by George Gramlich,
News, Analysis and Commentary

Contrary to what we have been told repeatedly by the West Custer County Hospital District Board (the “District”) and District Management for around the last decade, the District is required, by contract with the Custer County Board of County Commissioners, to provide emergency ambulance services to ALL of Custer County, regardless of whether the area is in the District’s taxing area or not. This surprising fact somehow has not been disclosed to the public by the District and directly contradicts multiple District Management statements that the District has no responsibility for areas
outside of their taxing district.
This fact has come to light in a letter to the District Board’s President, Mr. Robert Tobin, by BOCC Commissioner Tom Flower and an attached proposed Inter Governmental Agreement (the “IGA”) between the BOCC and the District that was recently obtained by the Sentinel.
The IGA contains some very, very interesting historical information. First, according to the IGA, every Board of County Commissioners in Colorado pursuant to C.R.S. 30-11-107 has the “statutory authority at any meeting to organize, own, operate, control, direct, manage, contract for, or furnish ambulance services for the County.”
The IGA then goes on to review some of the ambulance service history in Custer County. Prior to the District being formed on March 3, 1988, there was a volunteer ambulance/EMS service in the County called the Ambulance Corps. This Ambulance Corps provided emergency medical /ambulance service to the WHOLE county. It was disbanded when the District came into effect.
Section 5 of the IGA contains clear language on the District’s Service Plan:
The initial Service Plan for the District contains the following language in paragraph I: “The District will also furnish ambulance service providing 24-hour emergency coverage. The District will take over the functions and facilities of the existing Custer County Medical Foundation and Ambulance Corps.” In paragraph II.B. the Service Plan states: “The services now provided by the existing Ambulance Corps will be assumed by the District”. And in paragraph VII of the Service Plan the following language is found: “It is anticipated that the District will enter into a contract with the County to provide ambulance services to those portions of the County that are not included within the District.”

Section 7 of the IGA explicitly states that the District had agreed in 1989 to provide ambulance service to county areas outside of their taxing district:
In fulfillment of the language quoted above, the County and the District entered into an Agreement on January 3, 1989. Paragraph 4 of this Agreement contains this language:

“That the District agrees to pay all costs of operation and to provide ambulance service that has historically been provided by the Ambulance Corp, even though that service will be for areas outside the District.”

That is crystal clear and precise language, Hospital Board and Management. Why have you never told us this?
Apparently, some time after the District was created, they entered into a mutual aid agreement with the Florence EMS provider to cover Wetmore (i.e., generally, the area east of McKenzie Junction), therefore, in some way, fulfilling their contractual obligation to provide ambulance service to Wetmore. Florence Fire/EMS notified the County on June 23, 2019, that they were ending this agreement effective that date. The District then notified the County that they would only provide service to Wetmore until September 5, 2019.

Since that became known, the District Board and District Management have repeatedly stated that they have no obligation to provide ambulance service to the Wetmore area and that the County or somebody better come up with a ridiculous amount of money for the District to provide said service.

Recently, the District has offered as a temporary solution — that if a EMS call comes from the Wetmore area, AND if they can get a second ambulance and crew, then they will respond to the call. (Editor/GG: Note that a second ambulance and crew are OFTEN not available as per statistics provided to the Sentinel by the Custer County Sheriff’s Office. We hear this all the time on the Sentinel’s scanner.) Note that the District has stated that at some point it wants a ton more money to provide a service that it is CONTRACTUALLY OBLIGATED TO PROVIDE NOW.
The proposed IGA also demands that Wetmore and other areas outside the District’s taxing area without a mutual aid agreement be treated the SAME as areas in the taxing district. The IGA states that all calls in the County should be treated on a “first call” basis instead of the second-class treatment currently being provided by the
District for Wetmore.
The IGA is a temporary agreement until a mutual agreement can be made. But if the District decides to NOT provide service to Wetmore and other such areas, “It further acknowledges that if it goes forward with its plan to terminate ambulance service to the Wetmore area without the written consent of the County, such conduct could be treated as a breach of contract by the County and could result in legal action in the form of a lawsuit seeking a temporary injunction to compel the District to continue honoring its obligations under said Agreement.”
Bottom line, the District is contractually obligated to provide ambulance/EMS service to the WHOLE county no matter where. The District could NOT have been unaware of the original Service Plan’s language concerning whole county ambulance service and could also NOT have been unaware of the crucially important January 3, 1989, Agreement between the County and District where “the District agrees to pay all costs of operation and to provide ambulance service that has historically been provided by the Ambulance Corp, even though that service will be for areas outside the District.”
Unless we are missing something, this simply smells. The Board and Management must have known, or by any reasonable due diligence should have known, of these important contractual obligations and instead ignored it and essentially demanded ransom money from the County to do what they should be doing.
Great job, Commissioners and the County Attorney, in getting the history and facts out on this unacceptable behavior of the Hospital District.
Your move, District.

(Editor/GG: You know the citizens of Custer County have a little responsibility here, too. They overwhelmingly defeated a Clinic Board reform slate last election that promised to shake up the poorly performing Board, Clinic and EMS. The reform slate already had multiple family practitioner doctors lined up to work there, outside consultants willing to help the clinic for free, and were actively working on a doctor intern program for the clinic. But the voters voted for the status quo Board candidates and this is what we get. Lesson: Educate yourself before you vote. Elections have consequences.
The Clinic grosses around $2 MILLION a year ( mill levies plus ordinary clinic and EMS revenue) and we still have no full-time doctors (the Clinic head fakes us with “new doctors”. The sad part is that really means a couple of doctors coming one or two days a MONTH). The astronomical turnover at EMS is a constant problem. All the family practitioner doctors that did work at the Clinic 5-7 years ago quit due to management issues. How can this be when the old VOLUNTEER Ambulance Corps had backup ambulances and LOCAL crews (with ALS EMTs) available around the clock.
In addition, for the last few years the Clinic Board and Management have been extremely uncooperative in various dealings with the BOCC and the Sheriff’s Office. In fact, actually openly and personally hostile in one recent open District Board meeting. The reason for this “us versus them” attitude is unknown but it is completely out-of-place in our small community where we all need to work TOGETHER AS A TEAM to get things done in an efficient and effective manner. Clinic: Don’t be the “I” in TEAM.
Custer County citizens, take a hard look at the facts, performance, management and integrity of the Clinic Board and Management. Do you think we need a change?)