EMS Subcommittee

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: We’ll start. Okay, Robert, I’m 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 don’t 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, it’s just kind of an update to some of the stuff that we’ve 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 didn’t see them in the purchasing shared drive, yet. So, they just haven’t been digitally entered into the system, but we will get them all loaded in there. So, that’s all good.

I think we’re still looking for one more medic car positions and I don’t know if we have anymore staffing positions that are still open?

WATTS: Nope, we’re kind of full right now. We’re also looking for per diems. I don’t know if we need, are we limited on the amount of per diems that we can have?

DELORIA: That’s a Rob question.

WICK: Not necessarily, not that I know of, no, because they’re all just kind of this rolling, you know, part timer type position. So, I don’t know that there’s 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 there’s no limit on the number of?

WICK: No

WATTS: Nope

MERRIHEW: Until that budget’s 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 wasn’t 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, that’s why I was wondering if there was a limit on it.

MERRIHEW: It’s 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 that’s encouraging. We just wish we had about 13-14 more of them.

DELORIA: So, a subsequent letter, you think, phone call.

WATTS: I know Michael’s 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 there’s supposed to be getting back to him, but we haven’t 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 4^th and the basic EMT that was started in the 12^th?

WATTS: So, the basic, both of them have started. I honestly don’t know how many are in each one.

WICK: Okay

WATTS: But, I know that they did start. I think there’s either like four or six in the CFR one. The recert one, I’m 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 don’t know who their course sponsor is.

DELORIA: I don’t know, I don’t know, but they’re taking it, because it’s close by. I can follow-up on that and give you names, but I think there’s 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 that’s not written here, just FYI, is the 3^rd 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, we’ll be evaluating that, I’m 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, we’ll 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 we’ll probably have a resolution to award that bid.

DELORIA: Okay. Would they use the same software? It seems to me that if you’ve 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 didn’t 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. It’s 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, it’s a yearly contract with option for two renewals.

DELORIA: Okay

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 doesn’t cost us anything.

DELORIA: Right, right

MASCARENAS: Quite frankly, we’re not paying them a dime. They’re keeping whatever…

WATTS: Ten percent of whatever the collect.

MASCARENAS: So, somebody else came in and said, well, it’s 8% and now you’ve 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 they’ll stay out of our sandbox then.

MASCARENAS: Time will tell.

WATTS: A couple of things we have is, we’re 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 we’re doing CRP training and stuff. We’re finally implementing and effective the 3^rd of April. Where fire departments are going to be dispatched to all CRP calls.

DELORIA: Okay

WATTS: So, that’s a new policy that we’re coming up with.

DELORIA: Now, is that for chest pains?

MONTY: What’s 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, we’re tying up another entity, potentially.

WATTS: The fly cars are only in certain areas, at certain times.

MONTY: Well, they’re 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 let’s say they’re in Crown Point and the call’s in Ti. It takes them 10-15 minutes to get there.

MONTY: You’ve 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 the…

MONTY: I understand the object of it. I am just thinking of tying up another resource.

WATTS: Right

MONTY: Our fly cars are supposed to be out there doing those things with them in response.

WATTS: But, sometimes the fly cars, we’re better now than we were, but there’s still areas, like somedays we only have one on and it could be down in Moriah and there’s a call in Keene.

MONTY: It would work better if we had all of our fly cars manned, is what you’re saying?

WATTS: Yes

MONTY: Because your fly car can go immediately.

WATTS: Yes

MONTY: Whereas, you’re waiting when you call your ambulance squad, you’re 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 there’s 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 that’s seven days a week?

WATTS: Yes

MASCARENAS: Our original plan was, what was our original plan with fly cars?

WICK: Four full-time medic cars. We’ve 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 out….

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, that’s 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, E’town, Essex, Willsboro, Moriah and even, if they’re in Moriah, Crown Point and Ti and then one over in this area to cover E’town, 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?

WATTS: No

LAVALLIE: Unresponsive, not breathing.

MASCARENAS: Okay, so that’s what the policy is?

WATTS: Yes

MASCARENAS: Okay

MONTY: So, the fly cars, the employees come to the public safety building, get the fly cars and they’re dispatched?

WATTS: Well, they’re out on the road.

MONTY: That’s what I’m 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 don’t 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 we’ll have that.

WICK: And we also have the used ambulance, too.

WATTS: Yup

MASCARENAS: Do you guys mind, maybe, for next meeting bringing a map?

WICK: Sure, we’ve got those.

MASCARENAS: I know that we did it a bunch of times, early, early on, but so that people that don’t know.

TYLER: So, if you were fully staffed do you have the cars?

WATTS: Yes

MASCARENAS: For the ones that we have on the road, right?

WATTS: Correct

MERRIHEW: You’re still recruiting for one?

WATTS: We’re 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: That’s pretty good.

WATTS: Yeah, unfortunately, they don’t stay around here. I don’t know where they all go, but, because the average class is around 15-18 and I don’t know where they go. They’re 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 Chairman’s going with it.

WATTS: It’s right around $6,000.00 or $6,500.00, it’s 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, I’ll get it from Bruce.

MONTY: What’s the average number of calls a month that our fly cars are responding to?

WATTS: Around 40.

MONTY: That’s countywide, obviously.

WATTS: Yes

MASCARENAS: I get calls, here and there that cars are just sitting and I say, thank you, they’re doing their job, I’m glad to hear it. It’s 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 Meg’s 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 wasn’t 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 Lake’s area, anyways.

GILLILLAND: How many or which squads have paid employees that are not County employees?

WATTS: That are not?

GILLILLAND: Yeah

WATTS: AuSable, Lake Placid, Wilmington

WOOD: Schroon

MONTY: Etown/Lewis

WATTS: Schroon has two, they have E5, but they also have County employees.

WOOD: Yes

GILLILLAND: Okay, that’s a contract with E5?

MASCARENAS: Right, I think that’s 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 what’s going on with how we’re organized and one of the people that were talking about it was one of Mark’s constituents and they’re 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 don’t think that’s what is happening, but I think almost, we’re 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 we’re doing okay. Anyway, I think that’s something.

WATTS: Like for instance, Ticonderoga, we have a person there on our system, but they also have other full time people they’re paying through a temp agency.

GILLILLAND: Through a temp agency?

WATTS: Yup

GILLILLAND: You know, do you know why they’re doing that?

WATTS: I think it’s because it’s cheaper. They’re paying them less. In my opinion they’re not saving anything, really, because they’re paying them, they’re paying their taxes, where we’re covering the benefits and that part of it. They’re not covering all that and they also have to have workers’ comp on them, in addition to the volunteer workers’ comp. So, they have two workers’ comp that they’re 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, wouldn’t it behoove them to come to work for the County, those temporary people?

MASCARENAS: It’s a personal decision.

MONTY: You’re right, you’re right.

WATTS: But, we only have so many positions.

GILLILLAND: Well, that’s the story that needs to be told.

MONTY: But, we have positions that need to be filled. We’ve always had positions that need to be filled. We’ve always had positions that’s needed to be filled.

GILLILLAND: The perception that I got is that everybody is overpaying and we’re overtaxed and stuff like that and it’s all because of EMS. I’m 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, it’s a shift. So, whether you’re taxing the people on your county tax or whether you’re taxing them people on your town tax, it’s a cost shift. If we’re pushing out more sales tax to the towns, well, your property taxes are going to be adjusted to account for that, that’s simple in math. In my opinion, a district is always the best way to go, cost effect-wise, because you’re bringing in non-payer. Sales tax isn’t infusing new money in the system, that’s not what it would be doing. It’s simply shifting money you already have to cover something else and now you’re 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 aren’t contributing. So, that’s where the district always makes the most sense for those benefit types services, whether it’s water and sewer infrastructure, whether it’s EMS, fire, it always makes the most sense, but I know those debates can be tough. It’s easy for me to sit here and say it.

MONTY: So, you’re talking each individual town have a district?

MASCARENAS: Absolutely.

MONTY: My only concern about that is, where I’ve seen a couple of times, you have the wrong people sitting on the Board of Directors there and they’re asking for money that isn’t necessarily needed to supply the service.

MASCARENAS: Yup

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 he’s doing it doesn’t relinquish control.

MONTY: I have reasons.

MASCARENAS: I know.

MONTY: A lot of them are legitimate reasons.

MASCARENAS: Yup

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 can’t do that. But they were looking to replace all the equipment, everything and that. You can’t 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.

TYLER: Right

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.

MASCARENAS: Exactly

TYLER: That makes sense.

MASCARENAS: And if any of you are interested, contract Dave Wainwright and see what you’ve got for exempt value in your town.

MONTY: That would help me out, because the County’s got a lot of exempt value in Lewis.

MASCARENAS: Find out what you got for exempt value and you’ll 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 can’t get people to be on the board of directors or they’re short people, can the town take it over?

MASCARENAS: That’s a great question. I’ll 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 don’t have commissioners.

DELORIA: Is a referendum required to establish an EMS district?

MASCARENAS: Yeah

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 he’s talking about, so we can see it. I have some notes here, AuSable, Lake Placid, Wilmington, Etown/Lewis, I mean we’d 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?

WICK: No

DELORIA: Nothing? Matt, anything?

WATTS: No

DELORIA: Michael?

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. We’re putting a little bit of pressure on them to give us some proposals, fiscally for the next couple of years out. We can’t 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 Holzer’s going to be involved in, even though he’s in Florida, with Department of Health and Adirondack Health to know where we’re at with this emergency room and dental care coming up missing and it’s a mess. Once we can at least know what road we’re going down, then I can put a little bit more pressure on the ambulance guys to say, hey listen, it’s time to tell us where you’re at and if we need to start melding with the County sooner than later, let’s start a plan.

GILLILLAND: What time is the zoom?

DOTY: 3:00 and you’re in the invite list, aren’t you?

GILLILLAND: I didn’t get it.

DOTY: I’ll send it to you. Linda Beers will be on it.

DELORIA: Send it to me, if you would, too and I’ll listen in on it, too.

DOTY: Okay.

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.

GILLILLAND: Absolutely

LAVALLIE: Thank you to all of you for your help.

MASCARENAS: It’s 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.

Respectively Submitted,

Dina Garvey, Deputy Clerk

Board of Supervisors