The Lake County Board of County Commissioners met in regular session on Tuesday, June 13, 2000, at 9:00 a.m., in the Board of County Commissioner's Meeting Room, Lake County Administration Building, Tavares, Florida. Commissioners present at the meeting were: Welton G. Cadwell, Chairman; Catherine C. Hanson, Vice Chairman; Rhonda H. Gerber; Robert A. Pool; and G. Richard Swartz, Jr. Others present were: Sue Whittle, County Manager; Sanford A. Minkoff, County Attorney; Wendy Taylor, Administrative Supervisor, Board of County Commissioner's Office; and Sandra Carter, Deputy Clerk.
The Chairman opened the meeting.
EMERGENCY SERVICES/FIRE AND RESCUE/RESOLUTIONS
Commr. Cadwell stated that Lake County Emergency Order Resolution No. 2000-82, prohibiting the sale, purchase and/or use of fireworks, certain pyrotechnic novelties and trick noisemakers, and the use of flares and outdoor burning had been signed and would be in effect for seven days. He noted that this was the second Emergency Order Resolution that has been signed dealing with the issue of fireworks and that each time one is signed it is in effect for seven days.
WORKSESSION - AMBULANCE UPDATE
LAKE-SUMTER EMERGENCY MEDICAL SERVICES (EMS) BUSINESS PLAN
Commr. Cadwell informed those present that the purpose of this meeting was to bring the Board the Lake-Sumter Ambulance Committee's recommendation, with regard to ambulance service for said counties. He stated that this was the first time, since he has been on the Board, that there has been a true feel for what the ambulance service will cost and what services are going to be provided. He stated that the Committee's job was to attempt to create a public community based ambulance service. He stated that he had questioned the business practices of Rural/Metro Ambulance and that they were no longer being considered as an ambulance provider for the County. He stated that he hoped the Board would approve this date to move forward with the not-for-profit public entity, in partnership with Sumter County, to create and oversee the ambulance service, however, noted that, if that was not what they intended to do, they needed to give staff clear direction of where to go. He stated that representatives from Sumter County would not be present at this meeting, noting that they would be given information regarding the matter later this date.
Mr. Robert Moore, Mayor, City of Tavares, representing the Lake-Sumter Ambulance Committee, addressed the Board and presented the Business Plan for Lake and Sumter Counties for Emergency Medical Services (EMS), which he stated was designed around a not-for-profit corporate model that would manage and oversee the provisions of EMS in Lake and Sumter Counties. He stated that the numbers contained in the plan represent what the Committee believes is the cost for providing EMS in Lake County. He stated that it does not represent an increase in the costs, but does represent a transfer of who is going to pay those costs, which are currently being borne by Florida Hospital Waterman and Medicare. He stated that, under this plan, based on the Medicare rule changes, it is going to have to come from the taxpayers. He stated that the numbers in the plan are not meant to be a budget for the new service, they are individual line items and projected expenses in those line items. He stated that there are a lot of decisions that have to be made, before that document can be finalized.
Mr. Moore stated that the system is locally controlled and directed and is responsive to the community's issues and needs. He stated that the Board of County Commissioners, under this plan, will have more knowledge, oversight, and control than they have ever had before, with regard to the provision of EMS in Lake County. He stated that it will not be much different than a county department that the Board of County Commissioners oversees, noting that the Board of Directors will bring the Board of County Commissioners a budget each year, or whatever that budget cycle is determined to be, and the Board of County Commissioners will determine what they want to approve or deny, with regard to said budget. He stated that the Board of Directors will be comprised of seven (7) members, being: a County Commissioner from Lake and Sumter Counties; a city representative from Lake and Sumter Counties; a citizen representative from Lake and Sumter Counties; and a hospital representative.
Mr. Moore stated that, for the first time, the Board of County Commissioners is going to have complete knowledge of where each dollar is going, where each ambulance is stationed, what the real response times are, in providing the service, and how much money is being collected, for providing the service. He stated that said data has not been available to the Board in the past, in an accurate and complete way. He stated that the relationship the Board will have with a not-for-profit will be totally under their control, noting that they can establish whatever relationship they desire to have, to ensure whatever level of control they desire, and receive whatever information they desire. He stated that this plan provides the potential for some of the activities of the new service to be done by constitutional officers in Lake County, such as collections and accounting, which will ensure even more accuracy, as well as cost savings. He stated that the bottom line is that the taxpayers will know where their dollars are going.
Mr. Moore stated that, because this is a public entity, there is greater incentive to develop a true EMS system, which is based on the participation of all the potential resources in the community, two of them being the County and Municipal fire departments. He stated that this public scrutiny will, in the long run, lead to a higher level of service and much greater professionalism within the people who are actually providing the service. He stated that they are not recreating an EMS provider, a new EMS provider, or a new EMS system, which he feels is one of the strengths of the direction they chose to go. He stated that they are taking the system that has been developed, honed, and refined over 15 years and moving it over, with a different management structure overseeing it. He stated that they are taking the best of what has been developed and invested in for 15 years, whether it be personnel, policies and procedures, quality assurance programs, etc., and changing the management structure and oversight of it. He stated that it is a public management entity, rather than a private one.
Mr. Moore stated that he felt this would be one of the keys to what he feels is going to be the successful transition from where the County is today to October 1, 2000 - the fact that there is a structure in place and it is geared up and ready to go - all they have to do is turn it loose, with the proper oversight entities in place. He stated that it is a quality driven service, not a profit driven service. He discussed the level of service that will be provided, at which time he reviewed a graphic, indicating the number of on-duty ambulances that have been allocated to Lake County over time, of which there are currently nine, covering 1,163 square miles. He discussed various obstacles that they have to deal with, in covering Lake County, such as the number of bodies of water that they have to move around, urban sprawl, and a limited and ineffective non-emergency transport service, all of which affect the overall system delivery. He stated that those nine ambulances are currently responding to over 70 calls per day and transporting 18,823 patients per year. He stated that the Committee is proposing to add three 24-hour ambulances to that figure, for a total of twelve. He stated that this plan opens the door for cooperation with the County and Municipal fire departments, in the provision of EMS. He stated that he did not believe there was a real incentive, under private management, to form those types of relationships.
Mr. Moore referred to a map (drive bubble map), contained within the Board's backup material, noting that it indicates how far an ambulance can travel within an eight minute time frame from its current station in every direction from that station, for Lake and Sumter Counties. He stated that that eight minute response time is not being achieved in Lake County, at the present time, even though the contract calls for it. He reviewed the organizational structure that the Committee is proposing, however, noted that it is subject to change. He stated that one of the challenges facing EMS is the Omnibus Balanced Budget Act of 1997, where the Health Care Finance Administration (HCFA) is charged with the responsibility of reformulating how Medicare reimbursement is paid. He stated that they are coming out with a new reimbursement system and new reimbursement pricing. He stated that the worse case scenario might have an impact of up to $500,000.00, however, noted that it is a phased in impact, so the first year there will only be a 20% hit, or $100,000.00, as of October 1, 2000. He stated that, based on that fact, the County may not be as bad off as they originally thought.
Mr. Moore discussed the transition time for this plan, noting that the County only has a little over 100 days to accomplish it and that several key components have to be in place, to ensure the success of the transition. He stated that some of the things that have to be accomplished are (1) the County has to get a Medicare provider number that impacts with the insurance providers; (2) it has to get a state ALS license; (3) it has to contract with a Medical Director; (4) it has to do a number of Human Resource transitions; (5) an Executive Director has to be hired; (6) management positions have to be filled; (7) EMTs and paramedics have to be tested and hired and placed into an approved salary structure; (8) purchasing and maintenance contracts have to be executed and planned for; (9) leases must be extended, where needed, or renegotiated in another form; and (10) communications, accounting, and collection functions all have to be transitioned. He stated that, in order to do these things, the County has to set up a not-for-profit corporation, set up the Board of Directors and give it some authority, hire a Medical Director to be on board and contracted, and make it clear to all parties involved, including county staff, that they need to take the steps necessary to proceed to get it done.
Mr. Moore discussed how the costs involved with this plan will be shared with Sumter County. He stated that the Committee determined what percentage of the total patients transported were from Sumter County and what percentage were from Lake County and came up with the following percentages - 19% for Sumter and 81% for Lake. He discussed what is being shared between the two counties and noted that each county is going to get what it is paying for.
RECESS AND REASSEMBLY
At 9:25 a.m., the Chairman announced that the Board would recess for five minutes.
LAKE-SUMTER EMERGENCY MEDICAL SERVICES (EMS) BUSINESS PLAN (CONT'D.)
Mr. Moore reviewed various pages of a handout that he had distributed to the Board, noting that the Net Equity (Loss), which is the amount of money that would be needed to operate this system at its current level of service, would be minus $2,641,666, with the nine ambulances that are currently operating within the County. He stated that, if the County added back the three 24-hour ambulances that were deleted from its system a couple of years ago, the cost to do so would be $909,092.00, for a total of minus $3,550,758.00, however, noted that some value engineering could save the County approximately $500,000.00. He stated that there is also over $218,000.00 in lease payments each year, for the housing of ambulance crews, communications, maintenance, administrative overhead, and education. He stated that the Committee feels those costs can come down, however, noted that that issue will be addressed at a later date.
A brief discussion occurred regarding the fact that fire services and the cost of providing same were not included in this plan, at which time Mr. Moore noted that the County currently has a deficit of $2.6 million, without fire dispatch. He stated that, to add fire dispatch, that deficit would have to be increased by $110,000.00, bringing the total figure to $2.7 million.
Commr. Gerber stated that she was impressed with what the Committee wants to do, with regard to dispatching, as far as medical emergencies are concerned. She questioned whether there will be an increased cost for training EMS personnel.
Mr. Moore stated that there will not be an increase in the cost for training, however, noted that the Lake County Technical Center sets the rates for the basic emergency medical technician (EMT) and paramedic training. He stated that continuing educational training is available; however, it is done in-house and absorbed by the system.
Commr. Pool questioned whether the cities had agreed to participate with the County in this plan.
Mr. Moore stated that the Board of Directors for the League of Cities voted to support the proposed plan at their last meeting and that it was a unanimous decision.
Commr. Swartz questioned the amount of legal fees that has been figured into the budget for this plan, on an annual basis.
Mr. Moore stated that the figure is approximately $18,233.00 per year, which he noted comes from the national consultant that was hired. He stated that said cost is figured at $1.00 per call, which correlates with the number of calls that have been projected for Lake County. He stated that, based on the information the Committee currently has, it is a correct number.
Commr. Hanson questioned whether the Committee had looked at industry standards, since so much of the costs for this plan will be for personnel.
Mr. Moore stated that the Committee is not recommending salaries, they are calculating the costs for maintaining the current system. He stated that he felt the Board of Directors will conduct salary surveys and salary ranges will be set just like any employer will do, based on what the industry standard is.
Commr. Swartz questioned what the County's millage rate will have to be, to provide for this plan.
Mr. Moore stated that it will probably need to be 3.4 mills.
Commr. Cadwell stated that he wanted to get approval from the Board, this date, for the Interlocal Agreements, the Articles of Incorporation, and the Bylaws, in concept, with the understanding that Mr. Sandy Minkoff, County Attorney, will bring the final documents back to the Board for approval at the Board Meeting scheduled for June 20, 2000. He stated that he would also like for staff to bring the funding options back to the Board at said meeting, as well.
A motion was made by Commr. Pool and seconded by Commr. Hanson to approve the Lake-Sumter Emergency Medical Services Business Plan, as presented this date.
Under discussion, Commr. Pool stated that he appreciated the team effort that was put into this plan, the commitment from the community, and those who participated in putting the plan together. He stated that he feels the citizens of Lake County will benefit from it.
Commr. Hanson thanked those individuals who remained with the County's Emergency Medical Services. She stated that she felt a move forward would give the County a greater level of accountability, noting that the public will be able to see where their tax dollars are going, which is not something they have had in the past. She stated that it may have been there, but was not as readily available as this plan will make it.
Commr. Gerber stated that she was impressed with the fact that the Committee put this plan together in just 30 days and that she was impressed with the presentation, as well.
Mr. Moore thanked those individuals who worked with him in putting this plan together, noting that they put in some very long hours and showed a real professional commitment to trying to provide the Board with the best information they could, to allow them to make sound decisions for both Lake and Sumter counties.
Commr. Gerber stated that everyone needed to understand that the Board knew the County would be paying more for this plan. She stated that the County has been saving for two years, knowing that it was going to take the Medicare hit, however, noted that it appears it is not going to be as much as originally thought. She stated that she sees the County moving forward with the plan and sees it as a positive step for the County.
Mr. Minkoff, County Attorney, stated that, in order for the County to use the Municipal Service Taxing Unit option, the cities have to consent to the plan. He stated that one option would be to use a municipal service countywide and another option would be for the County to stay where it is and have an interlocal agreement with the South Lake Taxing District, if they would be willing to do that. He stated that a third option would be a general fund millage.
Commr. Swartz stated that the employees of the current ambulance system should have no doubt about his belief in the quality of service that they provide, noting that he feels they are very highly trained professional providers of ambulance service in Lake County. He stated that he was concerned about the County going from two to three options to just one, noting that he was not comfortable with it. He stated that the proposed plan is going to cost just about the same amount of money as a plan that was submitted to the County previously by an ambulance provider (Rural/Metro) that the Board threw out, because they felt it was too high. He stated that it troubled him greatly the way the County dealt with Rural/Metro, noting that they have been in the business for years and years and have done a good job for a lot of communities, including Orange County. He stated that he felt the Board eliminated them, because their proposal, which he noted mirrors what is in front of the Board this date, would have been approximately $1.5 million in subsidy, however, noted that the proposed plan amounts to approximately $3.5 million in subsidy. He stated that the taxpayers are going to pay $2 million more per year for their ambulance service and he finds it hard to go down that road, when the County had a provider that could provide the same service for $2 million less.
Commr. Swartz stated that he finds it ironic that the same people that were part of the system that the Board rejected are part of this plan, where costs are going to be higher and collections may be lower. He stated that there is nobody to protect the taxpayers with this plan, except the taxpayers themselves. He stated that they are the ones that are going to have to come up with additional dollars for any shortfall in revenues, or any unanticipated costs. He stated that he would not support the request for approval.
Commr. Cadwell rebutted some of the comments that were made by Commr. Swartz and urged the Board to approve the request.
The Chairman called for a vote on the motion, which was carried, by a 4-1 vote.
Commr. Swartz voted "No".
There being no further business to be brought to the attention of the Board, the meeting was adjourned at 10:30 a.m.
______________________________ WELTON G. CADWELL, CHAIRMAN
JAMES C. WATKINS, CLERK