Cal-Tahoe JPA moves towards new 10-year contract with County

SOUTH LAKE TAHOE, Calif. - For almost 18 years the California Tahoe Emergency Services Operations Authority (CTESOA) has been providing ambulance service to the portions of El Dorado County at Lake Tahoe and parts of northwestern Alpine County through a Joint Powers Authority (JPA).

They have operated through an agreement with El Dorado County and, if all goes as planned, will continue to operate the ambulance service for the next ten plus years. The CTESOA JPA is currently in negotiations with the County after they responded to a Request for Proposal (RFP) as the current contract comes to a close.

No other group or agency responded to the RFP though there had initially been some interest from another party.

The CTESOA is made up of two members from the City of South Lake Tahoe City Council, two members from the Lake Valley Fire Protection Board and one person from the Fallen Leaf Lake Community Service District. The fire chiefs from each agency are involved, but not voting members.

Barton Health wanted to be a voting part of the CTESOA since they work with ambulances on a daily basis, and discussion about their joining has been going on for months at the JPA and County Counsel level. The Barton board asked for a change to the JPA bylaws, and that would have required approval from the City, the County, Lake Valley FIre board and Fallen Lake Fire. Also, the addition of another voting member would have left the JPA at an even number, which left the possibility of tie votes.

The CTESOA board voted unanimously Monday to leave the makeup of the board the same and not include Barton at this time. They want to concentrate on getting through the new contract but stressed the importance of having the hospital group as part of their meetings in the future as they are a "critical member of the team." They said there were major sticking points in allowing Barton on the board: Required change of the bylaws, an even number of voting members, a potential conflict of interest, and exactly how a doctor could be part of the board if they weren't a Barton employee, but an independent contractor.

"Barton Health is committed to working collaboratively with all community partners ensuring patients receive timely and efficient emergency care in our area," said Barton in a statement. "Barton’s mission is to deliver safe, high-quality medical care for this community, and this is where our expertise is best suited. Given Barton’s role in providing emergency care, Barton will continue to partner with El Dorado County, the City of South Lake Tahoe and the JPA to deliver comprehensive, high-quality patient care."

As they go through negotiations there have been some issues the Lake Tahoe groups want to work through with the county, one of which is how interfacility transfers (IFTs) are managed and reimbursed.

The makeup of the JPA went through a change in 2015 when then South Lake Tahoe Fire Chief Jeff Meston said the City wanted to get "out of the ambulance business" and concentrate instead on fire protection services.

Part of the CTESOA's duties is to provide IFTs from Barton Hospital to hospitals outside of the area, sometimes as far away as Stanford and Napa. Prior to Meston's change, an ambulance with a firefighter on board would leave on those transfers, costing the City not only extra money but also creating a void in protection for the community while the ambulance is gone.

At that time, all of the City's non-fire ambulance staff became employees of the JPA. The City gave the JPA their Fire Station 2 through September 2019 as a home for the ambulances (a new home is being sought at this time).

Lake Valley Fire Protection District Fire Chief Tim Alameda sends a firefighter and paramedic on the ambulances that come out of his firehouse, but now he also has concerns about the increasing number of interfacility transfers coming out of Barton and resulting increases in expenses. During a stormy Sunday this winter it took one ambulance team 12 hours to get a patient to Stanford. Last week all three JPA ambulances were on out-of-town IFTs, requiring Tahoe Douglas Fire come into California to cover the City and Meyers.

CTESOA Chair Bob Bettencourt said it is important to get not only their members but also Barton management together in the same room to work out IFT and other ambulance issues.

"Get the whole team in the locker room if you're going to talk about the game," said Bettencourt.

The goal of CTESOA is to make their system whole and sustainable, according to their Executive Director Ryan Wagoner. The current contract expires August 30 but Wagoner said he'd prefer to have an agreement that matches their fiscal year which starts July 1. He and his staff will continue to work with El Dorado County on the new agreement.

CTESOA board member Leona Allen thanked Wagoner and the battalion chiefs who worked hard on the RFP.

In their vote, the board also voted unanimously to require a supermajority of 4/5 vote to approve any potential new members to their board in the future.