Leon County Works on EMS Contract

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EMS agreement a step closer
City, county leaders hash out beginnings of compromise
By Jeff Burlew
DEMOCRAT STAFF WRITER

Tallahassee Mayor John Marks and Leon County Commission Chairman Tony Grippa expressed a new sense of optimism Monday that the city and county will reach an agreement on the future of emergency medical services.

Marks and Grippa agreed to broad aspects of a new EMS system, including annual, upfront payments from the county to the city for the program, which is estimated to cost $8.1 million in its first year.

"I think we're making significant progress," Marks said after meeting with Grippa.

The county will take over EMS after Tallahassee Memorial Hospital discontinues the service. The county is asking TMH to extend by 90 days its Oct. 1 deadline to end the service, and TMH officials have said they will consider the request.

Under the plan, the county would contract with the city to provide paramedic and ambulance services. The Tallahassee Fire Department would hire a host of new workers, including displaced TMH paramedics, to deliver speedier and more advanced emergency medical services.

Some city commissioners have expressed reservations about entering into the EMS contract with the county, particularly because the city already estimates it is paying $1 million more each year than it should to provide fire service outside the city limits.

Marks said some city commissioners are apprehensive about a new program that also could prove more expensive than estimated.

"There are commissioners who are very, very antsy and have anxiety as to whether or not the county is going to follow through with the commitment," Marks said.

Marks said the dispute over the fire services agreement, which expires in 2008, will be taken off the table for the purposes of the EMS negotiations. He and Grippa agreed to revisit that and similar city/county issues once the EMS issue is solved.

Some city officials have asked the county to pay for EMS in part with a new half-mill property tax. Last week, city and county commissioners took first steps in setting up the tax, which could raise more than $4 million a year. A mill equals $1 of tax for every $1,000 of property value.

But Grippa said he would not be in favor of the contract if it means the county would have to impose the new tax without first trying to pay for EMS through budget cuts or other measures.

"I would not be doing my fiduciary duty as a county commissioner if in fact I took that approach," Grippa said. "It's just absolutely ridiculous that they would ask us to do that."

Marks said he would not require the county to create the tax as long as the county agreed to pay the city's costs for EMS, estimated at $7.4 million in the first year.

Grippa, meanwhile, proposed creating a fund with any annual savings from the EMS program. Half the money in the fund would be used for EMS employee bonuses, while the other half would go back into the EMS program. Both Marks and City Manager Anita Favors expressed general support for the idea.

Favors and County Administrator Parwez Alam hope to conclude their contract negotiations within a month. It would then go before city and county commissioners for final approval.

Once a system is in place, the city would have to hire new paramedics and purchase new equipment and vehicles. The county would hire a part-time medical director and set up a system for billing and collecting. The city and county also would have to address hundreds of operating procedures, Alam said.

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UPDATE

Posted on Mon, Jun. 09, 2003

Citizens get say in EMS decision
City Commission to discuss paying for new system
By Todd Wright
DEMOCRAT STAFF WRITER

Tallahassee property owners will get a chance to weigh in Wednesday on a proposed municipal service tax by Leon County to provide emergency medical service.

The municipal service taxing unit will fund the new EMS system, which will be a joint effort between the county and the city of Tallahassee.

EMS is now provided by Tallahassee Memorial Hospital, which plans to cease providing the service by October.

"This is an essential service the community wants and needs," said City Commissioner Debbie Lightsey. "Frankly, we are facing deadlines, and we need to facilitate these issues as quickly as possible."

At a meeting May 28, the City Commission authorized the city manager to begin contract negotiations for the new EMS system, which will use the city's fire department. It also voted to include Tallahassee residents in the countywide tax, which would generate close to $4 million to help pay for the service.

Assistant City Manager Tom Coe said the city and county will begin negotiating a contract to govern the service in the coming weeks.

Although the municipal service tax, or MSTU, would allow the county to move forward in making the EMS system a reality, city commissioners are unsure it will be in place by the TMH deadline.

"We don't want to rush through this process," Mayor John Marks said. "I want everything to be in place, from equipment to funding, before the city's fire department takes over. There are a lot of details to consider and they must be properly addressed before we provide this service."

Marks also said the city would ask TMH for an extension if negotiations were moving too slowly. If the two governments can't reach an agreement, the MSTU would be nullified

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Tax increases on the menu

County plans to raise taxes
Money would go to EMS, health care
By Jeff Burlew
DEMOCRAT STAFF WRITER

Taxes in Leon County are going up to pay for emergency medical services, buyouts of flood-prone properties and health care for the uninsured.

Tuesday's decision by the County Commission could help pave the way for a final agreement on EMS with the city of Tallahassee, which is expected to provide the service through the Fire Department after Tallahassee Memorial Hospital stops doing so.

The city, however, wanted the county to come up with a dedicated source of funding for EMS, which is estimated to cost more than $8 million in the first year.

"I think it was a very critical vote to provide a good ambulance service in the county," County Administrator Parwez Alam said.

Commissioners convened for their first of more than a dozen meetings scheduled through September to discuss and iron out the budget for the fiscal year beginning Oct. 1. During the meeting, commissioners also voted to raise two other taxes and to give themselves and county workers raises.

The decisions won't become final until after public hearings in September. The preliminary budget totals more than $190 million, an increase of nearly 2 percent over the current fiscal year.

The commission voted 5-2 to pay for EMS with a new property tax set at a rate of 0.41 of a mill. One mill equals a dollar for every $1,000 of property value.

Commission Chairman Tony Grippa suggested during the meeting that the county pay for EMS through a host of budget cuts, including increasing the cost of health care for county workers and nixing a plan to move the county's growth department. And while a few commissioners expressed support for some of the ideas, Grippa did not win majority support for any of them.

"It's tax-and-spend day, folks," Grippa said at the end of the meeting.

Commissioner Cliff Thaell described Grippa's budget-cut idea as "a desperate effort." Commissioner Bill Proctor supported a few of Grippa's key proposals - but that wasn't enough to sway the majority.

Commissioners also voted to increase a communications tax for residents outside city limits from 1.84 percent to 5.22 percent, which is the maximum rate allowed and the same rate levied by the city. The tax is levied on telephone, cable and satellite services.

The county plans to use the proceeds to help purchase homes in flood-prone areas.

Alam said the county could take the estimated $1 million generated each year by the communications tax hike to secure $20 million in bonds and grants - which, in turn, could finance the purchase of more than 100 homes.

Commissioners also raised a property tax that pays for the uninsured health-care program from 0.06 of a mill to 0.12. The program costs about $1.2 million a year.

One tax, however, was eliminated - a 2-percent fee on water and sewer services.

Under the new tax plan, the owner of a home valued at $100,000 within the Tallahassee city limits would pay an extra $35 a year, according to estimates provided by Alan Rosenzweig, the county's finance director. The owner of a similar home outside the city limits - where the communications tax is assessed - would pay $60 more.

Raises, park improvements

In addition to funding EMS, the proposed county budget will give county workers raises of 4 percent or $1,000 - whichever is greater.

Commissioners also voted to raise their own salaries according to state statutes, which means their pay will increase from $63,000 a year to $65,350.

Included in the preliminary budget is funding for a new Northeast Community Park, new community centers for Woodville and the Lake Jackson area, lighting for Woodville Community Park and widening of Buck Lake Road.

Commissioners also approved a plan to eliminate a fee assessed when county residents visit city parks and pools. County residents pay 50 percent more than city residents at city facilities. Under the plan, the city and county would pay $90,000 each to eliminate the fee.

Contact reporter Jeff Burlew at (850) 599-2180 or [email protected].

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Decision Delayed

City postpones a decision on tax for new EMS system
By Todd Wright
DEMOCRAT STAFF WRITER

Citing technical concerns, the Tallahassee City Commission postponed a decision on applying a Leon County emergency medical services tax to city residents.

The commission's hesitation comes after the County Commission on Tuesday took the first step toward raising property taxes to pay for a new EMS system. The system, now run by Tallahassee Memorial Hospital, would be run by the city Fire Department under a contract with Leon County.

The idea of a municipal service taxing unit - an assessment earmarked for a specific use - was first proposed by the City Commission, which was reluctant to enter negotiations about providing EMS service without a dedicated funding source.

"We don't want to send the wrong message," said Mayor John Marks, who decided to continue public hearings June 25. "I think we are sending a wise message to the county that we want to do what's best for Tallahassee."

Marks said the City Commission was unsure about "some of the language" in the ordinance. One of those snags for some commissioners was the lack of a withdrawal of consent, which would give the city the right to nullify the tax "in extreme circumstances."

"We have to have some provision if things go bad," said Commissioner Debbie Lightsey. "We need to be further along in negotiations and get some guarantees."

Those assurances are expected to be discussed in upcoming contract negotiations with the county. In meetings last month, the city identified having a dedicated funding source for EMS, a full-cost recovery guarantee and up-front payment from the county as several keys to successful negotiations.

City Manager Anita Favors, who is expected to meet with county negotiators today, suggested tabling the issue until she could deliver a progress report to the commission next week.

Commissioner Allan Katz said regardless of who provides the service, the city should help pay for it.

"We are as responsible as anyone else. We've been pushing for the (municipal service taxing unit). Even if we don't get the contract, the residents will benefit from the service so they should help pay for it," Katz said.

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Talks back on

County talking again with TMH about EMS
City doesn't want to contract for a fixed-cost system
By Todd Wright
DEMOCRAT STAFF WRITER

Leon County has reopened talks with Tallahassee Memorial Hospital to continue providing emergency medical services to the area.

The move comes as city and county negotiators struggle to reach an agreement that would have the city Fire Department take over EMS. TMH plans to stop providing the service unless the county pays the hospital to continue.

County Administrator Parwez Alam, who called the move "our Plan B," broke the news to City Manager Anita Favors in a meeting Tuesday.

"We are trying to find out if they can provide the service and how much it would cost," Alam said. "There has been nothing formal, but we are keeping the door open. It's our fallback if we are not able to work out some contract with the city. We don't want to be left out in the open."

While Alam described meetings with the city "progressive," time is running short for both sides. Alam said it would take the Tallahassee Fire Department close to six months before it could implement the system. That would push them close to TMH's service deadline.

Last week, TMH agreed to be paid by the county to run EMS through the end of the year. Alam expects to know whether a contract can be worked out with the city by the end of the month or whether TMH will become the primary option.

There are critical issues that need to be ironed out, most dealing with how the city would be paid to run EMS.

Favors said the county and the city have been at odds over what's called "full-cost recovery." Essentially, the city wants to be reimbursed for any and all costs associated with EMS. The city is also asking for a "true-up" process, in which the county would pay the city back if EMS costs more to operate than expected.

Consultants hired jointly by the two governments estimated the cost to start up a new EMS system would be more than $8 million.

"We did not come looking for this service, but we would be open (to provide it) under specific terms and circumstances. We don't need to fight because we were not pursuing this. It's their call," Favors said.

The county's inquiry to TMH comes as no surprise to the city or the hospital.

Alam said his staff has been in contact with hospital officials over the past six months concerning capital costs, collections and other financial issues relating to EMS.

"We have said all along through this process that we want to be part of the solution," said Ron Brafford, senior vice president of TMH. "I think the county has got to the point where negotiations aren't going the way they want, and they want to know if something doesn't work out, what are the alternatives."

"I am hopeful that they (the city and county) can reach an agreement, but if the county came to us with a formal request, I think our board would consider it."

Although negotiations will continue between the city and county, Mayor John Marks thinks the new developments might make the city a secondary option on the county's EMS-providers list.

"We are ready, willing and able to provide a quality service. We are not backing away," Marks said. "If the county feels it can find a better provider at a cheaper price, that's fine with us. I can assure you that TMH, or anyone else they negotiate with, is going to want full-cost recovery."

Alam said the consultants' recommendations were contingent on a performance-based system with fixed costs. The county contends that paying a fixed amount to the city would be easier to budget and also provide an opportunity for profit.

Under the county's proposal, if the city operates under their budget, profits could go to bonuses for the fire department or be placed in a savings account to cover any revenue shortfalls in later years.

"I cannot agree to giving the city a blank check, and that's basically what would happen. We won't know how much the system costs, so how would we budget for it?" Alam said. "I've never entered a contract without (a) fixed cost."

No new negotiation dates between the city and county have been set.

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Update

Firefighters play waiting game
By Todd Wright
DEMOCRAT STAFF WRITER

As tension grows between the city of Tallahassee and Leon County over emergency medical services, city firefighters find themselves in a different type of rescue effort - trying to prevent the negotiations from falling apart.

If the talks succeed, the Tallahassee Fire Department would take over EMS at the end of the year, replacing Tallahassee Memorial Hospital as the county's ambulance-service provider.

"It's natural for us to run the system. It's our job to save lives and property, and that's what we want to do," said Hal Eastman, a driver/operator for the Fire Department. "We are getting anxious. We are primed and ready to go, but we have to wait on direction."

County Administrator Parwez Alam and City Manager Anita Favors will meet once more before the county's Tuesday meeting to discuss possible contract terms. By the end of that meeting, both sides expect to have a clear picture on whether a deal can be worked out.

The city also must make a decision at its Wednesday meeting on the county's proposed .41-mill property tax increase to fund EMS. One mill equals one dollar of tax for every $1,000 of assessed property value. The property tax increase must be established by June 30 to be applied this year.

"I think there is still some posturing going on," said Eastman, who has been lobbying for the fire department and working with both sides to come up with a deal. "There is a need for leadership to bring unity."

Consultants recommend TFD

In May, the County Commission voted for an enhanced ambulance service to improve response times outside city limits. Consultants hired by the city and county recommended the Fire Department for the job, in part because of its 15 stations located throughout the county.

Differences emerged when the discussion turned to who would pay for what and how much.

The city wants a full-cost recovery contract, which would entitle it to reimbursement from the county for any and all costs of running EMS. The county says the consultants proposed a performance-based contract with a fixed budget.

"Fighting over money is very trivial in an issue where lives are at stake. How much money is the City Commission going to put on a life?" Eastman said. "I think they might be acting too cautious."

Firefighters have met with commissioners to discuss the benefits of using the Fire Department. The local firefighters union, Tallahassee Professional Firefighters, offered to give a demonstration providing national statistics on how effective EMS systems are when run by fire departments, but the city rejected them. Eastman has gone as far as developing a contract and pitching it to negotiators.

"We've done all that we can, but our hands are tied," said Jarvis Bedford, a union executive board member. "We have no control. All we can try to do is play mentor for both sides."

Neither side likely to budge

There is no sign that either side will back down from its original stance.

"I don't think any of our demands are unreasonable, considering the circumstances," said Mayor John Marks. "We will not enter into a fixed-cost contract. Asking for an open checkbook has never been our position, but we want to be paid in full for our service."

Alam had expressed concern that such an agreement would have the county "writing a blank check" to the city. The county also has begun to voice its frustration over the city's delay in approving the property tax increase.

"We're trying to get this deal done," said Vince Long, the county's assistant administrator. "Every time we get close, the city has an objection. The county has jumped through all the hoops for the city. We've done everything they've asked us to."

The county reopened talks last week with TMH to continue running EMS. Although the move is considered a "backup plan," the county acknowledges that negotiations with the city might be headed towards a stalemate.

Long said that his staff would recommend the county not budge on the fixed-cost issue and use the performance-based model provided by consultants.

"We're going to put the ball in their court. They can either say yes or no," he said.

In the city's eyes, the county is holding serve.

City Commissioners Debbie Lightsey and Mark Mustian argued that city negotiators might be doing too much to soothe the county's concerns.

"I know we are trying to be agreeable, but let's not be foolish," Lightsey said during a City Commission workshop last week. "We can't put the citizens at risk because we are trying to battle the county's incorrect perceptions."

Lightsey and other city commissioners have repeatedly made reference to the current fire-services contract with the county. The city is losing more than $1 million a year on the fixed-cost contract, which also uses the Fire Department, according to Marks. The city has asked for the EMS contract to expire in 2008 - the same year as the fire services contract.

Although any contract with the county will be subject to binding arbitration if a dispute arises, one of the city's main concerns is not to be charged for increases in labor costs or state and federal regulations that they have no control over.

"We are trying to bridge the gap of the county's perception," said Favors, "but we don't want any situation where we are debating our costs."

Preparations are under way

While negotiations continue, firefighters are waiting on the sidelines.

Fire Chief Tom Quillin said the department is preparing for a successful outcome. Organizational charts and job descriptions are being designed, along with possible shift schedules at each station.

The department also has contacted several ambulance manufacturers to determine the best price and quickest availability for the vehicles they would need to run EMS.

The consultant's evaluation of TMH's ambulance fleet revealed that 11 vehicles would need to be replaced or refurbished at an estimated cost of $910,000, but Quillin said purchasing an entirely new fleet is not out of the question.
"We want to be as ready as possible when we get the word," Quillin said. "We're just waiting on the word."


Contact reporter Todd Wright at (850) 599-2206 or [email protected].

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Another Update

Some want hospital back in EMS mix
By Jeff Burlew
DEMOCRAT STAFF WRITER

For Kathy Hogan, figuring out the future of emergency medical services in Leon County is easy.

"The answer is dangling in front of everyone's face," said Hogan, a Tallahassee Memorial Hospital paramedic. "The simplest, quickest and most financially advantageous remedy for the current EMS crisis is not even being considered."

Hogan, like some other paramedics at the hospital, is hoping TMH will continue to provide ambulance service despite its announcement last year that it would end the program amid mounting debt and liability concerns.

Hogan's solution actually is under consideration. On Tuesday, county commissioners will decide whether to formally ask the hospital to come up with a proposal to continue its ambulance service. And while County Administrator Parwez Alam recently described that possibility as "Plan B," Hogan and some other TMH paramedics are hoping it will become "Plan A."

The county has been pursuing a takeover of the ambulance service by the Tallahassee Fire Department, but negotiations with the city of Tallahassee have bogged down over financial terms in the proposed contract.

Hospital medics less costly?

Under a Fire Department model, the city would presumably hire TMH paramedics to expand its roster. Some TMH paramedics, however, said they would rather stay at the hospital.

Hogan said everything already is in place for TMH to continue its ambulance service, from the staff, vehicles and equipment to salaries, schedules and benefits. And she said the hospital could provide the service for less money.

"All we need is a subsidy - that's it," said Hogan, a paramedic at TMH for seven years.

TMH's cost to run the ambulance service has been estimated by county health officials at $4.7 million last year, though rising fuel and liability costs have likely pushed the cost up an additional $1 million or so. The proposal to allow the Fire Department to run the service has been estimated at more than $8 million a year.

However, the Fire Department plan includes provisions to improve response times outside the city limits, which will add to TMH's cost if it keeps the ambulance service, according to Hal Eastman, a driver/operator for the Fire Department who has been pushing for a TFD takeover.

"I don't believe they can do it cheaper than us," Eastman said.

Hogan doesn't want to join the ranks of the Fire Department in part because of its emphasis on fire suppression rather than medical care. It's a view shared by George Azar, who has been a paramedic for more than 25 years, including 10 years at TMH.

"Before long, dinosaurs like myself and some of the people I work with won't be paramedics," Azar said. "We'll all be firefighter/paramedics. We've been in this so long, we want to be paramedics, not firefighters."

Azar, who works overtime hours in the emergency room, and Hogan, who works part time on a medical helicopter in Taylor County, also said they don't want to join the Fire Department because of issues over pay and hours.

Fire Department personnel work 24-hour shifts every third day; paramedics at TMH work 24-hour shifts every fourth day. Azar, who also works part time in the TMH emergency room, said he would have to work 700 to 1,000 hours more each year at the Fire Department to earn his hospital salary.

"So the hours are longer...the hourly rate would be less, and of course there would be less time for me to do extra work like I'm doing now," Azar said.

Eastman responded that TMH workers would receive better benefits if they came to work at the Fire Department, including retirement pay and vacation time that accrue at a faster rate and more than $1,700 to offset health insurance costs.

The paramedics also are concerned about the Fire Department plan because it would change the way ambulances are staffed. TMH currently staffs its ambulances with two paramedics who can render advanced lifesaving techniques, but the TFD plan would replace one of the paramedics with an emergency medical technician, who can render only basic life support.

Hogan said that means the paramedic on board a TFD-run ambulance would have to perform most of the work on critical patients, such as those suffering from heart attacks. Currently, paramedics can take turns providing care for critical patients, particularly when they are responding to a string of emergency calls.

Eastman said in most cases, TFD also would send two paramedics to emergency scenes: one on board an ambulance and another on board a fire vehicle.

Jim Stalker, a TMH paramedic since 1986, said more hours on the job could take a toll on emergency workers.

"We're worried about recovery time," Stalker said. "Even though this is a fun job, it is stressful."

Question of response times

Stalker and Charles Norvell, a TMH paramedic since 1976, said they could support an ambulance system run by the Fire Department. But they said they would rather see the ambulance service stay at the hospital.

"Either would be good for the city," Stalker said. "But one is in place now that does work, and one is not in place and may never be in place. Why do you want to fix something that isn't broken? The system works very well."

One criticism of the current system is that response times aren't fast enough in far-flung rural areas. TMH paramedics in the 2001-2002 fiscal year responded to calls inside the city limits within nine minutes about 94 percent of the time. They responded to calls in remote county areas within 20 minutes less than 90 percent of the time.

Under the TFD plan, response times outside the city limits would be increased by placing paramedics on board fire engines at county fire stations. But Hogan said the same goal could be accomplished simply by placing TMH ambulances at the county stations.

Norvell said even the decision-makers at the city and county don't fully understand the complexities of the current system and all the services TMH provides.

"I don't think anybody has the whole picture," Norvell said.

Uncertainty over the future has hurt morale among the hospital paramedics, they said. But Norvell, who spent half his time as a paramedic on board the LifeFlight helicopter, said he was cautiously optimistic about the future.

"It's all going to work out," Norvell said.

Contact reporter Jeff Burlew at (850) 599-2180 or [email protected].

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The debate continues

Tallahassee Democrat

History haunts EMS debate
City thinks it's getting bad deal on 1988 fire-services contract
By Todd Wright
DEMOCRAT STAFF WRITER

Fool me once, shame on you. Fool me twice, shame on me.

That sums up Tallahassee City Commissioner Debbie Lightsey's opinion since negotiations began between the city and Leon County over the future of emergency medical services.

"It's a lesson we have learned from dealing with the county in the past," said Lightsey, a city commissioner for 14 years.

Some city leaders think the county is relying on contracts signed in 1988 to pay less than its share for fire services and recreational programs in unincorporated Leon County.

Lightsey and City Manager Anita Favors said the city is feeling the effects of "conscious decisions" by past city commissions to downplay the importance of guaranteed payments to appease the county.

The city contends that the existing fire-services agreement costs city taxpayers $1 million more per year than it should.

"They know it's an unfair deal, but it's the deal that's in place," Favors said.

County Commission Chairman Tony Grippa said he does not think the fire-services agreement should be part of negotiations on the future of EMS.

"The bottom line is it's apples and oranges," Grippa said. "I think linking the two is unfair."

But the history of city-county joint ventures could be the key reason the city and county have failed to reach an agreement over a proposal for the city's Fire Department to take over EMS from Tallahassee Memorial Hospital.

The city wants a contract that requires the county to pay all costs for EMS. The county wants a fixed-cost contract similar to the current fire-services agreement.

"Working together is essential for the community," Lightsey said. "We try to work together with them, but we don't want to be taken to the cleaners every time."

Negotiations are expected to resume today. The County Commission may decide tonight whether to use the TFD for county wide ambulance service, while the City Commission could decide Wednesday whether to approve a property-tax increase to help fund EMS.

According to David Reid, the city's budget director, negotiators have attempted to link the fire-services and EMS issues to collect an additional subsidy from the county, with little success. He said the only concession was to have both contracts re-opened for negotiations in 2008.

"When you are talking about extending services that we already provide through our fire department, I think it has everything to do with it," Reid said. "It's an equity issue."

County officials have said they are living up to their end of the fire-services agreement.

"We're working very diligently, but we're also working very cautiously," Grippa said. "It's a serious step, and also, people's lives are at risk."

Deal reached in 1988

The fire-services agreement dates to 1988, when the county was negotiating with a private company to provide fire protection outside the city limits. At that time, the county was paying the city more than $1.3 million per year for the service.

County commissioners decided to renew the contract with the city after city officials announced the possibility of layoffs if it lost the contract with the county. At the time, the contract accounted for 18 percent of the Fire Department's budget.

The new agreement led to the construction of six new fire stations and required that each station be staffed with at least two firefighters, a quick-response vehicle and a tanker/pumper.

The county paid the city $1.8 million in the first year of the 20-year contract, according to Alan Rosenzweig, the county's budget director. The only adjustments to the county's payment would be based on changes in the consumer price index.

In 2000, a consultant hired by the county estimated that providing fire service in the unincorporated area cost $4.1 million. Reid said the county paid $3.1 million that year and $3.3 million in the 2001/2002 fiscal year for fire service.

"If we are not paid for all costs, we will be doing the exact same thing again," Lightsey said. "We cannot have city taxpayers subsidizing for people in the unincorporated area."

The city argues a similar situation occurred in the parks and recreation agreement with the county. Also started in 1988, the county agreed to pay the city to open recreational programs to residents of the unincorporated area at no extra charge. The two governments adopted a scale on which county payments increased slightly every year for the first four years, peaking at $850,000.

Reid said the payments were to be based on the ratio of the population outside the city limits, but a population shift in 1992 ballooned the county's payments to more than $1 million for the next four years.

"Nobody anticipated the jump to come that high so quickly," he said.

In 1996, the two sides renegotiated, and payments now average close to $450,000 a year. The city now charges residents outside of the city limits 50 percent more to participate in recreational programs, which brings in close to $200,000 annually.

"Do they honor contracts? Well, when it suits their purposes," Lightsey said. "How are we going to call ourselves representatives of the community if we let city residents pick up the bill again?"


Democrat staff writer Jeff Burlew contributed to this report. Contact reporter Todd Wright at (850) 599-2206 or [email protected]

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The Mayors Opinion...Letter to the Editor

EMS: All must pay a fair share
By John Marks
MY VIEW

In the next week the Tallahassee City Commission will be a part of one of the most important decisions facing this community - Emergency Medical Services (EMS). This issue affects first and foremost the physical well-being of our residents, and it will have a direct financial impact on these same residents.

It's easy to fall back on the assumption that city and county government are unable to reach a reasonable solution because past contractual negotiations have not always gone well. I can assure you, however, that every member of the Tallahassee City Commission takes seriously the importance of this basic health and welfare issue.

We believe that EMS can be provided in an exemplary way by Tallahassee firefighters, whose ranks could include the current Tallahassee Memorial Hospital paramedics. Our firefighters have a history of serving this community with bravery and commitment.

The City Commission also has a financial responsibility to ensure that city residents pay only their fair share of necessary costs, while unincorporated area residents also pay their fair share. We are anxious about these details because other contracts between the city and county have left city residents subsidizing services for their neighbors in the unincorporated area.

The clearest example is the 20-year fire services contract between Tallahassee and Leon County. When negotiated 15 years ago, it was believed the contract would cover all costs, but years later, city residents are paying an additional $1 milliona year that should be paid by unincorporated county residents.

While the county's approach is that a deal is a deal, we believe this to be unfair to city residents. We don't want to make the same mistake when it comes to an EMS contract. This is why the Tallahassee City Commission has said full cost recovery is mandatory.

The city has proposed a true-up process with reasonable approvals. The true-up concept is simple: The costs of providing the service during any given period is compared to actual and "true" costs and adjusted accordingly. City and county staff reached agreement on a true-up process last week. The city has since learned the solution is no longer acceptable to the county.

Examples of true-ups already exist between city and county government. Perhaps the most successful is for fire services for station #15 on Bannerman Road. At this station, cost of service true-ups are done on an annual basis depending upon the number of service calls within the city and unincorporated area. For example, in 2002, 86 percent of the calls were in the unincorporated area, while 14 percent were within the city limits.

Had a fixed cost agreement been made, city residents would again be subsidizing county residents. On the other hand, if the mix of service calls change and more calls come from city residents, the county would pay less. The true-up process avoids inequities in payments.

The final decision on the best and most cost-effective EMS provider rests with Leon County alone. Should the county choose to continue services with TMH, the city will fully support that decision. If it chooses to enter into a contract with the city, we are prepared to provide the service. Either way, the providing entity will want to ensure all costs are fully covered.

As we address this critical life saving issue, we want residents of both the city and unincorporated Leon County to know we are fully committed, prepared and already beginning work to provide Emergency Medical Services. The only remaining issue is to ensure that all pay their fair share.


Tallahassee Mayor John R. Marks III can be reached via City Hall e-mail at [email protected].

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County Vows to Have Control

County vows to run EMS
Commission ends talks with city
By Jeff Burlew
DEMOCRAT STAFF WRITER

Debate on the future of ambulance service in Leon County has finally ended.

After negotiations between the city of Tallahassee and Leon County over emergency medical services turned sour, county commissioners late Tuesday voted unanimously - and somewhat unexpectedly - to create the county's own EMS department rather than partner with the Tallahassee Fire Department.

Commissioner Cliff Thaell suggested giving the city until noon Thursday to accept a take-it-or-leave-it proposal for EMS based on a model designed by consulting firm Fitch & Associates.

But Commissioner Jane Sauls said it was high time to make a final decision on the future of EMS. She even managed to persuade Chairman Tony Grippa, who had been a staunch supporter of a TFD take-over, to support the plan.

"I think we've waited long enough," Sauls said. "We need to give our paramedics some relief. They've been under stress for nine months."

Several paramedics from Tallahassee Memorial Hospital who attended the County Commission meeting cheered and hugged one another after the vote.

"It's a wonderful decision," said TMH paramedic supervisor Andrew Farber. "This is what we've wanted. It puts us in control of running the system and creating an excellent system."

Under the plan, the TMH ambulance program would essentially move under county oversight. Although many details are not yet known, County Administrator Parwez Alam said the county should be able to set up the program before Jan. 1, when TMH discontinues its program.

"It's not like landing a man on Mars," Alam said of creating the new department.

County officials also said a county-run EMS department would reduce the cost of the ambulance service from $8.1 million a year to about $7.2 million.

TFD partnership not viable

The decision, which many commissioners have said was the most important to face the community in years, came after Assistant County Administrator Vince Long reported that recent demands from the city meant that a partnership with TFD was no longer viable.

City officials wanted a full-cost recovery system in which the county would reimburse any costs incurred by the city in running EMS. The system included an annual "true-up" mechanism in which the city would be paid for any cost overruns.

County officials, on the other hand, wanted to stick with a fixed, annual price of $8.1 million developed in the Fitch plan. They said the "true-up" feature would make budgeting for EMS very difficult and ignore possible cost savings that could be achieved by operating EMS efficiently.

The city also wanted $125,000 to $225,000 more for insurance, an additional $80,000 for a communications worker, more money for training and supplies for volunteer firefighters and money to buy all new ambulances. The county didn't want to spend the extra money and wanted to purchase ambulances and other vehicles and lease them to the city.

Also, the city wanted the ability to withdraw its consent on a property tax that would pay for about half the cost of EMS, but county officials said such a provision would pose "serious implications" to the entire EMS system.

Property tax still needed

County commissioners still are counting on city commissioners to approve a countywide property tax that would pay for EMS. City commissioners are expected to take up that issue during their meeting today.

County commissioners already have approved the property tax and set a tentative rate at .41 of a mill. One mill equals one dollar for every $1,000 of property value. Now, county officials think they can reduce that rate to about .3 of a mill because of cost savings in the county plan.

If city commissioners don't approve the tax hike, county officials said they would likely be forced to raise their countywide millage rate.


Contact reporter Jeff Burlew at (850) 599-2180 or [email protected].

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County wants city as part of EMS
But negotiations may rekindle fiery relations
By Todd Wright
DEMOCRAT STAFF WRITER

Leon County officials are hoping that involving the city in emergency medical services plans will improve relations between the two, but it could do the opposite.

County commissioners want to use the city's Fire Department to provide advanced life support service outside the city limits. Advanced life support is an upgrade from the current level of life support firefighters are allowed to do.

Under current guidelines, firefighters are limited to techniques such as CPR to stabilize patients. They cannot administer prescription drugs or perform procedures that penetrate the skin.

At this point, the county has only filed a request for help from the city. But based on comments from city and county officials, if negotiations begin, talks could revert back to the initial bickering seen last month over who would run the entire EMS system. Those talks turned sour when city and county officials could not agree on how the city would be paid.

"We would consider helping, but it's going to be under the same terms we were going to do EMS," Mayor John Marks said Friday. "We want full-cost recovery."

Throughout negotiations with the county over EMS, the city demanded a payback system that would cover all expenses it incurred to provide the service. The county, on the other hand, insisted on a fixed-cost contract, which would force the city to operate within a budget and pay for any expenses over that amount.

Negotiations fell apart, and the county decided to start its own EMS system, which is scheduled to start Jan. 1.

With EMS plans now expected to include the city, the issue of city-county relations may rear its head again.

"I am hoping city-county contentiousness won't get in the way of a good EMS system for this community," said City Commissioner Allan Katz, who said he would support a fixed-cost contract for advanced life support. "We ought to be able to know how much it will cost. There is no good reason why we can't do this."

On July 9, County Administrator Parwez Alam sent a letter to the city manager explaining the county's interest in using the Fire Department. Alam said the county estimated it would cost $350,000 to bring advanced life-support service to residents in the unincorporated area. Instead of going ahead, the county wanted to see if the city could do it cheaper. Alam said it could be opportunity heal past wounds.

"It is a natural fit for the Fire Department to do this. I really think this is going to happen, unless the city comes up with a proposal that we cannot live with," he said.

Because of the upgrade in service, the Fire Department would have to add more staff and life-saving equipment to its stations. Vince Long, the assistant county administrator, said the majority of the cost to the city would be for additional training for staff and insurance.

City Manager Anita Favors responded to the county's request, saying the city would look at the offer, but would not be able to make a decision until its next commission meeting Aug. 20.

If the city did not give "some direction on where they stood" by that time, Alam said he would start looking elsewhere.

City Commissioner Debbie Lightsey views advanced life-support talks as a way to renegotiate a fire services contract with the county, which she says is costing city taxpayers $1 million per year more than it should.

"What they are asking for is an increased level of service in the unincorporated area from our firefighters," Lightsey said. "It's only logical that we handle it under one contract."

That could add fuel to an already fiery relationship between both commissions.

Both Katz and Marks said they would push for a separate contract to accelerate the process of integrating into the county's EMS system. Katz, who has had discussions with city staff about how much an advanced life support upgrade would cost, said he is leaning toward a short-term contract with the county.

"I don't think we are going to get anywhere throwing rocks over old contracts," he said. "This is too important for the citizens. We need to get this off the table."

Contact reporter Todd Wright at (850) 599-2206 or [email protected].

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County decision on EMS system is about accountability
By Parwez Alam
MY VIEW

The Board of County Commissioners decided June 24 that Leon County will assume the responsibility of providing countywide emergency medical services (EMS) to the citizens of our community.

The decision was made as a result of a serious dilemma that faced our community: the announcement by Tallahassee Memorial Hospital last fall that after 31 years of providing this critical service, the financial burden could no longer be sustained.

The process that led to this decision was thorough, deliberate and inclusive of this area's most dedicated and knowledgeable emergency medical professionals, top hospital and local government administrators, and front-line emergency responders. Indeed the decision of the county was not, as some have suggested, arrived at through magic or to spite the City Commission.

The suggestion has been made that the city should have been given every opportunity to provide EMS through its very capable fire department. I agree, and the city was afforded that opportunity. Through negotiations, however, it became apparent that the county was at the table with a party that was a disinterested, if not unwilling, potential partner.

Certainly, the city would have ultimately, albeit reluctantly, agreed to provide this service, but it would have been at a cost too high to pay. The County Commission was not willing to pay a cost made unreasonably high for all taxpayers for the service.

The cost of uncertainty borne by the families of skilled paramedics and EMTs and the cost of their leaving our community was equally untenable. And the cost of the county's sense of assurance in an EMS system operated by an unwilling provider was prohibitive.

Instead, the County Commission decided that the only way to truly ensure the future of EMS was to provide this service as a Leon County function. This was the only option that gave the county the management of the system and the ability to control costs to the taxpayers. It was the only choice that guarantees program stability and that ensures that this critical service will not be interrupted by contract disputes.

And, importantly, a county-run EMS provides job security to paramedics and EMTs now so that they can continue doing their life-saving work in our community.

The positive impacts of a Leon County EMS are already being felt. The county has just finalized an agreement with the world's largest and most clinically sophisticated air ambulance (helicopter) provider. This service was previously operated at a loss of over $500,000 to TMH. The county was successful in bringing this company to our community at no cost to taxpayers.

Compared to the estimate for providing EMS through the Tallahassee Fire Department, the cost now is projected to be $1.5 million less in the first year. Moreover, those savings are expected to grow.

The County Commission's decision to take on EMS was one of the finest displays that I have ever witnessed of a local government stepping up to the plate and doing the right thing for the right reasons.

The decision may not have been politically popular or bought the county any clout with any private providers. But with Leon County as a proven provider of the most professional and cost-effective county government services in the state joining with the Leon County Sheriff's Office for countywide dispatch, what it did was ensure the long-term viability of the most cost-effective and responsive EMS systems anywhere.


Parwez Alam is Leon County administrator. Contact him at [email protected] or (850) 488-9962.

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Paramedics Critical of System

Tallahassee Democrat

Paramedics criticize EMS plan
TMH workers raise questions over salaries, schedules

By Todd Wright
DEMOCRAT STAFF WRITER

Tallahassee Memorial Hospital paramedics and medical technicians tore apart a plan for a new emergency medical-services system in a meeting with Leon County officials Monday.

Many of the paramedics were critical of the new system's proposed work schedule and lobbied for more ambulances on the streets.

It didn't take long for the meeting - which was meant to give paramedics an update on the county's plans and to introduce paramedics to the new EMS facility at the county's Public Works Center - to turn into a critique session.

"The system they are talking about will fail," said Ed Skinner, who has been a paramedic at TMH for 12 years. "They want to increase the service levels but are asking us to work with less. And on top of all that, they want me to work more hours to do it."

For two hours, county officials listened to concerns of about 50 TMH employees about the new system. Paramedics raised questions about salaries, overtime, benefits and how much TMH staff would be hired, but they got no answers.

"We are new to this, and we don't claim to have everything worked out," County Administrator Parwez Alam said. "We had this meeting to get their input, and we will seriously consider what they have said."

However, Alam thinks the new system, which is based on a consultant's report by Fitch and Associates, is consistent with most EMS systems around the country and can work.

The new system shares many similarities to the current TMH-run service. Five full-time ambulances will be on call 24 hours a day, with three vehicles in reserve. The county also is proposing three quick-response vehicles that will respond to advanced life support calls outside the city limits.

The county wants to have a paramedic-emergency technician pair on each ambulance, which is different from the two paramedics on each TMH ambulance. In the county proposed model, the paramedic is the only person able to administer advanced life support techniques.

Shifts also would change.

Under the county-run EMS system, paramedics would have two days off between 24-hour shifts. Currently, paramedics get three days off between shifts.

Skinner and paramedic George Azar said the plan promoted a harder workload on paramedics and would not improve service.

"There is nothing enhanced about this system," said Azar, who has been a paramedic for 26 years. "What they are going to get is physically exhausted paramedics and increased burnout."

Since making the decision to run its own EMS system, the county has been working feverishly toward having a system up and running by Jan. 1, according to Vince Long, the assistant county administrator. The county still is searching for an executive director for the system but is in the final stages of negotiations with the hospital's Dr. Javier Escobar for the medical director position.

Alam said he would meet with a select group of TMH employees for more discussions on how to improve the current EMS model.

"We are going to try and use their input, but within the resources we have," he said, citing cost as a major factor for many of the suggestions. "If money wasn't an issue, we'd have 18 ambulances out there. Everybody wants more."

Contact reporter Todd Wright at (850) 599-2206 or [email protected].

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Employees evaluating the program

Workers weigh new EMS program
TMH paramedics mull pros and cons of move
By Jeff Burlew
DEMOCRAT STAFF WRITER

Paramedics who move from Tallahassee Memorial Hospital to Leon County's new ambulance program will work more hours each year. But they also will receive a number of perks, including free uniforms, cheaper health insurance and special-risk retirement benefits from the state.

Robert Koegel, who has worked as a paramedic for six years at TMH, is among more than 40 people who have applied for paramedic positions with the county since it began accepting applications last month. The county is setting up its own ambulance program by the end of the year to replace TMH's.

Koegel and other TMH paramedics currently have three days off between their 24-hour shifts. Those who are hired by the county will have only two days off between shifts, which means they will work 2,912 hours a year instead of 2,080 hours.

"I'll be making the same amount each year," Koegel said. "I'll just be working 900 hours more a year to get it. But that's pretty much the standard across the state. The benefits are definitely going to be better."

Koegel, who has applied for jobs outside the county, estimated that his family's health insurance plan would cost $200 less a month at the county than at TMH.

More than 260 people have applied for jobs with the county's new ambulance program over the past few weeks, according to Traci Reed, director of human resources and risk management. The jobs range from an emergency medical services director, who will oversee the program, to watch commanders, shift supervisors and emergency medical technicians.

Reed said the county hopes to hire an EMS director by the beginning of October to help determine staffing and interview applicants. She said the county anticipates hiring about 70 people for the program. Candidate assessments for most applicants begin Oct. 6.

TMH did not pay for uniforms or the cost to clean them, but the county will, Reed said. Also, retirement benefits for paramedics and EMTs will be calculated at 3 percent, or nearly double that of other workers, because they are considered special-risk under the Florida retirement system.

Paramedics will earn between $35,600 and $56,400 a year depending upon experience. The director of the EMS program will earn between $53,800 and $90,800 a year.

During a meeting hosted by county officials in July, paramedics and other rescue workers at TMH criticized the new EMS system in part because of the longer hours.

George Azar, a TMH paramedic, is among those who have criticized the schedule. But he said he and many other TMH workers are applying for the jobs because the county's ambulance program will be the only one in town.

"Everybody's applying," Azar said. "And I've got to work one way or the other. If you want to work, you have to go along with it. You either jump on the wagon or walk."



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Contact reporter Jeff Burlew at (850) 599-2180 or [email protected].

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Dissention still prevails

Tensions raised over Leon County budget

INSIDE POLITICS

There wasn't complete harmony among Leon County commissioners last week when they passed their new $198 million budget.

Chairman Tony Grippa and Commissioner Dan Winchester voted against increasing a property tax that pays for the county's uninsured health-care program. The tax increased from 0.06 mills to 0.12 mills. One mill equals one dollar for every $1,000 of property value.

Grippa also voted against a new property tax, set at half a mill, that will help pay for the county's new ambulance program. Commissioner Cliff Thaell also voted against the EMS tax.

"I felt like we could have funded this out of general revenue and not a property tax," said Grippa, who suggested the county cut $4 million out of its budget to help cover the cost of EMS.

Thaell proposed cutting $1.75 million earmarked for new branch libraries near Apalachee Parkway and Lake Jackson in hopes of getting rid of the EMS tax within a year. He pointed out that those areas already have leased branch libraries in shopping centers.

"The reason I voted against (the EMS tax) was a matter of priorities," Thaell later said.

But commissioners didn't go for the idea. Winchester, in particular, sharply criticized him for proposing the library cuts. Grippa and Winchester also said they felt doubling the health-care tax was excessive. The program helps uninsured people receive ongoing health-care at local clinics.

- Jeff Burlew