NJ News & Views

[Editor's Note: On December 27 and 31, 2009, this story was edited for style, content and accuracy.]

For the past decade, Lakewood Emergency Medical Technician (EMT) Ronald Hill, 33, has worked to save other people's lives.

Next year, he may be out of job.

The township's Emergency Medical Services (EMS) Department is the latest victim of a multi-million dollar municipal budget shortfall.

At the December 3 meeting of the Lakewood Township Committee, four members present unanimously voted to authorize a Request For Proposal (RFP) to solicit bids from privately-held companies seeking to replace the EMS department's 16 full-time and 14 part-time EMTs.

Committeemen did not publicly discuss the plan prior to holding a vote, nor was it listed as a resolution for action on the meeting agenda. Instead, Deputy Mayor Steven Langert, presiding over the meeting in the absence of Mayor Robert Singer, motioned a vote on the proposal prior to adjournment of the meeting.

Committeeman Marc (Meir) Lichtenstein, a volunteer with Hatzolah, which also provides Basic Life Support (BLS) ambulance services, seconded the motion.

Hatzolah receives public funding through the township's Urban Enterprise Zone (UEZ) program - making Lichtenstein's participation in the vote a conflict of interest.

Lichtenstein is the committee liaison to the Lakewood EMS - also a conflict of interest.

Singer, who was not present for the vote, is married to an employee of Kimball Medical Center, which treats patients transported there by Lakewood EMS, Monmouth-Ocean Hospital Service Corporation (MONOC) and Hatzolah.

Until recently, Singer was also an employee of Kimball Medical Center.

At a November 22 meeting with representatives of Lakewood's adult communities, Langert and Singer disclosed plans to replace the township EMS department with MONOC, which holds the exclusive rights to provide paramedic Advanced Life Support (ALS) services to Monmouth and Ocean County townships, including Lakewood.

Fairways resident William Hobday attended the November 22 meeting, which was not open to the public. He told a reporter for NJ News & Views that Langert, Singer and township Manager Frank Edwards said they could provide the same quality care at a reduced cost by replacing the department's BLS services with those provided by MONOC.

NJ News & Views asked Hobday if Langert, Singer or Edwards presented any documentation in support of their assertions. Hobday said no.

"My issue is, from a conservative viewpoint, if they can save $800,000 and not impair their service, my God, that's good," Hobday told a reporter.

While the Lakewood EMS department generates expenses in salaries, benefits and pension payments, it also generates revenue to the township - which a private EMS company would not.

Until 2009, when the township began operating at a deficit, EMS revenue increased annually. So have EMS salaries and related expenses.

In the 2007 municipal budget, the township reported that the department was anticipated to earn $600,000 in 2006, but realized $701,856.65.

The township appropriated $901,694 for EMS salaries and wages and $51,320 for other expenses in 2006, but paid or charged $927,069.63 in salaries and wages and $41,752.44 in other expenses.

In the 2008 municipal budget, the township reported that the department was anticipated to earn $700,000 in revenue in 2007, but realized $781,134.89.

The township appropriated $983,909 for EMS salaries and wages and $63,350 for other expenses in 2007, but paid or charged $976,705.23 in salaries and wages and $48,562.63 in other expenses.

In the 2009 municipal budget, the township reported that the department was anticipated to earn $780,000 in revenue in 2008, but realized $880,233.39.

The township appropriated $1,100,680 for EMS salaries and wages and $70,175 for other expenses in 2008, but paid or charged $1,024,962.09 in salaries and wages and $58,583.11 in other expenses.

As Lakewood's Orthodox Jewish population has increased, so has demand for competing EMS services provided by Hatzolah, a volunteer service that does not generate township revenue, but is also subsidized by the township.

In the late 1960s, Rabbi Hershel Weber founded the original Hatzolah EMS in Williamsburg, Brooklyn to improve rapid emergency medical response that also addressed the cultural concerns of a Yiddish-speaking, deeply religious Hasidic community. The idea spread to other Orthodox Jewish neighborhoods in the New York City area, and eventually to other regions, countries, and continents.

Hatzolah, as an organization, is the largest volunteer ambulance service in the world. Chevra Hatzalah in New York has more than a thousand volunteer EMTs and paramedics who answer more than 250,000 calls each year with private vehicles and a fleet of more than 70 ambulances.

Lakewood Hatzolah is the largest branch in New Jersey.

Last year, Lakewood Hatzolah also received a benefit that Lakewood EMS did not.

In a September 17, 2008 press release, MONOC Executive Director Scott A. Matin announced that Hatzolah paramedics would be working under MONOC's state license to operate Mobile Intensive Care Units (MICU) to respond to ALS calls for service in Lakewood.

The MICU ambulance used by Lakewood Hatzolah paramedics was funded through a UEZ grant of almost $100,000. Hatzolah in turn donated the ambulance to MONOC, according to www.wikipedia.com, an online source that notates whether or not information posted has been confirmed. The donation reportedly enabled Hatzolah to meet state requirements for hospital-based paramedic services.

In a December 28 e-mail exchange with NJ News & Views, Matin, now MONOC Vice President, denied that the MICU ambulance operated through the Hatzolah-MONOC paramedic partnership was donated to MONOC, as reported by Wikipedia.

Matin declined to provide the vehicle's title, registration and insurance card in support of his assertion.

The MICU Hatzolah ambulance includes its own rescue (extrication) unit.

So do Lakewood EMS ambulances.

Although at least two Lakewood EMTs are certified paramedics, they are not able to provide or bill for paramedic services.

NJ News & Views contacted Matin on December 23 to ask how MONOC would bill for services provided by a volunteer paramedic squad.

"We don't ask for insurance during the call," Matin said. "We try to work with people to pay for services rendered. We ask what kind of income they have. People on a limited income…fill out specific paperwork. If they have no income, we write it off. Everything we write off is a loss."

Matin said that when the state Department of Health began paramedic services in the 1980s, it assigned hospitals the right to provide them. Some groups of hospitals chose to assign their certificate of need to MONOC, giving it exclusive rights to respond to and bill for paramedic service calls in Monmouth and Ocean Counties.

Although Matin said there was no competition for paramedic services it provides throughout the two New Jersey counties, MONOC faces increasing competition for billings from companies that provide BLS services.

In a December 1, 2005 memorandum posted on the MONOC Web site, the non-profit organization announced its support for a volunteer EMS squad.

"Whenever the provider of basic ambulance service for Medicare/Medicaid patients generates a bill, and that patient also needs a paramedic, a conflict occurs," the memorandum stated. "Medicare/Medicaid prohibit the issuance of two bills in such cases. MONOC is thus forced to pay the ambulance provider a substantial fee in exchange for the right to bill for our services. Medicare/Medicaid do NOT reimburse MONOC for this additional expense. Since MONOC units are capable of transporting, the use of the ambulance service in these cases is simply redundant and needlessly adds to the expense of the overall care rendered."

In late 2001, Singer, who also represents Lakewood as state senator of the 30th Legislative District, sponsored a bill to address the problem on behalf of MONOC.

MONOC President Vincent Robbins discussed growing opposition to the proposed legislation in a May 15, 2002 memorandum posted on the MONOC Web site.

"Recently, we have received several inquiries from volunteer EMS agency representatives about New Jersey Senate Bill S865 and rumors that MONOC is trying to destroy New Jersey's "two tiered" EMS system through this piece of legislation," Robbins said. "Senate bill S865 was first drafted over a year ago with the intent to provide a way for MICUs in New Jersey to counter act the unreimbursed expense of interfacing with commercial* ambulance companies (*BLS services that bill) when we treat Medicare patients together."

Robbins said in the 2002 memorandum that MONOC would have to pay out over $300,000 that year to BLS respondents that arrived before MONOC ALS respondents.

"This expense is not reimbursable and will eventually bankrupt the MICU programs in New Jersey if it is not stopped," Robbins said. "We thought the least disruptive way to help ease this growing financial burden on MICU programs in the state, was to "level the playing field", so to speak, and grant paramedic units the right to transport when they interface with commercial ambulance companies. In this way, the MICU would have the option to transport the patient ourselves instead of incurring the extra cost of a commercial ambulance company. A close reading of the original draft legislation in question, shows that the entities most directly affected would have been commercial ambulance companies and not volunteer services."

Ironically, the MICU ambulance Hatzolah reportedly donated to MONOC was financed with UEZ dollars. The state founded the UEZ program to promote commerce and create jobs - which a volunteer EMS does not do.

Instead of partnering with Hatzolah to provide paramedic services in addition to BLS services that compete with the township EMS service, MONOC could partner with Lakewood Township. Local government subsidizes both EMS services, but does not realize revenue from Hatzolah.

There are currently two part-time Orthodox EMTs serving on the Lakewood EMS. By incorporating Lakewood Hatzolah as a specialized service within the township, volunteers could earn a paycheck and benefits and the township could earn a profit by billing Medicaid and Medicare for their services.

The arrangement would fulfill the goal of the UEZ program, which the current MONOC partnership with Hatzolah does not.

Hatzolah is a UEZ member.

In December 2008, Hatzolah Director Avrohom Waxman told the LDC that his organization provided services throughout Lakewood, as well as Jackson and Howell.

Only a quarter of Lakewood is located in the township's UEZ, which is the largest in the state.

Lakewood Township is approximately 25 square miles in size.

Matin told NJ News & Views that Hatzolah would respond to calls for paramedic service in other towns if no other paramedic unit was available.

Under the Smart Growth Plan recently adopted by the Lakewood Township Committee, Lakewood's downtown would eventually be extended to the border with Howell, while a population core would be established near the township's western border with Jackson, increasing demand for Hatzolah ALS and BLS services in both townships.

Howell installation of city sewer at its southern border with northern Lakewood will greatly accelerate development of the plan, despite a common border with the Metedeconk River, a state-protected waterway with a 250-foot buffer.

Last month, the Urban Enterprise Zone Authority (UEZA), which administers the UEZ program in designated municipalities, approved inclusion of Brook Road in the Lakewood UEZ.

Brook Road is located at Lakewood's northeastern border with Howell and would form the eastern boundary of an expanded downtown under the Smart Growth Plan.

All of Lakewood is zoned for mixed-use development.

Under the state UEZ program, which promotes urban renewal, Lakewood business and residential property owners on Brook Road are now eligible to apply to the LDC and the township for tax exemptions on their land, as well as tax abatements on new construction.

As a result of public policy, property owners will realize a profit on their investment in the area.

The township will not.

On December 31, 2008, the township certified it had realized $7,570,000 in surplus that year, according to the 2009 municipal budget.

In June, Lakewood committeemen balanced the 2009 municipal budget with state approval by deferring payment of more than $10 million in July school taxes owed to the district.

After deferring more than $10 million in July 2009 school taxes, committeemen adopted a 2009 municipal budget with a reported $5.5 million surplus.

Five months later, Edwards publicly stated during the November 19 committee meeting that the township had "virtually" no surplus.

As Lakewood grows into a city, public policy promulgated by its governing body will also affect efforts by neighboring townships to raise revenue, while increasing demand for municipal services.

This past summer, a reporter noted the departure of a Toms River police ambulance and police car from the Walgreen's parking lot in Toms River following the arrival of a Hatzolah ambulance that responded to a call for service there.

On December 9, The Lakewood Scoop reported a motor vehicle accident on its Web site that included a photo. According to the Scoop, at approximately 2 pm that day, two Hatzolah paramedics working on the MONOC Paramedic Partnership Ambulance were responding to a call in Toms River when their vehicle stopped at an intersection. Sources told the online news service that a vehicle behind the ambulance came to a stop, while a third vehicle did not.

The Scoop reported that one of the Hatzolah paramedics drove himself to the hospital with minor injuries and was released a short time later.

Four years ago, Robbins was forced to withdraw MONOC support for Singer's bill. Ironically, his organization will not need state legislation to eliminate BLS competition in the municipality Singer represents.

If the township committee proceeds with plans to eliminate the Lakewood EMS department, its staff of 30 will be unemployed.

One week after the committee vote, the LDC held a press conference to announce the township's job stimulus initiative.

According to a discussion at the December 1 LDC meeting, the stimulus package includes matching grants up to $20,000 each for advertising and marketing campaigns by small business owners, in addition to large companies.

The stimulus package also includes a grant award of $1,000 to companies that hire an unemployed job applicant, up to a maximum of $3,000.

A reporter for NJ News & Views left a voicemail message for LDC Chairman Moshe Zev Weisberg several days after the meeting. The reporter sought to know how the LDC intended to verify that companies receiving the grants did not intentionally lay off unemployed workers they hired once they received the money, then reapply for new grants.

Weisberg did not return the call for comment.

At the beginning of the year, Singer announced a township hiring freeze, but voted as a member of the LDC to increase the number of staff positions funded by UEZ tax dollars.

Since 1994, the LDC has generated its UEZ fund by relying exclusively on the collection of a reduced state sales tax that goes to the township instead of the state - not on interest earned on loans to qualified businesses.

The state designated Lakewood a UEZ in 1993.

In September, the UEZA reauthorized the Lakewood UEZ program for another 16 years, effective November 2009.

The same year the state first designated Lakewood a UEZ municipality, Hill became a volunteer firefighter after qualifying as a First Aid volunteer the previous year.

Following in the footsteps of his father and his grandfather, Hill also became an EMT. The township hired Hill as a part-time EMT in 2000. He became a full-time Lakewood EMT in 2003.

A former marine, Hill is the father of two young daughters - a 3-year-old by his current wife and a 9-year-old by his former wife.

In October 2008, he became a New Jersey homeowner.

Hill and his family face an uncertain future if his job is eliminated next year.

So do public and private companies that depend on his business for their livelihood as well - including the state, which projects an $8 billion deficit next year.

"If, God forbid, this (layoff) does go through and I'm unemployed, that will be the end of my daughter's pre-school education because I won't be able to afford it," Hill said in a December 22 interview. "I have a car and insurance payments to make, all the things that (enable) me to work. I also have a mortgage and child support payments to make. I rely on my job with Lakewood to pay them."