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"You can figure the numbers any way you want," Sylvester says. "What we were doing was all hypothetical. I'm not sure all factors were considered." She adds that if those later figures had been in everyone's hands ahead of time, the task force might have decided differently.
And in a memo dated August 2, Councilwoman Foster wrote, "At this time, we don't have a picture of the economic impact of the EMS service on DGH to make an informed judgment on the raw dollars of which proposal costs more."
Despite the request by some task force members to hire a consultant to analyze the cost estimates, the panel approved its final recommendations the same day as Foster wrote her memo.
"Why did they uniformly say they didn't understand cost and then vote on it?" Petre asks. (Foster defends the decision, saying the task force "fixed what was broken this year.")
The paramedics' battle reveals just one more instance of how the health-care industry is changing. Emergency medical service is an attractive business not only for private health-care providers but also for fire departments. Although fire administrators only cautiously allow that such a merger between their crew and the paramedics could have been worked out, the fire union clearly wanted it. Fire departments nationwide (and in metro Denver) are answering far more medical calls than fire calls, and both administrators and rank-and-file firefighters say they're nervous about the prospect of competition from increasingly powerful health-maintenance organizations or other private companies.
Consequently, more than 51 percent of fire departments across the country have paramedics as a part of their EMS service, according to 1994 figures. George Burke, spokesman for the International Association of Fire Fighters, says that percentage is expected to rise.
"The fire union's real issue is that over the past several years, firefighting as a job function has decreased," says Greg Stahmer, a senior paramedic at DHH and a member of the task force. "Their entire job is EMS. If they can't get into and stay in the EMS business, their entire existence is a question mark."
But no more than that of DHH, as it tries to keep itself afloat in a radically changing health-care environment. This summer the city is expected to turn DHH into a quasi-independent health authority, hoping it will be able to compete better with private industry. Its officials don't like the prospect of losing an important link in their health-care-delivery system. "Our mission is health, their mission is fire," says Denver General's Stephanie Thomas, arguing in favor of keeping the paramedic division where it is. "You're much better off for the future, when the dust settles, having an integrated health system."
Were a merger to take place, DHH would not only lose its paramedic division and the money it generates ($12,809,021 in gross revenue in 1994), but it would essentially turn over all EMS care (the first line of service in DGH's nationally admired trauma service) to the Denver Fire Department.
"The survival of the [new, independent health] authority is tied to our survival," says Stahmer. Some paramedics view DHH as poorly run and the yet-to-be-launched health authority as an already sinking ship. For them, the fire department is an island. "The hospital is great at practicing medicine," says Lieutenant Pat Hynes, executive boardmember of the firefighters' union, "but as far as taking care of people who provide the service, they're not as good."
"We're all fighting for a pile of crumbs, while the fire department presumably has more clout, a big union," Stahmer adds. "But would EMS have that same clout in the fire department? If they have a budget crunch five years from now, what do they cut first--ambulances or fire trucks?"
Although they've been stymied, the paramedics will continue to solicit city council support and, starting next month, will take their case to the people through community slide shows.
Though sympathetic, Mary Sylvester is skeptical about that tack, saying, "Frankly, I don't think people care. Who thinks about whether they need an ambulance?