Sen. Jack Latvala (R-Clearwater) talks about the importance of protecting citizens during a Nov. 30 public hearing at the Pinellas Park Performing Arts Center called by the Pinellas County Legislative Delegation about local bills to amend the Special Act that created the EMS Authority.
Photo by TERRE PORTER
Pinellas County Commission Chair Susan Latvala and County Administrator Bob LaSala give the Pinellas County Legislative Delegation the county’s perspective on the EMS situation during a Nov. 30 public hearing at the Pinellas Park Performing Arts Center.
Photo by TERRE PORTER
Lt. Scott Sanford, firefighter and paramedic with Palm Harbor Rescue, left, and Capt. Jim Millican with Lealman Fire Rescue, explain their plan to use fire-based transport in place of a private ambulance company during a Nov. 30 public hearing at the Pinellas Park Performing Arts Center.
This chart shows a decline in the historical EMS millage rates from the years 1981 to 2009.
PINELLAS PARK – State legislators won’t be considering changes to the Special Act that created Pinellas County’s EMS Authority when the session starts in January.
The Pinellas County Legislative Delegation voted unanimously Nov. 30 to approve a proposal set forth by Sen. Jack Latvala (R-Clearwater). The proposal requires the county to pay for a study, using EMS funds, by an independent nationally recognized accounting firm on the costs and potential revenue from two proposed plans to change the EMS system. The study also will consider the system currently in use.
The study must be complete by July 1, 2012. Local legislators will assist in the selection of an impartial group of people representing municipalities, fire service, the county and the current ambulance service provider. The six- to eight-member committee must be selected by Jan. 1.
In addition, the county cannot implement changes to the system proposed by a consultant and entities opposing those changes cannot take legal action.
The Nov. 30 meeting was called after the county’s legislators were asked to sponsor two opposing local bills that would change the special act that created the county’s EMS Authority.
“These are two very different bills,” Latvala said. “We didn’t understand it (the situation) enough to make a decision.”
He said the intent was to listen to as many perspectives as possible during a time-certain hearing.
“We all know why we’re here today,” he said. “There is no responsibility higher than protecting citizens – keeping them safe.”
The auditorium at the Pinellas Park Performing Arts Center was carefully staged with proponents of the bills sitting at tables to the right and left of a long one in the front where the legislators were seated.
Pinellas Park Mayor Bill Mischler welcomed the crowd and said the arrangement reminded him of a WWE SmackDown with opponents on both sides.
The county was asked to present its perspective first. Commission Chair Susan Latvala said the special act needed to be amended to give the EMS Authority, which is the county commissioners, the ability to control costs by changing the method used to reimburse providers for advanced life support (first responder) services. She also said the authority needed to be able to set the level of service.
She said it wasn’t “fair or equitable” to give the commission the authority to raise taxes but not control costs.
“We want help to stabilize costs,” she said.
County Administrator Bob LaSala said the intent was to provide a uniform level of service for the entire county. He said the current level of service of 7.5 minutes 90 percent of the time was considered a platinum level of service in the United States.
He said changes were needed to help the authority achieve equity in the distribution of revenue and expenditures, as well as allow for cost control and containment, which the county cannot do now due to budgets being set by the providers of the service.
He said the changes in the county‘s local bill would not threaten home rule as it gives the providers the ability to provide a higher level at their own expense.
“It’s quite simple,” LaSala said. “The board wants the authority and accountability that is unclear and lacking in the current special act.”
He explained that the EMS system uses a public utility model that provides transport by a private provider doing work under the county’s license and brand of Sunstar. The county does the billing using information provided by the transport provider.
He said Paramedics Plus was chosen via a sealed bid process and a contract was negotiated that included options for renewal ensuring continuity of service for the life of the contract. County commissioners most likely will vote to renew the contract with Paramedics Plus for at least one year on Dec. 6.
He said the service provided by Paramedics Plus was superb and second to none in the state of Florida.
“We have a service that is uniform throughout the county,” he said. “It is a cost-effective model of delivering effective service.”
He then outlined the areas where the county and the firefighters agreed and the areas where they did not. Perhaps the biggest sticking point is the issue of cost. Capt. Jim Millican with Lealman Fire Rescue and Lt. Scott Sanford, firefighter and paramedic with Palm Harbor Rescue, authors of a plan that advocates fire-based transport in place of a private ambulance company, say their plan will save money. However, county staff says actually it will cost more – at least $25 million more than a system using changes recommended by the county‘s consultant.
State officials want to get to reality figures, which is the impetus behind Sen. Latvala’s proposal to hire an accounting firm to go over the numbers contained in the proposals from the firefighters and county‘s consultant.
Regardless of which plan costs the most, some providers are opposed to changing the way the county pays for their services. The city of St. Petersburg says the method the county proposes to use to reimburse the 18 providers of advance life support (first responder) services, if the Special Act is amended, would put them out of business. St. Petersburg argues that the county’s plan does not really save money to the system it just shifts the burden of cost to fire departments and fire districts.
Sanford served as the spokesperson for the plan to allow fire-based transport.
“Jim and I started working on our proposal in direct response to LaSala’s IPS plan to save money,” he said.
He said many believe that the plan supported by LaSala and county staff does not save money or improve service. He said rather than just cutting costs, they had looked for a way to improve service and efficiencies to save money.
He said the fire departments had been good partners with the county and had done their best to reduce expenses unlike the transport provider who actually increased the cost of its service to residents.
“Incorporating fire-based transport is the best way to sustain the system into the future,” he said.
He said the county’s statement that their plan continues the dual response system currently in use is not quite accurate, although multiple units could still respond to calls that warranted dual response. He said the firefighters’ plan saves money by reducing management and still puts more units on the streets.
Response times
He said response time of 4.5 minutes on average could be maintained with the firefighters’ plan, which is quicker than the 7.5 minutes 90 percent of the time that is the county’s new standard for level of service.
St. Petersburg Fire Chief Jim Large said the county’s standard is lower than what has been achieved in the past. He told the legislators that the current average response time in the county is 6.23 minutes 90 percent of the time – more than 1 minute faster than the county’s mandated standard.
Sen. Latvala asks county officials how local response times compared to other areas that use fire-based transport and the county had no answer. The legislators then asked Bill Nesmith, a retired Hillsborough County fire chief, who happened to be in the audience, for the answer.
Nesmith worked with Tampa Rescue for 24 years and retired as division chief in 1994. He accepted the position of assistant chief with Hillsborough County Fire Rescue that same year and was promoted to chief in 1996. Nesmith is credited with merging the Hillsborough County Fire Department and Emergency Medical Services.
Nesmith said response time goals in Hillsborough were 6 minutes 90 percent of the time in urban areas, 7 minutes 90 percent of the time in the suburbs, and 10 minutes 90 percent of the time in rural areas, which Pinellas does not have. Only the rural areas had a response time greater than Pinellas County’s standard of 7.5 minutes.
Nesmith said when Hillsborough merged its two departments no paramedics lost their jobs unless they wanted to go. He said paramedics who wanted to do so were cross-trained as firefighters. Others were placed on ALS engines as paramedics.
He said he was concerned about delays in ambulance response, which was the complaint of some of the public, who talked about receiving quick response from the fire department only to end up waiting for an ambulance. Another complaint from the public was the cost of ambulance transport via Sunstar.
Large said the county’s plan would not really increase the number of units on the streets. He said while it did increase the number of Advanced Life Support units, it decreased the number of units overall. The county’s consultant recommends removing smaller rescue units in favor of the larger ALS engines. Large said if that happened, it would mean a reduction of 23 rescue units and 13 paramedics, which could lower response times.
Support for fire-based transport
The tide seems to be turning in favor of fire-based transport – if it proves to be as affordable as some firefighters believe. The majority of people speaking at the Wednesday afternoon public hearing supported at least exploring the option of fire-based transport. No one spoke in support of the county’s plan.
St. Petersburg Mayor Foster said up until Nov. 28, the county had refused to discuss fire-based transport, which he also supports. He said his city, the largest in the county, responds to 33 percent of the first responder calls in the county, which explains why it employs the most paramedics and has the highest cost of any provider in the system.
Foster objects to the proposed new funding formula that he says would shift the costs to the cities. He said the situation was much like the 1980s when the county tried to change how it paid its providers and lost a lawsuit against St. Petersburg. He warned of more legal action if the county proceeded with marginal cost funding.
Mark Weinkrantz, chair of the East Lake Fire Commission, said East Lake could take care of its own transport if it had the funding. He talked about concerns that small districts could be “shorted” in the distribution of funding if the method was changed. He wants to avoid any situation that would pit East Lake against other providers to justify their need for funding.
Norman Atherton, chair of the Palm Harbor Fire and Rescue Board, also advocated fire-based transport. He said it was wrong to allow a “private company to make profits off somebody’s suffering.”
Atherton brought up the county’s initiative to implement priority dispatch and said Palm Harbor had not been notified when it was implemented. He said there was a problem with communication. He said he supports the principle but questions the practice. He said priority dispatch could work if it is done right.
Others talked about potential problems with priority dispatch, although most agreed there needed to be a better way to do dispatch so multiple units weren't called to deal with minor injuries.
Millage rates
Largo Fire Chief Mike Wallace doesn’t think a change in the special act is necessary. He thinks everything the county needs to manage and fund the system exists today. He showed a chart of historical EMS millage rates for the years 1981-2009, which shows a steady decline in the amount levied.
Some residents were unhappy when Pinellas County Commissioners raised the EMS millage rate 46 percent for the current fiscal year to 0.85 mils, the same rate levied in 1992. However, some say that the current millage rate is not too much to pay for good service.
During much of the 1990s, millage rates hovered around 0.92 before spiking to 1.06 in 1989. The next year it fell to 0.7 mils. In subsequent years, the highest rate was 0.87 in 1993 and 0.75 in 2001. From 2002 to 2005, the millage rate remained the same, 0.66 mils. It was further lowered to 0.63 in 2006 and to 0.58 in 2008 where it remained until the current fiscal year.
When voters approved the referendum, which established the current EMS system, they approved a millage cap of 1.5 mils – far above what the EMS Authority (county commissioners) has ever levied.
Foster faults the county for not raising the millage rate when property values bottomed out and ad valorem tax collections decreased dramatically. Instead, they chose to use up the reserves, he said.
Wallace supports raising the millage rate to pay for the system, which he says has already been approved by the voters. He said it would not require amendments to the special act or changes in the funding formula.
Large agrees. He said cost containment wasn’t the real issue; instead, it is declining revenue due to lower property tax values.
“It’s the millage,” he said. “We’re containing costs fairly well.”
Large doesn’t support any of the local bills. He says the special act should be repealed.
More than amendments
Rep. Jeff Brandes (R-St. Petersburg) asked several speakers if it was time to do more than just amend the special act. He asked if it was time to look at it as a whole and perhaps rewrite it in its entirety. Opinions were mixed.
South Pasadena Mayor Kathleen Peters, speaking as a private citizen, said she was not in favor of either local bill. She suggested that the special act be rewritten to change the structure of the EMS Authority. By law, the Pinellas County Commission is the authority.
Peters thinks the authority should be structured the same as the Metropolitan Planning Organization or the Pinellas Suncoast Transit Authority, which include representatives from local municipalities – not just one board.
“They don’t’ fight at the MPO or PSTA because all the stakeholders are at the table,” she said.
Peters and others defended the county’s right to home rule and the ability to find solutions without having to involve the state.
Local bills won’t be considered this year
After listening to the speakers, Sen. Latvala was met by silence when he asked the delegation if anyone had an interest in moving either local bill forward.
Rep. Ed Hooper (R-Clearwater) said the county’s Cadillac system of EMS services had worked “beautifully” for years, but with less money coming in to pay for it, “we now have to shop at the Chevy dealership.”
He said any major changes to the special act should be approved by the voters.
“The citizens ought to have a say,” he said.
Rep. Peter Nehr (R-Palm Harbor) said his sponsorship of the county’s bill did not imply an endorsement. He said he agreed to sponsor it to open the matter to debate. He pointed out the vast differences between the two plans. He supported an independent study of both proposals.
“If we were to vote today, it looks like the support would be for the firefighters,” he said.
Rep. Rick Kriseman (D-St. Petersburg) said it was all about public safety. He said the difference between a response time of 4.5 and 7.5 minutes was life and death. He also supports fire-based transport if it can maintain service levels. Ultimately, he thinks the county and its municipalities should find a way to work it out without asking the state to get in the middle.
Rep. Jim Frishe (R-St. Petersburg) said there was a mandate from the people that allowed the EMS Authority to charge up to 1.5 mils when the current rate is only 0.85, which means the system probably could be funded by millage. He said a bigger “bone of contention” was the taxes for fire services in some of the smaller districts.
Rep. Jeff Brandes (R-St. Petersburg) said he felt a bit like he was attending a shotgun wedding. He said it was a fundamental issue of trust. He expressed concern about the cost of pensions for additional government employees – fire department employees doing transport versus a private company. The county claims it costs $40,000 more to pay paramedics at fire department versus those employed by Paramedics Plus due to pension costs.
Finally, Sen. Latvala asked to outline a proposal.
“The biggest point of contention is what Millican-Sanford says it will cost and what the county says it will cost,” he said. “There’s a huge difference. Somebody is way off.”
He said the best way to determine who was right in an impartial way was by hiring a nationally recognized accounting firm to study all the numbers.
“Then we can take further action,” he said.
LaSala said it would probably take six to eight months for a study to be completed – too late for the upcoming legislative session.
Sen. Dennis Jones (R-Seminole) urged the delegation to support Latvala’s proposal.
“Waiting another one session is worth it if we make the right decision from facts we all can agree to,” he said.
Hooper said he liked the motion, but was concerned about the timetable. The county must tell Paramedics Plus its intention on renewal of its contract by January. Commissioners are expected to vote on the matter Dec. 6.
Commissioner Latvala said even if the decision were made to go with a fire-based transport system, it would be years before it could be implemented. She said contracts would be needed with 18 providers – not just one as it is today. Sanford disagreed saying it should not take that long. He said the county already had contracts with the 18 providers that just needed to be amended.
Foster said he supported a study of the economics of fire-based transport to see if it is the most cost-effective way to maintain the level of service.
“The solution is probably not yet presented,” Brandes said.
He said he could support the motion “as long as it is understood it doesn’t preclude presenting another alternative.”
LaSala said the Sanford-Millican proposal was an independent study that didn’t represent the county’s 24 municipalities.
“They don’t represent anyone but themselves,” he said. “It’s not fair to ask them to be responsible for others.”
Sanford agreed he could not speak for all the cities.
“But residents and cities have spoken and the majority supports the concept of fire-based transport. They do not support the IPS (county consultant’s plan).”
Correction: Fixed spelling of Rep. Jim Frishe and identified Sen. Dennis Jones.
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