Monday, April 25, 2022 - 9:00 am
Robin DeLoria - Chairman
Chairman DeLoria called this EMS Subcommittee to order at 9:00 am with the following in attendance: Clayton Barber, Robin DeLoria, Derek Doty, Roy Holzer, Ike Tyler, Meg Wood, Mark Wright, Mike Mascarenas, Dan Palmer and Max Thwaits. Noel Merrihew had been previously excused. James Monty was absent.
Also present: Dina Garvey, Bryse Taylor (9:03), Rob Wick and Matt Watts.
News Media present: Tim Rowland
DELORIA: We can get started, okay, Robert, why donít you get us started here.
WICK: Okay, so for today we only have one resolution request going out for Ways and Means, itís the sole source award for the Nitronox system weíre procuring on behalf of Keene, because itís a sole source award we have to have the resolution to approve that one going forward. The company that is, well, thereís only one company thatís going to be able to produce this for us. They have a relationship with the manufacture and thereís really no other way we can get this for them. Thereís not an equivalent product, either, that also mixes the noxious oxide and oxygen, so thatís going to be a little bit different.
DELORIA: And thatís used for what? This unit.
WATTS: Pain management is what theyíre going to be using it for.
DELORIA: Yup, okay.
WICK: The thing that is kind of strange is itís the first time weíve run into it with all the different stuff that weíve bought for EMS supplies, all over the place and this is the only sole source issue weíve run into.
Other than that, moving into the agenda, all of the contracts and staffing roles are covered. So, when we refer to, like staffing gaps, thereís no backups. So, when we look at our staffing charts and the roles we need to adequately fulfill to be at full strength, we are not yet at full strength, but all the contracts and all the roles are being served right now. So, just to kind of clarify that point. We are going to be advertising for the account clerk, as soon as we can. That was in the budget for this year. It is our understanding it takes time to get that, we want to get that rolling here, soon.
We havenít gotten a formal request yet for the staff sharing position between Etown/Lewis and Westport, but it has been identified and we want to get that advertised out there, as well. Same thing for Keene and Keene Valley, there was discussion about them also sharing a EMT, I think, but we have not gotten a formal request, yet, from them. Bryse, were you guys also in that April 11th meeting, that that was discussed? †
THWAITS: He met with them, Keene wants their own, correction, Keene Valley wants their own staff, but also hasnít put in a formal request, yet.
DELORIA: Is that similar to the way that Newcomb was set up with that part-timer, because that person is also working elsewhere, other than Newcomb?
THWAITS: No, Keene Valley wants their own basic EMT.
WICK: So, itís like 2 total, 1 of each? Okay.
MASCARENAS: So, Rob, from a logistic standpoint, or Max or Matt, would the contract be altered to deal with that? Like Etown/Lewis, Westport, we had, I think an existing contract, weíre already been there, right?
MASCARENAS: So, the grantís already paid for X amount of dollars?
MASCARENAS: So, this person that theyíre requesting would automatically, the revenue would be coming from those agencies?
WICK: Right, right, outside the grant, as a new addition, yes.
MASCARENAS: Keene would get their year?
WICK: I think this was, so with the procurements that we have lined up, we have, let me backtrack, the money that we allocated for both additional backup staffing and procurements to all the other agencies, there was $495,000.00 total that we had set aside. Now, this does include the ambulance for Minerva, so of that weíve got $97,000.00 remaining. So, if we start providing staff out of that, then weíre not really going to be able to provide additional equipment through the course of the rest of the grant program, just so thatís aware.
WICK: So, I donít know. I guess thatís up to the Committee to decide, like if this is going to come out grant funds and just kind of burn it out, whatís remaining or if this is something, because it was outside of the original allocation and kind of the scope of the budget for the grant, that this is going to have to be something that is paid in?
HOLZER: So, have those communities received anything else out of this initial grant funding?
WICK: Keene is getting that noxious oxide system. Keene Valley they didnít request anything previously and then Etown/Lewis and Westport, theyíve also had some benefits of the program.
HOLZER: So, how much is the Keene system?
WICK: I think itís like $7,500.00, total.
HOLZER: Okay, so what would it be if we did say, okay, weíre going to give the opportunity to have the one-year agreement, like weíve done with other towns? Itís either or, so how much would be looking at, if we wanted to extend that offer?
WICK: Wages, just for the EMT?
MASCARENAS: Wages somewhere around $80,000.00, something like that.
HOLZER: That would burn up the rest of that grant money then?
WICK: For one year, yeah, for one year and this is, that value, that $97,000.00 was kind of intended to carry us through, you know the next few years for having to do critical procurements and stuff like that.
DELORIA: So, you prefer earmarking that for equipment?
WICK: Well, equipment and some of the, what we were calling per-diems, that kind of staffing, as well and I think when we were looking at that it was an average of say $50,000.00 a year, budgeted for that stuff. I donít think we used near that last year. I donít know if weíre planning on using all of that this year, but it would be good to have a significant part of that set aside for the next couple of years.
HOLZER: So, Rob, didnít we put like a timeline when communities could jump on this whole thing?
MASCARENAS: Yes, we did and several, we even exceeded our timeline, I believe.
WATTS: A couple of times.
WICK: Yes, we did.
MASCARENAS: And kept going back.
HOLZER: So, I would be inclined, probably, then, with that being said, to just leave it for equipment. Thatís my recommendation to the Committee.
DELORIA: And per diems, correct?
DELORIA: I am good with that, as I am sure, anybody have an objection to that? And weíll just plan on that?
Okay, so item #5, the training courses set up for this year. There were two that we are planning on doing, a day course in summer, a night course in fall. I donít think we have any dates that are finalized for those, yet.
TAYLOR: I have the dates for the night course for you.
WATTS: That starts August 8th.
TAYLOR: And ends January 14th.
WATTS: And itís 3/4th full already.
MASCARENAS: What does that mean? Whatís full?
WATTS: I think 20 is full and last I knew there was 14-15 signed up already.
MASCARENAS: Thatís good.
WATTS: And that was like within the first few days of it being announced.
MASCARENAS: Whatís the success rate, typically?
TAYLOR: 85%, roughly, for the basic class.
DELORIA: Whatís the status on North Country application to provide those courses? Are we any closer to them being able to do that, do we know?
TAYLOR: Thereís a whole lot of shakeup going on with program agencies in education, right now. So, North Country is completing their course sponsorship application or has completed it and will have the support of the REMSCO for them to provide classes. Clinton Community College is picking up some classes and Elizabethtown Community Hospital is also looking at becoming a course sponsor, because Mountain Lakes REMSCO is not going to be a course sponsor anymore.
DELORIA: Or theyíre not?
TAYLOR: And Mountain Lakes, Inc. is not going to be a program agency for the REMSCO.
PALMER: What are they doing, just got out?
TAYLOR: Yeah, the Stateís pushing for consolidation. So, weíll be under North Country EMS Program Agency; which is the Fort Drum Regional Health Planning Organization. They do North Country REMSCO and theyíll do the program agency for Mountain Lakes
REMSCO. So, the education committee of the REMSCO has been working with any of the local sponsors we can find. Etown and our County is looking at doing a cost analysis to start providing some of those other courses.
DELORIA: And would North Country be part of that alliance?†††
TAYLOR: North Country would be a course sponsorship.
WATTS: It would be separate from Etown.
WATTS: I believe that their application is in.
TAYLOR: I knew it was either completed or almost completed.
WICK: Okay, weíre not sure quite the status of this scheduling software and its adoption into the County, the MUNIS module that was, I think being acquired. So, weíre going to proceed forward with an independent solution, for now. Itís going to be roughly $4,500.00 a year for this software. A couple of different ones that weíve looked at. Theyíre all about the same kind of price. They all kind of do some of the similar functions. Weíre just kind of weighting some of the different features that will benefit these guys the most, whether it can be a permanent solution that they can use or if the solution from MUNIS ends up being something beneficial later on or widely adoptable. But, the ones that weíve looked at, theyíre pretty opened source. You know this is something that the, all the EMS practitioners would be able to access from smartphones and stuff like that, scheduling requests, these kinds of things, so it would be pretty dynamic. So, weíll try and get that in, pretty soon. †
So, Bryse, do you want to speak to the budget updates that you were queuing me on, recently, with what was included from the State and what was not and some of the impacts that are going to happen?
TAYLOR: Yes, so currently a lot of community outreach stuff that weíve been doing, vaccination support, pods, community paramedicine that were perusing, is all enabled, only under executive order. Itís actually statutorily prohibitive. There was a push to include changes to that statute in the Governorís Budget Bill, but that did not pass. So, after the Executive Order expires and theyíre not expecting the Executive Order to continue until the statutory changes can happen, community paramedicine, vaccinations, alternative designation transports are all going to be prohibitive. We reached a really good place with our attempt at a program. We have some buy-in from local stakeholders, but weíre going to put a pause in the program now while we push for legislative change to make that feasible for us to do it.
DELORIA: Can you put that in the form a resolution to pass it at the next Full Board meeting, next week and weíll support that?
TAYLOR: Yeah, I donít know if we had a resolution for the Community Paramedicine Program to start with.
DELORIA: The legislative change.
TAYLOR: Absolutely. There are several committees of the State EMS Council and some advisory groups to the Commissioner of Health that are pushing forth suggestions to change 4800 definitions and add some other stuff.
DELORIA: Yup, I think it would be important if we did from the whole County Board seeing we have this program in place.
TAYLOR: And then some mixed news, part of the budget that did pass is called the EMS Cost Recovery Act, it allows fire departments to bill. I donít know the exact wording, because they havenít written the actual bill, yet. But, a couple of prohibitions, the fire departments have to have had an active CON, as of 01/01/22 in order to bill.
DELORIA: So, would we, under your CON be part of that?
TAYLOR: No, you have your own CON.
DELORIA: We do, yeah.
TAYLOR: Then you can. But, Moriah Fire couldnít start an ambulance company and start billing, because they donít have a CON right now, the CON is held by the ambulance company.
DELORIA: And if they do it after the fact then would it be possible for them?
TAYLOR: Theyíre not eligible to bill if they were not actively providing service.
DELORIA: One of those grandfather laws.
TAYLOR: But, that will address Newcomb and Keene Valley. I donít know if Keene Fire retained their CON or if Keene EMS took the CON from Keene Fire.
DELORIA: But, essentially weíre going to do that under the County, correct, Newcomb?
DELORIA: Oh, weíre not? Weíre never going to do it under the County?
TAYLOR: We canít do it under the County.
DELORIA: For Newcomb?
TAYLOR: Yes, correct. Before this passed, there was not a way for us to bill on your behalf that didnít involve, leasing, you would lease your operations to the County.
DELORIA: Yeah, I know. Itís like a deck of cards and youíre stacking the deck.†
TAYLOR: And then Dan Palmer recommended against doing any of that, because of the statutory.
DELORIA: When does this take place, do we know?†
TAYLOR: As soon as the bill is written. Itís supposed to by the end of the year, in the budget that passed.
DELORIA: So, a work in progress.
BARBER: It would be the same for the Town of Chesterfield; correct? Because our CON is through Plattsburgh, if Iím not mistaken.
TAYLOR: For Keeseville, I think Keeseville Fire has your CON in the contract, for Plattsburgh to provide service.
TAYLOR: You would have to check.
BARBER: The reason why Iím questioning that is because I just went, they had an EMS meeting last week, of course I was trying to get them to sign the contract and they definitely have some questions on that and that contract was not signed last year or correct me, if Iím wrong.
TAYLOR: The new one that Dan Manning put together was not signed last year.
BARBER: So, they definitely have some questions on contract that they would like answered.
MASCARENAS: Contract with the County or contract with?
BARBER: Contract with the County.
TAYLOR: The one that has staffing, procurement and ALS intercepts all rolled into one, I am guessing.
DELORIA: So, youíll get with Dan Manning on that?
BARBER: I will, I will, because they even want me to bring it to the Town Attorney and have him look it over, but theyíre following through with Plattsburgh, also on the billing. I couldnít explain it to them, you know they were asking questions on, because I said, obviously there were two dropped calls according to the paperwork, last month, and they were questioning on what are we calling dropped calls. You know, one called that they had, Willsboro came to their aid, well, they called in case they needed them and then Willsboro was never dispatched. So, is that considered one of their dropped calls? That was their question.
TAYLOR: I donít know, because theyíre dispatched through Clinton County. So, it would be whatever Clinton Countyís criteria for a dropped call is.
MASCARENAS: Whatís ours, Bryse?
TAYLOR: So, if you have a first call in your district and it goes to mutual aid, thatís a dropped call.
PALMER: It doesnít mean it doesnít get answered.
TAYLOR: Somebody else answered the call and if itís the second call in your district, it doesnít count against you as a dropped call, because you met your first call and got a crew together. So, the second call doesnít count against you as a dropped call.
BARBER: Okay, so are you telling me it wasnít, because Willsboro responded?
TAYLOR: Iím telling you Iím not sure, because I donít know Clinton Countyís criteria and theyíre dispatched through Clinton County.
BARBER: So, I am talking about the report though, that I got from Essex County, supposedly Keeseville had two dropped calls. Is that not so?
TAYLOR: I donít think so. I donít know where that report would come from.
BARBER: Last month we did not have two dropped calls. The month before that, I believe they were accounted for one dropped call.
TAYLOR: If itís on, is it on the list of total, the entire County?
TAYLOR: Yeah, because we donít dispatch to Keeseville, I donít think that that is accurate. Iíll talk to Scott. Your dropped call statistics should come from Clinton County, because theyíre dispatching agency.
BARBER: The next time I get a report, Iíll show you, maybe Iím not understanding.
TAYLOR: Well, it may be on the report and it may just be a system error from the dispatch software, saying you dropped a call, even though we donít dispatch. So, weíll have our person that runs all our reports look into that and fix it going forward.
WICK: Okay, the only other thing I did want to mention here, so when you flip to page 3, I did expand the section there that kind of goes into kind of showing how that money was allocated for the procurement and staffing and all that. So, itís got a list of all the different communities and some of the different things weíre providing and then it kind of shows the cost allocation status for each of those. So, weíll keep that updated every month and if thereís any questions on any of that, please just let me know and I can keep you updated.
DELORIA: Do you anticipate getting any money from Albany on some of this thatís pending? Your guess is as good as mine, thatís how you answer that.
WICK: I can tell you, itís all been sent in and they said, yup, okay, weíre good and weíre just kind of waiting for a check or a high percentage of what we submitted and wait for them to send the other 10% or 20% that they kind of sometimes hold in retainer.
MASCARENAS: Rob, claim #3, it says in progress, I am assuming that it hasnít been submitted yet?
WICK: Oh, itís been submitted.
MASCARENAS: Okay, Claim #3 has?
WICK: Yeah, I am just kind of waiting on their finance folks to say, yes, okay, weíre tracking on this, we donít have any other questions to pester you with and weíre going to send you money at some future date.
MASCARENAS: They owe us about $2 million?
WICK: It was $1.1 for Claim #3.
MASCARENAS: Right, but Claim #2 is also outstanding? It says pending.
WICK: Right, so, all together, yes. To answer your question, it is close $2 million total.
DELORIA: So, then that will move from in progress to pending and it will land in there for a while?
PALMER: And that is why the County needs fund balance.
WICK: Any other questions?
DELORIA: Anybody have anything for these gents?
TAYLOR: So, just a follow up, he asked us to look into the call to the school at the last meeting.
DELORIA: Yeah, I think Mr. Monty had requested some information on that. What did you discover?
TAYLOR: So, they were dispatched in the evening, they had a full crew sent 2 minutes after the page went out and they were on scene within 17 minutes and there was some inclement weather that night.
DELORIA: In Newcomb thatís a great response time, if you get there in 17 minutes, Iíll tell you that right now.
TAYLOR: Yeah, I donít have any like follow-up on the actual patient, but they were at the hospital 32 minutes after the time of call. So, we did follow-up on that.
DELORIA: Okay, anything for us, Matt? Max? Anything else? We stand adjourned, thank you.
AS THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS TASK FORCE IT WAS ADJOURNED AT 9:25 AM.
Dina Garvey, Deputy Clerk
Board of Supervisors