Leon County Works on EMS Contract
EMS agreement a step closer
City, county leaders hash out beginnings of compromise
By Jeff Burlew
DEMOCRAT STAFF WRITER
Tallahassee Mayor John Marks and Leon County Commission Chairman Tony Grippa expressed a new sense of optimism Monday that the city and county will reach an agreement on the future of emergency medical services.
Marks and Grippa agreed to broad aspects of a new EMS system, including annual, upfront payments from the county to the city for the program, which is estimated to cost $8.1 million in its first year.
"I think we're making significant progress," Marks said after meeting with Grippa.
The county will take over EMS after Tallahassee Memorial Hospital discontinues the service. The county is asking TMH to extend by 90 days its Oct. 1 deadline to end the service, and TMH officials have said they will consider the request.
Under the plan, the county would contract with the city to provide paramedic and ambulance services. The Tallahassee Fire Department would hire a host of new workers, including displaced TMH paramedics, to deliver speedier and more advanced emergency medical services.
Some city commissioners have expressed reservations about entering into the EMS contract with the county, particularly because the city already estimates it is paying $1 million more each year than it should to provide fire service outside the city limits.
Marks said some city commissioners are apprehensive about a new program that also could prove more expensive than estimated.
"There are commissioners who are very, very antsy and have anxiety as to whether or not the county is going to follow through with the commitment," Marks said.
Marks said the dispute over the fire services agreement, which expires in 2008, will be taken off the table for the purposes of the EMS negotiations. He and Grippa agreed to revisit that and similar city/county issues once the EMS issue is solved.
Some city officials have asked the county to pay for EMS in part with a new half-mill property tax. Last week, city and county commissioners took first steps in setting up the tax, which could raise more than $4 million a year. A mill equals $1 of tax for every $1,000 of property value.
But Grippa said he would not be in favor of the contract if it means the county would have to impose the new tax without first trying to pay for EMS through budget cuts or other measures.
"I would not be doing my fiduciary duty as a county commissioner if in fact I took that approach," Grippa said. "It's just absolutely ridiculous that they would ask us to do that."
Marks said he would not require the county to create the tax as long as the county agreed to pay the city's costs for EMS, estimated at $7.4 million in the first year.
Grippa, meanwhile, proposed creating a fund with any annual savings from the EMS program. Half the money in the fund would be used for EMS employee bonuses, while the other half would go back into the EMS program. Both Marks and City Manager Anita Favors expressed general support for the idea.
Favors and County Administrator Parwez Alam hope to conclude their contract negotiations within a month. It would then go before city and county commissioners for final approval.
Once a system is in place, the city would have to hire new paramedics and purchase new equipment and vehicles. The county would hire a part-time medical director and set up a system for billing and collecting. The city and county also would have to address hundreds of operating procedures, Alam said.
Tax increases on the menu
County plans to raise taxes
Money would go to EMS, health care
By Jeff Burlew
DEMOCRAT STAFF WRITER
Taxes in Leon County are going up to pay for emergency medical services, buyouts of flood-prone properties and health care for the uninsured.
Tuesday's decision by the County Commission could help pave the way for a final agreement on EMS with the city of Tallahassee, which is expected to provide the service through the Fire Department after Tallahassee Memorial Hospital stops doing so.
The city, however, wanted the county to come up with a dedicated source of funding for EMS, which is estimated to cost more than $8 million in the first year.
"I think it was a very critical vote to provide a good ambulance service in the county," County Administrator Parwez Alam said.
Commissioners convened for their first of more than a dozen meetings scheduled through September to discuss and iron out the budget for the fiscal year beginning Oct. 1. During the meeting, commissioners also voted to raise two other taxes and to give themselves and county workers raises.
The decisions won't become final until after public hearings in September. The preliminary budget totals more than $190 million, an increase of nearly 2 percent over the current fiscal year.
The commission voted 5-2 to pay for EMS with a new property tax set at a rate of 0.41 of a mill. One mill equals a dollar for every $1,000 of property value.
Commission Chairman Tony Grippa suggested during the meeting that the county pay for EMS through a host of budget cuts, including increasing the cost of health care for county workers and nixing a plan to move the county's growth department. And while a few commissioners expressed support for some of the ideas, Grippa did not win majority support for any of them.
"It's tax-and-spend day, folks," Grippa said at the end of the meeting.
Commissioner Cliff Thaell described Grippa's budget-cut idea as "a desperate effort." Commissioner Bill Proctor supported a few of Grippa's key proposals - but that wasn't enough to sway the majority.
Commissioners also voted to increase a communications tax for residents outside city limits from 1.84 percent to 5.22 percent, which is the maximum rate allowed and the same rate levied by the city. The tax is levied on telephone, cable and satellite services.
The county plans to use the proceeds to help purchase homes in flood-prone areas.
Alam said the county could take the estimated $1 million generated each year by the communications tax hike to secure $20 million in bonds and grants - which, in turn, could finance the purchase of more than 100 homes.
Commissioners also raised a property tax that pays for the uninsured health-care program from 0.06 of a mill to 0.12. The program costs about $1.2 million a year.
One tax, however, was eliminated - a 2-percent fee on water and sewer services.
Under the new tax plan, the owner of a home valued at $100,000 within the Tallahassee city limits would pay an extra $35 a year, according to estimates provided by Alan Rosenzweig, the county's finance director. The owner of a similar home outside the city limits - where the communications tax is assessed - would pay $60 more.
Raises, park improvements
In addition to funding EMS, the proposed county budget will give county workers raises of 4 percent or $1,000 - whichever is greater.
Commissioners also voted to raise their own salaries according to state statutes, which means their pay will increase from $63,000 a year to $65,350.
Included in the preliminary budget is funding for a new Northeast Community Park, new community centers for Woodville and the Lake Jackson area, lighting for Woodville Community Park and widening of Buck Lake Road.
Commissioners also approved a plan to eliminate a fee assessed when county residents visit city parks and pools. County residents pay 50 percent more than city residents at city facilities. Under the plan, the city and county would pay $90,000 each to eliminate the fee.
Contact reporter Jeff Burlew at (850) 599-2180 or firstname.lastname@example.org.
The Mayors Opinion...Letter to the Editor
EMS: All must pay a fair share
By John Marks
In the next week the Tallahassee City Commission will be a part of one of the most important decisions facing this community - Emergency Medical Services (EMS). This issue affects first and foremost the physical well-being of our residents, and it will have a direct financial impact on these same residents.
It's easy to fall back on the assumption that city and county government are unable to reach a reasonable solution because past contractual negotiations have not always gone well. I can assure you, however, that every member of the Tallahassee City Commission takes seriously the importance of this basic health and welfare issue.
We believe that EMS can be provided in an exemplary way by Tallahassee firefighters, whose ranks could include the current Tallahassee Memorial Hospital paramedics. Our firefighters have a history of serving this community with bravery and commitment.
The City Commission also has a financial responsibility to ensure that city residents pay only their fair share of necessary costs, while unincorporated area residents also pay their fair share. We are anxious about these details because other contracts between the city and county have left city residents subsidizing services for their neighbors in the unincorporated area.
The clearest example is the 20-year fire services contract between Tallahassee and Leon County. When negotiated 15 years ago, it was believed the contract would cover all costs, but years later, city residents are paying an additional $1 milliona year that should be paid by unincorporated county residents.
While the county's approach is that a deal is a deal, we believe this to be unfair to city residents. We don't want to make the same mistake when it comes to an EMS contract. This is why the Tallahassee City Commission has said full cost recovery is mandatory.
The city has proposed a true-up process with reasonable approvals. The true-up concept is simple: The costs of providing the service during any given period is compared to actual and "true" costs and adjusted accordingly. City and county staff reached agreement on a true-up process last week. The city has since learned the solution is no longer acceptable to the county.
Examples of true-ups already exist between city and county government. Perhaps the most successful is for fire services for station #15 on Bannerman Road. At this station, cost of service true-ups are done on an annual basis depending upon the number of service calls within the city and unincorporated area. For example, in 2002, 86 percent of the calls were in the unincorporated area, while 14 percent were within the city limits.
Had a fixed cost agreement been made, city residents would again be subsidizing county residents. On the other hand, if the mix of service calls change and more calls come from city residents, the county would pay less. The true-up process avoids inequities in payments.
The final decision on the best and most cost-effective EMS provider rests with Leon County alone. Should the county choose to continue services with TMH, the city will fully support that decision. If it chooses to enter into a contract with the city, we are prepared to provide the service. Either way, the providing entity will want to ensure all costs are fully covered.
As we address this critical life saving issue, we want residents of both the city and unincorporated Leon County to know we are fully committed, prepared and already beginning work to provide Emergency Medical Services. The only remaining issue is to ensure that all pay their fair share.
Tallahassee Mayor John R. Marks III can be reached via City Hall e-mail at BonoM@talgov.com.
County Vows to Have Control
County vows to run EMS
Commission ends talks with city
By Jeff Burlew
DEMOCRAT STAFF WRITER
Debate on the future of ambulance service in Leon County has finally ended.
After negotiations between the city of Tallahassee and Leon County over emergency medical services turned sour, county commissioners late Tuesday voted unanimously - and somewhat unexpectedly - to create the county's own EMS department rather than partner with the Tallahassee Fire Department.
Commissioner Cliff Thaell suggested giving the city until noon Thursday to accept a take-it-or-leave-it proposal for EMS based on a model designed by consulting firm Fitch & Associates.
But Commissioner Jane Sauls said it was high time to make a final decision on the future of EMS. She even managed to persuade Chairman Tony Grippa, who had been a staunch supporter of a TFD take-over, to support the plan.
"I think we've waited long enough," Sauls said. "We need to give our paramedics some relief. They've been under stress for nine months."
Several paramedics from Tallahassee Memorial Hospital who attended the County Commission meeting cheered and hugged one another after the vote.
"It's a wonderful decision," said TMH paramedic supervisor Andrew Farber. "This is what we've wanted. It puts us in control of running the system and creating an excellent system."
Under the plan, the TMH ambulance program would essentially move under county oversight. Although many details are not yet known, County Administrator Parwez Alam said the county should be able to set up the program before Jan. 1, when TMH discontinues its program.
"It's not like landing a man on Mars," Alam said of creating the new department.
County officials also said a county-run EMS department would reduce the cost of the ambulance service from $8.1 million a year to about $7.2 million.
TFD partnership not viable
The decision, which many commissioners have said was the most important to face the community in years, came after Assistant County Administrator Vince Long reported that recent demands from the city meant that a partnership with TFD was no longer viable.
City officials wanted a full-cost recovery system in which the county would reimburse any costs incurred by the city in running EMS. The system included an annual "true-up" mechanism in which the city would be paid for any cost overruns.
County officials, on the other hand, wanted to stick with a fixed, annual price of $8.1 million developed in the Fitch plan. They said the "true-up" feature would make budgeting for EMS very difficult and ignore possible cost savings that could be achieved by operating EMS efficiently.
The city also wanted $125,000 to $225,000 more for insurance, an additional $80,000 for a communications worker, more money for training and supplies for volunteer firefighters and money to buy all new ambulances. The county didn't want to spend the extra money and wanted to purchase ambulances and other vehicles and lease them to the city.
Also, the city wanted the ability to withdraw its consent on a property tax that would pay for about half the cost of EMS, but county officials said such a provision would pose "serious implications" to the entire EMS system.
Property tax still needed
County commissioners still are counting on city commissioners to approve a countywide property tax that would pay for EMS. City commissioners are expected to take up that issue during their meeting today.
County commissioners already have approved the property tax and set a tentative rate at .41 of a mill. One mill equals one dollar for every $1,000 of property value. Now, county officials think they can reduce that rate to about .3 of a mill because of cost savings in the county plan.
If city commissioners don't approve the tax hike, county officials said they would likely be forced to raise their countywide millage rate.
Contact reporter Jeff Burlew at (850) 599-2180 or email@example.com.
Paramedics Critical of System
Paramedics criticize EMS plan
TMH workers raise questions over salaries, schedules
By Todd Wright
DEMOCRAT STAFF WRITER
Tallahassee Memorial Hospital paramedics and medical technicians tore apart a plan for a new emergency medical-services system in a meeting with Leon County officials Monday.
Many of the paramedics were critical of the new system's proposed work schedule and lobbied for more ambulances on the streets.
It didn't take long for the meeting - which was meant to give paramedics an update on the county's plans and to introduce paramedics to the new EMS facility at the county's Public Works Center - to turn into a critique session.
"The system they are talking about will fail," said Ed Skinner, who has been a paramedic at TMH for 12 years. "They want to increase the service levels but are asking us to work with less. And on top of all that, they want me to work more hours to do it."
For two hours, county officials listened to concerns of about 50 TMH employees about the new system. Paramedics raised questions about salaries, overtime, benefits and how much TMH staff would be hired, but they got no answers.
"We are new to this, and we don't claim to have everything worked out," County Administrator Parwez Alam said. "We had this meeting to get their input, and we will seriously consider what they have said."
However, Alam thinks the new system, which is based on a consultant's report by Fitch and Associates, is consistent with most EMS systems around the country and can work.
The new system shares many similarities to the current TMH-run service. Five full-time ambulances will be on call 24 hours a day, with three vehicles in reserve. The county also is proposing three quick-response vehicles that will respond to advanced life support calls outside the city limits.
The county wants to have a paramedic-emergency technician pair on each ambulance, which is different from the two paramedics on each TMH ambulance. In the county proposed model, the paramedic is the only person able to administer advanced life support techniques.
Shifts also would change.
Under the county-run EMS system, paramedics would have two days off between 24-hour shifts. Currently, paramedics get three days off between shifts.
Skinner and paramedic George Azar said the plan promoted a harder workload on paramedics and would not improve service.
"There is nothing enhanced about this system," said Azar, who has been a paramedic for 26 years. "What they are going to get is physically exhausted paramedics and increased burnout."
Since making the decision to run its own EMS system, the county has been working feverishly toward having a system up and running by Jan. 1, according to Vince Long, the assistant county administrator. The county still is searching for an executive director for the system but is in the final stages of negotiations with the hospital's Dr. Javier Escobar for the medical director position.
Alam said he would meet with a select group of TMH employees for more discussions on how to improve the current EMS model.
"We are going to try and use their input, but within the resources we have," he said, citing cost as a major factor for many of the suggestions. "If money wasn't an issue, we'd have 18 ambulances out there. Everybody wants more."
Contact reporter Todd Wright at (850) 599-2206 or firstname.lastname@example.org.
Employees evaluating the program
Workers weigh new EMS program
TMH paramedics mull pros and cons of move
By Jeff Burlew
DEMOCRAT STAFF WRITER
Paramedics who move from Tallahassee Memorial Hospital to Leon County's new ambulance program will work more hours each year. But they also will receive a number of perks, including free uniforms, cheaper health insurance and special-risk retirement benefits from the state.
Robert Koegel, who has worked as a paramedic for six years at TMH, is among more than 40 people who have applied for paramedic positions with the county since it began accepting applications last month. The county is setting up its own ambulance program by the end of the year to replace TMH's.
Koegel and other TMH paramedics currently have three days off between their 24-hour shifts. Those who are hired by the county will have only two days off between shifts, which means they will work 2,912 hours a year instead of 2,080 hours.
"I'll be making the same amount each year," Koegel said. "I'll just be working 900 hours more a year to get it. But that's pretty much the standard across the state. The benefits are definitely going to be better."
Koegel, who has applied for jobs outside the county, estimated that his family's health insurance plan would cost $200 less a month at the county than at TMH.
More than 260 people have applied for jobs with the county's new ambulance program over the past few weeks, according to Traci Reed, director of human resources and risk management. The jobs range from an emergency medical services director, who will oversee the program, to watch commanders, shift supervisors and emergency medical technicians.
Reed said the county hopes to hire an EMS director by the beginning of October to help determine staffing and interview applicants. She said the county anticipates hiring about 70 people for the program. Candidate assessments for most applicants begin Oct. 6.
TMH did not pay for uniforms or the cost to clean them, but the county will, Reed said. Also, retirement benefits for paramedics and EMTs will be calculated at 3 percent, or nearly double that of other workers, because they are considered special-risk under the Florida retirement system.
Paramedics will earn between $35,600 and $56,400 a year depending upon experience. The director of the EMS program will earn between $53,800 and $90,800 a year.
During a meeting hosted by county officials in July, paramedics and other rescue workers at TMH criticized the new EMS system in part because of the longer hours.
George Azar, a TMH paramedic, is among those who have criticized the schedule. But he said he and many other TMH workers are applying for the jobs because the county's ambulance program will be the only one in town.
"Everybody's applying," Azar said. "And I've got to work one way or the other. If you want to work, you have to go along with it. You either jump on the wagon or walk."
Contact reporter Jeff Burlew at (850) 599-2180 or email@example.com.
Dissention still prevails
Tensions raised over Leon County budget
There wasn't complete harmony among Leon County commissioners last week when they passed their new $198 million budget.
Chairman Tony Grippa and Commissioner Dan Winchester voted against increasing a property tax that pays for the county's uninsured health-care program. The tax increased from 0.06 mills to 0.12 mills. One mill equals one dollar for every $1,000 of property value.
Grippa also voted against a new property tax, set at half a mill, that will help pay for the county's new ambulance program. Commissioner Cliff Thaell also voted against the EMS tax.
"I felt like we could have funded this out of general revenue and not a property tax," said Grippa, who suggested the county cut $4 million out of its budget to help cover the cost of EMS.
Thaell proposed cutting $1.75 million earmarked for new branch libraries near Apalachee Parkway and Lake Jackson in hopes of getting rid of the EMS tax within a year. He pointed out that those areas already have leased branch libraries in shopping centers.
"The reason I voted against (the EMS tax) was a matter of priorities," Thaell later said.
But commissioners didn't go for the idea. Winchester, in particular, sharply criticized him for proposing the library cuts. Grippa and Winchester also said they felt doubling the health-care tax was excessive. The program helps uninsured people receive ongoing health-care at local clinics.
- Jeff Burlew
Davie--Fire Department Intensifies Recruit Training After 09/11
New firefighters face tough challenges
BY SAMUEL P. NITZE
Davie's latest fire recruits are on their knees, in near darkness, breathing through masks, smoke rising above them, heat racing toward 1,000 degrees, the captain shouting instructions.
They take turns with the hose, aiming short bursts of water as flames race across the ceiling. This is what a flashover feels like, the moment when everything in the room ignites all at once.
Fifteen minutes later, the firefighters emerge from the smoky confines of a shipping container used as a training tool at Broward Fire Academy, sweat running down their faces.
''Crazy. I've never experienced that much heat, ever,'' says 21-year-old recruit Chris Mercado. That was good -- to know what to expect.''
They can expect much more than heat, though.
= [100.0] size, offers more than its share of fire-rescue challenges: Million-dollar houses on rural expanses nowhere near a hydrant. Thousands of trailer homes. Florida's Turnpike and two busy interstates. A sprawling educational complex. Industrial development, barns, and mid-rise condominiums.
Like many current recruits, those in Davie are training to be firefighters and paramedics. And they are joining the fire department at a time when, after the Sept. 11, 2001, terrorist attacks, new procedures and equipment related to homeland security are working their way into circulation.
''There is a convergence of all these factors at once,'' said Fire Chief Donald DiPetrillo. ``These are the pressures on a fire department, and the greatest challenge is for these young folks to step up. It's an exciting time, but we are definitely asking a lot of them.''
DiPetrillo became Davie's fire chief more than two years ago, leaving his post as an assistant chief in Fort Lauderdale. He took over a troubled department in Davie whose fire chief and deputy chief were forced out of their jobs the year before.
DiPetrillo said he pushed for more resources from the start, believing the department hadn't kept pace with the town's rapid population growth -- an increase of 60 percent from 1990 to 2000.
The number of alarms exploded along with the population, from 8,000 in 1998 to 14,400 in 2002, according to figures provided by the fire department. Nearly 17,000 calls are anticipated by the end of this year.
Town officials backed DiPetrillo, and he also took his case to the public during a series of town meetings. Earlier this year, voters approved a $16.5 million bond referendum that will pay for two new fire stations, new equipment, and other improvements.
Davie has hired nearly 60 new firefighters since 1999, with dozens more expected in the coming years to staff the new stations and replace the large numbers expected to retire.
In a profession that relies heavily on experience and teamwork, the influx of so many rookie firefighters has quickened the pace of the entire operation, fire officials said.
Davie's new hires go through nearly four weeks of intense orientation -- including the flashover simulator -- then begin to work regular shifts, 24 hours on, 48 hours off.
During one of her first shifts, Monica Santana, 28, found herself on a crew fighting a fire in a condo complex, with the corpse of a murder victim just a few feet away.
''It was intense. We had to keep working in the room, and five feet away there's a body,'' she said. ``You're nervous, but that's when your training kicks in. It's an adrenaline rush. You never know what you are going to get in this job.''
On days when call volume is light, the recruits practice packing hoses, hooking up to hydrants and other routine procedures. When calls come in, recruits ride along and help where they can, always under the eye of their lieutenants, who fill out daily evaluations.
''It's a tremendous burden on us,'' said 28-year veteran Lt. Phil Lloyd, one of the longest-serving members of the department. ``But the refresher is good for everyone. . . . Repetition, repetition, repetition, and when something really happens, you've got it down pat.''
New recruit Matt Maresca was part of Lloyd's team earlier this week when they were called to an accident off the turnpike.
As Maresca stepped into his bunker gear and pulled on blue rubber gloves, siren wailing overhead as they raced toward the scene, he appeared to be thinking.
''I'm running the scenarios. If he asked me to do this, if he wants me to do that, making sure I can do it,'' Maresca said. ``Sometimes there are so many things going on, you lose track.''
An ambulance was already on the scene. The car was a mess. The driver, a young woman, looked dazed but appeared to be uninjured. She was fitted with a neck brace, placed on a stretcher and loaded into the ambulance.
Lloyd sent Maresca to the back seat of the wrecked car in case his help was needed as the crew unloaded the driver. Lloyd asked Maresca to unhook the car battery. And he sent Maresca to stop traffic for the tow truck.
Basic stuff, but good practice all the same, Lloyd said.
It went well, and Maresca seemed relieved as he clambered back into the truck.
''Me, I'm always on edge because I'm new,'' he said. ``You're being judged.''
But he won't be new forever.