs of 911 dispatch services when only 63% of the ambulance runs are operated by the city.

"All we're saying is we just can't afford to do that anymore. So, we've just got to spread the cost. And we'll do that," he said. "If they don't want to have the patients in their hospitals, they won't get 'em," said Bloomberg, referring to the possibility of hospitals no longer participating in the city's 911 system. "But my suspicion is - because they need to fill those beds to make their budgets - they will (pay)."

Beginning in January 2012, the administration plans to charge these hospitals fees based on the number of scheduled ambulance tours they operate in the 911 system. The annual fees are expected to range from about $73,000 to $1 million per hospital.

"The 911 system cost-sharing initiative would allow the city to recoup the costs associated with 911 system dispatch and telemetry that are currently borne by the city, namely, the costs associated with the staffing and operation of the Emergency Medical Dispatch Center and Online Medical Control (Telemetry) center," John Peruggia, FDNY's chief of EMS command, wrote to one of the hospitals.

Lewis Marshall, chairman of emergency medicine at Brookdale University Hospital and Medical Center in Brooklyn, said this new fee may cause hospitals to stop providing ambulance service.

"Hospitals such as ours in underserved areas would most likely think of not participating because of the added cost," Dr. Marshall said. "If a lot of hospitals drop out, then patients are going to suffer because of longer wait times."

Dr. Marshall said the city has pegged Brookdale's annual fee at nearly $300,000. "We're already a financially strapped hospital," he said

Brian Conway, spokesman for the Greater New York Hospital Association, a trade association representing area hospitals, said hospital executives were "floored by the letter telling them of this onerous new fee."

Most of these hospitals are safety-net providers, operating on razor-thin margins or even running deficits, in vulnerable communities citywide, Mr. Conway said.

"It's a fee that if implemented will cause serious financial hardship," he said.

Frank Gribbon, a spokesman for the Fire Department, said the hospitals benefit from bringing in patients. The city views the fee as "cost sharing."

"The goal here is not to drive anybody out," he said. "The goal is to share the burden and the cost."

The city has 967 eight-hour ambulance tours scheduled every 24 hours. Of those the Fire Department handles 614 of the tours and the private hospitals' ambulances handle 353 of them. If the private hospitals were to drop out of the system, the city would be forced to pick up the slack or sign agreements with other institutions to meet the demand.

Last month, the mayor unveiled $585 million of new budget cuts in the current fiscal year and $1 billion for the following fiscal year. Charging the hospitals these fees will save $8.7 million annually.

In his letter to hospitals, Mr. Peruggia acknowledged the "important contribution made by voluntary hospitals" participating in the 911 system.

Dr. Lewis Marshall, chairman of emergency medicine at Brookdale University Hospital and Medical Center in Brooklyn, one of the institutions affected by the new city policy, questioned the mayor's logic. If the city were to add ambulances and staff to make up for private hospitals dropping out, Marshall predicted it could cost the city more than the $8.7 million it hopes to save by charging this fee to the private hospitals.

"From a business standpoint I don't know if that would make sense," he said.


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City to Bill Motorists Who Crash and Need Aid - NY


This so-called "crash tax" or "accident tax" has left bill recipients in other places around the country outraged, and, already, a number of states have banned the practice.

The New York City Fire Department, the largest municipal fire department in the nation, "can no longer afford to provide" emergency services to motorists "at no cost to those who require them," a statement from the FDNY said.

A public hearing on the new charges will be held at FDNY headquarters Jan. 14. While FDNY officials promised to consider the public's input, the policy change doesn't need City Council approval and already has the support of FDNY Commissioner Sal Cassano and the mayor.

So, how much will this cost motorists?

A vehicle fire or any other incident with injuries will cost $490. A vehicle fire without injuries will cost $415. And incidents without fire or injuries will cost $365.

These charges apply to every vehicle involved in the incident.

"We want to relieve pressure on the taxpayer and place it on those at fault and their insurance," said Steve Ritea, a spokesman for the FDNY. "Right now if you're at fault at an accident or a vehicle fire, you get a free ride. And that should not be borne by the taxpayers."

But according to the rules proposed by the FDNY, the department will bill the "motorist to whom motorist services are provided."

Mr. Ritea confirmed that the motorist-whether that person is at fault or not-will receive the bill. The bill from the FDNY will include instructions informing motorists that they can refer the bill to their insurance company, he said.

Mr. Ritea said the FDNY will have discretion over whether it bills motorists.

"If we're talking about an act of God situation, a tree falls on car, then we have discretion, obviously not to bill in those cases," he said. "If the accident is exceedingly minor, we show up on scene and nobody needs medical assistance and there's no fire or anything like that, then, we have discretion."

While some fire departments have started charging people for services delivered to put out house fires, Mr. Ritea said the FDNY isn't currently considering that.

"We have no intention to move this beyond what we're talking about auto accidents at this time," he said.

Last year, the city responded to roughly 14,000 vehicle incidents in the five boroughs. Of those, about 2,900 involved fires and about 7,500 were accidents with injuries.

Officials in New York pointed to other cities that have already started charging motorists. In California, for example, 55 cities have enacted similar policies and another 20 are considering it.

Sam Sorich, president of the Association of California Insurance Companies, called these charges "bad public policy." Many insurance companies don't cover charges from emergency service providers, he said, leaving accident victims responsible for the payment.

"Firefighters and policemen who come to a scene of an accident are seen and should be seen as providing relief and service, not there as a fee-generating opportunity for the city," Mr. Sorich said. "The optics are not good."

New York City officials project this policy will generate $1 million in annual revenue.

New York City motorists reacted Thursday with outrage about the prospect of getting billed next year for accidents.

"That sucks," said Barret Ramnath, 48 years old, a Queens resident who makes his living as a driver. "Accidents happen, and you can't be held responsible. They need the money that badly that they are going to screw us?"

Chris Coppinger, 49, a sales manager who works at a music company and lives on Long Island, also denounced the plan. "It's a bad idea," he said.

"I already pay so much money right now," he said, referring to toll charges and the cost of parking in Manhattan.

"I don't choose to have an accident. It happens," he said.

Council Member Elizabeth Crowley, chairwoman of the council's Committee on Fire and Criminal Justice Services, said she is concerned about the new charges.

"I don't like the idea of passing a cost onto somebody who is driving a vehicle. However, if it's the insurance industry, I'm open," she said. "But really, at the end of the day, it will probably be passed onto the person purchasing the insurance."

Ellen Melchionni, president of the New York Insurance Association, said she views these charges as "double billing."

"If the police show up at your house for a domestic violence dispute or a break-in, are they going to send you a bill? Those are services that are typically covered when you pay your taxes," she said.

Ms. Melchionni said most auto insurance policies in New York don't cover these types of charges. And if the insurance companies are required to cover the charges, she predicted that premiums would increase.

Justin McNaull, a spokesman for AAA, called these charges "short-sighted."

"We have concerns that some motorists might be less likely to call police to crash scenes, allowing drunk drivers, uninsured drivers, drivers with suspended licenses, and others to go undetected," he said.

Deputy Mayor Stephen Goldsmith said New York City is simply following the path blazed by other cities that bill motorists and their insurance companies.

"Now New York City will, too," he said. "We are going to search for other ways to shift costs away from overburdened taxpayers and towards accountable parties."


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Posted: Monday, December 20, 2010 / Tulsa May Charge Motorists for Crash Response
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Posted: December 25, 2010 / No More Free Helicopter Rides - SAN DIEGO
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Posted: January 18, 2011 / FDNY Is Ready To Hose You - Would Bill Crash Vics
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Senator seeks to block FDNY response fee - NY



The FDNY has pitched the fee as part of a plan to cut $58 million in costs from its $1.4 billion annual budget

ALBANY, N.Y. Saying it's the FDNY's job to "serve and protect, not serve and collect," state Sen. Carl Kruger (D-Brooklyn) introduced legislation yesterday to block the Mayor Bloomberg-backed "crash" tax.

The proposed bill would make it illegal for the Fire Department to impose an "accident-response service fee" of $365 to $490 for sending emergency-service personnel to the scene of an accident.

The FDNY has pitched the fee as part of a plan to cut $58 million in costs from its $1.4 billion annual budget.

"It's outrageous," said Kruger. "That's why we're taxpayers. When we dial 911, we don't expect to get another bill in the mail. It's not budgeting. It's a money grab."

Legislation in other states has already banned similar fees. Kruger's bill, however, could face opposition in the Senate, where the Republican majority strongly supports Bloomberg.
By Brendan Scott and Sally Goldenberg / The New York Post


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Cash-Strapped N.Y. County Charging Sick, Injured - NY



Every time someone is rushed to the hospital by a Nassau County police ambulance, it means more money for the cash-strapped county.

On Feb. 1st, Nassau County essentially doubled the fees it charges patients for the ride to the emergency room. A basic lifesaving trip jumped from $400 bucks to a $1,000

Advance life support 1 in the ambulance went from $550 to $1,200, and advanced life support 2 from $650 to $1250.

Even additional mileage charges went up from $6 per mile to $15.

Nassau County Executive Ed Mangano promises that the new charges are not the equivalent of adding insult to injury.

"This is in line with Rockland County," said Mangano, adding, "For years Nassau has left too much on the table."

Carol Krantz was visiting her husband Thursday at the Nassau University Medical Center. He slipped on the ice, injuring his head and back, but he won't be billed the higher rates because that accident happened over the weekend.

"We're lucky and we don't have to pay that fine, but what about the poor guy that is hurt or injured after February first? They have no recourse, nobody has any recourse -- you're just billed. To try and get revenue for a medical emergency is utterly ridiculous."

The county hopes the new rates will add up to an extra $8 million in revenue.
Rob Hoell / WPIX-TV, New York


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Minn. districts consider 'crash tax' for rescues



SOUTH St. PAUL, Minn. It's sometimes referred to as a "crash tax" and it could be coming to a town near you.

South St. Paul and West St. Paul are considering charging nonresidents such a fee as a way to recoup some of the on-the-scene expense at serious traffic accidents in the cities.

Fridley and Columbia Heights already are taking advantage of a state law that allows cities to impose a "reasonable service charge" for serious crashes, rescues and other emergencies. Minneapolis, St. Paul and Burnsville charge only for removing someone from a crushed vehicle.

"Cities and governments are always looking for more ways to recover costs, and this is something that is authorized by state statute," said Kori Land, city attorney for South St. Paul and West St. Paul.

The fees are usually paid by auto insurance carriers, South Metro Fire Chief John Ehret said. Those without coverage would be billed.

South Metro would charge $577 per call. The proposal also allows the department to charge for water rescues, chemical spills and pipeline breaks; no matter where the person involved lives.

The idea to charge nonresidents, but not residents, for crashes is unique, Land said. The fire board finds it "unpalatable to charge a resident for fire services when they're paying taxes already," she said.

Beyond the court of public opinion, there is a risk in charging differently for residents and nonresidents. Courts in some states have decided it is unconstitutional, Land said.

"They basically have said that it's discrimination," she said.

Although the issue has not been decided by the Minnesota Supreme Court, she said, the U.S. Supreme Court has decided charging unequal fees for fire service impedes the constitutional right to travel.

The fee could bring up other issues, Land said. For in-stance, it hasn't been ironed out what would happen when a resident causes a crash involving a nonresident.

"I don't know that it's fair to make the nonresident's insurance company pay," she said.

On the plus side, she said, state law allows cities to collect the fee by assessing unpaid charges against a person's property, regardless of whether the person is a resident.

St. Paul has charged to extricate motorists from crashes since 2006. Last year, firefighters freed people from 63 cars, bringing the department nearly $33,000.

"Hey, it's a lot work," St. Paul Fire Marshal Steve Zaccard said, adding the department sends two, and sometimes three, vehicles to major accidents.

Last year, Minneapolis collected nearly $129,000 from its fee, which is collected through insurance carriers by a third-party vendor. The fire department had a 2010 budget of nearly $54 million.

The fee has not been well received in some communities.

Andover enacted a fee for serious crashes in January 2008, but it was dropped four months later after complaints from residents and insurance brokers, city administrator Jim Dickinson said.

"It wasn't popular," he said.

Mark Kulda, spokesman for the Insurance Federation of Minnesota, a nonprofit trade association, said all policy-holders ultimately pay for the fee through premiums, which are largely driven by claims' cost.

Kulda said that while it's been called a "crash tax," it more resembles a user fee.

"If you want to make it a user fee," he said, "then make the driver pay it themselves, not their insurance company, because we all end up paying for that one person's issue."

The proposed South Metro fee would raise an estimated $29,000 annually, Ehret said.

It comes less than three months after the department grudgingly entered into a new contract with HealthEast for advanced life-support care and transportation. City officials have estimated the department's annual revenue will drop about $152,000 under the contract.

"(South Metro) is trying to get creative," Land said. "Had they been able to keep all the revenues they had been getting from the ambulance contract then they wouldn't be in this predicament."

West St. Paul City Council members were generally in favor of the ordinance at a work session Monday.

"I understand what we're trying to do here I think recovering some of the costs makes sense," Mayor John Zanmiller said. But he added, "I do worry that we're going to make these things fee-based rather than tax-based and it's going to get out hand, not now, but farther down the road."

South St. Paul City Council members also debated the issue at a work session Monday night and "ultimately decided that they felt it is appropriate to recover some of the costs," Land said.

Both cities would have to pass identical ordinances in order for it to go into effect; initial readings are expected in April.
By Nick Ferraro / St. Paul Pioneer Press


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'Crash tax,' other public safety fees target out-of-towners - MI



LANSING, Mich. Out-of-towners would be wise to drive carefully when passing through Fraser, a suburb about 15 miles northeast of Detroit.

The city this year began charging non-residents who cause wrecks for the public safety and emergency response time involved in the accident. The fee is one of many revenue-raising ideas being considered by cities nationwide dealing with budget problems.

Reluctant to raise taxes on their own residents, local governments are looking increasingly at out-of-towners. But critics complain that the fees amount to taxation without representation, or double taxation, since those people already pay for roads and public safety services in their own communities. And unsuspecting out-of-town motorists who've have faced the bills say they send a hostile message.

"You're not welcome here outsiders not welcome," said Jay Middleton, a Mount Laurel, N.J., resident who fought a "crash tax" charged in a Philadelphia suburb. "That's what it says to me."

Middleton got caught up in the "crash tax" issue after a fender-bender while moving his daughter home from college a few years ago. Radnor Township, Pa., billed him $276.08 for the police time. The concept of governments hitting up visitors for cash isn't new. States often charge nonresidents more than locals for hunting and fishing licenses on the theory visitors don't pay the regular taxes used to support parks and recreation systems. A number of cities impose income taxes on suburbanites who come into a city to work. Omaha, Neb., planned a commuter fee that critics called a "wheel tax" before state lawmakers moved to block it this year.

Across Michigan, cities are struggling to fund their emergency services. The state has lost more than 4,500 police officers and firefighters in the past decade, mostly because of lower tax revenues during the recession and the state's economic decline. Fraser, a town of about 15,000 in southeast Michigan, has lost 13 public safety officer positions since 2006 a drop of 25 percent.

"I think we are now at the point where it's push versus shove," Fraser city manager Richard Haberman said. "The intent here isn't to gouge somebody. We're not out here trying to make additional revenue. We're just trying to cover costs."

For an accident caused by an out-of-towner, the driver or the driver's insurance company is billed $57.15 an hour for a police officer's time, $43.75 an hour for a paramedic's services and $41.96 an hour for time spent by a public works employee. Many of the fees charged so far have been $100 or less. Fewer than 25 motorists have been charged since the fees began in February, city officials said.

New York City's fire department plans to impose a response fee in July, with charges ranging from $365 to $490 depending on whether a vehicle fire or injury is involved. The fee would apply to residents and non-residents alike.

But it isn't always easy for the cities to collect. Insurance trade associations say most companies won't cover the fees, leading to lower-than-expected revenues for local governments.

Radnor Township in Pennsylvania eventually repealed its accident response fee ordinance, so Middleton didn't have to pay it. The west Michigan city of Wyoming scrapped its fees after a year of bad publicity in 2008 and earning lower returns than expected. A handful of California cities also have abandoned at least some of their emergency response fees or are considering doing so.

Officials in Petoskey, a northern Michigan tourist town, flirted with the fee idea last year but decided against it.
Associated Press


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Firefighting cost recovery fee approved in Calif.



Riverside County supervisors this week approved fee rates that will allow the Fire Department to start recovering costs when responding to accidents.

The rates, based on the hourly costs of various fire personnel along with a 13 percent administrative charge, would apply to incidents with negligence, Fire Chief John Hawkins said Thursday.

In March, supervisors directed Hawkins to develop the fee structure as a way to offset the costs when responding to accidents and fires. The department has sought ways to overcome a budget shortfall of nearly $10 million for the fiscal year starting July 1.

Examples of negligence would include traffic accidents where a driver is charged with driving under the influence or a hazardous materials spill, Hawkins said.

He said he'll return later this month to a specific list of the types of incidents the department will seek to recover costs.

The administrative fee would cover staff time in filing claims or taking cases to court, he said.

Currently, the department recovers about $1 million, but Hawkins said he hopes to add about $750,000 through the new rates. The department is only seeking to recover costs and not make money, he said.

But critics of the charges call the move a "crash tax" and voiced opposition this week to the supervisors' decision.

The Association of California Insurance Companies said this week that Riverside County is now among more than 60 municipalities and fire districts statewide that charge at-fault drivers.

Armand Feliciano, the organization's vice president, said "crash taxes" raise revenues without formally raising taxes and will only increase drivers' premiums.

"Riverside may learn that these crash taxes do not yield the expected revenues and can be a deterrent for tourists and businesses," Feliciano said in a statement. "Five cities have repealed their crash tax ordinances because they did not generate the projected revenue and cast a cloud over the city's business climate."

Hawkins disagreed. "We will not be going to crash tax. It is not a crash tax," he said Thursday. "It would be for negligence."
By Duane W. Gang / The Press Enterprise


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