City Of Los Fresnos

• Continued from Duro Bag Company

When I first went to work at Duro, I was living in Brownsville, Texas, where I rented a condominium. During my time off, I started going for bicycle rides. One day, I biked north a few miles and came to the small town of Los Fresnos.

Los Fresnos is actually a city, but a much smaller one than Brownsville. I had grown up in a very small town but had lived in large cities for more than a decade by then, so I looked favorably upon Los Fresnos. When my lease ran out in Brownsville, I rented a house in Los Fresnos.

I began attending the Los Fresnos Christian Church, which had a small congregation, many of whom (including the pastor) were involved in the volunteer ambulance service in Los Fresnos.

The Community Ambulance Service was a volunteer non-profit not operated or belonging to the city, just as the Los Fresnos Volunteer Fire Department was an independent non-profit.

I was talked into taking an EMT course and, since I worked the graveyard shift at Duro, I could fit that in easily enough. Once I had achieved my EMT certification, I went on to become an EMT-Special Skills (now EMT-Intermediate) and EMT-Paramedic. Although I tested out at the EMT-SS level, I went straight through, becoming a paramedic not long afterwards.

The classes were taught by Tom Scott, who had founded the EMT program at Texas Southmost College, but the EMT course was held at the Brownsville EMS station, while the paramedic course was held in Freddy Fender's hometown of San Benito, just north of Los Fresnos.

A few months after I became a paramedic, I learned that the city of Los Fresnos was going to hire a paramedic to work full-time, helping with the operations of the Community Ambulance Service and as a health inspector. I was a new paramedic though, and they were looking for someone with five years experience and some other certifications that I didn't have, so I wasn't going to apply.

After some applications were made for the job, I learned that they were considering hiring someone who had completed his EMT and paramedic with me, and had no more experience than I had. In fact, I had done better than he did in class, and I was already volunteering in Los Fresnos.

So I put in a last minute application. Although I was interviewed by the city manager, I had already learned from the mayor that I was going to be hired for the job, and I was.

I was told that I could take comp-time for any ambulance calls that I made at night or on weekends, but that otherwise I'd work nine to five. They didn't realize that nearly all of our calls were at night and on weekends, so they would rarely see me at work during office hours.

I offered instead, to not keep track of any hours that I spent doing ambulance calls at night or on weekends since I was doing that as a volunteer anyhow, but that if I was tired in the morning, I wouldn't feel obligated to report for work at nine, although I'd make a point of being there if anything was on the schedule that needed me, and that maybe I'd take late lunches.

That worked out well. Although I was generally at work during the day, I wasn't obligated to be at work at nine, I could go to lunch whenever I felt like it, and come back when I was ready to. Counting ambulance calls, I worked well over forty hours a week, but I enjoyed it.

I also did the food service inspections of restaurants, grocery stores, and other stores selling food items. Later, I took on some of the code enforcement stuff, such as sending letters out to people who hadn't mowed their lawns or who were keeping goats or other farm animals.

I volunteered with the Los Fresnos Volunteer Fire Department, but that was completely on my own, and not something that I was obligated to do as a part of the job, becoming a Lieutenant with the fire department.

The ambulance and fire departments worked extremely well together. I was grandfathered in as an EMS-Instructor and EMS-Coordinator when the Texas Department of Health created those certifications, and worked as an instructor with Texas Southmost College, teaching off-campus courses.

Since Los Fresnos was central to Cameron County, I taught many of my courses in Los Fresnos, which helped us train our own volunteers, and even brought people in from outside of Los Fresnos who wanted to volunteer with us. Plus, I got paid for teaching those courses as well, so it was a good thing all the way around.

Several members of the volunteer fire department became certified as EMTs or above, and pretty much all of them received medical training, and became familiar with where things were kept on the ambulance. Often, the fire department would arrive at motor vehicle accidents before us, and for a while we had only one ambulance, so they might be there long before us if our ambulance was on another call. They were able to do pretty much everything that we would do on the scene, and we'd arrive sometimes to find our patients completely packaged and ready for transport, along with a record of vital signs.

I have worked for other ambulance companies, but I have never since seen a fire department work as smoothly with emergency medical services as in Los Fresnos, and our EMS volunteers were every bit as professional as any paid service in the area. Our response times were also competitive.

I could tell EMS stories all day, and will probably add some from time to time. but Los Fresnos received a good mixture of trauma and medical calls, and the nearest hospital was in San Benito, twelve miles from our station and, since the San Benito Hospital was a small one, our more serious calls went either to Harlingen or Brownsville. From some parts of our service area, we were thirty or forty minutes from the nearest hospital so we had to be able to do some things that large city hospitals didn't have to deal with. For that reason, we carried some medications that most Texas EMS services didn't administer.

Since Los Fresnos was central to Hidalgo County, we provided mutual aid services to Harlingen, Port Isabel, South Padre Island, and Brownsville, and of course we called upon them to assist us when needed.

Although we were competitive on a business level, all of the ambulance companies in Hidalgo County worked very well together in the interests of patient care.

Port Isabel EMS had only one crew on duty at a time so when they had a call, we'd send one of our ambulances (not long after I was hired, we got a second one) to Port Isabel. If either the unit we had in Port Isabel, or the one in Los Fresnos, had a call, Harlingen would send a unit to Los Fresnos until someone was back in service. Our new ambulance had everyone's frequency programmed into its radio so we could take dispatches directly rather than depending on relayed messages.

Okay, enough of that.

After a couple of years, our mayor told me that the guy who Los Fresnos employed part-time as a building inspector was resigning, and he suggested I put in for that job.

Knowing little or nothing about building construction, I wasn't sure how good of an idea that was but he ensured me that the ability to read and understand the code book was what mattered, so I thought I'd give it a try.

They were paying the building inspector $12,000 per year so I offered to do it for $6,000 on top of what I was already earning. That brought my salary to a pretty comfortable level. The problem was that I never got a raise that amounted to anything after that. I was earning more than most city employees but I was wearing more hats.

Before I could go anywhere on weekends, I had to make sure that the ambulance crews were covered, and often had to rush back to man the second unit if something came up.

After six years, I put in for a budget that included $6,000 to hire someone to cover for me on weekends, and it was denied. I was offered a job as training coordinator for Catalina Ambulance Company, a much larger company in McAllen, Texas, so I took it.

• Continued on Catalina Ambulance Company

 

Here's the first ambulance I ever worked on.


Here's me with our new ambulance, about 1988.

 

When I was first hired to manage the Community Ambulance Service, also known as Los Fresnos EMS, they were charging a flat rate of $35 for ambulance calls, and weren't charging anything unless a patient was transported. As a community service, that might sound very nice and we were taking in enough to pay for the gas we used and to replace supplies used on the ambulance, but we weren't making enough for large investments, such as a new ambulance. We had only one ambulance and it was ten years old. The ambulance board was made up of wonderful people who would have arranged for the purchase of a new ambulance when the old one quit running, but there were times when we needed more than one ambulance at the same time.

There was also the problem that the going base rate for ambulance calls in that area at the time was $300, plus patients were billed for disposable supplies used, and for various procedures, as well. Because Medicare disbursements are based on the average rate charged by ambulance services in a region, our $35 base rate was bringing down the rates for everyone in the region, which was one of the reasons why the paid services were working to put the volunteer services out of business.

When I met with the board of directors about our need for a second ambulance, rather than a replacement for the one we had, I laid out a plan to bring up our revenue to a point where they could see that it would pay for itself within five years. Of course, we needed an ambulance earlier than that, but what I needed to do was show increasing revenue over a period of six months.

I raised our base rate from $35 to $250, and started billing for procedures and supplies. There wasn't much of an outcry because we were on the border of Texas and Mexico, and most people either had Medicare, Medicaid or insurance, or they weren't going to pay their bill at all, whether it was $35 or $350. Looking through our receipts, I could see that patients had been billed only once, and if payment was not sent in, the matter was dropped. I think the city secretary had been doing the billing, so I took over the billing myself, writing a computer program to automatically print our first, second and third notices.

I also went through the records for two years, and billed patients who hadn't paid previous bills. I didn't harass them for payment of bills from a year and a half to two years ago, but several people came in and paid, apologizing for having not done so earlier. With the excitement of the medical emergency, hospitalization or whatever, the bills had simply been overlooked and, since no one was sending a second bill, they were simply forgotten.

For a year, I entered into a contract with a collection agency for bills that hadn't been paid after three notices, but I decided not to renew that contract because the few overdue bills that were paid after turning them over to the collection agency were paid directly to me, rather than to the collection agency, so I had the feeling they'd have been paid regardless.

For those who did not have Medicare, Medicaid or insurance, I set up individual payment plans, and we forgave the debts of some people who simply did not have the money to pay their bills. By the way, we accepted Medicare payments as payment in full, without billing for deductibles. It's not so much that I was a nice guy, but almost no one was paying their Medicare deductibles anyhow, so it didn't seem to be worth the bother. Medicaid was the big problem because it was charity on our part, since Medicaid didn't even pay our costs. If we accepted Medicaid, we couldn't bill the patient for the balance. We weren't required to accept Medicaid but if we didn't accept Medicaid, we wouldn't collect anything at all.

Some people surprised me. We transported a Mexican National and, I think, his two children, from a motor vehicle accident, which incurred a bill that approached $2,000. It was an older car, and I didn't expect that I'd even get an accurate address to send the bill to, but the man came by the office after being released from the hospital to settle up, paying it all in cash before returning to Mexico.

We did get a new ambulance, one that is still in use more than twenty years later, although it is now their back-up ambulance.

 

I don't think I mentioned it, but I was aware of it.

 

Air ambulances are very expensive to operate. For one thing, the helicopters and planes are expensive, as are the maintenance costs. Then there are the costs of the pilot as well as the medics who provide care, insurance costs, and etc. There is also the fact that air ambulances aren't generally doing as many calls as ground ambulances are, yet all of the apparatus and personnel have to be there anyhow.

As for speaking Spanish, I learned to speak and understand Spanish well enough to get along but I was in no way fluent in the language. Two years in high school did me no good whatsoever. Of slightly more use was a course in conversational Spanish that I took in Brownsville, and the fact that pretty much everyone around me for twenty years spoke Spanish, although most also spoke English.

 

I'm in the middle, left side, with the beard.

 

That is covered in this thread. The short of it is that I was recruited by a company in Brownsville, Texas.