HomeMy WebLinkAbout2007 02-13 Pre
Meridian City Pre-Council Meetina
February 13. 2007
The Meridian City Pre-Council meeting was called to order at 6:00 P.M. on
Tuesday, February 13, 2007 by President Councilman Joe Borton.
Members Present: Mayor Tammy de Weerd, Keith Bird, David Zaremba, Charlie
Rountree and Joe Borton.
Staff Present: Ted Baird, Bob Stowe, Ron Anderson, Bill Johnson, Joe Silva and
Will Berg.
Item 1.
Roll-call Attendance:
Roll call.
X David Zaremba X Joe Borton
X Charlie Rountree X Keith Bird
X Mayor Tammy de Weerd (arrived at 6:04)
Item 2.
Adoption of the Agenda:
Bird: Mr. President.
Borton: Mr. Bird.
Bird: I move we adopt the agenda as published.
Rountree: Second.
Borton: It has been and seconded to adopt the agenda as published. All those
in favor say aye.
ALL AYES. MOTION CARRIED.
Item 3.
Presentation Concerning Ambulance Services Options:
Borton: Item No. 3 is a presentation, informational meeting concerning the
ambulance service options. We have had some dialogue with Ada County
concerning the recently adopted ambulance service ordinance and this Council is
extremely interested in becoming more educated in the options that we have got
available to us and how to best provide those services to our citizens. So, we will
start the presentation with Chief Anderson and then I believe Carl Vogt is here as
well to follow up with any additional questions.
Anderson: Thank you Mr. President and Madame Mayor and Council. I would
like to start off with kind of refreshing your memory about some of the events
leading up to tonight and then I am going to have Deputy Chief Niemeyer give a
presentation on one option for ambulance services just before Mr. Vogt gives his
presentation, but if I could kind of draw your attention to the screen up here, I
would like to take you back a little bit. About three years ago, this Council, some
of you were on the Council and some of you were not at the time, but this Council
decided that they wanted the Fire Department to upgrade their EMS service from
basic life support, BLS, to advanced life support, otherwise known as ALS and
the reason, I think that the Council and the Mayor decided that at the time was
because of lack of responsiveness and I guess inadequate coverage what we felt
was occurring from Ada County EMS and at the time there was not an
ambulance that was stationed in Meridian and response times were increasing
because of traffic conditions and also with population, the demand for service
was going up. So, I think that is probably what prompted the Mayor and Council
at the time to make the decision that they did with one another and find out
whether that was confirmed whether that was your reasons. But, in April of 2005
the city hired a new Fire Chief, which ended up being me and part of my specific
marching orders when I got here was that they wanted to make sure that as the
new Fire Chief that I kept the radar scope open and that we headed down the
road to get our ALS license. So, in December of 2005 we actually were granted
an ALS 5 license from the EMS Bureau, which is an advanced life support, non-
transport license. Now, as we got that license and we put our paramedics on the
fire engines, we starting operating our ALS engines. Things seem to be working
fairly well and at the time we were applying for our license, we were assured by
the County EMS Director that they had no intention of throwing obstacles in front
of us and they had planned on working hand in hand with us in the delivery of
emergency medical services throughout the county. The only real hiccoughs that
we had along the road in the first year of operation was an occasional, I guess,
disagreement about treatment that should go on out in the field between our
paramedics and their paramedics at times and a few personality conflicts that
were going on, but in late November of last year we learned that Ada County had
been working on a new EMS ordinance and this EMS ordinance and this EMS
ordinance took considerable leeway and control of all matters of EMS infringing
severely on the rights of cities and fire districts to even control their own destiny
and their own employees and write their own policies and hiring and testing and
re-certifications and those kind of things. So, as that ordinance came about there
was considerable opposition that we went and testified in front of the County
Commissioners, raised a number of legal issues as well as functional issues
about how this ordinance would operate and it seemed like this ordinance was on
a fast track and it did pass very rapidly under considerable opposition and the
ordinance went into effect on January 1, 2007. Along with that, as soon as the
ordinance was passed Ada County filed suit against Kuna Fire District and said
that they were duplicating service and it is now heading to court to I guess to test
the legality of the ordinance in regards to Kuna and their ability to operate an
ambulance service. Well, both Meridian and the City of Boise tried to meet with
the individual commissioners and to talk to them and try to understand what the
pressing reasons were, why they felt like they needed to pass this ordinance and
basically got the same answer and that was we just need to standardized the
level of care throughout the county while Mayor De Weerd asked the question is
there something broke? If there is not something broke what are trying to fix?
And I don't think they answered very well that there was anything broke with the
system. So, both Meridian and Boise then sent formal letters to the County
Commissioners after the new commissioner was in office and asked the County
Commissioners if they would consider resending their ordinance and to sit down
with the fire officials and the folks that provide the EMS service along with their
county ambulance service to work on an ordinance that would work for
everybody and you know have received, I guess, the answer from Ada County
and the answer was I guess kind of a polite no we are not interested in
rescinding our ordinance and they did state in their ordinance though that until
such time that the court has rendered its decision in the Kuna case, Ada County
will not consider any changes to the ordinance, but I would like to point out to you
that even if a court does render a decision in the Kuna case, the circumstances
that surround the Kuna case are considerable different than the circumstances
that involve Meridian and Boise and our paramedics that operate on our engine
and the issues that we have with them, so I don't know that sitting around waiting
for an answer from a court on the Kuna decision is necessarily what we would
like to do. So, what we have done tonight is we have prepared, I guess, some
options that we would like you to take a look at, mull over; we are not asking for a
decision tonight, we simply want to heighten your awareness, make you aware
that you do have some options out there and so with that I am going to turn this
over to Deputy Chief Niemeyer to kind of go over a little bit about what some of
those options are and we will go from there.
Niemeyer: Chief Anderson, thank you. Madame Mayor and Members of the
Council as we continue through this, what we want to do first was highlight some
of the key questions that we asked and some of those answers and relay what
we still think is a problem that will affect or is affecting our responders out in the
field. The first question was if Ada County's EMS medical director is the sole
dissenting voice on an issue, does he or she still have the final say so? The
answer that we got was in quote technically that could happen, but seems
unrealistic, but essentially yes, our medical director does have the final authority
in any veto vote on that. The problem with that is that this potentially takes away
any opinion our medical director that we have hired through the Meridian Fire
Department, Dr. Mike Ross, might have on any medical issue or protocol. To
address this further in Canyon County they are under similar circumstance,
however, the Canyon County EMS Medical Director and the Nampa Fire
Department Medical Director do not get along and see eye to eye and there is a
lot of tension that exists within that group. We do not want to see that happen
here with the Meridian Fire Department. Question number two: Is Meridian Fire
Department required to adhere to Ada County EMS testing criteria for
paramedics? The answer was to paraphrase, additional testing is needed to
ensure that every medic meets the local standard. That being Ada County EMS
standard. The problem with that is that this takes control of testing away from the
employer and mandates a test, which has not been validated or adopted by us as
a Meridian Fire Department. In addition, this is a duplication of testing and
certification that is already done at the state level. The third question: Why does
Ada County EMS want to control dispatch request for a medical helicopter and
the answer that we got was because in quote, EMS supervisor coordinates all of
the EMS activities with the hospitals and flight programs, end quote. The
problem with this is that when our providers get on scene of a critical accident,
we expect them to recognize the need for air transport, which speeds the
response to the hospital and that is the best patient care possible to get them to
the trauma center as quickly as possible. By having us go through an EMS
supervisor that is a layered communication and it is going to result in a delay of
that helicopter getting in the air. It also goes against the principles of (inaudible)
command, which we all practice which essentially states that the person that is
on scene is the one that makes the decision and then those decisions can
change when a person of higher authority gets on scene. It is worth noting there
that in talking to Life Flight, they do not support this part of the ordinance; they
want a helicopter in the air as quickly as possible when somebody recognizes the
need for that. That could be a Sheriff's Deputy, a City Police Officer, and a first
responder from the Fire Department or anybody else. The next question: Why
does the county feel their scope of practice standards needs to be imposed on
other agencies? And again the answer was Ada County EMS has established
medical standards and has safe guards in place to prevent substandard
paramedics from practicing. We agree and we have tried to promote that
standardization should be achieved, but it should be done through consensus
with the entire group getting together in a democratic fashion and not by
dictatorship, one agency telling everybody else what they should or should not
do. The next two questions are directly affecting the responders currently and in
the future as it relates to incident scenes and the way that those are managed.
The first question is: If Meridian Fire Department has been on scene for a long
period of time does the transport medic immediately assume control? The
answer was yes the transport medic will assume control end quote by policies
that have been established and those policies have been established by Ada
County as well. The problem with that is that if one of our medics has been on
scene for a long period of time, they have built up a rapport and a trust with that
patient. Whenever you do medicine, whether it is pre-hospital or in the hospital,
part of good patient care is developing a trust with the patient so that they trust
you to make the right decisions. If our medics have developed that trust and that
rapport and have done a treatment course, which is something that based on
what we see and what we find, we develop a treatment course for that patient.
Then the Ada County medic arrives on location and immediately assumes control
of the scene or command of that patient; that could break that trust factor that
has been developed over for a long period of time with our medics. As well as
that that treatment course could be altered by the medic coming in who may say I
am going to give this drug, I am going to go down this path and that could have
potentially negative outcome for the patient. The one question that we found
interesting that was missing from their answers or their response back to us was
if a senior Meridian Fire Department paramedic disagrees with a decision of a
less senior Ada County paramedic, does the less senior medic still have overall
medical authority? The answer was we didn't get one and to relay this or to give
an example of this, last week I had a complaint in my office from one of our
crews, they arrived on location of a t-bone accident, which is if you could envision
this type of accident - a car comes into the driver's door of another car. It was a
significant impact, about a foot and a half of intrusion, which is significant in our
world and per the protocol that we all abide by that patient should have received
a c-collar and a backboard as spinal precautions. We cannot tell if they have an
injury to their spinal column and so we put them in a c-collar and a backboard.
As our guys were going to get the tools to pop the door open so we could have
access to the patient the Ada County medic had the patient crawl through the
car, walk over to the gurney and sit down and they took off to the hospital. Right
now we have no way of saying that needs to stop. That is not good patient care.
So, they were very distraught over what can we do next time this happens? The
other problem that we see is that as more and more Ada County paramedics are
moving to the fire service and this is a reality right now. This is happening. Ada
County has to replenish that staff and typically that staff is replenished with
newer medics out of school and so part of our concern with this is that if we have
a 15 year paramedic that actually worked for Ada County at one time that says
we need to go down this treatment path, but that brand new paramedic from Ada
County says no I am going down this path, we really have no other options. It is
also worth noting that that is contradictory having personal knowledge of this to
their own internal medical seniority policy which states if a senior medic on an
ambulance disagrees with the other medic on that same ambulance then he or
she will have the ultimate medical authority on call if there is a disagreement that
does exist. So, looking at some of the realities from the field today, tensions are
rising a bit as our paramedics have less and less ability to do the right thing for
the patient and that car wreck is a pretty prime example of the frustration that
some of them are feeling when they know what the right thing to do is, but they
are not able to do it. Also when both agencies are on scene, more experienced
fire and paramedics are not giving the authority to make critical life saving
decisions regarding patient care. Again that falls back to part of the ordinance
that states Ada County will have the ultimate authority when they arrive on
location. Our paramedics are not always able to perform at their full potential
resulting in a three to five minute medic and I will explain that a little bit. When
we arrive on location, typically but not always, the ambulance is somewhere in
the neighborhood of three to five minutes behind us. Many of the medics that
walk in immediately assume control. I will preface that with saying that there are
some Ada County paramedics that walk in and allow our guys to continue to do
the job. They allow them to continue the examination, the questioning and the
treatment choices. But, oftentimes when the Ada County folks walk in they
immediately take command of the scene and assume patient control and kind of
push our guys off to the side. So, essentially this is resulting in a three to five
minute medic, meaning that our guys are with the patient for three to five minutes
and then somebody else comes in and takes over. Even though training through
our Fire Department addresses skills evaluations, cognitive learning, nothing can
replace actual patient care time to create an experienced highly qualified
paramedic, meaning that the longer that you spend with a patient the more times
you do it, you build up that knowledge base by hands on experience with those
patients to where when you walk in, you can pick out right away what is going on
and that comes through those patient contact hours. Currently, Ada County has
two ambulances stationed in the Meridian area; however, they are not specifically
dedicated to Meridian. They also respond to Star, Eagle, Kuna, the western
aspects of Boise. They also can get tied into standby services throughout the
spring and summer as the Meridian Speedway is going on, they do send units
over there. If that can't get that filled with folks coming in off of duty they do send
on duty folks over to those events to standby. So, they are taking those units out
of the 9-1-1 response system and going over to standby events. Currently what
we have is Ada County is not meeting the national standards that have been
established for the employment emergency medical response. The next slide -
these are the standards that everybody follows, it is NFPA 1710 and it is
standards for deployment of emergency medical operations. The first of which is
BLS first response with an AED, so be deployed to provide for the arrival within a
four minute response time 90 percent of the time; the second is the ALS provider,
should be deployed to provide for the arrival within an eight minute response time
90 percent of the time. Those standards also add - you will see the note down
there at the bottom. They had a one minute turnout time for the crew to
acknowledge the alarm and get to the apparatus. So, essentially what we are
talking about is a five minute response 90 percent of the time and then a nine
minute response 90 percent of the time when you add that one minute in there.
What this shows is our current response times - these are for 2006, they were
taken out of our fire house database. Those numbers come directly from CAD
through dispatch. So, as you can see in the BLS response in less than five
minutes, we are achieving that 91.15 percent of the time. In an ALS response at
nine minutes we are achieving that 99.55 percent of the time and that is district
wide. Those aren't just city numbers, not just rural numbers that is both
combined. The Ada County EMS numbers we had to take off of their 2005, 2006
annual report. That is the only numbers that we have access to until they put out
a new report that shows any change in those numbers - through that report their
ALS response nine minutes or less was 81.7 percent of the time. So you can
see that we are significantly faster getting to the scene both at the BLS level at
the five minute level and the ALS level at the nine minute level. So, looking at
our options, we do have more than one. Option one would be Ada County EMS
continues providing transport for the Meridian Fire Department. Option number
two would be to contract all EMS transport, both ALS and BLS to a private
provider. Option number three would be Meridian Fire Department to assume all
responsibility for all the EMS transport. Option number four is a mix of private
provider transport and Meridian Fire Department ALS personnel. Looking at
option number one our concerns about the future if we maintain the status quo,
first and foremost patient care of our citizens will suffer as tensions continue to
rise and a lack of true teamwork and professional courtesy exist. This is
something that I think that we can expect is teamwork and professional courtesy
and if that isn't happening those tensions are going to remain. Also, if we cannot
find other hands on sources for EMS training which we are evaluating; for
example, hospital ER rotations, hospital OR rotations, our paramedics will
continue to lack extensive or prolonged patient care hours. As we talked about
earlier that is what develops that experienced, highly qualified paramedic in
seeing those patients. Option number two is to contract all of the ambulance
services to a private provider. This would entail the private provider having both
BLS and ALS personnel on that ambulance and again the potential still exists for
those medical issue disagreements and who has the authority to make the right
decision. Also cities throughout the nation that use this option pay a specified
amount through a contract negotiation to that private provider for their service
and then in addition that private provider has the option to buy their billing
insurance companies, Medicare and Medicaid or the patient. Option number
three would be for the Meridian Fire Department to assume full responsibility of
all EMS transport, both BLS and ALS. The benefits of this option is that this
option does give Meridian Fire Department complete control over all EMS issues
within the city and the district. Ambulances are owned by the city and can be
deployed where needed. The downsides are increased administrative duties
required for the additional staffing; the initial startup costs is very significant and
an increase startup costs means an ongoing increased annual cost to the
department. Here what we did is highlighted the major points of the startup
costs, the ambulance costs, the personnel costs and you can see at the bottom
that it is roughly $1.458 million. Then the second slide here is the major annual
expenses and again these two slides do not hit on all the other required things to
start up and maintain an ambulance service - equipment costs, etc. These are
just the major points. So, an ongoing cost annually of about a $1 ,000,055.
Option number four would be the public private partnership. We think that there
are many benefits to this kind of development. One being the focus is on patient
care, not on personalities or politics; no medical disagreement exists - as
Meridian Fire Department would be the sole provider of ALS care. What that
means is that a private ambulance service could provide you with the transport
capability and basic EMT's. They would utilize our paramedics on scene for
those advanced calls. If for example, it is a BLS call or a basic call, our
paramedics could stay in service and that patient would go with the private
provider transport in a BLS environment. The other benefit is that Meridian
would have dedicated ambulances and service at all times. There is one
downside that we can see and that is private company stability as with any
private business, certain things can happen. Death in the family of the
ownership, financial difficulties, whatever those things are that arise, so there is
that question of overall stability long term. At this point unless you have any
questions, I would like to present Carl Vogt. He is the president of NPA
Northwest Paramedic Association to give a presentation to you.
Borton: Council any questions?
Bird: I have none.
Rountree: Mr. President.
Borton: Mr. Rountree.
Rountree: You mentioned in your discussion on option three that this would
provide coverage for both the city and the district. Now I believe there is some
questions still remaining as to the status of the district and anything we would
contract to do. Just to make that point that we are still kind of in a gray area
there in all our discussion. Hopefully we will get that resolved soon.
Niemeyer: Duly noted.
Borton: One question that comes up it is somewhat (inaudible--) and pose to you
or Mr. Vogt is the business end of it. Do you have rough round numbers of the
economic impact given to the county or the city as far as revenues, lost revenues
-an example is if the option if the city were to provide all ALS services what type
of revenue could be generated to offset some of those expenses or conversely
what kind of revenue is the county afraid to lose perhaps?
Niemeyer: Councilman Borton, I don't know if I can answer that completely.
think we could do a break down of revenue generation. It would be a
guesstimate on our part. Revenue that the county may lose would be the tax
dollars that they pay that I think you all are aware of and then the billing for any
calls that happen within the city and what those numbers are I don't have.
Borton: Okay, thank you very much. We will turn it over to Mr. Vogt to further
educate us of some of these options.
Vogt: Madame Mayor, Members of the Council my name is Carl Vogt. I live at
1404 Clear Creek in Boise, ID. Several months ago I received a phone call from
Chief Anderson and we've had some interaction over the years in EMS and he
asked me if I would be willing to have an informal discussion with his fire
commissioners on some of the various options that were available for the
delivery of EMS in the Fire District and after initially not really wanting to go out
there and sell my company he convinced me that probably the providers that
were in the industry were probably maybe a good source of information and I told
him that I would be willing to do that and after I made that presentation it got a
little bit more formal. So, I appreciate a couple of the familiar faces here.
Anyway, as I said my name is Carl Vogt. I am President of Northwest Paramedic
Associates. A couple of disclaimers - disclaimer one is that I am employed by
the State of Idaho, opposite the Attorney General. I am lead counsel for the
Idaho Transportation Department and anything - I don't expect to answer any
legal questions, but to the extent that those come up they are my personal
opinion and not Lawrence's or the State's or the Departments. Disclaimer
number two is I am a private ambulance provider. We have been in business for
ten years. So, I bring with me, I guess, certain biases. I think I will try to temper
those and if I don't, please I apologize in advance. As I said NPA has been in
this Valley for about 11 years. We provide services at a variety of different
venues and a variety of different settings. We have been behind the Buck 'n
Shoots Snake River Stampede. We do standbys for any concert that happens in
town. We are at the sidelines of every BSU football game; in the stands at the
BSU basketball games; we are the contracted provider for the Boise School
Systems; Optimist Football; it goes on and on; La Bois Park; virtually every
venue in the county at some point or another in the past ten or eleven years and
we have probably provided EMS services. About seven years ago, we competed
and were awarded the contract to provide EMS services for Elmore County and
we have held that contract through I think the fourth contract negotiation now.
So, we have done this albeit not in this Valley, but in a similar system in terms of
volume; a little bit dissimilar in terms of size. So, we have been around for a
while and we like I say provide a variety of different EMS services. Over the
years I was invited by Mike Roberts to participate in his adhoc committee, where
Ada County first, at least as far as I recall in my history, first attempted to address
some of the problems that they foresaw in the state statute. There also has
been, obviously several tasks force that you are all aware of that have talked
about EMS in this Valley for many years, several years. So, let's talk about
system options. Obviously the Chief and Deputy Chief talked to you about a few
of them, internal and external within the Fire Department and really what I want
to concentrate on is what I believe is a growing trend in EMS system delivery,
which is a public private partnership and I want to talk to you a little bit about that.
Before I do that, I want to say a couple more things. First of all I want to thank
the Chief as well as your auditor, as well as some folks from Ada County
Paramedics with providing me with a whole bunch of information to put this
presentation together. I think most of it is very current. Some of it I have had to
kind of generalize a little bit. So, it may not be specifically up to date, but I think it
serves the purpose of what we are trying to do here and provide this Council
some more information. All right - so, what do you need out of an EMS system?
You want it to be efficient. You want it to be effective. You want it to economical.
All of those things are important to providing the system of EMS delivery. You
want the best system that money can buy, given the resources that you have
available. This is a map of your district. It is interesting that if you place a map of
Elmore County over that it kind of looks similar. The only difference is the
Interstate would be substituted with the Snake River and obviously your 75 miles
of district is a little bit different than my 2,200 miles of county down there. Your
call volume is about 2,600. It has been growing steadily over the past few years
as you know. The breakdown between BLS and ALS and other is BLS, basic life
support; ALS, advanced life support. You need medics to perform those services
and then other is anything from refused transport, false call, anything in between,
couldn't find the patient. There is a lot of those. Pretty traditional, pretty typical
breakdown as far as numbers. About two thirds of your call volume is going to
be BLS. One third is going to be ALS and one third is going to be something
else. Once again this is your annual call volume in terms of time of day. You run
these numbers not to really show anything, but you run them to eliminate
anomalies and there is nothing abnormal about the breakdown of EMS calls in
the Meridian City as well as the District. The majority of your calls obviously
come in that time period that is not the middle of the night and that is fairly
typical. This is a colored chart of the District with the concentrations of call
volumes that the District and the city experiences; obviously the purple, the more
urban settings get the majority of your calls and as you spread out to the rural
settings, those calls per month decrease significantly. Ada County's call volume.
Once again has increased significantly over the past several years. The
interesting part of this statistic is while Ada County's volume has gone up 30 or
40 percent over the last six years; Meridian's percentage of that call volume has
only gone up three percent. So, it is real clear that Ada County is being stretched
to facilitate their needs and they obviously attempted as best they can to serve
their constituents as best they can. As Deputy Chief Niemeyer said there is two
stations that are dedicated to the Meridian District, but the important statistic with
that is that relatively - well only about 50 percent of the calls from those two
stations that are dedicated to service for Meridian actually are done in the
Meridian District. The other 50 percent of those calls from those two stations are
done outside of Ada County. They are going someplace else. They are either
going downtown or they are doing a transfer or they are calling to cover other
units that are out doing other things. So, there really is not a dedicated presence
to specifically be Meridian District and I think that reflects in some of the statistics
that Deputy Chief Niemeyer showed you. I think their response times, if they had
dedicated ambulances it would certainly improve. So, a real non-bias chart that I
put together of what I think is important to the system and I think both internal
and external ambulance operations can be effective and can be efficient. I think
the real downside is the economic side of things. It is very difficult for a 9-1-1
system that is simply a traditional system to do it without significant government
subsidy and that is just the life of EMS in this country. But, what I think is not
only a challenge, but an opportunity is a public private partnership melding the
advantages of both systems and minimizing the weaknesses of both systems
into a cohesive system that can really deliver EMS in an efficient, effective and
cost effective manner. Even though this is relatively new to the Treasure Valley,
the concept really isn't new to the country. The statistics show over the last 15
years that there has been a steady, steady increase of these types of
partnerships being put together and we see them being utilized more and more
all of the time. So, what are some of the advantages? I am going to try and not
duplicate what Deputy Chief Niemeyer talked about, but I think that there is some
things that we ought to highlight when you talk about a public private partnership
that does not exist in a third service like the Ada County EMS system has.
Obviously you solve your consistent and dedicated transport presence. You
always have under contract by an agreement between the parties, those
dedicated transport units available for yours. You obviously have uniform
medical direction. You don't have any competing agendas at all. You don't need
them. That medical direction is set out by contract. It eliminates what I call a
negotiated best practice. I mean, once again the criteria, the expectations,
everything is simply laid out in writing and everybody agrees to it and everybody
signs off on it upfront, you don't have these phone calls you know can we get a
training class or can we get and hope that maybe they can fit you in. You run
your own system and obviously you establish your own best practices and
probably the most important part of a public private partnership is you establish
performance based expectations whether it be response times or training or a
litany of different criteria that have been implemented across the country to say
what you want and then put it up to the provider to say well we can meet that or
yes we can do that, but or how about this - does this work? And it is all written
out and everybody knows and expects and has the same expectations going in.
Let's talk about efficiency of the system. Probably the number one issue in the
EMS is medicine. Obviously, it is. You need a quality control, quality assurance
system that really, truly. exemplifies what you are trying to do in the delivery of
EMS. It depends on active participation. It depends on sincere collaboration
between all elements of EMS system from the basic first responder up to and
including the emergency room doctor. Everything you do in a public private
partnership highlights that, whether it be system wide training, whether it be
increase familiarity of the people that are responding - you no longer have 100
people that every once in a while have a shift. You have 30 people that are there
everyday. You increase your exposure to the folks in the ER - that
fundamentally really drive the system. I mean we call this the practice of
medicine for a very good reason. If you don't have that interaction with the
doctors, you will lose an element of EMS that you really can't replace. So, every
part of that system is geared toward quality. I think one of the side benefits of a
partnership with a private firm for the delivery of EMS especially with a fire
program is that it exemplifies and highlights your ability to recruit. My company
has always been a training ground. We have literally hundreds of folks that
started as basics and advanced through the paramedic level and over the ten
years that is quite frankly something that I am relatively proud of. But one of the
things that is always a problem is recruitment. There is lots of folks out there that
want to be fire medics, but there is a limited opportunity. You increase the
exposure. You increase the ability for young people to get involved in the
system. You increase your ability to cherry pick those folks that you want to
advance into your system at some later date. Finally, probably a philosophical
reason to do this is that you gain community ownership and that is like I say that
is kind of a feel good type of thing. But it really does matter when your staffing is
standby or when you are participating in a parade or whatever else you gain the
community ownership. Okay let's talk about the taxation issue because that is an
important part of this. Ada County EMS is funded by property taxes. Some of
the statistics I have pulled and it almost seems like it varies weekly on the
medium price of a house in Meridian, but somewhere around I have seen
statistics of around $150,000 to $250,000, somewhere in that range. I don't
know what the medium price is, but bottom line is when you break that down into
the tax levy, the property owners in Meridian pay about $20 a year to Ada County
EMS for them to supply their service. That is mandated by state law. You can't
change that. It is what it is, whether you do your own service; whether you
contract it out; whether you continue to use Ada County; whether you establish a
partnership that $20 a year per household will always go to Ada County EMS
until any of the state law is ever changed. So, the challenge that you have is that
if you choose to do something different, you have to answer the question of why
should we duplicate services? Well, you duplicate services if you can provide a
better system or if you can do it more economically for the citizens. I will tell you
that and now I use NPA information that I am aware of. I don't know other
private providers. I don't know what they would charge or how they would run
their systems, but I know how I do mine. And I can tell you that the start up costs
and the annual costs for a public private partnership based upon what we charge
right now in Elmore County would be zero to the city. It would be zero annual
start up costs, it would be zero annual costs and that is just the way the numbers
work. So, even though you forfeit - well, even though your citizens pay that tax
bill every year to Ada County, there would be no additional costs to either the city
or to the Fire District. However, there would be a reduction in costs to the
citizens because for whatever reason the prices that once again my company
charges for the same types of services Ada County charges is significantly less
and like I say I base the representation on what NPA could do on the numbers
we use right now. So, I asked Mark to construct a variety of different scenarios
that EMS sees on a regular basis and he constructed four different scenarios
from a very minor BLS call up to a very critical care get the hospital now type of
call. We ran those numbers based up what we charge and what Ada County
charges. Now other private providers may be different than this, but it shows you
the difference in the cost to your citizens. Anywhere from $300 to about $600 a
call - if you just want to run through those that is fine, Mark - that you can save
your citizens by establishing some sort of a different system than you have right
now. So even though your citizens do pay Ada County EMS approximately $20
a year for these services, I can tell you that for any of these calls, it would take
about 20 years or so of paying those taxes to make up the difference in just one
ambulance call that your citizens need in some type of a different system. So,
the challenge of duplication of services I believe is answered. I believe you can
establish a better more cohesive system if you explore some of these options
that have been presented to you. I think it is economical for your citizens. It
doesn't cost them any more, in fact it would cost them significantly less, if you
can establish some sort of a private public partnership with a private EMS firm.
That is my presentation. I would be glad to answer any questions that you have.
Borton: Thank you Mr. Vogt.
Bird: Mr. President.
Borton: Mr. Bird.
Bird: Just for public record. Carl there is private public partnership as you
explained it, no cost to the city or our taxpayers extra than what they are already
paying right now?
Vogt: I believe that there are private firms out there that could provide that
service at no cost.
Bird: Okay, thank you.
(Tape turned over)
Zaremba: Mr. President.
Borton: Mr. Zaremba.
Zaremba: Mr. Vogt I have two questions. I am the rookie here, so forgive me if
they are dumb questions. The roughly $20 per household that goes to Ada
County, does a portion of that cover the 9-1-1 service that is necessary
regardless of who responds?
Vogt: As I understand your question, every homeowner in Ada County pays
taxes to support a county-wide EMS service. If the City of Meridian chose to do
something different, for example, do it on their own, the citizens of Meridian
would still pay that tax for the Ada County EMS system, Ada County just would
not be obligated to spend any of the money or respond to Meridian.
Zaremba: Well, I am thinking of the call system. When you call 9-1-1 there has
to be people there to answer it and to dispatch somebody.
Vogt: Okay.
Zaremba: Does some of our $20 per household pay for that or is that a separate
--? Councilman Bird is shaking his head no, so - okay, I was hoping to say that
you still get some worth out of that $20. Let me ask my next question if I may?
Hopefully it won't be as dumb as the last one.
Vogt: Well, I couldn't answer the last one, so it wasn't that dumb.
Zaremba: Councilman Bird - and maybe you are not the right person to ask but
it came to me while you were speaking. Regardless of who is going to do the
transportation of the patient, there is a handoff at some point. If Meridian Fire
Department EMT's responds and determine that transport is needed someplace,
does that emergency medical technician ride in the ambulance with the patient or
do they turn them over to somebody that is already in the ambulance (inaudible)
by your company or whoever is doing the transport?
Vogt: Madame Mayor, Councilmen well that depends on the system. Under the
current system, yes, Meridian responds initially and Ada County has established
what they call a transfer of care policy that says once Ada County is on scene
then they are the medical authority, so to speak and care gets transferred.
Under either of the middle two options, whether you do it internally and hire your
own medicine, buy your ambulances or whether you contract everything out to a
private provider, those conflicts - or that transfer of care probably doesn't exist
as much as it does in the current system. Under a private public partnership,
how it would be envisioned or how it really should work and how it most
effectively has worked is that the private provider really is providing a ride. That
is our job. For those times where an ALS intervention is necessary then we
simply take the medic with us to the hospital and then he or she continues the
care that they started in the field. So, hopefully that answers your question. It
does depend on the system.
Zaremba: Thank you.
Rountree: Mr. President.
Borton: Mr. Rountree.
Rountree: Carl you said you have been in the business for ten or eleven years.
Given what you have shown us this evening and you have heard a lot of stuff
from Ada County and other counties and other governmental entities, give me
three reasons why a governmental entity would even want to be in the
ambulance service, given that private enterprise can do it more efficiently?
Vogt: Well, I am not sure I can give you three, but I can give you the main one or
maybe the top two. Certainly public safety is a governmental function. I mean, it
is clearly something that governmental entities have decided that it is their job to
provide to their citizens, whether it be police, fire, EMS is a relatively new entry in
terms of years into that public safety system, but I believe that they got into
simply because they wanted to do the best job they could and over the years as
the economic realities of medicine have come home to roost, they have tried to
keep in that system as best they can because they do feel an obligation under-
you know in the public safety realm of their citizenry. I think another reason is
something out there and I think it is probably a generalization and as we know
they are all wrong, but I think there is a stigma attached, especially in certain
cases to private enterprise going into a traditional governmental function. I think
it is out there. I don't necessarily think it is always right. I mean, I can cite you
examples of fire base systems that have failed and third service systems that
have failed and private enterprise has failed when there is not adequate ground
rules, I guess would be the way to put it. It just depends on the system that you
establish. You know three or four years ago, Kootenai County had a third service
that failed and it was taken over by the fire system. I mean it is not necessarily a
bad thing, you just have to do your homework up front and establish realistic
expectations that everybody can life with. If you do that, if you do your upfront
job writing the contract, writing the RFP, writing whatever you send out the end
result is much more favorable. So, I think that is the reason that there continues
to be a hesitancy to simply farm EMS out. I think, like I say, be trend and it is a
good trend and over the last many years, five or six years - once again, I am a
little biased, but I really think it is a good trend. But I don't necessarily - unless
there is not another option, I don't really want to be in the EMS business. I want
to be in the transport business. I think private enterprise does a great job at
bottom line. I think we do a great job of billing. I think we do a great job of
maintenance. I think we do a great job of all of that. But, if you can figure out a
way to make it feasible to retain the public safety that service to the citizens'
aspect of it, I think it makes great sense.
Rountree: Mr. President.
Borton: Mr. Rountree.
Rountree: Thank you Carl, I appreciate that. Could you provide Chief Anderson,
if he doesn't already have the information that would illustrate the trends, who is
doing what, not extensive, but just some typical examples of the kinds of services
that are being provided by private enterprise?
Vogt: You bet.
Rountree: I would like to see that.
Bird: Mr. President.
Borton: Mr. Bird.
Bird: For Mr. Zaremba, we pay $0.75 on our telephone bills for 9-1-1. None of
this goes to the 9-1-1 out of EMS (inaudible--). Plus it is an actual budget item
for the county.
De Weerd: Mr. President.
Borton: Madame Mayor.
De Weerd: I guess also our Fire Department is charged per call. So, whether - I
mean, we are already being charged so we are going out on those calls.
Borton: Well, I want to thank you Mr. Vogt for coming and sharing some of your
information. Chief Anderson, Deputy Chief Niemeyer I appreciate the information
that you provided. Those four options are imminent concerns to this Council in
light of what is taking place and the Council's continued concern to make sure of
the safety of our citizens and providing the best care in the most cost efficient
manner stays at the front of our concerns. I think we will be taking swift and clear
action to make sure that we continue along that course. We appreciate the
information. It is very, very helpful. This brings us to the end of the Pre-Council
meeting agenda.
Rountree: Mr. President I move that we adjourn our Pre-Council meeting.
Bird: Second.
Borton: It has been moved and seconded to adjourn. All those in favor say aye.
ALL AYES. MOTION CARRIED.
MEETING ADJOURNED AT 6:58 P.M.
(TAPE ON FILE OF THESE PROCEEDINGS)
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