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 4th and the basic EMT that was started in
the 12th?
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 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, 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 3rd 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