‘Just not fair’: Salisbury fails to reach agreement to lower EMS costs

Salisbury Selectmen meet with the Penacook Rescue Squad board on Wednesday, Oct. 2.

Salisbury Selectmen meet with the Penacook Rescue Squad board on Wednesday, Oct. 2. JEREMY MARGOLIS—Monitor staff

By JEREMY MARGOLIS

Monitor staff

Published: 10-03-2024 6:07 PM

The town of Salisbury failed to reach an agreement Wednesday with its non-profit emergency medical services provider on a new cost-sharing formula after asserting that the amount it pays was “just not fair.”

Salisbury shares the services of Penacook Rescue Squad with Boscawen and Canterbury. The personnel expenses, which total $539,000 this year, are split on the basis of the three towns’ populations, but historically Salisbury has received a lower proportion of medical calls than its population would predict.

This year, the town of 1,500 footed about one-fifth of the bill but sustained only 10% of the calls.

The meeting Wednesday night between Salisbury’s Board of Selectmen and Penacook Rescue’s Board of Trustees came after Salisbury refused to attend future meetings with the other two towns.

Negotiations between the three towns began this summer and had centered on who should pay for the significant number of calls to the Merrimack County jail and nursing home, which are both in Boscawen. The issue is significant because of the 766 calls that Penacook Rescue responded to in the three towns over the first seven months of 2024, 28% were to the county facilities.

Boscawen has contended that the county, which currently pays nothing, should chip into the three-town cost-sharing agreement. Canterbury has largely stayed quiet, while Salisbury has argued that the county facilities are not their problem.

“We’re just one member of the county,” Salisbury Selectman chair Brett Walker said Wednesday. “The fact that we also happen to be in this compact with Boscawen doesn’t mean that we should necessarily be carrying an unreasonable burden.”

Representatives of Penacook Rescue, along with Boscawen and Canterbury select board members, are scheduled to meet with the board of commissioners on Oct. 28. Walker clarified Wednesday that Salisbury would be willing to attend that meeting.

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The jockeying among the three towns comes as medical calls and service costs rise across the region and prompt municipalities to re-examine how they provide emergency services.

Penacook Rescue is an unusual model. Of the 27 municipalities in Merrimack County – 19 of which have a population under 5,000 people – just over half currently rely on their own fire department to provide EMS services. Of the remainder, five pay for services from another town, four rely on a hospital ambulance company, and four – the three Penacook Rescue towns, along with Northfield – use an inter-town agency, according to information provided by the New Hampshire Department of Safety.

The most similar inter-town agency in the area, Tri-Town Ambulance Service in the Suncook Valley, dissolved last year when Allenstown decided to part ways with Pembroke. (Hooksett had left the service over a decade prior.)

Walker said Wednesday that he didn’t want to follow in Allenstown’s footsteps.

“We really don’t want to leave this compact. That is not our objective,” he said.

At an August meeting, Penacook Rescue proposed a new cost-sharing formula, which would be a 65%-35% composite of population and call volume, respectively. That model would lead Boscawen’s costs to increase eight percentage points, and Canterbury’s and Salisbury’s to drop five and three percentage points, respectively.

Walker said he would be in favor of flipping that ratio. He believes Salisbury should be somewhere between 10% and 13% of the total costs, rather than the 19% they pay now.

While the pay-sharing agreement between Pembroke and Allenstown was based entirely on call volume rather than population, Penacook Rescue board member David Collins stressed the danger of going that route was that call volume could change drastically from year to year due to building developments or a few high-need patients.

“We have no way to know what the future is,” Collins said. “You allow more housing; you allow a facility that’s maybe an assisted living facility … all of a sudden, that place is a very large burden, and your population really hasn’t changed.”

The meeting was amicable and the two sides did not engage in negotiations in earnest. Collins said following the meeting that it will be up to Salisbury to decide whether they want to stick with Penacook Rescue.

That may hinge on whether the county is willing to chip in. County Administrator Ross Cunningham said in a brief interview last month that it was “too premature” to answer that question.

Jeremy Margolis can be contacted at jmargolis@cmonitor.com.