Columbus has collected almost $69 million over the seven years the city has charged patients for ambulance rides to the hospital.
The program is generating more money than expected, and EMS crews want the cut they say they were promised to buy high-tech medicines and medical equipment.
When first proposed in 2001, the plan to bill insurance companies to transport patients was expected to raise about $5 million a year.
Last year, ambulance fees brought in $14.3 million, and revenue through June is $6.6 million.
The increase is attributed to conservative early estimates, higher charges for transporting and a soaring number of EMS runs over the years.
The money goes into the city's general fund to pay for daily operations, including street repairs, workers' salaries, police cruisers, snow plows, new medic units and other equipment. The money also has helped hire more police and firefighters, officials said.
"It's like any other revenue source," said Deputy Public Safety Director Dan Giangardella. "It's allocated in the budget process."
The city charges each patient's health-insurance plan $561 to $965, based on the level of care needed, plus $11.56 per mile to a hospital.
None of the money is earmarked for the Columbus Division of Fire, which accounts for 31 percent of the city's budget, Giangardella said.
When charging for ambulance rides initially was discussed, the fire union opposed the idea, saying it was an additional tax, said Jack Reall, president of the International Association of Fire Fighters Local 67.
So a new line item was created in the fire budget to buy new technology.
"When it was first set up, it was supposed to be some money set aside, some EMS seed tech money," said Capt. Shawn Koser, supervisor of continuous quality improvement for the division.
"Early in the patient-care reporting, they were giving us some money as promised, but that went away."
Koser said the line item was about $10,000 to $20,000 a year. The Fire Division used it to buy 40 to 50 breathing machines and supplies and monitors to measure the carbon-monoxide level in patients' blood.
"We were promised that they would set aside new money for new technology to try out," Reall said.
Giangardella and Council President Michael C. Mentel said they don't recall any promise or a line item.
Reall said Mentel and then-Council President Matt Habash sent a letter to the fire union agreeing to the line item.
Reall couldn't find the 2002 letter; Mentel said he didn't recall it. Habash didn't return phone calls to his office at the Mid-Ohio Foodbank.
Melinda T. Swan, former chief of staff for the City Council, negotiated the deal with the fire-union leaders. She said she recalls a letter outlining the details.
"It existed, but I don't remember the specifics of it," she said.
Mentel said the ambulance-billing legislation allowed for increased funding of technology, pharmaceuticals and equipment in the general Fire Division budget.
Giangardella said that since EMS billing started in 2003, the medical-supply budget has doubled and the city has added electronic medical records and new cots to hold people who weigh up to 650 pounds.
"Those are things we have done that we wouldn't have been able to do if we did not have the additional dollars," he said.
Battalion Chief Dave Whiting attributed the rising medical-supply budget to the fact that paramedics can no longer exchange supplies with hospitals.
Hospitals used to bill patients for these items, but when the city started charging for transports, the division had to start buying its own supplies, he said.
Reall said the electronic medical records are necessary more for billing purposes than for anything the Fire Division needs.
Mentel said he didn't know there was a problem with EMS billing dollars.
Reall said he'd like 80 percent or 90 percent of the money collected from ambulance runs to go back to the Fire Division.
He acknowledged that it might not change the size of the Fire Division's budget, but "it would be easier for us to reconcile the importance for EMS billing to our budget," he said.