EMS agencies refuse Macwahoc call, woman dies

EMS agencies refuse Macwahoc call, woman dies

By Ben Meiklejohn

  MACWAHOC PLANTATION, Maine – Mike Hunter called 911 on Jan. 8 requesting emergency service in Macwahoc Plantation. He expected that call to be met with sirens. Instead, that call was met with crickets as at least 9 EMS agencies refused to send an ambulance.

  At 9:21 a.m. on Jan. 8, Hunter called 911 after his wife, Rachel Worster Hunter, passed out on the couch, suffering from a low potassium condition. As each minute ticked by, agency after agency declined the dispatcher's appeal for service, and Mike Hunter witnessed his wife's condition worsening until her death at 10:15 a.m.

  As area residents express outrage at what is perceived as a lapse in public security, the family of Rachel Worster Hunter are left wondering why their loved one had to pay with her life for what they view as political statements being made by EMS agencies about money.

  Holly Worster, Rachel Worster Hunter's sister-in-law, said, “I'm really let down to think that, wow – what happened to neighbors helping neighbors? Take care of people first, figure out the payment after.”

  All agencies involved in the call for service to Macwahoc Plantation were contacted to piece together what happened in what is viewed by many local residents as one of the biggest emergency medical service failures in the state. Penobscot Regionale Communications Center and Aroostook County Sheriff's Office were working, together trying to acquire service from agencies across two counties.

  According to answers provided by the agencies themselves, and documents obtained through Freedom of Access Act requests, the most common rationale given for not answering the emergency call is that Macwahoc Plantation did not have a contract with any agency for service, and the plantation was “out of the coverage area.”

  Among the agencies in the region that declined to travel to Macwahoc Plantation to preserve Rachel Worster Hunter's life: Bangor Fire Department, Central Maine Highlands Fire & EMS District #1, East Millinocket Ambulance Service, Houlton Ambulance, Island Falls Ambulance Department, Lee Fire Rescue, Lincoln Fire Department, Millinocket Fire and Rescue and Patten Ambulance Service.

  One EMS agency however, G&H Ambulance Service, Inc., which provides service in Hudson, rose to the challenge, responding to a tone at 9:50 a.m., despite that they were over an hour away from Macwahoc and had no contract with them for coverage.

  The ambulance from Hudson arrived earlier than expected, said Hunter – at approximately 10:30 a.m. – but by then, it was too late.

  Mike Hunter said that he knew nothing of the politics in Macwahoc Plantation, or that the plantation had no contracts for emergency service; he assumed that a call to 911 would be answered, just like anywhere else.

  “Those people are supposedly professionals and like, yeah, they say they will do everything to save a life,” Hunter said. “You know, they didn't do anything that day.”

  “I've lost a sense of security, yeah, lost all faith ... How all of them them people could sit back and just listen to this all happen (on the scanners).”

  Lee Fire Rescue Chief Jay Crocker, whose agency refused service to Macwahoc, said that East Millinocket, Lee and Lincoln have all provided service to the plantation in recent years, often at a financial loss.

  “People want to say, 'It's not about the money,' but it is (about the money),” Crocker said.

  Lee Fire Rescue covers Lee and has contracts with Carroll Plantation, Kingman, Lakeville, Prentiss, Springfield and Webster, Crocker noted. If Lee Fire Rescue were to send its staff a half hour away to an area not under contract, and then not be available if something happened within their coverage area at the same time, Crocker said taxpayers in those towns would be outraged.

  Crocker said EMS agencies across the state experience a lack of resources – a problem that needs to be fixed “from the top down.” For example, he said ambulance service to Medicaid patients is reimbursed at a set rate that doesn't cover the cost of sending the ambulance.

  “Every time we transport a patient with Medicaid, we lose money,” he said.

  In terms of the 911 call made on Jan. 8, Crocker noted that many agencies may not have responded immediatley because the original information provided by Penobscot Regional Communiation Center, the dispatch center, characterized Rachel Worster Hunter's condition as “no priority symptoms,” which indicated it was “not life threatening.”

  At 9:24 a.m., the initial log indicated that the patient was a 52-year-old conscious female, sick, breathing, with no priority symptoms.

  Mike Hunter said, “When I initially made that call, I said she had labored breathing and she wasn't coherent. I said she won't answer me. How could that not be an emergency?”

  Despite the initial characterization, three minutes later at 9:27, the call type was reopened as “type e,” indicating a higher priority.

  Crocker said even if Lee Fire Rescue had sent an ambulance, it likely would not have made it there before Rachel Worster Hunter died, noting that the dispatch logs indicated she was already dead at 10:01 a.m. and that she had a “do not resuscitate” order.

  Mike Hunter said such justifications are inexcusable as nobody knew at the time whether Rachel Worster Hunter would die, or that she had a DNR order. Hunter also said his wife did not die until 10:15 a.m.

  When dispatch called Mike Hunter at 9:51 to tell him G&H Ambulance was on its way, but might take an hour to get there, Hunter said he despaired to them, “I don't think she's going to make it.”

  Hunter said he doesn't know why his comment of desperation was interpreted by dispatch to mean that Rachel Worster Hunter had already died, and that agencies were already being advised of her death at 10:01 a.m.

  According to Google Maps, a trip from Lee Fire Rescue to the Hunters' address would have taken 29 minutes in a non-emergency vehicle.

  Lincoln Town Manager Richard Bronson echoed Crocker's perspective that agencies are justified in not sending emergency technicians to towns that don't pay for the service.

  “These towns that don't want to pay, why should the taxpayers of Lincoln need to pay to send ambulances to other towns?” he asked.

  Bronson recounted as an example, a time when Winn stopped contracting for services with Lincoln, saying, “We let a few houses in Winn burn down before they came around.”

  “People don't want to understand or recognize that these things cost money,” he added. “It all costs money and these little towns don't want to pay.”

  Bronson said the duty officers at Lincoln Fire Department are trained “not to go” to areas not contracted with Lincoln.

  “Their inclination is to go,” he said. “It takes a lot of courage for them not to go.”

  “We'll set a deal with these places and go, but they need to come aboard and join us,” Bronson added. “There comes a time when the town fathers, councilors, selectmen say, 'It's costing us money, we can't charge our taxpayers for services to other places', and then, when do you finally have the courage to stick to it? There will always be taxpayers.”

  Bronson added, “We don't know if we had gone (to Macwahoc), if she would have lived.”

  According to Google Maps, a trip from Lincoln Fire Department to the Hunters' address takes 29 minutes in a non-emergency vehicle.

  State Representative Tracy Quint (R – Hodgdon), whose district includes Macwahoc Plantation, said she left Augusta in the middle of the work week last week to return to her district and meet with Mike Hunter and others in Rachel Worster Hunter's family.

  Quint said, “EMS is in crisis in Maine.”

  Mike Hunter said Quint has been supportive of the family and she is committed to using her role in the Legislature to improve things.

  “I'm trying to get a complete synopsis of what happened. I've spoken with the family, explained the situation and rules and laws to them,” said Quint. “I have so many emails with so many questions.”

  On Jan. 10, Governor Janet Mills (D) released her budget proposal, which includes a 6 percent tax on private ambulance services and a similar tax on pharmaceutical drugs, included in the same category as taxes on tobacco and alcohol.

  “She's trying to generate new revenue streams,” said Quint.

  With EMS services already strapped for funds and resources, Quint said Mills' tax proposal is “tone deaf.”

  State Representative Mathew McIntyre (R – Lowell), a freshman legislator who has been a consistent supporter of Central Maine Highlands Fire & EMS District #1 since its inception a year ago, said the state needs to make budgetary priorities that delineate the “wants” from the “needs.”

  “Money makes the world go round. Government cannot legislate morality,” McIntyre said. “I will never sit in a position of judgment of a command structure with limited resources – they have tough decisions to make.”

  “Imagine a small department that has limited resources,” McIntyre said. “A call comes in from a town they don't have (contract with) and now they're 30 minutes out of town. Now somebody calls from the town that they do have contracted services with – what do they do?

  “It's emotionally driven but at the same time, there are business aspects,” he added.

  Bronson and Crocker both suggested there is some blame to be attributed for the tragedy and it belongs with Macwahoc Plantation for refusing to contract with an agency for services.

  Macwahoc Plantation Assessor Sarah Thornton was contacted and asked about the plantation's coverage. Thornton answered that she didn't have time to discuss the matter. When asked when would be a good time to talk about it, Thornton hung up the phone.

  Through a Freedom of Access Act request, documents were obtained from East Millinocket Fire Department regarding the department's effort to reach a coverage agreement with Macwahoc.

  According to East Millinocket's fire chief, Kevin McAdam, phone communication was initiated in April, 2024. In a letter dated May 9, 2024, McAdam, then a newly appointed chief, wrote to Macwahoc Plantation Assessor Roger Pratt, “As you know, the East Millinocket Ambulance has serviced your town for EMS calls for some time now. ... To cover the ambulance service for liability purposes, we are required to have a contract in place with all areas we cover for medical calls.”

  McAdam noted in the letter that East Millinocket had responded to an average of 4.7 calls per year since 2017, and requested to reach agreement before July 1, 2024.

  McAdam informed that Pratt visited the East Millinocket Fire Department in July, 2024, after receiving the May letter. McAdam then sent Pratt a followup letter dated July 17, 2024, along with a contract proposal.

  In the July 17 letter, McAdam wrote, “The average cost of a contract for ambulance service is approximately $100 per capita. Your community has a population of approximately 62 people for a cost of $6,200 per year contract fee. With a call volume of only 3 to 10 EMS runs per year on average, I feel this is an unfair amount for us to start off with on short notice. I feel that a contract fee of $1,600 for a one-year contract is a fair amount for us to request. According to Maine EMS, Macwahoc is not in East Millinocket's coverage area but in Lincoln Ambulance's coverage area instead. Feel free to reach out to Lincoln Ambulance or Lee Fire Ambulance for comparison costs.”

  On Nov. 13, McAdam sent a letter addressed to Macwahoc Plantation's “Board of Selectmen,” stating that he had spoken face to face with Pratt in July and “he advised me the Plantation of Macwahoc will not be signing a contract for ambulance service because you will not be held liable for someone's ambulance bill. …

  “To date there has been zero respondence from you regarding this matter. After careful consideration … because you refuse to sign a contract of service, I regret to inform you that effective immediately the East Millinocket Ambulance will not be responding to medical calls in the Plantation of Macwahoc. I have spoken with Maine EMS on the matter, and they informed me that Macwahoc is not in East Millinocket's coverage area, and we have no obligation to respond to calls there. You are technically in Lincoln's coverage area and should contact them to get EMS coverage when needed. … the reality is that our ambulance responding to calls outside of East Millinocket cannot come at the expense of the taxpayers of East Millinocket.”

  When Nicole Lee, Rachel Worster Hunter's sister, was informed that Macwahoc Plantation had declined an offer from East Millinocket, she became markedly upset and with tears interrupting her ability to speak, cried, “So it sounds to me like a person's life isn't worth $1,600?”

  After collecting herself, Lee said, “That's a slap in the face. Yeah, I think somebody needs to be held responsible.”

  Holly Worster said Mike and Rachel Hunter would have had no reason to believe that there was no ambulance coverage in Macwahoc, because her sister-in-law had needed an ambulance in November, and one had arrived at her home.

  Worster said she is the tax collector and treasurer for Carroll Plantation and when three assessors there got notice that Lincoln and Lee would not provide service without a contract, they quickly brought the matter to the town voters to decide.

  The residents of Carroll Plantation chose between a $15,000 contract with Lincoln or a $12,000 contract with Lee, and ultimately went with Lee, not only because it was less costly but also because Lee would have a 15-minute shorter response time.

  “So we had to pull things together and bring it to a town – you know – bring it to a special town meeting and get a vote on it.”

  Like Worster, Nicole Lee said when she worked for the town of Springfield, they too had to decide between a contract with Lee or Lincoln.

  “Just from talking with those fire departments, what I got is, if there's no contract signed, then they don't have to go,” Lee said. “That's pretty much out of their mouth – if they want to go, they will; if they don't, they won't.”

  Lee said Macwahoc is primarily composed of older people who would more likely need emergency responses.

  “It sounds to me like none of them are aware that they don't have coverage,” she said. “If you're in a town and you're unaware of whether you have coverage or not, ask your selectmen or town assessors and find out.”

  Mike Hunter said if he knew how much of an issue money was to the agencies that refused to respond, he would have told the dispatcher to announce on the scanners that he needed help and could pay for it.

  Nicole Lee said of her sister, “Rachel had health insurance. They would have gotten paid whatever they submitted for a transport bill or whatever. Yeah, but that didn't matter, evidently – they all just flat out refused.”

  G&H Ambulance, the agency that did respond to Hunter's call, was contacted to ask, when so many agencies say, “we can't,” how G&H is able to say, “we can.”

  G&H Ambulance Deputy Chief Milissa Smart, said, “It's about right and wrong for us. We obviously are contracted with the town of Hudson.”

  “Our philosophy is we go to it. If we're toned to another town and we have a truck available and staffing to cover that truck, then we're gonna go. It's not about ego, it's not about who likes who, it's not about if we're gonna get paid for that call or not.”

  Smart said G&H Ambulance is a “small sustaining private not for profit 501c3” that got its start in the 1970s.

  Like other agencies, Smart said G&H is understaffed, with one medic, one advanced, five EMTs and five drivers, and currently, the agency is down to only one truck.

  “Even if (a call) took our truck out of service (from the local coverage area), we still would go,” Smart said. “Residents already move around.”

  Smart said that hoarding tax dollars in municipal borders is meaningless because not all patients helped in a coverage area are residents of that coverage area, and if they answer a call out of town, “How do we know that's not one of our own residents we're helping?”

  “If people want to say, 'Our tax dollars are expected to be in town,' are you asking them for a copy of their tax bill to make sure their name is on it every time you respond to a call? It's about doing what's right and wrong,” Smart advised.

  Smart said her agency has answered calls well beyond their locality – including Dexter, Dover-Foxcroft, Lagrange and Lakeview, and now, Macwahoc.

  Smart agreed with others who said EMS is struggling in the state, and offered solutions to make things better.

  “When it comes to budgeting, the state needs to look at manufacturers to make sure they're not grossly overpricing things,” she said.

  When it comes to responding to calls, Smart said there needs to be more statewide integration of services.

  “Everyone needs to work together, it's just, we shouldn't pick and choose,” she said. “We need to work together. We need to understand that we're potentially going to go out of our towns, right?”

  Smart said the state could set up a system with a fund that pays EMS agencies for responses they don't get paid for.

  “There's got to be different things that we can do to figure out the right reasons not to say no,” she said.

  An effort was made to contact all the agencies that declined service to Macwahoc.

  Central Maine Highlands Fire & EMS District #1 Chief Josh McNally wrote by email, “We do not have a contract with Macwahoc for any services, nor do we have a mutual aid contract with any fire or EMS service that covers the area. We also do not have that area listed on our EMS license, so we were unable to respond to the request.” According to Google Maps, a non-emergency vehicle would take 43 minutes to travel from the fire district's station to the Hunters' address.

  Crocker said it is not illegal for an EMS agency to travel outside of its coverage area or to a town it is not contracted with. Smart said all EMS licenses allow medics to work anywhere in the state.

  “If they have a Maine EMS license, then that EMS license covers the entire state,” she said.

  McAdam, of East Millinocket, reported they were “unable to respond due to not having staff available at that time.” According to Google Maps, East Millinocket Fire is 28 minutes away from Hunters' address, in a non-emergency vehicle.

  Houlton Fire Chief Milton Cone told Lincoln News that Houlton Ambulance did not respond because Macwahoc Plantation was “not in our coverage area.” According to Google Maps, a non-emergency vehicle traveling from Houlton Fire Department to the Hunters' address takes 50 minutes.

  Old Town Fire Rescue Chief Kyle Milan told Lincoln News that two other agencies were requested at the same time as Old Town and another agency responded first. “We were canceled before we responded,” he said.

  Answers have not yet been received from the departments in Bangor, Island Falls, Millinocket and Patten, as to why they did not respond. However, logs from the Penobscot Regional Communications Center note that Island Falls, Millinocket and Patten reported that Macwahoc was “out of the coverage area.”

  According to Google Maps, the EMS agencies in Island Falls, Millinocket and Patten are 36-, 39- and 38-minute drives respectively, from the Hunters' address, in a non-emergency vehicle.

  Worster observed the irony that her sister had worked much of her life in the health care field.

  “Rachel was a nurse and at one time, an EMT, I believe on the Lincoln Ambulance back in the 80s or early 90s,” said Worster. “She answered the tone and responded to the call, and when the time came for her to need help, nobody was there. That's the heartbreaking part, you know? She was there for others, but when it was for her – nobody. Nobody answered the call. Except G&H Ambulance, God bless them. … You know what? They are the true heroes.”

  Worster said both she and Mike Hunter have donated to a GoFundMe page that was set up by G&H Ambulance on Jan. 12 to raise $6,000 for vital equipment for the agency. People who would like to donate to the EMS agency in the name of Rachel Worster Hunter, may submit their donation at https://gofund.me/ee302141 .  

  In the meantime, Mike Hunter remains alone in his home to ponder how it could have ever been possible that one tragic hour – in which all the nearest EMS agencies refused to answer his call – would forever upend his life.

Timeline of Macwahoc 911 call

(all times are a.m.)

9:21 – Mike Hunter calls 911

9:23 – Aroostook County Sheriff's Office contacted with medical call

9:25 – Call to 911 completed

9:27 – Call type e reopened, assigned call number 98

9:28 – East Millinocket Ambulance paged

9:28 – Contacted Aroostook to advise that East Millinocket was not available, Aroostook asked to tone Lee

9:28 – Lee Rescue Service paged

9:29 – Lee assigned as responsible unit for call

9:29 – Logged, “Contacted Aroostook to advise Lee not available, asked for the list of who they'd like us to call so we didn't waste time calling back and forth. Aroostook advised to tone Lincoln, Island Falls, Patten, Millinocket.”

9:30 – Lee reports “out of coverage area”

9:30 – Lincoln Ambulance paged

9:30 – Lincoln reports “not in coverage area”

9:31 – Island Falls Ambulance paged

9:32 – Patten Ambulance paged

9:32 – Island Falls reports “out of coverage area call”

9:33 – Patten reports “out of coverage area”

9:33 – Millinocket Ambulance paged

9:34 – Logged, “After toning the departments requested I called Aroostook back to advise them no one was available for the call.”

9:34 – Dispatch calls Hunter to inform him no agency will respond, but dispatch will keep searching

9:35 – Call between dispatch and Hunter ends

9:35 – Logged, “Called Aroostook back advised CP had called back in to say patient now had significant difficulty breathing.”

9:38 – Millinocket reports “out of coverage area”

9:40 – Call type e reopened, assigned call number 104

9:41 – Following agencies requested and did not respond: East Millinocket, Island Falls, Lee, Lincoln, Millinocket and Patten

9:46 – Houlton Police called Houlton Fire Chief Cone, who stated, “No, they (Macwahoc) do not contract with Houlton.”

9:47 – Howland Ambulance paged

9:50 – Tones for Old Town, Hudson (G&H) and Milford transmitted

9:50 – Shift Officer at Milford indicated to PRCC that they would get back momentarily about ability to respond. Shift officer contacts Milford Fire chief for guidance.

9:51 – Dispatch calls Hunter to let him know Hudson agreed to go. Hunter tells dispatch, “I don't think she is going to make it.”

9:51 – Milford Fire Chief Zack Carlow indicates support to shift officer to respond to call

9:52 – G&H Ambulance paged

9:54 – G&H called and said they were willing to go and would be enroute momentarily

9:55 – Milford shift officer radios PRCC to confirm Milford will accept call, PRCC informs another ambulance has accepted call

9:56 – G&H assigned as responsible unit

9:59 – Aroostook County Sheriff's Office attempts to reach Bangor Fire and MedComm in Bangor, explores agencies in Piscataquis County

9:59 – Call from dispatch to Hunter that was initiated at 9:51, ends

9:59 – Dispatch logs, “Contact was made with CP to notify him that the town had no EMS contract and we were trying to locate any medical agency able to go to this call. At this time the CP advised that the female patient had passed away and a DNR was in place.”

10:01 – “ACSO advised that the pt was now believed to be deceased and that we would be calling DPS Houlton for a response from a Trooper, Troop F dispatcher was breifed on all information regarding and where their ambulance was coming from.”

10:03 – G&H enroute to call

10:06 – Advised Old Town Fire to disregard call

10:15 – Rachel Hunter takes her last breath

10:30 (approximate) – G&H Ambulance and Howland Trooper arrive

*This article was first published in a different form in the Lincoln News, Jan. 16, 2025