EMS Subcommittee
Monday, February
27, 2023 - 9:00 am
Robin DeLoria - Chairman
Supervisor Merrihew called
this EMS Subcommittee to order at 9:03 am with the following in attendance: Derek
Doty, Noel Merrihew, Matt Stanley, Ike Tyler, Meg Wood, Mark Wright, Matt Watts
and Mike Mascarenas. Robin DeLoria had been previously excused.
Also present: Dina
Garvey, and Rob Wick
MERRIHEW: We will call
this meeting to order.
WICK: So, I’ve got the
agenda is updated from the one that was emailed out, Monday. Mainly it’s where
some of the staff have been located.
And the other handout, we
mentioned, so this is kind of piggybacking off of last month’s meeting. We had
talked about getting a letter out to all the agencies that have requested some
of the per diem program involvement. So, attached is what we have. It’s a
letter that kind of goes through a bit of preamble and kind of explains what we
need from the agencies and why and then on the backside is basically the
information that we’re requesting from the agencies. The number of active
members. The number of per diem candidates with each type of positions and then
the names and certification levels of the people that are from the agency,
acknowledging they want to be a part of the per diem program. So, you know it’s
come up a lot of the course of the last several years, like we talked about in
the last meeting and there’s reasons why it didn’t move forward. So, this is
kind of our latest opportunity to get the buy-in from those agencies and
understand that their needs are and also have them identify what their level of
availability is to participate in the program, because absolutely, regardless
of money we need people and certification levels and their willingness to
actually be a part of the program. So, I think these guys are going to be
sending that out, every soon. So, hopefully by the time we have our next
meeting here at the end of March, we’ll hopefully have some good feedback and be
able to provide information to the committee and figure out the next steps.
WATTS: Yeah, we’re going
to send that out today. Unless there’s any changes that anybody thinks that we
should do to it, we’ll set that out today. I am going to put a date of, I
think, March 20th, to get it back so we have a week before to be
able to process everything for the meeting on the 27th.
MERRIHEW: That’s a nice
memo and at least it will get their direct engagement, one way or another.
WATTS: Hopefully
MERRIHEW: Good
DOTY: I’m even crossing
my fingers.
MERRIHEW: Hopefully,
they’ll all come back blank, they don’t need anything.
WICK: So, just kind of
checking that box from last month.
A couple of updates,
we’re still waiting on a couple of contracts to make their way around to get
them signed by both the agency leads and the towns. Obviously, all of the
support is still moving forward.
WOOD: We have a meeting
today.
WATTS: Okay
WOOD: At 1:30.
WATTS: Perfect. So, we
got a lot of them back.
WOOD: I just got it last
week.
WATTS: It was given to
Schroon Lake like 3 or 4 weeks, ago. Did they sign it Yet, on their part, the
agency?
WOOD: Yeah
WATTS: So, they probably
had to wait until their meeting to be able to do that.
WOOD: Yeah
WATTS: So, we got a lot
of them back. I’m waiting to get them all back and then I’ll bring down and
Mike will sign them and then we’ll them all back out.
WOOD: It’s fine, we just
have to rubber stamp it.
WATTS: Perfect
WICK: There’s still the
three outstanding requests for support that we haven’t really gotten any formal
letters back in yet. I think the one for Willsboro/Essex is addressed, because
that’s a split position with Moriah, now, correct?
WATTS: No
WICK: That’s still
outstanding?
WATTS: The split with Moriah
is just still the 40 hours; it’s just different people splitting it.
WICK: Okay, so it’s one
bill, it’s just multiple people filling it?
WATTS: Yeah
WICK: Okay, gotcha.
MERRIHEW: Specific for
Moriah?
WATTS: Specific for
Moriah and Willsboro.
MERRIHEW: Okay
WATTS: We do have some
updates for some of the training on the calendar, for the first half and one
that’s kind of put out there for the fall for North Country Community College.
So, the certified first responder course is going to be the 4th of
March at Public Safety and then North Country Community College has three on
the calendar, so far. Basic EMT on the 4th of March and new EMT
training on April 4th, at the Ti Campus, both of those are at the Ti
Campus.
And then, Mike Watts sent
out a note about some community outreach, they’re working with Essex County
Public Health to provide the bag value masks. We did some, we helped them out
with bulk procurement through the County contracts, so they could get some gear.
So, we’re now just trying to get them all fitted and get the squared away with
training and usage and also some of the law enforcement members. And later on
in this document, we’ve also detailed some of the work with the fire
departments. So, that’s listed under Task One, as just kind of an update to
that, instead of new stuff that’s going on, at the top of the agenda. So, that
had been an agenda item that was out for a while, but now we’re kind of
reengaging after, you know, all the post Covid busyness and trying to get a lot
of other stuff off the table. So, the CPR and AED training with the fire
departments that’s happening now and then also, there’s an initiative to try
and update some policies so that there’s more of a, kind of a conformed
dispatching protocol with fire department and EMS for like cardiac arrest calls
and stuff like that. So, we’ll have some more developments on that soon.
Beyond that, we did
update some of the roasters for the folks that moved around a little bit and
kind of simplified some of that. It was admittedly a bit convoluted where we
had some of the medic cars dispersed throughout. So, you can see on the left
column that tasks are a little bit out of order, but we have grouped medic cars
operations together, just so it makes a little bit more sense. This aren’t
quite so dispersed and we’re trying to read through who’s where and what we’re
doing and those sorts of things, just separating the county people from the
contract specific operations.
I think that’s pretty
much it, as far as anything new that we’ve identified in here. Does anybody
have anything else that they wanted to go over, any lingering comments or
concerns from the last meeting or anything new?
MASCARENAS: Just a couple
of things. The North Country trainings seemed to be pretty successful?
WATTS: Yeah, I believe
everybody in the first class, well, it wasn’t North Country, but the last class
that Dakota just finished in Crown Point, I think everybody passed, except for
one, maybe two at the most and they got to retest. So, I think there was like
13 that came out of that.
WOOD: That’s good.
MASCARENAS: That is good.
WATTS: Yeah, it was a
really good class.
MASCARENAS: I think the
combined efforts of everybody I think are starting to ramp up, finally to what
we thought it might be in terms of getting individuals trained and in the
system and be able to sustain that over time. So, that’s a good think.
The other thing I want to
start preparing the Board for and this Committee is, Rob, this grant ends this
year, correct?
WICK: No, the end of ’24.
MASCARENAS: The end of
’24. So, at some point though in ’24 will be have to subsidize the grant with
local dollars? Too early to tell?
WICK: I would say yes,
it’s too early to tell, only because we don’t quite know how the money’s going
to fall in terms of when we start getting all back. I mean, you could argue
that right now it’s 100% subsidized by the County just based on how slow.
MASCARENAS: Because they
don’t pay it back. Okay, alright, so just for a reminder for the Board. The
plan long term and this is all going to depend on the ask from the agencies is
really to try to absorb this in the budget without having a major impact on our
constituency, that’s our goal. Well, how do we do that? We do that through not
going into debt in other areas and paying off debt. We have debt that we’ll pay
off at the end of 2024, into 2025 that we can hopefully shift over into other
areas, which is why, you know, when we’re getting hit with some of these asks
from other places, I think we’ve got to realize what our long term plan is for
financial help.
TYLER: What big debt is
that?
MASCARENAS: What was
that?
TYLER: One or two
specific things that you’re going to be out of?
MASCARENAS: Yes, sir. One
of the bonds is paid off in 2024 and one in 2025. Those are the radio bond and
the jail bond. I don’t know which year is which.
TYLER: Right
MASCARENAS: So, how do we
pay for those now? We pay for those through mortgage tax, transfer tax and
local dollars. There’s a combination of that. One thing, Dan Manning and I are
working on is hopefully reintroducing a local law that will allow us to shift
that mortgage transfer tax into infrastructure, such as bridges. Bridges are
something that we typically bond for. So, if I can manage to get that
reallocated and repurposed into local infrastructure, I can avoid that debt
long-term and the local dollars that we use. So, the transfer tax doesn’t pay
for all of our debt. There’s an amount of local dollars that go into that, too.
In the tune of around $2 million. We can shift that to the EMS program. Now, it
may take a one-time hit on our fund balance to be able to bridge that gap
between all the debt being paid off and being able to transfer all that tax
over, but we’ll see when the time comes. So, it’s something that we’ve got to
keep in mind, long-term and realize that anything we do is going to ultimately
have an impact on something that isn’t currently being absorbed in the budget,
because it’s being paid for grant dollars.
DOTY: So, back to our EMS
total program. I’m trying to put a handle on, is there any other county like
Essex that is trying to prove this new?
MASCARENAS: No
DOTY: We are it?
MASCARENAS: We are it.
DOTY: So, I’m guessing
between the end of this year and the end of ’24 when funding runs out, we have
to present a case in order to survive? I mean we talked about $12-$14 million,
straight up costs. If New York State was to recognize the success of this
program, I take it, it would be a feather in the cap for a lot of the State.
MASCARENAS: Yeah, I think
New York State’s looking for us to pilot is sort of thing.
DOTY: I mean am I looking
at it wrong?
MASCARENAS: No, you’re
not. There’s a, you are when it comes to dollars being picked up by them,
because that’s don’t going to happen.
DOTY: I’m not suggestion
$12-$14 million, but recognizing a successful system would garner support in
the legislature, I’m guessing.
TYLER: No, that won’t
work, common sense.
MASCARENAS: Right now,
the answer’s going to be no. There are some grant programs that I think we can
take advantage of it to hopefully sustain things, such as equipment and those
types of things, long-term. There’s going to be one/two grants that you get that
go away.
DOTY: Other than that,
it’s getting handed over to counties.
MASCARENAS: Other than
that it’s going to be a local decision on just like any other service that we
provide. It’s going to be up in the air for debate on how that goes on an annual
basis and what levels the Board can fund that at reasonably and be sustainable
and I think that’s why things like these per diem letters that are going out
are so critical. Long-term it’s not a 24/7 operation, countywide really is not
cost sustainable, it’s just not.
TYLER: There are going to
be a lot less people living here, because they’re doing away with healthcare,
unified is doing away with there and there’s 1,000s of people that have that
health insurance.
MASCARENAS: I saw that.
TYLER: It’s crazy
MASCARENAS: I don’t know
what it means, yet. I haven’t looked into it, but I did see that.
So, I don’t think the
opportunity for us to take advantage, there’s no State funding streams set
forward now or in the future that would take care of that.
MERRIHEW: And for them to
open the door for 62 additional counties that was in there.
MASCARENAS: Yeah, they
just took all of our Medicaid money.
MERRIHEW: Right, basically
MASCARENAS: At the tune
of $800,000.00.
MERRIHEW: You’re right,
but with our debt service for the mortgage tax and all of that, like we have
done with the radio system and the Public Safety Building the constituents will
be served, because that’s an allocation, somebody else is paying for, it’s not
coming from the tax levy.
MASCARENAS: Right,
provided the need doesn’t accelerate to a level where, that’s far beyond where
we are now, because any further introduction of cost or need is going to have
to be absorbed somewhere by somebody and where does it come; right? Right now I
think we could handle it, if it was today, looking at what their budgets are
and it wouldn’t be a big deal. But, looking 5-6 years down the road without
having a robust per diem system and still have some volunteerism, it’s going to
be difficult to absorb it long-term.
DOTY: Just as a side
note, somewhat related. You know, Roy has been successful in getting a zoom
meeting with State officials, Linda Beers will be on it and that is going to
happen, Wednesday, I think at 1:00, it might be 4:00.
MASCARENAS: What are the
subjects?
DOTY: The closure of the
ER in Lake Placid, which directly affects our ambulance service and Wilmington,
as well.
MASCARENAS: So, it’s just
for everybody to start thinking. I know we get hit with a lot of things at the
Board. Somebody comes and says, hey, I need a half a million dollars, what does
that mean long-term, how we’re going to protect this critical service.
MERRIHEW: And this needs
to remain one of our priorities, it just has to.
MASCARENAS: Yeah
MERRIHEW: We’re to a
point now, there’s no possibility of, you know, we gave that a shot.
WATTS: Right
MERRIHEW: Now we’re going
to go back, it ain’t there.
MASCARENAS: And getting
back to what you’re talking about, Derek, yes, people are watching us. How are
we doing it? How are we getting it done and are we able to accomplish it?
DOTY: I’m so new to
learning this whole system, but my impression is that fly cars have really
taken the burden off so much of the cost.
WATTS: It’s helped. It’s
definitely helped with the coverage of the advanced life support part of it.
DOTY: Right
WATTS: Where agencies
don’t have to have their own 24/7 paramedics inhouse and stuff, we provide
that.
DOTY: Sure
WATTS: It’s definitely
helped with that.
MASCARENAS: It’s helped a
lot with the second calls.
WATTS: And second calls,
yes.
MASCARENAS: When agencies
are out and we can pull in a medic car right behind it, to deal with that until
they’re back in service.
WATTS: That happens
frequently in Moriah. Moriah always seems to get second calls.
STANLEY: Has there been
an increase in like payback to ambulance services, well, like the medics we get
those AuSable Ambulance Service. I get everyone of their paybacks, every two
weeks from their billing, a copy of that. Our contract is sort of setup so that
if we hit a certain amount, we get that back. Last year I seen bi-weekly
payments not really exceeding $15,000.00, maybe $18,000.00 every two weeks. We
haven’t paid AuSable Forks Ambulance Service their contract, yet, because,
well, for several reasons, but their medic payments, just in the last month
have been $49,000.00 and $29,000.00. So, has there been increases or something
in those payments back or are they, maybe, no that they’re not getting the money,
they’re actually billing everything they should be?
WATTS: I couldn’t tell
you.
MASCARENAS: That’s a
great question.
WATTS: I’m not aware of
any large increases, but I can certainly find out.
STANLEY: I’m hyper-aware
of this, because of the audit we just had with OFC. So, we had to pull all
those records and everything. So, I had every single one from last year pulled
out and we had nothing close to the last few payments we’ve had.
MASCARENAS: Wow, I can
tell you that Shaun went to a district in his town, I don’t know, it’s going to
be longer than I told you, 4-5 years ago and initially that district was going
to be quite expensive. When they started, billing and realizing what that
billing was bringing in, it went down to maybe $50,000.00 a year?
WATTS: $50,000.00 to
$70,000.00, something like that.
MASCARENAS: But, it was
projected to be much, much higher.
WATTS: Several hundred
thousand.
MASCARENAS: But, he gets
more private pay and I don’t know if maybe you’re seeing more of that up in
your area. The private pay bill or private insurance billing is much higher
than what Medicaid/Medicare, so if you’re, depending on what community you live
in and what number of those individuals, the insurance they’re carrying,
absolutely impacts what you get back. So, maybe they’re seeing an increase.
STANLEY: Well, I’m just
wondering if they’re actually billing more, because they have to borrow some
money at the end of last year and we sat down at the table and I said, you’re
not getting a 33% increase this year, you’re only getting a 20% increase and
I’m just wondering if they’re maybe actually billing properly now.
MASCARENAS: That seems
like a pretty good rate.
STANLEY: Yeah
WATTS: So, they were
getting $15,000.00-$18,000.00 and now you’re saying about
$30,000.00-$40,000.00?
STANLEY: I mean, Bryse
and I had a conversation after the last meeting and he said he would look over
the stuff from last year, because he was talking about the amounts that Moriah
was getting and he’s like, a lot of theirs are just Medicaid.
WATTS: Yes
MASCARENAS: Right
STANLEY: He’s like, up in
Jay you should be getting more insurance payments than Medicaid payments.
MASCARENAS: Right
STANLEY: So, I was going
to send the stuff over to him to look at, but I can forward all of last year’s
stuff to you.
WATTS: Yeah, would you?
STANLEY: And forward over
what we got this year.
WATTS: Sure
STANLEY: I want to make
sure our taxpayers are getting all the money that they deserve for that
service. Then maybe we can offer something more.
MASCARENAS: And it
reduces the cost for the overall system.
STANLEY: Absolutely
MASCARENAS: And that’s
where billing is critical. I think you just started not that long ago? Are you
seeing a good amount or don’t you really know?
WOOD: They’re getting
lots of money, lots of money. Last year they projected maybe
$40,000.00-$50,000.00 and I think they might have ended up with $120,000.00.
MASCARENAS: Yeah and
that’s what we’re seeing.
TYLER: Westport’s just
going to be starting to bill, they haven’t hired a company, yet, but they’re in
the process of going to billing.
TYLER: That’s good
MASCARENAS: It is critical.
I think…
TYLER: I know when we
first met with them, they were against it.
WATTS: I don’t know what
changed, but they reached out to me to ask me, you know, questions about.
TYLER: Have you seen that
commercial on tv where the dad tells his son what he should do with insurance and
then the tv dad’s there? I think that’s something to do with that. I don’t know
why I thought of that, but it seems parallel.
WATTS: They reached out
to me last week and I can them some recommendations.
TYLER: Great, that’s good
news.
STANLEY: Another thing
while I was at the Association of Towns, the best training I went to was saving
our fire districts, saving the fire service and there was that, that speaker
was from a law firm and it was a really, really good discussion that, even if
we brought him in here, I think it was be great.
WATTS: Who was it? Do you
remember?
STANLEY: I want to say
from Penske Law?
WATTS: Yup, so actually
Mike and I are going to a conference, later this week for, with Penske Law
about this and I think that might be one of the topics in the thing, too.
STANLEY: It was the best
thing I took from the entire time I was there, and being a firefighter, myself,
it’s a lot of those things firefighters don’t want to give up, like they don’t
want help. They’re too proud for help, but a lot of good points were about
helping fire departments with admin services and training and not so much
recruitment, but more retention and so it was really informative. I think the
sooner we get on that, hopefully our fire service won’t be where our EMS
service is.
WATTS: Only to get off
topic for just a second from EMS with fire. We had a meeting two weeks ago with
all the chiefs about training and stuff and it was a really good meeting, 21
out of the 24 fire departments showed up for the meeting, which I thought was
outstanding, I was very pleased with it. It was a 3-hour long meeting that we
had with them and we got a lot of information out from the chiefs on what they
need for training and stuff and we met with the State instructors and all that
stuff. It was a really good meeting. So, hopefully that will help with training
and stuff, too.
STANLEY: I think a lot of
those same aspects will also carry over to some of these EMS departments, too,
because once again, they’re similar type organization. They don’t want help,
but they need it. So, I think if we can start to just put out the olive branch
and say, maybe let us try and take some of that admin off your plate, so you
guys can focus on training and calls. That was a big thing I took out of there,
because we become firemen, so we can go to calls and train to go to those
calls, but we spend a lot of our time in the admin functions and fundraising
and all those things that start to wear on you.
MASCARENAS: That’s a good
point.
MERRIHEW: Any further
questions or comments for EMS?
WATTS: I know Moriah is
really happy with the 3rd person that we put on down there that’s
taking a load off of them. I spoke to the leadership down there, the end of
last week, so that’s working out really well, even though it’s only been a
couple of weeks. It’s taking a load off.
MERRIHEW: That’s good. I
see them every other day, they’re busy.
WATTS: Yeah. Moriah’s really
busy.
MASCARENAS: So, Matt are
you absorbing Bryse’s duties for now?
WATTS: Yes, between
myself and Michael being the senior medic. He’s doing like the scheduling and
the QA, QI and all that kind of stuff.
TYLER: Matt, do you want
to discuss, maybe just hit on the subject of the meeting we had with the
hospital?
WATTS: Oh, yes. So, we
did meet with the hospital. Ike was there, they are using the hallway. I mean I
think there was a lot of miscommunication.
TYLER: There was.
WATTS: A lot of
misinformation out there. We got it clarified within 5 minutes of the meeting.
TYLER: I think they
recognized the fact that they need to work together, even a little more.
WATTS: Yup
TYLER: There’s some
misunderstandings between the hospital and the…
WATTS: The ER staff and
the nursing home.
TYLER: It was a good
meeting, I thought.
WATTS: I thought it was a
really good meeting. You know, some of the concerns were the delay between the
nursing home calling the hospital saying, we need the door open and the
hospital sending stuff that they’re already short on, down there and then
having to wait 10 or 15 minutes. So, hopefully that communication will get a
little better and stuff. I thought it was a positive meeting and we got some
more information out of it than I thought we would.
DOTY: So, no loss of
service?
WATTS: No
DOTY: That’s what you
were worried about?
MERRIHEW: Yeah, it was
the rumor that you know they weren’t utilizing it and the insurances were
getting, so it’s good that that was all resolved.
TYLER: I just had an EMS
guy in my office from Westport, telling me that they were taking all kind of
calls out there and realistically…
WATTS: There was only one
or two.
TYLER: There wasn’t.
MERRIHEW: Anything else?
And so you’re taking over Bryse’s meetings?
WATTS: For the moment.
MERRIHEW: You got a list?
WATTS: There was a test
on January 14th, so we’ll see what comes out of that.
MERRIHEW: Anything
further? Questions? Comments? Thank you all very much, we stand adjourned.
AS
THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS SUBCOMMITTEE, IT WAS
ADJOURNED AT 9:29 AM.
Respectively Submitted,
Dina Garvey, Deputy Clerk
Board of Supervisors