Sunstar Paramedic Service, operated by Paramedics Plus under contract to Pinellas County, is eliminated in a proposal by local firefighters who say fire departments and fire districts should provide transport.
CLEARWATER – It’s not the first time firefighters have put together a plan to improve Pinellas County’s emergency medical services system. And, it’s not the first time county government has said it won’t work.
The debate centers on a dual transport system that some say is too costly due to flaws in the process. Residents, facing a hefty EMS millage rate increase, want to know why a fire truck and an ambulance go to almost every medical emergency.
The answer is complicated. Any solution has to include consideration of the special act by the legislature that created the system, settlement requirements of a lawsuit, inequities in how fire departments and fire districts are paid, as well as a mix of opinions on how the system should work and who should do what.
Fire officials have been talking about the problem for years.
In 2008, Largo Fire Chief Mike Wallace, currently president of the Pinellas County Fire Chief’s Association, voiced concerns about the EMS system. Speaking before his city’s commission May 13 of that year, Wallace said privatized ambulance system had outgrown its economies. Sending a fire engine as first responder to medical emergencies reduced his department’s availability to respond to a more serious call requiring its special equipment, he said. He suggested eliminating redundancies in the system.
In 2009, the county reduced EMS costs by eliminating some paid-for first responder units in areas where the need wasn’t justified. Fire officials and city managers objected, saying loss of those units would affect the ability to respond to fire emergencies. They said the positions and equipment they county no longer wanted to pay for were necessary to respond effectively to fire and medical emergencies.
Negotiations ensued. The county revised its plan. Still, in the end, some municipalities and fire districts lost some county paid-for positions and equipment.
Lt. Scott Sanford, firefighter and paramedic with Palm Harbor Rescue, representing the Fire Chief’s Association, presented what became known as the hybrid transport proposal in March 2009. Sanford’s plan called for fire departments to be allowed to do more transports. He said his plan would save money, reduce duplication and increase efficiencies.
In June 2009, county commissioners voted to take no action on Sanford’s plan after an ad-hoc committee comprised of city managers, fire chiefs and the county administrator concluded the plan was “too aggressive and not fact based.” The group did say the hybrid model had “potential for efficiencies” and recommended it be included as part of a broader study.
The county then hired Integral Performance Solutions to do a study on the EMS system and make recommendations. In January 2011, IPS released a draft version of its findings. The draft was picked apart by local fire departments and city managers, leaving the company’s principal Mic Gunderson scrambling to update information and clear up discrepancies.
Since that time, County Administrator Bob LaSala has been looking for support for IPS’s plan that includes extensive changes in the funding formula, leaving some cities with a bigger bill for fire and EMS.
So far, cities have not jumped on LaSala’s bandwagon. And another plan has come forward from local firefighters – the latest to be turned down by the county.
This time Sanford’s plan for fire department based transport services has a co-author, Capt. Jim Millican with Lealman Fire Rescue. According to a county report, this proposal calls for fire departments and fire districts to provide all EMS services – 911 and nonemergency - with the county providing only some central services.
The proposal continues the practice of dual response, using advanced life support services fire engines as first responders and advanced life support services rescue units to provide transport to medical facilities, staff said. It includes marginal engine funding as proposed by the ISP study, which is a sticking point with some local municipalities. The Sanford-Millican proposal supports priority dispatch – an area the county has been working on for years with some success.
“Following a comprehensive analysis, implementation of this proposal is not recommended,” Assistant County Manager Maureen Freaney and Director of Public Safety Services Dick Williams, wrote in a report presented Sept. 6 to county commissioners.
Freaney presented staff’s findings to the commission, prefacing her remarks by saying the county’s best experts had carefully gone through the firefighters’ proposal before making their recommendation. She reminded the commission of her own experience with public safety needs from her 20 years of service in Dunedin, including serving as assistant city manager.
The county is looking to spend $85.5 million for EMS services this year. If changes recommended in the ISP study are implemented, costs could be reduced to $74.5 million in fiscal year 2011-2012. The firefighters’ proposal says EMS could be paid for with $80.4 million; however, County Administrator LaSala said another estimated $12.5 million in expenses is not included in the firefighters’ plan.
Key concerns are costs requiring tax subsidy, such as ambulance service currently paid by user fees and funding inequities. IPS and the firefighters’ plan recommends changes in the funding formula to provide equity – something to which at least one city objects.
LaSala said cities and fire districts would have to take on more financial risk and be responsible for a larger workforce. He talked about problems with licenses required by Medicare and Medicaid regulations, lack of field supervision and centralized management.
He said the plan didn’t include a fleet size necessary for a 24/7/365 response to emergencies. There is no deployment plan. It does not adequately address workload.
“I’m highly skeptical,” he said. “I could not recommend this to any city.”
LaSala said ultimately, it would be up to the cities and fire districts to support it, which he said they had not yet done.
The Fire Chief’s Association passed a resolution Aug. 31 in support of the Sanford-Millican plan, requesting it be implemented on Oct. 1, 2012. LaSala said three of the chiefs abstained from the vote, including Wallace, the organization’s president, and the fire chiefs of St. Pete Beach and Clearwater.
When asked by the commission, Freaney said she believed the vote had been 8-4 by the association to support the plan with the three chiefs abstaining. LaSala said because it was a voice vote, he wasn’t sure which chiefs voted for or against. He also said he did not know if the vote indicated city support or represented the fire chief’s positions only.
“I’ll find that out,” he said.
LaSala said the Fire Chief’s Association had not evaluated the plan’s financial viability or other operational necessities. He said the resolution supporting the plan was “irresponsible and unprofessional.”
Freaney questioned why cities would want to take on the expense of transport, which was now paid for by user fees, instead of taxes.
“This would be a whole new cost to cities,” she said.
She also questioned how fire departments could effectively manage its workforce when personnel could be tied up an hour or more taking people to health facilities instead of getting back on the job after the first response and letting an ambulance do the transport.
“We have a good consolidated system, making $8 million in (ambulance) user fees,” she said.
Peak times was another area Freaney talked about, saying with the current system, ambulances could be parked in hot spots during peak times increasing response times.
“Personally, I don’t think this is close to workable.”
Freaney said any plan approved needed to include medical priority dispatch.
“This (dispatch) is the heart of what citizens get worked up about – multi-response,” she said.
Commissioner Karen Seel expressed her frustration with “not looking at the whole system (fire and EMS). She suggested forming a task force or study group to look at the issue in an “unbiased way” to find a better system that would save money.
“We’ve been squeezing the balloon. … It’s time to step back and look at it in a comprehensive way. This is the time to do it, if we’re ever going to do it.”
Commission Chair Susan Latvala agreed it was “time to get everyone at the table” and get a new plan in place.
“We have to keep moving,” she said. “We need to solve this financial crisis.”
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