Loading...
HomeMy WebLinkAbout07-11-2001 Meeting I AMBULANCE SERVICE STUDY SUBCOMMITTEE TECHNICAL COMMITTEE Room 605 - July 11,2001 8:30 A.M. ATTENDEES: J. Brigham, Commissioner, Chairman, M. Williams, Commissioner, G. Kolb, Administrator, J. Wall, City Attorney, J. Salazar, M.D., RC Medical Society, T. Strange, Finance Dept, V. Spratlin, Rural Metro, L. Mercer-Cobb, R. Zeyfang and P. Cowland, Region VI EMS, B. Callahan, Doctors Hospital, P. Wasson 9-1-1, E. Lightfoot, M.D., Stoney Medical Society, D. Hooten. ALSO PRESENT: L. Bonner, Clerk of Commission. MEDIA: H. Coryell, Augusta Chronicle. Committee recommendation: I Mr. Kolb: The Technical Committee of the Subcommittee for the Ambulance Service met on June 28. After considerable discussion the Committee is recommending to the Commission that (1) an agreement be negotiated with Rural Metro for up to 2 years to allow the Committee to develop standards and protocol for ambulance services in Augusta Richmond County. (2) The 9-1-1 Steering Committee be designated as the oversight -- for ambulance services in Augusta and that would include administering the contract with 'the successful providers and also assisting in developing an RFP for ambulance services for a longer and more permanent basis. (3) The Technical Committee would help in the development of performance standards for ambulance services in Augusta for both emergency and non-emergency services. In addition we would contact or are recommending that we contact the EMS Council to advise them that we are applying or reapplying for a license in Augusta's name as well as to open up the zone for other ambulance services to be designated providers. Mr. Brigham: Are there any questions about the recommendations? Mr. Cheek: Why was Rural Metro selected and were other ambulance services questioned as to their ability or desire to work this 2-year? I Mr. Kolb: There are several reasons for it. First of all we do not believe that we can develop an appropriate Request For Proposal for ambulance services between now and January 1. The consultant that we brought in, Jerry Overton, suggested that we develop a high performance RFP and we can't make that happen in 2-3 weeks. It will take several months and the collection of a lot of data in terms of response time, in terms of patient care standards, etc. The best approach is to begin the process by negotiating with our current provider Rural Metro. The second reason is that Rural Metro is the only ambulance service that is designated by the EMS for this zone. And I fear that is going to be a long process to get other ambulance services designated for Augusta Richmond County. So to let those two go along parallel tracks, the Committee decided it's the best course to negotiate a short-term agreement with Rural Metro and by short term I mean up to 2-years. I Dr. Salazar: The problem with this situation here is this, we've already gotten on a short-term frame. The mistake that Columbia County made in changing its provider was, got on a short-time frame and did not follow the process that was laid out by the State. There is a process through the Regional EMS Council by which the Regional EMS Council by which providers are designated as the zone provider designates providers as the zone provider. There are currently only 2 services, Gold Cross and Rural Metro which are even capable, under the zoning plan because of the 12-month exclusion clause that would meet the qualifications for applying for a zone. The process takes several months and it has to be done in conjunction with the Regional EMS Council Zoning Committee. Mr. Williams: So the process can be done, you said in a few months not a few years. Naturally, ifthere is a process we need to go through that. I've been advocating for the Fire Department taking over the EMS within a transition type period. I have not heard anything about that either which leads me to another question, which is 9-1-1. Have we talked about the Fire Department even with Rural Metro if we decide to do that, have we talked about a transition period with them as to cross training with them? We're talking about building several stations. If we're going to build those stations we need to build those stations where we can put the facilities in there for EMS. Has that been discussed? Mr. Kolb: Yes. We have discussed that, internally and also in the Committee. The Fire Department, we believe is part of the ambulance service or emergency medical system process. They would be and are being trained as first responders. When in terms of actual transport, we are not recommending that because that would be too expensive an operation for a municipality. I Mr. Williams: Right now, I understand that we won't be able to do that, but I'm talking about a transition period where we will be able to do that over a period oftime not in a period of months, but in the next few years. With the cross training, I was told that the cross training was already taking place in the Fire Department and manpower wise except for equipment. These guys are trained to do this, especially on First Responder type situations. I would like to see some of that down the line. Dr. Salazar: I think that was part of Mr. Overton's recommendation as well, was that this 2-year period be with integration with Fire Department First Response. In other words, that the 2-year contract not be a status quo contract but it be part of a high performance infuriated system and the systems approach that incorporates the Fire Department First Response along with Rural Metro in beefing up the current system as well during this 2-year period. The problem is the zone designation process and the time frame that is allowed. I I Mr. Brigham: We're trying to go in and extend a contract, we're working on two tracks. First, we're trying to get ambulance service for 1-2 years. The other thing we want to do is change the standards. We have the people in place to come up with those standards where we can open up Richmond County and see if we can attract more than two ambulance services so that they can bid on this proposal. We're trying to get ourselves into a much competitive situation and provide a better service to the people. Mr. Kolb: And at the same time integrate the Fire Department into the First Responder system as an integral part of the emergency medical process. But, I don't think anybody envisions the Fire Department ever transporting patients. Mr. Brigham: I think from the discussion at the last meeting the ambulances are almost as expensive as fire cross and that the technical advances are changing so rapidly in the medical field also there is another problem. The other thing is Marion you're as well aware as I am that if we're going to go to a capital base of funding the purchase of ambulances, and I think you all were talking 6-9, that we would have to fund that through the next phase of sales tax which we know is about 3 to 4 years away. I Mr. Kolb: There is another motive too. Since the hospitals and the medical directors and EMS representatives are on this committee what I'm hoping one of the benefits will be by setting the standards is that the hospitals and other parts of the medical community will also use the same ambulance service for non-emergencies which will help to defray the public cost for providing this service in the long term. Mr. Cheek: My main concern, and the sequence of events is very logical, my concern is, if we don't at least allow free market voices to work at this point and time during this transition, then we're going to get into the same situation we did with our bonding, where as one company who had always done the bonding for the city ended up having a monopoly. If we put Rural Metro in here without at least allowing Gold Cross to submit a proposal then they will have an unfair advantage when it comes time to select the actual company. I would be interested to see, rather than the City buy these things, once we faze out Rural Metro or Gold Cross or whoever they would no longer have need for those vehicles and it maybe possible for us to look at some type of equipment transition in the process from whatever private ambulance service over to our fire system. We could partner with these agencies in our fire stations allowing them to develop substations at these places to help the department as an expressed interest in the Diamond Lakes facility and using that as a substation and first aid station. I'm very concerned, especially in the light of the fact that Gold Cross has the capability to make it to Blythe in minutes, whereas Rural Metro after certain hours, if you're beyond Tobacco Road your coverage time is 20-30 minutes and to me for the folks in my district, that is an unacceptable time frame. I Mr. Brigham: Andy, I think what we're trying to do is take George's recommendation and give him the ability to negotiate with the ambulance services and come up with a change of standards to open up this area of the state, especially Richmond¨County, so we can have a more competitive situation. I think it's got to go on a two-tract tier from the discussions I've heard over the last couple of months. I the best thing we can do right now is to authorize George to enter negotiations, and I don't care if we enter into negotiations with Gold Cross and Rural Metro for next years ambulance services. I Mr. Cheek: I'm concerned about the length of a 2-year contract versus a year, which would allow us to get into our request for proposals. Mr. Brigham: During the technical meetings according to reports it's going to take probably six months to a year to get the standards in place and get the county open. After further discussion, Mr. Williams: I agree that some changes need to be made. I still say that we can't keep doing the same things and expect different results. I have a point that I would like to make about 9-1-1 and why not the Fire Chief being held to the ambulance service rather than 9-1-1. If we're going to transition to the Fire Department eventually, soon in my mind, that should fall under the Fire Chief rather than 9-1-1 who answers the calls. I think if the fire service will eventually get into first responding, I think the Fire Department should be in charge of that. Mr. Kolb: I need to make sure you understand that the Fire Department is not going to be an ambulance service provider. They are going to be a first responder in the emergency medical system. The Fire Department also is on the 9-1-1 Board so they will have a say as to what happens. I Mr. Williams: I'm trying to let you understand that in my mind I was with the understanding that we were going to transition not just the first responder, but eventually buy equipment. I think we need to step up to the plate and do some of the things that a progressive city would be doing. I'm saying that the Fire Chief who handles the fire operation or the day to day operation of the Fire Chief should include the ambulance service so that they could become more familiar with and know the ends and outs more so than being on the board. Mr. Kolb: Of course, the Commission can do whatever they want to. If they want to spend the money to purchase ambulances in the future and get into the transport business they absolutely can do that. My point is that we're looking at a total emergency medical system and the Fire Department is only one part of it especially today and for them to be responsible or the ambulance service to report directly to the Fire Chief ignores the other stake holders in the provision of emergency medical services. It is just too costly to have the municipality provide that level of service. I don't think the public can afford it. Mr. Cheek: One disturbing thing I've heard that I hope the Committee will look at is and this comes from firefighters is they are first responders and a lot of times they are the first ones there at accident scenes. And we are responding with engine companies and ambulance services are or the ambulance service that we're talking about is refusing I I to or not responding in a timely manner to calls, they're concentrating on the transport business which is a lower risk, higher profit type of endeavor. And that is completely unacceptable to me because it is far more expensive to the taxpayers of Augusta to have an engine company responding to an ambulance call basically. Mr. Brigham: Andy, I think that's why we're trying to get back to why we're trying to write these standards and this Committee will need the time to write these standards. The other problem, I think you and Marion understand is we have a budget that we have to make a recommendation for service next year and I think that we're getting to the point in time that we have to give George the ability to do what he has to do to make a recommendation to us where that budget is concerned. I want to give George the ability to negotiate on the ambulance service and also to get this Committee to bring back a recommendation to us to improve the performance level of the contract, the standards and in that process I think I'm also looking for a motion that we would be able to open up the zoning to go through the steps of opening the zoning in Richmond County. I think if we could accomplish those 3 goals today, we've done a major portion of the work that we can do at this point until we can get this Committee to function further. Mr. Cheek: Is it that Gold Cross is not at this point and time technically, as far as the state regulations are concerned able to operate in Richmond County as an emergency medical provider? I Mr. Brigham: I think, from what I understand, and somebody correct me if I'm wrong, that they could be but they would have to apply for it under an open zoning. Or they could possibly apply for it by the fact that they've operated an office in Richmond County for 12 months. Mr. Cheek: Has anyone asked them if they have done any of these things? Mr. Wall: You have committee representatives here from the EMS Council that would know if that has been done and it hasn't been done. Mr. Zeyfang: No it hasn't because zoning has not been open zoning would have to be requested open. Mr. Brigham: And the Commission has to request that and that's part of what's going on right now. Mr. Zeyfang If your question is if Gold Cross-is capable of applying for the zone under the zoning plan, the answer is yes. Is Gold Cross capable of providing emergency services to Richmond County without going through the zoning process, the answer is no. Mr. Brigham: We as a Commission have to make the request to open the zoning. And that's what I'm asking for as part of the recommendations to the Commission. I Mr. Williams: We've been talking not just about ambulance service but about everything in this government about a bid process, about making it fair and I don't see anyway we should ever come together and ask one provider or one service to do any thing if there is another one available. If there's not then that's understandable but if there is a way to make this competitive, to get the best that we can get for the citizens of Richmond County we need to look at that regardless of how much time and how long, even if it's a 3-year contract we need to understand that we need to get the best services for the citizens of Richmond County that we can. And with the transition period to be the transition to the Fire Department for whatever area they will accept, if they're going to be first responders or not. If they're not going to provide transport service as far as the ambulance service, if we're not going in that direction then we won't. We need to consider the best possible ambulance service for the people of Richmond County. I Mr. Brigham: The problem we have now is until we can get this zoning open, the way I understand it, state law says that we only have one provider we can deal with. And that's what I'm trying to do I'm trying to open it up so that we can be competitive and the only way we can open it up is for our Commission to make a request to open zoning from the EMS Council. The other problem we have is that we have to deal with next year's budget and this process is not going to be completed prior to the budget process. That's why I think we have to authorize George to have the ability to start negotiations as to what's going to take place in next years budget. Ms. Callahan: I appreciate hearing your insights in terms of what your issues and concerns are because I'm very new to Augusta. I would say that even if Gold Cross would put a proposal on the table without this Committee having had an opportunity to define what the quality standards are going to be that we would be just as blindly attempting to interpret their proposal as we would with what we understand to be Rural Metro and what they're trying to deliver. So from a timing perspective that's why we're talking about the parallel tract, one of which is to clear all legal hurdles but then give this Committee the opportunity to define what the quality standards will be for this county and then allow for qualified providers to demonstrate through the RFP process and through their historical numbers that they could bring us as to whether or not they are our provider of choice. And then having said that I have been in communities where fire service has provided the ambulance service as well as in communities where it's privatized or franchised. So as a member, I would commit to you that I will keep my mind open and that we will have an opportunity by virtue of looking at these quality processes to begin to provide for you a reasonable comparison of what would it cost and what quality could a fire service bring versus what would it cost in a franchised service versus what would it cost relative to a service that's totally owned by the county. But we need time I think to provide you that feed back to make a good conscious decision. I Mr. Williams: I would like to make a motion that we move the 3 recommendations of the Technical Advisory Committee to the Public Safety Committee for further discussion. I I Mr. Kolb: In tem1S of negotiating an agreement with Rural Metro or who ever we have to negotiate with we will be introducing performance standards in that contract whether it be a year or two year contract. We need to be able to test the standards to make sure that they work so that when we put an RFP together there is no misunderstanding or mistakes in performance and how we expect that service to perform. We will be collecting data during that contract period. Mr. Brigham: I'll second the motion. I think here's what we're going to do. I think we're going to carry forward a recommendation of requesting for opening of zoning and also asking this Committee to be proactive in developing standards locally that George will need to negotiate the contract with whoever he's going to negotiate with and for the RFP, We need for the Committee to start working on those standards immediately. I think the other thing that we need is we're going to allow the Committee to authorize George to enter into negotiations of the contract and the extended contract. Motion carried unanimously. ADJOURNMENT: With no further business to discuss the meeting was adjourned. Lena J. Bonner Clerk of Commission I Ibb I