Should the city of Ceres take the lead of other cities and begin charging people when a fire truck rolls to a medical emergency, such as for difficulty breathing, heart attacks or car accidents? What should that fee be? Would insurance companies pay the bill for first responder service? Would the move help solve Ceres' budget problems?
Those are all big questions which the city has the option of exploring as a remedy to budget deficit problems now - and in future years which are projected to be awash with more red ink if nothing is done.
"I would expect that this will be something that we will be exploring in the coming year and Modesto is already starting down a similar path," said Ceres City Manager Toby Wells.
"It'll be something we will consider, definitely," said Mayor Chris Vierra who for years has also been mulling of changing how the city provides EMS service. He said it doesn't make much sense to place wear and tear on a $1 million fire truck every time it responds to a medical aid call.
"Perhaps we're better served if we come up with a small mobile van type unit that is responding to those calls. Yes, either charging for that service or providing the service in a different way that doesn't abuse the million dollar pieces of equipment that we have that really needs to be sent to a structure fire not necessarily at EMS type call."
Vierra said the city's budget problems doesn't consider a lease payment for a $1.5 to $2 million fire engine "because the one we have, I'm being told, is tired and in the time it goes out it needs to come back in and be worked on. We have quite a bit of labor in the auto shop working on that that. So if we can limit its use maybe we prolong its life."
Since 2012 the city of Folsom began charging $225 to help defray the cost of providing emergency care by highly trained paramedics on fire engine and truck companies.
Long Beach (population 462,257) began implementing a $250 fee last year to generate an expected $1.8 million in revenue.
Sacramento Metro Fire currently charges $275 for medical aid calls.
The city of Murrieta charges $350 when a fire truck rolls to an EMS call but offers a subscription program of $48 per year to cover EMS service.
In 2014 the Cosumnes Fire Department mulled a $143 charge for every 911 call that ends in city fire engine paramedic services.
In 2010 the Tracy City Council shelved plans to charge a $300 first responder fee after the citizens there implemented a half-cent sales tax. Ceres already passed Measure H but still faces significant revenue shortfalls, blaming the problem on a sluggish growth in commercial transactions which produce sales tax income.
While health insurance almost always covers ambulance rides, it doesn't always pick up EMS fees. California's MediCaid program doesn't cover them at all.
"My understanding is that the recovery rate from the insurance companies is not very high," said Wells.
During the 2015 calendar year Ceres Fire Department responded to 463 fire calls, but 3,828 EMS calls. The department attended to 191 false calls, 78 hazardous waste spills, 639 "good intent" calls and 311 service calls.
Hypothetically speaking a $250 EMS charge could result in $957,000 worth of bills generated by Ceres Fire. If paid, that would plug the budget deficit for Ceres.
Opponents of such fees say it impacts the poor and could keep people from calling for help when they need it.
Fire Chief Bryan Nicholes was contacted for a comment but did not return a phone call.
Vierra remains hopeful that the tax base of Ceres will improve with the resolution of the Mitchell Ranch Shopping Center case. A group calling itself Citizens for Ceres has sought the project but the matter is in a Fifth District Court of Appeals courtroom this week. If approved the shopping center could be constructed by 2018 to produce an additional $500,000 to $1 million in tax revenue per year.