EMS Subcommittee

Monday, May 13, 2024 - 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, Steve McNally, Jim Monty, Cathleen Reusser, Favor Smith, Matt Stanley, Ike Tyler, Meg Wood, Mark Wright, Josh Favro, Matt Watts, Mike Mascarenas and Michael Watts.

 

ALSO PRESENT: Dina Garvey

 

DELORIA: I am going to call this meeting to order. I am going to allow Mr. McNally, a few minutes to share a program he’s interested in us discussing at some point and he’ll be providing us with written material and a program summary at some point, as well.

 

MCNALLY: Dina, made some copies, hot off the press of on the county’s role in EMS. EMS now, is an essential service. We are 50-miles from Etown, in Minerva and the fly cars are not effective when you have towns that 25-miles apart, like Newcomb, myself and Schroon Lake. The golden hour is deduced significantly, if the car is not in your zone that day. So, in the State of New York, there’s a paramedicine programs that have been established, there’s like 200 of them in the State, right now and we are going to run a pilot program on this with Johnsburgh EMS and Minerva EMS. It will an employee that works Monday - Friday, 8-hours a day, which they’ll have many responsibilities. Of course, they’ll respond to the EMS calls, but they’ll also maintain defibrillators and they’ll do a bunch of stuff like that, but what we’re trying to do, is they’re going to conduit, so that we have, because we’re so far from the County, we do not have access to Mental Health or Office for the Aging or the Health Department, Public Health, daily. We’re fortunate to get them down there when we really need them, or they do make some visits, but not every day, not like some counties, that I am sure that they representatives in your towns. So, what we’ve done, we’ve researched, we’re doing, last year was the smallest we’ve ever done. We had 800 people, plus second homes, we did approximately 80-90 calls, but then we looked into it and probably 10-15 of those calls were for the same person and the reason is, is because they’re lonely. They come home from the hospital, they bring them home, they drop them off, they’re there for a day, they have no family and they have a headache the next morning and they call EMS. So, this program would be a community program, they work hand in hand with Mental Health, Public Health, Office for the Aging, Social Services, whatever they had to do and I spoke, briefly to Krissy Leerkes about this and she sort of thinks it’s a great idea. So, when a person comes home from the hospital, we’ll plan visits, we’ll stop, it’s going to be in a small town, we’re going to be able to get out there. A lot of time we pay 40-hours a week and they sit in that building for 40-hours a week. We’re trying to help the community, overall health, as well as respond to emergencies for this position. So, we’ll have more information on it. We’re hoping to start this is July, it’s about $45,000.00 expense for a year. I think it’s going to be, they have a bunch of things they can do. They can responsible for the loan closet, now we have hospital beds and things that we loan out and there’s someone in the office, every day, every other day, getting a commode or something like this, they’ll take of that, they’ll take care of the delivery. So, it’s very popular, there’s 200 established, running, right now in New York State. Like I say, it could save us rescue squad calls, it’s better for the community and where we’re located I think it’s going to work really well being a small town, too. So, I just wanted to let you know that there will be more information on it, but there is 200 in the State, as we speak.

 

MONTY: Did you say it’s already been passed in the legislation for Special Services?

 

MCNALLY: I believe it has, hasn’t it?

 

WATTS, MATT: No

 

MONTY: No

 

MCNALLY: It’s very close.

 

GILLILLAND: No EMS stuff has passed.

 

MCNALLY: No? It is an essential service, no matter it is called.

 

MONTY: Well, so is broadband, but.

 

MCNALLY: I’m just saying, this program, we’re hoping is successful. There is, we’re working with 200 other agencies that have ran this program. I mean I don’t think it would work in a real large town, but one person could definitely handle a majority of our towns and we’re going to hope to stop that person who went in the ambulance, last year, 7 times with no real emergency from going to the hospital 7 times in one year.

 

DOTY: What kind of certification, Steve?

 

MCNALLY: It’s going to be a paramedic.

 

DOTY: Okay

 

GILLILLAND: This is actually comes under Public Health and we have looked into this a couple of times during Covid. There is a massive pushback to the State on this and you can imagine which union is going to pushback on that.

 

MCNALLY: It is the EMS providers?

 

GILLILLAND: No

 

WATTS, MATT: No

 

GILLILLAND: Some EMS providers, but mostly the nurses.

 

WATTS, MATT: Public Health nurses.

 

GILLILLAND: So, anyways, there is a lot of hoops to jump through as far as regulatory stuff and being certified by the State of Public Health. So, we would probably need to have Linda Beers come in and brief us as well.

 

STANLEY: Is this just another name for that Community Paramedicine that has been talked about?

 

MASCARENAS: Yeah

 

MCNALLY: But, you know, Linda is short on staff, Terri’s short on staff, everyone is short of staff, so…

 

MONTY: That’s why a lot of our programs overlap with each other. I know the Nutrition Program, Steve, you have a congregate site, right? You don’t go house to house?

 

MCNALLY: Right, but we make deliveries, too.

 

MONTY: Okay, so that’s one why that they’re checking on these people and seeing these people and things of that nature. You know, I think it’s all good, but I think maybe we should try and overlap what we have before looking to expand out to something that is going to be more costly.

 

MCNALLY: Well, the thing is, Jimmy, basically what the crux of it is, instead of hiring just another paramedic to be on call, during the daytime in Minerva, we’re going to hire them to also have other responsibilities.

 

MONTY: Which I see, I get completely, but while you’re doing that, then they have a call and on the other side of their area and they’re hired to hand those calls. I get it…

 

MCNALLY: We can’t just continue to stay the way we are.

 

MONTY: I don’t we have, I think we’re advancing it, it’s a slow process, like anything.

 

MCNALLY: We’re a complete different animal at the southern end of the County.

 

MONTY: You would be better off going to Warren County.

 

MCNALLY: Yeah, we are with Warren County. I mean our EMS…

 

MONTY: Well, we’re willing to trade.

 

MCNALLY: Our tax dollars to go with us, wherever we go. The EMS and our fire dispatch is our of Warren County and a lot of our programs are out of Warren County.

 

DELORIA: So, Steve, I think your vision would be that one of your people that’s employed as a paramedic, that’s on-duty, waiting to go out on a call, that if you could shake them free, they would do a wellness check?

 

MCNALLY: They would do some wellness checks, you know, if they’re there in town and Office of the Aging gets a call, instead of commuting all the way down there, they give this person a call and they go out and do the legwork or just like a said, the loan closet, you know there’s a lot of things they can do.

 

MONTY: Ironically, I just saw a news article, this weekend, in Vermont where the law enforcement agencies get a list of elderly people and every day, part of the job, the desk officer’s job, is to contact those people, how are you doing today? Are you okay? Do you need anything? If they’re fine, then they go to the next one. If they need something, they contact the agency that can provide it and they’re saying that they have had a lot of success, it was  just on the Channel 3 News.

 

WOOD: And it’s not just the elderly.

 

MONTY: Anybody that maybe just come up and surgery and stuff and is home and maybe not have a lot of people at home to check on them.

 

REUSSER: This is a complex subject, speaking for the nurses. It is a complex subject, because when a nurse goes out to a home, we are assessing for whether they are appropriately placed at the home or not. Hospitals are forever famous for sending someone home that has no person to advocate for them. So, I don’t know about paramedics or whether paramedic can, under their license able to access a person in their home or not, but that maybe the factor that gets in the way.

 

MCNALLY: Well, they’re doing it in 200 counties now.

 

REUSSER: Meals on Wheels is another low level service, that you’ve got somebody stopping and dropping a meal off and that’s another way to do wellness checks.

 

TYLER: Speaking of overlapping, I got to tell you something that I witnessed on Saturday. An elderly man was going out fishing and stepped off the dock in Westport and fell on the concrete and we couldn’t get an EMT there and so the person was there with the deputies and they took control and they did a great job. I mean it was fantastic that we can overlap and that’s one of the best things we’ve done is to have the deputies.

 

MONTY: That’s what I was saying, I think we’re moving in the right direction with the deputies.

 

WATTS, MATT: And Krissy from OFA does call us to go out and do welfare checks, that we do now.

 

MCNALLY: But, that’s another person, you know what it does basically is, you know in a small town that has 80-100 calls a year, it’s very hard to sit there and pay someone $50,000.00 a year to sit in that building and watch movies. How effective they’ll be? I think the person that they’re going to hire for this position is going to be great. Just having, you know a bonus out of it, basically.

 

DELORIA: Do you have County employees? 

 

MCNALLY: No

 

DELORIA: Because if they were county employees, now we’re talking about a civil service job description that would include wellness checks.

 

MCNALLY: We will pay them through contractual through Johnsburgh.

 

MASCARENAS: They should be civil service, even in the town. You don’t get to avoid civil service.

 

DELORIA: Is there such an animal?

 

MCNALLY: Our is non-for-profit. It’s not a town organization.

 

MASCARENAS: Okay

 

DELORIA: So, telehealth is another aspect that some of the health care homes are using, I mean you call them up and you can look at them on the IPad.

 

WATTS, MATT: Yeah, that’s more through Public Health.

 

DELORIA: So, that’s another means for them to reach out.

 

MCNALLY: Elderly people do not like that computer telehealth stuff.

 

DELORIA: They need a big screen, you can’t do it on your cell phone.

Okay, Stephen, thank you.

 

MCNALLY: That’s my spiel. We will let  you know how it goes.

 

DELORIA: Good. Okay, who’s the boss here?

 

WATTS, MATT: He can do it.

 

WATTS, MICHAEL: So, not a whole lot to cover this month. Some staffing updates; the Westport, part time position; we’ve posted it, we’ve completed interviews and we’re still working on the hire process there, hopefully that will be complete soon. Down in Ticonderoga, both of our new EMTs have been hired and started, it seems to be working out well there. Moriah; we still have one vacancy that was at the request of the agency to hold while they secure some funding. Etown-Lewis; one vacancy still remains and we still have one paramedic vacancy for the medic car. Our senior account clerk has been hired and she has a tentative start date of June 3rd.

Most of the contracts are complete. Wilmington; we just got an updated contract. Those from the County Attorney’s office that needed some modifications, so we just got that back, that will be completed soon and Schroon Lake…

 

WOOD: Is this what you’re waiting for?

 

WATTS, MICHAEL: I guess we know where it is.

 

WOOD: Yeah, North Hudson needs to sign.

 

WATTS, MICHAEL: Yup, Steve was working on tracking that down, but I guess we know where it is.

 

WOOD: It’s in North Hudson, so you’ll get it.

 

WATTS, MICHAEL: No new contracts, no new requests this month. Still working on getting some things wrapped up from last month. Wilderness CPR and First Aid for the town summer camps, that will held, June 8th at the Public Safety Building. I believe the Youth Services Bureau put it out to all the town camps and so if you guys have anyone that needs that, that is where that will be.

 

MASCARENAS: I think that, too, is an unattended benefit of having this EMS system. You all rely, not you all, you do not, Minerva doesn’t not, they have a pretty robust group of people, where everybody is a lifeguard in town and they can handle their own training, but you are all required by the Department of Health to have a certain amount of training for you summer rec program, those people just don’t exist and when this program started, I said, hey, let’s see if they can do it. Because now we have people in-house and I think that’s been really helpful that last few years in getting your summer day camp permits, so you can be operational in the summer.

 

DELORIA: I just received a memo from Health Department that even though CPR certification is due to expire, they have to take it at the beginning of program.

 

WATTS, MICHAEL: Yeah, even though they’re good for 2-years, they have to be done every year. 

 

MASCARENAS: Department of Health certifications are different than, let’s say, American Red Cross or Heart Association require. So, yeah, CPR is annual by the Department of Health, even though those cards last a little longer. So, you got to really pay attention that.

 

DELORIA: And they certify our program.

 

MASCARENAS: And they will give you a permit.

 

DELORIA: That’s correct.

 

WATTS, MATT: And these guys have been doing a lot of CPR classes with BOCES and county employees and we did one with DPW the other day. So, they’ve been doing a lot.

 

DELORIA: Our instructors are not low paying fruit that you can get.

 

MASCARENAS: They’re not.

 

DELORIA: That’s the problem, they’re so far out of touch with rural America, that they’ll never get it.

 

MASCARENAS: Right and that’s the debate on who wants to pay for what and what services are you providing for everyone versus, you’re providing increased services on EMTs, to me those are supports that all communities are using, whether you’re realizing it or not and should be spread our amongst everyone. So, you’ve got to understand the entirely on what you’re getting back.

 

DELORIA: So how many of our staff people in Newcomb at the rescue squad, how many of them are certified CPR instructors? 

 

WATTS, MATT: County employees, one. So, the only thing is the summer camp ones require a certain certification. The wilderness thing, not all CPR instructors are certified to do.

 

WTTS, MICHAEL: I believe there’s certified requirements for certain camps based off how far you are from the hospital.

 

MASCARENAS: And the activities that you provide. So, RTE was also an acceptable course for those instructors that are really hard to come up. We lost ours and that’s where the wilderness comes in.

 

DELORIA: Do they still use the dolls in the case? Is that still part of the program?

 

WATTS, MATT: Yes

 

DELORIA: Because we have two of them.

 

WATTS, MATT: So, are they up to date?

 

DELORIA: Probably not.

 

WATTS, MATT: Because now there are required to get the feedback.

 

DELORIA: I would think not because they have been there awhile, but they could. I’ll find out.

 

WATTS, MICHAEL: Flipping through the packet that I handed out as well. One of the things that I have gotten in my email the last couple of weeks is the new legislation that is out on the floor, right now to support EMS. I didn’t have it to go out in the email, but it is in the packet.

So, something that the New York State Association of Counties, as well as Fire and EMS Association have been pushing. There are a number of different bills that are listed in here, that they are encouraging to push through. One of them, which is pretty important, which is the treatment in place. That’s going to allow EMS agencies to be able to bill for patient refusals.

 

DELORIA: Which one on there?

 

WATTS, MICHAEL: The first one. So, say EMS gets called for a diabetic patient, whose blood sugar’s gone too low. They get there, they start an IV, they give them some medication to raise their blood sugar, they patient then doesn’t want to go to the hospital, doesn’t need to go to the hospital, right now, EMS can’t bill for that service. That’s a cost that’s ate by the agency, so this would allow them to bitt Medicare, Medicaid for that kind of service.

 

WATTS, MATT: What about lift assist, Michael?

 

REUSSER: That’s just wrong.

 

WATTS, MATT: What about for a lift assist? They go there, they lift somebody up, they evaluate them, they asset them?

 

WATTS, MICHAEL: If they’re evaluated, then yes.

 

WATTS, MATT: Okay

 

DELORIA: Lift assist?

 

WATTS, MATT: Yeah, as long as they evaluate them. If somebody falls and needs help lifting up and they actually assess them.

 

DELORIA: I would assume that would happen as a standard visit, would it not?

 

WATTS, MATT: It should.

 

WATTS, MICHAEL: As long as EMS responds, evaluates the patient and they don’t want to go, then they would be able to bill for that. Whereas, right now, it is a freebee.

There’s a number of other things in here. Some of them more applicable to us than others. One of the, the third one down, would remove EMS services from the tax cap. So, I think that would be pretty important, as well, not having an effect on the tax cap.

 

DOTY: Would that be, probably the first exemption ever granted under the tax cap law?

 

MASCARENAS: There’s a couple of little ones.

 

DELORIA: Yeah, there is, but they don’t apply to us.

 

MASCARENAS: Right

 

DOTY: I mean think of roads and sewer districts and water lines.

 

MASCARENAS: If you’re districts, it shouldn’t be.

 

DELORIA: Yeah, they’re separate.

 

DOTY: And there’s no exemptions.

 

MASCARENAS: No, because the regulatory is requiring that you do it, most of the time, right.

 

WATTS, MICHAEL: So, that’s something that they’re forming all these bills under the rescue EMS Act, that they’re trying to get pushed through, right now.

 

DELORIA: Do we know the sponsor? Is he one of us? Where is he from, the sponsor for that bill?

 

WATTS, MATT: I’m not sure.

 

MASCARENAS: It has the names, but I don’t know who they are.

 

DELORIA: That makes a difference.

 

WATTS, MICHAEL; But, those are the big pieces of legislation. They tried putting a lot of these into the budget, which didn’t get pushed through, but now they’re trying to go the other route.

 

MASCARENAS: You have recommendations for this committee to pass a resolution of support in form or another for all of these? Are all of these positive for you or are there some of them that are not?

 

WATTS, MICHAEL: I don’t think any of them would harm us, I mean as far as getting a thruway authority permit, not applicable to us, but doesn’t hurt us either. So, I think they are all beneficial to the County.

 

STANLEY: I like seeing the increases in the State income and then also making it so they can make the State income one and the local property tax credit, because that’s kind of why we haven’t passed the local credit, because still at the $200.00, it’s better to take the and like our school district hasn’t passed it yet, which is the biggest taxer, so. I just actually had the AuSable Forks Fire Department reach out to me, this weekend about it.

 

DELORIA: Yup

 

STANLEY: And it’s like until AuSable Valley does it, it’s not really worth it.

 

DELORIA: I wondered if they weren’t going to eliminate the State income tax credit and that’s way they pushed this other one through, but we didn’t adopt it either.

 

STANLEY: Right and I sort of feel until there’s legislation that you can take both, I feel that you’re exactly right, they’re going to push the local one, so the State doesn’t have to pay that out.

 

DELORIA: Well, but look at the amount of effort and work it puts on your local assessors, too.

 

STANLEY: Absolutely

 

DELORIA: Our trouble is, it was one of these that, you know with the assessed values, it’s all based on the assessed value and we don’t have $600,000.00 homes, if you did, then it would absolutely be beneficial. Let’s do it easy, check the box, you’ll get $200.00 in your income tax return.

 

STANLEY: But, I think if they were to even pass the one where it goes from $200.00 to $800.00. I mean that right there, makes the, if it didn’t have the component of being able to do both. That $800.00 is worth more than whatever tax exemption you would get anyways.

 

WATTS, MATT: So, as a group, do we want to have me bring this up as a resolution for all of these? Did everybody have a chance to look through them and see?

 

STANLEY: Mike, would they have to be done separately to support each bill, not all of them?

 

MASCARENAS: Yeah, I mean we can do a general one and have Dan Manning’s office separate them.

 

WATTS, MATT: So, I can just bring up, do a resolution supporting the Rescue EMS campaign?

 

MASCARENAS: Yeah, you can even do it for Ways and Means, if you’re not prepared today, but you can bring it up, they’re in the packet, it’s not a bad idea.

 

WATTS, MATT: Okay

 

MASCARENAS: I assume other counties are supporting that?

 

WATTS, MICHAEL: Yeah, I know a number of other counties that passed resolutions.

 

DELORIA: Where are they on the legislative framework in Albany, right now? I mean how soon do we need to support this?

 

MASCARENAS: Pretty quick

 

DOTY: Well, they’re only in session for two more weeks.

 

MASCARENAS: I’m surprised they still are. Usually once that budget goes, its hurry up and get out of here.

 

DELORIA: Let’s number these and we’ll pick which ones you guys are thinking about. You mentioned 1, 3 and 6, right and Matt, you mentioned 5?

 

STANLEY: Well, 6 actually takes 5 with it.

 

DELORIA: Okay

 

MASCARENAS: The second one is about districts, but I don’t know the  particulars.

 

DELORIA: Yeah, I wondered, too, because we’re a fire protection district.

 

WATTS, MICHAEL: The second one there is also recognizing EMS as an essential service, without knowing the whole thing.

 

DELORIA: Do we want to send something out on this?

 

MASCARENAS: We can even send a letter our local officials, basically with these listed.

 

DELORIA: Yeah

 

MASCARENAS: If we want to move a little more quickly.

 

DELORIA: Because either our guys are on top of this or they’re not.

 

MASCARENAS: Right

 

DELORIA: So, why should we do the work for them. I would say one letter and include all of them and let me pick which lollipop color they want.

 

MASCARENAS: Yup

DELORIA: Okay, so do we need a motion for that. So, do we need a motion for that?

 

STANLEY: I’ll make that motion.

 

DELORIA: And I’ll second it.

 

RECOMMENDATION TO THE PUBLIC SAFETY COMMITTEE IN SUPPORT OF THE NEW YORK STATE LEGISLATION TO PASS THE RESCUE EMS LEGISLATIVE PACKAGE PRIOR TO THE CONCLUSION OF THE STATE LEGISLATIVE SESSION AND AUTHORIZING THE COUNTY CHAIRMAN AND/OR COUNTY MANAGER TO SEND A LETTER STATING THE SAME.

Stanley, DeLoria

 

DELORIA: All in favor? Let’s get something going on that.

 

WATTS, MATT: So, do you still want me to bring this up at Public Safety then?

 

MASCARENAS: Yeah, that way the Board understands that we’re probably going to get it out prior to Full Board.

 

DELORIA: Right, it will go to our people.

 

MASCARENAS: Yup

 

DELORIA: It would be nice to know the history on this, because you know in the world that I, the rose colored glasses that I wear, I am wondering how many of these are democrated sponsored, you know and if they are, bing, bing, bing. I’ll go through just like…

 

WATTS, MICHAEL: That’s all I have.

 

WATTS, MATT: That’s all we got.

 

DELORIA: That’s good, okay and the moneywise? Was that an update on page two, that those claims, 2020-2021, were actually approved, pending what? Pending sending a check or pending another review of those claims, claim 2 and 3?

 

STANLEY: Probably pending the State having enough money to pay us?

 

MASCARENAS: Yeah, typically approved and pending means that they accepted it and we haven’t gotten it.

 

WATTS, MICHAEL: Yeah, that hasn’t been a change in a couple of months.

 

DELORIA: No, okay, we won’t hold our breath then. Okay, is there anything else from the committee members? If not, we stand adjourned. Thank you.

 

 

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