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, Iíve got the agenda is updated from the one that was emailed out, Monday. Mainly itís where some of the staff have been located.
And the other handout, we mentioned, so this is kind of piggybacking off of last monthís 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. Itís 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 weíre 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 itís come up a lot of the course of the last several years, like we talked about in the last meeting and thereís reasons why it didnít 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, weíll hopefully have some good feedback and be able to provide information to the committee and figure out the next steps.
WATTS: Yeah, weíre going to send that out today. Unless thereís any changes that anybody thinks that we should do to it, weíll 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: Thatís a nice memo and at least it will get their direct engagement, one way or another.
DOTY: Iím even crossing my fingers.
MERRIHEW: Hopefully, theyíll all come back blank, they donít need anything.
WICK: So, just kind of checking that box from last month.
A couple of updates, weíre 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.
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?
WATTS: So, they probably had to wait until their meeting to be able to do that.
WATTS: So, we got a lot of them back. Iím waiting to get them all back and then Iíll bring down and Mike will sign them and then weíll them all back out.
WOOD: Itís fine, we just have to rubber stamp it.
WICK: Thereís still the three outstanding requests for support that we havenít really gotten any formal letters back in yet. I think the one for Willsboro/Essex is addressed, because thatís a split position with Moriah, now, correct?
WICK: Thatís still outstanding?
WATTS: The split with Moriah is just still the 40 hours; itís just different people splitting it.
WICK: Okay, so itís one bill, itís just multiple people filling it?
WICK: Okay, gotcha.
MERRIHEW: Specific for Moriah?
WATTS: Specific for Moriah and Willsboro.
WATTS: We do have some updates for some of the training on the calendar, for the first half and one thatís 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, theyíre 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, weíre 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, weíve also detailed some of the work with the fire departments. So, thatís listed under Task One, as just kind of an update to that, instead of new stuff thatís going on, at the top of the agenda. So, that had been an agenda item that was out for a while, but now weíre 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 thatís happening now and then also, thereís an initiative to try and update some policies so that thereís more of a, kind of a conformed dispatching protocol with fire department and EMS for like cardiac arrest calls and stuff like that. So, weíll 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 arenít quite so dispersed and weíre trying to read through whoís where and what weíre doing and those sorts of things, just separating the county people from the contract specific operations.
I think thatís pretty much it, as far as anything new that weíve 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 wasnít 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: Thatís 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, thatís 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 í24.
MASCARENAS: The end of í24. So, at some point though in í24 will be have to subsidize the grant with local dollars? Too early to tell?
WICK: I would say yes, itís too early to tell, only because we donít quite know how the moneyís going to fall in terms of when we start getting all back. I mean, you could argue that right now itís 100% subsidized by the County just based on how slow.
MASCARENAS: Because they donít 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, thatís 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 weíll pay off at the end of 2024, into 2025 that we can hopefully shift over into other areas, which is why, you know, when weíre getting hit with some of these asks from other places, I think weíve 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 youíre 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 donít know which year is which.
MASCARENAS: So, how do we pay for those now? We pay for those through mortgage tax, transfer tax and local dollars. Thereís 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 doesnít pay for all of our debt. Thereís 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 weíll see when the time comes. So, itís something that weíve got to keep in mind, long-term and realize that anything we do is going to ultimately have an impact on something that isnít currently being absorbed in the budget, because itís being paid for grant dollars.
DOTY: So, back to our EMS total program. Iím trying to put a handle on, is there any other county like Essex that is trying to prove this new?
DOTY: We are it?
MASCARENAS: We are it.
DOTY: So, Iím guessing between the end of this year and the end of í24 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 Stateís looking for us to pilot is sort of thing.
DOTY: I mean am I looking at it wrong?
MASCARENAS: No, youíre not. Thereís a, you are when it comes to dollars being picked up by them, because thatís donít going to happen.
DOTY: Iím not suggestion $12-$14 million, but recognizing a successful system would garner support in the legislature, Iím guessing.
TYLER: No, that wonít work, common sense.
MASCARENAS: Right now, the answerís 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. Thereís going to be one/two grants that you get that go away.
DOTY: Other than that, itís getting handed over to counties.
MASCARENAS: Other than that itís going to be a local decision on just like any other service that we provide. Itís 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 thatís why things like these per diem letters that are going out are so critical. Long-term itís not a 24/7 operation, countywide really is not cost sustainable, itís just not.
TYLER: There are going to be a lot less people living here, because theyíre doing away with healthcare, unified is doing away with there and thereís 1,000s of people that have that health insurance.
MASCARENAS: I saw that.
TYLER: Itís crazy
MASCARENAS: I donít know what it means, yet. I havenít looked into it, but I did see that.
So, I donít think the opportunity for us to take advantage, thereís 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: Youíre 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 thatís an allocation, somebody else is paying for, itís not coming from the tax levy.
MASCARENAS: Right, provided the need doesnít accelerate to a level where, thatís 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 wouldnít be a big deal. But, looking 5-6 years down the road without having a robust per diem system and still have some volunteerism, itís 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, itís 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 weíre going to protect this critical service.
MERRIHEW: And this needs to remain one of our priorities, it just has to.
MERRIHEW: Weíre to a point now, thereís no possibility of, you know, we gave that a shot.
MERRIHEW: Now weíre going to go back, it ainít there.
MASCARENAS: And getting back to what youíre 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: Iím 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: Itís helped. Itís definitely helped with the coverage of the advanced life support part of it.
WATTS: Where agencies donít have to have their own 24/7 paramedics inhouse and stuff, we provide that.
WATTS: Itís definitely helped with that.
MASCARENAS: Itís 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 theyíre 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 havenít 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 theyíre not getting the money, theyíre actually billing everything they should be?
WATTS: I couldnít tell you.
MASCARENAS: Thatís a great question.
WATTS: Iím not aware of any large increases, but I can certainly find out.
STANLEY: Iím 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 weíve had.
MASCARENAS: Wow, I can tell you that Shaun went to a district in his town, I donít know, itís 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 donít know if maybe youíre 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 youíre, depending on what community you live in and what number of those individuals, the insurance theyíre carrying, absolutely impacts what you get back. So, maybe theyíre seeing an increase.
STANLEY: Well, Iím just wondering if theyíre 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, youíre not getting a 33% increase this year, youíre only getting a 20% increase and Iím just wondering if theyíre maybe actually billing properly now.
MASCARENAS: That seems like a pretty good rate.
WATTS: So, they were getting $15,000.00-$18,000.00 and now youíre 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 heís like, a lot of theirs are just Medicaid.
STANLEY: Heís like, up in Jay you should be getting more insurance payments than Medicaid payments.
STANLEY: So, I was going to send the stuff over to him to look at, but I can forward all of last yearís stuff to you.
WATTS: Yeah, would you?
STANLEY: And forward over what we got this year.
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.
MASCARENAS: And thatís where billing is critical. I think you just started not that long ago? Are you seeing a good amount or donít you really know?
WOOD: Theyíre 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 thatís what weíre seeing.
TYLER: Westportís just going to be starting to bill, they havenít hired a company, yet, but theyíre in the process of going to billing.
TYLER: Thatís good
MASCARENAS: It is critical. I thinkÖ
TYLER: I know when we first met with them, they were against it.
WATTS: I donít 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 dadís there? I think thatís something to do with that. I donít 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, thatís 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, itís a lot of those things firefighters donít want to give up, like they donít want help. Theyíre 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 wonít 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, theyíre similar type organization. They donít 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: Thatís 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 thatís taking a load off of them. I spoke to the leadership down there, the end of last week, so thatís working out really well, even though itís only been a couple of weeks. Itís taking a load off.
MERRIHEW: Thatís good. I see them every other day, theyíre busy.
WATTS: Yeah. Moriahís really busy.
MASCARENAS: So, Matt are you absorbing Bryseís duties for now?
WATTS: Yes, between myself and Michael being the senior medic. Heís 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.
TYLER: Thereís some misunderstandings between the hospital and theÖ
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 theyíre 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?
DOTY: Thatís what you were worried about?
MERRIHEW: Yeah, it was the rumor that you know they werenít utilizing it and the insurances were getting, so itís 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 realisticallyÖ
WATTS: There was only one or two.
TYLER: There wasnít.
MERRIHEW: Anything else? And so youíre taking over Bryseís meetings?
WATTS: For the moment.
MERRIHEW: You got a list?
WATTS: There was a test on January 14th, so weíll 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.
Dina Garvey, Deputy Clerk
Board of Supervisors