EMS Subcommittee

Monday, February 28, 2022 - 9:00 am



Robin DeLoria - Chairman


Chairman DeLoria called this EMS Subcommittee to order at 9:03 am with the following in attendance: Clayton Barber, Robin DeLoria, Derek Doty, Roy Holzer, Noel Merrihew, James Monty, Matt Stanley, Ike Tyler, Meg Wood, Mark Wright, Rob Wick, Mike Mascarenas, Dan Palmer and Max Thwaits.


Also present: Dina Garvey, and Darren Dickerson. Bryse Taylor had been previously excused.


News Media present: Tim Rowland



DELORIA: Okay, I guess if weíre ready and Robert, Iíll turn it over to you.


WICK: Okay, alright, good morning. So, weíll roll right through the agenda here.

Obviously, weíre still waiting for payment from Claim #2 from DOS and the grant program.

I do have a couple of resolution requests in. This is kind of a follow-up from last monthís meeting when we were talking about transitioning one of your part-time paramedics to full-time. Heís working, right now, part-time status for the Newcomb contract, but weíve got some other places where we can utilize him to fill some scheduling gaps as a full-timer. Generally, that was the consensus to approve that, so weíve got the budget mod and the hour increase resolutions, today, for that.




WICK: I sent the budget mod one to Judy, so we should be good there.

Those staffing gaps that we have are under continuous recruitment. I donít know if weíve had any additional candidates come in recently for those?




WICK: Okay, and I left item #4 on here, because I havenít heard since last meeting if that was moving forward, if we had another candidate for the other EMT that the Westport Fire Department wanted to have for their contract?


TYLER: We had a meeting with, about the other issue and they mentioned that.


WICK: Okay


TYLER: We need one, Iím sure. Iím not sure where it stood after I left, though.


THWAITS: They havenít specified what they wanted, yet. Last I knew, if they wanted nights, weekends, days.


TYLER: Well, right now I guess all they have is Monday through Fridays, right, days?




TYLER: So, I am assuming itís going to be a night thing, but Iím not sure. Bryse and them, I left and Bryse was still talking with them after I left.


THWAITS: Yeah and they havenít specified yet, what they want.




WICK: So, I guess until we get a formal request letter, you know, we just kind of keep that on the agenda and follow up.

I havenít heard if there are any other EMT, AEMT course scheduled for this year, yet.


THWAITS: I havenít either.


WICK: Okay, so the scheduling software that I believe from Personnel, just started to get setup for some of the training introductions to that, so weíll see shortly if the Munis model that the County is buying is going to work for Bryse and EMS to be able to support all of the very rapid schedule changes that they need and that flexibility. So, hopefully that will work out and we wonít have to buy another product, but we havenít had a chance to really get into that.

So, a note that I got from Bryse last week so that he had met with Westport and I guess, they were not wanting to move forward with the centralized billing right now.




WICK: So, I mean, okay. weíll keep on that I guess and see if we can make some movement there.

And also the other item that he had brought up last month, the Community Paramedicine. So, I really I took a lot of his notes that he provided in email and placed them right here and actually, Iím glad I did that, because heís not here to speak to it. So, what we have here, written in the agenda is the information that we have updated on that right now. Basically, heís trying to coordinate a lot of the stuff in the background. So, hopefully Cambridge Valley is a no cost, kind of collaborator with that and thereís a couple of other companies that provide some of those same services. Looking to see what those cost and the cost structure will be. Also, working with Etown Hospital to see if they can kind of cooperative with that program. And as always, there seems to be that thereís going to be some political things going on at the State to see if this is going to even allow this initiative to move forward. So, in that regard itís probably TBD, until we know what the Stateís going to do on that. But, with all the other footwork in the background it is hopefully something that will work out and save some time and money.

Other than that, letís see if there were anything major that we needed to go over. Just a brief note, there are a couple of updates that I had from the end of year report. Our contract revenue; we did get a little bit more that came in, some later payments, so that pumped up a little bit to $232,368.00 and weíve started to get some revenues coming in, already from that.

Medicare billings, so far for the year, which would be the end of 2021, I should correct is $2,700.00 and I think that was lower than we anticipated, because we had a lot of our medics that were helping a lot of the other agencies. So, they were doing a lot less direct responses that would provide direct billings from the County.

We still have, again, some scheduling gaps. Working to get those backfilled and further in the back, the document that Iíve got the January performance metrics loaded in there.

Unless there are some other questions, there was not a whole lot of other information to present this month.


DELORIA: Do we know why Westport would push back on the medical billing? Is it just not setup appropriate for them?


WICK: I have no idea. If I had to guess, I would think that perhaps the process of going through it might have been a little bit daunting.


TYLER: That was it. That was a major part of it.


DELORIA: So, it needs to simplified. It could be daunting for many, you know, if theyíre not tech savvy.


WICK: Yeah and then the administrative parts of it, like we talked about last month, can be a little overwhelming and probably cause a little bit of resistance when it appears that youíve got somebody else thatís going to be running your program, although itís really kind on intended to just cover a lot of legalities and liabilities and effectively is a pass through.




WICK: Hopefully, we can come to terms with that and provide a solution that will work out for them.


DELORIA: I would think, yes, because itís really free money. If you donít bill these insurance companies for the ambulance trip, you know, explain to me why you would want to say no to that? No matter who does that, whether the County does it or they do it. Itís a no-brainer, itís revenue. Keeps the tax levy down, you should push back on that.


TYLER: I already did.


DELORIA: Well, maybe we can push back on it. You know, have we ever discussed bringing in the people that need more information regarding this whole process, to sit them down and discuss it with them? Have you done that on your own?

THWAITS: Bryse did.




THWAITS: Itís a lot of work for a volunteer. Itís a lot of work to ask somebody to do that that isnít getting paid. So, unless youíre paying somebody to do the billing then itís a lot of work for a volunteer.


DELORIA: Right, right and I think that was where the County was headed with that, werenít they?


MASCARENAS: So, what is the difference, Max? My understanding is, they get to the hospital, they do a transport, whatís the difference when a volunteer does that in terms of billing versus non-billing? Thereís still certain amount of information that has to be filled out off that patient, correct?


THWAITS: There is, but thereís a lot of follow-up if you get paid, you didnít get paid, youíve got to call the billing company. Thereís a lot of work involved. When I managed AuSable, I had one full-time person that just did billing and itís a lot of work to ask a volunteer to do.


TYLER: On top of that, the process of changing over. There was three people at that meeting I went to and just like any other organization, thereís only a couple of people that do anything and they just donít have time to do all that.


DELORIA: Youíre saying volunteers, but what about the paid staff? They get paid.


THWAITS: Westport doesnít have any.


DELORIA: Okay, they donít have any currently?


THWAITS: The only paid staff they have is ours.


DELORIA: Work in process.


DOTY: So, is there revenue being lost then?


MASCARENAS: Not necessarily for us. Westport is going to reimburse us down the road for whatever individuals we provide them. So, for the new Board Members here, weíre probably talking a different language right now, but the way itís setup is, weíre really a staffing agency for all those programs that need support. So, if you fall short and need help, we try and find a trained individual, you contract with the County, we provide you with those individuals, so you donít drop calls and those type of things.


DOTY: Hence, centralized billing.


MASCARENAS: Yeah, the first yearís free, but then after that, the locality, either the town or the agency will reimburse us the cost of that individual, hour for hour and weíll pick up the benefit rate for those people. So, in terms of the County, Westportís going to pay us for those individuals we hire long term. Theyíre just going to lose the ability to recoup any revenue for their costs.


DOTY: I get it.


HOLZER: What is Westportís call volume?


MASCARENAS: I donít know, I was going to ask Rob that. I know heís provided that a bunch of times.


HOLZER: Because, Wilmington for example, we do the billing because of Whiteface Mountain Ski Center and all the tourists, but if we have local residents that donít have the means to pay it, itís just pretty much written off after a couple of times.


WICK: So, like last month they had 20 runs.




TYLER: Itís a lot easier, I think, for the few people that are involved with that to just do a budget and give it to the Town and thatís done.




HOLZER: Yeah, I agree.


MASCARENAS: Understood.


DOTY: It would depend on your number of calls.


MASCARENAS: Some communities have been able to sustain their program by going to billing. I know, Willsboro, I think Shaunís here.


PALMER: I donít see him.


MASCARENAS: I can tell you Willsboro, when they initially had to go to paid staff, their levy was really high, once they started billing they recognized, they experienced a greater level of revenue than what they ever thought was out there and were able to reduce that levy pretty significantly.


DELORIA: I think thatís the carrot that we can hang out once we have a database of how itís been working for the other towns.


TYLER: I think Willsboroís calls are a lot greater than Westport, especially with the home out there.


MASCARENAS: And the summer, especially.


TYLER: Well, the home out there, too.


MONTY: About the same as Elizabethtown-Lewis, yet their levyís half of what weíre levied.


MASCARENAS: With the same call volume?


MONTY: With the same call volume.


HOLZER: Paid staff or volunteers?




DELORIA: Do they do the medical billing?


MONTY: Well, once I complained at them enough they started doing it, two years ago.


DELOIRA: And the reason that you complained is that you werenít going to give them the money, if they were throwing money away? You just reduced the contract amount?


MONTY: I would rather not say my opinion on it.


DELORIA: Whatís next, Rob?


MONTY: When they took that paid staff from the County, right, there was a contracted issued between the communities and the County? Is that normally what happens?




MONTY: Well, when did they place the one in Etown/Lewis?


WICK: Let me see when they got deployed.


MONTY: Because, Iíve never the seen the contract, so, Noel saw it, Noel signed it. So, I guess heís paying the whole shot, because Iíve never seen the contract.


WICK: 03/21, so it was March of last year that that contract began.




MONTY: The Town of Lewis has never seen that contract.


WICK: Well, we have a copy that we can forward up to you.


MONTY: You know, I would have liked it before I signed it, so I donít care now, because Noel is going to pay for it.


TYLER: Prefect


MONTY: He signed it.


DELORIA: Okay, so medical billing will always be on this agenda, as far as Iím concerned, because I really think itís something thatís important and it takes time to bring people on board. We can survive financially, you know, everybody, until we get it fixed, but itís important.



The other thing that I would add, that I didnít put on here, just anecdotally, we have a couple of bids out there for some of the communities for some of those AED monitors and also have to circle back with Dan on the amendment for the Wilmington agreement, so we can get you reimbursed for those AEDs, as well.


HOLZER: Okay, we had them bill the County directly. So, thatís in the pipe works, as far as getting paid, right?


WICK: Right




WICK: I have to get that amendment and we should be good.


HOLZER: Now, weíre fine waiting, but that vendor should probably be taken care of.


WICK: Sure


HOLZER: Thank you Rob.


DELORIA: Speaking of AEDs, are municipalities required to have one in central offices, hanging on that wall? Is that State contract?


MONTY: Yeah, I bought some for our town with State contract.


DELORIA: Because, we currently do not and we know that weíre going to be looking at that over the next couple of weeks, so we can get some on-hand.


STANLEY: Do you guys have a contact to get those AEDs?


DELORIA: No, thatís essentially what I am fishing for right now.


STANLEY: Because, we donít have any either.




MONTY: I went through Maxís office.




DELORIA: Alright, Max, put out a mass email to the Board of Supervisors and whatever information you can provide us.




DELORIA: We have one on the ambulance, which is used rather frequently, but youíve always got the one time. My understanding is you can use one of those darn things on yourself, if youíre capable, right? You just turn it on, and hold the paddles and it will take it from there, tell you whether youíre alive or dead.

Do you have anything for us, Max?


THWAITS: I donít.


DELORIA: Okay, does anybody from the Committee have anything for these boys?


MASCARENAS: Rob, maybe you can get something out to the just, the new members that are sitting on the Committee. I know you have a lot of information on the program, what it is, what the metrics were, why it started to begin with, where weíre at today compared to whether we were.


WICK: Absolutely


MASCARENAS: I think that would be helpful to them in understanding.


DELORIA: Yeah, Iíve been kind of harping on that for a few months now.I think itís important.


MASCARENAS: Yeah, to keep it out in front.


DELORIA: Well, I think eventually one of the things that the State of New York was looking at us for is to develop this pilot program, if it works for Essex County, itís going to work for everybody. So, if we have what youíre calling the rubrics or metrics, you know a channel, a report that we can follow then itís a handout to prove how successful we are.


HOLZER: It has nothing to do with the Committee per se, but Wilmington, Frontier Communications phone lines have been out since Friday and I have a local number that Iíve been talking to and they keep ensuring me they have technicians on the site. I mean our water system backup is Frontier Communications, our fire department backup is Frontier Communications. Iíve talked to Max, but every time we try to get a hold of Frontier we get a complete runaround. Itís been out since Friday. Iíve got most of businesses along the main drag in Wilmington do not have communications right now.


DELORIA: I wish I could help you with that, but Frontier does not like me.


HOLZER: They donít like me, either. So, I do have a local supervisors name in Keeseville. Do any of you guys have any other contacts in Frontier?


MONTY: Do you have Jan Vandecarr?


HOLZER: I do, but.


MONTY: Heís not returning?




MONTY: He was about the only one that I could work with?


HOLZER: Yeah, you gave me that before and he did help me, but I guess I asked too much, because heís not returning my calls.


MONTY: Or they fired him, because he was doing his job.


HOLZER: Itís a horrible company, but Public Service Commission? Who should I go to now, the Governorís Office?


DELORIA: I can give you that information.


HOLZER: Sooner than later, thank you.


TYLER: I know there are some Verizon towers in Westport since Thursday or Friday or maybe even longer last week have had issues, I donít know if theyíre back up and running.


MONTY: And people are aware that the AT&T tower, if you have any 2G, 3G or home devices that are with AT&T, they shutdown assess to those lines.


THWAITS: Verizonís going to do the same thing.


MONTY: And Verizonís going to do the same thing. Theyíre been practicing in Lewis, on our tower in Lewis. I sit basically under the tower and once a week, all of a sudden I go from having 5 bars to no bars and stuff. So, AT&T has done that, I believe, it was the 22nd of February, shut them all down, something like that.


DELORIA: How long have you been out, Roy?


HOLZER: Since Friday. Theyíre hopeful that it will be up today, but thatís the local guy that, Frontier has become so corporate that they donít have any connection to their local substation management anymore.


MASCARENAS: So, Rob, your resolutions, are they going Ways and Means or is Max taking them to the Committee?


THWAITS: I thought you wanted them today?


WICK: Yeah, today, if possible.


DELORIA: So, theyíll be out? Are they part of the packet?


PALMER: I donít know if Judy has it in the packet.


MASCARENAS: I printed off the one that Rob included.


DELORIA: Thereís one for budget and one for staff? Is there two?


WICK: Yes, one for the budget modification and one for the hours increase for the individual.


DELORIA: And weíll have those for Judy?


WICK: Should be, yes.


DELORIA: Okay, anybody else have a non-topic that they would like to discuss?


DOTY: As the County prepares to look at the $7 million from Covid relief monies, Iím just wondering, how soon do we start hearing about what the Health Department might need, what EMS might need? So, that as funds are allocated, because I remember we just hired, apparently an appraiser company to help us determine how those monies can be allocated, but Iím still confused over the fact that when your local budget can show losses in the previous year, those Covid relief monies can basically put in the general fund.


PALMER: It can be used for general government services, provided you spend them on general government services. So, in other words, if you said, okay, this year Iím going to budget for a loader and you put that in your budget, you canít take the recovery funds and replace that line, it would have to be in addition to something that you didnít. You know, we clearly donít have $7 million left anymore. We have about $6 or a little less than $6.


DOTY: Right


PALMER: But, you know Iíve spoken to Department Heads, I said, if youíve got something that you want us to consider, then you need to submit it to me. Iím going to ask Shaun to get something together, a small committee or something, but Iíll try and develop a spending plan.


DOTY: And all of us, all of your towns kind of are approaching the same thing, waiting to allocate those monies and you know in justifiable terms.


PALMER: Again, because, what happened was, originally the final rules, the interim rules said that you have to spend it on something that was either Covid related or if it was lost revenue you had to spend it on some other general services that would somehow impact Covid. When they came out with the final rules they said, you know what? Anybody that got less than $10 million can consider it as lost revenue and can spend it on general government service.


DOTY: Thatís actually the last document I read and it listed items like childcare, water infrastructure.


PALMER: You know what? Davina called me about or somebody called me about replacing garbage receptacles down on Main Street.


DOTY: Right


PALMER: Itís a government service, you can spend the money on that.


DOTY: Okay


DELORIA: New cybersecurity was another.


PALMER: Anything that you would normally spend on government services you can spend recovery funds on. We havenít gotten the second payment. We wonít get that until April. The first $3.5 million came and then a year later the second $3.5 million comes. So, when we get that weíll develop a plan.


DELORIA: Dan, I did not get my contract back to you, but thereís something changed on that?


PALMER: No, not really.


DELORIA: Iíll get that to you this week.

Okay, anybody have anything else? If not, weíll stand adjourned. †††††






Respectively Submitted,




Dina Garvey, Deputy Clerk

Board of Supervisors