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HomeMy WebLinkAbout2015-08-04 Joint MtgJOINT MEETING GROTON TOWN BOARD, GROTON VILLAGE BOARD, AND GROTON FIRE DEPARTMENT AUGUST 4, 2015 AT 7:00 PM ThosePresent: Town Board: Don Scheffler, Rick Gamel, Kelly Smith, Ellard Sovocool, Sheldon Clark Village Board: Chris Neville, Betty Conger, Michael Holl, Jean Morey, Jeff Evener Fire Department and Others: Lee Shurtleff, Jamie Babcock, Lester Coit, Sharon Rumgay, Amy Germain, Dan Carey, Wanda Kuhn, Ed Smith, Matthew Duso, Ben Nelson, Lauren Dickerson, Jenelle Carr, Kenny Carr, Dale Muncey Scott Metcalf, Christy Nent (?), Chuck Rankin, April Scheffler. Don Scheffler - We asked to have this meeting because we've gotten quite a few complaints about ambulance service over the last few months. We're not here to blame anybody but to try to solve the problem before it gets out of hand. A lot of times people say the ambulance service comes and then they get charged for it and they don't feel that it's right. Rick Gamel - I know that in the meetings that we had prior, we were kind of in the situation where we had things under control. To the best of my knowledge, the last time I talked to a few of you we had things set and had people on the clock. Maybe things have changed since then. But I am sure many of you know we had a call up in my neck of the woods for a broken hip and once again, for the third time, the Dryden ambulance showed up. This is wrong. This has to change. I mean we sat at meeting after meeting, what six months ago, to get this ironed out and it is clearly not ironed out. Something needs to happen. We've got to change this. Either that, or we stop paying this out of tax money. I mean, if people are paying for this in their taxes and expecting the service. We've got to figure something out. It's gone on too long. Don Scheffler - I had another comment this weekend and I saw Bangs go by my house yesterday. Several Fire Department members said Dryden had not taken one of their calls yesterday and did not know why it would be there. Lee Shurtleff - Let me just start, I wear a lot of hats, but let me give you my background. I've been in the department for 30 years and joined specifically because of the ambulance service. This is something that literally everyone in my family has done since it started in 1967. As chief in the 90's when we went through similar issues, that was when we started to employ the daytime EMS responder. That solved a lot of the issues because at that point the daytime was the worst of the biggest problem and we ran fairly well up until recent years. Over the last 3 or 4 years we've begun to have problems finding EMTs. Now, just to put it in perspective of what we're doing today versus when we started: in 1970 there were between 50 and 100 ambulance calls a year. In those days we had Doctors Short and Blatchley who still took patients over here at their office and they responded to the health care so not so many people went to the ERs. The health care center opened, and we typically transported a lot of people over there, but that's gone away. By 1980, that 100 calls a year was 200 calls. In 1990, the number of calls handled by the Joint Meeting - Town, Village & Fire Dept. Page 2 of 8 August 4, 2015 ambulance it was 400. In 2000, it's 500 per year. In 2010, it averaged 600 per year. The last 2 years it's gone to 700, so by the end of the decade it will average 700 calls a year versus 100. When we started this business the standard of care was basic first aid. When TC3 was down here, we sent people down for 8 or 10 classes, they were blessed and away they went. In the late 70's they introduced Advanced Life Support. Advanced Life Support is a whole different level of care. They can provide heart monitoring, defibrillation, different levels of drugs, intravenous support, narcotics, etc. That, over the last 30 years has been a standard of care that has affected things nationwide. All your ambulance services today are more or less expected to be able to provide up to that level. The difference in training is about 110 to 120 hours for basic, 2 V2 times what it was when I started, versus about 500 hours for a critical care technician, versus 2 years of education for a paramedic. Maybe five years ago, we began to see a trend, not only in Groton, but in all the services around the County, an inability to respond or a delay to responses. We implemented what's called Emergency Medical Dispatch, and what that does is when you call in to the 911 Center, they question the caller as to some key findings, is this a male or female, how old, are they breathing, are they conscious, to determine the type of call. From that, there's likelihood from that series of questions whether it's going to be a basic transport or advanced life support. We began a system where, obviously someone has to transport when we get a call, the ambulance with the certificate of need has the primary responsibility for the territory. There are 5 ambulance services in Tompkins County. Groton has the entire Town of Groton; Dryden has the entire Town of Dryden plus parts of Harford and Virgil; Slaterville has just the Town of Caroline; Trumansburg has Town of Ulysses plus portions of Schyler in Seneca County; Bangs has all the rest of the County. Bangs runs on a paramedic level on every call they respond on. What we did was have each ambulance service inform dispatch what their status was on a 24- hour basis. If they had no crew, then automatically at the time they were toned, we would start an ambulance to come from another service on a mutual aid basis. We weren't going to wait and continually tone the rigs, we were going to ensure that if you dialed 911 an ambulance was coming, one way or another. If it was an advanced life support call but the crew was basic, we would start an advanced life support unit in addition to the basic ambulance that was scheduled. But what it does is it results in a second service coming and all other services bill for service when they come in at a rate that is set by the State, or the Federal Government through Medicaid and Medicare. Rick Gamel - In this case there was no second service, only one. Lee Shurtleff - That's correct. So, what happens today is that if there is no scheduled crew and no one available, you are getting the next available ambulance who will bill you for service when they come in. Last fall or summer, one of the things that was apparent with the service of the department was that we were in a situation where we were lacking daytime drivers. Through the spring we talked about some different mechanisms and how we might make that work. On June 1St when the new Village budget went into effect, the Village created a position and hired a daytime driver who also works for the water and sewer and electric departments when he's not assigned to the ambulance. Just to give you an idea, we also went back to recruiting for additional help to sign on to run advanced life support. At this point we've got somewhere between 8 and 10 either paramedics or critical care technicians that work for us on a per diem basis in addition to the daytime response. Now, let me give you some figures, because you alluded to the fact that things seemed better through the winter months, and they were. In January, we had 75 calls and the ambulance responded on 72 of those and an outside service was called 3 times; in February it was 36 by us and 4 by an outside service; in March it was 53 and 4. Joint Meeting - Town, Village & Fire Dept. Page 3 of 8 August 4, 2015 So you can see where there had been improvement but there were still periods of time when we weren't able to cover the schedule or we had a second call in the district which is a common occurrence. There are times when we can get 2 or 3 calls in the Town or Village of Groton at the same time. In April we saw this number go to 46 and 7. That was at the point that we went to the Village Board and told them that we had a serious daytime problem and the Board responded by creating the driver position. In May the numbers were 45 and 17. That was the month that the critical care technician used up her vacation hours and we were unable to cover all of the daytime shifts. In June it was 37 and 10. We got notice that the person was hired to a new position and has since moved on. We've attempted to fill in those daytime shifts with additional help in the meantime. In July it was 39 and 16. Now, these are numbers of patient contacts. It doesn't necessarily reflect the disposition. Of the 330 calls, only about 200 were transported and 95 were sign -offs, standbys, cancellations, or calls into other districts. We get called to other places, the same as they get called but not at the same rate. With the daytime responder leaving in June, we went back to the Village Board and proposed that we fill the position, not with one person, but with two. Our sense was that with the money that's been budgeted and the history of what we've paid and with the overtime that was being paid for the prior position, we felt comfortable that two persons could cover within the funding that's been allocated. Looking at it more closely, it would also give us an additional person so that if they stay, and we hope they'll stay, they, like any other employee are going to accrue time, vacation, sick time, what have you. It would give us the flexibility of two people that we didn't have with one. The Village Board gave us permission and we have made job offers to two full time people, one paramedic and one critical care technician. One will begin on the 12th of August and one on the 16th. The Village, in recognition of the added expenses of the Fire Department, is underwriting the driver's position to continue to make that available. So. I'm not making excuses, I'm just explaining where we were. We were in much improved condition, gaining, in the first four months, but lost it in May, June and July, but we have solved that vacancy. Now, that doesn't solve the overall problem. We're down on EMTs and we're down on technicians. We are actively recruiting. Part of what our process is that because they become Village employees they have to go through the Civil Service process. They have to register with Tompkins County Personnel, take an examination, be qualified, etc. It's a little bit more than what there would be if a private company were hiring somebody. A couple of other notes: of the transfers that Groton has done so far this year, the majority of those calls have gone to Cayuga Medical Center versus Cortland. When I got in the business years ago, 90% went to Cortland, the doctors were affiliated there. We still have an hour or less turn -around going there. If we go to Cayuga Medical, it's more than two hours. That impacts our ability to get volunteers during the day and in some of the evening and overnight hours. The other issue is that requirements have changed to a point that we now transport periodically to Syracuse, if it's a burn victim, a trauma, we can't get a helicopter, or if it's faster to go by ground. If it's a heart problem, we'll go to Cayuga or Upstate. If it's a stroke we'll go to Cayuga or Upstate because of their neurological capabilities. More patients are going further distances and that's taking our rigs out of business for a longer time. Rick Gamel - What about weekends? Lee Shurtleff - Weekends are tough. We do have a paramedic that works a full weekend every other weekend. Rick Gamel - The last time we met, I was under impression the daytimes were pretty well covered but weekends were being worked on. Joint Meeting - Town, Village & Fire Dept. Page 4 of 8 August 4, 2015 Lee Shurtleff - It's not consistent. It gives you an idea of what the volume is that we're working with. The demands are such, and the same for every service, 50% falls into the classification of needing advanced life support. That's a huge volume of calls. Some of the other issues, we're trying to pinpoint where these calls are. Of the 700 calls that we do this year, you'll see 500 transports roughly. Of those 500 calls, 40% of them are coming out of 10 locations: nursing home, 200 West South Street, 177 Main Street, the intermediate care facilities, the doctor's offices, four apartment houses in particular. There are some differences today in how we go about doing business. We talked a little bit about basic life support. We're having a hard time retaining it. I just let my card go after 30 years. I hope to get into a place for a refresher class in the fall and get back to it, but I had to hit 72 hours worth of continuing education over 3 year's time. I just couldn't put the time into the classes. The skills aren't any different today, except now as a basic EMT, I'm expected to, in addition to provide basic support, provide aspirin, epinephrine, assist with heart medications, use an automatic defibrillator, and soon we're going to be going to a ventilation CPAP machine that we'll all have to be trained on. In addition to that we all need to be able to deliver drugs such as Narcan. When I started, the reason I got into it was because of people like your mother. There was a call last night for some people that I have known my whole life, but in addition to that we had two ambulance calls for someone who's home health aid didn't show up and had to have assistance getting into bed. I can't tell you the number of calls we've had in the last two years related to heroin, narcotics use, overdoses, and mental health. This is stuff we didn't do 20 years ago. We have residences today where we won't go onto the property unless we have a police escort. I'm not blaming anybody, but I'm telling you that the nature of the business has changed and it drives part of the reason that we can't retain basic EMTs and why we're having to hire help. Let me broaden this out a little bit, putting on my County hat. You've got Groton up here in the corner of the County serving 5000 or so people, running 600 calls a year. You've got Trumansburg with 5000 people and they've got 600 calls a year. Dryden has 12,000 people and they're running between 1,500 and 1,800 a year with a large part of Dryden's volume being through Mutual Aid, not only to us but to Bangs and TLC in Cortland County. They're running because they are staffed and they are getting calls. We took a call for TLC last week because the commercial ambulance service in Cortland ran out of ambulances. Then you've got the Town of Caroline covered by Slaterville, with 3000 population and they're covering 300 calls. So, you've got 25,000 people in the County being covered by four services doing roughly 3,000 calls a year. Now, take Bangs, they have 3 times that population and running up to 10,000 calls a year. What's the difference? I've got a service over here that's trying to go paramedic based 24 hours a day; I got one here the same way with a single paramedic, non -paid; and I've got a service here trying to run 2 paramedics. So, you're trying to run five ambulances to cover 25,000 people and 3,000 calls a year. At the same time Bangs is running an average of five paramedic level ambulances doing three times the population and four times the number of total calls. It's a system issue. In order to put five paramedics down there, not counting drivers and attendants, and then five paramedics in these other services to run those five ambulances, you're looking at ten people around the clock. Factor that by the number around the clock, it takes about 55 people to fill just the paramedics. There aren't 55 paramedics in Tompkins County, far less than that. They are working at multiple services and they're being paid around $15 - $20 an hour, which is why they're working for multiple services. The problem is that as a system, as a state, as a nation, we can't sustain that. There aren't enough people at that level of training, or taking that level of training, or retaining or continuing. We've built the system and the expectations are beyond what can be matched. Doesn't help us Joint Meeting - Town, Village & Fire Dept. Page 5 of 8 August 4, 2015 locally, but I'm trying to put this into some perspective. When each of these services are out and recruiting and doing the best they can, for the most part they are getting out the door 72 times out of 75, they aren't getting out 100% and they aren't because you just don't have the bodies being trained. Rick Gamel - These are the same issues we talked about last time. It still doesn't change the fact that we have to change what we are doing to bring them in. If someone is going to pay, I'd rather pay Groton than pay Dryden. The reason we got those meetins together the first time was because Dryden said we can't do it anymore. They had too many calls in their district to cover ours too. I'm not blaming anybody, but we've got to fix it. Lester Coit - We don't disagree with you. We're trying to fix it as well. Rick Gamel - But what do we need to do? Lee Shurtleff - We keep going back to the issue of funding. If we had five people magically appear, we would find a way within the resources we've got to get them paid. We'd probably come and seek an increase in the contract, but we keep going back to should we bill or not, and the contracts will support what we've budgeted at this point. But we cannot find the fulltime or even part time people to work with us. The other answer might be to shift away from advanced life support and go to a basic service, but you're not doing your community any favors. Rick Gamel - How does Dryden have it and we don't? If someone is working somewhere in Tompkins County and not for us, that's a funding issue. If we're paying as much as they are then okay, they've chosen Dryden. But if Dryden is paying more than we are, let's steal them. Lee Shurleff - One of the reasons we were successful in getting the two that are coming on is the fact that they will get a fulltime benefit and they are probably taking a pay cut to come here. But by going fulltime with us we're able to put them into the State retirement system and provide them with health insurance. That's a plus to Groton that the nonprofits don't necessarily have. The other thing is that the rest of the people we have coming here are working fulltime somewhere else and they're just getting extra hours. And one of the reasons they come here is that they run like crazy when they work for these agencies during the week, but when they come here they get a little bit of a break because they might get one or two calls or even none. On the other hand you have some who don't want to come here because there's not enough action here. Rick Gamel - What is happening as far as recruiting? Lester Coit - Basically, word of mouth. We do put big flyers out to hospitals, requesting people apply. When we interviewed these two fulltime people, we actually had five people. These two were the only two who wanted to solely commit to Groton. The other three wanted to work their other fulltime jobs and put Groton second. Rick Gamel - Can you fill those people in on the times that aren't covered? Lester Coit - We're trying but they're working overtime at Bangs and Dryden. Some of the part timers working for us right now told us they're making $70,000 at Bangs, but they are working un -Godly hours. Lee Shurtleff - One of the other problems is that we've had some scheduled to work here and then they call and say they can't come because they're forced to work overtime where they are at. This is the third meeting I've had with a Town Board this year. It's the same thing in Caroline and Ulysses. They don't know where they are going to find people or how to fund it. Joint Meeting - Town, Village & Fire Dept. Page 6 of 8 August 4, 2015 It's no different than what hospitals are going through with nurses and what our nursing home is going through. There is a limited number of people who are certified and they shift back and forth where there is more money offered. Rick Gamel - Is there anything we can do as the Town as far as going through someone higher up? I hate to say lower the standards, but to lower the requirements. It's clearly a problem Statewide. People a basically volunteering their time at a very difficult job and are required to do hundreds of hours of schooling, pay out of pocket, and find time to do it. Lee Shurtleff - I think you are in a position. The State Fire Chiefs have argued this for years, but until Albany hears from the Association of Counties, Association of Towns, Conference of Mayors, and others and hears it loud and clear that it's too much, they're going to continue to have the requirements. (Mr. Shurtleff explained several other new requirements requiring hours of extra time and training being handed down by the State.) Rick Gamel - Could we do an ad about volunteers? You know that there are people out there who might volunteer some time if they knew it was needed, the driving portion or maybe they have their basic training. Sheldon Clark - I had a couple who were very interested at a time in their life, into retirement. I brought their names to your board but they never heard anything and I didn't hear anything. It's kind of sad. Lee Shurtleff - From time to time, we go through requirement. To go back to the question about paid services. For those who have divorced themselves from the fire departments and create independence, the tendency is that once they are out of the volunteer, community-based core, they're not able to start a very strong volunteer component. You've now got two entities providing services and there is a tendency of hiring drivers in these places in addition to paramedics. That's one of the goals we've had by retaining it within the service that we have, is that we've got a base of people who, not all the time, but for the most part, provide you with drivers and attendants. If you have any other organization, you find yourself having to fund the medical component, the paramedics and critical care technicians, and potentially the basic, but the drivers and attendants as well. Someone said that they would also have to pay the administrators. Lee Shurtleff - That's right. We've done the calculations. Rick Gamel - We went over that at the last meetings as well, but again, I go back to the fact that Dryden has gone to a paid service. I'm not saying it's the answer, I'm just saying that the three times in my life that I've had to call 911, three times Dryden showed up, not Groton. With that being said, they do have paid service, and you guys being taxpayer paid and you're not always showing up. Maybe I'm just an abnormality in the mix, but three out of three, and 45 minutes, that doesn't work for me. Mike Holl - I understand your frustration. Three out of three is rough. I just had an experience too with my mother and they almost beat me there. So, it's nice to have Lance driving now. With Lance and with the two new hires, can we get back to that 72 out of 75 number? That's 96%. Personally, I'm willing to pay for that. I understand your frustration, but for me, I'm willing to pay my tax money to have a service that covers 90% of the calls. Joint Meeting - Town, Village & Fire Dept. Page 7 of 8 August 4, 2015 Further discussion took place as to whether having the additional hired people would get the percentage up higher. Lee Shurtleff - You do realize that in addition to the paid service, that they are levying taxes in these other places as well. Rick Gamel - If it's in our taxes and it's in their taxes, are they paying for service as well? Are they paying as much for a Dryden call as someone in Groton would for the Dryden Ambulance? Lee Shurtleff - More. By the time you get done, with the tax levy in addition to the billing, the cost of the service is probably higher because we're not paying for the drivers and our overhead is significantly lower from the administrative standpoint and the fact that we're able to share things like workers comp and other administrative costs. Rick Gamel - But does Dryden charge the same for someone in Groton as they do someone in Dryden? Lee Shurtleff - There's two ways this can happen. One is they bill your person for the full transport if Groton doesn't respond, they probably will bill the full transport. If they come as an advanced life support, they're going to get a Medicare rate of x amount of dollars, which is a fraction of the bill that you would get for a full service respond. They are billing somewhere in the $400,000 range and Dryden is still leveling a tax of over $300,000 a year. The Town of Ulysses is looking at an ambulance budget in excess of over $400,000 for the same number of calls and the same staffing troubles that we're attempting to provide at half that. If you were to build for service today based on the mix of patients: Medicaid, Medicare, private insurance, no - pay, out of pocket, the estimates are roughly $125,000 to $140,000 that would be recouped before you take out the processing of insurance, the 10% fee that the billing company has, the added workers comp costs, the added expenses, you have a service on the other side of the lake which probably after they get into full billing is still going to be levying taxes well in excess of what the Village and Town here are paying together for what we have. Rick Gamel - We can't do what we're attempting to do and bill? Is there a legal issue against that? Lee Shurtleff - We're restricted as a Fire Department. Jamie Babcock - We hired an ambulance manager and were going down that road, but at the end of the day, the Village Board and the Board of Wardens said this was not what we thought it was going to be. Basically, it costs a lot of money. Further discussion took place on the pros and cons of billing and taxing. Mr. Shurtleff explained that General Municipal Law prohibits a volunteer based fire department to bill for the ambulance service provided under their organization. The only way to do it would be to create a new, commercial ambulance service or create a separate entity under the control of the Village with its own administration, as well as the administration costs. It would need to be separated completely from the Fire Department. Ulysses has separated from their Fire Department and they have lost volunteers because of it. They have also found that a certain amount of animosity is created when some of the people are paid and some remain as volunteers. There was discussion about a letter that had been written during previous meetings to inform the public of the problems facing the ambulance service. The letter had not been sent at that time. Joint Meeting - Town, Village & Fire Dept. Page 8 of 8 August 4, 2015 Further discussion also took place on how to fill the gaps in service, and advertising ideas to help get more volunteers. Chuck Rankin mentioned the tax cap and how hard it will be in the future to meet the tax cap if we have to continue to raise taxes to cover the ambulance service. It was suggested that at some point we may need to lower our expectations. Lee Shurtleff said that in the future these services would probably be forced into consolidation because they will just be unsustainable. He also said that at this point no commercial service would come to Groton when over 50% of the pay base is Medicaid. Discussion continued on how to get volunteers, what can be done to recruit more people, whether or not people would be willing to pay more in their taxes and the consequences of exceeding the tax cap. Rick Gamel thought there had been discussion previously that the Town and Village could possibly sponsor a volunteer to go through the training. Everyone talked about that possibility and how it might be accomplished to assure that the person actually finished the classes and then stayed around to work for our ambulance. Bob Walpole suggested that perhaps the Town could hire a couple paramedics. They were not sure that would work since it is a Village entity. Lee Shurtleff wondered if this would somehow fall under a shared service program and be eligible for a State grant. He also mention that there was a free tuition program that he didn't know a lot about, but would look into it. The previous letter was brought up again and Rick Gamel found that he had a copy of it and asked that the Clerk make some copies. They thought they would get the group together again and come up with a new version to send out to the public to both inform them of the current problems and attempt to recruit volunteers. The next meeting was set for Tuesday, September 1, 2015 at 7:00 pm at the Groton Town Hall. Meeting was adjourned at 8:35 pm. April L. Scheffler, RMC Groton Town Clerk