Ryan Brothers shares record of service, concerns with city’s 911 plans

By Kim McDarison 

Arriving last Friday to a retrofitted five-bedroom house now ambulance station on Arndt Street in Fort Atkinson, Ryan Brothers Ambulance Service owner Erin Ryan and the Ryan Brothers employees stationed there were eager to give Fort Atkinson Online a tour and showcase the services the company provides. 

With some 20 years of service in Fort Atkinson under his belt, Ryan said he and his employees feel connected to the community and take pride in their work. 

“It’s personal for us,” Ryan said, adding, “My name is on the ambulance.” 

Among those working at the station on Friday were Mike Roth, a Deerfield resident and employee with Ryan Brothers for over 30 years. He is an A-EMT, which, Ryan said, means he has more training than an EMT, but not as much as a paramedic, and Todd Overdahl, a resident of Fort Atkinson who has worked for the company for about 17 years. Overdahl is a critical care paramedic. 

Relaxing in the employee living quarters on the station’s lower level was Madison Sanderson, who began as a college student working with the company part-time and now works full time. She has been with the company for nearly two years. Sanderson is an EMT. 

Upstairs, Jesus Alcantara, who is a five-year Ryan Brothers Ambulance Service veteran, was updating patient information on a computer. Alcantara is a paramedic. He started with the company as an intern, Ryan said, adding that the company has its own intern program through which it sponsors individuals who are looking for a career in the field.

Ryan said the company usually finds candidates to enter into its intern program though recommendations coming through the University of Wisconsin-Madison. 

“We have a good working relationship with them,” he said, adding that a lot of students who are interested in medical school are also looking for hands-on training. The UW recommends students, many of whom enter into a gap year to take the internship and train, Ryan said.  

Still, Ryan added, his company has a good track record of retaining its employees. 

“The average EMT stays with us for two or three years. The industry standard is 18-months, he said, adding: “We like to utilize people who are career-oriented and if we can keep them for two or three years, that’s great.” 

Some company history  

Ryan, an A-EMT, said he began working for the ambulance company — which was begun in 1962 by his father and uncle — in 1995. That was the year he graduated from UW-Whitewater, he said. 

Ryan Brothers Ambulance Service has its headquarters in Madison, but the company has operated a station in Fort Atkinson for 20 years, he noted. 

Offering some history, Ryan said in 1965, Kutz Ambulance Service held the 911 contract in Fort Atkinson. 

At some point, he said, the Kutz family sold the business to one of its longterm employees, and the employee later sold it to AMR (American Medical Response). 

Both companies, while they held the Fort Atkinson contract, operated a station from the Arndt location from which Ryan Brothers Fort Atkinson, a separate branch of Ryan Brothers Ambulance Service, operates today. 

When the Kutz family owned the business, Ryan said, it operated 911 services and did transports to the the Fort Atkinson Hospital. 

While he wasn’t sure when contracts between the city and its former service providers began, he said, in 2001, the contract between the city and AMR was ended and the city released a request for proposals (RFP), to which several entities responded, among them was Ryan Brothers Ambulance Service. 

Ryan recalled being among four entities that made presentations to the city while vying for the contract, noting that even then, the city was surprised at the costs associated with providing 911 service. 

At the time, Ryan said, the Fort Atkinson Fire Department was among contenders responding to the RFP. 

After an initial round of presentations, he said, the four finalists were asked to come back with new sets of numbers.  

“They wanted the companies to include the revenues they received from hospital calls,” Ryan said. 

In 2002, he noted, Ryan Brothers was awarded the 911 service contract by the city, and Ryan Brothers Fort Atkinson, LLC, was created. The separate LLC owns the 911 ambulance stationed in Fort Atkinson, and, through another LLC, holds the loan on the Arndt Street building. Ryan Brothers Fort Atkinson rented the building in 2002 from the former longterm Kutz employee who was still its owner. The building was purchased by Ryan Brothers sometime between 2006 and 2008, Ryan recalled. A separate LLC for the 911 station was created, Ryan said, because 911 services come with different sets of liability. 

Two types of calls 

Within the ambulance service industry, Ryan noted, there are two types of calls: 911 and inter-facility transfers. 

Said Ryan: “The problem is with 911 calls, people don’t always have insurance and then we don’t get paid. So your numbers may show that you do 1,200 calls per year, but you can only bill for 700 calls, or you might go (to a location to pick up a patient) and you can’t transport because people refuse to go, or you can treat them on site and they don’t need transporting. There are only billable hours when you transport somebody. If you bill a patient and there is no insurance, some will get up a payment plan, and others, you just have to write them off.”  

He estimated about 30% of 911 transports are ultimately written off. 

Some go to collection agencies, he said, but, he added, that still doesn’t mean the ambulance company will get paid. 

“For 911 service, the city pays an annual stipend of $110,000 per year. That money is meant to cover expenses like our building and manpower,” Ryan said.   

Company facilities, staffing the station

Attached to the five-bedroom structure is an approximately 2-1/2 car garage that has been retrofitted to accommodate the two ambulances that are stationed in Fort Atkinson 24/7, Ryan said.  

In Fort Atkinson, crews work in shifts that are 24 hours on and 72 hours off. On average, crews leave the station about 2 minutes after receiving the 911 call. 

At Ryan Brothers, EMTs make between $14 and $17 an hour. Those with higher levels of training, like critical care paramedics, make closer to $25 and $30 an hour. 

Ryan said “a main core group” works in Fort Atkinson. Of the company’s 120 employees, 18 are among those that regularly work out of the Fort Atkinson station.  

An employee must be an EMT, paramedic or higher to work in the Fort Atkinson station, Ryan said.

“We run single paramedic; everyone has to be at least an EMT, and they have to meet our internal qualifications. We have two 911 locations and they get our most qualified people,” he said, adding: “The people that serve at the 911 stations are connected to the communities they serve. People in these jobs are passionate about what they do. We care because that’s our reputation. 

“They are here to do a job and take care of people. In Fort Atkinson, they are here to take care of the people in Fort Atkinson and the townships. As a company, we do about 300 hours of community service. In Fort, we do about 40 hours a year,” Ryan said. He described community service as anything from having an ambulance standby during an event to bringing an ambulance to an educational program at school.  

“One rig is always at paramedic level and the second one is at critical care paramedic level,” he noted. 

The full Ryan Brothers Ambulance Service company operates locations within three counties: Dane, Jefferson and Rock.  

From the various locations, the company performs inter-facilities transfers that might take ambulances and their crews on calls within several states. 

Of the company’s eight locations, two provide 911 services. They are Fort Atkinson and a station within the Madison suburb of Maple Bluff. Other stations, such as those operating in Middleton, Sun Prairie, Deefield, and Janesville house ambulances that respond to inter-facility transport calls. 

Of the two stations responding to 911 calls, Ryan described Fort Atkinson as “the biggest.” 

“In Maple Bluff, the 911 service is a paramedic service and we work with the fire department. We have been providing 911 service there since 2011,” he said.  

In Fort Atkinson, the station responds to both 911 calls and calls for inter-facility transfers, with one ambulance dedicated to responding to 911 calls within the Fort Atkinson Fire Department service territory, which also includes five townships — Koshkonong, Sumner, parts of Oakland, parts of Hebron, and the Town of Jefferson — which contract with the City of Fort Atkinson for 911 service. A second ambulance can respond to 911 calls and also responds to inter-facility transfers. 

All told, Ryan said, the company operates seven stations within the state and an administration building in Madison.  

Looking at the structure of 911 services, Ryan said, 911 calls are answered within a designated territory. The company only answers 911 calls within the designated service area, but it can go outside of the area when asked to respond to calls through mutual aid. 

Like municipal ambulance services, private ambulance services are included in mutual aid protocols, he said. 

Typically, Ryan Brothers requests help through mutual aid on between 20 and 25 calls each year and the company provides mutual aid to calls received from other jurisdictions between 30 and 35 times a year., he added. 

Protocols for inter-facility transport are different, Ryan said. 

He continued: “Fort Atkinson is staffed 24/7 with two rigs. There are four people here at the station unless they are out on a call. Each ambulance leaves with a team of two for 911 calls. Ambulances leaving for inter-facility services sometimes have crews of three. If a third person is needed, someone comes from another station by ambulance and meets the team at the hospital. 

Each year, he said, the company responds in Fort Atkinson to 1,200 911 calls. The full company responds to between 17,000 and 18,000 inter-facility transport calls. 

The inter-facility calls are statewide and some are even in neighboring states, Ryan said.  

The Ryan Brothers contract

Said Ryan: “In Fort Atkinson, the two ambulances will always be supported by a crew of at least two. Our contract calls for one rig at the EMT level, but we staff it at the paramedic level on our own, and our second rig was supposed to be on-call, but we staff 24/7 in-house and at the critical care level. Our contract says it can be paid-on-call, but we staff 24/7 in house.  

“In our contract, we also have a noncompete clause, so I was skeptical about a third ambulance in Fort Atkinson at the fire station,” Ryan said. 

When it was proposed, he added, he and the city signed an MOU (memorandum of understanding) stating that the third ambulance operated by the department would not be used for 911 calls. 

According to Ryan, the MOU was signed in 2018. 

Ryan described the contract with the city as a rolling three-year contract. In the beginning, he said, the first contracts the company entered into with the city were renewable every year. After a time, the parties agreed to go with a rolling three-year contract that would automatically renew each year. 

With the rolling three-year contract, he said, if one of the parties wanted to opt out, there was a two-year grace period. 

With this current contract, he said, the grace period is not done until 2023. The city gave its notice as stipulated within the specified time period, but the company continues, according to Ryan, as a paid service provider until Dec. 31 of 2023. 

During the Sept. 7 meeting held by the Fort Atkinson City Council, the body voted in favor of ending its contract with Ryan Brothers Fort Atkinson, advancing its understanding, as stated by City Manager Rebecca Houseman LeMire, that the contract would complete on Dec. 31, 2022. 

Ryan said he tried during the meeting to communicate his understanding of the company’s 2023 completion date, but the council did not give him recognition from the floor. 

As of last Friday, he said, he has had no communication with the city since the Sept. 7 council meeting. 

Said Ryan: “The city has not included us in anything and there has been no transparency. I’m not sure why the city is trying to rush this through. We are the most efficient and fiscally responsible game in town for this population. Their EMS budget is going to go up about 500%.”   

Looking at overall costs, Ryan said, according to calculations made by his staff, under the company’s most recent contract, each member of the population within the Fort Atkinson Fire Department’s service territory, which, he said, was calculated at 18,000 when including the five townships, was paying $6.25 for 911 service. 

“That’s very inexpensive,” he said. 

When it comes to a referendum, he said, “the people living in the townships are not represented. The city will vote on the referendum, and if it passes, the costs go up.”

While the company received a raise each year within its contract with the city calculated using the consumer price index (CPI), Ryan said, “we lose hundreds of thousands of dollars every year on this operation. We do it because we care and we are part of the community.”  

According to Ryan, Ryan Brothers Fort Atkinson loses money each year, but, he said: “Our No. 1 priority at Ryan Brothers Fort Atkinson or at Ryan Brothers Madison is to provide the best patient outcomes. It’s not just about the money.” 

Addressing patient outcomes, he said, given the broader resources of the full company, Ryan Brothers can offer a wide variety of experience to those in training. 

Looking as losses from providing 911 service, he said, “we make it up on the inter-facility transfers. We draw from a bigger pot. We can do it at a lower rate because we are coopting services from a bigger operation.”  

Looking ahead

Said Ryan: “You are getting the best trained people in the state at the most economical rate possible. Without the $110,000, we will repurpose this (911) rig and use it elsewhere for inter-facility transfers. That might happen a year from now or two years from now.

“If the referendum doesn’t pass, they (the city) may need to renegotiate with us.” 

If the city opts not to renegotiate, he said: “We would close Ryan Brothers Fort Atkinson down.”  

The company would continue to operate the Arndt Street station, he said, but it would only provide inter-facility transport services as part of the company’s broader network. It might also be a possibility that another municipality in the area might hire his ambulance for 911 services, he said, in which case the 911 service for that municipality might run from the Fort Atkinson station. 

“I want to do right by Ryan Brothers and the city, but I wouldn’t be a good leader if I didn’t have plans,” he said.  

Ryan said his company plans to hold the city to its three-year rolling contract and he remains open to negotiations with the city. 

“Right now, there are too many questions with no answers for me to know what’s really going on,” he said.  

Looking at next steps, he said: I’d like them (the city) to be transparent and find out what a budget will be so residents can see it because budgets don’t get smaller.

“A full-time paramedic in the state of Wisconsin costs between $175,000 and $200,000, that’s per year, per person. The figure includes salary, training and benefits. So if you hire 12, add that number by 12, and that’s just for paramedics.”  

He suggested the city might consider holding a “town hall meeting.” 

“We want to speak for ourselves,” he said. 

A story about plans under consideration by the city to bring 911 services in house is here: https://fortatkinsononline.com/ryan-brothers-contract-terminated-council-rolls-out-plan-for-public-safety-referendum/.

A story about the Fort Atkinson Fire Department’s concerns with issues of staffing and sustainability is here: https://fortatkinsononline.com/an-issue-of-sustainability-fort-firefighters-talk-about-call-volume-staffing/.