Monday, March 27, 2023 - 9:00 am
Robin DeLoria - Chairman
Chairman DeLoria called this EMS Subcommittee to order at 9:00 am with the following in attendance: Robin DeLoria, Derek Doty, Shaun Gillilland (9:02), Noel Merrihew, Jim Monty, Ike Tyler (9:06), Meg Wood, Mark Wright, Matt Watts, Michael LaVallie and Mike Mascarenas.
ALSO PRESENT: Dina Garvey, and Rob Wick
DELORIA: Weíll start. Okay, Robert, Iím going to try it right over to you for the agenda and move through it.
WICK: Okay, good morning. So, for today, this month we actually donít have a whole lot of new information to put forth. A lot of the information that we have in there, in the agenda has been, itís just kind of an update to some of the stuff that weíve got. A handful or more of the contract renewals have been fully executed, but there are still some that are outstanding.
WATTS: Actually to update you. I think these are in now.
WICK: Oh, they did come in? Okay, great.
We might have all of them executed.
WATTS: The contract renewals, I believe we have them all.
WICK: I just didnít see them in the purchasing shared drive, yet. So, they just havenít been digitally entered into the system, but we will get them all loaded in there. So, thatís all good.
I think weíre still looking for one more medic car positions and I donít know if we have anymore staffing positions that are still open?
WATTS: Nope, weíre kind of full right now. Weíre also looking for per diems. I donít know if we need, are we limited on the amount of per diems that we can have?
DELORIA: Thatís a Rob question.
WICK: Not necessarily, not that I know of, no, because theyíre all just kind of this rolling, you know, part timer type position. So, I donít know that thereís been anything that defined the amount of per diems that we allotted. We just kind of have a budget for it. I blocked budget for that.
WATTTS: Right, but thereís no limit on the number of?
MERRIHEW: Until that budgetís gone.
WICK: Right and even with last year, we had quite a bit of that budget allocation that carried over, that was unused. I mean there was maybe $10,000.00 or something like that in total use, that wasnít much at all.
MERRIHEW: But, I would hate to lose an interested per diem to represent if we can lock them in someplace.
WATTS: Right, thatís why I was wondering if there was a limit on it.
MERRIHEW: Itís good to have that backup.
WICK: And I can actually, we can piggyback on that topic, toward the bottom, the per diem volunteer thing, so far only Keene has responded with a complete roster. The letter that we brought forth, last month that we were going to put out to all the agencies. All those went out, but so far only Keene has responded and you know, that was actually good that they did, positive that they responded. They got their whole list of volunteers that signed up and were ready to be a part of that, so thatís encouraging. We just wish we had about 13-14 more of them.
DELORIA: So, a subsequent letter, you think, phone call.
WATTS: I know Michaelís working on it.
DELORIA: The other Michael.
MASCARENAS: He had a couple of inquiries, right?
WATTS: He had some people that asked him questions about it and thereís supposed to be getting back to him, but we havenít gotten anything formal, like we did from Keene, yet. But, there is talk out there and chatter about it. He will follow up before the next meeting on it.
WICK: Have there been any updates on the two training events that have started? The first responder course that started on the 4th and the basic EMT that was started in the 12th?
WATTS: So, the basic, both of them have started. I honestly donít know how many are in each one.
WATTS: But, I know that they did start. I think thereís either like four or six in the CFR one. The recert one, Iím not sure about.
DELORIA: Do you work with Hamilton County on any of the courses that they offer? Because I believe two of my guys are going to Hamilton County for a course.
WATTS: Yeah, that would be, fall under a different course sponsor. I donít know who their course sponsor is.
DELORIA: I donít know, I donít know, but theyíre taking it, because itís close by. I can follow-up on that and give you names, but I think thereís three people that are actually going over and taking these courses and it would be a state sponsored course, naturally.
WATTS: I can try and find out who theirs is, too.
DELORIA: Yeah, do that.
WICK: The only other thing thatís not written here, just FYI, is the 3rd party billing contract is up for renewal. An RFP went out, last month for that and I believe that is going to be due at the end of this week. So, weíll be evaluating that, Iím assuming it will probably be EMR, again. Only because they were so complete and so cost effective in the last round of this. We have had a couple more parties that have asked questions. So, weíll be putting together a group of people to review those bids when they come in.
DELORIA: We know that EMR will bid on it and potentially there are a couple more that might?
WICK: Yeah, absolutely. So, next meeting weíll probably have a resolution to award that bid.
DELORIA: Okay. Would they use the same software? It seems to me that if youíve got this EMR group.
WICK: Yeah, that was in our specifications that the same standard software and approach and operations that we have now.
WATTS: And include the hardware and the software and all of that, because EMR provides us with the IPads and all that stuff for the field.
DELORIA: Oh, interesting. It will be a hard bid to bet then, I would think.
WICK: Yeah, last round that was some of the qualifiers, anyway. I guess, some of the things that set them apart from their competition was the ability to basically provide a turnkey solution that we could fall into, relativity easily. Whereas, some of their competitors they didnít really offer that and it takes quite a bit of change.
DELORIA: If you did get one that was extremely lower with the same services, do you see have the option of looking at the EMR and saying, we have these people now, we want to stay with these people?
WICK: So, there was, so some of the quality metrics that, quality review metrics within the bid criteria, we have the ability to kind of assess things differently. Itís more qualifications based then just cost. So, we can take a look at those, the effects of either staying with EMR or transiting to something else with the costs associated with the transition, the time delays to be able to get the insurance revenues in and all that kind of stuff.
DELORIA: And how often do you have to bid that?
MASCARENAS: Whatever the contract period is.
WATTS: So, itís a yearly contract with option for two renewals.
MASCARENAS: And most of these contracts, these styles are really no cost contracts to any of us. What it comes down to is the percentage. EMR doesnít cost us anything.
DELORIA: Right, right
MASCARENAS: Quite frankly, weíre not paying them a dime. Theyíre keeping whateverÖ
WATTS: Ten percent of whatever the collect.
MASCARENAS: So, somebody else came in and said, well,† itís 8% and now youíve got to go into all that comparison and say, alright, what do we got going on in? Would it be a disruption of service? How much potential revenue are we going to lose over the next six months or whatever it would take for us to convert? Those are the types of things we would then have to look at.
WATTS: And that is about what it would take, is about six months to convert over.
MASCARENAS: Oh, I am sure.
DELORIA: Maybe theyíll stay out of our sandbox then.
MASCARENAS: Time will tell.
WATTS: A couple of things we have is, weíre finally, remember in the beginning we talked about dispatching fire departments for CPR calls and we got all the AEDs for all the fire departments and weíre doing CRP training and stuff. Weíre finally implementing and effective the 3rd of April. Where fire departments are going to be dispatched to all CRP calls.
WATTS: So, thatís a new policy that weíre coming up with.
DELORIA: Now, is that for chest pains?
MONTY: Whatís the logic behind that? We do have our fly cars, right?
WATTS: We do.
MONTY: They should be responding, as well as the ambulance service.
WATTS: They do.
MONTY: Now, weíre tying up another entity, potentially.
WATTS: The fly cars are only in certain areas, at certain times.
MONTY: Well, theyíre supposed to be, I thought the original way it was set up was they there supposed to be covering certain areas.
WATTS: They are, but letís say theyíre in Crown Point and the callís in Ti. It takes them 10-15 minutes to get there.
MONTY: Youíve driven it faster, I know you have.
DELORIA: So, the response time is all.
WATTS: Yup, the object is to get CPR and AED to theÖ
MONTY: I understand the object of it. I am just thinking of tying up another resource.
MONTY: Our fly cars are supposed to be out there doing those things with them in response.
WATTS: But, sometimes the fly cars, weíre better now than we were, but thereís still areas, like somedays we only have one on and it could be down in Moriah and thereís a call in Keene.
MONTY: It would work better if we had all of our fly cars manned, is what youíre saying?
MONTY: Because your fly car can go immediately.
MONTY: Whereas, youíre waiting when you call your ambulance squad, youíre waiting for the response there, unless they have someone in the house.
MASCARENAS: Can you explain that quick? Fly cars, where you have them, typically? If you were fully staffed on a given day.
WATTS: If we were fully staffed, we, so thereís one week during the week, we have a couple days were we have three on, because of Nate being the part-time one, but typically we have two on four days a week, I think and then one on one day a week, because we have three full-time people.
MONTY: And thatís seven days a week?
MASCARENAS: Our original plan was, what was our original plan with fly cars?
WICK: Four full-time medic cars. Weíve got a bid that we probably have to redo, because we had no one respond on a fourth medic car bid that we were trying to procure. Actually, that bid went outÖ.
WATTS: A while ago.
WICK: October, I think.
MASCARENAS: Well, cars are just a mess anyway, right now.
WICK: Yeah and then the other medic car, the paramedic to fill that, thatís been on continuously recruitment for quite a while, now, too.
WATTS: Yeah, so typically we would like to have one in the, like Westport/Moriah area to cover, like Westport, Eítown, Essex, Willsboro, Moriah and even, if theyíre in Moriah, Crown Point and Ti and then one over in this area to cover Eítown, Lewis, Keene/Keene Valley, that area, Jay, if need† be, Wilmington.†
DELORIA: Define CPR, what does that include?
WATTSL Cardiac Arrest.
DELORIA: Just somebody in cardiac, chest pains?
LAVALLIE: Unresponsive, not breathing.
MASCARENAS: Okay, so thatís what the policy is?
MONTY: So, the fly cars, the employees come to the public safety building, get the fly cars and theyíre dispatched?
WATTS: Well, theyíre out on the road.
MONTY: Thatís what Iím saying. They report there.
WATTS: in the morning and then go out, yes.
MASCARENAS: So, what was that original report, Rob? Was it five, was it four? What was it?
MONTY: I thought it was four and a fifth one as a floater. I think in the original plan.
WICK: Right and I think that the plan was to use the used vehicle, I donít know if that one is still available. The concept, originally was to take, the first medic car that we had, which was one that came from Emergency Services to be set up as the first medic car, use that one, because it was older, like just as a backup, if need be.
WATTS: And weíll have that.
WICK: And we also have the used ambulance, too.
MASCARENAS: Do you guys mind, maybe, for next meeting bringing a map?
WICK: Sure, weíve got those.
MASCARENAS: I know that we did it a bunch of times, early, early on, but so that people that donít know.
TYLER: So, if you were fully staffed do you have the cars?
MASCARENAS: For the ones that we have on the road, right?
MERRIHEW: Youíre still recruiting for one?
WATTS: Weíre still trying to recruit for one, but we have been for quite some time. Maybe with this, I think the next paramedic class is graduating within the next couple of months, so maybe we can get some out of that.
TYLER: How many are in that class, again?
WATTS: I want to say 17, right around there, give or take a couple.
MASCARENAS: Thatís pretty good.
WATTS: Yeah, unfortunately, they donít stay around here. I donít know where they all go, but, because the average class is around 15-18 and I donít know where they go. Theyíre not staying around here.
GILLILLAND: How much does it cost them to go to that class?
WATTS: $6,000.00, which is must cheaper than if they were to go to Hudson Valley or the other one down in Cooperstown area.
LAVALLIE: Is that something that you could do as a recruitment type thing and pay their tuition and have a job when they graduate or something?
GILLILLAND: Sign on bonus.
LAVAILLE: I see where the Chairmanís going with it.
WATTS: Itís right around $6,000.00 or $6,500.00, itís under $7,000.00 I know that.
MASCARENAS: But, you could potentially even do something with what some of your towns are doing in terms of CDL drivers and those types of things and have them enter a contract.
GILLILLAND: Have a three-year contract.
MASCARENAS: Have them enter a contract.
GILLILLAND: We do it with our police.
MASCARENAS: Yeah, we could consider it. Can you get me the exact number, Matt?
WATTTS: Yup, Iíll get it from Bruce.
MONTY: Whatís the average number of calls a month that our fly cars are responding to?
WATTS: Around 40.
MONTY: Thatís countywide, obviously.
MASCARENAS: I get calls, here and there that cars are just sitting and I say, thank you, theyíre doing their job, Iím glad to hear it. Itís one of those jobs.
WATTS: They had a pretty busy weekend. They did 3 or 4 or 5, this weekend.
DELORIA: Do they ever get down in Megís neck of the woods, Schroon Lake?
WATTS: Sometimes, actually Michael went there this weekend for, I think it was an accident and got there before the ambulance and was able to cancel the ambulance, because it wasnít needed. So, that put them back in service.
DELORIA: Was that right there in Schroon?
WATTS: I think it might have been North Hudson, but somewhere in that general area. It was Schroon Lakeís area, anyways.
GILLILLAND: How many or which squads have paid employees that are not County employees?
WATTS: That are not?
WATTS: AuSable, Lake Placid, Wilmington
WATTS: Schroon has two, they have E5, but they also have County employees.
GILLILLAND: Okay, thatís a contract with E5?
MASCARENAS: Right, I think thatís a two-part question. I think we need a chart, are they working directly for the squad, are they a contractor or?
WATTS: Even the squads that we have County staff in are also paying other people to work there, as well.
GILLILLAND: The reason why, I talked to Mike about it last week, but I was at an event in the Town of Moriah, talking to a bunch of Essex County citizens and stuff. There is kind of a misconception of whatís going on with how weíre organized† and one of the people that were talking about it was one of Markís constituents and theyíre paying full-time employees down there and then they also have County and all this other and I was sitting there looking at them, that I donít think thatís what is happening, but I think almost, weíre at the point, right now we need to start thinking about some sort of public information campaign to get out there about how we do EMS in Essex County. Maybe draw in members of the press and stuff like that and get them to, so that we get the story out there, because I was listening to a lot of negative thoughts and things and one of the things I was hit up with, was you know they want us to change our formula for sales tax and give it to EMS squads and stuff and I was like, I think weíre doing okay. Anyway, I think thatís something.
WATTS: Like for instance, Ticonderoga, we have a person there on our system, but they also have other full time people theyíre paying through a temp agency.
GILLILLAND: Through a temp agency?
GILLILLAND: You know, do you know why theyíre doing that?
WATTS: I think itís because itís cheaper. Theyíre paying them less. In my opinion theyíre not saving anything, really, because theyíre paying them, theyíre paying their taxes, where weíre covering the benefits and that part of it. Theyíre not covering all that and they also have to have workersí comp on them, in addition to the volunteer workersí comp. So, they have two workersí comp that theyíre paying. Moriah is doing the same thing, Schroon Lake contracts with E5.
MONTY: So, those people that are working there are actually getting paid less than the people working for the County.
WATTS: Etown/Lewis does the same thing.
MONTY: So, not being a very smart man, wouldnít it behoove them to come to work for the County, those temporary people?
MASCARENAS: Itís a personal decision.
MONTY: Youíre right, youíre right.
WATTS: But, we only have so many positions.
GILLILLAND: Well, thatís the story that needs to be told.
MONTY: But, we have positions that need to be filled. Weíve always had positions that need to be filled. Weíve always had positions thatís needed to be filled.
GILLILLAND: The perception that I got is that everybody is overpaying and weíre overtaxed and stuff like that and itís all because of EMS. Iím like, no
MASCARENAS: Yeah and I do want to just comment for the record on the sales tax formula. I think sales tax formula is good. I think it makes a lot of sense. I think everybody was happy with that. The problem with shifting that formula is just that, itís a shift. So, whether youíre taxing the people on your county tax or whether youíre taxing them people on your town tax, itís a cost shift. If weíre pushing out more sales tax to the towns, well, your property taxes are going to be adjusted to account for that, thatís simple in math. In my opinion, a district is always the best way to go, cost effect-wise, because youíre bringing in non-payer. Sales tax isnít infusing new money in the system, thatís not what it would be doing. Itís simply shifting money you already have to cover something else and now youíre going to hit it at the other end.† The important part is those non-payers, that are not paying for the system that are heavy users in your system, often arenít contributing. So, thatís where the district always makes the most sense for those benefit types services, whether itís water and sewer infrastructure, whether itís EMS, fire, it always makes the most sense, but I know those debates can be tough. Itís easy for me to sit here and say it.
MONTY: So, youíre talking each individual town have a district?
MONTY: My only concern about that is, where Iíve seen a couple of times, you have the wrong people sitting on the Board of Directors there and theyíre asking for money that isnít necessarily needed to supply the service.
MONTY: And as a district, then the townspeople have no choice, but to pay it.
MASCARENAS: There is a way.
GILLILLAND: The way I do it, is the Town Board is the District Board of Directors.
WATTS: It can be done two different ways, one being the way the Chairman says.
MASCARENAS: The way heís doing it doesnít relinquish control.
MONTY: I have reasons.
MASCARENAS: I know.
MONTY: A lot of them are legitimate reasons.
MONTY: Because some of those people that are involved were involved with the initial fire district that we established in Lewis, several years ago and the first budget went almost to $200,000.00 from $70,000.00 and fortunately, one of the board members was the fire chief and went down there and said, you guys canít do that. But they were looking to replace all the equipment, everything and that. You canít put that burden to the taxpayers.
TYLER: We have that same problem in Westport. They give us their budget and we pay it.
GILLILLAND: The fire district.
WATTS: Which is different than an EMS one.
GILLILLAND: If you have an EMS district and in the establishment of the EMS district, you make the town board the governing board, like a water district or a sewer district.
TYLER: That makes sense.
MASCARENAS: And if any of you are interested, contract Dave Wainwright and see what youíve got for exempt value in your town.
MONTY: That would help me out, because the Countyís got a lot of exempt value in Lewis.
MASCARENAS: Find out what you got for exempt value and youíll at least make a comparison nothing what you got.
TYLER: Does anybody know if you have a fire district and it has a board of directors, but you canít get people to be on the board of directors or theyíre short people, can the town take it over?
MASCARENAS: Thatís a great question. Iíll talk to Manning
MERRIHEW: I think that they have to.
MASCARENAS: Yeah, I would think you would almost have to take over in that capacity if you donít have commissioners.
DELORIA: Is a referendum required to establish an EMS district?
DELORIA: So, you could have a referendum to eliminate it, if necessary.
MASCARENAS: Yup, yup
DELORIA: Okay, maybe we could put that package together that heís talking about, so we can see it. I have some notes here, AuSable, Lake Placid, Wilmington, Etown/Lewis, I mean weíd got some other agencies that are doing things differently than, hypothetically these ones that are directly involved with the County and I think ultimately we would love to, come on, everybody get on the same boat so we can get off shore. So, we can stay on top of that.
Do we have anything else, we have a public hearing in five?
DELORIA: Nothing? Matt, anything?
LAVALLIE: No, sir
DELORIA: I would like to meet the other Michael at some point in time, so maybe you can include him in our next meeting.
DOTY: Matt, I should probably, just quick, under your notes here for points of discussion, as far as Lake Placid ambulance service is concerned. Weíre putting a little bit of pressure on them to give us some proposals, fiscally for the next couple of years out. We canít continue to just give them more money each year without a plan, but a lot of that depends, probably on our zoom call today, on which Roy Holzerís going to be involved in, even though heís in Florida, with Department of Health and Adirondack Health to know where weíre at with this emergency room and dental care coming up missing and itís a mess. Once we can at least know what road weíre going down, then I can put a little bit more pressure on the ambulance guys to say, hey listen, itís time to tell us where youíre at and if we need to start melding with the County sooner than later, letís start a plan.
GILLILLAND: What time is the zoom?
DOTY: 3:00 and youíre in the invite list, arenít you?
GILLILLAND: I didnít get it.
DOTY: Iíll send it to you. Linda Beers will be on it.
DELORIA: Send it to me, if you would, too and Iíll listen in on it, too.
MASCARENAS: The storm, I just wanted to, hats off to you guys. I know Mike got thrown to the fire, two months in and I got to say, you did a killer job.† You really did, I really appreciate your communication.
LAVALLIE: Thank you to all of you for your help.
MASCARENAS: Itís a testament to you, Matt, you hired the right guy.
WATTS: Thank you, I think so.
DELORIA: Thank you, we stand adjourned.
AS THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS SUBCOMMITTEE, IT WAS ADJOURNED AT 9:27 AM.
Dina Garvey, Deputy Clerk
Board of Supervisors