Bangor Daily News

PENOBSCOT COUNTY, Maine — An unexpected change from Northern Light Health threatens to leave multiple rural Penobscot County towns without their long-standing ambulance service unless they can come up with tens of thousands of dollars on short notice.

Seven towns will have to pay Northern Light Health for ambulance services — a change the towns said they didn’t expect — while insurance and patients also continue paying the healthcare giant.

Eddington, Etna, Dedham, Dixmont, Glenburn, Kenduskeag and Newburgh received letters in June about the changes, said Andrea McGraw, associate vice president of Emergency Medical Services, Northern Light Medical Transport and Emergency Care. Other towns have heard they’ll also be affected, but Northern Light said it’s “premature” to talk about other regions as those contracts have not been reviewed.

These contract disputes are just the latest example of rural Maine towns struggling to maintain ambulance services amid rising costs. Other towns have had to contract with neighboring towns, hire private ambulance companies or even purchase their own ambulances to continue providing services to their residents.

For years, Northern Light paid the towns to provide emergency medical services before an ambulance from the health care system arrived.

Dixmont received about $2,500 a year for those services, the town’s First Selectman David Bright said. The money went to the town’s volunteer fire and rescue department.

The Dedham Fire Department received a “small stipend” for the medical services it provided before the ambulance arrived to transport patients, Dedham Fire Chief Craig Shane said.

Contracts between those towns and Northern Light end this year. Now Northern Light will charge the towns a yearly fee of $17 a resident, McGraw said.

Reimbursement for ambulance services are at an all-time low, which means Northern Light carries the cost of whatever insurance and patients do not pay, McGraw said. Paying people who work in emergency medical services, as well as the upkeep of ambulances and equipment is expensive, she said.

“In order to continue to care for our Maine communities for generations to come, we have to make some changes,” McGraw said.

The per capita charge model is used across the country, with fees ranging in price from $3.50 per capita in Palmyra, Pennsylvania, to $55.95 per capita in 2018 in Vermont.

“The cost of municipal-based EMS is high, and we can no longer avoid making this change,” McGraw said. “Our rates are at the low end of providing this service.”

Towns are required to have a contract for medical transport of people, so an agreement will have to be reached to ensure ambulance services continue, Shane said.

Even with a new contract, there is no guarantee that an ambulance will respond to a call, something Shane said he wants to address in the new contract. Northern Light was unable to send an ambulance to 28 percent of his department’s calls last year, he said.

“Sign a contract to do what?” Shane asked. “Have an ambulance service that struck out 28 percent of the time? That’s disheartening.”

Dixmont’s contract in which it’s paid by Northern Light ends Dec. 31 . The town will have to pay $20,587 a year to continue receiving ambulance services. But the town cannot spend that money until residents vote on a budget at its next annual town meeting on March 15, 2025.

The new contract is not yet finalized, so it’s unclear what will happen to the ambulance service in the three-month gap from the end of the old contract to the town meeting.

Dixmont doesn’t know where it will find the money, as it hasn’t started budget preparations, Bright said.

“We have an obligation to provide health and safety to our occupants so if that’s what we’ve got to do, we’ll do it,” Bright said.

Dedham learned about the changes days after the town finalized its budget July 1, Shane said. For years the towns have had it good with the way the contract works, and a change made sense at the business level, especially with staffing issues. It’s the way the change was presented and the amount requested that is the problem, he said.

“It’s painful,” Shane said, referring to how the town learned about the change just after finalizing its budget.

Dedham will pay $30,000 for the ambulance service. Shane said he’s thankful the per capita charge is based on permanent residents and not seasonal residents.

“It’s going to be pinching pennies for the next 11 months to scrimp and save on a budget that’s already tight.”

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Created by Gardiner architect Adam Lemire, the design beat out entries from nearly every state (and abroad), ranging from the “clearly not serious,” as one person put it, to the more elaborate.

In November, residents will decide whether they want to make Lemire’s design the official state flag in a statewide ballot measure.

Secretary of State Shenna Bellows organized the contest this summer after the state Legislature passed “An Act to Restore the Former State of Maine Flag” last year.

The legislation held that the redesign “must be buff, charged with the emblem of the state, a pine tree proper, in the center, and the North Star, a mullet of 5 points, in blue in the upper corner.”

The contest and upcoming referendum follows years of debate and attempts by lawmakers to readopt the original flag, Bellows said.

Many have criticized the current state flag, which replaced the first after eight years, saying it is too crowded and bears too many similarities to others, such as Vermont’s. The same color blue as the American flag, it features the state coat of arms, a pine tree flanked by a farmer and a seaman, and the motto “Dirigo,” meaning, “I lead,” in Latin.

Since Maine’s bicentennial in 2020, the old-school design has seen a resurgence in popularity — appearing on items such as tees and tote bags, as well as a simpler version on flags created by the Maine Flag Company in Portland.

“When you drive the coast of Maine, you will often see, waving at people’s dooryards, flags with a pine tree and a North Star,” Bellows said. “That’s a nod to our heritage, but also a design that a lot of Mainers just think is cool.”

Yet like many issues nowadays, whether to replace the flag has become a proxy for the culture wars, with those favoring the status quo — mostly Republicans — bemoaning fading traditions.

(Massachusetts has also tried — and failed — to replace its own controversial flag.)

But Bellows, whose office was charged with approving a model design that she will send to the state’s National Guard to use for official purposes, said she doesn’t see it that way.

“In these challenging times, people are really seeking community. Our symbols, like our state flag, bring people together. The decision on Question 5 … is a question without politics,” she said. “It’s really one of personal taste and design. It’s a fun question that brings some community and identity and unity, potentially, to our state.”

Her office initially considered a longer process for the flag redesign, as Minnesota and Utah have done, but opted for the contest given the tight deadline with the referendum, she said.

The proposed designs varied from the “very serious to the amusing,” she said.

Moose, lobsters, pine cones, the Maine coastline, and yes, Norris of “Walker, Texas Ranger” fame (but no immediately apparent connection to the state) were among the unsuccessful designs.

The “most fun” designs were those “clearly done by kids,” Bellows said.

“It made me so happy that there were some kids who wanted to participate,” she said. “I sent a thank-you note to everyone who participated via email, and one of the Moms wrote back and said, ‘My 10-year-old son is a budding vexillologist. He loves flags.’ And that just made me so happy.”

Bellows and her team selected 10 finalists, which were brought to an advisory panel that included Democratic and Republican lawmakers and community advisors. They used software to see how the designs would look as flags waving in the wind and as small lapel pins. In the end, Lemire’s design emerged victorious.

He told Bellows that his final design was based on an Eastern white pine in Augusta’s Viles Arboretum that he saw while taking walks with his son.

He worked on it for a while and submitted it as his wife was in labor, Bellows said.

“Her due date happened to coincide with our deadline for the flag design contest,” she said. “So it was really delightful to meet him and his partner.”

A future nursery decoration, perhaps? “I think so for sure,” Bellows said with a laugh.

Take a look at all of the rejected submissions:

Shannon Larson can be reached at shannon.larson@globe.com. Follow her @shannonlarson98.