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Tri-town ambulance in turmoil
The men and women of Tri-Town Ambulance leave their homes and jobs to answer the call for emergency medical assistance at all hours of the day or night and in all weather conditions. However, for all of the considerable dedication and life saving skills of its volunteers, Tri-town leaders have struggled to heal the internal strife that has riven the organization.
In November the Tri-Town ambulance committee, made up of representatives from the three member communities of West Tisbury, Chilmark, and Aquinnah, turned to an outside mediator for help. He is Chuck Doran, executive director of Mediation Works, a Boston-based firm that specializes in resolving business, commercial, and organizational disputes.
Chilmark police chief Tim Rich, long-time Tri-Town ambulance committee chairman, said the committee decided that a neutral third party would be in a better position to bring all the parties together. He described the problem as one of growing pains in an organization that has grown laterally but lacks an effective command structure.
"More has changed with the Tri-Town ambulance in the past five years than in the previous 25," said Mr. Rich, a former EMT.
The decision to hire a professional mediator at a cost of $5,000 was made after all other tactics had failed. Mr. Rich said something needed to be done to stop what he described as the backbiting and bad-mouthing that divided squad members. "It's been like a cancer within the service," he said.
To date, mediation has been only marginally successful, said Mr. Rich. An examination of meeting minutes provided to The Times in response to a request bears that assessment out.
On Dec. 7, Deb Cini of West Tisbury, hired to be the Tri-Town advanced life support coordinator and the service's first full-time employee, requested and was granted a six-month leave of absence.
According to the minutes of a meeting on December 13, West Tisbury police chief Beth Toomey, a member of the committee that approved bringing in a mediator, requested that she not participate in mediation with one of the principal supervisors, long-time EMT and Tri-Town ambulance coordinator Martina Mastromonaco of West Tisbury.
At a stormy meeting on Dec. 21, Sloan Hart of Chilmark, Tri-Town clerical coordinator and 2004 Island "EMT of the year," submitted her letter of resignation.
Many of those with intimate knowledge of the issues described a combination of management growing pains, clashing personalities, and differing visions of Tri-Town's future that have played out largely in private.
While Tri-Town has remained largely a volunteer organization, other Island towns operate with a mix of paid full-time staff and volunteers. Those who spoke to The Times uniformly said the internal dissension had not affected emergency response or services. However, the toll on morale is evident in conversations with squad members.
"So now we are going to phase two," said Mr. Rich. Exactly what that will be has not been determined, but it will include an examination of the rank and structure of an organization that has suffered from a diffuse command structure, he said.
The only squad member contacted by The Times willing to speak on the record was Nick Thorne of Aquinnah. He is one of only three paramedics and the only one who lives up-Island.
"From my perspective," said Mr. Thorne, "the committee needs to detach itself from the workings of the squad."
Lateral command
Tisbury and Oak Bluffs each have a separate ambulance service under the control of a full-time department head. In Edgartown the ambulance service is a department of the fire department under the control of the fire chief.
Tri-Town's administrative model includes the members of the ambulance committee, an advanced life support coordinator/ paramedic (Ms. Cini), ambulance coordinator (Ms. Mastromonaco), clerical coordinator (Ms. Hart), and mechanical coordinator (Simon Bollin).
Although Ms. Mastromonaco was nominally the squad supervisor, both she and Ms. Cini reported to members of the committee.
This week Tri-Town members in the center of the storm expressed their dedication to the job and to varying degrees declined to elaborate on their views for fear of causing more unrest and dissension.
Ms. Cini cited personal reasons for her decision to take a leave of absence. She said she preferred not to comment on why the service chose to seek the services of a mediator.
Ms. Hart, who handled billing and clerical responsibilities, told The Times that her decision was precipitated by what she characterized as the disrespectful treatment of the ambulance coordinator by some committee members.
Ms. Hart refused to elaborate. She said that the committee did not want her to quit and asked her to meet with them again. She said she loved the ambulance service and the turmoil has been hurtful and upsetting.
Reached by The Times, Ms. Mastromonaco said she loved her job and referred all questions to Mr. Rich.
Chief Toomey said that the minutes inaccurately reflected her position as a request. She said she was initially willing to sit down with a mediator but as circumstances changed she said she would not sit down with Ms. Mastromonaco. "It is not that I am unwilling; I don't think it is productive right now," she said.
The focus needs to be on needed changes, Ms. Toomey said, adding that while change is never easy what is occurring within Tri-Town is not unusual and happens across the Commonwealth as small volunteer agencies grow into something else. "We can't remain the way we were," she said. "We need to move forward."
Although she has yet to participate, Chief Toomey said mediation was beneficial because it facilitated conversation and provided an opportunity for people to talk. In that sense it was successful, she said.
Ms. Toomey sees events continuing to progress in a positive direction. Asked what is behind the current problems, she said there is a difference of opinion about how Tri-Town should operate. She said she has advocated for a new structure for years. "I personally am looking forward to seeing a change," she said.
Raising the bar
The Tri-Town committee was comprised of the police chief from each member town and one selectman or a selectman's designate.
The intergovernmental agreement that established the Commonwealth's only three-town service was recently amended to allow for the addition of an elected ambulance squad member, bringing the committee up to seven voting members.
The committee currently consists of Mr. Rich, Ms. Toomey, Aquinnah police chief Randhi Belain, Aquinnah fire chief Walter Delaney, teacher Mary Boyd of Chilmark, selectman Dianne Powers of West Tisbury and squad member Dan Johnson.
Each member town pays one-third of the budget, $124,862 per town in the current fiscal year. According to the annual town meeting reports published last spring, in 2006 Tri-town responded to 363 calls for the ambulance and had 29 EMTs on the rolls, not counting responders from outside the three towns.
Over the years the growth of the year-round and seasonal up-Island community, as well as the crush of Island summer visitors and changing state and federal standards have placed ever more demands on all of the Island's emergency medical service responders.
With the financial support of all the Island towns and in conjunction with the Martha's Vineyard Hospital, in January 2005 the Island's emergency responders were able to boost emergency care to the paramedic level designation.
Paramedics are at the highest level of emergency medical technicians (EMTs). They possess advanced emergency life-saving skills, including the ability to carry and administer certain drugs and use advanced cardiac monitoring equipment.
In 2005 Tri-Town's member towns provided money for the advanced training of EMTs at the paramedic level.
The service also received an ambulance provided by the Wampanoag Tribe to be stationed in Aquinnah and began participating in an Island-wide paramedic program intended to provide around the clock advanced coverage.
In July 2006, the start of the fiscal year, Tri-Town began billing patients or their insurance companies for the previously free cost of patient care and ambulance transportation in order to alleviate some of the costs to taxpayers.
In some cases, Island EMTs who hold the paramedic rank are full-time town employees and in other cases they are people with outside jobs who have achieved paramedic rank and bring those skills as part of their volunteer service.
At the same time all of the towns' emergency ambulance services continue to rely heavily on core groups of basic and intermediate level EMTs who receive stipends of various amounts.
Tri-Town's decision in July 2006 to hire a full-time paramedic/ALS coordinator with supervisory authority changed the existing culture and initiated a period of unease for some squad members.
Added to that was the difficult job of striking a balance in the time demands placed on an all-volunteer force when the pager call may be a dramatic summer accident that brings all hands running or a winter midnight call to assist someone who fell from bed that requires only a few volunteers.
Last year squad members agreed to institute a year-round shift system, in which EMTs sign up to cover a specific time slot and maintain the existing system of paging for volunteers to respond where needed.
Mr. Rich acknowledged the gap that has grown between the committee and squad members. He said for years Tri-Town operated out of one barn located in Chilmark and many of the ambulance committee members were also EMTs, which is no longer the case.
Mr. Rich thinks the addition of a squad member to the ambulance committee will help to close the distance that has grown up between the committee and the rank and file EMTs. He said that one issue that needs to be resolved is the command structure and the committee's role in that structure.
"It needs to be said too that this is an internal thing," said Mr. Rich. "It has not affected the quality of the service and patient care at all. I am completely confident that we will emerge from this and get back on track."
