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EMS resolutions receive county approval
By SUZETTE PORTER
| Article published on Friday, March 20, 2009 |
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CLEARWATER - Despite pleas to delay, the Board of Pinellas County Commissioners unanimously approved on March 20 two resolutions intended to set a framework for increasing efficiencies and reducing costs of EMS services.
More than 20 speakers presented their concerns during the special meeting on Friday. Commissioner Nancy Bostock was absent.
Almost all asked the board to delay its decision to adopt two of three resolutions first presented in a workshop meeting on Feb. 24. The board approved the first resolution transferring the responsibility of emergency medical dispatch from the county’s ambulance contractor (Sunstar) to the county’s 911 center on March 3.
The March 20 vote approved resolutions setting standards for EMS levels of service, as well as reasonable and customary costs for which service providers can expect to be paid.
The decisions by the board were made while acting as the Emergency Services Authority, which was established by an Act of the Florida Legislature in 1989. The authority has the responsibility for providing funding for reasonable and customary costs associated with providing EMS services. The authority also has the power to set the levels of service for emergency medical services, provided that the funded services are not lower than the minimum level provided by those providers prior to Jan. 1, 1989.
Currently, the county contracts with 19 municipalities and special fire districts to provide advanced life support first responder services. It also contracts with a private company to provide ambulance transport service.
Among the objections voiced on March 20 was that the resolutions could result in lower levels of service than those in place in 1989.
Clearwater Vice Mayor George N. Cretekos said in 1989 the city provided response times under five minutes. He said the standard established by resolution of 7 1/2 minutes 90 percent of the time was a reduction in service and thus could violate the legislative act.
Response times in general were a point of discussion with providers maintaining that the current level is 7 1/2 minutes 96 percent of the time. Also, the point was made that several national agencies recommend a response time of 5 minutes for emergency response to heart attacks.
Smaller municipalities, such as South Pasadena, who sat down with staff to negotiate an exception to the resolution on reasonable and customary costs, were concerned about a rule that cut funding to providers that respond to less than 10 advanced life support calls a day.
South Pasadena Commissioner Larry Crowley said due to the legislative act his municipality would be entitled to an exception to the new reasonable and customary costs to maintain the same level of service. He said the new rules say that any unit running less than 10 calls would only be reimbursed for the cost of one paramedic on an advanced life support call. South Pasadena averages eight calls a day.
“We have always had one paramedic and one EMT,” he said.
He said reducing the level of funding for smaller providers could end up with the undesirable result of having one lone paramedic responding to advanced life support situations.
All told, the county’s plan proposes several advanced life support units be eliminated, which local fire chiefs say would shift the burden of response to units reserved for firefighting. They were also concerned about possible layoffs that would result from the reduction of those units.
Fire officials said the loss of those units would undoubtedly result in increased response times for emergency calls - fire and EMS.
Craig Hare, Pinellas County EMS manager, said passing the resolutions would not necessarily result in any of the scenarios expressed by the speakers. He said the next step would be to “zoom in district by district” to confirm the data provided through a computer model on which response time capability had been predicted.
He said over the next 30 days, as the budgets were being worked on, the computer model data would be measured against historical data to ensure response times could be met. He said if the evaluation showed that response times would be impacted, changes would have to be made.
Officials with the cities of St. Petersburg and Clearwater as well as others said they believed that historical data of actual calls would prove the flaws from averaging done to provide numbers for the computer model.
County staff, EMS providers and city managers have been working for several months on a plan that would eliminate the $18.5 million deficit in the EMS budget. Last year, the county made up the budget deficit by dipping into EMS reserve fund, but the commissioners made it clear that the move would be one time only.
According to County Administrator Bob LaSala, a series of meetings with the providers failed to result in acceptable compromises that would balance the budget. Subsequently a small group of city managers and a deputy mayor from St. Petersburg worked to hash out the plan on which the resolutions were based.
Officials from other municipalities, including Belleair Bluffs Mayor Chris Arbutine expressed displeasure at being excluded. Fire chiefs and fire officials also expressed displeasure as they also were not included in the final round of discussions.
Everyone said there had to be a better way.
Scott Sanford, firefighter and paramedic with Palm Harbor Rescue, representing the Pinellas County Fire Chiefs Association, presented an alternative solution to what LaSala described as a “redistribution of resources.”
Sanford said the association’s “hybrid proposal” would not require the elimination of 16 units and still result in substantial savings and efficiencies. He also estimated that as many as 65 to 70 full time paramedics would lose their jobs under the county’s plan.
Currently 1,200 firefighters, paramedics and emergency medical technicians are employed countywide.
The association’s plan calls for allowing fire departments to do more ambulance transports than are currently allowed. Current operations call for a first responder to be dispatched by one of the 19 providers. Many times that response vehicle is capable of transporting the victim to the hospital. However, due to the agreement with the county’s ambulance service provider, the first responders have to wait for Sunstar to arrive on scene to do the transport.
Sanford said currently there are 25 rescue units paid for by the county in service by the fire departments that could be used to transport to hospitals.
“They’re already in the system, why not use them,” he said.
He said the hybrid plan could save $7.6 million, reduce duplication and increase efficiencies.
The commissioners expressed great interest in the hybrid proposal, but questioned why it had not been presented before.
Sanford said the plan had been proposed during the first series of meetings but was shot down by county staff. He said he had been told the plan would be passed on to the commissioners for their review.
“I find it interesting that the county buys trucks but tell the providers they can’t be used to transport and that they have to use the other truck we buy to do that,” Commissioner Neil Brickfield said. “I think this (hybrid proposal) is a credible alternative worth looking at. Any solution is worth looking at that will close the $18 million gap.”
Commissioner Calvin Harris said currently everything was on the table.
“This is just one vote or one engine and we’re all on it,” he said.
When seconding the motion to approve made by Commissioner Susan Latvala, Commissioner Ken Welch said he wanted to make it clear that further analysis would be done including discussions with interested parties and looking at the hybrid plan.
Brickfield requested that county staff be directed to take a look at the fire chief’s hybrid proposal to see if it would work and how.
The commissioners agreed.
“A vote for these resolutions won’t stop any alternatives,” LaSala said.
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Article published on Friday, March 20, 2009
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