A new for-profit ambulance service planning to transport patients between medical facilities says it will fill a gap that now leads to backups in critical parts in the chain of hospital care. But some local EMS volunteers believe the company is eying a bigger piece of the market, and have urged the state to consider the consequences of green-lighting the startup.

The new ambulance service, Garnet Transport Medicine, is the brainchild of Vermont paramedic Ryan Ferris, a former member of the University of Vermont Medical Center’s critical transport team.

Ferris left that job in November to oversee the rehab of Garnet’s new home – a 7,300-square-foot building on the campus of GlobalFoundries that once housed the fab’s fire station. He said Garnet will work mainly with UVMMC and hoped his ambulances will hit the road within the next few months, depending on how long it takes to train employees and receive the rest of the equipment.

Before picking up patients, however, the company must earn a license from the health department, which must first receive a recommendation from the EMS District 3 board after its review next month. Garnet has yet to submit an application, but the health department already heard at least one critical take on the company’s proposal.

In a letter to the department, Essex Rescue volunteer and board president Hillary Danis said licensing Garnet could leave “widespread destabilizing effects” on Vermont’s EMS system.

Underlying her argument is the suspicion that Garnet will try to expand into 9-1-1 service, a move she fears will jeopardize the viability of surrounding EMS volunteer agencies. Take Essex Rescue, which boasts the second-lowest per-capita expenses of any Vermont EMS agency thanks to some significant yearly call volumes: nearly 2,000 on average.

High demand allows the department to recoup enough money from insurance companies to cover its budget and capital reserve fund, Danis said, while still keeping costs on municipalities low.

“If our call volumes were threatened, that could be a threat to the way we operate,” she said, adding the same is true for most volunteer-based agencies around the state.

Ferris said fears that Garnet is eying a 9-1-1 takeover are misguided. He cited one simple reason: “There’s no money to be made in 9-1-1.”

Compared to interfacility transport, he said, which are typically pre-authorized by insurance companies or patients who know the out-of-pocket costs upfront, 9-1-1 emergency service is a much less reliable funding source, with no guarantee of payment if the patient isn’t transported.

“For us to get into 9-1-1, it would be really in a community service aspect,” Ferris said. “Most communities are better served by the agencies they have working for them now.”

Danis agreed that 9-1-1 calls are indeed less reliable, but she said revenues are higher. And though she sees a need for interfacility services – she’s heard of patients waiting hours for a transport ambulance –  she doesn’t believe demand is anywhere near enough to support a new business, especially one that’s already made some significant start-up investments.

“On top of all that, they want to be able to turn a profit?” Danis said. “I just don’t see the dollars and cents.”

Garnet’s top brass assures both are within reach. “We wouldn’t launch the business otherwise,” said Ken Merritt, a Burlington-based attorney and co-owner of Garnet.

Merritt said market research confirms there’s enough demand to support the new service, noting Garnet would be only the second interfacility transport service in EMS District 3, joining UVMMC’s HealthNet.

To Danis, Garnet’s public messaging suggests plans beyond interfacility transport, including its job postings, which ask for requirements typical of 9-1-1 providers.

Garnet Medical Transport will operate out of the former fire station on the campus of GlobalFoundries, pictured above (photo by Colin Flanders).

Ferris said that’s because Vermont laws make no distinction between what specific type of service an agency will provide, so Garnet must still comply with all the requirements that pertain to a 9-1-1 service. He said not requiring its employees to know all the necessary duties would be “counterproductive,” as there’s a high likelihood the company will be called upon during mutual aid or mass casualty situations.

Ferris understands why some may be skeptical about for-profit medical agencies, acknowledging such organizations have not done themselves any favors in recent years, with stories of exorbitant rates and debt collectors making headlines. To that end, he said Garnet has a made a decision against the practice of charging patients beyond what their insurance picks up even though its legally allowed to do so.

“We’re here to do business in a friendly way and in the best interest of the patients and the people that are utilizing the service,” Ferris said. “We’re not here to make enemies.”

Garnet has found some support from other members of the EMS community, like Richard Smith, an Essex Jct. resident and EMT who serves on the local fire department.

Smith said Garnet’s plan to provide more interfacility service is much-needed in Vermont (Smith once worked for the now-defunct TransCare, which provided interfacility transport from Essex until closing in 2013).

Though he did expect Garnet will eventually expand into 9-1-1 service, Smith believes the company will focus more on underserved communities, since Essex Rescue already has a long standing relationship with the community here.

As long as that lasts, Smith said, “I don’t see them losing out.”

Others say a little competition would only benefit the Vermont’s emergency medicine providers.

Essex resident Joshua Burleson, who serves as an Advanced EMT in Vergennes, said Garnet’s decision to require qualifications beyond what’s typical not only benefits patients in the area, but pushes other services to keep pace.

Plus, if Garnet is going to bill at exorbitantly high rates for interfacility travel, then people won’t choose its service, Burleson said.

Ferris and Merritt believe the service will only benefit the EMS community, bringing more than 20 full- and part-time jobs to the area. Still, they aren’t surprised to hear criticisms of their plan. “EMS in Vermont is a very,” Ferris said, pausing for a moment, “interesting industry.” Merritt added that he’s found it “insulated and resistant to change.”

Danis countered she’s not against new services in theory. Rather, she worries Garnet has set itself up as a financially unsustainable entity, one that will sweep through the state and leave a void in its wake.

Garnet’s owners expect that feeling will fade. “Once it’s clear who we are and what our focus is, a lot of that resistance will frankly go away,” Merritt said.

Editor’s note: This story has been corrected to show Joshua Burleson works as an advanced EMT in Vergennes, not Shelburne.