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Fire officials seek budget boost, highlight cost of ambulance subsidies

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(Cindy Chew/S.F. Examiner)

The Fire Commission is defying a Mayor’s Office directive to cut its budget and not add positions in a spending proposal due to be submitted Wednesday.

Commission staff say growing salary and benefits and required staffing levels make it difficult to make cuts without impacting public safety.

But two commissioners have also highlighted the fact that the Fire Department subsidizes ambulance services for homeless and low-income seniors to the tune of $100 million annually.

The commission approved a budget proposal in a 4-to-1 vote last week that would increase the Fire Department’s budget to $401.4 million, up from $383.6 million in the current fiscal year. The commission and the department, which work together on the budget proposal, also have a “wish-list” of $27.8 million of other needs they are hoping to get funded through negotiations with the Mayor’s budget office.

The budget proposal ignores Mayor’s Office instructions to all city departments to propose two-year budget proposals with a 2.5 percent cumulative cut in each of the next two fiscal years and avoid adding more positions. All city departments must submit their budget proposals Wednesday.

To make the case for more funding, Fire Commissioner Joe Alioto Veronese, who is also running for District Attorney next year, highlighted that of the $139,656,170 in ambulance billing the Fire Department is projected to send out this fiscal year, which ends June 30, the department will lose $113 million.

Annually, the department ends up subsidizing about $100 million in unpaid ambulance bills.

“It’s not a number we should ignore every year because it could be paying for so many other things,” Veronese said.

“Why aren’t we just giving out free healthcare to people if we are not going to go after people to actually pay that back?” Veronese said. “The other way to look at this, there is probably a huge population that is involved in this number that is homeless.”

Fire Commissioner Francee Covington suggested that since the Fire Department is providing services to the homeless population, some funding could come from other departments’ budget, like the Department of Homelessness or the Public Health Department.

“If we can’t get more money from the general fund then maybe some funds from the other two departments can be given to us,” Covington said. “We are a big part of that safety net and I don’t think we are getting the recognition for that. I am very passionate about us getting what we need to do the job that we do.”

She added that, “I think it is important for the mayor, the mayor’s budget analyst and the citizens of San Francisco to understand that these dollars are not reimbursed to us. They have not been reimbursed to us. They will not be in the future reimbursed to us because the homeless population is not going down.”

But Fire Commission Vice President Stephen Nakajo cautioned his colleagues that the discussion of the ambulance services “takes us to ‘the homeless,’ but there is more than the homeless that takes advantage of our ambulance services.”

He said that he is an executive director of a senior center in Japantown and “many people who use these services are seniors.”

“It is not just the homeless who are out there. There are seniors out there,” Nakajo said. “We as a Fire Department, what are we doing to do, make a judgement out there, when we are out there, of can you pay, can you not pay, are you homeless, are you not?”

Joanne Hayes-White, San Francisco’s fire chief since 2004, said “This is not a San Francisco Fire Department issue only. I would say for any urban jurisdiction that has fire-based EMS those are the returns on the care that we provide,” Hayes-White said. “It is a nationwide issue.”

Fire Department Chief Financial Officer Mark Corso said that payment for ambulances is annually about 20 to 25 percent of the billing amounts because many people without health insurance can’t afford it and others have health insurance that only covers a small fraction of the bill.

“We have a number of Medicare, Medi-Cal patients,” Corsos said. “For each bill that we generate we probably get 25 percent reimbursement on a Medicare account. Those flat rates are established at the federal level.”

He continued, “If we have, hypothetically speaking, a $2,000 ambulance bill, then we get reimbursement of $450 on that and there is no flexibility with the government. That remaining balance is written off.”

Veronese noted that if they had more reimbursement for the ambulances services they would not have to be “going to the Mayor’s Office and begging for extra things.”

He continued, “We’ve got things on there….that are absolutely necessary for us to deliver a state of the art department to this city. I don’t think we are a state of art department to this city. I’ve been to many of the stations. A lot of them are run down.”

As part of the budget proposal approval, the Fire Commission voted to add a new grant writing position to the department at a request from Covington, after both Covington and Veronese expressed the importance of having a full-time grant writer to generate more funds.

Fire Commissioner Michael Hardeman opposed the budget because the added position defies the Mayor’s budget instructions. “I think we’ve handled this really poorly,” Hardeman said.

Mayor Mark Farrell will use the city departments’ budget proposals to put together The City’s two-year budget, which he must submit to the Board of Supervisors for review and adoption by June 1.

Farrell won’t be mayor for the final approval of the budget, which includes negotiations with the board and the Mayor’s Office. He will be replaced by the winner of the June 5 mayoral election.

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