The debate continues whether or not it is time for local fire departments to provide ambulance service instead of a private company contracted by Pinellas County government.
CLEARWATER – The list of stakeholders is growing, as Pinellas County Commissioners, local firefighters, municipalities and taxpayers continue to argue the merits of different plans aimed at finding an affordable solution to funding emergency medical services.
And, now the state has entered the fray with opposing local bills sponsored by members of the Pinellas County Legislative Delegation.
Interested parties have been talking about the EMS for years with no agreement in sight on how to stop escalating costs. County Administrator Bob LaSala insists without changes, EMS millage rates will continue to rise and still there won't be enough money coming in to pay for the system.
Commissioners approved a 46 percent hike in EMS ad valorem taxes for the current year to stop the bleeding from reserve funds. LaSala said without millage increases, and other modifications, reserves will be gone by 2013.
A consultant hired by LaSala presented a plan that staff says will solve the problem. But, the stakeholders don't like it. Local firefighters offered an alternative plan, but the county says it won't work. Some municipalities, including Largo, Seminole and St. Pete Beach, have refused the firefighters’ request to speak. Others have endorsed transport by local fire departments.
It’s a difficult and complicated situation.
An underlying thread is a Special Act passed by the state in 1980 that gives commissioners the authority to govern a countywide EMS system and levy ad valorem taxes to pay for it. The act includes several provisions that prohibit changes some say are necessary.
A secondary undercurrent is a 1989 judgment by the courts after the city of St. Petersburg won a lawsuit against the county that prohibits changes to the method used to pay the 18 local fire departments and fire districts that provide advance life support (first responder) services.
Last on the list of arguments is the use of a single private-party ambulance provider, doing business on behalf of the EMS Authority under the name of Sunstar. Firefighters want to take over that service and eliminate Sunstar. The county opposes firefighter transport partly because of the money Sunstar brings in to help pay for EMS. County officials also say that the firefighters plan is inefficient and more costly.
Public hearing scheduled
The factions found sponsors for two local bills the legislative delegation will take to Tallahassee. The bills seek state approval to modify the 1980 special act governing the county’s EMS Authority.
The first bill, filed on behalf of county commissioners, seeks to change the funding method used to pay ALS providers. The second, requested by local firefighters, requires consolidation of advanced life support and emergency medical services and elimination of the county’s private ambulance provider. The bill also supports a funding formula based on average actual costs.
Rep. Peter Nehr and Sen. Jack Latvala are sponsoring the county’s bill. Rep. Ed Hooper and Latvala are sponsors of the firefighters’ bill.
Latvala, who is chair of the county legislative delegation, scheduled a public hearing Wednesday, Nov. 30, 2 to 4:30 p.m., in the Pinellas Park Performing Arts Center, 4951 79th Ave. N.
Local legislators want to hear opinions on the two bills from county officials, emergency management staff from agencies throughout the county, as well as the public.
“Pinellas County is unique in that we have 24 municipalities as well as the unincorporated areas. Within our borders, we have 14 law enforcement agencies, 19 municipal and independent special district fire departments and Sunstar,” Latvala said in his meeting announcement. “Our citizens deserve the best service that we can provide to them, especially in a traumatic situation. When someone dials 911, they are already in a dire state. It is my hope that we can discuss these bills and determine the best course of action so that we can continue to provide our citizens with the top-notch EMS service they deserve.”
Commissioners started their Oct. 25 meeting an hour earlier than usual to allow firefighters to present their plan to improve EMS using a model with transport by local fire departments. The presentation preceded a 9 a.m. work session on EMS that included a presentation by Mic Gunderson with Integral Performance Solutions, the county’s consultant, as well as a staff presentation on their take on the situation.
LaSala and staff support the IPS plan and are opposed to the firefighters’ proposal. The commission, as a whole, has not endorsed either plan; however, it did give support for the local bill to amend state law allowing the EMS Authority to set the level of service to be met by EMS providers.
Discussion of the bills was on the agenda, but due to previously scheduled noon meeting with the Legislative Delegation time ran out.
A summary analysis provided by staff explains the two bills. The county’s bill asks for an amendment that would confirm the EMS Authority’s power to establish levels of service that providers would be required to meet. It also removes service levels in place since Jan. 1, 1989.
Fire departments and fire districts would be allowed to provide a higher level of service at their own expense. Providers would no longer be paid “full reimbursements” of cost associated with their service, but would be given “reasonable and customary costs” instead.
The opposing bill that supports the plan from Capt. Jim Millican with Lealman Fire Rescue and Lt. Scott Sanford, firefighter and paramedic with Palm Harbor Rescue, calls for an amendment to require consolidation of ALS and EMS services in favor of fire-based transport, including 911 and non-emergency. Sunstar would be eliminated. The county would continue to provide some centralized services, such as administration.
The plan and supporting bill does not ask for a change to the current approach of dual response using paramedics as first responders, according to a staff report. It does change how providers are paid and it supports priority dispatch, which the county has been trying to implement for some time.
The only real difference between the two plans and their supporting bills is transport – ambulance service. Should transport be done by one provider under control by the county or should local fire departments and fire districts take on ambulance service.
County staff says the firefighters’ plan would cost taxpayers $25 million more than the consultant’s plan. It would cost $14 million more than the current system and provide no guaranteed performance standards, staff said.
Sanford said the plan would save money and allow service providers to maintain a higher level of service than the county’s mandated 7.5 minutes 90 percent of the time. He said the IPS plan increases the cost of EMS, reduces the level of ALS service and reduces the level of fire service.
The IPS plan recommends that the county eliminate 23 rescue units and use fire engines instead.
“There’s a reason for 23 rescues in the system and it evolved over time,” Sanford said. “There’s a need for the rescues. They are less expensive to operate.”
He said a fire engine costs $500,000 to buy dependent on equipment compared to a rescue unit priced at $150,000. Fire engines also are harder to maneuver through neighborhoods and in traffic.
The county argues the firefighter’s plan would require hiring at least 200 new employees. In prior presentations, Sanford and Millican have said employees of Sunstar would probably be hired by providers needing more staff for transport service. County staff said most providers pay better than Sunstar, thus increasing payroll, benefits and pension costs.
High payroll, benefit packages and pension costs are a primary reason funding EMS has become more difficult over time is another argument made by county staff. They say that as long as service providers can set their own ALS budgets, inequities will remain in the system.
Some say the county’s plan to change how it pays providers shifts the burden of cost to the municipalities and doesn’t really provide savings for taxpayers. The city of St. Petersburg stands to lose the most funding and opposes the new plan. The two sides discussed their differences on Oct. 31 and talks are expected to continue.
Support for fire department transport
Pinellas Suncoast Fire & Rescue sent a letter to commissioners Sept. 22 informing them of the intent to pass a resolution saying the district does not support the IPS plan and strongly recommends against renewing the contract with Sunstar.
“The Pinellas Suncoast Fire and Rescue District believes that the provision of EMS transport functions by current local fire department providers is an idea that deserves legitimate consideration and meaningful dialogue,” wrote James G. Mortellite, chair of the PSF&RD board.
The city of Pinellas Park passed a resolution Sept. 22 supporting emergency medical care first response and ambulance transport by the fire service of Pinellas Park. The Fire Chief’s Association passed a resolution Aug. 31 in support of the Sanford-Millican plan, requesting that it be implemented on Oct. 1, 2012.
South Pasadena Mayor Kathleen Peters told commissioners Oct. 25 that she lacked confidence in the IPS plan. She said after meeting with LaSala and the county’s staff her confidence had been further reduced. She also said she did not feel any confidence from the board in support of the consultant’s proposals.
She asked commissioners to slow down and consider carefully.
“Lives are at stake,” she said.
Commissioner Karen Seel wants to create a task force to study the situation. For years, Seel and other commissioners have requested that EMS and fire service be considered together instead of two separate systems.
“I think it is time to look at the whole system,” she said.