HomeMy WebLinkAbout1999-05-04 Municipal Operations Committee Minutes Municipal Operations Committee
�� Meeting Minutes
May 4, 1999
Councilors Attending: Gerry Palmer, Nichi Farnham, Pat Blanchette, Michael Aube
Staff Attending: Edward Barrett, Chief Cammack, Rick Petrie (Meridian
Ambulance), Ken Hewes (EMH),
1. Review and Discussion, Proposed Ambulance Policy
Ed Barrett explained that over a year ago discussions began about the nature and level
of ambulance service that the Bangor Fire Department provides. These discussions
began with a request from the Fire Chief to ofFer expanded inter-facility transport
service for a four-month trial period. At the time the proposal came forward,
representatives from Capital Ambulance/EMH indicated that they had concerns over
how such an activity would impact their operation and requested that the item be
tabled until they had an opportunity to meet with City staff and Council. The Council ,
appointed an ad hoc group consisting of staff and Councilors who held a series of
meetings that ended in May of 1998 with a memo outlining the potential conceptual
� framework for discussion. As a result of these meetings, it became apparent that there
was some limitations as to what could and couldn't be done due to legal issues of anti-
trust laws as interpreted by the State Attorney General's Office.
One approach decided upon was that the Council should look at establishing an
ambulance service policy which would clearly define what the Fire Department would
and would not do particularly in terms of inter-facility transport. That policy came
before the Council in September at which time there were still issues outstanding
between Capital/EMH and the City with the policy itself, including geographical issues
about the area the Fire Department would serve and concerns with a portion of the
policy which indicated that the City would respond to both individual and institutional
choice as opposed to just individual choice. As a result, that policy was tabled and
discussions resumed with Capital/EMH.
At Bangor Fire, service was upgraded to insure that personnel trained to higher levels.
We also went from one ambulance to three front line ambulances, one at each station,
and a back up unit. The first responder program was implemented which allows engine
companies to respond to certain medical emergencies where they may be able to get
on the scene quicker or provide additional manpower.
One of the reasons this was done is because a public ambulance service operated by a
• fire Department can provide a level of service and response that is difficult for other
groups to match because of the staffing levels. Bangor Fire tries to maintain 19
� firefighters on duty, with a minimum level of 17. In staffing a fire Department, it is
impossible to staff full time the total number of people you would need to respond to
any conceivable emergency. The Department is staffed in a way to meet most of the
basic needs that a community has. There is also an issue of response time which relates
to ambulance service as well as firefighting service. To meet minimum needs, there
have to be at least 4-5 individuals per station. Cost becomes an issue because it is
expensive to maintain a minimum staffing level of 17, plus the dispatcher, without a
large cost associated with it. Traditionally, the Department has been the single most
tax dependent Department in the City in terms of the total portion of the tax
commitment that it uses. Since a portion of the firefighter's job is stand-by time, there
is excess capacity available most of the time to handle ambulance calls and other duties
as required. As a marginal cost, in looking at the program budget for the current year
which doesn't reflect the inter-facility transport that is being talked about, staff is
looking at approximately $20,000 out of pocket cost for supplies and materials directly
devoted to ambulance service and approximately 6.6 full time equivalents. At any time,
there will be 6 people assigned or capable of operating the two ambulances. This is the
actual time they spend devoted to responding to emergency ambulance calls and
training and other associated functions. $380,000 in revenue is produced. The cost for
the 6.6 full time personnel is approximately $280,000. It nets out at approximately an ,
$80,000 profit. In adding inter-facility functions, excess capacity is used for this
function.
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For the last 10 months, the Department has tracked the inter-facility operations. There
have been 1,156 transfers at an out of pocket expense of about $91,000. $208,000 has
been billed for those calls and they have collected $146,000. This is a $55,000 -
$56,000 net revenue to the City. The number of transports is about 1/3 of the level of
inter-facility transports that the Fire Department originally anticipated that they would
do if they went into this operation to the extent they wanted to originally with their first
proposal to the Council. Slightly less than 4 inter-facility transports are run per day.
The original proposal had estimated that there would be 12. One reason there number
is less is the agreement not to aggressively market the operation during this period of
ti me.
With the proposed budget, the Fire Department has conservatively projected
approximately $5Q0,000 in ambulance revenues; $350,000 coming from the emergency
side of the business and $150,000 from inter-facility transports. If inter-facility
transports are not done next year, net revenue will fall approximately $67,000. This
would need to be addressed in going into next year's budget process. If emergency
ambulance service were no longer provided, there would be a net loss of approximately
$280,000. To make up for this drop, the current staff of 17 firefighters would need to
be dropped to 15.
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The heart of the issue is what is the appropriate role for the Fire Department in both
� emergency and non-emergency ambulance services. The Department has always done
some emergency transport services, but want to do more. One reason is that there is
the capability, and that the Department is under significant pressure to try to find ways
to reduce the level of tax support that is required for the Department.
The argument against the City being in the inter-facility transport service is that it is a
situation where the City is competing with a private sector firm than can do an
adequate job at providing that service.
Ambulance Policv •
The ambulance policy, as drafted in September, indicates that the City's policy is to
provide the highest level of emergency medical service and emergency ambulance
response possible. It would authorize the Department to do inter-facility transports to
the extent that they can do so with existing equipment and manpower without
negatively impacting the Department's primary emergency response mission. It outlines
our interests and goals, including maintaining skills in the Department, and indicates the
City's desire to ofFset a portion of the cost to the taxpayer. The policy insures the
training of dispatchers in medical dispatch and maintaining all certifications required.
The City recognizes that individuals or institutions in the community retain the right to •
use their provider of choice for both emergency medical response and transport
• services. Critical care transfers will not be done. Transfers will be done originating in
the area covered by existing mutual aid agreements.
Chief Cammack commented that the only means the Department has to generate
revenue is through EMS. Chief Cammack commented that the proposed Ambulance
Service Policy ties his hands. In the policy, there are functions that the Department will
not be able to do which will prevent them from expanding upon the business. Chief
Cammack spoke with the Chiefs of the Augusta and Portland Fire Departments who
indicated they are currently in the same process as Bangor. Portland is very much
ahead of what Bangor does and, unlike Bangor and Augusta, Maine Medical Center and
Portland Fire Department are inseparable.
Councilor Aube asked Chief Cammack what sections specifically tie the Department's
hands? Chief answered that Section 4.i.a, the way it is written, hinders his ability as
Fire Chief to supervise the operation of the fire Department as directed in the laws and
ordinances of the City. The Chief suggested changing the section that reads... "operate
and maintain in good working condition 3 primary service ambulances with one such
unit to be located in each of the Department's fire stations. An additional backup unit
shall be maintained to allow for necessary maintenance and repair of front line
equipment." The proposed amendment would read... "operate and maintain in good
condition three primary service rescues with one rescue to be located at each of the
• Department's fire stations. An additional rescue shall be maintained to allow for
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necessary maintenance and repair of front line rescues and be put in service when
� necessary." Chief Cammack explained that there are several instances where the
fourth vehicle is put into service. If there are the available people to put it in service
and it's needed, it will go into service.
5.2 reads that ... "inter-facility transfer service does not extend to critical care
transfers..." Chief Cammack suggests that this be deleted from the policy. For a long
time the Department was not licensed at the paramedic level. A Department can either
be permitted or licensed to a certain level in the State of Maine. If you are licensed to
that level, you are required to provide that service all the time. If you are permitted,
you provide it when you can. The Fire Department licensed to the paramedic level.
The Chief feels that if he can not pursue the critical care aspect now, it will be a
stumbling block further down the road, and the Department will be playing catch up
again.
Councilor Farnham asked Chief Cammack in looking at 4.2, in using that additional
rescue vehicle, can it be worded "for emergency cases only". Nichi asked under what
instances would the Chief want the staff up to do additional inter-facility transports.
Chief Cammack explained that if there are a series of transfers that would take place
between 3:00 and 4:00 a.m. and staff would be called back so they are not taking
away from emergency functions. EMH is already providing critical care transports, so it ,
was specified that the Department wouldn't provide that service.
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Councilor Aube's understanding was that this was put together at a time when a
tentative agreement under discussion with EMH as to how the Department and Capital
would try to operate in a collaborative sense in the community. However, the legal
issues do not allow the City to do this. The question becomes, what kind of policy will
the City have in this operation? Councilor Blanchette pointed out that the only way to
stay prepared is to train your people and utilize your staff on a day-to-day basis. If the
City opts not to go with an ambulance service, the ChieYs hands are tied as well as
every firefighter. The skills and training they receive need to be utilized. You will only
downgrade the quality of service to the citizens of Bangor if they are stopped from
practicing their trade. In practicing their trade, it sharpens their skills and the very
service can take some of the tax burden off the property taxpayers in the City of
Bangor. Revenue for the Fire Department comes through reimbursement for
transports, and directly affects the amount of money that the City has to tax its
taxpayers.
Ken Hewes/Eastern Maine Healthcare Representative: EMH sees this as a public policy
issue about how much the City is willing to compete with the private sector. EMH is
capable of delivering the services that the Department wants to deliver. EMH's concern
lies with the inter-facility transport issue. It has affected their business. Volumes are
up for the City but are not up for Capital Ambulance. As such, they have seen a
• decrease in their revenues. Policy questions EMH asked of the Council: 1. How many
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vehicles will the City support to do non-emergency transfers? 2. What is the
� geography the Department will be dealing with? 3. With the City be soliciting
emergency transport contracts with other communities? 4. Will the City be getting into
the critical transport business suggested by Chief Cammack? and 5. Will the City orient
the Central Dispatch individuals to correctly route a 911 call that requests another
provider?
Rick Petrie of Capital Ambulance pointed out that their calls have dropped off. The
most significant drop is in inter-facility transports. Councilor Blanchette asked if this
could be due to the nursing homes not transporting as many patients off-site because
of the varied care that they offer in the nursing home? Rick answered that there have
been a certain number of nursing homes that have found other ways to transport their
patients. There was some drop overall, but the reality is that this is a small percentage
of the calls. The figures provided by Maine Health Information Center show an 800%
increase in what Bangor Fire has done from 1997 to 1998.
Dr. Anthony (St. Joseph's Hospital): Dr. Anthony reiterated that both of these services �
do a superb job and there is enough business in general within this area to support
these services and patient choice should be maintained to the greatest extent possible.
Patient choice keeps business good and keeps costs down in general and the service at
a high level.
• A Council Workshop will be held to discuss the current draft policy taking all the
concerns into consideration. Staff will put together options/alternatives to present at the
workshop.
With no further business to discuss, the meeting adjourned.
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