EMS Sub-Committee

Monday, February 22, 2021 - 8:30 am

HELD VIRTUALLY

 

Robin DeLoria - Chairman

 

Chairman DeLoria called this subcommittee to order at 8:30 am with the following in attendance: Clayton Barber, Robin DeLoria, Archie Depo, Shaun Gilliland, Ken Hughes, Jim Monty, Ike Tyler, Patty Bashaw, Mike Mascarenas (9:00 am), Noel Merrihew (9:00 am), Matt Watts (9:00), Jay Rand (9:00), Davina Winemiller, Jeffrey Subra. Dan Palmer and Rob Wick had been previously

 

Also present: Dina Garvey

 

DELORIA: Weíll call this meeting to order, Patty you can start. Rob is not here today.

 

BASHAW: Robís Dad has been sick and heís gone down there a couple of times and then he got called like 10 days ago, now and he passed, last week, I canít remember the day. So, he is back, but heís still out of work.

 

DELORIA: Okay, perhaps from this Committee, we can put forth a resolution and condolences of Robís father, Patty? Is that correct?

 

BASHAW: Yes

 

DELORIA: Patty, I want to take this agenda forward today, so, that between now and the next time we meet, that you and Rob and Don and Matt can get together and try to, you know, give us a fingerprint of where this whole EMS countywide program is going. I think thereís a lot of towns out there that may or may not be part of the program. I think Clayton Barberís town is one of them. However, now he may benefit from a mutual aid standpoint and I think we really need to see what that looks like on paper with the 18 towns. I know, like Newcomb, currently is not part of the program. I was actually asked by Wes Miga if we were joining this year and I said no, weíre going to hold that at bay until we get a little bit further down the road with the COVID and try to get a handle on where we are today.

 

BASHAW: Okay, so our budget right now is mostly, not 100%, but Iíd say 80% tagged to the next steps. So, I guess the question is, moving forward, depending on how much of the grant is left, how much weíll have available, you know, for the other towns. So, I definitely need Rob for that. There is still that $350,000.00 for the per diems, that hasnít been spent yet. So, that probably could be redirected or continued down that same pathway of utilizing the volunteers and stipending them to help cover their towns. ††††††

 

DELORIA: Okay, let me just interject here. I, I really think where weíre at today isnít about how much money is left in the program. Itís about, you know, from the start of the program where are we? You know, specifics in the nature of how are these fly cars meeting the initial goal of even having them? You know, the number of calls that theyíre responding to? We donít have to get the names of, of the clients, necessarily, but, you know, where are they located and where are they responding to? You know some sort of, give us that.

 

BASHAW: You received that already.

 

DELORIA: Iím sorry?

 

BASHAW: You received that already, in Robís overview.

 

DELORIA: Okay, okay, but, Iím not looking for piecemeal. Thatís all this Committee has gotten from day one and I think what we really need to do is to have, you know, the program laid out, where are we today? I mean, Clayton at the last meeting that we had, was raising questions that, Iím sorry, as Chairman, you know, maybe I havenít been paying attention, but I couldnít answer those questions, and that, that sets me back, and I think Iíll allow some of the other committee members to pipe in here, and ask exactly, what are we looking for? For me, maybe itís a PowerPoint. Itís a comprehensive look at what we started with, where weíre at, and where weíre going and so that the Committee can look at this and determine, you know, is there effectiveness thatís going through with this program and has what we started in Ticonderoga, has that worked?

 

MONTY: I have a question, when weíre talking about the statistics, Patty, with the fly cars, my understanding is that, like they automatically roll when thereís a call come in? Is that correct? My understanding when we started the program, the fly cars were not going to roll until it was determined that there was not a squad ready to go and if they did roll, then they would go to the station and wait there, in case there was a second call come in when they went out.

 

BASHAW: Thatís not the way it was set up. Thatís not the way weíve talked about it.

 

MONTY: Yeah, we have talked about that, we have. Iíve heard it.

 

DELORIA: Well, let me interject here, so this doesnít get away from us. Patty, exactly the reason. Jim has a different understanding, heís on the Committee, then youíre telling us. I donít doubt either side, right now, but I donít have enough data in front of me to even interject and make a determination of, you know, where we are and I think thatís what weíre looking for and itís really Patty, is up to you to provide that and then youíve got Rob Wick, youíve got Don Jaques that youíre responsible to and even Matt and the other Matt. So, I think between the four of us, the four of you guys, we ought to be able to get some information together. I mean thatís what weíre looking for.

 

HOLZER: Patty, so I did have a member of my fire commissioners contact me about the mutual aid, the rover, just self-dispatching and their concern was, if weíre not asking for them and theyíre self-dispatching, and then theyíre going to turn around and bill our constituents, that is a huge issue with them and Iím just making you aware of it. We need to address that, because I do think it should be, we should be calling for help when we need it, not just automatically self-dispatching or if we do self-dispatch, our constituentís insurance companies arenít charged. I get the fact that weíve got to, got to figure out ways the fund this, this system. I actually think the dispatch cars are going to probably be the best part of this whole thing. I can tell you, right now, talking to our fire chief, itís worked out really well here in Wilmington, having your guy here to be able to call. There is concern, though, about self-dispatch and charging our constituents for a call they werenít asked to be on.

 

DELORIA: So, a quick question, Roy. Patty, do we actually have a policy that was developed by, by your group?

 

BASHAW: Yes

 

DELORIA: To help present to the Committee, so that we can look at how this has been rolled out with the fly cars so that perhaps we can interject and, and maybe answer some of Royís questions and perhaps, Jimís, do we have anything, yet?

 

BASHAW: You had that, I believe it was with the policies, that big packet of paper that you have a while ago, I will double check that, but, Iím fairly certain that it went out with all those policies.

 

DELORIA: Okay, will you forward that when you find it, Patty, please?

 

BASHAW: Sure

 

DELORIA: Thank you

Mr. Barber, at the last meeting, you brought up some questions about how your community was, was being folded into this. I think that your community needs to be part of this countywide program. I believe that we can offer the mutual aid aspect to you guys, but you have some questions and so go ahead and feel free to address us with those.

 

BARBER: Well, my questions are actually coming from the fire department. Weíre, in the beginning when everybody started talking about this and I know that Jerry didnít want anything to do with it and the fact is, as I said to you, I do have 24/7 coverage, right now. Now, weíre in partners with Peru, obviously, my fire district and emergency services is in Clinton County and then we also have a contract with CVPH as our backup now. So, how is this, and Iím not, and I understand this and I understand how other towns need this and everything, but how am I going to explain this to my constituents on being taxed for this when we already have our coverage? I actually handed out, I sent it to you, Patty, I handed it to Mike and they are actually waiting for a, Patty said that she would have a meeting with our emergency services to see how we were going to benefit from this.

 

DELORIA: Okay, Patty, has that meeting occurred at this point?

 

BASHAW: No, with COVID and stuff, I didnít do the meeting.

 

GILLILLAND: The point is, is it, there are two taxing entities, thereís a town taxing entity and thereís a county taxing entity. The county is, is, you know, determined by the whole Board of Supervisors. The town taxing is determined by the board, the town board, for fire districts, itís the district board and stuff. This is actually a countywide system, therefore it is evenly taxed across, you know, across the county. The system is not set up to be opting out. If you donít want to play or if you donít want the services, fine, but itís still going to be taxed. Itís just like any other service the County provides, whether it be DSS, whether it be the Sheriffís Department, whether it be Public Health, Community Resources, all this is paid for through the County tax system; okay? The way the systemís setup, you donít get to opt out and not pay and not play; okay? Thatís just the way, thatís just the law. If this Board doesnít want this system anymore, you can cancel the whole grant, but donít expect to ever get another one from the State. So, you know, you can sit and weight and measure, howís this going to help my town, if you donít want to play, okay, but itís, this is for the entire county to provide uniformed service throughout the County. If you decide that you donít want to take part and you want to pay more or something else through another entity, thatís up to the town. So, you know, itís not, well, Iím going to opt out, my residents arenít going to pay those taxes. Okay, so those residents are going to get their houses foreclosed on. Itís as simple as that. The system is not set up to have somebody carved out of it. You know, when the town and county tax rates are set, the county tax rate is set.

 

DELORIA: Thatís correct and Iíll just, Clayton, I think you and I had this conversation, that down in Newcomb, I mean weíre somewhat once removed, but weíre still part of the county, but you know, down here, we, we own two vans. One van is used for the senior citizens, has got a wheelchair lift, the other van we utilize for the local recreation program. We have two Honda CRV cars that are all wheel drive that we pay for and we donít tax the County. We donít bill the County to provide some of the services that the County provides from Social Services, for medical appointments and things of that nature. So, you know, I canít nickel and dime the County on what, what Newcomb pays to Essex Countyís levy, just similar to this particular program. This is just another program, countywide, as is our Sheriffís Department. You know, any vision. We certainly take part in that, the Senior Meals Program, but then again, Newcomb, we pay a driver and they use one of our cars to deliver these meals. So, and again, we donít, we donít send the County a bill for that. We can opt in on that, but listen, weíre so far away, why would we, you know? And what we have works now. So, I think maybe if you took that back to your, your fire commissioners and Patty, I think they, I think you should still meet with them. I think the request is there. You should meet with them so that you can explain a little bit more about the program. But, backing up, if you can explain to this committee, as much as we need to know so that we can explain that program. I think everybody would be better off and we have not gotten that data yet.

 

BARBER: And again, like I said, unfortunately, my whole district is in Clinton County. So, Iím paying for this extra service, through CVPH, so I just donít understand how this town, because weíre tied in with them, obviously, what if they say, okay, if you have this County program, we are going to drop the Town of Chesterfield? And so the Countyís going to be responsible and picking this up?

 

GILLILLAND: Yes, thatís correct. Thatís what the system does. They drop you or they drop any town or their service drops out, thatís, then the Countyís on the hook to come in and provide the required services, EMS.

 

DELORIA: Exactly, weíre the safety net.

 

MONTY: I think, Clayton, youíre confusing your service district is in Clinton County, your district that is served, though, is in Essex Count, am I correct? Chesterfield is in Essex County; right?

 

BARBER: Yea, yeah.

 

MONTY: So, whatís being served is in Essex County, the services that you are paying for come out of Clinton County, but like Shaun said, if Clinton County all of a sudden says, now we donít want anything to do with you, then Essex County will come in and take it over.

 

DELORIA: And Clayton, Minerva, the Town of Minerva is no different. The deal that Steve has set up down there was that he would pay Johnsburgh, North Creek, to assist the Town of Minerva with their, with their rescue calls, but Steve has people in place in Minerva, and they have the second ambulance thing going on there. So, that, even though the contract is, is with Warren County, the Town of Johnsburgh, thatís essentially what you guys have got up there and if CVPH or Clinton County says, listen, we donít want to do this anymore, this is the whole purpose of this countywide program, to provide them with a safety net to ensure that every single resident of Essex County has got ambulance service and every single individual that vacations here or is even simply driving through the County, we know that we have that coverage and essentially, I believe that was Randyís vision and thatís why New York State permitted us to do what we have.

 

BARBER: So, okay and then itís going to come to the fact of, so, my ambulance is going to come from Willsboro or Lewis or somewhere instead of across the river, here?

 

DELORIA: Well, we donít know that.

 

BARBER: They come from Peru, which is 4 miles away.

 

DELORIA: We donít know that Clayton. Youíve got that coverage now, we donít, we donít quite know. We donít know how that would play out.

 

BASHAW: And theyíre already getting some benefit of the grant already, when Willsboro/Essex mutual aidís up there or backup coverage for a second calls. So, you guys are already getting some part of the grant.

 

DELORIA: So, we need to see that on paper, Patty, because thatís something I didnít understand and thatís one of the little pieces of this puzzle weíre trying to put together and you know, when you got all these parts missing and you look in the box and thereís nothing there to, to sort through, so we can put that piece in there. Thatís where you guys have got to come in and explain how is Claytonís town, howís the Town of Chesterfield folded into this whole program and that is critical for this Committee to get that information.

 

MONTY: How many times Patty, has your squad responded to Exit 33, an accident, there? Which would really be the Chesterfield district.

 

BASHAW: Definitely above Pok-O-Moonshine, because we both get dispatched.

 

MONTY: Right, I know weíve gone up there several times, so they are being covered by Essex County.

 

BARBER: Right and Iím not denying that there have been some calls there.††

 

DEPO: Weíre in the same situation down in Jay where we pay for our coverage. We have our own ambulance district. I got the same issue, weíre paying and weíre in a partnership with the Town of Black Brook. We pay roughly $500,000.00 for coverage ourselves and then turn around and tell us that weíre going to have a tax through Essex County for coverage, too. Itís kind of a hard pill to swallow.

 

BASHAW: So, I have been in contact with Cory and Sarah up there. They certainly have appreciated the medic car responding up there and he has helped out with good handful of calls, including second calls where your area is covered by the medic car, when the ambulance goes out and I believe so far theyíve had one second call that theyíve taken with your other ambulance and a volunteer. So, again, it is working in that area, as well.

 

DELORIA: Yup, yup and that data, Patty, is what we need to see. Do you see where Iím going with this whole report that you need to generate? So, that these questions of the committee members are answered and I think Jeff Subra has a few question, too. Jeff, did you want to comment on what direction weíre going here?

 

SUBRA: Morning, yes, sorry, this report didnít come in until late Friday, so I took the time this morning, as you were talking to read through it. I wanted to see what Rob had to say.

First question I have is, how many towns, in this report, on number 3, it says each EMS agency bills insurance carriers for their service, how many agencies in Essex County currently bill?

 

BASHAW: So, seven bill with EMR, a couple still do paper PCRs, one uses Medex, and then AuSable Forks, Lamoille does their own internal billing and AuSable Forks uses PCR cloud.

 

SUBRA: So, thatís 11 of the 18 towns.

 

GILLILLAND: Who bills?

 

BASHAW:Who bills?

 

GILLILLAND: The question is, how many, how many agencies bill. I donít care whether itís paper or cloud, or whatever. Whatís the total number?

 

BASHAW: So, Eítown/Lewis does, Lake Placid does, Minerva does through Johnsburgh, Keene does not, Newcomb does not, Lamoille does, Westport does not, Ti does, Saranac Lake does, Willsboro/Essex does, Schroon Lake does, Moriah does.

 

SUBRA: Schroon Lake does not bill.

 

GILLILLAND: Essentially, what youíre saying Patty and tell me if you agree with me, everybody bills except for Schroon Lake and the fire districts; am I correct?

 

BASHAW: Yes

 

GILLILLAND: Fire districts cannot bill, because fire districts ambulance services are prevented by law.

 

BASHAW: Correct

 

MONTY: Shaun, now, Eítown/Lewis ambulance squad contracts with the fire district can they bill or is that because itís a fire district theyíre contracted with, they canít bill either?

 

BASHAW: Eítown/Lewis does not contract with a fire department and if Lewis or Eítown had their own ambulance squad they would not be able to bill.

 

MONTY: You donít contract with Westport?

 

BASHAW: Oh, you didnít say Westport.

 

MONTY: Yes, I did, but thatís alright. Westport?

 

BASHAW: Westport fire district, correct. Theyíre contract is already up.

 

MONTY: But, you canít bill?

 

BASHAW: They cannot bill.

 

GILLILLAND: But, Patty do you bill for those calls?

 

BASHAW: No, unless itís an ALS link-up, like, yesterday afternoon was.

 

DELORIA: Okay, so Patty, this whole billing situation needs to be addressed so that we can understand it completely. Iíll throw Newcomb into the pie, Newcomb is a fire protection district and because the ambulance is part of our fire protection contract we cannot bill. So, that was one of the reasons why Newcomb was certainly interested in opting into this County program, so that there was revenue being generated, which we currently do not have and apparently Schroon Lake is a little bit different, as well as, who was the other town? And apparently thereís, thereís quite a little variation going on with, with the billing aspect of this whole program.

 

BASHAW: I would say 80% of the billing is done by EMR, with the same program and those agencies have been billing for quite a while now. The least, probably, is Willsboro/Essex, around 3 years. So, thatís probably our newest bunch in there, but still theyíve been 3 years.

 

DELORIA: Can we get a report from EMR as so when the 18 towns signed up for their service? I just, just so we can see, as well, when did they drop into this EMR? I guess my understanding when we first met with these people, that they were going to come in and help us with billing that wasnít occurring, but now Iím being told that many of the 18 towns have already been doing this, but can EMR generate a report and tell us when these towns signed up for their service?

 

BASHAW: We can do that or I can ask the agencies and I know for a fact that most of the agencies, Lake Placid, have been doing it for greater than 10 years. Moriah has been doing it for almost 5 or 6 years. I can get general, the general figures.

I guess my, and not to show, let me say this correctlyÖ

 

DELORIA: Right, so if we can get it from EMR. I think thatís what Iím looking for, because thatís the agency, this private company that the County is willing to contract with for our services and I guess my assumption, maybe I havenít been paying attention for two years, that EMR would be doing this billing and somehow the County would be involved in it, but through contracts with the various agencies as itís put out.

 

BASHAW; I did speak with EMR. They would be willing to do the whole County billing. It would be just transitioning agencies over to them. It doesnít really impact them, at all, because the call volume is still there. The problem, maybe, that the agencies may not want to switch over unless we get, like for example, Royís agency uses CAG, theyíre the only ones that use that company. So, it would have to be, you know, a sell with each agency to get them to come over.

 

DELORIA: Whatís the name of the agency? CNT?

 

BASHAW: CAG

 

SUBRA: Patty, we are, our squad is independent now of the fire department and weíre battling, weíre literally battling back and forth, we have, they have not signed their contract for this year for the town, so we will not be funding them in the future. The battle goes back and forth, they cannot bill, because itís in our contract that they cannot bill. We keep requesting, please put something on the table so we can understand your billing process. Zero results, so I finally said no more money. Youíre on your own until we get a signed contract. Number one, we canít remove that condition until you present to us, something to show us how youíre going to bill for our constituents, being that weíre providing 95% of their funding, so Iím just requesting that we get some help. If EMR is a greater part of the County already, I need some help to convince our emergency squad to get on the ticket here, so they can start billing.

 

DELORIA: And what I am saying here is it is very critical, because this, this is a local town, community levy that the local taxpayers are paying for and a contracted squad thatís essentially receiving revenue and they donít want to provide that to the town of Schroon Lake?

 

SUBRA: Theyíre not there yet and Iím just getting frustrated.

My second question is, before I get cut off here. What are the County hours? Iím looking at the schedule that was just sent out and Iíve got one of the two county employees only working 36 hours a week, it looks like. What is an actual EMS work schedule for the benefits and everything? Is my question.

 

BASHAW: 80 hours in a pay period, so figure up for the whole pay period.

 

SUBRA: Yeah, okay, so thatís why theyíre working an extra four hours in that two-week period? Is that what it is?

 

BASHAW: Yup

 

SUBRA: Okay, thank you

 

BASHAW: Those are requests for what they need for coverage.

 

SUBRA: Alright, thank you

 

GILLILLAND: One of the things on the original study, the vision on this, on billing, you know is the fact that fire districts are prevented by law, probably not going to be able to bust through the legislature to change that, even though Betty tried a couple of times, but if we were, if we were able to, once we get everybody settled in this system, and we restructure the contract between the County and the agencies, including the fire districts to essentially read, that a fire district or an ambulance district or an ambulance squad contracts as an agency of the County system, all right?

 

BASHAW: Correct

 

GILLILLAND: Follow me? Then the County under a centralized billing system can bill for all, then return net revenue back to the agency or to the fire district. The fire district itself is not billing, okay? The County has contracted with that fire district to provide EMS services within their area, under the County hat, be it as it was. Follow me on that?

 

DELORIA: Yup

 

GILLILLAND: Therefore, you get more revenue than the seven or so fire districts that are providing services now that donít get it and the money for those systems are coming out of the taxpayerís pockets.

That was the vision of going forward with this contracting, you know, with each of the agencies, and move to a centralized billing system.

 

BASHAW: Correct

 

HOLZER: Yeah, just to follow-up on what Shaun just said. So, in the Town of Wilmington, we have a fire district, but the way it was set-up years ago is the Town of Wilmington actually owns the ambulances and we contract with the fire district to operate through the fire department, the ambulance service, which legally allows us to charge insurance companies. Weíve been in it over 10 years, no longer than that, actually. And weíve generated some serious operating cash to offset taxpayersí expense of operating our system. So, what Shaunís talking about makes a lot of sense for generating revenue, so itís not just going on property tax to fund this system. Thatís just my two cents.

 

DELORIA: Well, thatís correct Roy and you know, who the check comes from, whether it be a fire district or the County, itís irrelevant. The fact that weíre trying to develop this countywide CON, so that we can generate, put together this countywide program for the benefit of everyone. You know, so thereís a lot more to it than meets the eye on this.

 

HOLZER: Itís more of having a standard system. Itís like going into the beginning of this meeting, where I was talking about paying for, billing our constituents where we didnít request the service. I think those things need to be ironed out Patty.

 

BASHAW: So, so the thing is, is, we have multiple goals weíre trying to put in the air. If your agency calls for an ALS link-up or one of your persons from Lake Placid, that person would be billed. That insurance would be billed.

 

HOLZER: Right

 

BASHAW: And thatís exactly whatís happening with the medic car. When they go, the way itís set up, is if they go and are needed on that rig, then that patient will receive a bill.

 

HOLZER: Excuse me, if theyíre self-dispatched and weíre not using then medic car should not be billing our constituents.

 

BASHAW: They are not.

 

HOLZER: Theyíre not? Okay, there was a misunderstanding from your meeting the other day, then.

 

MONTY: If theyíre self-dispatching, weíre actually taking that medic car away from where itís supposed to be, in case thereís a second call, you know, if itís needed, fine, but if itís not needed and theyíre in one area of the area theyíre covering and something happens someplace else and they gotta turn around. They may have been more centrally located at one other time. I mean I donít see them; I donít believe they should be self-dispatching.

 

SUBRA: Hey Jim, I would disagree, because I think, Iíve been on an ambulance, Iíve done, I used to be critical care, so I know what itís like to roll. You automatically roll based on the call and if youíre needed, if you get there and they wave you off, youíre fine, but itís tough if youíre 15 minutes out and you havenít left the barn yet and they need you on a bad accident. Itís better that they roll, but if they get there and they get waved off, there is no charge; right, Patty? Itís no different than what it was before?

 

BASHAW: Correct

 

SUBRA: And because of the logistics where we are in the North Country, I donít disagree with that policy, if theyíre available. I mean if somebody calls up and has a headache, obviously, I doubt if the companyís going to roll to that scene or to that call, but on any kind of heavy medical call or trauma, I would think they would, you know theyíre going to use their judgement to roll out to preempt, and then if theyíre not needed, waved off back into service.

 

BASHAW: It depends on their location, too. But, the other part of that is most of these agencies are only rolling with two people and in some cases the driver is somebody who is elderly, like in Willsboro, like in Westport, you know, like in other towns, so the extra lifting help is very beneficial. And they go back out and or like stay in like Moriah and cover that area until ambulance gets back. So, I understand the self-dispatching part, and we already had that conversation over here and weíre working on it. But, the medic car and we can give you statistics on the medic cars, they have been, if you ask your agencies, they will tell you that they have been extremely beneficial, as with the staffing, obviously, that theyíre getting.

 

DELORIA: And Patty, I believe you did provide some sort of, a form that talked about the charges for lift assist, did I see that, at some point in time?

 

BASHAW: You guys approved those, like 4 or 5 months ago.

 

DELORIA: I donít know when, Iím just saying that there has been a document thatís generated and provided to Mike Mascarenas or whoís actually doing to billing for lift assist?

 

BASHAW: We are not doing billing for lift assist, right now. That is one of the charges that you guys did approve.

 

DELORIA: Okay

 

BASHAW: And quite frankly, it keeps the EMS agency available if only one person needs to go in there to lift that person.

I donít, so I guess particularly with Mike on now, I guess I need, I mean, to do, I guess tell me exactly what you want, because we keep providing information and we spend time on this information, you know we keep going over the same things over and over again and I mean how much in the weeds do you want us to get with everything?

 

DELORIA: Patty, I think, I think whatís necessary is that you and I and perhaps, Mike and Shaun and we can sit down and try to, try to work out, you know I think that youíve provided a great deal to this program since day one and, you know, youíre, youíve got a lot of energy and stuff, but you know the piecemeal approach isnít working on this committee and every supervisor thatís attended and spoke up today, weíre all over the place. So, you know, why donít we, why donít we plan on, you know, can we put together some sort of an email, just to help direct us and we can get together and discuss, you know, what we weíre asking and what Iíve been asking for, probably, at least three months now, to put some information together so that this committee can understand what this program looks like at a glance.

 

SUBRA: Patty, is it possible that we can request ALS rather than just EMTs? That may solve some of the problems that weíre having with E5, as theyíre having with staffing. Because right now weíre staffing with just two EMTs and I think, you know, probably at least 30-35% of our calls are probably ALS. But, I see all the other towns are provided ALS type coverage, we are not. So, Iím wondering if thatís a possibility that we bump up and provide for that higher level service, so Number One, we donít need the chase car, necessarily and secondly, that may resolve some of the problems that E5 is having with staffing.

 

BASHAW: There is a significant issue, as a matter of fact, Tony reached out me, I think it was last week. It was early last week, asking if we could provide ALS. I put it back to him, asking how many people that we wanted and then one of the agenda items that I had on my list was to ask this committee, you know, how do we go about doing that? Do we just charge them the wage, and the County still covers the benefits?

Also, Westport, also this week, the fire district asked me for weekend coverage. So, you know, I want, and again, we need to find out, you know, what you folks feel the mechanism is for providing that additional coverage.

 

GILLILLAND: Patty, but, can you answer the question, please? Can an ALS be provided to Schroon Lake?

 

BASHAW: Yes, absolutely

 

GILLILLAND: Thank you

 

TYLER: So, sitting back and listening to this conversation, of course, my mind doesnít take much to get boggled, but thereís a lot, this is complicated, and when we first started with this project, we knew it was going to be very complicated, we already discussed it and the complexities of this program is kind of overwhelming, especially for, Iíve been in many conversations and Iím still having a hard time following. So, people youíre asking Robin, as far as to get some kind of a documentation so when people do ask us questions about this, so we can answer them to the best of our ability, to, I think thatís a good step forward and I really got to commend everybody on this panel, because this is a tough issue and weíre trying to do something that nobody else in New York State has done.

 

DELORIA: Thatísí correct

 

TYLER: And we got to keep our heads up and work through it and do the best we can and really, I thank everybody thatís on this.

 

DELORIA: Yup, yup and let me use the word pilot, because I remember that being talked about, even when Randy was with us, is that this is a pilot program. You know, here we are, weíre trying to develop this cookie cutter for a County thatís as diverse, widespread and far apart as any county in the State is and itís important when we get this thing rolling and things are working and weíre working the bugs out of it that we have this cookie cutter and Iím telling you right now, we do not have a cookie cutter. We donít have a program at a glance, even this Committee understands. Patty, itís, itís in here for you, we understand that, and you speak from your heart and youíre speaking this program out, but we need that on paper. Thatís where weíre at and the piecemeal isnít working because everybodyís so all over the place, you know?

 

BASHAW: Mike, do you want to speak to that and Robís, Robís overview?

 

MASCARENAS: Well, I do think and I apologize for missing the beginning of the meeting, I had it written down for 9:00 in my calendar, so thatís on me., I screwed up. So, I missed the whole conversation at the beginning, but Iím sensing where that meeting was going.

I do think we, we have needs that are different in every community that weíre dealing with, different asks, different wants and, you know, getting to some level of uniformity is absolutely difficult I think weíre, weíre doing okay. The one thing Iíll say is, the metrics speak to what I believe that the program is actually working; which is our goal, but we do need to understanding in terms of everybody on this group, so we can explain it to the, the greater public and the board as a whole, as to what weíre, how we actually got here and what we need to do to continue.

So, Iím all for trying to simplify things, I know I work with Patty and Rob, regularly on trying to simplify things and what that information is, and how that message gets out. So, I apologize for some of that confusion. I absolutely will take responsibility for, for my role in any of that and I can tell you that we will work on getting you that information you want and doing it in a meaningful way. So, that everybody, whether they agree or not, is one thing, but at least being able to get to a level of understanding, we absolutely need to get there. So, Iíll do whatever you need me to do in terms of doing that.

 

DELORIA: Okay, Mike, we thank you for that. Now, the Committee members, if you would, Clayton, Jeff, Roy, Ike, everybody, if you have questions and concerns that you donít understand about this program, if you would just please email them and what Iíll attempt to do is put together some sort of a template for Mike and Rob and Matt to follow, so that we can get this, again, Iím looking at PowerPoint as a way to go and we can start up from square one and you know, what we began with, what the vision was and how we, how we built this program. And you know, the loose pieces, the whole, the whole nine yards and Mike Mascarenas, thatís what we need, am I correct?

 

MASCARENAS: Yeah, I agree and Dan Palmer and I, for some of you that remember, and did one initially for the entire Board and some of the members werenít on that Board that are on there now and to be honest, Iím interested to pull that up and revisit it, because I think itís pretty much what we presented at that time. Thereís been some subtle changes, some differences in terms of per diems and how thatís shaken out, but I donít think it would take a lot of tweaking of that original presentation that Mr. Palmer and I did to the Board probably a couple of years ago, at this point.

 

DELORIA: I agree with you. Iíll agree with that 100% that, that you know, some of this stuff, Iím not going to say all of it, but some of the stuff that weíve been doing is fitting the original profile of how this County was being built out, this whole program. But some of it isnít working, perhaps correctly or lacks policy, there lacks direction, and again, I think thatís what the Committee was established for. So, that, you know, weíve got eight minds trying to work out the problems and not just laying it on all Patty.

 

MASCARENAS: Sure, yeah and if we had all those questions and where peopleís confusion lies, that would, that would be a really good start to be able to do like a FAQ for everybody and answer those questions.

 

DELORIA: And Mike, I donít want to ask this question, but Iím going to be transparent about it and ask it anyway. We have no idea, right now, what the actual levy amount is going to be per town on this program, say in 2022? Do we have any idea of where weíre at on that?

 

MASCARENAS: We donít have a concrete number, right now. We can absolutely put that together. The difficulty would be in determining the whoís going to be part of it in 2022. So, if youíre assuming everybodyís on board with, we could take that route and that would be how we would prorate our staffing, to get what that levy number would be. Itís not going to be nearly as high as what we originally thought, because most communities arenít utilizing what they need or what we originally thought they would need. When we originally figured it out it was 24/7 paid coverage for every community. Well, thatís not whatís shaking out.

 

DELORIA: Right, right, so for example, like Newcomb, I think you were looking at what the total tax levy is per community, that certainly has a factor in what Newcombís going to pay; correct?

 

MASCARENAS: Absolutely

 

DELORIA: Right and again, I think that weíre pretty well up there on list of full values, as far as all the State land that we have and certainly I have absolutely no qualms about paying into this countywide program to help any other town, you know to help any other town, you know in the County. So, Iím all in, you know.

 

MASCARENAS: Yeah, by the time we get off the grant, Mr. Palmer and I have spoke about this regularly, there are some other things that should be coming off the levy. So, our levy as a whole shouldnít be impacted that heavily, due to the buildings that will be paid off. Now, if other things come up in the meantime, thatís stuff that we have to do, so like, your courthouse, your public safety building, those things are going to end around 2024, 2025, in terms of the bonding and at that time, you know, if we stay around that $2 million figure, is where we thought it was, in terms of the levy impact, we should be able to absorb that without necessarily increasing the county levy at all.

 

DELORIA: Right

 

MASCARENAS: But, the need is going to matter; right? So, if the need climbs, then the number also climbs with it.

 

DELORIA: Well, exactly and I think, when Newcomb gets folded into this, I think that part of the presentation that has to come to this committee is, as you know, how is Newcomb set up, right now? What are they paying right now? What type of overtime are they paying? Now, to me as a supervisor, I look at some of the overtime hours thatís coming out of there and it mind boggles me and the biggest problem is, as weíre, weíre understaffed and those people arenít available. So, if you donít have somebody available, you got somebody sitting in the squad house, watching that HBO, but theyíre ready and prepared and are, they are certainly capable of responding to any emergency we have. However, you know, why are we paying time and a half; okay? When, if this countywide program was structured in such a way that we couldnít pull somebody from another area within the County to help staff that, to reduce the overtime hours? Bottom line, the taxpayers are paying for this and the rescue squads and fire departments are not driving this train, itís our train.

 

MASCARENAS: And thatís still a big unknown for me, personally. I donít know, exactly, Iíve looked at Mr. Subraís stuff, because he has brought it up previously to see what, what Schroon was paying and I know what Robinís been paying, because of what he told me. Iíve heard Clayton speak to what theyíre paying up in Chesterfield, but countywide? I donít know what every community is paying in terms of that. I just donít

 

DELORIA: And another factor that I think we need to see the data on, is like Newcomb, I can tell you right now, weíre about 100 runs a year; okay? Just about 100 calls a year. I donít think it various much to each year. That could change. We could have 200 next year, but I think you can look at the average number of runs and that realistically itís going to determine what type of coverage, see? So, I mean, if we were doing 200 runs I think weíd be having a second ambulance. So, I mean I think thatís the difference that weíre going to see between the Town of Ticonderoga, the Town of Schroon Lake and even the Town of Minerva. So, thatís the type of data that Iím looking for Patty.††† ††

BARBER: Can I ask one more question? So, is everybody going to start off with the same amount of emergency service when you do this? Because this is supposedly a backup program; correct me if Iím wrong. ††

 

DELORIA: No, I donít believe itís a backup program. I think itís a countywide program that, for example, the Town of Minerva currently is opting to get their services from Warren County; okay? However, Minerva, as part of our mutual aid system and Minerva, as part of the county program for providing those services like to say to Newcomb or North Hudson or say, Schroon Lake. So, itís a bigger, I think what youíre asking is not so, itís a countywide program, as Shaun said and thatís how itís being built.

 

MASCARENAS: Yeah, weíre subsidizing staffing is what weíre really doing currently and in those communities that, that need it the most, but as, as Robin said, the mutual aid does play into that a great deal. What I donít know right now is, is how many times, is Willsboro going to Chesterfield? I donít know that.How many time does that have to happen during, during the course of a year? Well, if Willsboroís got some of our staff there and then ultimately theyíre headed to Chesterfield; right? You may or may not know that. So, you know, that information is critical, too, to have for the committee.

 

DELORIA: It is Mike, but I will say this, but itís not critical to the billing, itís not critical to the Town of Chesterfield or the Town of Minerva to be part of this program. I mean, you tell me how many times the Essex County Sheriffís Department has come to Newcomb? And Iíll tell you what, in the last year the only reason they came here was to bring us the PPE, the masks and the hand sanitizers, other than that, I dare say they almost never come. Do you see what Iím saying? So, we canít look at this program and try to micromanage it and say, well, we only sent the fly car up to help Chesterfield six times this year. It could be sixty. We donít know year to year, and thatís why itís a countywide program.

 

WINEMILLER: Robin, this is Davina. I know Iím not a member of this Committee, can I ask a question, please?††

 

DELORIA: You can and Jeff, you can follow Davina.

 

WINEMILLER: Okay, sure, so Iíve been reviewing the documentation, because this EMS thing started prior to me becoming a town supervisor and it was mentioned over and over and over and over again that town could opt out of the countywide system. Now, that hasÖ

 

DELORIA: That was talked about Davina, but was not the Board resolution and itís not part of this program. It was thrown out there.

 

WINEMILLERA: Okay, but I have read that over and over and over, again. So, now I understand that youíre trying to do the countywide system, and Iím hearing things about the billing, the ambulance billing and things like that and no, my thought is when we took on this grant, that it was trying to help those seven towns that needed help get to the point where they could run their own program, using this money to get them up to par and then you know they would take it back over and now it switched over to something entirely different and Iím just curious about the billing and how that would offset the tax levy and would it equal out? I mean, you all know how I feel; okay? But, I donít want to see any town go without what they need and I donít have a problem with that. I have a problem with towns not getting anything and being levied on the taxes for it. But, how much is that realistically? Are we talking about billing ambulance services, insurance I mean, individuals that use that to offset that levy? Do you get what Iím trying to say Robin?

 

DELORIA: Yes, I do Davina, but a lot of the questions that have been raised today and need to be addressed are going to be put forth in a report and I donít think you were on initially, when I asked the committee members and anybody else thatís just participating today, to send, what you just said, send to me in an email; okay?

 

WINEMILLER: Okay

 

DELORIA: Weíll put this stuff together and weíll see if we can develop some sort of a template, so we can put this information together, so that the Committee has time to digest it.

Jeff, you were going to say something?

 

SUBRA: Yeah, Mike, you kind of hit on something and Patty, weíve talked about this briefly, but and this would be a E5 staffing problem from the get go. But, it seems like recently, weíve been called out to do mutual aid to Warren County, more frequently that I hear coming over the scanner in my office. So, again, just another puzzle piece and all of these things, you know, here we are the Countyís trying to provide services, the towns are trying to ante up, but then you know, then it comes to where another county is having issues. Just a question of that moving piece and where now, you know, Iíve got paid services through the County and through the EMS squad and now we get called out of service, weíve got a second ambulance, but then it goes to just volunteer. Just another moving piece that may get questioned if we start backing up other counties, which they do for us, too. I donít know, I understand that, but itís just a unique and Patty, you and I have had this conversation last week. I was just kind of concerned that lately the volume, it could be totally an E5 issue with staffing, but I think it brings up a uniqueness in all of this, because now weíre talking more taxpayer money and such and now we seem to be getting out across the line, so I just wanted to mention that. That may be another moving issue that hopefully weíll get it resolved, but if not, that maybe on the peripheral, you know, especially up in, Clayton, in your area, too, I donít know. But, weíre got to consider that. What the needs are, what weíre providing, when weíre, you know, weíre trying to just keep one paid staff on and that we get called out of the area and weíre kind of vulnerable again, just to mention it. Thatís all.

 

DELORIA: I think mutual aidís important Jeff and Iím glad that you brought that up.

Letís see, unless somebodyís got some other questions, letís try and bring this meeting to a conclusion. Mr. Rand, I see you joined us. Do you have anything for us today?

 

RAND: Yeah, I joined the conversation a little late. I also thought it was 9:00, sorry about that. Iím not a committee member, but itís always interesting and Iíve spoke with Patty, and Patty came up and filled us in on the program that youíre been discussing. So, Iíve got a better understanding of it and certainly I think itís a good direction that the Countyís moving on and I would agree that a countywide program is a good thing. Iím not sure how, at this point, Iím not sure how deeply involved North Elba will be, but certainly Iíll keep in touch with Patty and I used to work with Roy quite a bit when I was manager of Whiteface and I think that was one of the toughest things, just keeping, well I mean we would pack two in an ambulance at the same time and the volunteers there were just worn down. After that we started paying to have an ambulance just on-site that we leased. So, definitely thatís a great thing to address so we can all get on the same page.

 

DELORIA: Yup, Patty, just to emphasize the purpose of putting this, this whole thumbprint program together, is I know nothing about what happens in North Elba, on this program. I have no clue whether theyíre even part of it. How many people we have up there. What type of equipment we have up there? Are they part of the fly cars? Do you see where Iím going with that? And itís not that I havenít been paying attention, itís just that the Committee needs to have this in booklet form, so that we can, you know, make this a successful program. I think weíre off it a good start, but I think, right now, and I will say this as Committee Chair, this thing can go right into the shredder if weíre not careful. So, how bad do we want this? See what I mean? Whereís the benefit countywide? I see a great benefit, but weíve got to get this together, so that everybody that sits at this Committee understands how important it is and where everybodyís folding into it, including my little town, down here in Newcomb. I want to be a part of this, but itís not my time, yet, I understand that.

So, did anybody else have anything they wanted to add, at this time? If not, weíll stand adjourned and I think we have Ways and Means at 10:00.

 

AS THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS TASK FORCE IT WAS ADJOURNED AT 10:00 AM.

 

 

Respectively Submitted,

 

 

 

Dina Garvey, Deputy Clerk

Board of Supervisors