Voters countywide will get to say on Nov. 4 whether they want to fund a county-operated emergency medical helicopter that primarily serves the Middle and Lower Keys.
Supporters say the proposal is a low-cost way to keep TraumaStar, the air ambulance chopper, operating. Critics say it will tax the Upper Keys for a service residents there don't use.
The question near the end of the ballot is titled "special referendum." The result will advise the Monroe County Commission but not force the adoption of a tax for the service, according to Mike Rice, Sheriff's Office chief administrative officer.
The Sheriff's Office operates TraumaStar.
County officials say TraumaStar, which bills patients for the cost of service, would have to make between 20 and 40 flights a month to break even without the tax revenue.
The county has provided trauma helicopter service since 2002, but officials have had a harder time justifying the nearly $2 million annual expense in tough economic times, and when a for-profit company says it's willing to take over at no cost to the county.
The ballot initiative has the backing of the Sheriff's Office and Monroe County Fire Rescue. Officials say taxing property owners below mile marker 95 about $52 a year, and those north around $27 per year, is the only way the county can afford to subsidize its helicopter.
Officials say the TraumaStar helicopter is a better option to the one operated by LifeNet at the Lower Keys Medical Center and in Miami-Dade County, and that the county service is more reliable than LifeNet, which recently shut down operations in Lake and Osceola counties.
Critics, including Sergio Garcia, Key Largo Volunteer Fire-Rescue chief, and Tom Tharp, a Key Largo Fire Rescue and Emergency Medical Services District commissioner, say the Upper Keys from mile marker 65 to the Miami-Dade County line, including Ocean Reef, don't benefit from TraumaStar and shouldn't pay for it.
That area is included in the Upper Keys Health Care Taxing District.
The trauma district, as the taxing district above mile marker 65 is known, has had an agreement with Miami-Dade County Air-Rescue and LifeNet since the 1990s. It guarantees patients' transport to either Ryder Trauma Center at Jackson Memorial Hospital in Miami or Miami Children's Hospital.
Garcia said the agreement with Miami-Dade is a "public-use service," meaning patients are not billed.
LifeNet does bill patients, but for Upper Keys residents, the trauma district serves as a "payer of last resort for residents with no insurance or any other means of payment," according to an advertisement the Key Largo fire district placed in several newspapers opposing the referendum.
Both TraumaStar and LifeNet charge patients a fixed fee per flight plus a charge for distance flown. TraumaStar charges $5,500 plus $80 per mile from the lift-off area to the hospital, Rice said.
LifeNet charges about $10,000 plus $100 per mile from lift-off to the hospital. The benefit to using LifeNet, said Randy Layman, director of state affairs for LifeNet, is that the county is not paying close to $2 million per year to subsidize emergency air service.
"If the county finds it no longer needs TraumaStar, we're prepared to service the entire Keys. But we have no intention of making TraumaStar go away," Layman said.
Rice said the Key Largo fire district's five-member board would need to approve and sign an agreement with the county before a tax for TraumaStar could be applied to Key Largo. The same is true for any municipality or special taxing district in the Keys, Rice said. Key Largo residents "don't have to be a part of it," Rice said. "I don't understand the reasons the district is opposing it."
Tharp said he's not convinced the language adopted by the Monroe County Commission in July authorizing the referendum gives the Key Largo fire district the same power to opt out of the agreement as other Keys municipalities.
"I'm not totally satisfied. I haven't gotten a clear reason from someone I totally trust that we could hold a vote and decide to exempt the district," Tharp said. "I'm not sure we're on par with the village of Islamorada, the city of Marathon or the city of Key West."
County Attorney Suzanne Hutton wrote in an e-mail to Rice that taxes for TraumaStar can't be assessed if taxing districts don't enter an agreement with the county.
"If they don't enter into an interlocal agreement, I think we can't assess there. Essentially, the statute says that we can assess in the unincorporated county, and where we have an interlocal agreement with an applicable independent special district, and where municipalities pass an ordinance agreeing to the service and its funding via [property taxes]," Hutton wrote.
Other criticism surrounding TraumaStar is the county's policy of calling it first for emergencies, even when another helicopter from LifeNet is based closer.
"If there is an accident in Key West that requires a patient to be airlifted, [county first responders] wait for TraumaStar to come," Layman said. "Our biggest concern is getting to the patient and getting the patient to the hospital as quickly as possible."
Rice said the county's fire department does have a policy to call TraumaStar first, but he said where the helicopter is based is irrelevant.
"It's how fast the patient can be flown to the hospital once aboard the helicopter," Rice said. He said TraumaStar, a 1982 Sikorsky S-76++, has a top speed of 155 knots and is faster than LifeNet's Eurocopter EC-135, which has a top speed of 140 knots.
Sandra Schwemmer, director of the county's emergency medical services, defended the policy, saying TraumaStar can be anywhere in the Keys within 15 minutes.
"We do what's best for the patient. A variety of triage concerns come into play," Schwemmer said.
Layman said he disagrees with Schwemmer and Rice's logic.
"If I'm in a car accident in the Key West area, and I hear there is a helicopter five minutes away at the Key West airport, and one 30 minutes away in Marathon, I want the one closest to the scene," he said.
Both TraumaStar and LifeNet helicopters are also used for nonemergency medical transport. In fact, that's LifeNet's primary role.