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HomeMy WebLinkAbout68-08 RESOLUTION4 RESOLUTION NO. 68-08 A RESOLUTION TO APPROVE AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICE BY AND WITH THE CITY OF FAYETTEVILLE, WASHINGTON COUNTY, ELKINS, FARMINGTON, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON, AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON -EMERGENCY AMBULANCE SERVICE WITHIN THE CITIES WHEREAS, A.C.A. § 14-14-910, and § 14-266-102 and § 25-20-101 authorize cities and counties to enter into interlocal contracts to provide services such as emergency and non -emergency ambulance services; and WHEREAS, the above cities and Washington County have determined that the continued provision of ambulance service is necessary for the health; safety and welfare of the residents of said cities and Washington County; and WHEREAS, Washington County, the City of Fayetteville and all other cities listed in the Resolution's title agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. § 14-266-100 et seq. is in the best interests of all parties and their citizens; and WHEREAS, the Ambulance Authority should be established pursuant to the Agreement For Ambulance Services interlocal agreement attached as Exhibit A to this Resolution; and WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishingof emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are parties to this agreement. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1: That the City Council of the City of Fayetteville, Arkansas hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes Mayor Coody to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Fayetteville and every other city which is a party to this agreement as broadly as authorized in A.C.A. § 14-266-102 and 105. ""'O PASSED and APPROVED this the 18'" day of March, 2008. APPROVED. By: ATTEST: By DAN COODY, Mayor 4 SONDRA E SMITH, City Clerk/Treasurer `.`"E,RK/TR��''.. Ci d+ •\TY 13;.•F',5;%' s •r... G•cn U• p: 'c ;FAYETTEVILLE; z�z• •%570 't ANSPS J�``S ''oh'GTON G;;:••% ''Iauuuua�'� AGREEMENT FOR AMBULANCE SERVICES THIS INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("Agreement") is made and entered into by and between WASHINGTON COUNTY, ARKANSAS, ("County") and the cities of ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW and JOHNSON ("Cities"). WHEREAS, A.C.A. § 14-14-910, A.C.A. § 25-20-101, and A.C.A. § 14-266-102 authorize cities and counties to enter into contracts to co-operate or join with each other to provide emergency and non -emergency medical services and to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. § 14-14-910, A.C.A. § 25-20-101 and A.C.A. § 14-266-101 et seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties. NOW, THEREFORE, IT IS AGREED: ARTICLE 1. AUTHORITY ORGANIZATION. (a) One individual selected by each entity shall represent said entity on the Board of Directors of the Authority to be known as the Washington County Regional Ambulance Authority. (1) Each Board member shall serve a term of three (3) years and be eligible to serve two (2) consecutive terms. (2) The initial term of each Board member shall be determined by the drawing of lots or similar method so as to provide staggered terms. (b) The Board shall meet on no less than on a quarterly basis to transact all business associated with the powers and responsibilities conferred upon it. However, the Board shall reserve to itself the right to meet on whatever basis it determines is appropriate. (c) The Board shall employ an executive director to manage a regional ambulance system. (d) In order to ensure maximum efficiency and effectiveness of the operation, an executive committee shall be formed to be charged with the oversight of the day-to-day operation of the system. The members of said executive committee shall be as follows: (1) The County board appointee who shall reside in the unincorporated service area. (2) The Fayetteville City Council appointee; (3) A second Fayetteville appointee (Both City Council appointees shall serve at the pleasure of the City Council and can be removed and replaced by different representatives by City Council Resolution.); (4) A small city appointee to be chosen by the aforestated cities, excluding the City of Fayetteville; (5) A Nursing Home or medical profession representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees, and the small city appointee. (6) A Hospital representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees, and the small city appointee. (7) A representative of the financial community residing in the service area to be chosen by the County appointee, the Fayetteville appointees and the small city appointee. ARTICLE 2. PURPOSES, POWERS, RIGHTS, OBLIGATIONS AND RESPONSIBILITIES OF THE CREATED ENTITY. (a) All parties acknowledge that the need to create an entity to own, operate and manage an ambulance service is necessary and appropriate. (b) The Authority created herein shall have the following powers: (1) To provide advanced life support emergency ambulance service in the designated area; (2) To provide emergency medical dispatch including pre -arrival instructions in accordance with approved dispatch protocols; (3) To set ambulance user fees; 2 (4) To own system revenues; (5) To provide exclusive emergency and non -emergency (within the cities only) ambulance service; (6) To enter into mutual aid and automatic aid agreements with neighboring ambulance services for emergency services; (7) Comprehensive regulatory powers over the ambulance system performance; (8) Ownership of or access to key components of the system infrastructure; (9) Centralize medical direction and clinical oversight of the ambulance system to the extent deemed necessary; (10) To promulgate rules and regulations to further effectuate the purposes of this agreement, (11) To own and dispose of real and personal property; (12) To adopt and oversee comprehensive system performance on an annual basis to include periodic revisions to comply with emerging technologies and changes in clinical and operational standards. (c) Washington County Regional Ambulance Authority's Specific Duties. The Authority created herein shall have the following specific duties and responsibilities in addition to the statutory and administrative requirements of § 14-266-109, the Arkansas Medical Practices Act, and any other government or professional standards. (1) Minimum Standards Continue. The Authority shall continue to meet all existing minimum performance standards within Fayetteville as stated in the current City of Fayetteville Contract For Emergency Medical Transport Services with CEMS except as to quarterly reports to the City of Fayetteville. (A copy of this contract is attached as Exhibit A.) (2) Reporting Requirements. A) Fayetteville On the third Tuesday of July each year, the Washington County Regional Ambulance Authority by the two Fayetteville representatives on the Executive Committee shall appear before the Fayetteville City Council to present: (i) The written annual, audited report of the previous year's financial and response data reports; 3 (ii) A written report of the financial and response data for the first half of the current year; (iii) Plans and projections to replace or enlarge capital property and equipment within the next 18 months; (iv) Plans and justifications for any personnel increases within the next 18 months; and (v) Revenue/expense projections for the next 18 months. (B) Any Other Member Of This Authority. Upon written request by any other member of this authonty, the Board Member representing that entity shall provide the full written and oral report referred to in (A) to that City or to the County during its regular July or August meeting. ARTICLE 3. FINANCING; TRAINING; COMPLIANCE WITH A C A $ 20-13- 301 ET SEO. (a) All parties acknowledge that the need for a guaranteed revenue source independent of and in addition to fees for service is necessary in order to ensure the continued viability of said service. (b) The annual regional ambulance service -funding source for all parties of this Agreement shall be based upon the most recent Federal Census including any special Census. (1) All Cities shall pay $4.00 per capita except that only those citizens of Johnson within CEMS's territory shall be counted for the per capita fees. The City of Fayetteville shall maintain at least its minimum annual contribution of $270,000.00 through the end of 2011. (2) Washington County shall pay $15.50 per capital for the unincorporated population served by CEMS with at least a minimum annual contribution of $550,000.00 through the end of 2011. (c) The Authority shall continue to seek a sustainable funding source with the goal of reducing subsidies proportionately across the board. (d) Except as stated above, no party to this Agreement may be financially obligated without the approval of its governing body. (e) All governing bodies party to this agreement must approve any increases in subsidy. (1) A percentage of these funds shall be set aside for replacement of capital items. 4 (g) The ambulance service owned or under contract with the Authority shall be required to provide, at no additional charge, the Arkansas Department of Health 24 hour basic refresher course to all EMT certified firefighters that act as first responders with said ambulance service. (h) The financing provided by the parties hereto shall be from general revenues; furthermore, the financing and this agreement are contingent upon compliance with A.C.A. §20-13-301 et. seq. by the County and all the parties will cooperate to the extent necessary in complying with such. The parties shall receive credit for payments already made to CEMS in 2008 for this year's annual subsidy commitment ARTICLE 4. TERM. This initial term of this agreement shall be from the date that all parties have agreed to this interlocal agreement through December 31, 2011. This agreement shall be automatically renewed with possible changes to Article 3 Financing for an additional five year term unless any party notifies the Authority in writing of its refusal to participate in the Authority and this Agreement by September 1, 2011. All parties agree to consider the effects of the 2010 Decennial Federal Census upon the division of the County Sales Tax between the County and the Cities and the proportional changes of the populations of the Cities and the unincorporated portions of Washington County and make any adjustment or amendments advisable and necessary to Article 3 to ensure financial viability of the Authority and faimess for all parties. A second automatic renewal shall occur on December 31, 2016 unless any party notifies the Authority in writing of its refusal to participate in the Authority and this Agreement by September 1, 2016. A substantial review of the financial status of the Authority and all parties should occur in 2021 after the 2020 Federal Decennial Census and prior to further renewals of this Agreement. Not withstanding the above terms, all parties to this Agreement may withdraw from this agreement upon six months' written notice to the Authority and shall only be responsible to pay its per capita fee for that portion of the year. ARTICLE 5. TRANSFER OF OWNERSHIP OF EQUIPMENT TO WASHINGTON COUNTY REGIONAL AMBULANCE AUTHORITY Property currently owned by any party that is transferred to the Washington County Regional Ambulance Authority shall be returned to that party or purchased from that party at its fair market value if such party terminates its membership from the Authority and withdraws from this Agreement by July 1, 2011, after giving its six month notice All property and resources of the Washington County Regional Ambulance Authority purchased during its existence or owned by it on July 2, 2011, or thereafter shall remain the Authority's exclusive property throughout the Authority's existence. ARTICLE 6. SEVERABILITY. The provisions of this Agreement are declared to be severable If any provision hereof shall be held to be invalid or to be inapplicable to any person or circumstance, such holdings shall not affect the ability or the applicability of the remainder hereof. 5 ARTICLE 7. EFFECTIVE DATE. This Agreement shall not be effective until approved and signed by all parties in accordance with the law. APPENDIX TO AGREEMENT APPENDIX DEFINITION OF TERMS WHEN AND IF USED. Ambulance Authority: Quasi -governmental entity created to oversee and deliver ambulance service in a specified geographical service area. Ambulance Service: Means emergency and non -emergency transport services offered by the Authority, including management, supervision, mass gathering and community events. Exclusivity: Sole provider emergency and non -emergency ambulance rights granted by ordinance or resolution by each party to the extent allowed by State Law. Per Capita: Funding structure set forth by this Agreement based on population. Cities contribute at $4.00 per capita due to the increased number of calls generated within their city limits. The County contributes at $15.50 per capita due to the increased coverage area and decreased density of call volume in the unincorporated areas of the County. No reduction of any entity's gross subsidy shall occur during first term of this agreement. Subsidy: Government funds requested by the Authority to provide ambulance service. User Fees: Fees charged to patients treated or transported by the ambulance service, or fees charged to an individual or an organization for ambulance standby coverage. 6 Signed this day of , 2008. CITY OF FAYETTEVILLE, ARKANSAS ATTEST: By:�OVt t&A/ Sondra E. Smith, City Clerk/Treasurer 7 1 Tony Johnson Submitted By 1 City of Fayetteville Staff Review Form City Council Agenda Items and Contracts, Leases or Agreements March 4, 2008 City Council Meeting Date Agenda Items Only Fire Division Action Required: Res 3fr�/,8 6g'va ../rote 2 /nkr/dc4/ + Fire Department Council approval of the proposed Inter -local ambulance agreement between the City of Fayetteville and Washington County. There is no cost associated to the approval of this agreement. Cost of this request Account Number Project Number Category! Project Budget Program Category / Project Name Funds Used to Date Program / Project Category Name Remaining Balance Fund Name Budgeted Item Budget Adjustment Attached Department Director r Cit • z • tO • Of Date ZS d� Date Tam Q• 2 -26-6Y Finance and Internal Service Director Date ayor -2,12.042"? Date Previous Ordinance or Resolution # Original Contract Date: Original Contract Number: Comments: Revised April 16, 2007 ird,/ed 4 eared 7,!,,,as y yfC_ City of Fayetteville Fire Department 303 W. Center St. Fayetteville, AR. 72701 Phone (479) 575-8365 Fax (479) 575-0471 February 20, 2008 To: MayorCoody Fayetteville City Council From: Tony Johnson, Fire Chief 19.. Subject: Proposed Inter -local Ambulance Agreement F Attached, is the proposed inter -local Ambulance Agreement between the City of Fayetteville and Washington County. After the many discussions, amendments, and reviews, I believe the proposal to be favorable to the City of Fayetteville as well as Washington County. The proposal, if accepted will -provide for the continuation of a service that the residents of our community have become accustom to. In addition, it will place an emphasis in the delivery of a service that is home grown and not driven by the need to show a profit I encourage your careful consideration and passage of the proposed inter -local ambulance agreement. RESOLUTION NO. A RESOLUTION TO APPROVE AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICE BY AND WITH THE CITY OF FAYETTEVILLE, WASHINGTON COUNTY, ELKINS, FARMINGTON, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON, AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON -EMERGENCY AMBULANCE SERVICE WITHIN THE CITIES WHEREAS, A.C.A. §14-14-910, and §14-266-102 and §25-20-101 authorize cities and counties to enter into interlocal contracts to provide services such as emergency and non -emergency ambulance services; and WHEREAS, the above cities and Washington County have determined that the continued provision of' ambulance service is necessary for the health, safety and welfare of the residents of said cities and Washington County; and WHEREAS, Washington County, the City of Fayetteville and all other cities listed in the Resolution's title agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. § 14-266-100 et, seq. is in the best interests of all parties and their citizens; and WHEREAS, the Ambulance Authority should be established pursuant to the Agreement For Ambulance Services interlocal agreement attached as Exhibit A to this Resolution; and WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are parties to this agreement. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1: That the City Council of the City of Fayetteville, Arkansas hereby approves the interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes Mayor Coody to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Fayetteville and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105. PASSED and APPROVED this the 4th day of March, 2008. APPROVED: ATTEST: By: By: DAN COODY, Mayor SONDRA E. SMITH, City Clerk/Treasurer • AGREEMENT FOR AMBULANCE SERVICES THIS INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("Agreement") is made and entered into by and between WASHINGTON COUNTY, ARKANSAS ("County") and the cities of ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW and JOHNSON ("Cities") WHEREAS, A.C.A. §14-14-910 and A.C.A. §25-20-101 authorizes Cities and Counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties, and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. § 14-14-910; A.C.A. §25-20-101 and A.C.A. §14-266-101 et. seq is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, All parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties NOW, THEREFORE, IT IS AGREED: ARTICLE 1. AUTHORITY ORGANIZATION. (a) One individual selected by each entity shall represent said entity on the Board of Directors of the Authority to be known as the Washington County Regional Ambulance Authority. (1) Each Board member shall serve a term of three (3) years and be eligible to serve two (2) consecutive terms. (2) The initial term of each Board member shall be determined by the drawing of lots or similar method so as to provide staggered terms. (b) The Board shall meet on no less than on a quarterly basis to transact all business associated with the powers and responsibilities conferred upon it However, the Board shall reserve to itself the right to meet on whatever basis it determines is appropriate. (c) The Board shall employ an executive director to manage a regional ambulance system. (d) In order to insure maximum efficiency and effectiveness of the operation an executive committee shall be formed to be charged with the oversight of the day-to-day operation of the system. The members of said executive committee shall be as follows: (1) The County board appointee who shall reside in the unincorporated service area. (2) The Fayetteville board appointee (3) A second Fayetteville appointee (4) A small city appointee to be chosen by the aforestated cities excluding the City of Fayetteville. (5) A Nursing Home or medical profession representative, who shall reside in the city of Fayetteville to be chosen by the County appointee; the Fayetteville appointees and the small city appointee. (6) A Hospital representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees and the small city appointee. (7) A representative of the financial community residing in the service area to be chosen by the County appointee, the Fayetteville appointees and the small city appointee. ARTICLE 2. PURPOSES, POWERS, RIGHTS, OBLIGATIONS AND RESPONSIBILITIES OF THE CREATED ENTITY. (a) All parties acknowledge that the need to create an entity to own, operate and manage an ambulance service is necessary and appropriate. (b) The Authority created herein shall have the following powers. (1) To provide advanced life support emergency ambulance service in a designated area (2) To provide emergency medical dispatch including pre -arrival instructions in accordance with approved dispatch protocols (3) To set ambulance user fees. (4) To own system revenues (5) To provide exclusive emergency and non -emergency (within the cities only) ambulance service. (6) To enter into mutual aid and automatic aid agreements with neighboring ambulance services for emergency services. (7) Comprehensive regulatory powers over the ambulance system performance (8) Ownership of or access to key components of the system infrastructure (9) Centralize medical direction and clinical oversight of the ambulance system to the extent deemed necessary (10) To promulgate rules and regulations to further effectuate the purposes of this agreement (11) To own and dispose of real and personal property (12) To adopt and oversee comprehensive system performance on an annual basis to include periodic revisions to comply with emerging technologies and changes in clinical and operational standards ARTICLE13. FINANCINGNTRAINING;TCOMPLIANCEIWITHWOAN§2013'-30117 se . (a) All parties acknowledge that the need for a guaranteed revenue source independent of and in addition to fees for service is necessary in order to ensure the continued viability of said service. (b) The regional ambulance service funding source for all parties of this Agreement shall be based upon the most current Northwest Arkansas Regional Planning Commission population estimates or most recent Census. (1) Cities at $4.00 per capita*. (2) County at $15.50 per capita (unincorporated population). (c) The Authority shall continue to seek a sustainable funding source with the goal of reducing subsidy proportionately across the board. (d) Except as stated above, no party to this Agreement may be financially obligated without the approval of its governing body. (e) All governing bodies party to this agreement must approve any increases in subsidy. (f) A percentage of these funds shall be set aside for replacement of capital items. *City of Johnson assessed at $4 per capita for that portion of the City now served by Central Emergency Medical Service. (g) The ambulance service owned or under contract with the Authority shall be required to provide, at no additional charge, the Arkansas Department of Health 24 hour basic refresher course to all EMT certified firefighters that act as first response with said ambulance service. (h) The financing provided by the parties hereto shall be from general revenues; hfwthe theifinanc n ndrttiis agreement are contingent upo npliar with7A!C!AR§20!13*301ret . by�the County andralrthe parties willcoon` Aerate to the extent necessary in co�mplymg.with such' ARTICLE 4. DURATION. This authority will exist in perpetuity, however, any party may terminate and withdraw from this Agreement in whole or in part upon six (6) months written notice; any property, real or personal purchased with funds from such party shall either be returned to the terminating party or purchased by the remaining parties at its fair market value. ARTICLE 5. SEVERABILITY. The provisions of this Agreement are declared to be severable. If any provision hereof shall be held to be invalid or to be inapplicable to any person or circumstance, such holdings shall not affect the ability or the applicability of the remainder hereof. ARTICLE 6. EFFECTIVE DATE. This Agreement shall not be effective until approved and signed by all parties in accordance with the law. APPENDIX TO AGREEMENT APPENDIX DEFINITION OF TERMS WHEN AND IF USED Ambulance Authonty: quasi -governmental entity created to oversee and deliver ambulance service a specified geographical service area. Ambulance Service: means emergency and non -emergency transport services offered by the Authority, including management, supervision, mass gathering and community events. Exclusivity: sole provider emergency and non -emergency (cities only) ambulance rights granted by ordinance by each party to the extent allowed by state law; exclusivity of non- emergency service does not include the unincorporated areas of Washington County as such power is not granted to counties by state law. Per Capita: funding structure set forth by this Agreement based on population. Cities contribute at $4.00 per capita due to the increased number of calls generated within their city limits. The County contributes at $15.50 per capita due to the increased coverage area and decreased density of call volume in the unincorporated areas of the County. Subsidy: government funds requested by the Authority to provide ambulance service. User Fees: fees charged to patients treated or transported by the ambulance service, or fees charged to an individual or an organization for ambulance standby coverage. W-row Aua &- ' WashingtonRegional c� "`' 3N-fog March 3, 2008 The Honorable Jerry Hunton Washington County Judge 280 North College 210 Court House Fayetteville, AR 72701 The Honorable Dan Coody Mayor, City of Fayetteville Administration Building 113 W. Mountain St Fayetteville, AR 72701 Gentlemen. As the predominant healthcare provider for the City of Fayetteville and Washington County, Washington Regional Medical Center believes it importantto offer its perspective on the discussion occurring between the City and County with regard to the merits of having an exclusive provider service the emergency transport needs for the entire County or the County and City having separate arrangements for such services. Our perspective on this issue derives from our daily operation of the largest acute care hospital in the region and one of the state's busiest emergency departments: That „ perspective is further influenced by our charitable mission to serve the healthcareneeds of all of Washington County's citizens and the surrounding area. Any resolution of this issue must keep two important considerations in mind. First, healthcare services do not follow typical free market economic tenets. Healthcare is for the most part a technological and capital -intensive endeavor where competition often produces expensive duplication of services with no measurable qualitative benefit — either in the realm of improved patient care or reduction in overall healthcare costs. Indeed, it has been my experience that where duplication of services occur higher prices for consumers generally follow. Second, ambulance services are considered a low to no margin business as there is a continual need to maintain, upgrade and replace equipment and train personnel while operating in a reimbursement environment that is heavily regulated, and therefore unpredictable, and where a large number of the consumers of the service are uninsured or unable to pay for the service. 3215 NORTH HILLS BOULEVARD • FAYETTEVILLE, AR 72703 • (479) 713-1000 • wregional.com rye fayow Ambulance Service Page 2 Washington Regional Medical Center, therefore, believes that the concept of a single ambulance provider for emergency services remains the only prudent and logical means of ensuring that the overall emergency transport needs of all citizens are adequately met, whether they live in the City or elsewhere. While it remains unclear as to whether an exclusive provider would enjoy the prerogative of serving both the emergent and non- emergent transport needs for all citizens, such course may be necessary to ensure the economic viability of the overall service. Washington Regional would be concerned that multiple emergent transport providers servicing Fayetteville, Springdale, and the Larger County would have a deleterious effect on the overall delivery of healthcare in our County. While establishment of an exclusive emergent transport arrangement requires attention to detail and the development of adequate safeguards to ensure that the County, each municipality and the overall citizenry receive the highest quality of service at the most effective cost, benefits that are not traditionally associated with a monopoly, Washington Regional Medical Center believes that the single emergent transport provider ensures the most effective emergency care for all citizens of the County. Sincerely, Williai L. Bradley President and Chief Executive Officer Mar 04 2008 9:11PM HP LASERJET FAX WashingtonRegional March 4, 2008 The Honorable Jerry Hunton Washington County Judge 280 N. College Ave. 210 Court House Fayetteville, AR 72701 Dear Judge Hunton: 1 14_ p.2 6-41 aguAn� �I e-b%/lam. Nvoe As our earlier correspondence indicates, we endorse the concept of an exclusive, centralized ambulance service for the county's emergency transport needs. While we did not specifically address a vendor for this critical service, our experience with Central EMS has been positive. With that in mind, we do not see any rationale for a change in this regard unless necessary to meet regulatory or fiduciary requirements unknown to us Sincerely, William L. Bradley President & Chief Executive Officer 3215 NORTH HILLS BOULEVARD • FAYETTEVILLE, AR 72703 • (479) 713-1000. vneg'lonoI.com Here/fit-you. 9 94y 9 1 1 1 1 1 1 1 r teal EMS SYSTEM RE=DESIGN Washington County, Arkansas September 2005 Report for: WASHINGTON COUNTY, ARKANSAS CITY OF FAYETTEVILLE Prepared by: • HEALTH CARE VISIONS 201 Moming Dove Court Argyle, Texas 76226 TABLE OF CONTENTS A. EXECUTIVE SUMMARY......................................................................................... 1 B. INTRODUCTION & METHODOLOGY.................................................................... 4 ..ANALYSIS.OF CURRENT SYSTEM....................................................................... 6 D. SYSTEM RE -DESIGN RECOMMENDAT:ONS....................................................17. D1. Current D2. Recommi E. LIST OF ATTAC Design.............................................................................. 17 System Design: The Public Utility Model .......................... 19 NTS.................................................................................... 26 EMS SYSTEM RE -DESIGN - Washington County, Arkansas A. Executive Summary In Washington County, Arkansas, emergency medical services are provided by a number of different private, response to questions of funding stability, geographical that have arisen over the years, a Washington County look at different system design options- The Committ proven design option called a public utility model (PUM). services (EMS) and other ambulance non-profit and public organizations. In coverage and operational performance EMS Study Committee was formed to ee's investigations led to a historically The public utility model EMS system design is a complex business structure designed to incorporate the core competencies of governmental and private system components. The primary features that distinguish the PUM from other related system designs include market exclusivity and PUM Authority ownership of the business trade name and ambulance services • licenses, the revenue stream from subsidies and accounts receivable and frequently, certain high cost portions of the EMS system infrastructure. Washington County and the City of Fayetteville retained the consultant firm Health Care Visions to perform a review of Washington County's current systern(s), evaluate the appropriateness of • the public utility model design and develop a series of system design. recommendations. This Health Care Visions EMS system re -design report reflects a multidisciplinary approach to information gathering. A review of historical performance, the direct observation of current performance and interaction with the system's service providers all contributed to the collection of both qualitative and quantitative information. Health Care Visions consultants drew on 60 years of combined industry knowledge and several different references and data sources, in performing a comprehensive evaluation of the Washington County EMS system. ANALYSIS OF CURRENT EMS SYSTEM The analysis of the current EMS system focuses on Central Emergency Medical Service (GEMS) as the likely primary ambulance provider for the City of Fayetteville and Washington County under any system re -design, an assumption that is addressed fully in .the discussion of system re -design recommendations. The City of Springdale's fire department and the private ambulance companies providing non -9-1-1 services were not evaluated except as to how their services relate to CEMS' performance. City and county officials have been generally satisfied with the level of service that CEMS has provided over the years under the current system design. The consensus is that CEMS could provide "an excellent level of service" with and within certain organizational changes. Health Care Visions' operational analysis found no reason to refute that view. CEMS has been impressive with its operational successes through dramatic industry change and has the structure, history and knowledge to continue to be the major provider in Washington County. Ambulance operations appear to be appropriately deployed in both scope and size, and incremental additions of resources, both people and ambulances, have kept pace with increasing call volume demand over the years. GEMS does not utilize many "short" shifts for demand staffing, and it is recommended that any additional unit hours be applied to match HEALTH CARE VISIONS Page t September 2005 9 EMS SYSTEM RE -DESIGN- Washington County, Arkansas demand. While some 24 -hour shifts might be eliminated as a result, matching new unit hours to demand would likely provide better demand coverage. The current system is performing well with regards to response time. Code 2 performance is significantly lower than Code 3 performance, but the response -time criteria in most systems for such calls is significantly longer than it is for life -threatening emergencies. Under a more appropriate (i.e., longer)Istandard,-current Code 2 performance would not be out of line. Some system stakeholders have expressed some dissatisfaction with the current deployment plan due to their perception that the plan causes ambulances to too often move either into or toward Fayetteville. Any system re -design will have to address the issue of potentially long response times in partslof Washington County and the higher costs associated with providing coverage to those areas. Because call volume is currently low, moving to a more fluid deployment process may not be feasible at this time, but a more aggressive system status management (SSM) process may be called for if additional call volume is added to the system. The level of oversight ptovided by the system's medical director is appropriate. Any change or enhancement of the current system design will require more aggressive involvement by the current medical directorland/or a medical control board. . The billing and collections department appears to be very efficient and, is producing good results. The billing process used produces excellent results in days to bill and days accounts outstanding. The patient charges and the average patient charge (APC) are all well within expectations for an organization of GEMS' size and complexity. SYSTEM RE -DESIGN RECOMMENDATIONS Health Care Visions' re'view.and analysis of the existing governmental and EMS operational components in the City of Fayetteville and Washington County has verified that a system re- design toward a public utility model (PUM) is the appropriate "next step" for the stakeholders and decision -makers in the market area. The recommended PUM design, although complex, will provide an infrastructure that protects both market rights and system funding while, most importantly, enabling the' improvement of patient care. Current System DesigIn The current Washington County EMS system is best described as a multiple provider, multi - jurisdictional emergency ambulance franchise. Market rights for non -emergency ambulance services are not locally regulated or assigned, and multiple providers, including CEMS, engage in retail competition to serve the non -emergency segment of the market. Clinical quality and response time performance are reported to be appropriate within the emergency segment of the market, but due to the unregulated nature of the non -emergency business, the level of quality and performance within that segment is largely indefinite. Market fragmentation and proprietary interests of the multiple providers make it difficult to determine response times, clinical,quality or fiscal responsibility for the non -emergency market segment. HEALTH CARE VISIONS September 2005 Page 2 v EMS SYSTEM RE -DESIGN - Washington County, Arkansas Recent changes among the non -emergency providers, including the cessation of service within the county by one provider during this study, hint at potential service and economic problems within the non -emergency market segment. Without a system design change, rising public standards coupled with economic pressures resulting from changes in medical reimbursement will make it increasingly difficult to meet public expectations for performance in both the emergency and non -emergency segments of the market. Eliminating the current costly and dangerous duplication of services and system resources with the consolidation of Washington County market segments will allow not only a consistent level of performance for both markets but also the ability to capture the financial resources necessary to provide system improvements. The very survival of the Washington County EMS system may hinge on the successful consolidation of the current system into an exclusive market Recommended System Design: The Public Utility Model Health Care Visions finds that the public utility model is Uniquely well suited to improve EMS services within Fayetteville„ Washington County and perhaps a wider regional area., Accordingly,the primary recommendation of this study is that the City and County deveie an - Y Y P exclusive ambulance. market and implement a PUM EMS system to improve the quality, reliability and cost of local emergency medical services. An implementation timeline is difficult to predict due to the many variables, however, with the current environment, it is conceivable that a target set for six to nine months from the beginning date of implementation could be met. The formation of a public utility model involves a complex matrix of steps and approvals that must be approached carefully and thoughtfuily. Normally, each. participating government entity will pass a uniform EMS ordinance, assigning exclusive market rights, establishing basic performance requirements and assigning the oversight and management of the EMS system to a PUM Authority Board. The participating governments simultaneously enter into an interlocal agreement that forms the Authority, with the agreement including the rights of each participant in a number of areas including "equity", ownership, board representation, enforcement and withdrawal from the system. If the City and County wish to proceed with the conversion of the existing EMS system to a publiq;•Utility model system design, a series of steps and key decisions will be required at critical points. This report includes recommendations and sub -recommendations related to the following broad steps that system designers will face in developing a PUM system for Washington County: 1. Begin committee discussions regarding the public utility model and the opportunities that it presents and begin drafting the interlocal agreement and uniform EMS ordinance. 2. Identify those jurisdictions that intend to fully participate in the governance of the system and those jurisdictions that do not wish to participate in system govemance but do wish to be served by the system. 3. Develop the Authority, medical control and ambulance provider structure. 4. Develop the implementation timeline and transitional and system funding guidelines/budgets. HEALTH CARE VISIONS September 2005 Page 3 EMS SYSTEM RE -DESIGN - Washington County, Arkansas B. Introduction I& Methodology In Washington County, Arkansas, emergency medical services (EMS) and other ambulance services are provided (by a number of different private, non-profit and public organizations. Emergency 9-1-1 ambulance services are delivered through geographically based arrangements that are exclusive in practice but not by ordinance or regulation. An open, unregulated market exists for the County's non -9-1-1 ambulance business. Questions of funding stability, geographical coverage and operational performance that have arisen over the years have led some governmental stakeholders to meet in order to discuss future design options for Washington County as a whole. Spearheaded by the City of Fayetteville and Washington County, a Washington County EMS Study Committee was formed to look at different system design options. The Committee's investigations led to a historically proven design option called a public utility model (PUM). Many EMS systems across the United States, including several operating in the country's, largest cities, have successfully used a public utility model to address issues of governance, operationa! performance and funding. The Committee became interested in further exploring the model and deeded to seek information and counsel regarding the potential transition of Washington County's current EMS system to a PUM design. In March of 2005, Washington County requested statements of qualifications from experienced industry consultants interested in assisting with the identification of possible changes necessary for the long-term success of the county's EMS system. Five EMS consulting firms submitted information, and Health Care Visions was selected in June to per!ornra review of Washington County's current system(s), evaluate the appropriateness of the public utility model design and develop a series of system design recommendations. Over the course of several months, consultants Steven L. Athey and David Shrader performed an assessment that included a comprehensive offsite analysis of pertinent documentation in addition to approximately twenty days of onsite review that involved both interviews and direct observation of system participants and EMS operations. The study performed by Health Care Visions was financed equally by Washington County and the City of Fayetteville. ANALYSIS METHODOLOGY An analysis of any operation should include some measurement or benchmarking against national industry standards. Although the ambulance industry has a number of valuable analytic tools, it does not have a "book" of comprehensive fixed performance outcomes and practices against which a syste I or operation can be directly compared. Therefore, for the purposes of this system review, Health Care Visions relied on parameters drawn from several different sources for comparison against actual performance. References & It is widely accepted that for any EMS system to be considered successful, many different EMS components must function properly and interact efficiently. The National Highway Traffic Safety Administration (NHTSA) has provided EMS industry leadership for over 30 years and in EMS Agenda for the Futureidentifies fourteen EMS attributes that require continuous development HEALTH CARE VISIONS Page 4 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas and attention. Providing a reference point for this efficiency and effectiveness review of the Washington County system, those EMS attributes are: 1. Integration of Health Services 2. Public Education 3. Human Resources 4. Communications Systems 5. Legislation and Regulation 6. EMS Research 7. Medical Direction 8. . Information Systems 9. Public Access 10. System Finance 11. Education 12. Evaluation 13. Prevention 14. Clinical Care Attributes and standards established by the Commission on Accreditation of Ambulance Services (CAAS), the ambulance industry's accrediting body since 1990, were also used for comparison purposes: A board. of representatives made • up of members of the American Ambulance Association, the Emergency Nurses Association,'the International Association of Fire Chiefs, the Naflonal Association of Emergency Medical Technicians, the National Associatioh of EMS Physicians and the National Association of State EMS Directors oversees CAAS and the standards that the organization promulgates. Information on EMS systems recognized for their high performance levels, including PUM systems, provided valuable reference points. Health Care Visions also used resource material in the American Ambulance Association's Community Guide to Ensure High Performance Ambulance Service and drew on over 60 years of combined industry knowledge for the review of the Washington County system. Multidisciplinary Approach This EMS system• re -design report reflects a multidisciplinary approach to information gathering. Health Care Visionsreview of historical performance, direct observation of current performance and interaction with the system's service providers all contributed tothe collection of both qualitative and quantitative information. A • complete • evaluation of the Washington County, Arkansas EMS system, system design, associated relationships (contractual and otherwise) and surrounding infrastructure was completed for the following areas: • Management and Administration • Ambulance Operations • Human Resources • Clinical/Quality/Training • Vehicles/Equipment/Fleet Maintenance • Risk and Safety • Financial/Billing and Collections HEALTH CARE VISIONS September 2005 Page 5 EMS SYSTEM.RE-DESIGN - Washington County, Arkansas C. Analysis of EMS System 9-1-1 emergency medical services (EMS) for the City of Fayetteville and most of Washington County are provided by Central Emergency Medical Service (CEMS). The City of Springdale's 9-1-1 EMS is provided by that city's fire department. Non -9-1-1 ambulance services throughout Washington County are provided by GEMS and a variety of unregulated.. private ambulance providers. Therefore, this study and Health Care Visions' associated recommendations assume that GEMS will be 'the primary ambulance provider for the City of Fayetteville and Washington County, an assur iptiori that is discussed fully in the System Re -Design Recommendations section of this report. Under that assumption, it became important for Health Care Visions to perform an analysis of the GEMS operation tc ensure that CEMS can meet or exceed any performance criteria that would be required under an enhanced system design. The City of Springdale's fire department and the private ambulance companies providing noh. 9-1-1 services were not evaluated except. as to how their services relate to CEMSperformance. OVERVIEW OF ANALYSIS OF CEMS OPERATION CEMS is a non-profit '501(c)(3) organization that has been providing ambulance and other services to the City of. Fayetteville and Washington County since March 1, 1980. City and county officials have been generally satisfied with the level of service that CEMS has provided over the years under the current system design. The consensus is that CEMS could provide "an excellent level of seriice with and within certain organizational changes. Health Care Visions' operational analysis found no reason to refute that view. Like many ambulanceIorganizations in the country today, CEMS is an organization that is attempting to meet ever-increasing expectations with limited and/or shrinking revenues. The entire EMS industry has had to adjust to a phased -in five=year reduction in Medicare fees paid for ambulance services, with one year still to go. CEMS has been impressive with its operational successes through this time of change and has the structure, history and knowledge to continue to be the major provider in the Washington County system. As current CEMS operations are alreadytwell known to system participants, this report does not spend a great deal of timedescribing current operations, except where some change is recommended, but reports instead in summary on the overall analysis of each division. MANAGEMENT & ADMINISTRATION GEMS, operating as a non-profit 501(c)(3) organization, answers to a self -nominating board of directors approved by the County Judge with the advice and consent of the Quorum Court. This five -person board is charged with ensuring that CEMS is meeting the needs of the communities served. Currently, CEMS is contracted to provide 9-1-1 services to the City of Fayetteville (Ordinance 4676) and to provide ambulance and other services to Washington County. Both agreements require a paramedic level of response, while the City contract also requires an eight -minute (08:00) average response time. Neither contract, however, is exclusive in that there is no prohibition against another ambulance service providing either non -9-1-1 or HEALTH CARE VISIONS September 2005 Page b EMS SYSTEM RE -DESIGN - Washington County. Arkansas emergency services if they so wish. The re -design recommendations in this report will discuss why an EMS "open market" is undesirable. The current board structure appears satisfactory in size, responsibility and governance. A system design change to a public utility model, as recommended in this report, will by necessity affect the makeup and governance of the existing board. Organizational Structure Health Care Visions was provided an organizational chart for CEMS that shows the organization's relative position within the county structure. CEMS operates under a typical hierarchical structure, with the Administrator, Tony Hickerson, answering to the board of directors. The CEMS Administrator oversees three direct reports: a Patient Accounts Manager, a Captain of. Operations and.a Captain.of Communications and Logistics. Each of these managers has direct reports who perform necessary job functions. The organizational chart displays 'an adequate span of contro! throughout the organization. While the span of management control is appropriate, two functions that do not appear on the organizaticnal chart need to be identified to ensure proper attention and resource allocation. The functions that are not accounted for are human resources and safety. Management Team The GEMS management team is made up of senior members of the organization. . All management members were found to be appropriately skilled in their positions with an above average to excellent knowledge of the system in which they operate. CEMS has gone through considerable growth in the last several years, and the management team may be reaching full capacity. For example, many of the supervisors carry additional responsibilities such as supplies, scheduling, etc., that, although approphate for today, could easily hamper the ability to handle multiple priorities with any growth in system complexity, call volume or geographical coverage. While-CEMS has provided management training and education, in particular the American Ambulance Association's Ambulance Service Management Program successfully completed by the management team and one Lieutenant, no structured management training exists that anticipates the very real risk' of limited management capacity. A program designed to strengthen management depth can be implemented without considerable cost and will support better planning for future opportunities. AMBULANCE OPERATIONS CEMS operates in Washington County, Arkansas as the 9-1-1 provider for the City of Fayetteville and for Washington County south.oi Springdale. The primary response area encompasses 900 square miles and a population of 125,000 residents and is comprised of urban, suburban and rural areas. HEALTH CARE VISIONS - Page 7 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas GEMS provides r (FTEs) and 46 pa remainder of the maintenance and GEMS does approprie using the excess re transports non-ambul technicians (EMTs) in to be appropriately dr both people and amt years. Response Time Per ie for the response area using approximately 56 full-time employees employees. 35 FTEs are used for direct ambulance coverage, with the nnel utilized in administrative and support roles, including dispatch, All ambulances are staffed at the advanced life support (ALS) level. operate and compete in the inter -facility transfer ambulance business •e capacity of the organization's ALS fleet and personnel. GEMS patients through the wheelchair division, using emergency medical -person specialty -equipped vans. The ambulance operations appear• fed in both scope and size, and incremental additions of resources, ces, have kept pace with increasing call volume demand over the The only contractual response time obligation that GEMS operates under is the eight -minute (08:00) average response time requirement for 9-1-y calls in Fayetlevi!ie. To GEMS' credit, the management has realized that an average measurement does not meet any modern standard for response time measurement and has begun measuring against a higher standard. High-performance ambulance services measure response times by fractile distribution at the 90"h percentile. While imeasuring to the 90th percentile is standard in such systems, the time interval to be achieved I90% of the time varies considerably. Variations in response -time criteria depend on local demographics, geography, first responder capabilities and financial resources. Some systems use an interval as short as seven minutes and 59 seconds (07:59), while others use an interval as long as ten minutes (10:00) or more.. Response -time criteria for suburban and rural areas are usually longer. To complicate matters, even high-performance systems don't always agree on exactly what time interval is considered to be the ideal response time. Today, GEMS self -measures and reports response time compliance in a fractile manner, striving for a compliance of eight minutes and 59 seconds (08:59) ninety percent (90%) of the time for both life -threatening and non -life -threatening emergencies in Fayetteville. Rural and small -city response times are also measured, using response -time criteria that other systems use for non- urbari'areas. Current response time standards for each level of CEMS response are outlined below. CODE 3: Emergency Potentially Life Threatening — Lights and Sirens o Fayetteville = 08:59 / 90% o Small Cities = 112:59 / 90% o Rural Area 2.0:59/90% CODE 2: Emergency Non -Life Threatening — No Lights and Sirens o Fayetteville 8:59 / 90% HEALTH CARE VISIONS September 2005 EROS SYSTEM RE -DESIGN -Washington County. Arkansas o Small Cities = 12:59 / 90% o Rural Area = 20:59 / 90% CODE 1: Non -9-1-1 Inter -facility Transfers No response -time criteria. The following charts present Code 3 and Code 2 response time performance for the last nine months as reported by CEMS. • 1 10704 1x11/04 'ii'A? 04''`01/05"�r02105"� ^03705,,1104/OS I. ;, --t OW05. t�TIMEi • ••i.i<kHMl:Y:;r'?F. 54: "{�i']r{Y iir£~.T.aXe4 lY'II4V • .�.�L'.t ��W'1't•. Si'. i�vp}L�in' .lfi�'"iii9 - rsa Rural 1-. 83% j 82% 76% j 80% 77%4'B2% '82% 85% 83% 83% 120:59 • 10`7!0'4' 1�t,.1/QaR"'.' 12J0� ,L17Q5''1 '02705f„Q31OS s'+OA705 �."`0�5/OS Ig7aer45,; TIME V rY �.. hit, •l i-, .�xiYry y A"{:Yrt�� i Ay1jo Y ld in'H i• jY..,a 2Y-. Ind lC.avcLt �.1;rn • '3 4'f ^ti }'. Rural 1 83% ' 86% I 6% I 86% 1 71% 1 84% 162% I'100%I 83% 1 20:59 Any discussion of an enhanced system design will include the participants' definition of appropriate response times in both minutes and percentage of performance required. However, the current system is already performing very well. Code 2 response performance (no lights and sirens) is significantly lower than Code 3 performance, -but the response -time criteria in most systems for.such calls is significantly longer than it is for life -threatening emergencies. Under a more appropriate (i.e., longer) standard, current Code 2 performance. would not be out of line. It should be noted that as the Tractile percentage increases, the cost for reducing times by each additional percent becomes exponentially higher. Staffing Levels CEMS uses a schedule of mostly 24 -hour shifts to cover staffing for the response area. Five 24 -hour shifts are scheduled each day, and one 12 -hour shift is scheduled daily from 0700 to 1900 hours. This provides 132 unit hours a day of staffing. GEMS is at full.or nearly full staffing and reports that personnel recruitment is cyclical. Turnover ratios for 2004 were 6% for paramedics and over 30% for EMTs. The paramedic turnover rate is very low. Management explained the high EMT turnover rate as a cyclical anomaly. There didn't appear to be an ongoing measurement of the workload for either the individual EMT or the overall system. Anecdotal information indicated that some shifts may be working "harder' than HEALTH CARE VISIONS Page 9 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas others, and those shifts should be identified in an attempt to equalize the workload. Workload measurements and the tracking of workload trends are critical to all decisions to add or delete personnel from a system. A system's productivity and the employee workload can be identified and tracked through unit hour utilization (UHU). Unit hour utilization is the industry -standard efficiency measurement used to determirie how well individual shifts are performing or how hard the organization as a whole is working! Unit hour utilization offers a formula by which efficiencies can be measured. The UHU formula is a factor of unit hours deployed and transport volume. Formula definitions are provided below with an example UHUI measurement. I Unit Hour: One unit hour is described as one fully staffed and equipped ambulance on call or available for a call in the system for one hour. Transport: F A transport is defined as a response that resu!ts in a transport to a facility. UHU Formula: TRANSPORTS (for a particular period) = Unit Hour Utilization Ratio JUMBER OF UNIT HOURS (for the same period) Example: 8 Transports = .33 UHU �4 Unir Hours In the example above, the crew (producers of.the 24 unit hours) transported .33 patients an hour or about one patient every three hours. System designers understand that the UHU ratio encompasses all the variables of unit movement, responseswithout transports, etc. that are part of operating a specific system. UHU measurements facilitate comparisons of different.time periods for the evaluation of system and participant efficiency. Unit hour utilization should not be used to directly compare the efficiency of different systems because UHU ratios do not take into account each system's unique variables such as geography, call demand, transport time and task times. For instance, the Las Vegas system operates a UHU of over 0.5, and the Fort Worth system operates a UHU of around 0.4, and yet both are considered equally efficient. Systems like CEMS that use resources to cover areas with a low population density will typically have a lower UHU due to low call volume in those areas. The following chart lists system -wide response and unit hour utilization data for the CEMS system across corresponding periods in 2004 and 2005. (The chart does not include Veterans Administration staffing or call volume data.) HEALTH CARE VISIONS September 2005 Page 10 lb EMS SYSTEM RE -DESIGN — Washington County, Arkansas 5 x.. .[ a • APRIL04 tMAVO442 .n .ese:.}..gL 1N- fJliNE041. rk^.I n^ .r ,yil ht sAPRILR05u#AMAO5 a<IY uJI �✓'-4'VL J. .. 2•"-.�z t`JUNEO J c [�H i s .+ _4 �..__ _ __•T'. 4aC4It ' aC ♦ }-.(y9.y 1'i flfl ( The above chart clearly illustrates how workload increases when call volume goes up without additional unit hours. By comparing UHU numbers every month or quarter, GEMS system administrators will be able to better gauge whether the workload for individual shifts is increasing or decreasing, allowing for the implementation of appropriate system modifications and resource allocations to improve efficiency. 1 GEMS does not utilize many "short" shifts for demand slatting, and it is recommended that any additional unit hours be applied to match demand. While some 24 -hour shifts might be eliminated as a result, matching new unit hours to demand would likely provide better demand coverage. 1 Communications & Dispatch The Central Emergency Medical Service's communications center is,located at GEMS' main station in Fayetteville. the center is a secondary primary service answering point (PSAP) for several primary PSAPs around the county and a primary PSAP for wireless 9-1-1. The center is equipped with a state-of-the-art computer -aided dispatch (CAD) system, the ZOLL RightCAD, and enhanced 9-1-1 capabilities. The radio system uses eleven towers at various locations across Washington County, with three primary frequency bands. Staffing includes nine full-time employees and an appropriate number of part-time, management and support staff. The center cross -utilizes GEMS staff to provide dispatch services for seveteen area rural fire departments. Appropriate hiring, quality assurance and measurement tools appear to be in place. All dispatchers, as well as management, are certified as both Emergency Medical Dispatchers and Emergency Fire Dispatchers. The system uses Medical Priority Dispatching, which has been recognized as an international standard. Deployment Plan Health Care Visions was provided an Ambulance Placement Guidelines document used to assist the dispatcher in the deployment and movement of available ambulances throughout the coverage area. The deployment plan appropriately addresses the strategic placement of ambulances in Fayetteville and in the "small cities" of Prairie Grove, Lincoln and West Fork. The plan also identifies the recommended movement of ambulances when the system becomes busy in the urban or rural areas. There is a mutual aid agreement with the Springdale Fire Department to ensure cross -coverage for both agencies during times of extreme demand. HEALTHCARE VISIONS Page 11 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas Some system stakeholc to their perception that Fayetteville. Any syste times in parts of Washir those areas. System Status Because call volume is feasible at this time, bu called for if additional c and non -emergency bu: and "when" of ambular status plan (SSP).• Sc necessary for system st Key elements required • Enhanced data coil • Demand analysis a • fnnoinn nerfnrmai > have expressed some dissatisfaction with the deployment plan due e plan causes ambulances to too often move either into or toward re -design will have to address the issue of potentially long response Xn County and the higher costs associated with providing coverage to currently low, moving to a more fluid deployment process may not be a more aggressive system status management (SSM) process may be ill volume is added to the system with the granting of exclusive 9-1-1 ness. System status planning involves the development of the "Where" :e placement and the tracking and constant readjustment of a system �histicated data collection within the capacity of the GEMS system is tus. planning. the implei entation of a more fluid deployment system are: SSP development, and review (exception reporting, "wasted unit hour" reporting, etc.) and Attachment #1 includes a discussion of demand analysis and a plan development outline. Policies; Procedures & Forms Health Care Visions examined a number of agency manuals, documents and. report forms and found them satisfactory.. Good documentation and proper "paper trails" exist throughout the organization. While proper policies and procedures for an operation of GEMS' size were in place in memorandum or directives form, a complete policy and procedures manual was nonexistent. At employee meetings held as part of Health Care Visions', system review, the lack of a formal policy manual was mentioned as a source of dissatisfaction within the organization. Management reported that a formal manual is in progress. As the organization procedures manual Care Visions has e procedures manual desired. HUMAN RESOURCES There is no Human I management staff ap HEALTH CARE VISIONS September 2005 inues to grow in size and complexity, a detailed operations policy and need to be developed and integrated into the GEMS culture. Health ed a compact disc (CD) with this report, which provides a policy and plate that can be adopted for use within the GEMS operation, if so ;es Manager within the GEMS organization, but the existing to be accomplishing all required tasks. However, as the Page 12 EMS SYSTEM RE-DES!GN — Washington County, Arkansas organization grows. in complexity and size, the expansion of human resources functions will • probably dictate the need for a person to fill that role. Health Care Visions reviewed a binder titled Orientation Packet that outlines a ten-day orientation process with a standard agenda. Orientation includes one day set for "driving". An excellent company overview is provided as well as customer service and conflict management information. Appropriate check sheets for new personnel, including check sheets for field training orientation, list appropriate "behaviors" and provide an evaluator scoring guide. Field Pay & Benefits Pay and benefits were reviewed, and the following annual salaries were noted: I. These salaries seem to be in line with private ambulance company salaries for both EMTs and ' paramedics in the region. A recent salary survey completed by Health Care Visions that included companies from Texas, Arkansas and Louisiana showed mean salaries at year 5 for paramedics and EMTs were $36,726 and $22,91C respectively. Personnel Files Personnel files appear neat and orderly and contain appropriate information. The files are kept with the Administrator. Some files have incomplete "checklists". 1 One file included employee medical documentation that should be in a separate file. Generally, medical information and training information should be filed separately so that information can ( be retrieved by appropriate personnel without accessing complete personnel files. Employee Manual Health Care Visions reviewed, an employee manual dated the year 2000. The Table of Contents shows a comprehensive listing of items that should be present in an employee manual. However, there is no evidence of any manual updates. The manual provides the mission statement, describes benefits and work rules, etc., is well written and appropriately applied. Some of the discipline policies in the employee manual seemed to contradict information in the personnel files. CLINICAL/QUALITY/TRAINING CEMS provides clinical, quality and training oversight through appropriate measures. A Quality Improvement (01) Standard Operating Guideline was provided that outlines the company's quality program. A review of the program and the medical protocols used by CEMS and other HEALTHCARE VISIONS Page 13 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas companies in the Northwest Arkansas Region was performed by Health Care Visions' physician consultant, Jeffrey M. Goodloe, MD, FACEP, and is provided in this report as Attachment #2. Medical direction for' CEMS S is provided by Dr. Lee Gray, who was interviewed as part of Health Care Visions' review. D. Gray has an "oversight" role in the clinical care provided by the first responders and the GEMS medical personnel. Dr. Gray's oversight and level of involvement is normal for most medical director/ambulance provider relationships. Any change or enhancement of the curent system design will require more aggressive involvement by Dr. Gray and/or a medical control board. VEHICLES/EQUIPMENT/FLEET MAINTENANCE Vehicles and equipment) in the GEMS operation appear to meet common industry standards. The vehicle list provided showed only one vehicle with mileage exceeding 200,000 miles, and that vehicle was schedulled for replacement. GEMS schedules vehicles for replacement using a "replac'ement'cost vs. operational, cost"' formula. Remounts are used, provided through the Exceilance Corporation. GEMS' staffing mcde! peaks during certain hours at seven ambulances, six regularly staffed units and one unit' staffed by administrative and support personnel. GEMS would therefore need a minimum of ten'lambulances to provide 125% to 140% reserve capacity, the level most high-performance systems require to eliminate any need for shift closures due to ambulance repairs or higher than normal out-of-town transports. GEMS has eleven ambulances, more than the necessary minimum. Due to the distances in CEMS'. coverage area and the call volume increases, the operation should continue to be staffed at the extreme end of that standard. GEMS uses PhysioControl LifePak 12 monitor/defibrillators, complete with pulse oximetry and end -tidal CO2. The monitors are serviced under contract with the manufacturer. All other major equipment is in line with expectations and appears properly maintained by the organization, either internally or 'through authorized maintenance facilities. Equipment is approved by the Medical Director before it is placed in service. Supplies are standard. Supply exchange is done through Washington. Regional Hospital when possible, with supply billing done appropriately through the hospital. Fleet Maintenance The fleet maintenance procedures followed by GEMS outline an adequate preventive maintenance plan that dictates not only preventive measures but also replacement of parts at designated mileages, whether or not failures have occurred. Ambulances are required to be "maintained' every 3,000 miles. No fleet maintenance program is used, but an in-house Excel spreadsheet provided alll necessary information. Health Care Visions reviewed preventive maintenance procedures to verify the consistency of the 3,000 -mile maintenance schedule.' Review results are shown in the following chart: HEALTHCARE VISIONS Page 14 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas I 1 1 ) 1 MAINTENANCE HISTORY 3425 3275 3339 3346 1 'l C �Truck \�y1f��l •JGJ F.`Yi .e „Y1j lj. ' r,.;J7t'3'ct't2i+ni; �I. n..ff�J4�/v}�<....{y{ ` fW� 1/r iVn i}`</.;�a'.�.�y N� as Y I� F:2 .�.t5 ISM ,r x,°'255;,1 .ry. t.l in s' '..' �,''ft.` r1r ii ..l s, '( 4:54 , 131i�\ji.`�.� ,} ..� rn1 Cr. tlP,.`Tiwy r�.F F��uuy�,', .1.. �! z 5 i J„ i .r r ,� �!�^,�'3''2.8t` : nx' , t N• �� '::,Y�e.s .,i .�: •� Truck 3 6329 5391 2960 4893 Yj1.IT1 {'J,L F4 l`.. CIS Y �3"35=(' ~ I!2fl I! + ¢" y{.e1{:_�v , �r7klr 44. �f`!` i���Y1{i�'r �ip r 9` wyf-- ,RPI "�f 14:4`4 i»/11 FIY I4ti1.i�,.i1�V5 R, 4 r, 4 $ r s 2yf8 �i µ'�{• 68 ..S • Trucks 3235 3230 3677 3387 .i.% iN ' ` e-" fl' .� V f `''680ri��IGuyd1� yl v Y ,1, 33350 n ne 4 s 3 g� Ir l" 9 -..4 '>�.MI �L�ii n'.{4 �{��`°�, `+ ! ifA '�«'��k:. x. •IrCf � %�1`�if}f 4 �^�:'i The average for a number of trucks exceeds the prescribed preventive maintenance interval of 3,000 miles. However, a 3,000 -mile interval is very aggressive, and many successful dompanies are applying preventive maintenance checks at 4,000-. or 5,000 -mile intervals.. RISK'& SAFETY Accident files were reviewed, and appropriate paperwork was found for primarily minor incidents. Accident files all had the appropriate crew paperwork, but none included any safety team or management comments. A supervisor reviews accidents and determines 'what happened." Depending on the severity of the accident, the crew may be pulled off duty with pay pending investigation. There was no consistent documentation to indicate a formalized review committee or incident review board process for the determination of issues of fault, refraining or accident incident trends within the organization. The number and severity of CEMS accidents does not, however, appear problematic. Injury & Illness Prevention Program The injury and illness prevention program outline included all necessary components. While the organization's Safety Policy provides for a safety officer, that person was not identified and there was no mention of a safety committee. - Driver..Training Driver training policies and procedures found in the Orientation Packet are basic. Driver training could benefit from some enhancement to include more detailed information regarding safe vehicle operation. FINANCIAL/BILLING & COLLECTIONS The scope of work and diversity of duties within the billing and collections department seem appropriate. Five people, including four full-time employees, perform billing and accounts receivable functions. The billing and collections department appears to be very efficient and is producing good results. Reported gross collection rates (gross billings to cash receipts) exceed 60% for 2OO4 and seem to run 57% to 62% regardless of the period measured. A recent study of ambulance services in the 200 largest U.S. cities found a 55% average collections rate for emergency HEALTH CARE VISIONS Page 15 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas .ambulance transports. he billing process used produces excellent results in days to bill and days accounts outstanding. The patient charges and the average patient charge (ARC) are all well within expectations for an organization of GEMS' size and complexity. Billing Policies & Procedures Manual The Billing Policies and Procedures Manual is well written and covers all billing department operations, including sections on Medicare/Medicaid billing and compliance. A separate compliance manual provides more comprehensive compliance procedures. Data Collection GEMS utilizes electronic charting using the electronic patient care report (ePCR) from Medusa Medical Technologies. Crews complete the ePCR and download it wirelessly into the system at either Washington Regional Medical Center or at one of the GEMS stations. Billing Process Data entry occurs five days a week. Patient bills are generally mailed within two to three business days. B!ue Cross/Slue Shield of Arkansas is the intermediary for the Medicare program and is also the major commercial insurer for the area. Collections Process ' The staff appropriately! handles cash and cash instruments. Deposits are made by the employee who matches and posts the accounts. A manager reviews accounts and deposits on a weekly and monthly basis. A collection agency is used for outside collections EMS SYSTEM RE -DESIGN - Washington County, Arkansas D. System Re -Design Recommendations Health Care Visions' review and analysis of the existing governmental and EMS operational components in the City of Fayetteville and Washington County has verified that a system re- design toward a public utility model (PUM) is the appropriate "next step" for the stakeholders and decision -makers in the market area. The recommended PUM design, although complex, will provide an infrastructure that protects both market rights and system funding while, most importantly, enabling the improvement of patient care. This section of Health Care Visions' report describes the local business, governmental and environmental conditions that led to a public utility model recommendation. D1. Current System Design The current Washington County EMS system is best described as a multiple provider, multi - jurisdictional emergency ambulance franchise. The City of Fayetteville arranges for emergency ambulance services through Ordinance 4678, assigning the, emergency segment of the market to Central Emergency Medical Service (CEMS). Washington County arranges for emergency ambulance. services for most of the county through a Memorandum of Understanding with CEMS. The City of Springdale provides emergency ambulance services directly, through the Springdale Fire Department. Market rights for non -emergency ambulance services are not iocaily regulated or assigned, and multiple providers, including CEMS, engage in retail competition to serve the non -emergency segment of the market. Clinica! quality and response time performance are reported to be appropriate within the emergency segment of the market, but due to the unregulated nature of the non -emergency business, the level of quality and performance within that segment is largely indefinite. Market fragmentation and proprietary interests of the multiple providers make it difficult to determine response times, clinical quality or fiscal responsibility for the non -emergency market segment. Recent changes among the non -emergency providers, including the cessation of service within the county by one provider during this study, hint at potential service and economic problems within the non -emergency market segment. Without a system design change, rising public standards coupled with economic pressures resulting from changes in medical reimbursement will make it increasingly difficult to meet public expectations for performance in both the emergency and non -emergency segments of the market. Consolidating the market segments in Washington County wilF allow not only a consistent level of performance for both markets but also the ability to capture the financial resources necessary to provide system improvements. EMS ECONOMICS EMS systems may be accurately described as public utilities. A public utility is defined as "an essential service, provided or regulated by local government, in which the cost of providing and maintaining the infrastructure required to reliably serve the public equals or exceeds the direct cost of delivering the actual units of service." Arkansas law (14-54-704) recognizes EMS as a public utility and authorizes local governments to contract for EMS services. The most efficient EMS providers in America generally incur more than 50% of their costs in developing and distributing the. network of communications services, ambulances and personnel required to HEALTH CARE VISIONS Hage i 1 September 2005 I EMS SYSTEM RE -DESIGN- Washington County, Arkansas cover their se vice areas. In most EMS systems, the marginal cost of providing each ambulance response is a small part of the total system cost. Water and electrical distribution systems are obvious examples of public utilities in which the cost of developing the distribution network greatly exceeds the cost of the product or service that is distributed. Many of the economic principles.that have been learned in these industries are applicable to EMS systems. Some of these. principles are counterintuitive. This is particularly so in regard to competitive practices. Competition in EMS For most commercial activities, retail competition provides powerful incentives for vendors to improve services,! lower prices and control costs. In public utility industries, however, retail competition generally results in higher prices, increased costs and reduced performance reliability. The costs. associated with establishing and maintaining .duplicate management structures and provide 1 networks within the same service area usually drive increases in; prices and decreasesin�pertormance. Conversely, market consolidation, in which a'single provider serves an entire market, usually results, in decreased costs and offers opportunities for improvements in service through more efficient use of the network infrastructure. Market Consolidation Significant efficiencies in the use of the network of EMS resources can be derived through market consolidation. Horizontal and vertical consolidation can generate operational and economic efficiencies. . Generally, greater degrees of horizontal and vertical . market consolidation offer; improved opportunities for economic efficiency. Horizontal consolkuiatio t refers to geographic consolidation of the market. Generally, using the EMS system to serve a wider geographic market and larger population is more efficient The inclusion of urban :and suburban population centers in the exclusive market often makes quality service feasible for sparsely populated rural areas. Vertical consolidation refers to the integration of EMS lines of service, including emergency, non -emergency and specialty care ambulance services, within the system's exclusive market rights. Some EMS systems further extend this vertical consolidation to include exclusivity for special events medical coverage, wheelchair transportation and helicopter air ambulance services. Horizontal consolidatio t and vertical consolidation work because they reduce duplication of activities and cost centers associated with administration, billing, communications and operations support. Health Care Visions has found horizontal and vertical EMS consolidation theories to hold true for Washington County's system. EMS ECONOMICS IN WASHINGTON COUNTY GEMS currently provides emergency (9-1-1) ambulance services to the majority of Washington County. Springdale Fire Department provides emergency ambulance services within the City of Springdale, including portions of the city that are located in Benton County. CEMS, Arkansas Paramedic Transport (APT) and Northwest Ambulance compete on a retail basis for the non - HEALTH CARE VISIONS September 2005 Page 18 EMS SYSTEM RE -DESIGN - Washington County, Arkansas emergency segment of the market. This arrangement results in the overlap and duplication of many portions of the EMS system infrastructure. Under today's system design, ambulances within Washington County are managed by four management teams and dispatched by four communications centers. Four billing offices seek reimbursement for services. Multiple medical directors provide varying degrees of clinical oversight. No one source has access to sufficient information or data to determine the total cost of ambulance services or even the entire demand for services, making it impossible for any of the participants to develop an efficient plan to provide either emergency or non -emergency services. Despite reasonable efforts on the part of the two emergency providers to employ automatic and mutual aid provisions to marginally improve the reliability and efficiency of emergency ambulance services, four overlapping ambulance networks require significant duplication, of deployment coverage and cost. Money that is wasted to support the unnecessary duplication of services is hot available for the improvement of response times, equipment, salaries or prices. Recommended Consolidation of the Washington County Market Washington County has an opportunity to consolidate its EMS system and eliminate costly and dangerous duplication of services and system resources. Structural changes in the system design will be required to accomplish a market consolidation improvement. Actual or virtual consolidation of the entire county into a single exclusive EMS market is a logical step to improve services and control costs. Consideration should be given to the consolidation, to the maximum degree possible, of EMS system components such as medical direction, ambulance dispatch, billing, .training, quality improvement,, fleet operations, equipment/supply functions and administration. The very survival of the Washington County EMS system may hinge on the successful consolidation of the current system into an exclusive market. D2. Recommended System Design: The Public Utility Model The public utility model (PUM) EMS system design is a complex business structure designed to incorporate the core competencies of governmental and private system components. The PUM usually functions as a public "third service" EMS system and can employ in a variety of ways private for-profit or not -tor -profit contractors or public contractors to provide some portion of the services delivered by the system. The primary features that distinguish the PUM from other related system designs include market exclusivity and PUM Authority ownership of the business trade name and ambulance services licenses, the revenue stream from subsidies and accounts receivable and frequently, certain high cost portions of the EMS system infrastructure. Many variants of the public utility model exist across North America, all sharing similar features, including: • A' government -appointed oversight board or entity (the Authority) • The ability for the Authority to set ambulance rates • Ownership of the system revenues by the Authority • The ability to build net worth HEALTH CARE VISIONS Page 19 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas • Exclusivity for emergency and non -emergency ambulance services t o Comprehensive reg i • Use of one or rnore • The ability to safely • Ownership of or acc • Centralized medical Washington County an observing the highly el several decades. Durit were charged with con and recommend the sy: on of EMS system performance rations contractor(s) to manage daily operations ect against operational non-performance to certain key components of the system infrastructure ction and clinical oversight of the EMS system the City of Fayetteville are familiar with the public utility model after :ient and effective PUM EMS system that has served Little Rock for the initiation phase of this study, the Health Care Visions consultants aeration of the public utility model but specifically directed to evaluate !m design that would best serve the County and the City. Health Care Visions finds that the pubic utility model is uniquely well suited to improve EMS services within Fayetteville, Washington County and perhaps a wider regional area. Accordingly, the primary recontmendation of this study is that the City and County develop an exclusive ambulance market and employ a PUM EMS system to improve the quality, reliability and cost of local emergencv medical services. FORMING A PUBLIC The formation of a public rust be approached ca development of a "quas outcome of certain intent( within a specific medica agreements.) Normally, ordinance, assigning ezcli assigning the oversight ar participating government: Authority, with the agree including "equity",. ow ter system. Day-to-day managemi executive director and functions, operations i all responsibilities of ih The interlocal agre medical director or an Emergency Rhy from all receiving n The following diagram HEALTH CARE VISIONS September 2005 MODEL utility model involves a complex matrix of steps and approvals that 3fully and thoughtfully. The PUM system design results in the •governmental" entity, usually called the Authority, as the direct :al agreements of and between governments (cities and counties) service trade area. (See Attachment #3 for sample intedocal each participating government entity will pass a uniform EMS sive market rights, establishing basic performance requirements and 1 management of the EMS system to the PUM Authority Board. The simultaneously enter into an interlocal agreement that forms the ient including the rights of each participant in a number of areas hip, board representation, enforcement and withdrawal from the t of the PUM Authority and system operations is usually handled by an tall employed by and answering to the Authority Board. Administrative ersight, accounts receivable administration and financial reporting are Authority. and uniform EMS ordinance dictate the clinical oversight of a separate of physicians selected to provide system -wide clinical direction. Often, Advisory Board (EPAB) is established, which includes representatives facilities in the system. ' the organizational structure of a public utility model EMS system - Page 20 EMS SYSTEM RE -DESIGN — Washington County, Arkansas implementation. The following recommendations outline the broad organizational steps and key decisions that system designers will face as well as a series of sub -recommendations related to the development of a P III M system in Washington County. Washington County, the City of Fayetteville, the City of Springdale and other area cities should pursue the establishment of.a PUM EMS system design through an interlocal agreement and uniform EMS ordinance! During developmental meetings, many of the following system design elements will necessarily be discussed and developed. It is recommended. that the agreement/ordinances creating the new EMS system be countywide or as geographically inclusive as. possible. Although it is not absolutely. necessary to include the entire county, the less] agmented the system is in thesystern development stage, the stronger it becomes in terms of finances, market protection (exclusivity) and the provision of a single level of service. The area and market segment currently served by the Springdale Fire Department should continue to be served by that provider through an agreement with the newly formed PUM Authority. I - Although there are several options available regarding market exclusivity, it is strongly recommended that the system be designed as an exclusive system (oral! ambulance transports to the fullest extent allowed by law. This would include emergency transports, non -emergency transports and commercial standby services. Granting the Authority market exclusivity provides the strongest financial and clinical practice model and offers the PUM design the greatest chance of long-term success. Criminal and civil penalties to be imposed for violations of the exclusivity provisions oflthe uniform EMS ordinance should also be developed. Generous reimbursement for air ambulance services has resulted in the proliferation of medical helicopters and a tremendous increase in their utilization in many systems. It is recommended that the availability and use of helicopter air ambulances in Washington County should be contemplated during thle development of the PUM. Operational and safety concerns on a national scale indicate that language regarding - the appropriate use of this mode of transportation should be incorporated in the controlling ordinances and medical control structure created later in the development process. Operational concerns regarding the coordination of ground and air resources abound, and protocols for utilization, transport destination, standards for permitting or licensure, regulation of medical transportation rates and compliance with public safety and medical control standards are a few of the basic issues that should be addressed in the uniform EMS ordinance. An exclusive contractor f lanchise is likely to improve the availability, quality and safety of air ambulance services within Washington County. HEALTH CARE VISIONS; September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas Cities may opt to participate in PUM system governance by adoption of the interlocal agreement and uniform EMS ordinance or may opt to simply be: served by the PUM by consenting to inclusion in the service area. Participating cities would participate in the governance and.share the financial equity, including risks, of the public utility model and non -participating cities would continue to enjoy uninterrupted and probably improved levels of service. While system design elements are being developed, a letter of intent or similar instrument should be used to identify jurisdictions that wish to participate. Many significant participant jurisdiction and board representation issues will be discussed and decided by the system designers. Concurrent with the development of interlocal agreements and EMS ordinances, the Authority, medical control board and ambulance provider structure of the PUM must be developed. These components provide the backbone of the system and must work in concert for successful system operations. For the Washington County PUM system, it is strongly recommended that the organizational design developed as a result of the interlocal.agreements and EMS ordinances "closely hold" or fold in GEMS and its assets as part of the business structure for the Authority. Several other options do exist, such as contracting for services with GEMS or holding a competitive bid process to select a private contractor, but Health Care Visions found those options to be potentially costly or overly disruptive for the system. The newly created Authority would be responsible for the tasks normally associated with an Authority, including billing, accounts receivable management and procurement, as well as the operational tasks. Current subsidies, if they continue, would be paid to the Authority. The Authority Board would set rates and may allow any city to reduce rates within its jurisdiction through the payment of subsidies to the PUM. Care should be taken during the design and implementation process to preserve future opportunities to establish an Emergency Services District as a mechanism for raising capital if the need arises. Similarly, mechanisms to allow additional jurisdictions to join the PUM should be incorporated in the design. Medical. oversight to provide clinically driven improvements and standards for the Washington County system must be developed through the establishment of an Emergency Physician Advisory Board with a medical director or some variation on that structure. In this and every high-performance system, the level of participation and regulatory control that the medical director and the board have is user -defined by the system designers. HEALTHCARE VISIONS Page 23 September 2005 EMS SYSTEM RE -DESIGN - Washington County, Arkansas These issues will includle the clinical levels of service required by the system and emergency and non -emergency response time performance criteria for the urban, suburban and rural areas of the service area.! An implementation tim determined and the dc environment, it is conce implementation could I agreement, passing of displaced ambulance pi e will be difficult to predict due to the many variables yet to be ions necessary for project completion. However, with the current ole that a target set for six to nine months from the beginning date of met. Complications related to the development of the interlocal uniform ordinance for each jurisdiction and any challenges from lers could of course derail any timeline. The Authority and the board will determine the amount, if any, the participating cities and county may be required to paylfor organizational and transitional costs. If startup funding is provided by the participants, it is recommended !hat the Authority be structured to refund those costs through payments or bylailowing the participants to earn equity in the system. FINANCIAL DISCUSSIONS Forward -looking proforma budgets will need to be developed during the imitation phase of this project as more detailsare decided regarding the public utility model design. With the many variables that will have to be decided throughout the development of Washington County's new PUM system these budgets will fluctuate at each step of the initiation. The proforma budgets will fluctuate mostly on a sliding scale of "new call volume" expected with decision and the initiation of exclusive market rights. Without the exclusive market rights, revenue projections for the system would be basically unchanged from today's budget and the new system design concept would be difficult, if not impossible, to implement. New call volume adds "new revenue' and allows for better design options for the region. Cost projections for the e proforma budgets will be produced with a conservative assumption of improved efficiencies as it can normally be assumed that certain productivity efficiencies can be accomplished as call volume increases within certain geography, loweringoperating or unit hour costs. H. Depending upon the increase in call volume, some capital expenditures may be necessary, but the primary increases in both cost and revenue occur with the operational changes that will need to be implemented with the expected call volume increases under the new system design. Revenue increases will be seen through the capture of the non -emergency market that is currently being siphoned away by other providers. Actual transport numbers were not available and standard projections using data from other "captive" markets were inconclusive. However, anecdotal evidence within the system shows that as many as fifteen non -emergency transports a day could be used for budget projection, but it would be wise to be conservative in that estimate. HEALTH CARE VISIONS Page 24 September 2005 IS • S. • • . • Ar" TMr :1 1Y Y3> �j lJ 4. �` 2�,1F Jt i(•i; rf Ix_ TnY^.'9v Y�Y. ii C# vy '.JAA NEW ANNUAL"�- -,, x•AV�pAGE"� `-' '"' �� 0--_ 710N,`�-�� i PROJECTED • - ®_�1NAW® PATIENT Cl1ARGEl .,,-.:. ��., 'tar �4;#4b iPEFiCENTAGE,'� CASH '„ •• • U. • ••' • • • • • • • • •' •• _• - • • • •♦ Jo�ffff 'n{)D`1..' • ^'r , AF f`Y' tZ /i+}' > Tf CIS iJ[Fl�.}y.�yk(. FF i`.i� v '• `�rvt ' `+���� PROJECTEDr"�S•' A0DITI0NALUNIT'" +'" t• "T F� • • • 4' NEYl ANNUAL--� n'A "' H0U 4 E0E0r •'• a•UTR 1T A { i NEi REVENUE,' •, RS NE °}''H0UN h I T EWC -{ I,TFiANSPV0RT$ 1_"I ��CA$HI"x'�+X ,G022;EFFI r �♦ toi➢ p, a,nrt i �l, 'I•u. 4v Y CIENCY 4 RCOS -'' ' r :IX tv�li I fl Jr. ^Y,i 64 vr}i-.♦F.v ] :fYhn. 'ln I'T Yt 'r nln♦ W pit ivafl flfl I AS EMS SYSTEM RE -DESIGN - Washington County, Arkansas E. List of Attachments • 1 . Demand Analysis Discussion & Plan Development Outline 2 Physician Review of Quality Program & Medical Protocols 3 Sample Interlocal Agreements CD Enclosure Policy & Procedures Manual Template 4 ,I I HEALTHCARE VISIONS Page 26 September 2005 Attachment 1 System Status Management Discussion Demand Analysis &1 SSP Development Perhaps the most important tool in system status planning is the demand analysis. A demand analysis provides a numerical and graphical comparison of system call volume for a particular hour (demand) and unit hours staffed (supply). Performing this analysis for a single hour or a single day is easy but deciding how long a time period to measure cAn be more difficult. In systems with sophisticated data collection capabilities, demand analysis is used for system status planning in the following manner. 1. Collect data for running twenty (20) -week period 2. Graph call'volume by hour in the following three (3) ways: o Peak — highest call volume for that hour in the twenty (20) -week period o Average — total .call volume forthat hour divided by twenty (20) o High Average — divide the twenty (20) -week period into five (5) four (4) -week periods.; Ad•, the peaks for the hour of each four (4) -week period and divide by five (5) 3. Staff to meet the high average number A demand analysis will reveal not only where unit hour coverage is suspect but also where there is an excess of unit hours in the system. The ability to move and adjust resources accordingto real-time data with the development of a system status plan based on demand analysis will enhance the CEMS system planning and efficiencies. Ongoing Performance Review The systematic review of response time performance requires that reviews be performed by a staff (member on a daily, weekly and. monthly basis. The chart below outlines'ariticipated SSP SP review duties once data collection can be enhanced. •�{ Cf?u,i'x5�X 11»"34 ^� f ' " '' .YGYlf'+.iirl t` ' rt LN+.�by lr r • •'{T!'ivf ( r t.�'.. �}t al afT •.iyv T54 yr�.1M1 fit f�tOGESS'"+4 .•- t''l r ' , '11SYSTEIN STATUS L`iDiNNING!Rt:L _e;T..�-.P _{SI1 cut'- YYca jn '5[.:n ..m .�-Y.�S.M4`.`w..�S...e:e�9'-:°`4 .^.i .[ Ihxtt.ra t2 '! au _-'[ti'i. •�.tSl fnra --• I U. -•• I I- I I. a- • • • •I R- -•I -- I. I- • I . -11 -11• •- I- - I•-• I• I •- I I • I- 1 . MONTHLY • Review summary indicator reports (chute times, hospital drop times, etc. — reports need to be developed) • Review summary reports and identify trends • Discuss change plans/perform major SSP changes UNIT -HOUR TRACKING - An integral part of performance review is the tracking and measuring of unit hours. An ambulance organization produces unit hours as its function of production and the tracking of unit hours "lost" (anticipated but not used or paid for) or "wasted" (produced and paid for but not used for transports) is imperative. A system can be instituted that will capture and measure any data surrounding the addition or loss of unit hours for the period measured. In an urban system, it is especially important to begin capturing the amount of unit hours that are added to the system when out -of -area units are used for system coverage and/or transports. Additionally for any reporting it is more efficient to use the actual unit hours produced number, but still ensure that key managers remain aware of and manage lost and wasted unit hours. It may take some creative solutions to capture and report the data to measure items like "hours lost to maintenance" and other details but the ability to match demand with true supply and to stop paying for unit hours that don't producerevenue will make the solutions worth the troub;e. - Unit Hours not filled Staffed Unit Hours Hours lost due to maintenance Hours lost due to Out of Town Hours lost due to supervisor + Hours in from out of area, + Added Unit Hours/overload Hours lost due to drop times Actual Unit Hours Produced Lost Unit Hours (not paid for) Unit Hours available for that shift/day Wasted Unit Hours (paid for -not used) Wasted Unit Hours (paid for -not used) Wasted Unit Hours (paid for -not used) Additional Hours Additional Unit Hours Wasted Unit Hours (paid far -not used) Unit Hours Used for Demand EXCEPTION & KEY INDICATOR REPORTING To'be a truly useful tool in the management of a system, the exception report must be developed with detail. The minimum amount of information that should be collected in each exception report is as follows: • Call information, time, date, call number • Run times • Address responded to and where the crew was responding from • Level of the sy Item (how many ambulances were available) and whether the system was in compliance (were units where they should have been) • The crew and the dispatcher (crew information is not currently captured) • Some explanation from the crew explaining long chute times, route of travel, etc. This specific information becomes critical when trying to determine the reason for an exception or exceptions. Much of the necessary data should be retrievable using the City's CAD and the CAD "snapshot" feature. The CAD currently in use is one that can provide a great deal of information regarding the daily operational components of the system. TIME ON TASK' One of the e!ements of reviewing "wasted unit hours" is watching the "time on task" (lime from dispatch to available). Time on task in the ambulance industry is generally measured,assuming none (1) -hour task time. Defining what is appropriate for the system is an important part of saving, unit hours in the system and time on task data should bejanalyzed on an ongoing basis. I Attachment 21 Northwest Ark Jeffrey M. Gi The protocol indications of EMS oractitio The scope of I directives quite care, yet still us In general, encourage Northwest Based upon carefu commentary addres • 1) I1 this is • updated, of '.hose and upd, • research 2) While th, find it e. protocol: these pn 3) Airway A Protocol Esophag sequenc validate proper e standard 4) Regional EMS Protocols Review Commentary MD, FACEP ed October 2002, is well written. Most protocols feature helpful history and physical examination that should be conducted by the easonable etiology differential is similarly denoted. s and organization further affords the EMS practitioner a set of •for detailed review of professional expectations and standards of ntemporaneously with patient care should the need occur. the work performed by the protocol development group and efforts in optimizing the standard of EMS care throughout the inn e consideration of ibis particuiar protocol set, I offer the following ng specific aspects of this set: e most current form ct the protocol, it should be reviewed and ith subsequent review and updating to be scheduled at least Substantial advancement in EMS care has occurred between 02 and July 2005, with well -regarded, published, peer -reviewed the primary basis for these advancements. I believe frequent revision is in line with the following statement indicated on page 7 )tocols: 'These guidelines are meant to be reviewed contiguously d as national, state and regional standards change and scientific d literature support" are many EMS organizations involved in the protocol process, �ntial that more than 2 physicians are integrally drafting these While it is apparent that additional EMS medical directors endorse cols, more should be involved at the earliest development stage. iagement Protocol — Page 11: While the Intubation—Orotracheal 'age 137 clearly indicates the appropriate inclusion of the J Intubation Detector (EID) into the placement confirmation the EID is not delineated in this protocol. Numerous studies now 3 importance of using both the EID and capnography to ensure otracheal intubation placement. Any opportunity to reinforce this care practice should be taken. Airway Management Protocol — Page 11: Versed and/or Morphine is listed for medication -facilitated intubation. Versed is certainly widely utilized for this purpose in the United States; morphine is less frequently utilized in this manner. Etomidate is well -supported for use in medication -facilitated intubation. Etomidate has a more reliable dose-responsepredicted outcome, as well as a safer hemodynamic profile. Both of these traits make Etomidate worthy of consideration for inclusion in this protocol, potentially to a point of replacing Versed and/or Morphine. Y 1 1 1 5) Spinal Immobilization Protocol — Page 12:,Very Very nicely drafted, including all the necessary clearance points from the NEXUS study. 1 6) Pain Management Protocol — Page 14: Numerous analgesic options exist, potentially confusing the EMS practitioner as to the appropriate agent and reasonable dosing regimen. Additionally, operating cost savings may be realized with the purchase of fewer analgesic agents with concurrent simplified controlled substance accountability. There is a helpful review of prehospital analgesia in the July 2005 JEMS. journal that may enable simplification of this protocol. 7) Automated Defibrillation Protocol — Page 15: Throughout the protocol set, there is consistent emphasis on earliest possible defibrillation. Since the time of this protocol set's release, there is greater acceptance that earliest possible defibrillation does not consistently produce optimal outcomes from out -of -hospital cardiopulmonary arrest. The following bibliography will likely prove useful in illustrating the benefit of 90-180 seconds of quality BLS CPR prior to defibrillation in many patients: Wik I, Hansen TB, Fylling F, Vaagnes P, Auestad BH, Steen PA. Delaying delibrillation to give basic cardiopulmonary resuscitation to patients in out-cf-hospital ventricular fibrillation. JAMA. 2003;289:1389-95. j Cobb LA, Fahrenbnich CE. Walsh TR, et al. Influence of cardopulmonary resuscitation prior to defibrillation in patients with out -of -hospital ventricular fibrillation. JAMA. , 1999;281:1182-3. P. Menegazzi JJ, Callaway CW. Overcoming ACLS Dogma: How quickly should we change? Prehosp Emerg Care. 2003;7:410-3. 8) Asystole Protocol — Page 16: Vasopressin in the care of asystole is now supported, though still debated in terms of effectiveness. The study by Wenzel (NEJM 350;2:105-113 with accompanying editorial) paired with a more recent study reported from Pittsburgh, PA EMS in Prehospital Emerg Care warrants a healthy debate and consideration that vasopressin be included in this asystole protocol. 9) Cardiac Arrest Protocol — Page 18: See commentary from Automated Defibrillation Protocol above. Additionally, advocating mechanically -assisted chest compressions is recommended. Regardless of device utilized, the performance of continuous, consistent chest compressions, only enabled by mechanical means, optimizes the chances of cardiac arrest survival. It should be noted by reviewers of this document that recently developed, perhaps more effective, mechanical chest compression devices represent a significant capital expenditure. Accordingly, EMS organizations should be allowed appropriate time in any incorporation of such a device. In full disclosure, the author of this commentary owns a minimal number of shares in Zoll Corporation, a manufacturer of a mechanical chest compression device. 10) PostlResuscitation Protocol — Page 21: Inclusion of such care directives is often overlooked in EMS protocol development. This protocol is nicely written and highlights the necessary and critical actions the EMS practitioner must address after successfully restoring spontaneous circulation in the cardiac arrest victim. 11) Pulmona y Edema — Cardiogenic Protocol — Page 22: Inclusion of Continuo l s Positive Airway Pressure (CPAP) delivery is being widely adopted in EMS. This therapy is supported by multiple publications. The application of CPAP is easily accomplished and very effective, often eliminating the necessity of endotracheal intubation in the Cl-IF patient in extremis. CPAP is widely regarded to be effective even in systems with relatively short scene to emergency department transport times. CPAP inclusion in this protocol is recommended accordingly. 12) Ventricular Fibrillation Protocol — Page 24: See commentary from Automated Defibrillation Protocol above. 13) dynamic listed in whether c options ft dosing of would be 14) Seizure Manage potential reasona enable patient. commer 15) Eclamps Protocol 16) Complic 17) Airway Airway Toxic Exposure Protocol — Page 39: Review of the usage of n is highly recommended. While a useful agent for the reversal of I sedation in a patient pcpulation subject to medical history c, the usage of this agent by EMS should be discouraged. There is tential to induce seizures in patient chronically utilizing epines. Such chronic usage may rarely be reliably obtained in the operations of EMS field evaluation and care. While phenytoin is he pharmacology compendium of these protocols, it is unclear very EMS unit carries phenytoin. Moreover, the first line treatment a seizure are all benzodiazepines, arguably quite ineffective post - this benzodiazepine reversal agent. A better risk:benefit practice :o simply provide necessary airway management for the victim of a epine overdose. rotocol — Page 41: Similar to the commentary in the Pain ant Protocol above, numerous benzodiazepine options exist, confusing the EMS practitioner as to the appropriate agent and dosing regimen. A, consensus agent and dosing regimen may ;ier and more effective pharmacologic intervention in the seizure Similar cost savings mentioned in the pain management y may be afforded as well. Protocol — Page 52: See commentary from Seizure in Childbirth Protocol — Pages 54-55: Particularly well done. A )I for EMS organizations. — Pediatric Protocol — Page 59: See commentary from Protocol above. 18) Overdose/Toxic Exposure — Pediatric Protocol - Page 68: See commentary from Overdose/Toxic Exposure Protocol above. 19) Seizure — Pediatric Protocol — Page 71: See commentary from. Seizure Protocol above. 20) Flumazenil Protocol — Page 88: See commentary from Seizure Protocol above. 21) Succinylcholine Protocol — Page 112: There is no indication of neuromuscular blockade assisted intubation in any other protocol in this set. While no national consensus exists regarding the recommended number of intubations per paramedic per year to enable judicious, safe, and effective usage of succinylcholine for out -of -hospital intubation, the authors of these protocols should further delineate any usage of succinylcholine in the airway management and intubation protocols. References to ongoing Continuous • Quality Improvement programs related to. any neuromuscular blockade, assisted intubations should also be clearly referenced within the protocol set_ 22) Bag Valve Ventilation Protocol — Page 122: There are landmark studies within the interval from this protocol release that should be referenced in regards to ventilation rates: Emergency Ventilatory Management in Hemorrhagic States: Elemental or Detrimental? Pepe el al 2003, Journal of Trauma. Hyperventilation -Induced Hypotension During CPR - Aufderheide el al 2,304 23) Cricothyrotomy — Surgical Protocol — Page 126: Consideration should be afforded commercially available percutaneously placed cricothyrotomy airways. As a rarely performed procedure by any medical personnel, particularly EMS practitioners, any simplification and/or minimization of surgical incisions should be encouraged to keep misadventures in procedural performance more rare than the procedure itself. 24) Death/Withholding Resuscitation Protocol — Page 127: A more precise definition of "extended downtime with asystole.on the EKG" may prove useful in this sometimes difficult decision to not initiate resuscitative measures. 25) Intraosseous Access Protocol — Page 135: Recent technology, well supported in scientific literature, promotes the utilization of intraosseous access in the adult population. Review of these devices and their usefulness should be performed. In summary, the reader of this commentary should recognize that many of the above suggested enhancements to the Northwest Arkansas Regional EMS Protocols may be currently included in the most current set of protocols or in the development process for inclusion. To underscore, in general, I find the protocols supplied for my review and commentary to be well written, useful to the EMS practitioners, and I applaud the work performed by this protocol development group. Encouragement should be readily offered in multiple forms in their further efforts in optimizing the standard of EMS care throughout the Northwest Arkansas region. Central EMS Commentary Review of Guideline ir and approp critical for w I i am uncertain as represents. Clearly of calls. Generall sampling for review. Pertinent call times Patient encounter I question the signific comprehensive' eme to optimiza tile! cart practitioner arrivai. call would fit this de expeditious coriside medical dispatch, w optimization, but wic provide such pre -an and/or the disoatchii The remainder within the EMS and ongoing ir internal and exi Improvement Standard Operating Guideline Review & 5, 2004 Draft Quality Improvement (QI) Standard Operating reasonably comprehensive O1 program. Of particular importance field personnel are afforded inclusion into the review body. This is field acceptance and buy -into the program. what percentage of calls that 25 calls per week being reviewed ere is a greatly diminishing return as an agency approaches 100% speaking, a randomized 10% of calls represent a reasonable srid events identified for review seem reasonable and customary. Des identified for review seem reasonable and customary. I do nce of "any call that a dispatcher gave pre -arrival instructions." A gency medical dispatch pre -arrival instruction set should be utilized a patient teceives by bystanders/caliers prior to professional EMS such a system is being utilized, then it would appear nearly every nition as stated. If such a system is not being utilized, serious and rtion for such a system's incorporation should occur. Emergency standardized pre-arrivai instructions, is not only indicated for care lly and nationally regarded as today's standard of care. Failure to tal instruction and care constitutes a major risk for an EMS service 3 entity. document supports the generally accepted forms of effective O1 ;try. As with any process critical to ensuring proper care delivery !ment in practitioner performance, frequent updating based upon :ommentary should be occurring. 1 I 1 1 EMS INTERLOCAL COOPERATIVE AGREEMENT WHEREAS, the State of Texas, in the Interlocal Cooperation Act, has provided in Chapter 791, Texas Government Code, et seq., that this City (hereinafter called "this Jurisdiction)' may jointly exercise with other local governments the power to provide governmental services for the public health and welfare, and such services include ambulance services; and WHEREAS; it isin the best interests of the public health and welfare of the people of this Jurisdiction to have available to them a state-of-the-art, high performance, high quality, pre -hospital emergency medical system, with stringent medical controls and accountability, and adequate response times; and WHEREAS; due! to the relatively low population and low population density of some portions of the geographic area in Tarrant County, Texas, and the extremely high, start-up and fixed operating costs of a state-of-the-art emergency medical system, it is necessary to award a single. provider the right to' engage in ambulance operations within this Jurisdiction, in order to maximize economies of scale for providing such emergency medical services. THEREFORE, 1 jurisdictions which have agrees as follows: 1. In 1988, Interlccal Cooper called the "Autt described in Pars Authority, by the the Uniform EM; the Uniform Sch, 2. The Auth the Authority sha (a) TI withdraw the date of 2 be given than twe it resolved that this Jurisdiction, which has joined with al; other )pted this Restated Interlocal Cooperative Agreement (the" Agreement"), administrative agency was created, pursuant to Sec. 791.013 of the >n Act, called the Area Metropolitan Ambulance Authority, (hereinafter :y"). The Authority has all of the powers and duties set forth and ph 8, below. This Jurisdiction has elected to become a member of the >ption of this Restated Agreement, and by the adoption concurrently of -dinance (Exhibit A), and by the selection of a price/subsidy option from les of Price/Subsidy Options. (Exhibits B and C). ity's term of existence and provisions for withdrawal from membership in be as follows: existence of the Authority is perpetual. This Jurisdiction may not intil July 31, 2004. Thereafter, this Jurisdiction may withdraw on the i date of the competitively awarded contracts for ambulance services with tor, and the expiration dates of all options for extension thereof. This is right to withdraw shall occuron the last day of each contract, or the last option for extension thereof. Notice of such intention to withdraw shall writing to the Authority, and to each member jurisdiction thereof not less (12) months before the proposed effective date of withdrawal. 204249.v2 (Interlocal Cooperative Agreement, cons_ ...) .. 3. The Authority's Board of Directors shall be composed of no more than nine members, constituted when possible as follows: (a) Members who are knowledgeable or have experience in one or more of the following areas: health care, finance or accounting, business administration or law and who have resided for at least three years in a jurisdiction which is a member of the Authority. (b) The Medical Director of the Emergency Physicians Advisory Board, who shall serve ex officio, but with voting rights. (c) The terms of office of all members of the Board of Directors shall be for a period of three years. No member of the Board shall be appointed for more than two consecutive,terms in office. (d) No member of the Board of Directors shall have any interest, financial or otherwise, either directly or indirectly in any firm or organization which is a bidder for the competitively awarded contract, or in any firm or organization which contracts to provide ambulance service or other goods and service to the Authority; (e) ' The membership of the Board shall be chosen as forth below in Paragraph 13. (f) Any member of the Board who fails to attend any three (3) consecutive, regularly scheduled Board meetings or who fails to attend at least six (6) regularly scheduled meetings in any twelve (12) month period, without a reasonable and valid reason for such absence may be removed from the Board, and his position filled as provided in Paragraph 11, below. Removal of a member pursuant to this provision must be approved by a majority of the members of the board, excluding the member in question. 4. Requirements for membership in the Authority shall be as follows: (a) Membership shall be open, on an annual basis, to any city which is:in Tarrant County, Texas or to any jurisdiction which is contiguous to the geographic area served by the Authority, if such city is not located in Tarrant County, Texas, subject to approval by the Authority_ Rural Fire Prevention District Number One of Tarrant County ("Tarrant County Fire District") may become a member by adopting and • executing this Agreement and. selecting a price/subsidy.option from the Uniform Schedules of Price/Subsidy Options. 004249.v2 i (Interlocal Cooperative Agreement, con[. _.j (b) Any jurisdiction which becomes a member after June 15, 1999 shall be required to pay a one-time initial capital assessment which is equal to that jurisdiction's per -capita share of the net worth of the Authority, as calculated in Paragraph 10(b), below. Such payment of the pro -rata share of the net worth maybe paid:' (1) By a one-time payment at time of joining; or.. (2) In monthly payments over a two-year period which payments shall also carry interest at the statutory rate for judgments, pursuant to Texas law. 5.. This; Jurisdiction accepts no financial responsibility or commitment for its membership.in the Authority except for costs of furnishing a mechanism for transferring 911 callers requesting medical assistance from the Jurisdiction's 911 center to Authority's designated EMS control center, and that referred to in Paragraph 11(b), below. The sole requirements for membership in the Authority are: (a) Except for the Tarrant County Fire District, this Jurisdiction agrees to adopt and enforce the Uniform EMS ordinance, which is attached hereto, and incorporated by reference herein (Exhibit A); (b) f This Jurisdiction agrees to establish and participate in the Authority's first responder program, as provided for by the Uniform Ordinance which program shall be regulated by EPAB, and to fund first responder operations within this Jurisdiction; provided, however, that the Authority's ambulance service contractor shall provide initial and continuing first responder training without charge to this Jurisdiction. However, the contractor will not be required to provide initial EMT and paramedic certification or training. Provided further that, at this Jurisdiction's option, required first responder medical and communications equipment may be financed and purchased by the Authority and paid for by way of an increase in the subsidy or price level ;applicable in this Jurisdiction.' (c)/ Options. responder (d) Se 804249.V2 royal and adoption of one of the Uniform Schedules of Price/Subsidy rovided that if the Emergency Physicians Advisory Board certifies a as advanced life support first responder such jurisdiction may choose it B or C; however, those jurisdictions certified as basic life support first iall use Exhibit C (Exhibits B and C); on by this Jurisdiction of one option from the Uniform Schedules of Options (Exhibits B and C); 7 (Interlocal Cooperative Agreement, cont...:) (e) Thereafter, this Jurisdiction agrees that, no later than July 31 of each year, it will annually select, approve and adopt from the Authority's annually revised Uniform Schedules of Price/Subsidy Options a price/subsidy formula to be effective in this Jurisdiction. Prices selected on July 31 shall then become effective on the following January 1, and the selected subsidy level shall become effective on the following August 1. (f) Until such time as the Authority has accumulated a prudent net worth as defined in Paragraph, 10(b), below, the annual level of subsidy shall not be decreased by more than 10% during any single year. Such subsidy contributions shall be made, quarterly, in advance, to the Authority beginning with the quarter starting August 1, 1999. For purposes of this provision, subsidies paid for first responder services shall not be counted as subsidy. (g) L` the subsidy/price structure effective in any member jurisdiction during fiscal year 199?- 1998 was in excess of an applicable combination shown on the Uniform Schedules of Price/Subsidy Options, that jurisdiction may upon becoming a member of the Authority reduce its initial subsidy/price balance to any levels shown on the Uniform Schedules. Thereafter, the restriction on rate of subsidy reduction specified in Paragraph (f), immediately above, shall apply. (h) Should any member jurisdiction fail to maintain substantial compliatice with any membership requirement specified herein, the Authority's Board of Directors may, at its option and after written notice to that jurisdiction and reasonable opportunity to correct the deficiency; disqualify that jurisdiction, from membership in the Authority and revoke its membership status. In such event, the removed jurisdiction shall not be eligible for distribution of any share of the Authority's then - current net worth. 6. The Authority shall have all of the powers allowed or provided by Chapter 791 of the Texas Government Code, the "Interlocal Cooperation Act." 7. The Authority shall not itself operate the ambulance service, except in the event of default by the Authority's competitively selected provider ("Contractor"). In the event of such a default by the Contractor, the Authority may operate the ambulance system for a period not to exceed 18 months, during which time the Authority shall again conduct a competitive Request for Proposal process for the award of a contract to another provider. 8. The business structure of the emergency medical system to be created by this Agreement, shall be what is known as the "Public Utility Model," although it is recognized 4 804249.v2 (Interlocal Cooperative Agreement, coot that, at sorhe point in time, a modification of this system to a "Fail Safe Franchise Model" may occur! 9. The Authority shall have the following additional duties and powers: (a) i To set response time standards forth] areas of each memberjurisdiction, and to nfor compliance therewith through contractually imposed financial penalties. I (b) To provide each member jurisdiction with advanced life support ambulance service, such service to comply with all applicable state laws and rules, as well as all rules, regulations, and clinical standards as the Emergency Physicians Advisory Board inlay from time to time promulgate. (c) To provide such ambulance service by the competitive award of a contfart by way of a Request for Proposal process. Such competitive Request for Proposals shall be conduicted for the selection of a Contractor no less frequently than every ii years. TheI contract awarded to the contractor shall require the contractor to provide all ambulance services in each member jurisdiction, except for those exempted in Section 5F of the Uniform EMS Ordinance (Exhibit A) adopted concurrently (d) To prepare and distribute, not later than June 30 of each year to each member jurisdiction a schedule of price/subsidy options, called the Uniform Schedules of Price/Subsidy Options which shall range from zero -level subsidy with full cost user - fees! to zero -level user fees with full -cost annual per capita subsidies, and shall also include a first responder system with either a basic life support first responder option or advanced life support first responder option, as determined by each local jurisdiction. Future Price/Subsidy Option Schedules shall be prepared in the same general format as Exhibit B and C to this Agreement. Each member jurisdiction shall, no later than July 31 of each year notify the Authority of that member's selection of a price/subsidy formula from the Uniform Schedules of Price/Subsidy Options received by the jurisdiction from the Authority. The Authority shall set the rate schedule for each member jurisdiction according to that member's decision effective the following October 1, and the newly selected level of subsidy shall be effective the following October 1. (These effective dates are offset by three months to allow adequate time to compensate for the substantial fee -for -service collection lag I which preivails in the pre -hospital care industry.) (e) , To bill patients, third -party payors or other responsible parties, and collect the revenue from such bills, for all ambulance services provided; 5 804249.v2 (lnterlocal Cooperative Agreement, cons....) (f) The Authority shall implement an ambulance service subscription program unless otherwise prohibited by law. That program shall be a contract which allows a resident, and members of the resident's household of any member jurisdiction to annually purchase and prepay all uninsured portions of medically necessary ambulance service. (g) To engage in related services such as nurse or physician staffed critical transports, wheel chair or ambulatory non -emergency transports, or a Demand Management System, either directly or through the contractor, or through other sub- contractors. (h) To purchase, lease, acquire, accept, own or hold real or personal property, to operate or maintain the same, to borrow or incur debt in its own name, to accept gifts, grants or bequests, to insure itself and its members for any liabilities which might be incurred through performance of this Agreement, to contract in its own name and to • sue or be sued in its own name. . 10. To fund the Authority's required operations, and to insure use of sound business controls and financial management practices in the Authority's day-to-day operations, the following financial requirements shall be met and maintained. (a) The Authority shall adopt sound business practices and accounting methods, appropriate to a governmental Enterprise Fund operation: (b), The Authority shall establish and maintain a prudent net worth, which shall mean an amount of money not less than $5,000,000, or 50% of the Authority's annual budget, whichever is greater. Net worth shall be defined as the fund equity of the Authority. Each member jurisdiction's pro -rata share of the Net Worth shall be calculated at least once every fiscal year. Each members' pro -rata share of the Net Worth shall be based upon the population of each member city as reporter by the United States Census Bureau, compared to the total population of all member jurisdictions, as reported by the United States Census Bureau. (c) The Authority shall operate on a fiscal year, which; shall begin on October 1 and end on September 30 of each year. (d) The Authority shall cause to be developed and implemented a long range financial management plan designed to ensure long-range financial stability. (e) Until such time as the Authority has established a prudent net worth, the Authority's Uniform Schedules of Price/Subsidy Options shall automatically be 6 804249.v2 (Interlocal Cooperative Agreement, cons....) adjusted in conformance with the Medical Consumer Price Index for the most recent twelve month period for which such data are then available, not to exceed a 12 percent increase in any single year. After that prudent net worth level has been achievedJ all future Uniform Schedules of Price/Subsidy Options shall be revised as necessary to maintain, but not exceed, a prudent net worth as defined herein, not to exceed a 12 percent increase in ambulance service fees,in any single year. (f) At such time as the Authority's prudent net worth level has been achieved, member jurisdictions may apply population -based discounts as may then be available as described in Exhibit D, "Memorandum of Understanding" hereof, in any of the following ways: (1) To reduce.rates or subsidies in that jurisdiction; or, To reduce the subscription program fee charged in that jurisdiction, or (3) A combination of (1), or (2) above. (g) The Authority shall make provision for an annual audit of the Authority by an independent certified public accounting foot. (h) Any decision by the Authority affecting the financial obligations, contingent or other, of a member jurisdiction shall be subject to prior approval by the affected member jurisdiction. 11. Subject to the provisions of Paragraph 2 above, this Jurisdiction may withdraw from membership in the Authority. Should this Jurisdiction withdraw as a member, for any reason except that Iisted below in, Subparagraph (c) of this Section, this Jurisdiction: i (a) Forfeits all rights, title, interest or claim to any asset, or combination of assets of the Net Worth of the Authority; (b) Commits itself to pay to the Authority any unamortized infrastructure costs attributable to this Jurisdiction or unpaid costs of first responder equipment financed by the Authority which are carried on the books of the Authority, and which were originallyjapproved by this Jurisdiction. (c) In the event any member jurisdiction experiences repeated and chronic failure of the Authority, or the Authority's Contractor, to comply with the response time standards iestablished for that member jurisdiction, and after written notice to the 7 804249.v2 (Interlocal Cooperative Agreement, cent. :..) Authority and reasonable opportunity to correct such deficiencies, that member jurisdiction may withdraw subject to the following terms: (1) The member jurisdiction must give written notice to the Authority that the member intends to invoke this section of this Agreement; (2) Upon a continued failure for the following three full months after receipt by the Authority of the written notice described in (c) (1) above the member jurisdiction may withdraw as a member, by giving written notice to the Authority, to be effective ten (10) days after receipt of such notice by the Authority. (3). Upon the effective date of the withdrawal, the Authority shall cease ambulance service to the former inernber jurisdiction and within one hundred eighty (180) days, the Authority shall remit in full to the former mcmher its per capita share of the Authority's Net Worth, as defined in Paragraph 10(b) above, as of the last fiscal year, less any unamortized capital costs and unpaid first responder equipment owed by the former member jurisdiction, as defined in Paragraph 11(b) above. 12. Until such time as the total population of all member jurisdictions of the Authority exceeds 880,000 persons, the membership of the Board of Directors shall be appointed in the following manner: (a) The Medical Director of the Emergency Physicians Advisory Board shall be a member of the Board of Directors, ex officio, but with full voting rights. (b) The City of Fort Worth shall appoint four (4) directors. (c) . Should the City of Arlington choose to join, Arlington may appoint two (2) members qualified to be directors. (d) All other member jurisdictions of the Authority combined shall be entitled to one (1) seat on the Board of Directors for each 110,000 persons residing within all other member jurisdictions combined, but no less than one (1) memberin any event. All members of the Board selected by jurisdictions other than Fort Worth and Arlington shall be chosen as follows: (1) Each member jurisdiction shall be entitled. to appoint one (1) member to a selection Committee. Voting on the Selection Committee shall be on a one vote per jurisdiction basis. 804249. v2 (Interlocal Cooperative Agreement, cant....) No later than July 21, 1999, the Selection Committee shall, for each sition for which an appointment shall be made, compile a list of not more n three (3) persons. Each list of nominees for each available position shall called the "Candidates List," and all nominees on each such Candidates (3) The Candidates' List shall be submitted no later than July 22, 1999 to the City Council of each member of the Authority, with the exception of Fort Worth (and Arlington). If Rural Fire Protection District Number One of Tarrant County is also a member of the Authority, the Candidates Lists shall also be presented to the Board of that District. (4) Each member jurisdiction shall cast all of its votes for one (1) of the eligible candidates on the Candidates' List. Each member jurisdiction shall be entitled to the number of votes which corresponds to the number of residents residing in that member jurisdiction, as announced by the most recent Unified States Census Bureau Statistics. The candidate for each available position receiving the most votes be certified as the winner of the election to that seat. The Selection rittee shall forward the certified results of the first election to the ng Board Members appointed by Fort Worth (and Arlington and Tarrant ty Fire District, if members). Those Board members shall receive and y the results causing the elected persons to become members of the 1. Thereafter, the Selection Committee shall forward the results of all ons of the Board to the other Board members of the Authority_ Those I members, shall receive and certify the results causing the elected ns to become members of the Board. 13. At such time as the total population of all member jurisdictions exceeds 880,000 -residents as reporter by the U.S. Census Bureau, the following methods shall apply to select members offthe Board: (a) The total population of all member jurisdiction shall be divided by eight (8), the number of appointed seats on the Board: (b) Fdrt Worth and Arlington may each appoint one (1) member for each 1/8th of the total population which the respective population of those two cities represents, provided such appointees meet the eligibility requirements for residency and type of expeirtise asset forth in Paragraph 12, above, and provided that no more than two members possessing the same expertise may sit on the Board simultaneously. There 9 004249.v2 (Interlocal Cooperative Agreement, cons....) shall be no representation for fractional population; that is, for a Board membership a full 1/8 of the total population is required. (c) All other member jurisdictions shall elect Board members in the manner described in Paragraph 12(c), above, except that instead of one _Board. member for each 110,000 population, the other member jurisdictions may appoint one Board member for each 1/8 of the then -current population of all member jurisdictions, and provided that no more than two members possessing the same expertise may sit on the Board simultaneously. 14. The Authority is expressly prohibited from furnishing service to any area which is not a member of the Authority, except for service pursuant to a mutual aid agreement approved by the Authority, or emergency coverage of non-member jurisdictions not to exceed sixty (60) days in duration. LIST OF EXHIBITS Exhibit A. Uniform EMS Ordinance Exhibit B. Uniform Schedule of Price/Subsidy Options for ALS First Responder Exhibit C. Uniform Schedule of Price/Subsidy Options forBLS First Responder Exhibit D Memorandum of Understanding (Population -based Discounts) APPROVAL Approved by the City Council of , Texas, this day of. 2_ Authorized Official Attest by: 10 B04249.v2 Emergency Medical 3Q Profit Rises I Uhron.com - Houston unromcle ragv Markets Nov. 2; 2006, 12:18PN Emergency Medical 3Q Profit Rises © 2006 The Associated Press GREENWOOD VILLAGE, Colo. — Emergency Medical Services Corp., parent company of AMR Inc., the nation's largest private ambulance service, said Thursday third-quarter net income rose sharply, helped in part by revenue from new contracts. Quarterly net earnings totaled $10.3 million, or 24 cents per share, compared to a profit of $3 million, or 11 cents per share during the same period last year. There were 42.5 million average diluted weighted shares outstanding during the quarter compared with 34.2 million shares during the same quarter last year. Revenue gained 7 percent.to $485.7 million, from $456.2 million during the same period last year. Analysts polled by Thomson Financial expected a profit of 22 cents per share on revenue of $489.3 million. Results were -helped by revenue increases from new contracts, higher net revenue per encounter, new business lines and positive results from risk mitigation programs and lower expenses. Emergency Medical said it expects a restructuring charge between $4 million and $5 million in the fourth quarter due to a consolidation initiative involving AMR. The company said it expects results better than the high end of previous guidance of earnings between 85 cents and 90 cents. Analysts are looking for a profit of 89 cents. Company shares dropped 67 cents, or 3.7 percent, to $17.23 during midday trading on the New York Stock Exchange. The stock has traded between $11 and $18.65 during the past 52 weeks. ADVERTISING: Contests I Fraudulent Ads I Information & Rates I Place An Ad I Singles In Houston I ' CHRONICLE: Subscribe Now I Subscriber Services I Buy Photos I Chronicle in Education I Corrections I Public Affa SERVICES: Copyright Notice & Privacy Policy I Help I Registration I Report a Problem I -Site Map I News Ale http://wwwchron.com/disp/stOry.mPl/aP/fflI43O595 1.html 11/2/2006 #06-679: 10-05-06 American Medical Response Pays $9 Million to Settle Civil Fraud Case Page 1 of 1 :43rVartMrUt of Jus#irr FOR IMMEDIATE RELEASE CIV THURSDAY, OCTOBER 5, 2006 (202) 514-2007 WWW.USDOJ.GOV TDD (202) 514-1888 American Medical Response Pays $9 Million to Settle Civil Fraud Case WASHINGTON — American Medical Response Inc. (AMR), one of the nation's largest ambulance providers, has paid the United States over $9 million to resolve allegations that the company violated the False Claims Act, the Justice Department announced today. The government alleged that the ambulance company provided illegal inducements to hospitals in Texas in exchange for referrals. The settlement relates to allegations that the Greenwood, Colo. -based company provided or offered inducements to Texas hospitals in the form of contracts known as "swapping arrangements." Such contracts gave the medical facilities discounts on transports in exchange for the referral of all or some of the ambulance transports of patients being discharged from the hospitals, which were billed to Medicare. "Illegal inducements corrupt the integrity of the Medicare program by freezing out competitors, masking the true costs of services, and misdirecting program funds, among other things," said Assistant Attorney General Peter D. Keislercf the Civil Division. "This settlement shows cur ongoing commitment to pursue allegations of fraud and abuse in the Medicare system vigorously." The settlement arose out of qui tam or whistleblower lawsuits filed in 2000 and 2001 by two former AMR employees, Daniel Block and Adam Wightman. Under the False Claims Act, private individuals or firms, known as relators, can file suit on behalf of the government and may share in the recovery: As a result of the settlement, the two men will receive $1,620,000. The investigation was conducted by the Civil Division of the Justice Department, the U.S. Attorney's • Office for the Southern District of Texas, the Office of Inspector General for the Department of Health and Human Services, and the Federal Bureau of Investigation. The cases are United States ex rel. Block v. Laidlaw Medical Transport, et al. (S.D. Tex.); and United States ex rel. Wightman v. Laidlaw, Inc., et al. (S.D. Tex.). • •tt II 06-679 http://www.usdoj .gov/opalpr/2006/October/06_civ_679.html 9/16/2007 The Orange Bulletin - News - 12/28/2007 - AMR response time scrutinized Page 1 of 1 /tT Y• F S i W+ d 1_ 1 !Ifrj i3V!.V/t �i Y Cove ing o atr>, 8etivi tyaw Woo Jll �ig9 12/28/2007 AMR response time scrutinized By: Marilyn Moss, Special to the Bulletin WOODBRIDGE - Concerns are being raised about ambulance response times in town. The ambulance response time, or the time it takes an ambulance to respond to an emergency call, can be critical in an emergency. A recent Woodbridge medical emergency at Woodbridge Country Club revealed that American Medical Response, the ambulance service provider for the town, took 23 minutes to arrive at the scene. Sean Rowland, the assistant fire chief who was at the scene, said, "People were upset that the ambulance took so long." Fire Chief Andrew Esposito, who also was at the scene, said, "People were asking where the fire department's ambulance was. We don't have an ambulance anymore." From 1998 to 2001, the town had its own ambulance service. Prior to 1998, the town had used AMR services, but, dissatisfied with AMR's response times, the town had established a local ambulance service in an attempt to improve response times. According to a statement in the Jan. 23, 2002 Bulletin by Roger Harrison, the former first selectman, response times by AMR prior to 1998 had historically been in the 15 -minute range. With the implementation of local services, the response time was reduced to 6 minutes. Despite the improvement in response times, town officials decided to end the local ambulance services in late 2001. Town officials had become concerned about the continued costs of supporting an ambulance service. Instead, the town contracted with AMR to resume providing coverage for the town. This past November, the town renewed its AMR contract for three more years. Joe Hellauer, the town administrator, expressed concern about the recent ambulance response time. "I'm still trying to find out what happened. It took too long," said Hellauer. Hellauer said that two physicians happened to be on the scene. Additionally, the paramedic, an employee of AMR, arrived within three minutes of the event. The paramedic does not have an ambulance and cannot transport the patient, however. "The patient had medical attention right from the get -go," said Hellauer. According to AMR cerporate spokesman, Doug Moore, the AMR ambulance cevering Woodbridge on Dec. 20 had been located in northeast New Haven when it received the cal!. Moore said that the time of the Wcodbridge call was a peak time for calls. AMR had planned to reposition the ambulance to central New Haven, placing it in a better location to respond more quickly to emergencies. The Woodbridge call, however, came in before that was accomplished. Moore also added that the call had been graded as a priority 2, which does not require lights or sirens. "Priority 2 is a non -life - threatening call," explained Moore. It is unclear why and when the call was rated as a priority 2, since Esposito reported that the patient lost consciousness more than once. ;n addition, Moore could not speculate on how the absencof lights or sirens may have affected the response time. To complicate matters, Esposito also pointed out that accessing the ambulance, once it had arrived, became an issue. Members of the..AMR team wanted to use the elevator, since the path from.entrance.to parking lot encompassed a long flight of stairs. The Woodbridge firefighters asserted that the elevator could not possibly fit all the necessary equipment and. personnel. Esposito said, "You couldn't use the elevator. It's too small." Despite the insistence of the AMR team, the Woodbridge firefighters carried the patient down the entrance stairs, according to Rowland. In order to provide adequate emergency services, Esposito said, "You need somebody who knows the local facilities and roads, and somebody who knows the people." Rowland said that the switch to AMR may have saved some money over all, but added, "What's a person's life really worth?" Harrison said, "Our response time was better with our own town ambulance. It's like an insurance policy. Hopefully you never need it, but when you do, it's there." ©The Orange Bulletin 2008 http://www.zwire.com/site/printerFriendly.cfm?brd=1661 &dept_id9538&newsid=19152... 2/27/2008 The Orange Bulletin - News - 02/15/2008 - EMS commission, AMR agree on new initiati... Page 1 of 3 02/15/2008 EMS commission, AMR agree on new initiatives By: Marilyn Moss , Special To The Bulletin WOODBRIDGE - Responding to concerns about emergency medical services in town, the Emergency Medical Services Commission enacted some new initiatives at a meeting on Feb. 4. These measures were adopted to provide commission members with the information needed to more effectively evaluate emergency coverage. Representatives of American Medical Response, the provider of emergency services for the town, attended the meeting, along with Ed Sheehy, the first selectman; Michael Luther, the Board of Finance liaison; Lt. Jeff Leiby, the liaison from the police department; and Joe Hellauer, the town administrator. Questions about the emergency medical coverage in town were prompted by a prolonged response time by an AMR ambulance on Dec 20. in that instance, the ambulance took more than 20 minutes to arrive on the scene of a medical emergency rated as priority one, the most serious. Additionally, a report in the Bulletin revealed that AMR failed to meet its contractual agreement for priority one ambulance response times for eight of the first II months in 2007. In view of these issues, Sheehy directed the EMS Commission to begin meeting monthly instead of quarterly to review statistics. Accordingly, the commission met in February to address emergency services. Alan Tyma, chairman of the EMS commission said, "It's a question of getting to a point where we can get satisfactory performance." The town has a contract for emergency medical services with AMR that calls for certain compliance standards. Tyma said, "We have a contract, and the contract calls for goals and standards." AMR provides a two -tiered emergency response. An AMR paramedic is stationed in town and is equipped to provide advanced life support in the field but cannot transport the patient. Transportation must be supplied by a separate AMR ambulance By contract, the paramedic must respond to all calls within nine minutes 90 percent of the time. According to performance reports, the paramedic response time is.met without fail. Dr. Alan Davidson, a commission member, said, "You (AMR) have hit the mark consistently." I - Sheehy also praised the paramedic, saying, "The important thing is to stabilize the patient. And you're doing a good job at it." Although the paramedic provides advanced life support in the field, the patient needs access to rapid transport to the hospital. AMR supplies the ambulance for this function. Unlike the paramedic who is stationed in town, the ambulance coverage is provided by one of a number of regionalized vehicles. The AMR ambulances provide simultaneous service to a number of towns in the region. The covering ambulances circulate around the region, attempting to take up positions that can provide the fastest service for all areas. Dan O'Brien, chief executive officer of Northeastern AMR, said, "It's a little more complicated working at it from a regional perspective. But that's what makes it affordable." Contract parameters for responding ambulances require that for emergency calls categorized as priority one, the most urgent, the ambulance must arrive on scene in 13 minutes 90 percent of the time. For priority two calls, which are less serious, the ambulance is required to be on scene in 16 minutes 80 percent of the time. Tyma said, "There were between 6 and 13 non -compliant responses of the transporting ambulance to priority one every month over the past few months. It hasn't been absolutely on target." Sheehy said, "The ambulance response times are important." One of the commission members, Dr. Gary Desir, asked if AMR could realistically achieve a 90 percent compliance rate for http://www.zwire.comlsite/priflterFriefldlY.CffflThrdl66 1 &dept_id=953 8&newsid=19301... 2/19/2008 The Orange Bulletin - News - 02/15/2008 - EMS commission, AMR agree on new initiati... Page 2 of 3 priority one ambulance response times. O'Brien responded, "Without isolated instances, yes." O'Brien added, "It's not an easy number to hit. We wanted to have a goal that was high enough to make everybody stay on their toes." Some of the commission members expressed concern that they were not provided with enough data to assess performance, particularly in regards to non -compliant response times. At present, the commission is given a compliance percentage for each category, ie category one or two. Individual calls are not addressed. Jeff Axl, a commissioner, said, "We don't have data to assess the variance in response. How much are we missing by?" Roy Ivins, another commissioner, requested that AMR report each non -compliant call monthly so that the commission could evaluate the data. Ivins said, "Are we missing it by two or three minutes, or more? That's what we need to know." Sheehy agreed, saying, "You (the commission) need those numbers. You are the relationship between AMR and us. You should question those numbers if you have any doubts about them." Axt also said that he was working on ways to manage AMR data so that it was more user-friendly. Axt hoped to be able to present the data in the future so that the commission could glean as much as possible from it. "Let's get to a true picture that gives us a "dashboard": a concise picture," said Axt. O'Brien said that AMR could supply the additional data. "We can tweak the reporting," said O'Brien The contract also spells out avenues open to the town to deal with non-compliance. Should AMR be found wanting, the town can begin to take steps to ensure better compliance by the ambulance company. This has not been done in the past, however. Tyma said, "The contract calls for ways for the town to act." Tyma suggested that perhaps the commission should begin imposing some of the repercussive actions. It quickly became a moot point when AMR produced its response figures for January 2008. Those numbers revealed that AMR ambulances responded to priority one calls within requirements 97 percent of the time. Another contract measure never invoked is the requirement that AMR submit written explanations for any response time longer than 20 minutes. This requirement accomplishes the purpose of evaluating what occurred to prolong the 2mbulancc so that appropriate measures can be taken, if needed. To address that deficiency, AMR submitted :wo letters to Joe Hetlauei, the town administrator, that addressed prolonged times. For two of the incidents, AMP. explained the prolonged time with "system overload, secondary tc volume". Sheehy was not satisfied with that verbiage. He asked, "Can you get more specific with these? These are kind of generic." Davidson said, "If we see too many overloads, something is wrong with the system ... you don't have enough ambulance coverage." AMR agreed to supply more detailed information in the future. AMR also took some initiatives on its own. To begin with, the company reviewed how the ambulances were positioned to be sure adequate coverage for the town was ensured. "We re-evaluated the system status plan to be sure the trucks (ambulances) were in the best place," said O'Brien. Additionally, AMR looked at those calls that did not meet requirements to see if there were extenuating circumstances that influenced response times. Under contract, AMR is allowed certain exceptions to its requirements, such as during bad weather. These situations could affect overall compliance rates. Chuck Babson, the manager of AMR, said, "We looked at all the non -complaint calls for 2007. There were exceptions we didn't account for that we could have by contract." According to Babson, just such a case happened in February 2007. The reporting figures for that month revealed that AMR was only at an 82 percent compliance rate for ambulance response times to priority one calls, having missed response times in 10 of 56 calls. Babson related to the commission that, in fact, five of those 10 calls would have met exclusion criteria, http://www.zwire.conVsite/printerFriendly.cfm?brd=1661 &dept_id=953 8&newsid=19301... 2/19/2008 The Orange Bulletin - News - 02/15/2008 - EMS commission, AMR agree on new initiati... Page 3 of 3 bringing the compliance rate up to over 90 percent, which is within the contractual agreement. When asked why AMR did not factor those exceptions in, O'Brien said, "It takes a little more digging, and our general sense was that the system was working." - - The commission seemed satisfied that, in the future, they would have a better handle on things. Tyma also noted that the overall trend of AMR's performance had shown a steady improvement. Tyma said, "We have a system that is looking at achieving goals." Leiby, who has been on the police force more than 20 years, remarked that things overall had changed dramatically for the better over the years. Leiby said, "The standard of care has improved greatly." Davidson said, "I am so pleased with the service you are giving the community." AMR seemed eager to cooperate. O'Brien said, "We want to provide you with a comfort level." The next meeting of the EMS commission is scheduled for March 10. ©The Orange Bulletin 2008 - http://www.zwire.comlsite/PriflterFriefldlY.Cfi11?brd=166 I &dept_id=95 3 8 &newsid=193 01... 2/19/2008 AMR contract renewed despite slow responses - Examiner.com Page 1of! Send to Printer << Back to Article j.examinercom Local AMR contract renewed despite slow responses Edward Carpenter, The Examiner 2006-10-11 09:00:00.0 Current rank: Not ranked REDWOOD CITY, Calif. - County approves two-year extension; firefighters object, citing substandard service REDWOOD CITY — Supervisors approved a two-year contract extension for the county's ambulance provider despite concerns that it failed to meet on -time performance standards in three of the last nine months. The slower response times by American Medical Response occurred earlier in the year and cost the company more than $122,000 in fines, according to emergency medical services administrator Barbara Pletz. Supervisors could have voted to cancel the contract based on the infraction, but instead decided to extend it, citing improved response times since March. County firefighters, however, who must wait at the scene when AMR is slow to respond, are speaking out against the renewal. Firefighters also ride to the hospital with patients, putting their fire rigs out of service, when dispatchers send an ambulance without a paramedic to an emergency, according to Ed Hawkins, a San Mateo fireman and president of the Local 2400 county firefighter's union. "What we see on the frontline is that the bottom line is more important to AMR than quality emergency care," Hawkins said. Hawkins cited a recent incident in which his rig responded to an emergency on Polhemus Road in San Mateo and it took 14 minutes for an ambulance to arrive, Hawkins said. Under its contract, AMR must arrive within a specified time according to zones — in this case six minutes and 59 seconds — 90 percent of the time or be fined, officials said. Representatives for AMR did not return calls for comments for this story. Despite failing to meet its 90 percent on -time arrival standard in December 2005 and February and March 2006 improvements have been made, Pletz said. "If they had net demonstrated improvement, then I dcn't think we have would have been extending the contract," she said. - Since March, AMR has raised ita performance to the 9G percent to 91 percent level, records show. "There have been performance problems and they have exceeded their times, bat that's why we have increased the finis for penormance" in the latest amended contract, said Jerry Hill, president of the Board of Supervisors; who along with the rest of the board voted to extend AMR's contract until June 2009. Beginning in January, fines for late ambulance response times will increase from $7.50 per minute and a maximum $350 to $35 a minute with a $750 maximum, according to the contract. Fines for sending an ambulance without a paramedic to an emergency will jump from $350 per occurrence to $2,500, the contract shows. "We're looking fora change in the system, we'll definitely be going out to bid at the end of this contract," said Adrian Anderson, vice-president of the county firefighters union. ecarpentei@examiner.com Examiner http://www.examiner.com/printa-337132—AMR_contract_renewed_despite_slow_respons... 2/27/2008 Untitled Page 1 of 2 This is a printer friendly version of an article from vmw.fosters.com To print this article open the file menu and choose Print. Back Article published Jul 27, 2007 AMR contingency plan to avert strike not disclosed SOMERSWORTH — •With the impending American Medical Response strike scheduled for Monday, AMR representatives are saying there is a contingency plan in place for emergency response. The plan, however, has not yet been disclosed and 13 communities served by AMR may be affected by the strike. AMR serves 13 communities in New Hampshire and Maine, including Somersworth, Hamptons Falls and North Hampton, and Berwick, Eliot and Kittery. . "We're confident in the contingency plan," said AMR spokesperson Doug Moore. 'We're confident we can continue to provide the service we have been providing." But Jim Gambone, labor relations for the National EMS Association, or NEMSA, said while AMR says they have a contingency plan, they "to this date have not revealed it to us." Somersworth Fire Chief Don Messier was unavailable for comment on the issue. As Berwick receives ambulance service from Somersworth for 911 calls, Berwick Fire Chief Dennis Plante said the contingency plan AMR has provided has been looked at by the department. "We've looked at that contingency plan and we're satisfied with their plan," Plante said. "We're confident they can provide the service they have been providing" if there is a strike. Gambone said the strike was initiated after AMR's "last and final bargaining offer at the bargaining table was a 1 percent reduction in pay and an increase in health insurance." NEMSA's former contract with AMR had step increases which Gambone said averaged about 3 percent. This year, AMR proposed all employees would receive those step increases until January 2008, at which time the reduction would take place. "A strike is imminent unless AMR makes some kind of change to their prior decision," Gambone said. AMR released a statement Tuesday that negotiations with NEMSA would open again this Sunday in hopes of staving off a strike. "AMR has been and remains committed to resolving the issues with NEMSA," the statement reads. "We are pleased that the Federal Mediator has been able to schedule a resumption of negotiations on Sunday, July 29th, consistent with provisions of the ground rules http://www. fosters. com/apps/pbcs.d l I/article?Date=20070727&Category=FOSTERS01 &A... 2/27/2008 Untitled Page 2 of 2 established by the parties. We are hopeful to reach an amicable resolution to the outstanding issues." Gambone said, however, that as negotiations are closed, Sunday's discussion will be a mediation, which will similarly make an attempt for both parties to reach an agreement prior to going to a strike. Gambone said NEMSA is supported "100 percent" by the International Association of Firefighters, who have stated on their website they will not cross picket lines. http://www. fosters. coin/apps/pbes. dl I/article?Date=20070727&Category=FOSTERSO 1&A... 2/27/2008 r rk1 -I l .. - • rr -i ,LTllt c- MA: American Medical Response laying off 35, closing By PITTSFIELD — American Medical Response, one of two emergency medical response companies in Pittsfield, will close its local operation as of Dec. 31. At a meeting on Tuesday, the company distributed layoff notices to its 35 full- and part-time employees. According to one employee, who wished to remain unnamed, the company was in the midst of contract negotiations with local union officials at the time. Even though the city of Pittsfield has two emergency response companies handling calls, the city has nevertheless had to seek emergency aid from neighboring towns when crews are spread too thin. But Pittsfield acting Fire Chief James Sullivan said the loss of AMR emergency response teams should not affect the city's ability to respond to emergencies, as the other company contracted by the city, County Ambulance, is working to add equipment and personnel. "I believe County is adding vehicles and personnel to meet the anticipated need," he said. According to David Pelletier, general manager of the Western Massachusetts division of AMR, the company has been working in the Pittsfield area for more than 10 years, with a dispatch garage on West Housatonic Street. By phone from his Springfield office, Pelletier attributed the closure to declining reimbursements from health insurance companies and Medicare and to the increased expense of doing business. He said the closing should not reflect poorly on local AMR employees. "We're very proud of the employees up there," he said. "They are hard workers and good people." He said the company will be meeting with union representatives soon to discuss severance details. "Declining reimbursements caused revenue declines. Expenses grew to exceed the income, which makes it hard to run a business unit," Pelletier said. The ambulances will be "redeployed throughout our company," he added. Another AMR employee, who also requested anonymity, said that many of the laid -off workers are applying for jobs at County Ambulance and have had favorable results. He declined to elaborate. Brian Andrews, president of County Ambulance Service, said his company is indeed moving to pick up the slack left when AMR leaves. AMR employees are being interviewed for "at least a dozen full-time openings and a few part-time slots," he said. "AMR closing makes us a bigger company over here," Andrews said. "We know there is going to be a void, so we've already started the process buying more vehicles and interviewing their employees." The family -owned County Ambulance, which has been working in Pittsfield since 1982, also has a new ambulance unit on the way and is in the process of purchasing others, although it is too early to determine exactly how many they will need. The decline in reimbursements from insurance companies and Medicare, Andrews said, has been an issue for the industry, but hasn't had as much of an effect on County because "we're a small company, and we don't have a lot of Print Version :. Page 1 bf 2 W • � p'T�ri/biT�nce-E�a(g�le �%o .l..Jl Y e it Y s ✓ o J X... Print Page Last modified: Saturday, July 7, 2007 12:40 AM MDT American Medical Response pledges to meet growing demand for services By Jodi Rogstad j rstad@wyomingnews.com CHEYENNE - The company that provides ambulances to all of Laramie County has pledged to catch up with the growing demand for its services. One week ago Mayor Jack Spiker put American Medical Response on notice. If ambulances continue to be tied up when people need them, Spiker said, the city will sever its contract with AMR, set to expire in 2008. Through May of this year, 53 people throughout the county who called for ambulances were told they would have to wait. lri 2006, there were 73 of what are known in the industry as Code 10 calls. Thursday, Spiker and Cheyenne Fire and Rescue Chief Guy Cameron got a response from AMR. Stephen Willoughby, Cheyenne's operations manager, said he also is troubled by the number of Code 10 calls. "None are really acceptable," he said Friday. "We try to eliminate them completely. "AMR has always been committed to resolving those and making sure they don't occur." He said they are working "very diligently" to resolve these issues. "My goal to stay in community," he added. Willoughby said in the letter that the company is monitoring the system every day and "will add additional resources as necessary." AMR had added a unit in February, he said. "While appearing to initially help, it is clear by May's report this was not enough additional coverage," Willoughby said. Last month - on 20 occasions - there were no ambulances available when someone needed one, though the city's fire squads have paramedics and the county's volunteer fire districts have EMTs. http://www. wyomingnews. com/articles/2007/07/07/local_news_updates/201oca1_07-07-07... 2/27/2008 .: Print Version :. Page 2 of 2 Spiker and Cameron both said AMR should have a chance to make things right. But the letter validates their concerns, Cameron said, adding that "we're going to watching that closely." "They now recognize they have a problem," Cameron said. "That means it's not just a problem in the city; that's a problem wherever you live. "I hope service improves for both city and county residents." Laramie County officials have said they will not get on board with the city's ultimatum. County Commissioner Jeff Ketcham and emergency management director Rob Cleveland both have said AMR is doing a good job. They said the rate of Code 10 calls in the county is infrequent. But Spiker said, "It's still worse in the county." The volunteer fire districts don't have trained paramedics, they have EMTs, he added. In the letter, Willoughby proposed adding a safety net for Cheyenne Fire and Rescue: AMR would give a fully stocked ambulance to the department. If the city needed to use it, then AMR would reimburse the city. Already, each city fire squad has a certified paramedic. The only thing these people can't do is give the patient a ride to the emergency room. The ambulance would facilitate this when AMR's paramedics were tied up. But Cameron seemed lukewarm to that idea. AMR is under contract to remedy Code 10, so its responsibility is to add staff and equipment, he said. "We had to be the driving force to remedy (the Code 10 calls)," Cameron said. http://www.wyominguews.com/artic les/2007/07/07/local_news_updates/20loca1_07-07-07... 2/27/2008 .: Print Version :. Page 1 of3 W`'ribe a -Eagle o .n e corn • g Last modified: Saturday, June 30, 20071:49 PM MDT EMT service tells patients to wait City threatens to sever ties with ambulance service following series of alarming' delays Printpage_ By Jodi Rogstad j rogstadnwyomingnews.com CHEYENNE - Through the end of May, 53 people who called for an ambulance were told they would have to wait. That's because the crews who work for American Medical Response, which services all of Laramie County, were tied up on other calls. This is one example of what Cheyenne Fire and Rescue Chief Guy Cameron says are "alarming trends." Not only is he unhappy with the delays, he's not happy with the number of times AMR is at capacity. This puts the public at risk, he said. It's not as if these people were out there bleeding to death. When an ambulance is called, Fire and Rescue crews, who are trained in first aid and life support, also are dispatched to the scene. Still, the patient must wait to be taken to the hospital and to see a doctor. Cheyenne Mayor Jack Spiker said these delays by AMR are just like having a power outage in a hospital emergency room with no backup system available. "There is absolutely no excuse fdr delayed service," he said. On Thursday, Spiker put AMR on notice. If the numbers don't improve, Spiker likely will seek a vote by the Cheyenne City Council to sever ties with AMR, based in Greenwood Village, Colo., and sign a contract with another company. The grounds for possible dismissal: Breach of contract. AMR has been asked to fix this problem since 2003, Cameron said. Its 2005-08 contract says they must remedy what are known as Code 10 calls. While Cheyenne Fire and Rescue does have a trained paramedic for every crew that goes out, Spiker said this is not a move to get the city into the ambulance business. It's about accountability. In May alone, AMR logged 20 Code 10 incidents. This is the highest rate in any month since January 2005, the start of the new city -county contract. http://www.wyoniingnews.coin/articles/2007/06/30/local_news_updates/20local_06-30-07... 2/27/2008 Print Version:. Page 2 of 3 "What it tells me, when you have a Code 10, you've run out of ambulances," Cameron said. "Those numbers in May mean there wasn't an ambulance available 20 times for a medical emergency." The AMR paramedics working in Cheyenne are "good folks working hard every day," Cameron said. Management is the problem here, he said, "and possibly corporate." Cynthia Wentworth, AMR's director of communications and government relations, said the company has added paramedics to Cheyenne's fleet this year. There currently are two full-time crews working 24 hours a day, seven days a week. There also are two on -call crews. On Monday, they will add another on -call crew in Cheyenne, which had been in the works since April; Wentworth said. From there, they will continue to evaluate the statistics and adjust schedules as needed to fill what are typically the busiest times. "When you look at these (delays), it's never more than 2 percent of the calls." Wentworth said. "Smaller than 1 percent is optimal. "Obviously, you don't want anyone waiting. That's why AMR is taking these steps." So what caused the spike of delays in May, even though the call volume didn't spike along with it? Wentworth said it was a timing issue. The paramedics were jammed with calls coming in at the same time. Other months, they were spaced out. "Maybe it's acceptable for AMR, but not if your family member is waiting on an ambulance," Cameron said. "It's not acceptable for me as a fire chief looking out for their performance on that contract." Laramie County also has a contract with AMR. Spiker had sent copies of the notice to county officials; but they said Friday that they are happy with AMR's service. At the county level in the last two years, there were 10 delays in one and 12 the next, said Laramie County Emergency Management Agency Director Rob Cleveland. "It's not an alarming number for the county at all," Cleveland said. Laramie County Commissioner Jeff Ketcham said he has received "no calls or complaints" about AMR's service. AMR has been Cheyenne and Laramie County's ambulance provider since 1998. In 2002, then -Cheyenne fire chief Scott Alvord wanted to do a study to analyze the benefits of having a city -owned ambulance service. But Spiker said Friday they had backed off that idea because of the amount of "pushback from the county." http://www.wyomingnews.com/articles/2007/06/30/local_news_updates/20local_06-30-07... 2/27/2008 .: Print Version :. Page 3 of 3 "We were willing to go into the county," Spiker said. "We felt we could go into the county quicker. because of the number of stations." What the city did instead was train of number of firefighters to become full-fledged paramedics. There's now enough so there's one on every crew. "I think that was really the right thing to do," Spiker said. When the contract with AMR was renewed in late 2004, Alvord included some penalty clauses. This meant that for every Code 10 and late response time, AMR would be fined, $500 for each Code 10 and $40 for every minute they were late. The city would assess and collect 72 percent, with the balance to the county. Even though AMR was logging delays, they were not fined by the city or county. That is, not until the city began fining in September 2006 under interim Fire Chief Jeff Fox. This may be a "black eye" on Alvord, Spiker said. "But the bright side of this coin is that he put together this performance contract," he said. The county still hasn't enforced the penalties on AMR. Between January and May, AMR went to 430 county calls; there.were 14 Code l Os. "My thought on it is the amount of Code l Os does not justify that penalty clause," Cleveland said. Ketcham said he agrees with Cleveland. "Unless (the Code l Os) were excessive, we wouldn't impose any fines," Ketcham said. "They're within our standards." Cleveland is the "eyes and ears" on this service, Ketcham said. "lie hasn't brought anything to me." And the county's volunteer fire districts have emergency medical technicians on their fleets. They aren't as highly trained as the city's paramedics, but the EMTs can provide basic life support, Cleveland said. Dan Bond is the fire chief of Laramie County Fire District 8, which starts roughly at Gilchrist .- Elementary and extends to the western -most county border. He said that "99 percent of the time," his crews arrive before the paramedics. "But since we're all volunteers, especially during business hours, sometimes we're delayed," Bond said. But he had good things to say about AMR. He had only been faced with a Code 10 once, but no one ended up heeding a ride to the hospital. http://www. wyoniiugnews.coin/articles/2007/06/30/local_news_updates/20local_O6-30-07... 2/27/2008 Money: Ambulance service to lay off 120 in OC.- OCRegister.com Page 1 of! REGISTER ocrepkter com Saturday, February 10, 2007 Ambulance service to lay off 120 in OC American Medical Response will close its Garden Grove office. BY COURTNEY PERKES The Orange County Register A Colorado -based ambulance company will lay off 120 Orange County paramedics, nurses and dispatchers effective April 1, a result of losing key contracts in Southern California. Employees at American Medical Response learned last week that they will lose their jobs, The company's ambulances will no longer provide non -emergency transports in I-os Angeles and Orange counties, company spokesman Jason SorricI said Friday. American Medical Response will continue to respond to 911 calls in Los Angeles. It does not provide emergency transport in Orange ,.�Lrrrcrsm1 County and will no longer transport patients for Kaiser Permanente . The lays offs come after the company lost contracts with Los Angeles County last year. About 417 employees there will lose their jobs. "in all likelihood, many of these employees are going to be picked up in other openings in the company," Sorrick said. In LA, you have about 28 different ambulance companies. There's a huge volume of other providers that will be able to pick up some of this volume after April 1." The company operates locally out of Garden Grove and Cerritos and the offices will be closed, Soriick said. He said employees will receive severance packages and assistance finding other jobs. American Medical Response is the nation's largest private ambulance provider, employing more than 17,000 paramedics, emergency medical technicians and support staff. Started in 1992, it acquired regional companies that had been providing service in Southern California since 1928. Contact the writer: 714-795-3686 or eperkes@ocregister.com' A bright idea in online advertising, PrinterStitiale Ads by Format Dynamics. Formatoynamics Print Powered By Format©ynamics- http://www.ocregister.com/ocregister/money/article_1575616.php 2/27/2008 AMR will pull out at noon Tuesday Page 1 of 2 AMR will pull out at noon Tuesday By Amanda Miller Item Staff Writer PICAYUNE— American Medical Response ambulance service will stop providing service to Pearl River County at noon on Tuesday, according to AMR Jackson Public Relations spokesperson Jim Pollard. AMR has been providing temporary ambulance service to Pearl River County since Emergystat ambulance service pulled out of its contract with the county in January due to the loss of its liability insurance. Pollard said in a phone interview on Monday that AMR provided Pearl River County officials with a letter on Friday, informing them of the company's intent to withdraw from providing service to the county unless a deal could be negotiated for a temporary contract for service. "We gave them with approximately four and a half days lead time to make the transfer over to a new provider. We provided what we hoped would be sufficient time to allow the new contractor to take the reins," Pollard said. Ricky Fayard, AMR Public Relations spokesperson out of Biloxi, said Monday the original agreement with Pearl River County was to provide services for two weeks while the board tried to choose a permanent provider. "We extended that original agreement until the board could make its decision. Once we had the decision on Friday, we sent our exit plan to the county," Fayard said. Wade Spruill, Chief Executive Officer for AAA Ambulance, said in a phone interview Monday that AAA will be able to service the county once AMR pulls out on Tuesday. "We called AMR on Friday to discuss a transition plan, and were told at that time they would be leaving on Tuesday," Spruill said. Spruill said the full complement of five ambulances promised to the county will not be available on Tuesday, but AAA will be providing a paramedic sprint car and three or four ambulances until other arrangements can be made. "AAA's fleet is huge, with access to Rescue and plenty of adequate backup. We will be starting out in the county with three, possibly four ambulances, so we will be ready to go when needed," Spruill said. Spruill compared AMR's decision to pull out of the county with Emergy scat's removal earlier this year. "Unfortunately AMR has made its decision and we liken that decision to the situation with Emergystat. We tried to appeal to them in the public interest to wait until we could work out a transition period, but they went ahead and pulled out... Our original proposal to the county said we would be able to move into the county 30 days after the contract was signed with a paramedic sprint car and five ambulances. However, with AMR's decision to pull out, we should be there at noon on Tuesday," Spruill said. Emergency Management Director Danny Manley said that AMR had offered to stay if the county could arrange for a subsidy for the remaining time needed. However, with AAA willing to go ahead and come into the county, that arrangement will not be needed. District I Supervisor Anthony Hales said he is grateful to AMR for stepping in, but that the county had not promised AMR a contract just because of the temporary service they were providing. "The county appreciates what AMR has done. They came in and were working without a contract, and were not receiving any money from the county for that. But we made it plain that our awarding them temporary service in no way guaranteed a permanent contract for service to the county," Hales said. District IV Supervisor Patrick Lee said he understood AMR's decision to go ahead and withdraw from the county. "It has cost AMR lots of money to be here temporarily. They don't want this dragged out, and I understand that. But AAA is stepping up to the plate, and the county won't be without service," Lee said in a phone interview Monday. http://www.picayuneitem.com/local/local_story_057123628.htmi/resources_printstory 2/27/2008 AMR will pull out at noon Tuesday Page 2 of 2 County attorney Joe Montgomery said he is in the process of drafting a contract for the service, but may not be able to have the contract ready by the time AAA takes over tomorrow. . "I'm working with the AAA attorney in order to get the contract together, but they can operate in the county without it until we get it sorted out and signed... I'm also working on an inter -local agreement for the county and the•cities of Picayune and Poplarville. The county is ready to sign the contract now, just as soon as we get the paperwork ready," Montgomery said. The reason the contract was not drawn up before the board meeting on Friday, Montgomery said, was because he needed to be certain of which provider the county was going to choose. "We needed to wait until a decision was made because the proposals were so different. Once the decision was made, we were able to start drafting a contract," Montgomery said. Copyright © 1999-2006 cnhi, inc. http://www.picayuneitem.com/local/local_story_057123628.html/resources printstory 2/27/2008 County to Award Ambulance Pacts After 2 Years of Lobbying By Jack Leonard, Times Staff Writer March 14, 2006 Two years ago, as Los Angeles County's emergency transportation contracts were set to expire, ambulance companies girded to compete for the exclusive right to deliver the county's sickest and most seriously injured patients to hospitals. They hired lobbyists. They donated thousands of dollars to politicians. And they sought support from officials in dozens of small cities throughout the county. What was supposed to be a six- month process dragged on as the county's Department of Health Services tried to develop objective criteria for recommending who should get the lucrative contracts, which last for 10 years. Now, with the five -member Board of Supervisors scheduled to consider today who should get those contracts, several ambulance companies are in the final stage of a ferocious behind -the - scenes campaign to secure the needed majority of votes: Lobbying for county business is hardly unique to this set of contracts. Supervisors' campaign treasuries are filled with donations from developers, contractors and others seeking to benefit from county regulation or grants. Lobbyists do a rich business helping clients gain access to press their cases with influential bureaucrats and supervisors. But the companies that win the ambulance contacts will be responsible for providing a singularly vital service, one of the most important that the supervisors oversee, and the companies' performance will touch the lives of thousands of residents in the nation's most populous county. Every year, county -authorized ambulances rush about 150,000 people to local hospitals, their response time often determining who lives and who dies. For some healthcare experts, the attempt to influence the ambulance contracts underscores how business frequently is done at the county level, where even issues that involve critical medical decisions become political. 'We're not talking about widgets here. We're not talking office contracts. We're talking about life - and daath situations," said Jim Lott, executive vice president of the Hospitai Assn. of Southern California, which represents hundreds of hospitals that will treat patients delivered by the winning bidders. Two dozen cities in the county, including Los Angeles and Long Beach, operate their own ambulance services or hire private companies to do the job. The rest — including unincorporated areas and 62 cities that stretch from Cerritos to Lancaster — look to the county to decide who will provide emergency medical transportation in their areas. The territory is so vast that the county divides it into seven zones and awards exclusive contracts for each. American Medical Response currently has the rights to operate in the vast majority of county - controlled areas, with two other companies holding contracts for relatively small territories. Bidder David Mintz, a national vice president at American Medical Response, contends that one reason the process has become politicized is that health officials failed to properly evaluate the firms. "Ultimately and theoretically, it should not be a political decision. The reality is that you know that is how decisions are made," Mintz said, 'We're just going to continue to work the board offices, give them facts as we know it, encourage them to find out for themselves, encourage them to talk to their communities and make a decision." The private ambulances respond to 911 calls with two employees trained to provide basic lifesaving services if they arrive before fire department paramedics, who are trained to give more advanced care. Once patients are stabilized, private ambulances drive them to the nearest available hospital. Ambulance companies make money by billing patients or their health insurance providers. The firms are not required to disclose how much profit they expect, but county officials said they believe the deals are highly profitable. It is not uncommon for companies to charge $700 or more to treat and transport the seriously ill. "It's lucrative," said Carol Meyer, who oversees the evaluation of bids as the county's director of emergency medical services. Offsetting some profits is a county requirement that ambulance firms pick up the tab for patients who cannot pay. As the Health Services Department began soliciting bids on new contracts in May 2004, officials recruited five experts on emergency medical services to evaluate the proposals. Together, Meyer said, the panel brought to the task more than 125 years of experience. Nine companies submitted bids. But the inches -thick glossy binders that arrived at the Health Services Department contained more than just dry statistics on such criteria as ambulance maintenance, response times, cost to patients and employee training. The bids were evaluated to determine such things as which companies offered the fastest response times and greatest financial stability. Other, less quantifiable, factors also entered into the equation. In many communities, ambulance companies cement ties with a good bedside manner, donating vehicles, appearing at local events and in some cases teaching schoolchildren. about medical safety. The bids included dozens of letters signed by local officials endorsing one company or another. "As city manager," wrote Ken Pulskamp in Santa Clarita, "I ... feel it would be a great loss to us and the surrounding communities if AMR [American Modica; Response] was not permitted to continue to provide emergency services.' American Medical Response, determined to get its message to the supervisors, hired two lobbying firms, for which it paid $120,000 a year. Anaheim -based Care Ambulance Service Inc., meanwhile. had hired its own lobbyist at the, end of 2003 and added a second a year later. "We run an ambulance company, and we know ambulances, but when it gets to the political process, we have a consultant," said Rick Richardson, who runs the company with his brother Dan. By the end of 2004, three more firms had armed themselves with lobbyists. In all, county records show, the companies have spent $491,000 on lobbying for the contracts in the last two years. Those same firms also dug deep into their pockets to help each of the five Los Angeles County supervisors, donating more than $45,000 combined to their campaign and officeholder committees in the last two years. When asked about the donations, supervisors said they would not allow such support to influence their decisions on awarding contracts. Yvonne Brathwaite Burke, who received $18,000 from ambulance firms, noted that the contributions came from five ambulance providers. "I don't think that most of us look at who has given more or less when we evaluate a contract," she said, adding that she saw no reason to turn down donations from companies with business before the county. "If [contractors] feel that ... they want to have some influence as to who represents them, that's a determination that that contractor can make." In September 2004, the Health Services Department announced its recommended choices: four of the nine companies. The news set off a flurry of protests from the other ambulance firms. Lobbyists wrote to the supervisors. So did local elected officials. American Medical Response was particularly active. Under the staff recommendations, it was both a winner and a loser — it secured the recommendation for more of the contracts than any other company but also, because it had controlled more of the area initially, would lose more business than any other. The California Contract Cities Assn., which represents more than 50 cities in Los Angeles County, weighed in. The association urged supervisors to pick American Medical Response for all seven zones, not just the four that experts recommended. Competitors and their lobbyists — including Schaefer Ambulance Service and Westmed/McCormick Ambulance Service — urged supervisors to rely on the bidding process rather than on local politicians. Some protests focused on how the county had evaluated the bids. American Medical Response argued that the examination of response times — how fast ambulances arrive at a patient's side — was flawed. An appeals board made up of county administrators agreed and recommended that the Health Services Department make changes. The department accepted some changes but rejected others. Its final recommendations to supervisors left American Medical Response with three zones, Westmed/McCormick with two and Schaefer and Care with one apiece. In the last two weeks, the firms have stepped up the pressure on the county. Today's discussion by the supervisors marks the latest milestone in that debate. And as it has approached, lobbyists have taken to wandering the eighth floor of the ccunty's Hall of Administration in downtown Los Angeles, buttonholing supervisors' aides to make their arguments. It is, one aide offered, a case of "drive -by lobbying.' . -- ' Gazette, The (Colorado Springs): Ambulance operations in county under fire Page 2 of 4 Top publications by title • Chicago Sun -Times • Milwaukee Journal Sentinel, The • Gazette, The (Colorado Springs • Sporting News The • Swimming World and Junior Swimmer view more titles n Save a copy of this page Print this page Ambulance operations in county under fire Gazette, The (Colorado Springs), Aug 7, 2005 by ED SEALOVER THE GAZETTE Thirty-two times in the first half of this year, the private company responsible for ambulance service in El Paso County has not had an ambulance available to answer 911 calls. . No one knows if anyone has suffered as a result of American Medical Response hitting "level zero," a term that means AMR has no ambulance to send. The contract with AMR specifies that each time it hits level zero, it will be fined $1,000. But the Emergency Services Agency, the intergovernmental board that oversees the deal, has yet to ask AMR for a cent. The reason: It interprets the requirement to have a spare ambulance more loosely -- so loosely it likely will never fine the company, an El Paso County official said. Pages you've viewed City and county leaders say they don't know of any Instances when • Results for <search> dropping to level zero has caused problems for 911 callers. Mark • Results for <news> Bruning, the local vice president of operations for AMR, said he also does not know of specific times in which prospective patients were denied service. » Link to this page Pages others have viewed • Belmont Club: August 2004 Love the big leagues? Visit LookSmart Baseball Paul Lastrella, the county's emergency medical services compliance administrator, acknowledged he doesn't track that information. Continue artide ADVERTISEMENT Some Colorado Springs and county elected officials have taken to criticizing AMR .,nd the detract structure., most recently at an ESP, board meeting last week. The contract is up at the end of 2006, and they say it must be changed or a new provider must be found. "This sounds to me like we're no longer holding our vendor accountable for the equipment our vendor has on the street," Colorado Springs City Councilwoman Margaret Radford said. "So why the heck do we have the contract?" The deal gives AMR responsibility for transporting people from emergency scenes to hospitals, though fire departments that respond first can begin on -site victim care. It requires the company to respond within a period that ranges from eight minutes in central Colorado Springs to 45 minutes in the southeastern part of the county. ESA board members fine AMR each time it takes more than 150 percent of its allowed time to respond to calls. Those penalties totaled $12,593 in 2004 and $6,518 in the first six months of 2005. Lastrella has not fined AMR for times when its ambulances have been unavailable, however. He interprets "level zero" to -mean a time when not just AMR but all the agencies with which it has mutual aid agreements -- including Colorado Springs, Fountain, Calhan and other fire departments -- are without vehicles. 3/20/2006 Gazette, The (Colorado Springs): Ambulance operations in county under fire Page 3 of 4 Asked how often that happens, he replied: "We'll never get there. We'll be in bad shape if we ever hit that point." Radford and El Paso County Commissioner Sallie Clark said that was not what they thought the rule meant when they served together on the City Council in 2002. Bruning, however, said the definition of level zero wasclarified in 2004 to mean a systemwide lack of vehicles. When AMR alone is without an available ambulance, that's called "deferred response," he said. No matter what term is used, the number of times when there's no AMR ambulance available is up this year. While AMR had 24 such situations in 2003 and 18 in 2004, it is on pace to have 64 in 2005. Bruning blamed the increase on a busy summer. If calls continue at the current rate, they will exceed last year's total 43,970 -- by 2.2 percent. Bruning and Lastrella also said they know of no reports of people whose medical care has suffered because a fire department has had to cover for AMR. The mutual -aid squads get to the scene quickly, Bruning said. Still, AMR has hired more people and is looking to add more ambulance crews, Bruning said. It also is evaluating whether to reduce responses to -lower -priority calls or hold some of its vehicles back for major emergencies, he said. Clark and Radford said, though, that they hope to persuade ESA board members to make changes to the AMR contract if it is extended. A decision whether to put the contract out to bia won't be made until the end of this year. The changes could include more -enforceable fines and a repeal of the provision that forbids elected officials from serving on the ESA board, they said. Clark said the board also should tighten the standard response times, which allow AMR 20 minutes to respond to calls in some parts of the city, such as Broadmoor Bluffs. Clark said she also wants to increase the number of available ambulances, As it stands, AMR must have at least six in service, but four at a time may be used for nonemergency private duties such as transporting elderly patients home from the hospital. "Perhaps the problems are not necessarily with AMR," the commission vice chairwoman said. "The problems are with the contract itself." The city is conducting a survey on whether changes are needed, including the possibility that the Colotado Springs Fire Department provide transport within the city limits. Any changes, however, will encounter an increasing skepticism rural fire departments seem to have toward the city. The Pikes Peak Chiefs' Forum has urged an independent survey, rather than relying on results from Colorado Springs. 3/20/2006 Gazette, The (Colorado Springs): Ambulance operations in county under fire Page 4 of 4 Pam Baysinger, an ESA board member and chief of the Calhan Fire Protection District, questioned why "none of this has been brought to light until Springs has an interest in transport." She has asked to spearhead any study the ESA board conducts. The Colorado Springs City Council is expected to discuss the results of its survey and its plans for emergency transport more next month. CONTACT THE WRITER: 636-0184 or sealover@gazette.ccm BY THE NUMBERS American Medical Response, the company that provides emergency transport In El Paso County, sometimes has no vehicles available to answer 911 calls. A look at how many times it has hit this state of deferred response, which is sometimes called "level zero," in recent years: 2002 -- 71 2003 -- 24 2004 -- 18 2005 -- 32 (through June 30) SOURCE: El Paso County emergency services agency administrator's office Copyright 2005 Provided by ProQuest Information and Learning Company. Al; rights Reserved. � IN Olympic Sports Copyright G 2G06 LookSmai t, Ltd. - ALou: Uc - Privacy Policy - Terms of Service Advertise with Us - saefljkfl Look5mart Sports: Adventure Sports Auto Racing -Baseball Basketball College Sports • College Women 59orts> - Cycling Food Gymnastics Hockey - Horse Racing - Ice Skating • Lacrosse - Olympic Sports Soccer - Tennis - Wrestling LookSmart Solutions: Auto - Cities - Education • FlndArticlesTM - Food - Furl.net Health • Home Living - Money - Music - Recreation Tech & Games • Travel 3/20/2006 Emergency Medical Services Announces AMR Managed Transportation Agreement with ... Page 1 of 2 Powered by . Business Wire Search Results for Google Sharing El Diog f., 8 .rry M. acd Hrvo C"tK".U,m del.icio.us LI Newsvine February 25, 2008 12:00 PM Eastern Time . . c Reddit IQ Google Emergency Medical Services Announces AMR nYahoo Managed Transportation Agreement with Golden Living Permalink GREENWOOD VILLAGE, Colo. —(BUSINESS WIRE) —Emergency Medical Services Corporation (NYSE: EMS) (the "Company") today announced that its American Medical Response, Inc. (AMR) subsidiary has entered into an agreement as a national managed transportation provider for non - emergency medical transportation services and non -emergency medical transportation management services with Golden Living. Golden Living is a leading provider of short-term post -acute and long-term care. Under the agreement, AMR initially will implement a pilot program in each of the four Golden Living divisions. When fully implemented, AMR will provide services to 350 Golden Living nursing homes and assisted -living facilities in 22 states. The relationship is expected to generate approximately $9.0 million in new annual net revenue and a positive margin consistent with the Company's other non -emergency transportation services. EMSC Chairman and CEO William A. Sanger said: "We're very pleased with the expansion of our relationship with Golden Living. This agreement is another example of the Company implementing its strategy to level age organic growth opportunities using the significant scale and scone of both our technology, including AMR's proprietary Access2Care managed transportation software, and our record of quality service. Access2Care's powerful rules -based software helps assure that AMR provides Golden Living residents the right level of care and transportation, at the right time, for each resident." According to Ramon Rodriguez, Golden Living Senior Vice President: "Our approach to healthcare draws on our decades of experience ... emphasizing teamwork and personal involvement to ensure the highest level of care for our residents. Our new ability to manage the transportation to and from our facilities lends a whole new definition to the continuum of care —we feel fortunate to work in a business that's all about making a difference in other people's lives." About Emergency Medical Services Corporation Emergency Medical Services Corporation (EMSC) (www.emsc.net) is a leading provider of emergency medical services in the United States. EMSC operates two business segments: American Medical Response, Inc. (AMR), the Company's healthcare transportation services segment, and EmCare Holdings, Inc. (EmCare), the Company's emergency department and http://www.businesswire.com/portal/site/google/?ndm V iewld=news_view&newsld=20080... 2/25/2008 Emergency Medical Services Announces AMR Managed Transportation Agreement with ... Page 2 of 2 g Print hospital -based management services segment. AMR is the leading provider of ambulance services in the United States. EmCare is the nation's leading provider of outsourced emergency department staffing and related. management services. In 2007, EMSC provided services to 10 million patients in more than 2,000 communities nationwide. EMSC is headquartered in Greenwood Village, Colorado. About American Medical Response American Medical Response Inc. (www.amr.net), America's leading provider of medical transportation, is locally operated in 37 states and the District of Columbia. AMR's 18,500 paramedics, EMTs and other professionals transport more than four million patients nationwide each year in critical, emergency and non -emergency situations. Operating a fleet of approximately 4,500 vehicles, AMR, a subsidiary of Emergency Medical Services Corporation, is headquartered in Greenwood Village, Colorado. Forward -Looking Statements Certain statements and information herein may be deemed to be "forward - looking statements" within the meaning of the Federal Private Securities Litigation Reform Act of 1995. Forward -looking statements may include, but are not limited to, statements relating to our objectives, plans and strategies, and all statements (other than statements of historical facts) that address activities, events or developments that we intend, expect, project, believe or anticipate will or may occur in the future. Any forward -looking statements herein are made as of the date of this press release, and EMSC undertakes no duty to update or revise any such statements. Forward -looking statements are not guarantees of future performance and are subject to risks and uncertainties. Important factors that could cause actual results, developments and business decisions to differ materially from forward - looking statements are described in EMSC's f:!ings with the SEC from time to time, including in the section entitled "Risk Factors" in the Company's most recent Form 10-K. Among the factors that could cause future results to differ materially from those provided in this press release are: the impact on our revenue of changes in transport volume, mix of insured and uninsured patients, and third party reimbursement rates; potential penalties or changes to our operations if we fail to comply with extensive and complex government regulation of our industry; and the loss of existing contracts and the accuracy of our assessment of costs under new contracts. Contacts Emergency Medical Services Corporation Deborah Hileman, 303-495-1210 deborah. hileman(aemsc.net Busieesswir,e Terms of Use 1 ©2008 Business Wire http://www.businesswire.com/portal/site/google/?ndmV iewId=news_view&newsId=20080... 2/25/2008 Ethical Question Raised in Spokane/AMR Relationship Page 1 of 3 JEMS.com News • PRINT PAGE • EMAIL PAGE Ethical Question Raised in Spokane/AMR Relationship Bill Morlin, Staff writer Spokesman Review (Spokane, WA) 2007 Sept 14 The son of Spokane Mayor Dennis Hession has been hired by American Medical Response, the ambulance company that is a defendant in a pending class-action lawsuit for allegedly overbilling more than 20,000 city residents in the last decade. Patrick Hession is working as a paramedic in Spokane, where AMR has an exclusive contract to provide ambulance service within the city, AMR regional manager Art McKiernan confirmed Tuesday. City Councilwoman Mary Verner, challenging Hession in November's election, and unsuccessful primary mayoral candidate Al French, both said Tuesday the issue should be examined by the city's Ethics Commission. "It doesn't feel good, and it doesn't smell good," French said when asked about the propriety of the mayor's son going to work for one of the city's largest private contractors. The mayor did not return telephone calls seeking comment. Marlene Feist, his public affairs aide, called The Spokesman -Review on Tuesday to ask the nature of the questions. Later, Hession's campaign. chairman, Steve McNutt, called the newspaper and said the mayor didn't know about- his son's new job until after he was hired by AMR. McNutt said Hession didn't want to answer questions because "it is a campaign issue, not a city administration issue." "We were out jogging about a month ago and Dennis told me Pat got a position with AMR," McNutt said. "He shook his head worrying about the political consequences." "I think this is a political low -blow," McNutt said. At AMR, McKiernan would not say who within the company - the nation's largest ambulance service provider - made the hiring decision. "I wasn't involved in hiring him," said McKiernan, who moved to Spokane in January from Montana where he also worked with AMR. Patrick Hessian was hired "fairly recently," but McKiernan couldn't provide a hire date. "To be honest with you ..I found out after we'd actually hired him that he was the mayor's son," the AMR executive said. "I don't believe there was knowledge beforehand that there http://www.j ems.com/news_and_articles/news/Ethical_Question_Raised_in_Spokane_AM... 2/27/2008 Ethical Question Raised in Spokane/AMR Relationship Page 2 of 3 was this relationship." Asked if there was an appearance of conflict for the company to hire the mayor's son, McKiernan said, "I wouldn't think so." "He's not in a management position," McKiernan said. "He's in the field,working as a paramedic, you know, taking people to the hospital and taking care of the sick. "I think it would have been unfair to not hire a qualified person just because of the position and the job his father holds," the AMR executive said. The mayor's son, who is 25, had been pursuing a master's degree in clinical anatomy at Creighton University in Nebraska. He couldn't be reached for comment Tuesday. The AMR contract with the city of Spokane will expire in October 2008. By that time, it's possible that outlying fire districts, including Spokane Valley, may join the city as part of a countywide contract with a single ambulance provider. Under the city's ethics policy, Hession would have to recuse himself from any involvement with the new contract if it goes to AMR. Hession, appointed mayor in December 2005, faces Verner in November's election. She and French were part of a City Council subcommittee that spent several months investigating claims that AMR had overbilled city residents under its monopoly contract granted by the city. The inquiry ended when AMR officials admitted overbilling city residents $320,689 between January 2003 and March 2006. As the city's chief executive, Hessian alone determined the fine AMR had to pay in that case. He could have fined AMR hundreds of thousands of dollars under terms of its contract with the city, but Hession settled on a fine of $80,172 in June 2006. "This fine is significant enough tc express our serious concern about the multiple billing errors that occurred and sufficiently measured to acknowledge the professional manner in which AMR responded to this issue," the mayor said the day he announced the fine. Shortly before AMR admitted the overbilling, a Superior Court lawsuit was filed and later certified as a class-action against AMR by city residents who allege they'd been cheated: That case is scheduled to go to trial Nov. 5. AMR's decision to hire the mayor's son surprised Verner. "You caught me off guard with that one," Verner said when reached for comment. "It's quite a shocker, quite interesting." She said the mayor last year gave the ambulance company "a light rap on the fingers when it was found that AMR was, in fact, overbilling our customers at their most vulnerable moments when they have to call an ambulance." Now with Hession's son working for AMR, Verner said, "I certainly don't like the sound of it." "This sounds like something the ethics commission should investigate," she said. George Iranon, vice chairman of the city's new ethics commission, said it would be http://www.jems.com/news and articles/news/Ethical Questioi Raisedin Spokane_AM... 2/27/2008 Ethical Question Raised in Spokane/AMR Relationship . Page 3 of 3 inappropriate for him to comment on the issue. "Until it comes before the committee, we're not going to make comments or judgment," he said Tuesday. "It would be unfair to talk about this or make any comments about a specific situation that hasn't come before us." French said he first "heard rumblings" about the mayor's son on Aug. 29, the day before he left on a vacation after losing to Hession and Verner in the Aug. 21 primary. "I haven't had a chance to get any of the background on this thing to determine whether in fact it is an ethics violation or not, but 1 certainly think it does raise some questions about the timing and sequence," French said. "It's possible everything was done above board, but there are issues about who was involved, who made decisions." Copyright © LexisNexis, a division of Reed Elsevier Inc. All rights reserved. Sk User Comments http://www.jems.com/news_and_articles/news/Ethical_Question_Raised_in_Spokane_AM... 2/27/2008 •Ill 1!111 -11 FVA ii 1t!- III ifl .I ,jiitiURThWt4DI. Spokane's contract with AMR may violate law By Bill Morlin, Spokesman -Review (Washington) The city of Spokane may be violating a federal "anti -kickback" law by taking $300,000 a year from a company that has a contract for exclusive ambulance service, some legal experts say. American Medical Response pays the city $25,000 a month, which goes to the Fire Department under "management services" requirements of the city's contract. But a state auditor's report, formally released Friday, concludes the city has not been adequately monitoring the contract with AMR, resulting in overbilling of customers —including the federal government, which pays Medicare bills. City officials promised changes after being called on the irregularities by state Auditor Brian Sonntag. A Fire Department battalion chief makes monthly spot audits of AMR's bills to its customers living in Spokane, but the city has not kept complete records of those random checks of the ambulance company's contract, the auditor's report says. "The city performed monthly reviews of ambulance billings, but retained documentation only for one month of each year until 2005 when the city retained documentation for August, September, October and November," the audit report says. The city's improved record -keeping of ambulance billings came about the same time in 2005 that a City Council subcommittee began asking questions about the ambulance contract. Issues raised by the subcommittee included ambulance response times to 911 calls, overbilling of patients and a practice of Fire Department paramedics giving medical supplies — purchased by city taxpayers — to AMR crews. who frequently then billed patients for the same supplies. AMR's current five-year contract, drafted by the city attorney's office, is expected to produce $27.5 million in revenue fnr the nation's largest orivate ambulance company, according to the state auditor's report. The fine pr nt in the city contract, drafted by an ass;stant city attorney. requires the $25,000 -a -month payment from AMR to cover the city's costs of monitoring the contract. _ But one or those listed "management services" — ambulance dispatching — is handled by AMR, not the city. Under a previous contract, the city required AMR to pay $5,000 a month. City documents don't give a reason for the 400 percent increase in the current contract. The federal "anti -kickback" law prohibits any "knowing or willful solicitation or receipt of any remuneration" in return for referrals of services reimbursable by any federal health care program. Many city residents brought to area hospitals by AMR ambulances have their bills paid by private insurance or the federal government through Medicare. "Both parties to an impermissible kickback transaction may be liable — the party offering or paying the kickback, as well as the party soliciting or receiving it," according to Kenneth Nolan, a Florida attorney who is a nationally recognized expert on the federal anti -kickback law. City Attorney Jim Craven said Friday he couldn't make "any informed comment" about the contract that was approved long before he took the job last summer. "What you're telling me is interesting," he said when asked about the federal anti -kickback law. "But nobody has asked me to look into the issues you're describing." Marlene Feist, a spokeswoman for the city, said AMR has "similar provisions" for cash payments in its contracts in Seattle and Clark County, in southwestern Washington Feist and other city officials couldn't identify any other of the city's approximately 740 contract vendors who make payments to the city as a condition of their contracts. Doug Wolfberg, an attorney and expert on ambulance contracts with municipalities, said it's his opinion that the payments the city of Spokane is getting from AMR — required by the contract — appear to violate the anti -kickback law. 'Technically and strictly speaking, yes, the statute is written broadly enough to prohibit payments by an ambulance service to a municipality when the municipality is in the position to act as a referral source and select the services of an exclusive ambulance provider," said Wblfberg, of Mechanicsburg, Pa. Paul Dayton, a Seattle attorney who represents AMR, said its his opinion that neither the city of Spokane nor his client is violating the federal law. "Cities and other EMS sponsors may charge ambulance suppliers amounts to cover the costs of supplying services such as dispatch, monitoring, and administration," Dayton said Friday. 'This is a common practice in the ambulance industry and consistent with applicable legal guidance," he said. •Dayton currently is defending the ambulance company in a state Consumer Protection Act lawsuit brought in Spokane County Superior Court by patients who allege they were overbilled. Spokane attorney Roger Reed, a former assistant state attorney general who filed the class-action suit, said he has found serious discrepancies in 114 of the city's spot audits — the so-called "contract monitoring" — between Jan. 1, 2003, and last April. 'The city has failed to produce 65 percent of the 'medical incident reports' relating to AMR billing incidents reviewed as part of the contract monitoring for the years 2003 through 2006," Reed said. "The best we can say is, 'It's a mystery,"' Reed said when asked why the spot audits can't be found. "It doesn't make sense." Reed said it would be tough to successfully prosecute the city or AMR under the federal anti -kickback law because proving criminal intent would be part of such a case. "Yes, it looks bad in the particular case because there doesn't appear to be any solid rationale for it," he said. The contract says AMR is paying the city in part for ambulance dispatching when, in fact, the company handles its own dispatch services, Reed said. "Here you've got a city contract, draftad by an assistant city attorney, that givas them a lot of 16931 cover for this kind of conduct," Reed said. "It may be an 'empty head, pure heart' defense that may give them an escape route;he said. "It's bad public policy to have a deal like this, but I don't think it rises to the level of a criminal violation." The city of Spokane and about 14 other tire districts, including Spokana Valley, are drafting a plan for a countywide ambulance contract that currently doesn't contain any payments to the municipalities. The Spokane City Council hasn't decided if the city will cancel its current contract and join the countywide system. Regulations promulgated by the U.S. Department of Health and Human Services under the anti -kickback law provide certain "safe harbor" provisions that essentially legalize contract tradeoffs for such things as space and equipment rentals and discounts for certain patients. 'There are no 'safe harbor regulations that protect this type of arrangement or immunize it under the federal law," Wolfberg said when asked about kickback provisions of the Spokane contract Wolfberg said he is unaware of any federal prosecutions under the law when those involved are a local government and a private ambulance company. "The inspector general for the Department of Health and Human Services seems to have taken a largely hands-off stance when it comes to the enforcement of the anti -kickback statute in the context of payments by an ambulance company to municipal referral sources," he said. Contracts in the Arizona cities of Scottsdale and Chandler recently came under legal scrutiny by the state because they contained municipal costs required to be paid by the ambulance companies, ultimately increasing patients' bills. "In one of those cases, the Arizona Department of Health disapproved one of the arrangements where large payments were required by the private ambulance company," Wolfberg said. Spokane, WA Mayor to Decide AMR Fine Page 1 of 3 ERRS NESPUNDER.co >> Click.Here to Print This Page << Spokane, WA Mayor to Decide AMR Fine Fine would be separate from suit Posted: June 8th, 2006 02:37 PM EDT BILL MORLIN, Staff writer Spokesman Review (Spokane, WA) As many as 30,000 residents of the city of Spokane who have used the emergency •' LexisNexis' ambulance services of American Medical Response since October 1998 now could be part of a just -expanded class -certified lawsuit. The suit, filed last December by three Spokane residents, alleges AMR has overcharged patients and violated the state's Consumer Protection Act over the past eight years. Three months later, while under scrutiny by a City Council subcommittee, AMR admitted overcharging patients $320,689 the past two years and said it would make refunds. Spokane Mayor Dennis Hession said Tuesday he expects to decide by next week the amount of a fine to be levied against AMR for violating its current contract with the city. The fine by the city would be separate from the class action suit, now set for trial in September 2007 The mayor also said he will respond soon to a call from Firefighters Local 29 for an "external investigation" into the relationship between AMR and Spokane Fire Department administrators who oversee the contract. The contract allows for a $1,000 fine for the first offense, $3,000 for the second and $5,000 for each violation thereafter. According to AMR officials, at least 881 individuals and an undisclosed number of insurance providers, including Medicare, were overcharged for ambulance services. Hession said he is scheduled to meet Friday with Fire Chief Bobby Williams to discuss the amount of the fine. Williams said Tuesday he likely will recommend to the mayor that the fine "be in a five -figures range," but the fire chief wouldn't be more specific. "It's important to make a statement about the seriousness of what happened," Hession said. "But it's not designed to make money for the city. The real impact of this was on the individuals who were (overcharged)." AMR, the nation's largest ambulance company with 18,000 employees, operates in the city of Spokane under an exclusive contract granted by the City Council and monitored by the Spokane Fire Department. The city contract makes AMR the predominant ambulance provider for the entire region, including http://publicsafety.com/online/printer.j sp?id=3520 2/27/2008 Spokane, WA Mayor to Decide AMR Fine Page 2 of 3 outlying suburban areas where service and mileage rates generally aren't regulated. After a lengthy hearing on Friday, Superior Court Judge Jerome Leveque agreed with. a request by attorney D. Roger Reed to certify the suit as a class action, meaning thousands of city residents could now be potentially affected. AMR patients will be divided into two groups: "Subclass A" for individuals transported between Oct. 5, 1998, and Oct. 31, 2003, and billed for services actually provided by fire department paramedics; "Subclass B" will be for patients who used ambulance service since Aug. 19, 2003 and were accompanied by a fire department paramedic. Paul J. Dayton, a Seattle attorney representing AMR, opposed expanding the suit to include other potential patients. He argued that the ambulance company already had identified patients it inadvertently overcharged and mailed refunds to them or third -party insurance companies or Medicare. "The mere fact that the plaintiffs have alleged facts which, if proven, establish their claim against AMR does not ensure that (they) may properly represent a class of others with respect to such claims," Dayton said in legal filings. "I am really pleased with the court's decision, certifying this as a class action suit," Reed said Tuesday. "Now the truth of how many people have been over -billed by AMR, how long this practice has gone on and whether AMR has committed unfair and deceptive practices in violation of our state's Consumer Protection Act, will be decided in a court of law," Reed said. "AMR is no longer the judge and jury on these issues," Reed said. Reed said in opposing the class action suit, AMR was offering a "trust us" approach with its own accounting review that "was far short" of an independent audit and only covered the last two years. In his legal motion, Reed said there are common issues of law, and a class action would be indisputably superior to flooding the courts with possibly 30,000 claims for less than $300 each. The case against AMR is the "quintessential class action," involving many small claims of individuals who couldn't afford to pursue separate legal suits, said Reed. Copyright 2005 LexisNexis, a division of Reed Elsevier Inc. All rights reserved. Terms and Conditions I Privacy Policy News stories provided by third parties are not edited by "Site Publication" staff. For suggestions and comments, please click the Contact link at the bottom of this page. MIQ6fl http://publiesafety.com/online/printer.j sp?id=3 520 2/27/2008 Spokane, WA Mayor to Decide AMR Fine Page 3 of 3 Printable version may be for personal use only. Content may not be duplicated, re -used or otherwise replicated without expressed, written consent from EMSResponder.com and/or the original author/source. Provided by EMSResponder.com - A Cygnus Business Media site Visit EMSResponder.com daily for the latest industry news, commentary, features and more. Click Here to Print This Page http://publicsafety.com/online/printer jsp?id=3520 2/27/2008 AMR Loses Ruling in Spokane, Washington Page 1 of 3 BESPI ERA » Click Here to Print This Page e AMR Loses Ruling in Spokane, Washington Judge says state's Consumer Protection Act applies Posted: August 21st, 2006 01:09 PM EDT Bill Morlin, The Spokesman -Review, Spokane, Wash. Aug. 19 --City of Spokane residents who have used American Medical Response •• LexisNexis" ambulances since 1998 have the right to pursue "exemplary damages" under the state's Consumer Protection Act, a judge ruled Friday. Superior Court Judge Jerome Leveque denied two motions brought by AMR attorney Paul J. Dayton, of Seattle, that would have essentially killed the lawsuit filed late last year. "This was a key ruling in the case because the judge agreed that we do have a right to pursue our Consumer Protection Act and breach of contract claims," said Spokane attorney D. Roger Reed, who represents the plaintiffs. The riling also allows the plaintiffs to ask a jury a year from now to award "exemplary damages" up to $10,000 for each viciation and attorney fees, Reed said. "We contend 'exemplary damages' can mean each instance of an overcharge," Reed said. The suit was filed by patients Lori E. Davis -Bacon and Lorraine and Doug Bacon, all of Spokane, who contend they were charged for "advanced life support" services when they only should have been billed for cheaper "basic life support." In :Tune, the judge agreed to expand their lawsuit to a class action, meaning potentially as many as 30,000 patients who were transported by AMR ambulances between 1998 and the date of the lawsuit's filing could become co -plaintiffs. But after losing that class action fight, AMR's attorney came back with two summary judgment motions on Friday, asking the court to toss out the suit. The AMR attorney argued for dismissal because the plaintiffs had failed to prove the ambulance company engaged in "deceptive" business practices -- required groundwork to prevail under the state's Consumer Protection Act. Dayton argued to the court that AMR -- the nation's largest ambulance company -- had merely made "billing errors" without deception and had voluntarily agreed to pay $320,689 in refunds. Those refunds, however, only apply to patients who used AMR ambulances between 2004 and March of this year, when the company admitted the overbilling while under scrutiny for such violations by the http://publiesafety.com/online/printer.jsp?id=3931 2/27/2008 AMR Loses Ruling in Spokane, Washington Page 2 of 3 City Council's Public Safety Committee. Dayton argued that the suit should be dismissed because the city serves as a. "regulatory agency" in monitoring AMR's ambulance services. "I can't rule in favor of the defendant in that," Leveque said The judge also said it was his "visceral feeling" that "people who paid too much can't get any relief' other than by bringing the lawsuit. But Leveque also said there is no evidence before the court at this point that AMR had engaged in "deceptive business" practices, as the plaintiffs allege. Reed argued that plaintiffs seeking redress under the state's Consumer Protection Act don't have to prove a company was involved in fraudulent practices. "Pure heart and empty head doesn't apply here to AMR," Reed said. "We don't examine (the company's) heart. We examine what was done -- people were ripped off. "Regardless of AMR's intent," Reed said, "we don't have to prove fraud to proceed with claims under the state's Consumer Protection Act." He also argued that city residents transported by AMR are "third -party" beneficiaries under the city contract that gives AMR the monopoly on ambulance service inside city limits. In June, Mayor Dennis Hessian levied an $80,172 fine against AMR for its overbilling -- only a fraction of what could have been assessed under the contract. Under the contract, the Spokane Fire Department audits bills by making spot checks on a monthly basis of city residents who use AMR ambulances inside city limits. AMR is not regulated for what it charges patients outside the city. If firefighters ride in the ambulance and help provide advanced life support, city residents who, pay an emergency services tax are only supposed to be charged for basic, services. In return, the Fire Department is paid. $25,000 a month by AMR: Copyright (c) 2006, The Spokesman -Review, Spokane, Wash. Distributed by McClatchy-Tribune Business News. For reprints, email , call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. Copyright 2005 LexisNexis a division of Reed Elsevier Inc. All rights reserved. Terms and Conditions I Privacy Policy News stories provided by third parties are not edited by "Site Publication" staff. For suggestions and comments, please click the Contact link at the bottom of this page. http://publiesafety.com/online/printer.jsp?id=3931 2/27/2008 AMR Loses Ruling in Spokane, Washington Page 3 of 3 M..dtPPI M Printable version may be for personal use only. Content may not be duplicated, re -used or otherwise replicated without expressed, written consent from EMSResponder.com and/or the original author/source. Provided by EMSResponder.com - A Cygnus Business Media site Visit EMSResponder.com daily for the latest industry news, commentary, features and more. » Click Here to Print This Page u http: //publiesafety. com/onl ine/printer. j sp?id=3 931 2/27/2008 SR.com: City to face decision on countywide ambulance pact Page 1 of 3 SPOKESMANREVIEW.OOM Monday, Decen City to face decision on countywide ambulance pact Bill Morlin Staff writer December 10, 2006 The city of Spokane, now in the middle of a legal battle over excessive ambulance rates, will have to decide in the next few weeks whether to cancel its current contract with American Medical Response. Mayor Dennis Hession and likely the City Council must decide if the city should join the cities of Spokane Valley, Airway Heights, Cheney, Medical Lake and seven outlying fire districts in seeking a new master contract governing rates and response times for the majority of Spokane County. Those outlying fire districts and cities joined together earlier this year and just completed a draft of an "inter - local cooperation agreement" allowing them to jointly seek bids for a single contract, governing rates and response times for ambulance services. Spokane Valley Fire Chief Mike Thompson, who led the.effort for the countywide ambulance contract, said last week he hopes to put out bid proposals next month and have a new contract in place by late March or early April. Such a countywide contract, Thompson said, would cover two-thirds of the county's geographic area and approximately 400,000 of its residents if the city of Spokane participates. "It will be particularly significant for these fire districts and municipalities to come together for one contract for ambulance service," Thompson said. The city of Spokane's decision to participate or stay on the sidelines likely will have an impact on the number of bids received and rates and response times. Start-up Posts would be particularly significant for an ambulance company that was restricted only to outlying areas and couldn't service patients in the city of Spokane, Thompson said. The city of Spokane, represented by Medical Service Chief Rich Kness of the Fire Department, has been involved in meetings over the past several months where the inter -local agreement and bid requirements were discussed and drafted, Thompson said. The Spokane Valley fire chief said he has no idea if the city of Spokane will participate, but said the decision must be made soon. Mary Verner, Bob Apple and Joe Shogan, members of the Spokane City Council Public Safety Committee, said Friday they knew outlying fire districts were drafting a combined contract, but they didn't have the details and were unaware the negotiations were so well -advanced. Fire Chief Bobby Williams said he briefed the Public Safety Committee about the issue in June and again last month. "It would seem to be of some conceptual advantage to the citizens of Spokane to have a countywide ambulance contract, but that's a decision for the mayor and City Council," Kness said Friday when reached at the Spokane http://www.spokesmanreview.comItools/stor)pf.asp?ID163805 12/11/2006 SR.com: City to face decision on countywide ambulance pact Fire Department, which monitors the AMR ambulance contract. Page 2 of 3 "I think the city should take an honest look at the advantages and disadvantages for our citizens if we participate in a countywide contract," Kness said. If the city of Spokane stays with AMR and exercises a five-year renewal option in October 2008, there could, be contract implications if another ambulance company wins the bid to service the outlying areas, Kness said. Of particular concern, he said, is the number of ambulances available for a "mass -casualty incident." Apple said he believes the city's Public Safety Committee should have been more directly involved, possibly with public hearings about joining a countywide contract and a discussion to determine if that would benefit residents of the city of Spokane. "I began hearing rumors about this a few weeks ago," Apple said. "We at first were ignored by the administration and only told that 'negotiations were under way.' "At this point, it looks like the administration has gone well beyond what's reasonable, and we've been left out of the loop," Apple said, expressing disgust with the process. Now, probably within the next month, the City Council will be faced with the "significant decision of whether to cancel its current AMR contract" and join the other cities and fire districts, Apple said. Shogan, the City Council president, said he knew the city was participating in the drafting of the countywide contract but had not seen the inter -local agreement or bid proposal. "We're expecting it to come back before us at some point," Shogan said. Verner and Shogan, both attorneys, said they believe that the decision to terminate the current ambulance contract rests solely with the mayor, but both said it would take a City Council vote to approve any new contract. Mayor Hession did not return a call Friday seeking a comment. Other cities in Spokane County and most of its fire districts currently don't have contracts for ambulance service; and many residents of those areas have complained about excessive bills for patient transport to medical centers. The new contract would spell out response times and regulate charges. The level of complaints from residents of Spokane Valley and other more -rural areas of the county grew louder after a group of Spokane residents filed a lawsuit one year ago, alleging they were being over -billed by AMR. The ambulance company was unsuccessful in legal attempts to get the class-action suit dismissed, and it is now set for trial next year. The City of Spokane is not a defendant in the suit, but its Fire Department's spot audits of ambulance calls and emergency response records are part of the litigation. The suit was brought against AMR by two patients — city residents — who contend they were overcharged by the ambulance company. In March, three months after the suit was filed, AMR voluntarily admitted it had overbilled city of Spokane residents $320,689 in the past two years. In June, Hession fined the company $80,172 — only a fraction of the potential fine allowed under the existing contract for overbilling. AMR, the nation's largest private ambulance company, has an exclusive contract, which lasts through October http://www.spokesmanreview.comltools/story_pf.asp?ID=l 63805 12/11/2006 SR.com: City to face decision on countywide ambulance pact 2008, to provide ambulance service inside the city of Spokane. Page 3 of 3 Under the Spokane contract, AMR bills city residents $358 for "basic life support" (BLS) service and $494 for "advanced life support" (ALS) care. If a city firefighter accompanies a patient in the ambulance, AMR is only supposed to bill for the BLS rates, regardless of the type of care rendered, because city residents pay an emergency services tax, directed to the Fire Department. AMR's exclusive -service contract; which includes a $25,000 monthly kickback payment to the city of Spokane to "monitor" the contract, leaves it as the only major ambulance company to provide services in the other areas of the county where rates and response times aren't controlled by contracts. With the exception of Medicare reimbursements, AMR is largely able to charge whatever it wants to patients who live outside the city limits of Spokane. http://www.spokesmanreview.comltools/stoiy_pfiasp?ID163805 12/11/2006 Spokane AMR Overbilling Trial Postponed — (EMSResponder.com) Page 1 of 2 Spokane AMR Overbilling Trial Postponed Bill Morlin Spokesman -Review (Washington) Nov. 6 --Superior Court Judge Jerome Leveque expressed frustration Monday that • LexisNexis' attorneys on both sides of an ambulance company overbilling lawsuit haven't reached agreement on the production of documents and patients' names before a trial can occur. The jury trial in the 2 -year -old class action lawsuit against American Medical Response had been scheduled to begin this week, but it now likely won't occur until sometime next fall. Seattle attorney Paul Dayton, representing AMR, and attorneys Roger Reed and Adam Tait, representing a group of Spokane residents who were overbilled by the ambulance company, were in court Monday seeking a new trial date and arguing over release of documents. The judge gave Dayton and Reed until Friday to draft a list detailing areas of agreement and disagreement and outline a process for resolving those differences. "If it's not done, the court will do it by order," the judge told the attorneys. Since 1999, American Medical Response has had an exclusive contract to provide ambulance service in the city of Spokane. Because city taxpayers fund Fire Department emergency medical services, city residents can only be charged certain rates if a fire paramedic accompanies the ambulance crew to a hospital. At the core of the litigation is how many of those patients were transported by AMR ambulances in the past eight years. Reed told the court h&won't be ready for trial _until AMR is forced to disclose a complete list of city residents who were overbilled, going back to 1999. Those customers were charged the more -expensive "advanced life support" rate when they should have been charged the cheaper "basic life support" rate if a city fire paramedic was involved in the ride -in treatment. The plaintiffs attorneys estimated there could be as many as 30,000 city residents affected by the class action suit. After all potential members of the class action are identified, each will have to be formally notified, probably through mass -mailing and public advertising. They will be given the chance to opt out of the lawsuit if they aren't interested in pursuing damages. Another one of the remaining areas of dispute involves an estimated 20,000 city residents who were transported by AMR between January 2003 and October 2005. The ambulance company voluntarily audited those bills for that period and agreed to make $320,689 in refunds. Some of those refunds went to insurance companies, at discounted rates, or Medicare, which paid the ambulance http://www.emsresponder.com/article/article.jsp?siteSection=l&id=6501 11/8/2007 Spokane AMR Overbilling Trial Postponed — (EMSResponder.com) Page 2 of 2 bills. Reed argued to the court that even if an ambulance bill was paid by Medicare or an insurance company, those residents still may be entitled to interest and treble damage awards under the state's Consumer Protection Act. To see more of The Spokesman -Review, or to subscribe to the newspaper, go to http://www.spokesmanrevievw.com. Copyright (c) 2007, The Spokesman -Review, Spokane, Wash. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374- 7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. Copyright 2005 LexisNexis, a division of Reed Elsevier Inc. All rights reserved. Terms and Conditions I Privacy Policy RSS Feeds for EMSResponder.com: Top EMS News Section Printable version may be for personal use only. Content may not be duplicated, re -used or otherwise replicated without expressed, written consent from EMSResponder.com and/or the original author/source. Visit EMSResponder.com at http://www.emsresponder.com for the latest industry news, commentary, features and more. copyright © 2007 Ali rights reserved. Cygnus Interactive, a Division of Cygnus Business Media. http://www.emsresponder.com/article/article.jsp?siteSection=l&id=6501 11/8/2007 American Medical Response Over Billing Patients Page I of I Home pane > Law Suits Filed >> American Medical Response American Medical Response - •- Search 10,000 recent Spokane, WA residents tried to file a class action lawsuit against the nations largest cases and settlements ambulance company for allegedly over billing hundreds of patients and insurance companies. American Medical Response (AMR) tried to get the lawsuit dismissed, but a Spokane County Superior Court Judge ruled Spokane residents who used AMR ambulances Home since 1998 can pursue state Consumer Protection Act and breach of contract claims against the company. Several patients were charged for advanced life support when only basic life • Quality Marketing support was applied. The certified lawsuit was filed on behalf of 30,000 patients who were for Lawyers transported by AMR ambulances between 1998 to present. Lawsuits: Register your AMR Complaint If you or a loved one has suffered damages in this case, • In the News gyou may qualify for damages or remedies that may be awarded in a possible class action or lawsuit. Please click the link below to submit your complaint to a lawyer for a free evaluation. Services: • Free Newsletters Click here for.legal help anda free evaluation of -your, possible case • Email this Page to a Reed & Giesa - Roger Reed Friend Posted on dug -22-06 - Legal Help Now CLICK HERE FAQ I TOS I Privacy• I Oise?imar I About OLM I Ccntact 0.M I Press I Advertise I Link to OLM I Writers Wanted I Site Map © 2001-2U07 Online Legal Marketing Ltd. All rights reserved. http://www.lawyersandsettlements.com/case/amr_classaction.html 9/16/2007 Printer -Friendly Version 1 -'age I of i Universi of ONE UNIVERSITY R understands hmv ou'��% y LFAHNI.1aREt ,kv[:.:i k$Phoenir live today, and where you osna.edu * "p iidrk.'WI want to go tomarrntt. A�/y' Rescue service loses contract Richmond Ambulance Authority to manage paramedics and EMTs Saturday, Oct 13, 2007 - 12:09 AM Updated: 10:52 AM By JIM NOLAN TIMES -DISPATCH STAFF WRITER Citing a failure to meet emergency response times in six of the past seven months, the Richmond Ambulance Authority board voted unanimously yesterday to terminate its contract with the company that manages the city's ambulance response and emergency medical personnel. The decision to dump American Medical Response just one year into its five-year contract means that the authority will assume management of roughly 168 employees, including about 90 paramedics and emergency medical technicians. AMR, the largest private provider of ambulance services in the country and a subsidiary of Colorado - based Emergency Medical Response Corp., was due to be paid $9 million this year. AMR had provided ambulance services in Richmond for 11 years. Ambulance authority Executive Director Jerry Overton said the transition, which will take effect Nov. 18. should have no negative impact on city residents. Rather, he said, the hope is that direct management of emergency personnel and the day-to-day operations of the response system will produce a more stable work environment for employees and lead to better deployment of ambulances that bring faster response times to emergency calls. The authority owns all the assets that AMR was using -- the ambulances and the equipment on them, the communications system and the technology infrastructure. Under its contract with the authority, AMR guaranteed that it would be able to respond to life - threatening emergency calls within 9 minutes, 90 percent of the time. Similar time and percentage guarantees were also in place for response to emergency calls of lower priority. For six of the past seven months, however, Overton said, AMR failed to meet the contracted standards in a number of response categories. Response for September, he said, was even lower than the previous month. "It is a performance -based contract, and we take that very seriously," Overton said. "We have very strict response times, and the response -time provisions have not been met." When trouble surfaced this year, the authority notified the company that it was in default of its contract. Penalties were assessed totaling $500,000. Overton said the authority would seek to claim an additional $500,000 from a performance bond put up http://www.timesdispatch.com/cva/ric/news/community/richmond.PrintV iew.-content-art... 10/17/2007 Printer -Friendly Version Page 2 of 2 by the company to back up its contractual obligations. "I think that it is probably a good decision," said Richmond City Councilwoman Kathy C. Graziano, who sits on the authority board. "I don't think it's going to be easy for the ambulance authority to carry out; however, a contract has been breached, and things have not improved -- if anything, they had gotten worse," she added. "For the well-being of the citizens, we had to do it." Like Overton, Graziano said the difficulty in retaining employees and questions of where ambulances were located played a role in the failure to reach the contracted response -time goals. In a statement, AMR expressed disappointment in the board's decision, acknowledged staffing difficulties and said they would work toward an orderly transition of their services to the ambulance authority. "Although public safety has never been compromised, and we have made progress in addressing the authority's concerns, we have continued to have staffing challenges related to caregiver profiles which have affected our ability to meet the stringent requirements of the contract," Tracy Thomas, head of AMR operations in Richmond, said in the statement. Graziano said the board will spend the next few weeks before the transition assessing what, if any, fiscal impact the takeover will have on the city, as well as research liability issues it may face by running the system itself. Overton said it is the authority's intention to retain the ambulance response personnel who now currently work for AMR, provided they passed background and drug tests. The Richmond Ambulance Authority is a government entity created by the state legislature to provide emergency medical services to the city of Richmond. It receives finding from the city, and its board is appointed by City Council. Contact Jim Nolan at (804) 649-6061 orjnolan@timesdis_patch.com. olanf✓ltimesdispatch.com. Go Back NewsI Sports I Entertainment j t_iving_j $hoppin IQtassi ieds 1 Weather I Opinion I Obituaries I Serviceslcontact lJs 2007, Media General Inc. All Rights Reserved. Terms & Conditions I Site Map -- Part of the GatewayVa Network -- webmaste rjinrich.com I i MtTWORK http://www.timesdispatch.com/cva/ric/news/community/richmond. PrintV iew.-content-art... 10/17/2007 Printer -Friendly Version Page 1 of3 Ambulance response 'troubling' Richmond authority says its provider isn't meeting contract terms Saturday, Oct 06, 2007 - 12:09 AM By JIM NOLAN TIMES -DISPATCH STAFF WRITER The company hired by the Richmond Ambulance Authority to respond to medical emergencies in the city has not met required response times in six of the last seven months. As a result, the ambulance authority's board is considering dumping its contract with American Medical Response of Richmond -- worth $9 million this year -- and assuming control of the operations itself. The board met yesterday but came to no decision, said officials who attended the meeting. It is scheduled to meet again this Friday. Jerry Overton, the ambulance authority's executive director, said the slower -than -desired response times have had no negative impact on patient care. Despite that, City Councilwoman Kathy C. Graziano, who sits on the board, said, "It's very troubling." "And that's why we are addressing it, trying to work with the contractor to make sure citizens' safety is not put in harm's way." A takeover of the response duties is an option, Graziano said. "We know we have a problem, and we're trying to look at how we can fix the problem. It's a very sensitive situation." Overton said responses to the 50,000 emergency and non -emergency calls made each year in Richmond -- the busiest system, per capita, in the country -- are still among the fastest in the nation. "Our response times are superb," he said. "It's an accountability issue." At issue is the provision of the American Medical Response contract with the ambulance authority that an ambulance arrive within a prescribed time at least 90 percent of its runs. The 90 percent requirement is less than nine minutes for the most critical, or life -threatening calls; less than 13 minutes for non -life -threatening emergency calls; and less than 30 minutes for urgent emergency calls. The ambulance authority found that AMR responded within nine minutes on life -threatening emergency calls less than 90 percent of the time in March, April, May, July, August and September. The lowest compliance rate occurred in March, when 87.4 percent of the calls were answered within nine minutes. http://www.inrich.com/cva/ric/search.PrintV iew.-content-articles-RTD-2007-10-06-0174.... 10/10/2007 Printer -Friendly Version Page 2 of 3 Overton said the problems started surfacing in November 2006, several months after AMR signed a new five-year contract with the Richmond Ambulance Authority, for which it had provided services for the previous 10 years. At first, response times for non -emergency calls and transportation requests failed to meet requirements. In recent months, the response problem has crossed over into emergency calls. The trouble led the ambulance authority in April to declare AMR in default of its contract. In a letter to AMR and its Colorado -based corporate parent, Emergency Medical Services Corporation, Overton said the move was "the only recourse to protect the public health and safety of its patients and the interest of its customers." Overton said penalties of $500,000 have been assessed so far.. American Medical Response is the largest provider of ambulance services in the country. The company has roughly 250 contracts in 37 states and 18,000 employees, serving cities including Dallas, Houston and Colorado Springs. In Richmond, AMR has 168 employees -- including paramedics, emergency medical technicians, dispatchers and administrators -- who use the equipment and facilities of the Richmond Ambulance Authority. Tracy Thomas, head of AMR operations in Richmond, said the company is working to improve response times and has submitted a plan that addresses the problems. Among the difficulties faced in the city, she said, is a nationwide shortage of paramedics, which earlier this year led to Richmond having 14 of its 46 paramedic positions unfilled. Thomas said the company is also refining when and where it deploys ambulances so they can respond faster to emergency calls. Richmond, she said, has one of the most stringent contracts of any municipality in the country when it comes to requiring swift response times by its ambulance service. City officials said they want to keep it that way, no matter who runs the ambulances "We have these standards that they have contractually agreed to meet, and we're going to enforce them," Overton said. Contact Jim Nolan at (804) 649-6061 or inolan@timesdispatch.com. Go Back News I Sports I Entertainment! Living I ShoopinolClassifieds I Weather I Opinion I Obituaries I Servicesleontact Us @2007, Media General Inc. All Rights Reserved. Terms & Conditions I Site Map -- Part of the GatewavVa Network -- webmaster@inrich.com http://www.inrich.com/cva/ric/search.Print V iew.-content-articles-RTD-2007-10-06-0174.... 10/10/2007 FireTimes - Print Story Page 1 of 3 Printer Friendly Version •AMR accused of falsifying Richmond response times.. Friday, March 01, 2002 Times -Dispatch Richmond, Virginia - The company that runs the city's ambulance service falsified 99 response times for non - emergency calls between June and September, according to an audit report. American Medical Response did it to avoid missing time limits set in its contract with the Richmond Ambulance Authority, which fines the company for late responses. '7t was deliberate. It was to cheat the system," said Jerry Overton, the authority's executive director. The authority asked Health Care Visions to do the audit after unidentified tipsters raised concerns in September about AMR's reporting practices. No patients were harmed because of the mistakes and AMR has stopped falsifying response times, according to the authority. AMR also replaced its vice president for operations in Richmond on Monday and removed its communications manager last month, according to sources. "There were a number of issues the authority brought to my attention, which we take very seriously," said Raymond Hayes, AMR's chief executive officer for the southern region. "We came. up with a comprehensive game plan with the authority to address the issues." Overton told AMR in October it had breached its contract. And the company was ordered to clean up its act or lcse its five-year contract and a $1 e:illion performance bond. "They were immediately responsive to fixing the problems," Overton said. The authority has fined AMR $361,200 during the past two years for respohding late to emergency and non -emergency calls. Those fines come out of the money the company could earn from its contract. AMR is fined for every minute an ambulance is late. The fines include $15 for every minute late during emergency calls and $10 per late minute for non -emergency calls. Created by the General Assembly in 1991, the Richmond Ambulance Authority now has 18 employees and an $11.2 million budget. It owns 26 am- bulances and contracts with AMR to run them. AMR hires emergency medical technicians, paramedics and dispatchers to care for the city's 197,790 residents. The Denver -based company stands to earn $7.5 million from the authority this fiscal year. The authority responds to about 50,000 calls for help a year. And AMR transports about 100 patients a day. http:/Rvww.firetirnes.com/printStory.asp?FflgID=2 104 3/21/2006 FireTimes - Print Story Page 2 of 3 It costs $398 plus.$7 a mile for a person to ride in one of the authority's ambulances during emergencies. For non -emergencies, the price drops to $350 plus $7 a mile. Henrico and Chesterfield counties own their own ambulances and hire paramedics and dispatchers. They do not have ambulance authorities. AMR falsified its response times by reporting it had one ambulance responding to two calls at once, according to the audit. For example, AMR would report it had an ambulance at a hospital to pick up a patient when it was still delivering a separate patient to the same place. Some patients were kept waiting at hospitals for more than 30 minutes past their scheduled pickups during these "double -logged" calls. In a June 13 e-mail to senior officers, AMR's communications manager encouraged the practice. "This is a reminder that if you have a unit at destination at a facility where there is a non -emergency transport that may be late ... that you are to double log the unit and place them on scene," the AMR manager wrote. The authority's audit stated "it is clear that some members of the AMR management team were aware that the practice could be used to inappropriately avoid late calls." After correcting its falsified records, AMR showed it responded to all of the calls within the authority's time limits more than 90 percent of die time. Those time limits include eight minutes. 59 seconds for life -threatening emergencies and 29 minutes, 59 seconds for scheduled, non -emergency pickups. Joseph P. McMenamin, chairman of the authority's hoard, called the falsifications "misleading" and "distressing." It was an approach to record -keeping that was not consistent with accuracy and integrity." he said. Also, according to the audit, AMR did not inform the authority it lowered the priority for ambulances responding to 85 calls'between June and September. In 10 of those calls, AMR paramedics determined ambulances could spend more time getting to patients, who required more urgent attention, the audit says. "That strikes me as risky and frankly foolish," McMenamin said about the 10 calls. "If the case has been downgraded, what is the mind -set of the medics sent to care for that patient? What do they believe about that patient? And how does that belief affect what they do?" Keith F. Henderson, associate medical director at Cape Fear Valley Medical Center in Fayetteville, N.C., reviewed records of the 10 calls for the audit. He determined AMR lowered the response priorities for them inappropriately. Paramedics originally listed the 10 calls in a "priority one" category, which requires an ambulance response within 8 minutes, 59 seconds at least 90 percent of the time. Ambulances arrived later than that http://www.firetimes.com/printStoiy.asp?FragID=2104 3/21/2006. FireTimes - Print Story Page 3 of 3 for six of the calls. The audit concludes: "The supervisory personnel interviewed all stated that by downgrading a priority one call they potentially freed up that unit to be reassigned to a higher priority call during busy times and provided additional time to make compliance." In one Sept. 25 call, a patient had suffered from a seizure and was violent. The ambulance was late, arriving in 17 minutes, 28 seconds. The original time limit for the call was 8 minutes, 59 seconds. A paramedic was with the pai:ients before the ambulance arrived during each of the 10 calls in question. Those paramedics, who had emergency equipment and medicine, determined the ambulances could treat the calls with less urgency. Steve Athey, owner of Texas -based Health Care Visions, audited AMR's response times. He credited the authority for discovering the falsifications and ordering corrections. "The system worked just like it was supposed to." FT Notebook: Webs ite for the Richmond, Virginia Ambulance Authority: http://www.raaents.org/ Close Window Go to FireTimes Front Page fl All Content B 2001-2002 FireTimes and other news sources. See User Agreement. FireTimes.comfFire rimes.net are registered trademarks of FireTimes Total Wor'dWide News Coverage Updated Dpily with Yellow Bnx. Copyright© 2.002 Yellow F3rix All rights reserved. http://www.firetimes.com/printStory.asp?FragID=2104 3/21/2006 Michigan Ambulance Firm to Leave Metro Area, Cut 250 Jobs — Emergency Medical Services (... Page 1 012 Michigan Ambulance Firm to Leave Metro Area, Cut 250 Jobs Economy blamed; offices to close after holidays Stan Donaldson and Amber Hunt Detroit Free Press (Michigan) Nov. 25 --About 250 technicians, paramedics and dispatchers in Pontiac and Lincoln Park are j• LexisNexis' looking for new jobs now that a medical ambulance service has announced it will leave metro Detroit at the end of the year. ' American Medical Response, in metro Detroit since the 1980s, will close'its Pontiac and Lincoln Park offices Dec. 31, said AMR Vice President Jonathan Greene. "It's a tough economy in Michigan and it has been difficult for us to be profitable in this part of the state," Greene said Wednesday. "My No. 1 concern is to try to get as many of our current employees jobs so they can feed their families." AMR contracted to provide emergency services for the Auburn Hills Fire Department and previously worked in Southfield and Birmingham. Greene said the company, which operates in 36 states, would keep its facility in Grand Rapids and transfer some staffers to other states. Pontiac City Council President Art McClellan said the announcement is disappointing. "It would be nice if they stayed, but we can't cry over them leaving because we have to move on," he said Wednesday. Last week, city officials learned they would lose more than $1 million in income-tax revenue after General Motors said it would move 3,600 employees to its Warren facility. The city also received a lowered bond rating that week. AMR said the number cf emergency calls it has received -- often requesting private transportation for nursing home residents to hospitals -- dropped from more than 1,000 a week several. years ago to about. 700 a week this year. Greene attributed the decrease to increased competition and to fire departments doing their own transports. Heartland of Allen Park, which has beds for 160 seniors, uses AMR, but an employee there said its residents will simply return to using its former service. The 47 residents at Belle Fountain Nursing Home and Rehab Center in Riverview also use AMR -- along with two other services, said Jenny Johnson, a licensed practical nurse. Auburn Hills City Manager Mike Culpepper said the city approved a 3 -year contract Monday with Star EMS' to handle emergencies there. But while clients apparently won't be deeply affected, employees will -- and right after the holidays. Chris Freytag, 36, of White Lake worked as a dispatcher with AMR for 16 years until Monday. But he found work at Star EMS hours later. - Still, he said, 'There are some who don't know what they will do." Contact STAN DONALDSON at 248-351-3691. http://www.emsresponder.corn/article/article.] sp?siteSection=I &id=4477 11/29/2006 Michigan Ambulance Firm to Leave Metro Area, Cut 250 Jobs — Emergency Medical Services (... Page 2 of 2 Copyright (c) 2006, Detroit Free Press Distributed by McClatchy-Tribune Business News. For reprints, email , call 800-374- 7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. Copyright 2005 LexisNexis, a division of Reed Elsevier Inc. All rights reserved. Terms arid Conditions I Privacy Policy News stories provided by third parties are not edited by "Site Publication" staff. For suggestions and comments, please click the contact link at the bottom of this page. RSS Feeds for EMSResponder.com: Top EMS News Section Printable version may be for personal use only. Content may not be duplicated, re -used or otherwise replicated without expressed, written consent from EMSResponder.com and/or the original author/source. Visit EMSResponder.com at http://www.emsresponder.com for the latest industry news, commentary, features and more. Copyright © 2006 All rights reserved. Cygnus Interactive, a Division of Cygnus Business Media. http://www.emsresponder.com/article/article.jsp?siteSection=l &id=4477 11/29/2006 Rural/Metro losing deals to competitor, changing strategy - The Business Journal of Phoe... Page 1 of 1 The Business Journal of Phoenix - February 18, 2008 http hoenix.biziournaIs.com/phoenix/stories/2008/02118/story6.html PHOENIX usineSS JO 11111 Friday, February 15, 2008 Rural/Metro losing deals to competitor, changing strategy The Business Journal of Phoenix - by Angela Gonzales Phoenix Business Journal On the heels of cutting 40 positions from its Southwest Ambulance subsidiary, ............_............................................................................. Rural(Metro Corp. has lost another 911 emergency services contract to Professional .._....._......_....._....._........_. Medical Transport Inc. Rural/Metro is trying to make up for lagging contracts by diversifying and building its nonemergency ambulance sen' ce, which already makes up about 54 percent of its business. But the only analyst left covering the publicly traded Scottsdale company said that may not be enough. "If they're losing 911 business, I don't know how much nonemergency business they can really do," said Salomon Kamalodine,, an analyst with B _Riley &.co. Inc. in Los Angeles. This article is for Paid Print Subscribers ONLY. If you are already a The Business Journal subscriber please create or sign into your bizjournals.com account to link your valid print subscription and have access to the complete article. Become a Print Subscriber ¢w For immediate access to V4ESNss<Jx ate ' this article, as well as r-' ; " = the most recent edition of The Business Journal .At-AIW x t online, become a print subscriber. Create a Bizjournals Account Already have an Account Email Address: Password: I Submit I Forgot_Password? All contents of this site © American City Business Journals Inc. All rights reserved. http:/Ibizjoumalshire.com/phoenix/stories/2008/02/18/story6.html?t=printable 2/27/2008 Rural/Metro earnings continue to drop as stockholders seek more control - The Business J... Page 1 of 2 The Business Journal of Phoenix - February 11, 2008 http:/lphoenix.bizjournals comlohoenix/stories/2008!02111fdailyA html ilusliless Irma! Monday, February 11, 2008 Rural/Metro earnings continue to drop as stockholders seek more control The Business Journal of Phoenix - by Angela Gonzales Phoenix Business Journal Rural..Metro Corp. is spiraling closer to red ink. The Scottsdale -based ambulance and fire provider reported $754,000 in net income for its second fiscal quarter ended Dec. 31. down from $1.31 million during the same period in 2006. For the six months ended Dec. 31; Rural/Metro (Nasdaq:RURL) reported a decline in net income to $1.17 million from $2.99 million during the six months ended Dec. 31, 2006. The company's earnings statement shows an increase in operating expenses, including professional fees related to restated financials and IRS matters, as well as increased fuel costs. At $2.64 a share, its stock is hovering near its 52 -week low of $1.84 a share. Its 52 -week high is $8.30. Despite its drop in net income, Rural/Metro's revenue is up 4.5 percent to $119 million for the second quarter, compared with $114 million during the same quarter in 2006. For the six months ended Dec. 31, Rural/Metro reported $238 million in net revenue, up a bit from $228 million during the same period in 2006. Trouble also appears to be underfoot as stockholders wrestle for more control of the board. On Jan. 28, Rural/Metro and Accipiter Capital Management LLC reached an agreement to settle an election contest for. Rural/Metro's March 27 annual meeting of stockholders. As part of that settlement agreement, Rural/Metro said it will seek stockholder approval for amendments to the company's certificate of incorporation to allow special meetings of stockholders to be called by stockholders holding an aggregate of 35 percent or more of the outstanding voting power of the company's voting stock. Basically, stockholders don't want Rural/Metro's board to amend the company's bylaws without stockholder approval. Rural/Metro will keep its independent registered public accounting firm PricewaterhouseCoopers LLP. Stockholders will vote at the annual meeting to ratify the audit committee's appointment of PricewaterhouseCoopers for the fiscal year ending June 30. According to its 2007 annual report, PwC billed Rural/Metro $2.55 million in audit fees, up from $2.2 million in 2006. Rural/Metro had a series of restated financial statements in 2003, 2004, 2005 and 2006. Its http:/fbizjournalshire.com/phoenix/stories/2008/02/11/daily3.html?t=printable 2/27/2008 Rural/Metro earnings continue to drop as stockholders seek more control - The Business J... Page 2 of 2 net income was as high ad $8.1 million in 2004 (restated) and sunk to a loss of $i million in fiscal 2007. For more: www.ruralmetro.com. ..............................I......_.........._......._..............._.......... All contents of this site ©American City Business Journals Inc. All rights reserved. http://bizjoumalshire.com/phoenix/stories/2008/02/11/daily3.html?t=printable 2/27/2008 PMT ousts Rural/Metro for Tempe emergency services - The Business Journal of Phoenix: Page 1 of 1 The Business Journal of Phoenix - February 8, 2008 http�hoenix.bizjournals comlphoenixlstoriesl20D8102l04/dailv67 html PHGENtX Bustuess Journal Friday, February 8, 2008 PMT ousts Rural/Metro for Tempe emergency services The Business Journal of Phoenix - by Angela Gonzales Phoenix Business Journal Professional Medical Transport has ousted Rural/Metro. Corp.'s Southwest Ambulance in a bid to provide emergency services in Tempe. The Tempe City Council unanimously approved Tempe -based PMT to provide 911 emergency services beginning May 8. PMT also serves works in partnership with the Scottsdale, Paradise Valley and Chandler fire departments. The company now will work with the Tempe Fire Department to provide integrated emergency transportation. The Tempe contract is for two years, with three one-year renewal options. All of PMT's ambulances are dispatched by Phoenix Fire Department's Regional Dispatch Center as part of the Valleywide automatic aid system. PMT was acquired in 2OO5 by Starwest Associates, whose principals are Bob Ramsey and Pat Cantelme. Ramsey, who also founded Southwest Ambulance, said PMT now is "four for four" in direct competition with that Mesa -based company. Rural/Metro (Nasdaq: RURL) acquired Southwest Ambulance in 1997. For more: www.pmtambulance.com. ...........__.............................................- All contents of this site ©American City Business Journals Inc. All rights reserved. http://bizj ournalshire. com/phoenix/stories/2008/02/04/daily67.html?t=printable 2/27/2008 Rural/Metro announces new contacts, to sell Scottsdale building - The Business Journal o... Page 1 of 2 The Business Journal of Phoenix - November 14, 2007 httPhoenix bizjournals comlohoenixfstoriesl20071111121dai1y41 html 811 Joumal Wednesday, November 14, 2007 Rural/Metro announces new contacts, to sell Scottsdale building The Business Journal of Phoenix - by Angela Gonzales Phoenix Business Journal In their earnings call with investors Wednesday, Rural/Metro Corp.'s executives announced the Scottsdale company garnered a $2.5 million contract with Nashville -based HCA Inc, ......_............__............ Under the agreement, Rural/Metro will provide up to 95 percent of patient transports among io HCA hospitals within the Nashville area beginning Dec. i. Jack Brucker, president and chief executive of Rural/Metro, said he also has been contacted by three HCA operations in other areas to be in their preferred provider network to transport patients. "None of those have been signed," he said. "We're very excited HCA selected Rural/Metro (Nasdaq:RURL) as its preferred non -emergency provider at least for the Nashville, Tenn., operations. We hope to move that across the country as quickly as we can. No promises, but certainly we have high hopes." Brucker told investors he expects the new HCA contract to produce about $2.5 million in revenue the first year. "We see this growing to $5 million at the end of the first 12 months," Brucker said. He also is optimistic about a contract in Rochester, N.Y., that the city council is scheduled to vote on Nov. 20. "It is still our belief that we will retain that contract for the long term," he said. "We believe we will get a positive vote from the city council in Rochester next week, which will give us a long- term contract with several renewal options at the end of it." That contract is valued around $15 million, he said. These contracts come at a time when Rural/Metro is losing money. The Scottsdale ambulance and fire.service company reported a loss of $i million for the year ended June 30, compared with $2.9 million in net income the previous year. Net revenue increased, however, to $469 million for the fiscal year ended June 30, compared with $451 million a year earlier. http://bizjoumalshire.com/phoenix/stories/2007/ 11 / 12/daily4l .html?t=printable 2/27/2008 Rural/Metro announces new contacts, to sell Scottsdale building - The Business Journal o... Page 2 of 2 The company attributes the $3.9 million decrease in net income "to a decrease of $10.1 million in income from continuing operations offset by a decrease in losses from discontinued operations of $6.2 million," according to its in -K. Revenue for the company's first fiscal quarter, ended Sept. 30, hit $119 million, up from $114 million during the same time a year ago. Net income checked in at $411,000, or 2 cents a share, compared with $1.69 million, or 7 cents, a year ago. The company restated its financial statements for the years ended June 30, 2006 and 2005, and didn't file its 10 -K on time, which triggered a notice of default from the trustee of some of its notes, according to its io-K filed Nov. 14 with the U.S. Securities and Exchange Commission. . Rural/Metro executives will chip away at the company's long-term debt when they sell a 98,000 -square -foot facility at 4141 N. Granite Reef in Scottsdale valued at between $8 million and $9 million. The property, which is being used by the company's billing department and other tenants,. is listed with Coldwell Banker. Brucker said the facility was built in the 19805 and doesn't have the energy efficiency of Rural/Metro's new leased headquarters at 9221 E. Via de Ventura in Scottsdale. According to the 10 -K filed Nov. 14, Rural/Metro will pay $13.2 million in rent for its corporate headquarters and 240 facilities across the country. All contents of this site ©American City Business Journals Inc. Al! rights reserved. http://bizjoumalshire.com/phoenix/stories/2007/11/12/daily41.html?t=printable 2/27/2008 Rural/Metro delays year-end filing as financial review continues - The Business Journal o... Page 1 of 1 The Business Journal of Phoenix - September 14, 2007 http:F1pboenix.bizjournals.com/phoenjxJstorjesI2oo7/o9 O/dailv5o.html bPHOENIX usiness Journal Friday, September 14, 2007 Rural/Metro delays year-end filing as financial review continues ' ' The Business Journal of Phoenix Rural(Metr.o ............. .......... Corp. said Friday it is unable to file its annual financials for the fiscal year ended June 30 by the Sept. 13 due date as it continues to review its current and historical records. The Scottsdale -based ambulance and. fire services company (NASDAQ:RURL) identified accounting misstatements related to income taxes, deferred refit and other items. Although Rural/Metro has not yet completed the restatement of its financials, the company estimates the cumulative effect of the adjustments will be between $2 million and $4.5 million on an after- tax basis. The company also is evaluating whether any of the matters identified in the course of the restatement are the result of one or more material weaknesses in its internal controls. All contents of this site ©American City Business Journals Inc. Al! rights reserved. http://bizjoumalshire.com/phoenix/stories/2007/09/10/daily50.html?t=printable ,. 2/27/2008 Knox County fines Rural/Metro Ambulance $97,500 Service did not fully comply with contract response time News Sentinel staff Originally published 11:25 a.m., July 10, 2007 Updated 11:25 a.m., July 10, 2007 The Knox County Health Department said today it has assessed a $97,500 penalty against Rural/Metro for not fully complying with its contract to provide ambulance service. Health Department spokesman Ranee Randby said there is no reason for the public to be concerned about a lack of ambulance service, however. "If people call 911, there will be an ambulance available," she said. "There are contingency plans for other services to step up if Rural/Metro gets overloaded with calls." Rural/Metro service is judged on whether they can respond to an emergency call within 10 minutes or less 90 percent of the time, and on the number of vehicles available for response at a given time. Randby said Rural/Metro did not dispute the Health Department's assessment of penalties due under the contract. More details as they develop online and in Wednesday's News Sentinel. © 2007, Knoxville News Sentinel Co. 1 Comment Posted by ktownddy on July 10, 2007 at 4 p.m. A drop in the bucket compared to the value of the ambulance contract. Does ANYBODY know how much Rural/Metro is making in Knox County? Where was the "Ethics Panel" when a new contractor was recommended and then the decision was overridden by County Commission? Wake up Knox Countians!!!! • Reply to this post • (Suggest removal) San Diego renews contract with Rural/Metro Corp. - The Business Journal of Phoenix: Page 1 of 3 The Business Journal of Phoenix -July 2, 2007 http:llphoenix.biziournals comlphoenixlstoriesl2007/07102/newscoIumnl.html B IX us""mess Journal Friday, June 29, 2007 San Diego renews contract with Rural/Metro Corp. The Business Journal of Phoenix - by Angela Gonzales The Business Journal RuraljMetro Corp. renewed its contract with the city of San Diego, expecting to generate $3.1 million in net revenue each year. The Scottsdale -based -company took part in a competitive bidding process to continue as the exclusive provider of 911 ambulance transportation services to four counties in the San Diego area. The contract was awarded on a unanimous vote by the San Diego County Commission. The renewal contract begins Sept. 1 with an initial two-year term, followed by two earned renewal options of two years each. Through a subsidiary called San Diego Medical Services Enterprises LLC, Rural/Metro ....._....... ..........................._.........__-......_............._.............. ...... has served that area since 2ooi. The loo -square -mile, tax -supported district known as County - Service Area 17 represents a population of about 120,000. For more: www.ruralmetro.com. ................._..............__..........._...................._....__. Happy birthday, Mayo Mayo Clinic in Scottsdale is celebrating its loth anniversary this month. A party complete with birthday cake and an appearance by veteran journalist Ted Koppel were among the highlights. Mayo opened the clinic in 1987 and a hospital in 1998. The two Scottsdale campuses now total 40o acres. For more: www.mayoclinic.org/scottsdale. Dental group gains partner Healthcare Connect, a nonprofit that pairs low-income, uninsured residents of Maricopa County with discounted medical services, has teamed with American Dental Plan. Founded in 2003, HealthCare Connect has more than 3,000 active members who now will have access to enhanced dental services as part of the new partnership. American Dental, founded in 1978, offers discounted health services to more than 25,000 active members. For a $54 fee per person, the company links its members with dentists who http://bizjoumalshire.com/phoenix/stories/2007/07/02/newscolunm l .html?t=printable 2/27/2008 San Diego renews contract with Rural/Metro Corp. - The Business Journal of Phoenix: . Page 2 of 3 agree to give discounts on their services. For more: www.arizdental.com. Compare local hospitals The Centers for Medicare & Medicaid Services updated its Web site to give consumers better insight into the quality of care provided by local hospitals. The agency, which is part of the U.S. Department of Health and Human Services, also unveiled an update of pricing and volume information on certain elective hospital procedures. For more: www.hospita1compare.hhs.gov. West Nile virus is back The West Nile virus season officially has begun in Maricopa County. The Maricopa County Department of Public Health and the Arizona Department of Health ...__.............._.. ......... ......._............. Services confirmed that a West Valley man in his 60s was the first human case of the virus ......................... . ....... recorded in the county this season. The than has been released from a local Valley hospital and is recovering. Dr. Bob England, director of the Public Health Department, said the virus is not going away. "We have seen over the past few years that this virus can affect anyone, in any part of our Valley," he said. "It is important that we all take steps to protect ourselves." The virus is transmitted to humans by infected mosquitos. About 20 percent of the people infected with the virus will feel flu -like symptoms three to 15 days after the mosquito bite: Symptoms may include fever, headache, body aches, nausea, vomiting, swollen lymph glands, and a rash on the chest, stomach and back. A few people have more severe symptoms, such as meningitis, encephalitis and paralysis. Last year, six people out of the 75 confirmed West Nile virus cases died. For more: www.wearepublichealth_org. Abused animals get expert help Arizona Humane Society is partnering with a forensic psychiatrist to help address the issue ........_...-........................_......._......_............. of animal abuse and its link to societal violence. Dr. Steven Pitt of Scottsdale will volunteer his time to help the nonprofit understand why some people torture or kill helpless animals and to create profiles of serial, animal abusers. He already offers consultations for several local and national law enforcement agencies. Cheryl Naumann, president and chief executive of the Humane Society, said the organization always has focused on meeting the physical and emotional needs of animal victims. But the organization has never been able to answer questions as to why some people abuse animals, she said. http: //bizj oumalshire. com/pho enix/stories/2007/07/02/newscolunm l .html?t=printable 2/27/2008 San Diego renews contract with Rural/Metro Corp. - The Business Journal of Phoenix: Page 3 of 3 "Now, we will have that type of resource readily available so that members of our community will have a much better understanding as to the severity of these types of crimes, and the dangers that animal abusers present to society as a whole," she said. For more: www.azhumane.org. ....................... _..... _......................... _.......... InNexus ranks tops InNexu.sBiotechnology Inc. was named to the TSX Venture Top 50, which ranks the top to public venture capital companies in five industry sectors listed on the TSX Venture Exchange. The Canadian company recently moved its main operations to the Mayo Clinic campus in Scottsdale. Its stock is traded on the TSX Venture Exchange under the symbol ISX and over the counter under the symbol IXSBF. The drug development company is working on antibodies to fight cancer. For more: www.ixsbio.com. All contents of this site ©American City Business Journals Inc. All rights reserved. http://bizj oumalshire.com/phoenix/stories/2007/07/02/newscolumn l .html?t=printable 2/27/2008 Ambulance service inks deal with Missouri hospital - Memphis Business Journal: Page 1 of 1 Memphis Business Journal - December 15, 2006 http://memphis.bizjoumals com/memphis/stories/2006/12/11/daily38.html Memphis BISllleSS Joidilal Friday, December 15, 2006 Ambulance service inks deal with Missouri hospital Memphis Business Journal Rural/Metro Corp. has reached an agreement with Health Management Associates ........._.__..__.........................__.. ... .. .... .... Inc. to provide ambulance services in Butler County, Mo. - Under the io-year agreement Rural/Metro] will also be the non -emergency medical transportation service for HMA's Poplar Bluff Regional Medical Center. The deal could generate $2.2 million in revenue for Rural/Metro. "This agreement represents our ongoing efforts to capitalize on the trend toward outsourcing of hospital -based ambulance services," said Jack Brucker, Rural/Metro president and CEO, in a statement. "We are proud of our success in initiating and negotiating solutions that work for Rural/Metro and for our customers." Poplar Bluff Regional Medical Center is the largest hospital system in Southeast Missouri, with two hospital campuses and five outreach clinics serving a six -county region. The facilities are • owned and operated by HMA (NYSE: HMA), a leading operator of acute care hospitals, primarily in the Southeast and Southwest United States. Bryan Gibson, regional president, said he's pleased to establish a base of operations in that area of Missouri "and to further leverage our operational hub in nearby metro -Memphis, Tenn." Based in Scottsdale, Ariz., Rural/Metro (Nasdaq: RURL) provides safety services in 23 states and 400 communities across the U.S. Locally, the company provides 911 emergency ambulance services to Arlington, Collierville, Germantown, Lakeland, Millington, and Unincorporated Shelby County. 175 employees in the area provide more than 35,000 medical transports each year. The company also provides private fire protection for FedEx Corp. (NYSE: FDX). All contents of this site ©American City Business Journals Inc. All rights reserved. http://bizjoumalshire.com/memphis/stories/2006/12/11/daily38.html?t printable 2/27/2008 Rural/Metro ambulance contract renewed - Orlando Business Journal: Page 1 of 1 Orlando Business Journal - September 29, 2006 http://orlando biziournals com/oriando/stories/2006109/25 /daiiy43.html UNIONS Journal Friday, September 29, 2006 Rural/Metro ambulance contract renewed Orlando Business Journal Rural/Metro Corp. has been awarded an exclusive contract renewal to continue providing emergency ambulance services to Orange County. Scottsdale, Ariz. -based Rural/Metro (Nasdaq: RURL) provides medical transportation, private flit protection services and, other safety services in 23 states. The contract is expected to generate annual net revenue of about $io million. The contract term begins Oct. 1 and continues through Dec. 31, 2OO7. Rural/Metro has served Orange County and metro Orlando since 1985, providing more than 45,000 emergency medical transports in the last year. In addition tc 911 emergency ambulance services, the company's nearly 300 employees provide non -emergency medical transportation services to hospitals, long-term care centers and other health care facilities in Orange, Seminole and Osceola counties. Rural/Metro is the exclusive ambulance provider to Orlando Regional Healthcare, which includes eight major hospitals throughout Central Florida. "Our operations throughout Orange County continue to expand as population growth and density drive the demand for ambulance services," says Boo Heffner, Rural/Metro group president, in a prepared statement. Rural/Metro's stock has a 52 -week trading range of $6.33-$9.88 per share. The firm had a $3.5 million profit for the 12 months ended June 30. All contents of this site © American City Business Journals Inc. All rights reserved. http://bizj oumal shire. com/orlando/stories/2006/09/25/dai ly43. htm l?t=printable 2/27/2008 Rural/Metro ambulance deal could generate $50M - The Business Journal of Phoenix: Page 1 of! The Business Journal of Phoenix - December 14, 2004 http://phoenix.biziou rnals.comlphoenix/stories/2004/12/13/dailyl2.html Bns ness Journal Tuesday, December 14, 2004 Rural/Metro ambulance deal could generate $50M The Business Journal of Phoenix Rural/Metro Corp. Tuesday announced it has been awarded the exclusive contract to .._..........._..._..._...- ......................—. provide emergency and non -emergency ambulance services to Salem; Ore. The contract will begin July 1, 2005, with an initial term of five years, followed by five one-year optional renewal terms, for a total possible length of 10 years. The company estimates the contract will generate approximately $5 million in revenue annually. Scottsdale -based Rural/Metro Corp. (OTCBB: RURL.OB) provides emergency and non - emergency medical transportation, fire protection, and other safety services in 23 states and approximately 400 communities throughout the United States. For more: www.ruralmetro.com. All contents of this site © American City Business Journals Inc. All rights reserved. http://bizjoumalshire.com/phoenix/stories/2004/12/13/dailyl2.html?t=printable 2/27/2008 Pinellas' first -year EMS provider focus of county audit - Tampa Bay Business Journal: Page 1 of 3 Tampa Bay Business Journal -October 30, 2006 http://tampabay.bizjournals,comltampatkay./stp iizs!2006110/301storry4_htrn,l BTAMPA BAY usiness Jo rnot Friday, October 27, 2006 Pinellas' first -year EMS provider focus of county audit Tampa Bay Business Journal - by LarryHalstead Web Editor/Staff Writer When a Pinellas County audit of ambulance services points out numerous deficiencies in a $25 million annual contract, it gets the attention of county supervisors. The audit, released Oct. 19, showed a nearly $3 million loss by Paramedics Plus LLC, the Florida subsidiary of Paramedics Plus based in Tyler, Texas. The county's exclusive ambulance contractor is in its first year of the lucrative contract but incurred nearly $600,000 in response time penalties. It also doled out excessive bonuses to temporary staff, the audit said. None of the issues compromised the county's ability to respond to emergency calls, assured Chuck Kearns, director of Pinellas County_ . Emergency Mediarvc l Seies. ..... ............ The contractor's challenges are normal for a company new to Flcrida, Kearns said. The contractor agreed. Kathleen Cabbie Sunstar EMS crew members Jenne Nitishin, materials supervisor and Jose Velez, paramedic, check advanced life support equipment. Sunstar is the trade name for Pinellas County's emergency response service. View J.arger "This was an acquisition for us, and we knew going in that there would be changes," said Mark Postma, COO for Paramedics Plus. "But we're very happy with where we are now." Track record in the plains Paramedics Plus is not new to emergency service. It operates in 17 counties in East Texas and Oklahoma City and Tulsa, Okla. Pinellas experienced a surge of emergency calls in 2OO5 and is averaging almost 2,500 more transports a month above the 8,000 base calls dictated in the contract, the audit said. It's unclear to county executives why there's a recent spike in 911 calls. They usually only vary 1 percent a year, Kearns said. The increased demand for urgent care created a dire need for more ambulances at $125,000 http://www.bizj ournals. com/tampabay/stories/2006/ 10/30/story4. html?t=printable 2/27/2008 Pinellas' first -year EMS provider focus of county audit - Tampa Bay Business Journal: Page 2 of 3 each. Paramedics Plus added 10 ambulances, paid for by the county, and now has 68 and three supervisory cars. Paramedics Plus was assessed penalties for any month that its reliability rate for response time was less than 92 percent of the calls in 10 minutes or less. The county assesses a fine of $7 for every late minute to assure compliance with state guidelines on response times and standards of service, Kearns said. Factoring into response -time delays, the entire fleet needed repair for maintenance due to a Ford Motor Co. wiring defect, so for most of the whole first year it was not at full capacity, ........._........_ ................... Kearns said. To counter response time problems, Paramedics Plus opened a south hub at Edward White _.-..............._..............._.............. Hospital to station ambulances for faster deployment in south county. It is considering a similar hub for north county, the company said. So far, for the first quarter of the second year of the contract, the contractor is improving. Response time penalties have decreased to $64,668, less than half what the penalties were for the same period of the previous year, the audit said. The loss is also less.•Paramedics Plus reported a net loss of $134,163 for the first quarter. The second year of the contract is now complete, and the company did "substantially better" on the bottom line, Postma said, although he could not cite specific numbers because of incomplete financial reports. Adapting a work force When Paramedics Plus won the contract, it hired nearly all of the 388 workers that the previous provider used, most of whom had been part time. During the first year, as the contractor was converting the workers to full-time status, substantial overtime was incurred, costing the company approximately $650,000 in bonuses, the audit said. Since converting the workers to full time, the overtime rate has been reduced to less than 3 percent, Kearns said. Pinellas uses a voter -mandated model for emergency services that brings the entire county under the umbrella of one management agency. In turn, it contracts all ambulance services to a single provider and handles the billing to the end -users' insurance companies. It pays a wholesale rate of $208 a transport to Paramedics Plus and bills the patients approximately $451. But the contractor collects nothing if an emergency call is made and later cancelled because the patient decided to get another ride to the hospital or declined to get further medical attention. Last year this cancellation gap represented 52,000 of the 170,000 responses, Kearns said. Before Paramedics Plus, American Medical Response had the contract for Pinellas. It still provides basic life support response in Hillsborough County, which uses a different emergency http://www.bizjoumals.com/tampabay/stories/2006/10/30/story4.html?t printable 2/27/2008 Pinellas' first -year EMS provider focus of county audit - Tampa Bay Business Journal: Page 3 of 3 model than Pinellas. lhalstead@bizjournals.com 1 813.342.2467 All contents of this site © American City Business Journals Inc. All rights reserved. http://www.bizjournals.com/tampabay/stories/2006/10/30/story4.html?t=printable 2/27/2008 NewsOK.com Article Page 1 of 1 WS December 13, 2006 Council votes to keep EMSA Bryan Dean Staff Writer Oklahoma City win keep EMSA as its ambulance provider for another five years. The city council voted 6-2 Tuesday to continue an agreement with Me Emergenq Medical Services Authority. The vote came after council members reviewed several other options that would have placed Me responsibilky with the cty's fire department. . -I'm happy for the250 employees Mat work Me streets as hard as they do to estabfsh Me level of care that we've established there for the last 12 years,EMSA President Star Williamson said. "We are just extremely excited to have It over with and be able to start with our new initiatives." A $1.7 million savings A breakdown of the city's optlors showed staying with EMSA for the next five years would save about $L7 million over Me next-0,eape5 plan. Most of those savings are In the first two years of the contract, when high startup costs would drive up the prior of a city -run ambulance service. The decision on whether to kcep EMSA now rests with officials In Tulsa. The trust that governs EMSA is an agreement between the . state's two largest does. Councils In both does voted in October to extend to Jan. 31 the deadline for making a decision. If Tulsa decides to pull out of the EMSA agreement, Oklahoma City will need b find a new wayto provide ambulance service. Tulsa spokeswoman Sheryl Irvelady salt a committee formed by Mayor Kathy Taylor heard presentations from EMSA and Me Tula Fire Department and Isworking an a reportcomparirg the costs and benefits of EMSA and an ambuance service operated by the fire department. Sponsored Unks "They am on track to give her Mat report by Me end of Me week" tovelady said. "The No. 1 Issue here is Me delivery of quality care to the citizens, we are not going to compromise the qualty of care.- Mortgage Rates at 4.65°/° $170,0001oan.for $656/month. See New Payment - SSN Loveiady said Taylor will make a decision by Jan. 31. Refinance.Lead5[gn.tomm Save NOW T ca. Okiahama City Council members attended a vorkshop in Noveinbe where they reviewed options and asked questbns on the Isue. Notre Dame Certificates Ward 5 Co nciiman Jerry Foshee could not attend Tuesday's meeting and asked City Mana er Ann Cash to read a letter for him in Notre en Negotiation -and LeadersNp & Y 9 Management iine. m line) vMiM he asked that a decision be delayed so he could vote on Me pmp¢al. www.NotreDameOnlne.m $50 in tun dltlu Subsidy draws lire In the letter, Foshee questioned profits made by Paarnedl6 Plus, which operates EMSA's ambulances. "I've now been informed their profit Is In excess of $1 million annually plus the cost of executive compensation for Paramedics Plus and for EM5A ogldals; Foshee stated In Me letter. "We have been subsiding EMSA so they can pay a profit. I ask you: Is this in Me best interest of the taxpayers? I think not. Ward 2 Councilman Sam Lowman and Ward 6 Councilwoman Ann Simank cited Me growing subsidy as Me reasonfor voting against the contract. Those voting to renew Me contract said it was lero to look past the high stamp costs of putting the ambulance service under Me ay's fire department. Ward 1 Councilman Gary Maims, a former cry fire thief, said meting such a dramatic change Is a risk. Mans said tak!ng such a risk any r.akeF sense If It wind save :nonev or if Me can ent ar.'5uiance servl¢ s ursatisfactcrf. ' "I don't think there isa financial reason to take this risk," Mans said. "I have not had a snple person — commurty leader, citizen, business leader — come to me and champion getting rid of EMSA' http://newsok.com/article/2984644/?print= 1 2/27/2008 Oklahoma City Joins Tulsa in Delay on EMSA Decision — Emergency Medical Services (EMS... Page 1 of 2 Oklahoma City Joins Tulsa in RpuFMS d.&, Delay on EMSA Decision Bryan Dean The Daily Oklahoman Oct. 25 --Leaders of the state's two largest cities will have until Jan. 31 to decide on the future of O.il• LexiSNexis ambulance service. City council members in Oklahoma City and Tulsa are trying to decide whether to continue relying on the Emergency Medical Services Authority or shift the responsibility for ambulance service to their fire departments. Oklahoma City Council members voted Tuesday to extend a deadline on the decision, which had been set for Oct 31. Tulsa council members approved the three-month extension last week. Oklahoma City Manager Jim Couch said arranging for the extension was complicated. EMSA officials supported extending the deadline. "The more time they take, the more they'll understand our complicated system, which will only help us," EMSA spokeswoman Lara O'Leary said. "What they'll find is that EMSA provides unparalleled clinical excellence and unparalleled value to the city." Tulsa officials requested the extension earlier this month after a report from the Tulsa Fire Department showed the city could save money by ending its relationship wtlh EMSA. EMSA officials dispute the fire department's numbers. Oklahoma City appeared ready to vote to extend the agreement before Tulsa requested the extension. Oklahoma City's fire department looked at what it would cost for firefighters to take over ambulance service and found the city would pay at least $4 million more in the first five years. Council members attended a workshop in September where they went over several options for changing ambulance service. None were cheaper than the current arrangement with EMSA. Ward 1 Councilman Gary Marrs said the city is looking at another option that could be cheaper-- running ambulances with civilian employees but consolidating administration under the fire department. Although Oklahoma City officials have studied the issue more than their Tulsa counterparts, some council members still wanted more time. Ward 6 Councilwoman Ann Simank said she was relieved when Tulsa asked for the extension. "This will give our staff plenty of time, hopefully, to get those numbers together and brief all of us," Simank said. "It will also give council enough time to host another workshop and maybe have a public meeting with input. I think this is a large enough decision that we need to do it that way." Copyright (c) 2006, The Daily Oklahoman Distributed by McClatchy-Tribune Business News. For reprints, email , call 800- 374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. http://www.emsrespondercom/article/article.j sp?id=4327&siteSecfon=l 10/31/2006 Oklahoma City Joins Tulsa in Delay on EMSA Decision — Emergency Medical Services (EMS... Page 2 of 2 Copyright 2005 LexisNexis, a division of Reed Elsevier Inc. All rights reserved. Terms and Conditions I Privacy Policy. News stories provided by third parties are not edited by "Site Publication" staff. For suggestions and comments, please dick the Contact link at the bottom of this page. . RSS Feeds for EMSResponder.com: Top EMS News Section Printable version may be for personal use only. Content may not be duplicated, re -used or otherwise replicated without expressed, written consent from EMSResponder.com and/or the original author/source. Visit EMSResponder.com at http://www.emsresponder.com for the latest industry news, commentary, features and more. Copyright © 2006 All rights reserved. Cygnus Interactive, a Division of Cygnus Business Media. http://www.emsresponder.com/article/article.jsp?id=4327&siteSection=l 10/31/2006 Okiahmoma City Cites Cost of Proposed Ambulance Switch — Emergency Medical Services (E... Page 1 of 2 Oklahmoma City Cites Cost ofS.. Proposed Ambulance Switch. Bryan Dean, Staff Writer The Oklahoman (Oklahoma City, OK) Putting the Oklahoma City Fire Department in charge of ambulance service would cost taxpayers a LexisNexis' minimum of about $2 million more during the next seven years, city staffers said in a report released Tuesday. Depending on what option Oklahoma City Council members chose, the cost could be about $7 million more, the report shows. City council members have until the end of October to decide whether to continue the Emergency Medical Services Authority partnership with local communities and Tulsa or hand over ambulance service to the fire department. Oklahoma City will pay $3.4 million to subsidize EMSA this year. The subsidy is more than double what it was when the city began paying it in 1999. Backers of the switch claim the move would be beneficial for city residents because it would give the fire department control of how medical emergencies are handled. . Some backers also say the fire department could operate ambulances more cheaply by using firefighters, Supporters point out that today, all Oklahoma City firefighters are qualified as emergency medical technicians. The city has 149 firefighters who have the additional year or more of training required for paramedic. certification. They also note the city recently has bought EMSA's ambulances as part of the subsidy. Fire Chief Keith Bryant said Tuesday the costs would be high if the city assumed ambulance services from EMSA during the next two years, however. The fire department would need to hire 95 new employees, including 86 additional firefighters, to take over ambulance service, On average, the city expects to pay EMSA a subsidy of about $4.7 million a year through 2013. The cost of switching ambulance service to the fire department would average between $5 million and $6 million a year during the same period. The city would pay about $6.4 million in 2008 and between $9.6 million and $10.7 million in 2009, according to the report. After 2009, the additional cost to the fire department would be less than the subsidy required by EMSA, the study shows. Stephen Williamson, EMSA president and chief executive officer, said the study validates what EMSA has been doing in Oklahoma City. 'When we are compared anywhere in the United States, we are providing the highest level of care at the lowest cost to the city and the patients,' Williamson said. EMSA employs 204 people in the Oklahoma City area, including 73 full-time paramedics and 72 emergency medical http:f/www.emsresponder.com/article/articlei sp? siteSection=1 &id=413 8 9/22/2006 Oklahmoma City Cites Cost of Proposed Ambulance Switch — Emergency Medical Services (E... Page 2 of 2 technicians. The report also looked at the cost of using firefighter paramedics with EMSA personnel. The combined approach would rely on the fire department to provide the more highly -trained paramedics while continuing to employ emergency medical technicians through EMSA. The report also proposes using civilian emergency medical technicians who aren't part of EMSA - this option would cost the least of any of the fire department plans - but it still would cost more than what it would cost to stay with EMSA. The city is currently paying the EMSA subsidy out of its general fund, made up mostly of sales tax revenue. Another option would be forming an ambulance district, which would collect money from property taxes. Mark Schwartz, attorney for the city's firefighters union and a former city councilman, said shifting ambulance service to the fire department could have other benefits. He expects other cities that currently depend on EMSA will end up contracting with Oklahoma City for their ambulance service. Copyright 2005 LexisNexis, a division of Reed Elsevier Inc. All rights reserved. Terms and Conditions I Privacy Policy News stories provided by third parties are not edited by "Site Publication" staff. For suggestions and comments, please click the Contact link at the bottom of this page. RSS Feeds for EMSResponder.com: Top EMS News Section Related Links . Debate Set or, Oklahoma City EMS Service Printable version may be for personal use only. Ccntent may not ba duplicated, re -used cr otherwise eplicated without expressed, written consent from EMSResponder.com and/or the. original author/source. Visit EMSResponder.com at http-//www.emsresponder.com. for the. latest industry news, commentary, features and more. Copyright © 2006 All rights reserved. Cygnus Interactive, a Division of Cygnus Business Media. http://www.emsresponder.com/article/article.jsp?siteSection=l&id=4138 9/22/2006 Print version The Morning News II Local News for Northwest Arkansas P:,,FinYP;ag Medicare billing fraud lands three in federal prison By Ron Wood The Morning News FAYETTEVILLE -- The former owner of an ambulance transportation service and two employees were sentenced to federal prison Friday for fraud and overbilling the government. Debra J. Drummond, William H. Noblin and Michael Noblin -- through Drummond's companies, Arkansas Patient Transfer and Arkansas Transport Service -- were part of a scheme to defraud Medicare and Tricare, which pays for the care of retired veterans and their families. The companies routinely transported patients who weren't qualified for the service, then fraudulently billed the government, according to prosecutors. They also altered certificates from doctors to indicate that patients needed the transfer service when, in fact, they did not. Drummond was aware of the practices, prosecutors said. Sometimes they didn't have qualified personnel on board the ambulances as required by their certification. "Some were transported simply because they didn't have a ride home," U.S. District Judge Jimm Larry Hendren said, reviewing a presentencing report. Hendren called one $30 trip for which the government was billed $687 "astounding." All pleaded guilty in a deal with prosecutors in September. Arkansas Patient Transfer and Arkansas Transport Services have been sold as part of the plea deal's requirement that Drummond and the Noblins not participate in any business that bills Medicare or Tricare. Drummond was sentenced to six months in federal prison, one year of supervised release, fined $2,000 and is responsible, along with each of the other defendants, for paying the government $42,000 in restitution. William H. Noblin was also sentenced to six months in federal prison, one year supervised release and fined $2,000. Michael Noblin was sentenced to three months in federal prison, one year supervised release and a $1,000 fine. Drummond is also responsible for $23,200 in fines against each of the two businesses. The government has filed a civil lawsuit aimed at recovering more ill-gotten gains from the defendants, prosecutors said. http://www.nwaonline.net/articles/2007/02/10/sews/021007fzambulancefraud.prt 2/12/2007 Print Page Crawford JPs Put Ambulance Vote On Hold By Rusty Garrett Tuesday, October 10, 2006 10:29 AM CDT - TIMES RECORD • RGARRETT@5WTI_M_ E_S_COM The re-entry of one bidder and the desire by some Crawford County justices of the peace to hear a pitch from another delayed a vote on an ambulance service provider Monday. The Quorum Court voted 7-6 on a motion by JP Uoyd Cole to amend the budget of its monthly meeting and consider a provider of emergency medical service for the rural areas of the county. The vote was short of the two-thirds majority required for the action. Justices of the peace Don Jenkins, Sharon Partain, Delia Friddle, Giles Osborne, Sharon Blount and Penny Lane opposed the amendment. Supporting it were Cole, Johnny Ragsdale, Marsha Woolly, Travis Steele, Dorothy Cox, Ernie Schimmelman and E.H. Pitchford. Cole, who is chairman of the court's Health and Welfare Committee, said representatives of Southwest EMS, a Mena - based service that withdrew its bid at the Sept. 18 committee meeting, indicated they again are interested in the contract and want to be considered. Southwest has been awarded an exclusive contract for providing service in the Van Buren city limits, effective Jan. 1. Partain criticized Cole for not letting iPs know earlier the company had changed its mind. She also observed that earlier consideration of the issue had attracted numerous citizens and she felt they ought to have advance notice of a final vote on the contract. Osborne said the reversal by Southwest "kind of troubles me." Jenkins said he had received a letter from one of the local companies bidding on the service that they did not understand they would be allowed to make a presentation at the Sept. 18 meeting, so they did not send anyone. Jenkins said he felt the court should investigate his claim and make sure everyone interested in the contract be allowed to speak before a vote is taken. Care One EMS was the firm not represented at the meeting. Representatives of Angel Care EMS, Southwest and Southern Paramedic Service of Brinkley made a presentation and fielded questions. During the meeting both Southern and Southwest withdrew their bids. The committee voted to recommend the Quorum Court contract with Angel Care, the current contracted provider of service to both the county and Van Buren. That contract expires Dec. 31... Cole offered a second motion proposing all the remaining bidders be invited to the court's Nov. 13 meeting to address the full Quorum Court, which will vote on the service provider at that meeting. http://www.swtimes.com/articles/2006/10/10/news/newsO7.prt 10/11/2006 'imes Record Page 1 of 3 Navigate News index Page Week In Review TOP STORIES: Scrapbooks Chronicis GMng Hospital Boom Permit Laval Hogs Chow Up Chlppswas NEWS I SPORTS [BUSINESS I OPINION I FEATURES I OBITUARIES I INSIGHT I Spats I Sports Calendar I Week in Review I Fort Smith &aIEaFCNNSt,Com I NBA -cam I NFL.com I MLB.ean I NHL Circulation I Suj at,e Career Opportunites Contact Us Advertise With Us Upload Ads Stephens Media Helpful Links On fine Forms FAQs Digital Coupons Photo Gallery ., Mailing List Wednesday. December 6,20068:59 AM CST JPs Award Ambulance Pact Despite Suit Threat Vy Ruaty earns TIMES RECORD • RGARRETTGBWTWES.COM Despite a threat of a lawsuit by one attorney and a warning by their own attorney their action cannot withstand a own challenge, the Crawford County justices of the peace voted to award the county's ambulance service oontrect to Care One EMS. The Quorum Court voted 9.3 Monday for an emergency ordinance authorizing a three-year contract with the Van Buren•basad service effective Jan. 1. JPs Johnny Ragsdale, Travis Steele and Marsha Woolly opposed the measure. Voting for a were JPs Sharon Blount, Lloyd Cole, Dorothy Cox. Don Jenkins, Penny Lane. Gass Osborne, Sharon Pertain, E.H. Pitchford and Ernie Sthlmmetman. Delia Friddle did not attend the meeting. The action followed a discussion during which Charles Baker, county attorney, warned JPs the threat of a lawsuit had been lodged by John Everett. S Fayetteville attorney rapreseneng Jeff Marvin, owner of AngelCare EMS. Baker told JPs, "I think there is a problem in this case. and suggested the coast •back up end do things according to the law" to eliminate the threat of legal action. In his letter, Everett alleges the bidding process for ambulance service, in which both AngelCare and Cate One partiipated, "involves more deficiencies in matters of procedural due process and violations of the law of this state than one can count' Everett wrote that Marvin had instructed him to try to persuade the court to start the bidding process tom square 0neso that all parties Involved have equal and unbiased opportunity to bid fairly. He asks for bidding by sealed bids,' without the opportunity to make oral modifications of bids, without the opportunity to unnecessarily Influence Quorum Court members, without members of the Quorum Court meeting in apparent violation of the Freedom of Information Act. r The letter states that if the court does not comply, Everett will file suit against the county and each member of the Quorum Court Individually 'for the manner in which they have conducted this bidding process and damaged AngelCare EMS' In a letter to County Judge Jerry Williams and the Quorum Court. Baker said he had reviewed htip://www.swdmes.com/articicb(2006/12/06/week iu_review/Bews�wednesday/news06-W I2/12/2006 'imcs Record JL !/- Page 2 of 3 county bid documents and Care One's bid and has concluded Everett is correct. The proposal submitted by most of the providers were not responsive and should not have been ooruWered,' Baker wrote. He said Care One's bid 'is wholly unresponsive to the county's proposal.' and concluded, 1 do not believe there Is any possibility that the county could defend is selection of Care One It this mater is challenged In court' Baker wrote the desCiandee largely clammed from Care One's derision to submit its own proposal Instead of contploting the bid document. He wrote as a result 'Care One's proposal was aloof on numerous requlements of the county proposal. Baker recommended JPs rescind their decision to Contract with Care One, made at the Court's Nov. 20 meeting, and begins new bidding process for the service. He said because the coody's current contrad with AngelCare expires Dec. 31, the county should extend a ehort- term contract to a provider of is choosing, or allow the contract to expire without raining a provider, allowing any interested company to provide services Until a long-term contract is signed. ' Baker also provided JPs a list citing 17 apecilc de6Ciendes In the prmpoeal as wel as a time lino of the county's action with regard to the bids. Rather than farad Bakefa advice. JPa chose to consider en ordinance naming Care One as the service provider. Batter chWbnged s motion by Jenkins to consider the ordinance, noting the agenda for the special meshing indlcated JPs were to disass Implementation of the ambulance contract not vote an a contract. Reactions to the warnings were varied. Steele expressed concern, agreeing that some bids were incomplete and that the cast had Ignored is own procedures In considering the proposals. He said the court relied on IS Health and Wettare Committee tot a recommendation, which It did not get. Re gadale complained about the oeledien process at the November mooting, during which no vote was taken for AngelCare. Jenkins termed Everest's communication a'sky is felling letter and said the court had not violated the law and had In tad and above and beyond what is required' in the process. Print Nis story i Email this clay http://www.swtimes.com/atticles/2006/12!06/week in_review/news/wednesday/news06.txt 12/12/2006 1'heCabin.net print version •• MEMS board cuscusses aavertising campaign rage i TheCabin , et ,t t ogfakitnDemocat This article was originally published on January 23, 2008 MEMS board discusses advertising campaign By MONICA HOOPER LOG CABIN STAFF WRITER During its board meeting Tuesday, members of the MEMS board of directors discussed launching an advertising campaign to promote a membership drive with the ambulance service provider in an effort to increase funding for the organization, which asked the Conway City Council and the Faulkner County Quorum Court for subsidies of about $150,000 in 2007. Blake Rutherford, public relations manager from Stone Ward creativity services, gave a presentation on advertising costs to boost the proposed MEMS Alert subscription drive in Arkansas. According to the advertising budget given by Rutherford, MEMS would invest $130,700 in order to run a print media and TV campaign urging residents, including those in Faulkner County, to sign up for MEMS Alert, which would provide ambulance service to private citizens for an annual fee. There was a discussion over the cost of launching a TV advertising campaign in relation to which TV stations MEMS would use and whether or not the end of the advertising campaign would justify the means. Rutherford felt that MEMS should try for several stations rather than relying on public service announcements so that the group could attract their target audience. MEMS Executive Director Jon Swanson said he shared Rutherford's concern. Advertisement - 'We could spend $50,000 on a campaign and see it fail and get nothing for it," Swanson said. Rutherford said an awareness campaign like MEMS is considering "cannot be one- dimensional." Rutherford went on to say, "I would be careful about saying, 'Lets just run a print campaign now and six months from now we'll do TV' because, quite frankly, six months from now you're going to have to start all over." Rutherford added that now is the cheapest time to purchase air time because of upcoming elections. Board members questioned how long it would take to recoup the investment in both forms of media and earn money to reduce the amount of subsidies that were requested. MEMS has already started bulk mailing, which is separate from the print media campaign, to counties in Arkansas. For Faulkner County, Swanson has proposed a mailing. Tim Tyler, a Faulkner County representative for MEMS, said, "We're going to (mail out ads) in Faulkner County. The county judge has already said he wants to put http://www.thecabin.neticgi-bifllPrtfltme.Pl 1/25/2008 1'heCabin.net print version MEMS board discusses aciverusmg campaign rage L vi J the inserts in tax receipts,' which will come out in June. Patty Lueken, who serves on the MEMS board, asked Rutherford about the success of the mailers and a print media campaign. Rutherford replied that it would get the word out, but that he couldn't project any figures. Tim Tyler asked about taking out billboard space. Rutherford replied that billboards get the word out but may not facilitate the call -to -action that MEMS hopes to generate. Swanson added that the advertising campaign wasn't only a subscription drive but a public image component because the drive would put MEMS in front of people and "the whole context of the issue of public subsidies" Swanson said. "There's intangible benefit in that regard." Board member Doug Lauder of Maumelle said, "I have to look at Maumelle giving $63,000 in subsidies, then they'll see (MEMS advertisements) on television and say, 'Gee I wonder how much that cost.'' Sandy Brewer, a MEMS board member from Faulkner County, later said, "By everybody's own admission, we acknowledge that we may not even come close to breaking even whether we spend $5 or $500,000 and we're looking at a protracted payback at best. What we're trying to do is generate some cash flow here ... I still contend that we do not have any track record on what" anyone's proposal to generate funds will do. "Therefore, I'm not really interested in investing a bunch of money in something" that will not guarantee a payback. "When you have very little investment, there are a number of opportunities out there, a number of resources, something well beyond on what I can bring to the table." Brewer revisited the point that MEMS qualifies for public service announcements since it is a non-profit organization. "I don't think anything, but a very minimal investment of cash and a maximum investment of our talents and resources that we have at this table" will help the group generate funds. Lueken then proposed that the group take the alternaiive considerations to a committee and have the committee give a proposal to MEMS during its Feb. 26 meeting. Brewer suggested that members go back to their communities and "find out exactly what you can do toward this effort" by connecting with their local media. Tyler also asked for time to return to the county and present advertising figures. Lueken proposed tabling the issue until the next meeting on Feb. 26 to which the board unanimously agreed. MEMS has asked the city of Conway and Faulkner County for subsidies to cover deficits leftover by Medicare cutbacks that came into full affect in 2006. Swanson said that MEMS currently has five stations in Faulkner County, three of which are in Conway. While Conway approved $91,000 for subsidies, Faulkner County has not committed to the $55,000 subsidy requested, Swanson said. Swanson explained MEMS subscriptions will give residents an opportunity to pre -pay for ambulance service. In Conway, the average response time was 5.44 minutes, throughout the county response time averaged 12.22 minutes in 2007, according to MEMS. Without the subsidies asked of Faulkner County, Swanson said he could not guarantee the same response times because there will not be as many ambulances available to the county. (Staff writer Monica Hooper can be reached by e-mail at monica.hooper@thecabin.net or by phone at 505-1266. Send us your news at www.thecabin.net/submit) http://www.thecabin.net/cgi-bin/printme.pl 1/25/2008 From KATV: Arkansas Taxpayers Could Fund Operating Cost for MEMS Location: Arkansas Reporter: Jessica Dean Posted: October 10, 2007 9:41 PM EST URL: httD://www.katv.corfl/fleWs/st0ries//462787.html Arkansas - Cuts in federal funding could leave some Arkansas taxpayers paying the operating costs for MEMS Ambulance Service. Five out of the ten areas covered by MEMS must now decide if they will subsidize ambulance coverage. MEMS representatives say they have done everything they can to absorb the federal pay cuts without lowering their quality of care, but now they need outside financial assistance just to break even. MEMS answers around 200 emergency calls a day, and they don't want to slow down anytime soon. (Jon Swanson, MEMS) "We don't want to have any reduction in the coverage, the training and capability of the crews, the equipment they carry." But cuts in Medicare payments across the nation are making that goal increasing difficult for the non- profit ambulance services MEMS. That's why MEMS is now asking some of the areas it cover to subsidize its operating costs. (Swanson) "We've reached a point now in some communities, in order to continue to sustain high quality operations, we need some financial support." MEMS asked five areas for subsidies, including, Sherwood, Cabot, Lonoke, Grant County and Maumelle, where the total subsidy amount would be close to $63,000. (Mike Watson, Maumelle Mayor) "It's a need if we have an automobile accident that needs three ambulances, if we only have one, where do we get these other two ambulances." Mayor Watson says in the end, the subsidy only makes sense. (Watson) "In the long run, I think it's cheaper and better for our community." If any of the communities decide not to subsidize MEMS service, MEMS will continue to cove, them until the area finds a new ambulance service. Copyright 2007 katv, LLC previous page EXPERT http://www.katv.com/printarticle.lirb?a=p&f=n&s=462787&fl=loc&stat=katv 10/11/2007 Eudora resident skipped by EMS Ambulance lack risky, town says BY MIKE LINN ARKANSAS DEMOCRAT -GAZETTE Seven weeks ago, Eudora resident Gwendolyn Dotson called 911 and asked for an ambulance to come get her L3 -year -old son Gavin, who is plagued with a rare heart disease and was having a seizure. The ambulance company, Emergency Ambulance Services Inc., notified her that a truck was coming to transport the teen to Chicot Memorial Hospital in Lake Village. Minutes Later, Dotson said she received a call from dispatch notifying her that the ambulance service had a change of plans and was unable to make the 16 -mile run from Lake Village to Eudora to pick up Gavin, who by that point had passed out from lack of oxygen. Dotson and Gavin's tutor, Beverly Dowdy, drove the youngster to the hospital and doctors were able to stabilize him. Dotson, however, fears the next time Gavin has a seizure, he may not be so lucky "If it happens again - and I know it will - I fear he may die or lose consciousness for a long time," Dotson said Thursday in a telephone interview. "It's a serious matter for me and the elderly people here in Eudora. It's a serious matter for everybody." For the past year, the city of Eudora has had no guaranteed ambulance service to transfer residents to hospitals, a. problem the local 911 coordinator says reverts the town near the Louisiana border back to the Stone Age. The 2,531 -population Chicot County community declined to enter into an agreement this year with Emergency Ambulance Services Inc., a Pine Bluff company with a two - ambulance station near Chicot Memorial Hospital in Lake Village. EASI and another ambulance company 35 miles from Eudora in Dermott, Elite Medical Services Inc., will transfer Eudora residents to hospitals on a case -by -case basis, although neither company is obligated. The lack of guaranteed ambulance service has led to resident complaints, including one from Dotson, who has filed hers with Eudora Mayor William Stanton. "It's a pretty serious situation out here in Eudora," said James Cathey, the Chicot County 911 coordinator. "Not having an ambulance service puts us back in the Stone Age." The city of Eudora had had an ambulance company stationed in its community from the early 1990s until last September, Cathey said, when Elite moved its ambulance company from Eudora to Dermott. Elite, by moving, canceled its emergency services contract with Eudora and entered into one with Dermott, population 3,422, according to the U.S. Census Web site. Spearheading Elite's move to Dermott was the decision by EMS of Southeast Arkansas, another ambulance service company, to cancel its agreement with Dermott last year. Since Elite left Eudora, 911 dispatchers have to contact Elite or EASI to transfer Eudora patients to hospitals on a case -by -case basis. EASI, which is closest, is the first company contacted in case of an emergency, Cathey said. Ken Starnes, the owner of EASI, said he receives about 20 calls for service to Eudora each month and is able to serve about 85 percent of those calls. Had the city entered into the contract, Starnes said, he would be obligated to answer all of the calls to Eudora. "I feel terrible for these folks in Eudora because they don't have an ambulance service," Starnes said. "They're basically unprotected." Stanton, however, said the agreement with EASI would have been worse than what the city has now. He said EASI's franchise agreement with the city of Lake Village means the ambulance company has to have one ambulance available there at all times. EASI has two ambulances in Lake Village and serves the rural part of Chicot County, so if one ambulance is called out to the county, a second ambulance must be stationed in Lake Village. This means if one ambulance was on a call and Eudora needed the second ambulance, they would have to wait for the first ambulance to return to Lake Village, Stanton said. The proposed agreement, the mayor said, did not provide for an ambulance to be stationed in Eudora, which was what the city wanted. The contract did say an ambulance, if called, would have to be on location in Eudora in less than 20 minutes in accordance with the standards of the American Ambulance Association. Starnes said if Eudora had entered into an agreement with EASI, his company would have been obligated to come pick up its residents - whether or not there was an ambulance in Lake Village. If EASI didn't have an ambulance available, Starnes said his company would have had been obligated to call for mutual aid from other ambulance services in Dermott or neighboring Ashley County. As it stands now, EASI will help out Eudora the best it can, but without an agreement the ambulance service isn't obligated to respond, Starnes said. ''Right now, if we get a call from Eudora, and I have two ambulances in Lake Village, I'll send one to Eudora, but if I only have one, I won't leave my service area uncovered to help somewhere that's outside my service area," Starnes said. "Had they entered into the agreement, then I would have." Stanton said the situation is endangering his residents. He said he's thought about the possibility of having a city -owned ambulance staffed by city employees, but he doesn't believe the city could afford it. Starnes said he has offered to give Eudora an old ambulance for free for them to use as a safety net. The city would have to get the ambulance licensed through the health department and insured, Starnes said. "I offered a contract to them, which they didn't warit, and then offered to give them an ambulance," Starnes said. "I'm not really sure what else I can do." Meanwhile, Elite and EMS of Southeast Arkansas have filed a federal lawsuit against EASI, the city of Lake Village, Chicot Memorial Hospital and Chicot County alleging they violated the U.S. Constitution's commerce clause and anti-trust laws. The lawsuit alleges that EASI can't be the only ambulance service allowed to transport patients from Chicot Memorial to other area hospitals and nursing homes. Jim D;'ntelman, owner of Elite, declined to comment for this story and referred all calls to his ztterney, John L. Kearney, of Pine Bluff. Kearney did net return calls. Starnes declined to comment on the lawsuit, but did say if a Chicot Memorial patient is going to be transported from the hospital, the patient is asked whether he or she has a preference on what ambulance transports them. If they don't, EASI makes the transport, Starnes said. On Tuesday, the Lake Village City Council - after going out for bids for an ambulance service - voted to extend its contract with EASI for three years, city officials said. Other complaints against EASI include the ambulance service's requirement to take its Chicot County residents to Chicot Memorial Hospital first. 6 Some of the residents in Eudora and south Chicot County have a physician who works at West Carroll Memorial Hospital in Oak Grove, La. Starnes said he can't technically take patients to hospitals in Mississippi or Louisiana, because they aren't in his service area. He can, however, transfer a patient from Chicot Memorial to an outof-state hospital in a non -emergency. Starnes pointed to the Arkansas Board of Health's rules and regulations for emergency • medical services, which says under section 3-B-1 that "A licensee under this act shall transport any patient to the care facility of the patient's choice within the service area of the ambulance." "In times of disaster, all rules are out the window," Starnes said. "But we can't routinely transport a patient from Eudora to Oak Grove, La. Louisiana doesn't like it, because we're not licensed to run an ambulance in their area. Arkansas doesn't like it, because their rules say we have to bring patients to the local hospital in our service area." Chicot County Judge Fred Zieman has scheduled a meeting for December with all of the Chicot County communities to discuss issues related to ambulance service. "We're all bent out of shape on this ambulance issue," he said. This article was published on page 7 and 11 of the Monday, November 12, 2007 edition in the Arkansas section. rit A -i3aW- Z'.O t M ' t A long-awaited report from the Government Accountability Office (GAO) on Medicare reimbursement for ambulance providers has concluded that the cost of providing care to Medicare patients is more than the reimbursement paid. the GAO found that for the years 2001 to 2004, Medicare payments were on average 6% below the national average cost of providing ambulance services. However, the report also found a wide range in ambulance costs, depending on the location of the ambulance service, the types of calls they ran and whether they were receiving a tax subsidy. The range of actual costs were from a very nominal $99 per transport to a rather extreme $1,218 per trip. Obviously, with the cost numbers varying so greatly, some providers will be making a significant profit at the current Medicare rates, while others will be operating at a loss. For the report, the GAO looked at average costs and reimbursement and found that the average cost of providing ambulance transportation services was $415 per trip. Underpayments Add Up The 6% average underpayment may not seem like a large amount, but if you look at it in terms of dollars, for each trip that costs the expected $415 to provide, you are receiving only $390. Every time you transport a Medicare patient, you are basically giving $25 to the Medicare program. The study also found that Medicare patients represent 40% of all ambulance transports; therefore, it does not take long for that $25 to amount to a significant sum of money. Also, the GAO did not take into account the potential for bad debt on the patient's 20% co -pay portion. Rather, numbers for Medicare co -pays to determine how much more money you are losing on a Medicare patient. Unless you are getting all of your co -payments, you are losing even more on each transport than the report suggests. Medicare -allowed amount is paid. Look at your own write-off • There was no significant disparity between urban and rural areas after applying the rural mileage payment adjustment and the geographical adjustments (the geographical price cost index, or "GPC"). However, the cost to reimbursement comparison was much worse for "super -rural" areas. For those locations, Medicare payments were 17% below the cost of supplying ambulance services. This means that the current adjustments for rural areas are working well to bring their reimbursement in line with urban areas; however, the adjustments for Will Congress Modernize Medicare? The study was requested by Congress as part of the Medicare Modernization Act (MMA), which gives me hope that Congress will act upon the results they were looking for by adjusting the Medicare ambulance fee schedule rates to compensate for our subsidizing the Medicare program out of our operating budgets. In fact, there is already a bill pending that would extend the Medicare payment adjustments that were part of the MMA. If that legislation is passed, it would be a patch for the problem, but because of how the current adjustments are http://www.ernsresponder.cornlfeatures/article.j sp?siteSection=0&id=6001 LVLVULV41V 1V1615111J— LLLlla SV11VJ 1VI J1%?Gl 0M1 V1Via `Li1V1J1\VJIJVIILLIa.IiV LLL7 1 "6V L V1 L structured, it might not address the disparities in some areas of the country as much as others. Hopefully, any long-term resolution to this problem will be fair across the country and will take into account all of the study's findings. The report did find that even without additional modifications to the fee schedule, reimbursement rates by 2010 would catch up to the current underpayments. Of course; Medicare rates are a significant improvement over what we are paid by most states' Medicaid programs. But the two cannot really be compared: Medicare is.an insurance program, while Medicaid is a government benefit for the needy. The reality is, while Medicaid rates may be far below the actual cost of providing service, the individuals who need access to healthcare may not be able to pay anything; therefore, the Medicaid rates are better than what providers may expect to collect otherwise. The full 61 -page GAO report cannot be completely summarized here. It breaks down costs and reimbursement in several ways that might be of interest to different types of providers in different areas of the country. I encourage all of you to read the report with your service in mind. It can be viewed on the GAO's website at www.gao.gov. This article is not intended to be legal advice. G. Christopher Kelly is an attorney practicing in Atlanta, GA. Chris focuses on federal laws and regulations as they relate to the healthcare industry and specifically to the ambulance industry. He also lectures and advises ambulance company clients across the U.S. Contact him at chris@emscltd.com. Chris Kelly is a featured speaker at EMS EXPO, October 11-13, in Orlando, FL. For more information, visit www. emsexpo2007. corn. Printable version may be for personal use only. Content may not be duplicated, re -used or otherwise replicated without expressed, written consent from EMSResponder.com and/or the original author/source. Visit EMSResponder.com at http://www.emsresponder.com for the latest industry news, commentary, features and more. Copyright © 2007 All rights reserved. Cygnus Interactive, a Division of Cygnus Business Media. http://www.emsresponder.com/features/article.jsp?siteSection=O&id=6001 9/20/2007 UI1ICr D1V1J 1GGG5 ,pL.91111111U11 ULLUgbI JIIUI'11Q11 : 11Q1JlCJ1ICW 8fGVll1 rAgc I Em Collier EMS faces $2.4 million budget shortfall By RYAN MILLS - - Thursday, February 14, 2008 The Collier County Emergency Medical Services Department is facing a $2.4 million shortage in 2008 due in part to fewer projected transports and an increase in the percentage of calls paid by Medicare. As a result of the projected short fall, EMS is recommending a reduction of four EMS units encompassing 24 field medics, and postponing the purchase of three scheduled replacement ambulances, according to an Executive Summary report released today. "I'm kind of in shock right now," said Chief Jeff Page. "This is a tough thing." The recommendations will be presented to the Collier County Board of Count Commissioners at its Feb. 26 meeting. EMS has an $11.2 million budget for fiscal year 2008, but because of a downward trend in revenues, the department has revised Its revenue projections to only $8.8 million, according to the report. The trend is expected to continue into 2009. EMS officials have revised the 2009 forecast to $9.1 million, which is $2.7 million below the original projections. The report indicates a number of factors accounting for the revenue shortfalls. For instance, the number of ambulance transports for 2008 was projected to increase by 5 percent over 2007 based on population increase projections, the report said. Instead, the revised forecast estimates 23,087 transports in 2008, slightly less than the 23,270 transports in 2006. "Although the population came, people are not using our services as much," Page said. "That sometimes happens when you have a slowdown in the economy. People are less likely to go to the doctor." In addition, the percentage of billable calls attributable to Medicare was budgeted at 40 percent of EMS's total revenues, but is instead closer to 47 percent, the report said. Medicare will only pay its allowable amount of $304, even though the rate for ground transport is $700, the report said. The department has also seen a change in the mix of patients with commercial insurance and those with no insurance at all, known as self -pay accounts. Postponing the purchase of three ambulances would save $555,000, and reducing the number of EMS units by four would save $983,345 in 2008, the report said. "We would be going back to the level of service that we had In prior years," Page said. "It's based on the number of transports. That is what it is solely." The department is also looking to save $454,173 through attrition and reduced operating costs, the report said. Page said his department will be seeking guidance from the commissioners as to what to do next, adding that they may choose to keep staffing levels where they are and move forward with the ambulance purchases by supplementing the department though the general fund. However, that would not affect the projected shortfall for 2009, which would require an additional contribution from the general fund. ----------------------------------------- © Naples News http://www.naplesnews.comlrleWs/2008/febtl 4/collier-ems-faces-24-mil lion-budget-shortf... 2/19/2008 Ocala.com This Is a printer friendly version of an article from www.ocala.com To print this article open the file menu and choose Print. Article published Sep 27, 2006 City of Ocala may opt out of ambulance alliance BY SUSAN LATHAM CARR STAR -BANNER OCALA - The city of Ocala likely will not help fund the countywide ambulance service when the five-year Emergency Medical Service Alliance contract expires in 2008. "Is the city going to want to be part of that?" County Commissioner Andy Kesselring asked about EMSA. "Probably not," City Councilman Kent Guinn replied at Tuesday's joint city county meeting. Marion County Professional Firefighters and Ocala Professional Firefighters protest along Silver Springs Boulevard near the Marion County Library EMSA was formed after Munroe Regional Headquarters on Tuesday. Medical Center and Ocala Regional Medical PHOTOS BY ERICA BR0UGH/STAR-BANNER Center said they could no longer afford to run the ambulance service. An alliance was formed among the county, city and the two hospitals on Oct. 1, 2003, to share the cost of running the ambulance service for five years. Kesselring said there is always the possibility that the two hospitals will continue to help fund the service. However, under state law, the county is the entity responsible • for providing ambulance service. The hospitals currently pay 50 percent of EMSA's operating expenses, capped at $1.6 million. Anything above.that is split by the city and county, with the city paying 29 percent of the balance and the county paying 71 percent. "We think all the players are going to run for cover, the city and both hospitals," County Commission Chairman Jim Payton said. "I think that's an accurate assessment," Ocala Councilman Kyle Kay said. County Administrator Pat Howard said that if the city did not renew the agreement, the ambulance service could be integrated into the county fire service. It could be paid for through a countywide municipal service taxing unit, or MSTU. Ambulance service in the city might be coordinated with the city fire department, he said. This year, the city has contributed $804,290 to EMSA and has budgeted $1.05 million for fiscal year 2006-07. http://www.ocala. com/apps/pbcs. dll/article?AID=/20060927/NEW S/209270344/ 10011NEW S01&... 9/28/2006 Besides ambulance service, there were eight other topics of discussion at Tuesday's meeting. Among those was the issue of fire service in the urban service area, where there are unincorporated enclaves. Brandon Oxford, 11, died in a house fire nearly a year ago when it took 16 minutes for a fire truck to arrive at a county enclave on the city's border. City Councilman Kent Guinn said the city was trying to help the county when it offered to provide fire service to the entire urban service area for $600,000 a year, an offer the county rejected as being too expensive. He said the offer still stands. "Ultimately we have the same constituents," Payton said. "We all want to serve them the best we can." City Manager Paul Nugent said the city and county need to coordinate where they build fire stations so that there is no overlap of service. City Councilman Charles Ruse Jr. said consolidation of the fire departments "has some merit." County Commissioner Randy Harris suggested that the city and county fire departments should operate a station together to "provide services on both sides of the line until we can come up with something better." "We have egos involved," Payton said. "There's too much history on the table. Let's get somebody that's unconcerned, a third party, to study it and come back with a recommendation." City Councilwoman Mary Rich said one-on-one negotiations do not work. "If it's three commissioners and three council persons, maybe we.could come to some sort of agreement really soon," Rich said. There also was discussion about consolidating the city and county's parks, because county residents use city facilities and vice versa. Payton said he would like to have a workshop to discuss the matter further. He said such a change might involve having an MSTU countywide to pay for recreational services. The group also talked about possibly changing the utilities' urban service area boundaries and having representatives of each body in negotiations to buy utilities outside their respective service areas. They also touched briefly on transportation impact fees, with the county saying It is http://www.ocala.com/apps/pbcs.dll/article?AID=/20060927/NEW S/209270344/1001/NEW S01&... 9/28/2006 looking to change the methodology to shift the burden away from businesses and onto the residential customers. Susan Latham Carr may be reached at susan.carr starbanner.com or (352) 867- 4156. http://www.ocala.com/apps/pbcs.dll/article?AID=/20060927/NEW S/209270344/1001/NEW S0 1&... 9/28/2006 VGala.l:Ulfl rage 1 UI ., Ocala.com This Is a printer friendly version of an article from www.ocala.com To print this article open the file menu and choose Print. Article published Nov 18, 2007 Ambulance service still undecided Service contract set to expire in 2008 BY JESSICA GREENE STAR -BANNER OCALA - The approaching expiration of Marion County's ambulance service organization has government officials diligently exploring alternatives. September 2008 marks the end of the Emergency Medical Services Alliance, a five-year partnership among the city of Ocala, county government, Munroe Regional Medical Center and Ocala Regional Medical Center to jointly fund local ambulance service. State law requires county government to provide ambulance service. If the county absorbs the ambulance service, it most likely would impose an additional tax on incorporated Ocala. To do so, the county would need the City Council's approval. On Monday, the council sent a letter to the County Commission requesting a further investigation of the cost of hiring a private ambulance company to serve the entire county. Both local bodies have been exploring potential solutions to the dilemma through separate initiatives. In April, Commissioner Charlie Stone created a task force to conduct research and come up with alternatives. THE ISSUE September 2008 marks the expiration of a five-year partnership to jointly fund local ambulance service. WHAT'S NEW? The City Council believes privatization is viable and wants to further investigate the cost of such a system. WHAT'S NEXT? The EMSA Task Force will hold a public meeting at 2 p.m. Tuesday. The task force hopes to present its recommendations to the County Commission by January. "The question is, how can we best provide service while keeping it at a level that residents need - or better? But we have to keep in mind that there's only so much money," said Pat Gabriel, EMSA Task Force chairwoman. http://www.ocala.com/apps/pbcs.dll/article?AID=/20071118/NEWS/2 11180342&templat... 11/26/2007 ucam.wur rage z ur i Privatized service emerged as a viable option for the city during a September workshop held in conjunction with Rural/Metro Ambulance, a private service provider in Orlando. The workshop revealed that, through privatization, ambulance service could be provided to city residents without implementing additional taxes because such services receive funding through third -party insurance companies, Medicare, Medicaid and government subsidies if necessary. The EMSA Task Force is finalizing its research and is preparing its recommendations for the County Commission. Hiring a private company to run local emergency service, however, is not likely to be a suggestion, Gabriel said. Concerns with privatization include the high employee turnover average - 16 percent - within private companies and local government's lack of immediate authority over service levels, she said. "Ambulance service to me is like police or fire - there are certain services that belong with the government and to the people," said Mike Sizemore, an EMSA Task Force member. But council members want to make sure the option has been fully investigated before it is ruled out. "There may be a better deal if we can do this together," City Councilman Kyie Kay said. Alternatives to privatizing emergency service include keeping EMSA as a separate agency or merging it with Marion County Fire Rescue. If the county chooses one of these alternatives, the city could still employ a private company within incorporated Ocala. But it would need permission from the county. "I think the city wants to work together, but they also have to look at it from taxpayers' perspective," Stone said. Officials on both sides agree that regardless of which alternative is chosen, service needs to be provided to residents countywide in a cohesive manner. "I would like for us to be on one accord. We don't need a city system or a county system. We need a community system," City Council President Mary http://www.ocala.com/apps/pbcs.dll/article?AID=/20071118/NE W S/211180342&templat... 11/26/2007 ucaia.com rage 3U!3 Sue Rich said. EMSA, which currently operates on an $18 million budget, was established roughly four years ago after Munroe advised local government it could no longer afford to support the operation's growing budget service as it had done in the past. The EMSA Task Force will hold its next public meeting at 2 p.m. Tuesday at the McPherson Governmental Complex, 601 S.E. 25th Ave., Ocala. Because Florida's open government laws prevent elected officials from holding meetings "in the dark," commissioners have not yet had the opportunity to discuss the letter among themselves and, will do so at a workshop Monday, Stone said. Jessica Greene may be reached atjessica.greene@starbanner.com or 732- 7159. http://www.ocala.com/apps/pbcs.dll/article?AID=/20071118/NE W S/211180342&templat... 11/26/2007 ragc I ti 4. Ocala.com This is a printer friendly version of an article from www.ocala.com To print this article open the file menu and choose Print. Article published Dec 13, 2007 Advisory board opposes private ambulance service Ocala, Marion County to begin discussing future beyond EMSA contract. BY CHRISTOPHER CURRY STAR -BANNER OCALA - The next week should bring a clearer picture of the future of ambulance service in Marion County. The Emergency Medical Services Alliance, or EMSA, agreement expires on Sept. 30. Today, an advisory board the county formed to make recommendations on the ambulance service will make a presentation to the Ocala City Council on privatization. On Wednesday, that advisory group, called the EMSA Task Force, will formally present its recommendations to the Marion County Commission after some 18 meetings dating back to April. They will not recommend contracting out with a private ambulance service, task force chairman Pat Gabriel and task force member Mike Sizemore said. "We as a group have ruled out privatization," Gabriel said. "We do not feel it's in the best interest of the citizens. AMBULANCE SERVICE MEETINGS Ocala City Council and Emergency Medical Services Alliance task force meet 11:30 a.m. today, Ocala City Hall, 151 S.E. Osceola Ave. EMSA task force presents its findings and recommendations to Marion County Commission, 2 p.m. Wednesday; Dec. 19, at McPherson Governmental Complex, 601 S.E. 25th Ave. "Privatization is really not as free as some people think it is." Gabriel said an Oklahoma company that runs the private Sunstar ambulance service in densely populated Pinellas County did make a presentation to the task force but did not send a formal proposal to the county. The task force will identify two preferred options to the County Commission - making the ambulance service its own department within the county hlftp://www.ocala.coili/apps/pbes.dll/article?AID=/200712://www.ocala.comlapps/pbcs.dll/atticle?AID/2007 I213JNEW S/212130359/1001/NE... 12/14/2007 UuMdAeVlll government, or having Marion County Fire Rescue absorb it. a EMSA is a stand-alone nonprofit group made up of the city of Ocala, Marion County, Ocala Regional Medical Center and Munroe Regional Medical Center. Both hospitals and the city have informed Marion County they will stop funding the partnership when the five-year contract expires Sept. 30. Under state law, county government is required to provide ambulance service. The Ocala City Council is looking at the possibility of hiring a private firm, but the County Commission would have to vote to allow that. Without the funding partners of the hospitals and the city, the County Commission has discussed expanding the geographic boundaries of the taxing district that funds the county's portion of the ambulance service to cover the, city of Ocala. That would require approval of the Ocala City Council. So it remains to be seen if the two governments will reach an accord or clash over the ambulance service. City Council President Charles Ruse Jr. said the meeting today is a chance to hear the information the EMSA Task Force has gathered on privatization. He said the city has not decided that is the route it wants to go. Like task force members Gabriel and Sizemore, County Commission Chairman Charlie Stone said he believed one ambulance service should cover the whole county, including the city of Ocala. "When a person calls 911, they don't care whether they're in the city of Ocala or unincorporated Marion," Stone said. Christopher Curry may be reached at chris.currv(starbanner.com or 867- 4115. http://www.ocala.cornlapps/pbcs.dll/article?A1D120071 213/NEWS/212130359/1001/NE... 12/14/2007 I IUCpei iuet iit oiuuy Od b r-/:i--. 1 auil.+i-11; tat Vvnl Rbtlbt It i Iltl -111111 •5r—aaa�a" ��::V VL. t •avaY iv:I vvVc t I - iIL ,,,1 ,;t rharna Rate per transport $610.00 56% $341.00 ($278.75) $62.25 is tI+ ;G: fP t:..I •V.��TT4.11YfYM NY •.. YY MJ IN.v �iyS5. 11 F VEVst ui +£f'Hi Yoe $199.89 Iv luu Li1 C VG1 a �V V..V VUV/- 56% /'1'n/ lT b 111 II lb . YVii • \V f V..MV i' [lf' ieut l -spur' $111.91 ($278.75) ($166.81) FAYETTEVILLE THE CITY OF FAYETTEVILLE, ARKANSAS KIT WILLIAMS, CITY ATTORNEY DAVID WHITAKER, ASST. CITY ATTORNEY DEPARTMENTAL CORRESPONDENCE TO: Dan Coody, Mayor City Council Chief Tony Johnson FROM: Kit Williams, City Attorney DATE: March 18, 2008 RE: Final Amended Draft of Washington County Regional Ambulance Authority Interlocal Agreement LEGAL DEPARTMENT Attached is what I believe to be the final amended draft of the Interlocal Agreement with two changes requested by Washington County. First, under Article 3 Financing, I inserted the same proviso under (b) that the City of Fayetteville would join the county in agreeing to pay at least the same annual amount as is currently appropriated through the end of 2011. Since the subsidy is based upon the latest official census data in our growing region, unless the per capita amount can be reduced in 2011 because of revenue from exclusive non - emergency services, it is unlikely that total gross subsidies from any city will ever decrease. The bottom line is that if the Agreement is approved the Authority will now be receiving subsidies not only from Fayetteville and the County, but nine other cities and may be able to earn hundreds of thousands of dollars annually in non -emergency revenue to reduce or offset taxpayer subsidies after 2011. The second change discussed at the Ambulance Committee meeting was to allow the County (which now has title or joint title to some ambulances) to transfer this equipment to CEMS and the Washington County Regional Ambulance Authority while keeping the right to get any such ambulance back if the county withdraws from the Authority by July 1, 2011. I think there is virtually no chance of Washington County withdrawing from the Authority it has created and championed. But I put in the language they wanted. '-I SUMMARY OF PROPOSED CONTRACT (A) The Executive Committee handling the day-to-day oversight of CEMS operation has seven members, four of which must reside in Fayetteville. Two of those members will be appointed by and serve at the pleasure of the City Council and be responsible to give an annual report in July of each year to the Fayetteville City Council covering: (1) Annual audited report of previous year's financial and performance data; (2) Report of financial and response data for first half of year; (3) Plans to replace or enlarge capital property or equipment for next 18 months; (4) Plans and justification for any personnel increases for next 18 months; (5) Revenue/expense projections for next 18 months. (B) The current minimum standards we have contracted with CEMS to achieve remain required :fl this amended Interlocal Agreement. k (C) Both the City and County agree to continue meeting the current annual funding for CEMS until 2011, but now will be aided by the same per capita per city dweller by the nine other cities served by CEMS. (D) Exclusivity for non -emergency ambulance service to reduce the cost having to be paid by taxpayers is allowed by this agreement, but must also be specifically authorized by Resolution in addition to the Interlocal Agreement. Thus, to establish exclusive non -emergency ambulance service, the City Council would need to pass the Resolution as currently before you. If an Alderman opposes exclusivity, he should move to amend that Resolution to remove the section which authorizes exclusivity. (E) Review in July of 2011, rather than "perpetual" term provides for a comprehensive review following the 2010 Census to ensure changes in population location and distribution of the County Sales Tax are incorporated into the funding formula for a fair distribution of taxpayer funding for the authority. If exclusivity is granted, 2011 would be a good time to review whether it has achieved its estimated revenue income to offset taxpayer dollars and whether its service has been satisfactory. Exclusivity can be granted or revoked by future City Councils. I-' • 0 AGREEMENT FOR AMBULANCE SERVICES THIS INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("Agreement") is made and entered into by and between WASHINGTON COUNTY, ARKANSAS, ("County") and the cities of ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW and JOHNSON ("Cities"). WHEREAS, A.C.A. §14-14-910, A.C.A. §25-20-101, and A.C.A. §14-266-102 authorize cities and counties to enter into contracts to co-operate or join with each other to provide emergency and non -emergency medical services and to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14-910, A.C.A. §25-20-101 and A.C.A. §14-266-101 et. seq is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties. NOW, THEREFORE, IT IS AGREED: ARTICLE 1. AUTHORITY ORGANIZATION. (a) One individual selected by each entity shall represent said entity on the Board of Directors of the Authority to be known as the Washington County Regional Ambulance Authority. (1) Each Board member shall serve a term of three (3) years and be eligible to serve two (2) consecutive terms. (2) The initial term of each Board member shall be determined by the drawing of lots or similar method so as to provide staggered terms. (b) The Board shall meet on no less than on a quarterly basis to transact all business associated with the powers and responsibilities conferred upon it. However, the Board shall reserve to itself the right to meet on whatever basis it determines is appropriate. (c) The Board shall employ an executive director to manage a regional ambulance system. (d) In order to ensure maximum efficiency and effectiveness of the operation, an executive committee shall be formed to be charged with the oversight of the day-to-day operation of the system. The members of said executive committee shall be as follows: (1) The County board appointee who shall reside in the unincorporated service area. (2) The Fayetteville City Council appointee; (3) A second Fayetteville appointee (Both City Council appointees shall serve at the pleasure of the City Council and can be removed and replaced by different representatives by City Council Resolution.); (4) A small city appointee to be chosen by the aforestated cities, excluding the City of Fayetteville; (5) A Nursing Home or medical profession representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees, and the small city appointee. (6) A Hospital representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees, and the small city appointee. (7) A representative of the financial community residing in the service area to be chosen by the County appointee, the Fayetteville appointees and the small city appointee. ARTICLE 2. PURPOSES, POWERS. RIGHTS, OBLIGATIONS AND RESPONSIBILITIES OF THE CREATED ENTITY. (a) All parties acknowledge that the need to create an entity to own, operate and manage an ambulance service is necessary and appropriate. (b) The Authority created herein shall have the following powers: (1) To provide advanced life support emergency ambulance service in the designated area; (2) To provide emergency medical dispatch including pre -arrival instructions in accordance with approved dispatch protocols; (3) To set ambulance user fees; 2 (4) To own system revenues; (5) To provide exclusive emergency and non -emergency (within the cities only) ambulance service; (6) To enter into mutual aid and automatic aid agreements with neighboring ambulance services for emergency services; (7) Comprehensive regulatory powers over the ambulance system performance; (8) Ownership of or access to key components of the system infrastructure; (9) Centralize medical direction and clinical oversight of the ambulance system to the extent deemed necessary; (10) To promulgate rules and regulations to further effectuate the purposes of this agreement; (11) To own and dispose of real and personal property; (12) To adopt and oversee comprehensive system performance on an annual basis to include periodic revisions to comply with emerging technologies and changes in clinical and operational standards. (c) Washington County Regional Ambulance Authority's Specific Duties. The Authority created herein shall have the following specific duties and responsibilities in addition to the statutory and administrative requirements of § 14-266-109, the Arkansas Medical Practices Act, and any other government or professional standards. (1) Minimum Standards Continue. The Authority shall continue to meet all existing minimum performance standards within Fayetteville as stated in the current City of Fayetteville Contract For Emergency Medical Transport Services with CEMS except as to quarterly reports to the City of Fayetteville. (A copy of this contract is attached as Exhibit A.) (2) Reporting Requirements. (A) Fayetteville. On the third Tuesday of July each year, the Washington County Regional Ambulance Authority by the two Fayetteville representatives on the Executive Committee shall appear before the Fayetteville City Council to present: (i) The written annual, audited report of the previous year's financial and response data reports; 3 (ii) A written report of the financial and response data for the first half of the current year; (iii) Plans and projections to replace or enlarge capital property and equipment within the next 18 months; (iv) Plans and justifications for any personnel increases within the next 18 months; and (v) Revenue/expense projections for the next 18 months. (B) Any Other Member Of This Authority. Upon written request by any other member of this authority, the Board Member representing that entity shall provide the full written and oral report referred to in (A) to that City or to the County during its regular July or August meeting. (a) All parties acknowledge that the need for a guaranteed revenue source independent of and in addition to fees for service is necessary in order to ensure the continued viability of said service. (b) The annual regional ambulance service -funding source for all parties of this Agreement shall be based upon the most recent Federal Census including any special Census. (1) All Cities shall pay $4.00 per capita except that only those citizens of Johnson within CEMS's territory shall be counted for the per capita fees. The City of Fayetteville shall maintain at least its minimum annual contribution of $270,000.00 through the end of 2011. (2) Washington County shall pay $15.50 per capital for the unincorporated population served by CEMS with at least a minimum annual contribution of $550,000.00 through the end of 2011. (c) The Authority shall continue to seek a sustainable funding source with the goal of reducing subsidies proportionately across the board. (d) Except as stated above, no party to this Agreement may be financially obligated without the approval of its governing body. (e) All governing bodies party to this agreement must approve any increases in subsidy. (f) A percentage of these funds shall be set aside for replacement of capital items. n (g) The ambulance service owned or under contract with the Authority shall be required to provide, at no additional charge, the Arkansas Department of Health 24 hour basic refresher course to all EMT certified firefighters that act as first responders with said ambulance service. (h) The financing provided by the parties hereto shall be from general revenues; furthermore, the financing and this agreement are contingent upon compliance with A.C.A. §20-13-301 et. seq. by the County and all the parties will cooperate to the extent necessary in complying with such. The parties shall receive credit for payments already made to CEMS in 2008 for this year's annual subsidy commitment. ARTICLE 4. TERM. This initial term of this agreement shall be from the date that all parties have agreed to this interlocal agreement through December 31, 2011. This agreement shall be automatically renewed with possible changes to Article 3 Financing for an additional five year term unless any party notifies the Authority in writing of its refusal to participate in the Authority and this Agreement by September 1, 2011. All parties agree to consider the effects of the 2010 Decennial Federal Census upon the division of the County Sales Tax between the County and the Cities and the proportional changes of the populations of the Cities and the unincorporated portions of Washington County and make any adjustment or amendments advisable and necessary to Article 3 to ensure financial viability of the Authority and fairness for all parties. A second automatic renewal shall occur on December 31, 2016 unless any party notifies the Authority in writing of its refusal to participate in the Authority and this Agreement by September 1, 2016. A substantial review of the financial status of the Authority and all parties should occur in 2021 after the 2020 Federal Decennial Census and prior to further renewals of this Agreement. Not withstanding the above terms, all parties to this Agreement may withdraw from this agreement upon six months' written notice to the Authority and shall only be responsible to pay its per capita fee for that portion of the year. ARTICLE 5. TRANSFER OF OWNERSHIP OF EQUIPMENT TO WASHINGTON COUNTY REGIONAL AMBULANCE AUTHORITY. Property currently owned by any party that is transferred to the Washington County Regional Ambulance Authority shall be returned to that party or purchased from that party at its fair market value if such party terminates its membership from the Authority and withdraws from this Agreement by July 1, 2011, after giving its six month notice. All property and resources of the Washington County Regional Ambulance Authority purchased during its existence or owned by it on July 2, 2011, or thereafter shall remain the Authority's exclusive property throughout the Authority's existence. L ARTICLE 6. SEVERABILITY. The provisions of this Agreement are declared to be severable. If any provision hereof shall be held to be invalid or to be inapplicable to any person or circumstance, such holdings shall not affect the ability or the applicability of the remainder hereof. ARTICLE 7. EFFECTIVE DATE. This Agreement shall not be effective until approved and signed by all parties in accordance with the law. APPENDIX TO AGREEMENT APPENDIX DEFINITION OF TERMS WHEN AND IF USED. Ambulance Authority: Quasi -governmental entity created to oversee and deliver ambulance service in a specified geographical service area. Ambulance Service: Means emergency and non -emergency transport services offered by the Authority, including management, supervision, mass gathering and community events. Exclusivity: Sole provider emergency and non -emergency ambulance rights granted by ordinance or resolution by each party to the extent allowed by State Law. Per Capita: Funding structure set forth by this Agreement based on population. Cities contribute at $4.00 per capita due to the increased number of calls generated within their city limits. The County contributes at $15.50 per capita due to the increased coverage area and decreased density of call volume in the unincorporated areas of the County. No reduction of any entity's gross subsidy shall occur during first term of this agreement. Subsidy: Government funds requested by the Authority to provide ambulance service. User Fees: Fees charged to patients treated or transported by the ambulance service, or fees charged to an individual or an organization for ambulance standby coverage. 6 CITY OF FAYETTEVILLE CONTRACT FOR EMERGENCY MEDICAL TRANSPORT SERVICES This Agreement is entered into on this 7i 1 day of, #XS( the City of Fayetteville, hereinafter known as the "City" and Central Emergency Medical Service, hereinafter known as "CEMS," an Arkansas not -for-profit corporation. . WHEREAS the City has determined that a public need exists for an emergency ambulance service that operates within the city limits of Fayetteville to serve Fayetteville residents, WHEREAS CEMS has developed an emergency ambulance service that operates within the City limits and serves Fayetteville residents. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the City and CEMS agree as follows: I. This Agreement will begin on the date first written above. 2. CEMS agrees to develop, operate, and maintain an Advanced Life Support (ALS) Emergency Ambulance Service that serves Fayetteville residents and respond to all emergency medical calls for service within the city limits of Fayetteville. This ALS service will be provided in conjunction with the Fayetteville Fire Department's emergency response units, with the Fayetteville Fire Department agreeing to provide Basic Life Support (BLS) Non -Transport Emergency Response Service. The Fayetteville Fire Department shall maintain control over the use of Fire Apparatus as First Response Units and CEMS shall maintain control over the use of Ambulances. 3. The Fayetteville Fire Department agrees to operate according to the established patient treatment protocols, as identified by the CEMS' Medical Director, from the time patient contact is made until the time the patient is removed from the incident scene and transported, via ALS Ambulance, to recognized medical treatment facility or hospital, or until CEMS personnel determine the call is a no -transport 4. CEMS agrees to provide written quarterly and annual reports to the City's Project Coordinator describing the activities undertaken during the preceding period and also to report on the following performance measures: Number of calls responded to, average response time for these calls, type of patient service provided for each response. (Whether the patient accepted or declined care). The parameters for calculating the average response time will be from the time the call is verified at the CEMS medical communication center until arrival at the incident location by the first arriving transporting Ambulance. "Time call is verified" shall be the moment the communication center personnel receive both sufficient location information to know where a response is required and sufficient information to determine the presumptive run priority designation. "Arrival at incident location" means the moment an ambulance crew notifies the medical communication center that it is fully stopped at the location where the ambulance shall be parked while the crew exits to approach the patient in situations where the ambulance has responded to a location other than the scene (e.g. staging areas for hazardous material/violent crime incident's or non -secured scenes), arrival at the scene shall be the time the ambulance arrives at the designated staging location. The quarterly reports are to be submitted to the Project Coordinator by April 15, July 15,.October 15, and January 15 for the preceding calendar quarter. The data used to compile these reports will include only those calls for service within the corporate city limits of the City of Fayetteville, Arkansas and will be reported for the current quarter, current year-to-date, and prior year-to-date. 5. •CEMS commits to maintaining an average response time not to exceed eight (8) minutes within the City • of Fayetteville's corporate limits for the duration of this contract. 6. CEMS agrees to make both financial and response data records available for review by the Project Coordinator and the City's Internal Auditor as requested, and to provide the City with an annual audit performed by a certified public accountant licensed by the State of Arkansas. CEMS agrees to comply with the Arkansas Freedom of Information Act as applicable. Requests for records shall follow compliance requirements of the Health Insurance Portability and Accountability Act (HIPAA). 7. For the purposes of this Agreement, the Project Coordinator for the City will be the City Fire Chief or his/her designee. The Project Coordinator for GEMS will be GEMS Administrator Tony Hickerson or his successor or designee. Communications pertaining to this agreement will be through the respective Project Coordinators for the City and CEMS. .8. The term of performance for this agreement will expire December 31, 2008, subject to approval of an annual City budget containing funding for the service. The City agrees to pay and CEMS agrees to accept, as payment in full for its services, the annual amount of $250,000.00 in twelve (12) monthly installments of $20,833.00. The amounts to be paid for services in future budget years are dependent on the amounts appropriated by City Council for each budget year. If the Public Utility Model is accepted and instituted for this service, this contract will automatically terminate upon the effective date of the Public .Utility Model. 9. CEMS will hold harmless, defend, and indemnify the City, from any and all claims, actions, suits, charges and judgments whatsoever that arise out of the performance or nonperformance of the services or subject matter in this Agreement 10. GEMS must provide and maintain in force, at all times during the term of the contract, insurance for worker's compensation as provided by state statute, commercial general liability, and vehicle liability. Such policies will be issued by companies authorized to do business in the State of Arkansas. Minimum amounts required for commercial general liability and automobile liability are $1,000,000. . 11. For any work sublet, CEMS will require the subcontractor to provide similar worker's compensation insurance. In case any employee engaged in work on the project under this contract is not protected under workers' compensation insurance, CEMS will provide and will cause each subcontractor to provide adequate employers' liability insurance for the protection of such of his employees as are not otherwise protected. A certificate of insurance addressed to the City listing the above coverage amounts is to be submitted with contract approval. The premiums for all insurance required herein will be paid by GEMS. 12. GEMS and the City agree to establish a standing Emergency Medical Services (EMS) Workgroup. This EMS Workgroup shall consist of three (3) representatives from GEMS; three (3) representatives from the Fayetteville Fire Department; and two (2) representatives from the Fayetteville Police Department's Central Dispatching Office. This Workgroup will meet to discuss the coordination of services, facilitate the exchange of ideas to enhance the quality of service being provided and develop a problem -solving mechanism. This Workgroup shall meet as requested by any member of the Workgroup, but not less than once per quarter during the calendar year. 13. All notices required or permitted under this agreement will be submitted in writing to the other party in this agreement by certified mail, return receipt requested, which notice will be effective three (3) days after deposit therein addressed to the following: City of Fayetteville Fayetteville Fire Dept CEMS Dan Coody, Tony Johnson, Tony Hickerson, Mayor . Fire Chief Administrator 113 West Mountain St. 303 W. Center St. 645 S School Ave Fayetteville, AR 72701 Fayetteville, AR 72701 Fayetteville, AR 72701 16. Neither party may assign any of its rights or obligations under this agreement, without the express written consent of the other. Nor shall this agreement be construed to bestow any rights or benefits upon anyone other than the City and GEMS. 17. It is agreed and understood that the failure of either party to invoke any of the available remedies under this contract or under law in the event of one or more breaches or defaults by the other shall not be construed as • a waiver of such provisions and conditions and shall not prevent the parties from invoking such remedies in the event of any future breach or default 18. This contract contains the entire agreement of both parties hereto, and no other oral or written, agreement shall be binding on the parties hereto. No modification or variation of the terms of this contract shall be valid unless made in writing and signed by the duly authorized agents of the City and CEMS. This contract supersedes all prior agreements, contracts and understandings of any kind between the parties relating to the subject matter hereof. This contract may be executed in all or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 19. Each paragraph of this contract is severable from all other paragraphs. In the event any court of competent jurisdiction determines that any paragraph or subparagraph is invalid or unenforceable for any reason, all remaining paragraphs and subparagraphs shall remain in full force and effect 20. This contract shall be interpreted according to and enforced under the laws of the State of Arkansas. The parties further agree that any litigation arising from this contractual relationship shall be commenced in either the Circuit Court of Washington County, Arkansas, or the United States District Court for the Western District of Arkansas, Fayetteville Division. The parties hereby submit to the personal jurisdiction of said courts, and waive any objections to venue in said courts. 21. Tax Exempt Status: Attached hereto and made part hereof is a copy of the correspondence from the Internal Revenue Service dated confirming the 501(c)(3) tax exempt status of the Central EmergencyMedical Service. IN WITNESS WHEREOF, we have hereunto set our bands on the date first written above. Central Emergency Medical Services, Inc. City of Fayetteville, Arkansas 'PONY }LICIf RSON; Administrator - DAN COOD , ayor is ATTEST: U P: 3 3.27.08 Clarice Pearman - Res. 68-08 Page 1 II From: Clarice Pearman To: Williams, Kit Date: 3.21.08 3:28 PM Subject: Res. 68-08 Attachments: 68-08 Ambulance Service Interlocal Agrmt.pdf; Res 68-08 Ex A Agreement.doc CC: Audit Kit: Attached is a copy of the above resolution and agreement. Please let me know if there is anything else needed for this item. Also attached is the agreement I made the typo corrections for your records. Have a good weekend. Thanks. Clarice Clarice Buffalohead-Pearman, C.A.M.C., C.M.C. City Clerk/Treasurer Division 113 West Mountain Fayetteville, AR 72701 479-575-8309 cpearman@ci.fayeftevillear.us JERRY HUNTON County Judge WASHINGTON COUNTY, ARKANSAS County Courthouse May 27, 2008 Mayor Dan Coody City of Fayetteville 113 W. Mountain Fayetteville, AR 72701 280 North College, Suite 500 Fayetteville, AR 72701 RECEIVED MAY 302008 CITY OF FAY�EVILLE MAYORS OFFICE RECEIVED JUN 0'2 2008 RE: Ambulance Service - Interlocal Agreement CITY OF FAYMEVILLE CITY CLERK'S OFFICE Dear Mayor: Please find enclosed for your records a signed copy of the interlocal agreement between Washington County and other cities in the County regarding ambulance service. . Thank you for your help in this matter. Sincerely, Karen Beeks, Secretary County Judge's Office /kb Encl. i cc w/encl: Kit Williams, City Attorney Telephone: 479 / 444-1700 • FAX: 479/ 444-1889 • KarenlEMS-#2RevlsedlnterlocalAgreement.doc 03/19/08 Adopted by Quorum Court 03/20/08 —Ordinance No. 2008-12 AGREEMENT FOR AMBULANCE SERVICES THIS INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("Agreement") is made and entered into by and between WASHINGTON COUNTY, ARKANSAS, ("County") and the cities of ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW and JOHNSON ("Cities"). WHEREAS, A.C.A. §14-14-910, A.C.A. §25-20-101, and A.C.A. §14-266-102 authorize cities and counties to enter into contracts to co-operate or join with each other to provide emergency and non -emergency medical services and to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14-910, A.C.A. §25-20-101 and A.C.A. § 14-266-101 et. seq is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an-. Authorit will demand close and continued cooperation of all parties. NOW, THEREFORE, IT IS AGREED: --' - Mt ARTICLE 1. AUTHORITY ORGANIZATION. .(a) One individual selected by each entity shall represent said entity on the Br'd of Directors of the Authority to be known as the Washington County Regional Ambulance Authority. (1) Each Board member shall serve a term of three (3) years and be eligible to serve two (2) consecutive terms. (2) The initial term of each Board member shall be determined by the drawing of lots or similar method so as to provide staggered terms. (b) The Board shall meet on no less than on a quarterly basis to transact all business associated with the powers and responsibilities conferred upon it. However, the Board shall reserve to itself the right to meet on whatever basis it determines is appropriate. (c) The Board shall employ an executive director to Tn system.B�O�,r (d) In order to ensure maximum efficiency and effectiveness of the operation, an executive committee shall be formed to be charged with the oversight of the day-to-day operation of the system. The members of said executive committee shall be as follows: (1) The County board appointee who shall reside in the unincorporated service area. (2) The Fayetteville City Council appointee; (3) A second Fayetteville appointee (Both City Council appointees shall serve at the pleasure of the City Council and can be removed and replaced by different representatives by City Council Resolution.); (4) A small city appointee to be chosen by the aforestated cities, excluding the City of Fayetteville; (5) A Nursing Home or medical profession representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees, and the small city appointee. (6) A Hospital representative who shall reside in the City of Fayetteville to be chosen by the County appointee; the Fayetteville appointees, and the small city appointee. (7) A representative of the financial community residing in the service area to be•chosen by the County appointee; the Fayetteville appointees and the small city appointee. ARTICLE 2 PURPOSES POWERS, RIGHTS. OBLIGATIONS AND RESPONSIBILITIES OF THE CREATED ENTITY. (a) All parties acknowledge that the need to create an entity to own, operate and manage an ambulance service is necessary and appropriate. (b) The Authority created herein shall have the following powers: (1) To provide advanced life support emergency ambulance service in the designated area; (2) To provide emergency medical dispatch including pre -arrival instructions in accordance with approved dispatch protocols; (3) To set ambulance user fees; (4) To own system revenues; (5) To provide exclusive emergency and non -emergency (within the cities only) ambulance service; '1 (6) To enter into mutual aid and automatic aid agreements with neighboring ambulance services for emergency services; (7) Comprehensive regulatory powers over the ambulance system performance; (8) Ownership of or access to key components of the system infrastructure; (9) Centralize medical direction and clinical oversight of the ambulance system to the extent deemed necessary; (10) To promulgate rules and regulations to further effectuate the purposes of this agreement; (11) To own and dispose of real and personal property; (12) To adopt and oversee comprehensive system performance on an annual basis to include periodic revisions to comply with emerging technologies and changes in clinical and operational standards. - (c) Washington County Regional Ambulance Authority's Specific Duties. The Authority created herein shall have the following specific duties and responsibilities in addition to the statutory and administrative requirements of § 14-266-109, the Arkansas Medical Practices Act, and any other government or professional standards. (1) Minimum Standards Continue. The Authority shall continue to meet all existing minimum performance standards within Fayetteville as stated • in the current City of Fayetteville Contract For Emergency Medical Transport Services with GEMS except as to quarterly reports to the City of Fayetteville. (A copy of this contract is attached as Exhibit A.) (2) Reporting Requirements. (A) Fayetteville. On the third Tuesday of July each year, the Washington County Regional Ambulance Authority by the two Fayetteville representatives on the Executive Committee shall appear before the Fayetteville City Council to present: (i) The written annual, audited report of the previous year's financial and response data reports; (ii) A written report of the financial and response data for the first half of the current year; (iii) . Plans and projections to replace or enlarge capital property and equipment within the next 18 months; 3 (iv) Plans and justifications for any personnel increases within the next 18 months; and (v) Revenue/expense projections for the next 18 months. (B) Any Other Member Of This Authority. Upon written request by any other member of this Authority, the Board Member representing that entity shall provide the full written and oral report referred to in (A) to that City or to the County during its regular July or August meeting. ARTICLE 3. FINANCING; TRAINING; COMPLIANCE WITH A.C.A. 420- 13-301 ET. SEQ. (a) All parties acknowledge that the need for a guaranteed revenue source independent of and in addition to fees for service is necessary in order to ensure the continued viability of said service. (b) The annual regional ambulance service -funding source for all parties of this Agreement shall be based upon the most recent Federal Census including any special Census. (1) All Cities shall pay $4.00 per capita except that only those citizens of Johnson within CEMS's territory shall be counted for the per capita fees. The City of Fayetteville shall maintain at least its minimum annual contribution of $270,000.00 through the end of 2011. (2) Washington County shall pay $15.50 per capital for the unincorporated population served by CEMS with at least a minimum annual contribution of $550,000.00 through the end of 2011. (c) The Authority shall continue to seek a sustainable funding source with the goal of reducing subsidies proportionately across the board. (d) Except as stated above, no party to this Agreement may be financially obligated without the approval of its governing body. (e) All governing bodies party to this agreement must approve any increases in subsidy. (f) A percentage of these funds shall be set aside for replacement of capital items. (g) The ambulance service owned or under contract with the Authority shall be required to provide, at no additional charge, the Arkansas Department of Health 24 hour basic refresher course to all EMT certified firefighters that act as first responders with said ambulance service. (h) The financing provided by the parties hereto shall be from general revenues; furthermore, the financing and this agreement are contingent upon compliance with A.C.A. §20-13-301 et. seq. by the County and all the parties will cooperate to the 2 extent necessary in . complying with such. The parties shall receive credit for payments already made to CEMS in 2008 for this year's annual subsidy commitment. ARTICLE 4. TERM. This initial term of this agreement shall be from the date that all parties have agreed to this interlocal agreement through December 31, 2011. This agreement shall be automatically renewed with possible changes to Article 3 Financing for an additional five-year term unless any party notifies the Authority in writing of its refusal to participate in the Authority and this Agreement by September 1, 2011. All parties agree to consider the effects of the 2010 Decennial Federal Census upon the division of the County Sales Tax between the County and the Cities and the proportional changes of the populations of the Cities and the unincorporated portions of Washington County and make any adjustment or amendments advisable and necessary to Article 3 to ensure financial viability of the Authority and fairness for all parties. A second automatic renewal shall occur on December 31, 2016 unless any party notifies the Authority in writing of its refusal to participate in the Authority and this Agreement by September 1, 2016. A substantial review of the financial status of the Authority and all parties should occur in 2021 after the 2020 Federal Decennial Census and prior to further renewals of this Agreement. Not withstanding the above terms, all parties to this Agreement may withdraw from this agreement upon six months' written notice to the Authority and shall only be responsible to pay its. per capita fee for that portion of the year. ARTICLE 5. TRANSFER OF OWNERSHIP OF EQUIPMENT TO WASHINGTON COUNTY REGIONAL AMBULANCE AUTHORITY. Property currently owned by any party that is transferred to the Washington County Regional Ambulance Authority shall be returned to that party or purchased from that party at its fair market value if such party terminates its membership from the Authority and withdraws from this Agreement by July 1, 2011, after giving its six month notice. All property and resources of the Washington County Regional Ambulance Authority purchased during its existence or owned by it on July 2, 2011, or thereafter shall remain the Authority's exclusive property throughout the Authority's existence. ARTICLE 6. SEVERABILITY. The provisions of this Agreement are declared to be severable. If any provision hereof shall be held to be invalid or to be inapplicable to any person or circumstance, such holdings shall not affect the ability or the applicability of the remainder hereof. ARTICLE 7. EFFECTIVE DATE. This Agreement shall not be effective until approved and signed by all parties in accordance with the law. APPENDIX TO AGREEMENT APPENDIX DEFINITION OF TERMS WHEN AND IF USED. Ambulance Authority: Quasi -governmental entity created to oversee and deliver ambulance service in a specified geographical service area. Ambulance Service: Means emergency and. non -emergency transport services offered by the Authority, including management, supervision, mass gathering and community events. Exclusivity: Sole provider emergency and non -emergency ambulance rights granted by ordinance or resolution by each party to the extent allowed by State Law. Per Capita: Funding structure set forth by this Agreement based on population. Cities contribute at $4.00'per capita due to the increased number of calls generated within their city limits. The County contributes at $15.50 per capita due to the increased coverage area and decreased density of call volume in the unincorporated areas of the County. No reduction of any entity's gross subsidy shall occur during first term of this agreement. Subsidy: Government funds requested by the Authority to provide ambulance service. User Fees: Fees charged to patients treated or transported by the ambulance service, or fees charged to an individual or an organization for ambulance standby coverage. 6 Y _e: EXHIBIT "A" CITY OF FAYETTEVILLE CONTRACT FOR EMERGENCY MEDICAA /LITRANSPORT SERVICES This Agreement is entered into on this 7 rl day of, /CNr._"between the City of Fayetteville, hereinafter known as the "City" and Central Emergency Medical Service, hereinafter known as "CEMS," an Arkansas not -for-profit corporation. WHEREAS the City has determined that a public need exists for an emergency ambulance service that operates within the city limits of Fayetteville to serve Fayetteville residents, WHEREAS CEMS has developed an emergency ambulance service that operates within the City limits and serves Fayetteville residents. NOW, THEREFORE, in consideration of the mutual covenants contained herein, the City and CEMS agree as follows: 1. This Agreement will begin on the date first written above. 2. CEMS agrees to develop, operate, and maintain an Advanced Life Support (ALS) Emergency Ambulance Service that serves Fayetteville residents and respond to all emergency medical calls for service within the city limits of Fayetteville. This ALS service will be provided in conjunction with the Fayetteville Fire Department's emergency response units, with the Fayetteville Fire Department agreeing to provide Basic Life Support (BLS) Non -Transport Emergency Response Service. The Fayetteville Fire Department shall maintain control over the use of Fire Apparatus as First Response Units and CEMS shall maintain control over the use of Ambulances. 3. The Fayetteville Fire Department agrees to operate according to the established patient treatment protocols, as identified by the CEMS' Medical Director, from the time patient contact is made until the time the patient is removed from the incident scene and transported, via ALS Ambulance, to recognized medical treatment facility or hospital, or until CEMS personnel determine the call is a no -transport. 4. CEMS agrees to provide written quarterly and annual reports to the City's Project Coordinator describing the activities undertaken during the preceding period and also to report on the following performance measures: Number of calls responded to, average response time for these calls, type of patient service provided for each response. (Whether the patient accepted or declined care). The parameters for calculating the average response time will be from the time the call is verified at the CEMS medical communication center until arrival al the incident location by the first arriving transporting Ambulance. "Time call is verified" shall be the moment the communication center personnel receive both sufficient location information to know where a response is required and sufficient information to determine the presumptive run priority designation. "Arrival at incident location" means the moment an ambulance crew notifies the medical communication center that it is fully stopped at the location where the ambulance shall be parked while the crew exits to approach the patient. In situations where the ambulance has responded to a location other than the scene (e.g.. staging areas for hazardous material/violent crime incidents or non -secured scenes), arrival at the scene shall be the time the ambulance arrives at the designated staging location. The quarterly reports are to be submitted to the Project Coordinator by April 15, July 15, October 15, and January 15 for the preceding calendar quarter. The data used to compile these reports will include only those calls for service within the corporate city limits of the City of Fayetteville, Arkansas and will be reported for the current quarter, current year-to-date, and prior year-to-date. 5. CEMS commits to maintaining an average response time not to exceed eight (8) minutes within the City of Fayetteville's corporate limits for the duration of this contract. 6. CEMS agrees to make both financial and response data records available for review by the Project Coordinator and the City's Internal Auditor as requested, and to provide the City with an annual audit performed by a certified public accountant licensed by the State of Arkansas. CEMS agrees to comply with A the Arkansas Freedom of Information Act as applicable. Requests for records shall follow compliance requirements of the Health Insurance Portability and Accountability Act (HIPAA). 7. For the purposes of this Agreement, the Project Coordinator for the City will be the City Fire Chief or his/her designee. The Project Coordinator for CEMS will be CEMS Administrator Tony Hickerson or his successor or designee. Communications pertaining to this agreement will be through the respective Project Coordinators for the City and GEMS. 8. The term of performance for this agreement will expire December 31, 2008, subject to approval of an annual City budget containing funding for the service. The City agrees to pay and CEMS agrees to accept, as payment in full for its services, the annual amount of $250,000.00 in twelve (12) monthly installments of $20,833.00. The amounts to be paid for services in future budget years are dependent on the amounts appropriated by City Council for each budget year. If the Public Utility Model is accepted and instituted for this service, this contract will automatically- terminate upon the effective date of the Public Utility Model. 9. CEMS will hold harmless, defend, and indemnify the City, from any and all claims, actions, suits, charges and judgments whatsoever that arise out of the performance or nonperformance of the services or subject matter in this Agreement. 10. CEMS must provide and maintain in force, at all times during the term of the contract, insurance for worker's compensation as provided by state statute, commercial general liability, and vehicle liability. Such policies will be issued by companies authorized to do business in the State of Arkansas. Minimum amounts required for commercial general liability and automobile liability are $1,000,000. 11. For any work sublet, CEMS will require the subcontractor to provide similar worker's compensation insurance. In case any employee engaged in work on the project under this contract is not protected under workers' compensation insurance, CEMS will provide and will cause each subcontractor to provide adequate employers' liability insurance for the protection of such of his employees as are not otherwise protected. A certificate of insurance addressed to the City listing the above coverage amounts is to be submitted with contract approval. The premiums for all insurance required herein will be paid by CEMS. 12. CEMS and the City agree to establish a standing Emergency Medical Services (EMS) WorkgroupThis EMS Workgroup shall consist of three (3) representatives from CEMS; three (3) representatives from the Fayetteville Fire Department; and two (2) representatives from the Fayetteville Police Department's Central Dispatching Office. This Workgroup will meet to discuss the coordination of services, facilitate the exchange of ideas to enhance the quality of service being provided and develop a problem -solving mechanism This Workgroup shall meet as requested by any member of the Workgroup, but not less than once per quarter during the calendar year. 13. All notices required or permitted under this agreement will be submitted in writing to the other paity in this agreement by certified mail, return receipt requested, which notice will be effective three (3) days after deposit therein addressed to the following: City of Fayetteville Fayetteville Fire Dept. CEMS Dan Coody, Tony Johnson, Tony Hickerson, Mayor Fire Chief Administrator 113 West Mountain St. 303 W. Center St. 645 S School Ave Fayetteville, AR 72701 Fayetteville, AR 72701 Fayetteville, AR 72701 16: Neither party may assign any of its rights or obligations under this agreement, without the express written consent of the other. Nor shall this agreement be construed to bestow any rights or benefits upon anyone other than the City and CEMS. 17. It is agreed and understood that the failure of either party to invoke any of the available remedies under this contract or under law in the event of one or more breaches or defaults by the other shall not be construed as EXN�b't � c4 - 2- a waiver of such provisions and conditions and shall not prevent the parties from invoking such remedies in the event of any future breach or default. 18. This contract contains the entire agreement of both parties hereto, and no other oral or written agreement shall be binding on the parties hereto. No modification or variation of the terms of this contract shall be valid unless made in writing and signed by the duly authorized agents of the City and CEMS. This contract supersedes all prior agreements, contracts and understandings of any kind between the parties relating to the subject matter hereof. This contract may be executed in all or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 19. Each paragraph of this contract is severable from all other paragraphs. In the event any court of competent jurisdiction determines that any paragraph or subparagraph is invalid or unenforceable for any reason, all remaining paragraphs and subparagraphs shall remain in full force and effect. 20. This contract shall be interpreted according to and enforced under the laws of the State of Arkansas. The parties further agree that any litigation arising from this contractual relationship shall be commenced in either the Circuit Court of Washington County, Arkansas, or the United States District Court for the Western District of Arkansas, Fayetteville Division. The parties hereby submit to the personal jurisdiction of said courts, and waive any objections to venue in said courts. 21. Tax Exempt Status: Attached hereto and made part hereof is a copy of the correspondence from the Internal Revenue Service dated confirming the 501(c)(3) tax exempt status of the Central Emergency Medical Service. IN WITNESS WHEREOF, we have hereunto set our hands on the date first written above. Central Emergency Medical Services, Inc. City of Fayetteville, Arkansas By M By: SONDRA SMI Ctty Clerk 4rr�j1°1^r R1VTR�''a, .'�\SY°op rGp • .F: S ° FAYETTEVILLE; ''rr'ryJG S0N Pc 3' Signed this I8'+It day of , 2008. CITY OF FAYETTEVILLE, ARKANSAS By: ATTEST: is 'M[:.st�'�'lIL►�►`: ;FAYETTEVILLE; 7 SIGNED THIS � rl.viv DAY OF , 2008. CITY OF ELKINS, ARKANSAS BY: G� ACK LADYMAN, MAYOR ATTEST: BY: NS CITY CLERK SIGNED THIS I'' 4-k DAY OF ///1 /Ll5 , 2008. CITY OF GREENLAND, ARKANSAS BY: ATTEST: l i BY: Or,vt4-y� DQhNA- CI ;EjF',VERS',' RECORDERZTREASURER SIGNED THIS / DAY OF ' / G , 2008. CITY OF FARMINGTON, ARKANSAS BY: Cf ERNIE PENN, MAYOR ATTEST: BY:k A FARMINGTON CITY CLERK RECEIVED: 5/15/08 1:24PM; ->WASHINGTON COUNTY; #202; PAGE 8 MAY=15-2008 THU 01:05 PM P G,Water Dept FAX N0, 4798465649 P, 08 SIGNED TIES o1 i DAY OF 12008. CITY OF PRAIRIE ATTEST: BY: _ CAROL PAIR, CITY CLERK L!i SIGNED THIS _ DAY OF____, 2008. CITY OF WEST FORK, ARKANSAS BY: JEFF BAKE,71S4AYOR rauncsm N BY: PAULA CAUDLE, CITY CLERK 13 SIGNED THIS lJ� DAY OF , 2008. CITY OF GOSHEN,ARKANSAS BY: JO NSON, MAYOR ATTEST: BY: cLLQAJ CHERYL WHIT OCK, RECORDER/TREASURER SIGNED THIS DAY OF _______________,2008. CITY OF JOHNSON, ARKANSAS BY: L NNIE BARRON, MAYOR ATTEST: BY 15 SIGNED THIS 14 _` DAY OF ______________,2008. CITY OF WINSLOW, ARKANSAS BY: RA� j GAN, MAYOR ATTEST: 16 st SIGNED THIS a / " DAY OF .2008. WASHINGTON COUNTY, ARKANSAS BY: .R3))HU1tTON, COUNTY JUDGE - 1 ��. iii 1 � 9 L/ i!. , . �•I WI CERTIFICATE OF RECORD City of Fayetteville t� State of Arkansas I,Sondra E. Smith, City Clerk/Treasurer for the City of Fayetteville, do hereby certify that the foregoing instrument is a true and correct cop,of the on final file in my office on the day of Wit ass m hand and seal o2L da of RESOLUTION NO. 68-_____ asSondra E. Rm fd L g'L I S TO APPROVE AN INTERLOCAL AGREEMENT IvOO FOR AMBULANCE SERVICE BY AND WITH THE CITY OF FAYETTEVILLE, WASHINGTON COUNTY, ELKINS, FARMINGTON, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON, AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON -EMERGENCY AMBULANCE SERVICE WITHIN THE CITIES FAYE:1 EV LLLE WHEREAS, A.C.A. § 14-14-910, and § 14-266-102 and § 25-20-101 authorize cities and counties to enter into interlocal contracts to provide services such as emergency and non -emergency ambulance services; and WHEREAS, the above cities and Washington County have determined that the continued provision of ambulance service is necessary for the health, safety and welfare of the residents of said cities and Washington County; and WHEREAS, Washington County, the City of Fayetteville and all other cities listed in the Resolution's title agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. § 14-266-100 et seq. is in the best interests of all parties and their citizens; and WHEREAS, the Ambulance Authority should be established pursuant to the Agreement For Ambulance Services interlocal agreement attached as Exhibit A to this Resolution; and WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are parties to this agreement. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section. 1: That the City Council of the City of Fayetteville, Arkansas hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes Mayor Coody to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Fayetteville and every other city which is a party to this agreement as broadly as authorized in A.C.A. § 14-266-102 and 105. PASSED and APPROVED this the 18'" day of March, 2008. E :FAYETTEVILLE* APPROVED ATTEST: ^ �� o . By: By: enwuuu DAN COODY, Mayor SONDRA E. SMITH, City lerk/Treasurer RECEIVED: 4/24/08 3:39PM; ->WASHINGTON COUNTY; #61; PAGE 2 04-24-08;03:48PM; ; # 2/ 3 <emnlEMSdk2Revisedlnte$ocaL4greementCites.ord.doc 0324/08 ORDINANCE NO. F8 Qq-�3-7,O8 BE IT ORDAINED BY THE COUNCIL OF THE CITY OF ELKINS, STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON - EMERENCY AMBULANCE SERVICE WITHIN THE CITIES. ELKINS WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties •acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County. and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14- 910 and §14-266-101 et. seq, is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, ' WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties, and, WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CENTS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are party to this agreement. RECEIVED: 4/24/08 3:39PM; ->WASHINGTON COUNTY; #61; PAGE 3 04-24-08:03:48PM; tF 3/ 3 NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF ELKINS, ARKANSAS: ARTICLE 1. That the City Council of the City . of Elkins, Arkansas, hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes the Mayor to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Elkins and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105. ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services In Washington County and the cities therein due to the ability to control cost therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. OY-/7- cce DATE -Karen',EMS-#2Revisedlntedoca1AgreementCities.ord.doc 03124/08 GREENLAND ORDINANCE NO. 2008 - BE IT ORDAINED BY THE COUNCIL OF THE CITY OF GREENLAND, STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON- EMERENCY AMBULANCE SERVICE WITHIN .THE CITIES. WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14- 910 and §14-266-101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties, and, WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are party to this agreement. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF GREENLAND, ARKANSAS: ARTICLE 1. That the City Council of the City of Greenland, Arkansas, hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes the Mayor to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Greenland and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105. ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. a4 C q_IN-0bV 49ktN GRAY, GFNLAND MAYOR DATE D,0 ?'1E CHEEV . $, fR.ECORDFR/TREASURER LINCOLN ORDINANCE NO. 2008- 06 AN ORDINANCE TO AUTHORIZE THE CITY TO ENTER INTO AN INTERLOCAL.AGREEMENT WITH WASHINGTON COUNTY AND OTHER CITIES FOR THE CREATION OF AN AMBULANCE AUTHORITY AND FOR OTHER PURPOSES. BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF LINCOLN, ARKANSAS, THAT: Section One: Title. This Ordinance shall be known as the Washington County Regional Ambulance Authority Interloca] Agreement Ordinance. Section Two:. Parties. The proposed parties to the Interlocal Agreement are Washington County and, the Cities of Elkins, Farmington, Fayetteville, Goshen, Greenland; Johnson, Lincoln, Prairie Grove, West Fork and Winslow. Section Three: Authorization. A.C.A. §§ 14-14-910, 14-266-101 et seq., and 25-20-101 e1 seq. authorize cities and counties to enter into contracts to cooperate or join with each other to provide services; such to specify the responsibilities of all parties. Section Four: Need for Interlocal Agreement. All parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named cities and county and the parties mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.CA. §§14-14-910, 14-266-101 et seq., and 25-20-101 et seq. is in the best long-term interests of the parties. Section Five: Interlocal Agreement Attached. The attached hrterlocal Agreement provides for the formation of an Ambulance Authority pursuant to Arkansas law, and provides all parties, including the City of Lincoln, with a representative on the governing board of such authority. The attached Interlocal Agreement is hereby incorporated herein as if set forth word-for-word Section Six: Officials Authorized to Sign Agreement The Mayor and Clerk/Treasurer are hereby authorized to sign the Interlocal Agreement to bind the City to the terms of such agreement. The Mayor and Clerk -Treasurer are further authorized to take such steps as are necessary and incident to its implementation. Section Seven: Effective Date. This Ordinance shall become effective immediately upon its adoption, an emergency being declared to exist. Section Eight: Repealing Clause. Ordinances or parts thereof in force at the time that this ordinance shall take effect that are in conflict herewith, are hereby repealed, including Ordinance 2007-14. Section Nine: Saving Clause. Nothing herein shall be deemed to affect any rights or obligations existing at the time of the passage of this ordinance. Section Ten: Severability-Clause. In the event any portion of this ordinance is declared inoperative or invalid as a result of a statute or. judicial decision, then only that portion expressly so declared to be inoperative or invalid shall be affected thereby and all other provisions hereof shall remain in full force and effect. Section.Eleven: Emergency Clause. The City Council expressly finds, as a matter of fact, that: S. emergency and non -emergency ambulance service is critical to the health and well-being of its citizens; that the attached inter -local agreement for ambulance service is in the best interests of the citizens of Lincoln; and for these factual reasons an emergency exists and this ordinance should be in full force and effect immediately upon its date of passage and publication. Approved this 14" day of April, 2008. (Attest) 'EU(JL L2an.Cr., BeckyCaJ, Clerk -Treasurer KyrentEMS-#2Revisedlnfedoca/AgreementCitles.ord.doc 03/24/08 ORDINANCE NO. 2008-____ BE IT ORDAINED BY THE COUNCIL OF THE CITY OF FARMINGTON, STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE . CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE . EXCLUSIVE EMERGENCY AND NON- EMERENCY AMBULANCE SERVICE WITHIN THE CITIES. FARMINGTON WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14- 910 and §14-266-101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties, and, WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and GEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are party to this agreement. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF FARMINGTON, ARKANSAS: . ARTICLE 1. That the City Council of the City of Farmington, Arkansas, hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes the Mayor to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Farmington and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105. . ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. ERNIE PENN, FARMINGTON MAYOR FARMINGTO1�CITY CLERK -/ y-Zoo1 DATE I PRAIRIE GROVE ORDINANCE NO. 2008-1 AN ORDINANCE TO AUTHORIZE THE CITY TO ENTER INTO AN iNTERLOCAL AGREEMENT WITH WASHINGTON COUNTY AND OTHER CITIES FOR THE CREATION OF AN AMBULANCE AUTHORITY AND FOR OTHER PURPOSES. BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF PRAIRIE GROVE, ARKANSAS, THAT: Section One: Title. This Ordinance shall be known as the Washington County Regional Ambulance Authority Interlocal Agreement Ordinance.' Y Section Two: Parties. The proposed parties to the Interlocal Agreement are Washington County and the Cities of Elkins, Farmington, Fayetteville, Goshen, Greenland, Johnson, Lincoln, Prairie Grove, West Fork and Winslow. Section Three: Authorization. A.C.A. §§14-14-910, 14-266-101 et seq., and 25-20-101 et seq. authorize cities and counties to enter into contracts to cooperate or join with each other to provide services; such to specify the responsibilities of all parties. Section Four: Need for Interlocal Agreement. All parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named cities and county and the parties mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §§ 14-14- 910, 14-266-101 et seq., and 25-20-10I et seq. is in the best long-term interests of the parties. Section Five: Interlocal Agreement Attached. The attached Interlocal Agreement provides for the formation of an Ambulance Authority pursuant to Arkansas law, and provides all parties, including the City of Prairie Grove, with a representative on the governing board of such authority. The attached lnterlocal Agreement is hereby incorporated herein as if set forth word-for-word. Section Six: Officials Authorized to Sian Agreement. The Mayor and Clerk/Treasurer are hereby authorized to sign the Interlocal Agreement to bind the City to the terms of such agreement. The Mayor and Clerk -Treasurer are further authorized to take such steps as are necessary and incident to its implementation. Section Seven:Effective Date. This Ordinance shall become effective immediately upon its adoption, an emergency being declared to exist. Section Eight: Repealing Clause. Ordinances or parts thereof in force at the time that this ordinance shall take effect that are in conflict herewith, are hereby repealed, including , Ordinance 2007-25. Section Nine: Saving Clause. Nothing herein shall be deemed to affect any rights or obligations existing at the time of the passage of this ordinance. Section Ten: Severability Clause. In the event any portion of this ordinance is declared inoperative or invalid as a result of a statute or judicial decision, then only that portion expressly so declared to be inoperative or invalid shall be affected thereby and all other provisions hereof shall remain in full force and effect. Section Eleven: Emergency Clause. The City Council expressly finds, as a matter of fact, that: emergency and non -emergency ambulance service is critical to the health and well-being of its citizens; that the attached inter -local agreement for ambulance service is in the best interests of the citizens of Prairie Grove; and for these factual reasons an emergency exists and this ordinance should be in full force and effect immediately upon its date of passage and publication. 34 Approved this ≥ day of April. 2008. (Attest) Carol L. Pair, Clerk -Treasurer KarenlEMS-#2RevisedlntedocalAgreementCities. ord.doc 03/24/08 WEST FORK ORDINANCE NO. 2008- 398 BE IT ORDAINED BY THE COUNCIL OF THE CITY OF WEST FORK, STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON- EMERENCY AMBULANCE SERVICE WITHIN THE CITIES. WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14- 910 and §14-266-101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties, and, WHEREAS, in order to save taxpayer money and to reduce, the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are party to this agreement. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF WEST FORK, ARKANSAS: ARTICLE 1. That the City Council of the City of West Fork, Arkansas, hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes the Mayor to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout West Fork and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105. ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. y/09loy JEF ER, WEST FORK MAYOR DATE PO.4uL Ccu ..L PAULA CAUDLE, CITY CLERK GOSHEN ORDINANCE NO.79 AN ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON -EMERGENCY AMBULANCE SERVICE WITHIN THE CITIES, TO DECLARE AN EMERGENCY, AND FOR OTHER PURPOSES WHEREAS, A.C.A. § 14-14-910 and A.C.A. §14-266-101 et. seq. authorize cities and counties to enter into contracts to cooperate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County, and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. § 14-14-910 and § 14-266-101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties; and, WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the famishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non - emergency ambulance service within all cities that are party to this agreement. • NOW, THEREFORE, BE IT ORDAINED BY TEE CITY COUNCIL FOR THE CITY OF GOSHEN, ARKANSAS: ARTICLE 1. That the City Council of the City of Goshen, Arkansas, hereby approves the Interlocal Agreement for Ambulance Services attached as Exhibit A, authorizes the Mayor to Page 1 of 3 Ordinance No. 79 sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Goshen and every other city which is a party to this agreement as broadly as authorized in A.C.A. § 14-266-102 and 105. ARTICLE 2. EMERGENCY CLAUSE: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore, an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. Joe Benso Mayor ATTEST: Page 2 of 3 Ordinance No. 79 ROLL CALL VOTE ADOPTING THE ORDINANCE Names Of Those Voting YEA Paula Anderson Andy Bethell Dr. Brian Buell May Poye J.J. Lockhart Absent Jamie Boyd Names Of Those Voting NAY. ROLL CALL VOTE ADOPTING THE EMERGENCY CLAUSE Names Of Those Voting YEA Paula Anderson Andy Bethell Dr. Brian Buell May Poye J.J. Lockhart Absent Jamie Boyd Page 3 of 3 Names Of Those VotinaNAY Ordinance No. 79 KarenlEMS-#2RevisedlntedocalAgreementCities.ord.doc 03/24/08 JOHNSON ORDINANCE NO. 2008- 03 BE IT ORDAINED BY THE COUNCIL• OF THE CITY OF JOHNSON, STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON- EMERENCY AMBULANCE SERVICE WITHIN THE CITIES. WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14- 910 and §14-266-101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties, and, WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are party to this agreement. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF JOHNSON, ARKANSAS: ARTICLE 1. That the City Council of the City of Johnson, Arkansas, hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes the Mayor to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Johnson and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105. ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. I'►vY'1-Q �Q.wH-- ' 003 LONNIE BARRON, JOHNSON MAYOR D TE SON Y C %R� Karan\EMS-#2RevisedtntedocalAgreementCities.ord. doe 03/24/08 WINSLOW ORDINANCE O. 2008- M -O3 BE IT ORDAINED BY THE COUNCIL OF THE CITY OF WINSLOW, STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"); AND TO ESTABLISH THE AMBULANCE AUTHORITY AND CENTRAL EMERGENCY MEDICAL SERVICES AS THE EXCLUSIVE EMERGENCY AND NON- EMERENCY AMBULANCE SERVICE WITHIN THE CITIES. WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14- 910 and §14-266-101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties, and, WHEREAS, in order to save taxpayer money and to reduce the need for taxpayer revenue to subsidize the furnishing of emergency ambulance service to our citizens, the Ambulance Authority and CEMS should be designated the exclusive provider of emergency and non -emergency ambulance service within all cities that are party to this agreement. NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF WINSLOW, ARKANSAS: ARTICLE 1. That the City Council of the City of Winslow, Arkansas, hereby approves the Interlocal Agreement For Ambulance Services attached as Exhibit A, authorizes the Mayor to sign this agreement, and designates the Ambulance Authority created by this agreement to operate Central Emergency Medical Services as the exclusive emergency and non -emergency ambulance services provider throughout Winslow and every other city which is a party to this agreement as broadly as authorized in A.C.A. §14-266-102 and 105: ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. i oo1 RAND JA , WINSLOW MAYOR -T ATE WASHINGTON COUNTY ORDINANCE NO. 2007-66 — - BE IT ORDAINED BY THE QUORUM COURT .- a> .. OF THE COUNTY OF WASHINGTON, ��-: —o STATE OF ARKANSAS, AN ORDINANCE TO BE ENTITLED: v. AN EMERGENCY ORDINANCE APPROVING AN INTERLOCAL AGREEMENT FOR AMBULANCE SERVICES ("AGREEMENT") BETWEEN WASHINGTON COUNTY, ARKANSAS ("COUNTY") AND THE CITIES OF ELKINS, FARMINGTON, FAYETTEVILLE, GOSHEN, GREENLAND, LINCOLN, PRAIRIE GROVE, WEST FORK, WINSLOW AND JOHNSON ("CITIES"). WHEREAS, A.C.A. §14-14-910 and A.C.A.§ 14-266-101 et. seq. authorize cities and counties to enter into contracts to co-operate or join with each other to provide services; such to specify the responsibilities of all parties; and, WHEREAS, all parties acknowledge that the continued provision of ambulance service is crucial for the continued health and safety of the residents of the named Cities and the County; and, WHEREAS, the County and Cities mutually agree that the creation of an Ambulance Authority or similar entity as provided for in A.C.A. §14-14-910 and §14-266- 101 et. seq. is in the best long-term interests of the parties; and, WHEREAS, said Authority should consist of representatives of the above named Cities and the County; and, WHEREAS, all parties acknowledge that the formation of such an Authority will demand close and continued cooperation of all parties. NOW, THEREFORE, BE IT ORDAINED BY THE QUORUM COURT OF WASHINGTON COUNTY, ARKANSAS: ARTICLE 1. That said interlocal agreement is approved and the County Judge is authorized to sign such. ARTICLE 2. Emergency Clause: It is hereby determined that it is in Washington County's best interest for this contract to be authorized, and the general welfare of the citizens are affected by such in that the provision of emergency services by a regional, publicly owned entity is critical to the viability and quality of emergency services in Washington County and the cities therein due to the ability to control cost; therefore an emergency is declared to exist and this ordinance shall be and is effective from the date of its passage. JER N N, County Judge W ( i rugs -Qp1 KAREN COMBS PRITCHARD, County Clerk DATE Sponsor: Joe Patterson Date of Passage: November 8. 2007 Votes For: 11 Votes Against: - 1 Abstention: 0 Absent: 1