LA CROSSE COUNTY BOARD PROCEEDINGS

PLANNING MEETING

WEDNESDAY AUGUST 6, 2008

The La Crosse County Board of Supervisors Planning Meeting was held on August 6, 2008 at the University of Wisconsin La Crosse Cartwright Center Room Valhalla “B”.  Chair Steve Doyle called the meeting to order at 6:00 p.m.  The County Clerk, Marion I. Naegle, took attendance.  All supervisors were present except as noted:

County Board Chair Steve Doyle

Called the meeting to order at 6:07 p.m.  He briefly explained the order of the meeting.  He also made the public aware that there will be more meetings on the part of the City of La Crosse and the County Board and everyone is encouraged to attend. 

County Overview: Ambulance Service History and Description of Proposal

Power Point:  City/County Ambulance Proposal

·         There is no “Agreement”

o        Proposal to be introduced by two individuals – the Mayor and the County Board Chair

o        Earliest the City Council will vote is 5 weeks from now and the earliest the County Board will vote is 10 weeks from now

·         History of EMS in La Crosse

o        Pre- 1980’s – Police car, private vehicle

o        1980’s – Two ambulance providers – Tri-State and Medstar – Battle over Basic Life Support versus Advanced Life Support/Paramedic

o        January 1, 1990 – contract between County and Tri-State

o        1995 – Gundersen/Lutheran purchased Tri-State

o        2002 – City conducts study on taking over ambulance service

o        December 1, 2007 – EMS contract expires -  we presently have no EMS contract

·         Important considerations

o        There is no mandatory duty for a County to provide EMS services

o        Each municipality has the right to provide its own EMS services

o        The County’s goal has been to provide integration, stability and efficiency by having one provider and one 9-1-1 service

o        There is presently no tax subsidy

·         Current Situation

o        January 28 2006 - Mayor Johnsrud is quoted in the media about City’s intention to get into ambulance service – “War of words” begins as issue is debated in the media

o        March 16 2006 – city announces the hiring of Gregg Cleveland as Fire Chief

o        March 20 2006 – County Board Chair sends letter to Mayor expressing concern about ambulance service and asks for meeting.

o        May 17 2006 – Meeting on EMS – Attended by La Crosse County, City of La Crosse, Gundersen-Lutheran/Tri-State, Franciscan Skemp – Agreed on four main principles:

§         Must consider a regional approach

§         Should enhance clinical quality and patient safety

§         Strive to control healthcare costs

§         Be a collaborative effort and provide inclusivity

o        Interim Agreement – 4 points

§         1.  County will extend Tri-State contract for one year – to December 31, 2007

§         2.  Fire Department and Tri-State will work together to examine options/models

§         3.  Parties will refrain from further debate in the media

§         4.  The group will meet again in the fall to determine the next steps

o        Several months of little progress

o        Tri-State proposes EMD – April 30, 2007 – Public Safety Communications Board

§         “Emergency Medical Dispatch”

§         Pre-arrival instructions by a trained dispatcher

§         City concerned Tri-State is trying t lock in its role as provider

§         Advisory committee established to review the idea

o        May 15, 2007 – County proposes outside mediator

o        Mediation begins

§         “Pre-mediation meeting” is June 12, 2007

§         Howard Bellman is mediator

§         Four parties involved: La Crosse County, City of La Crosse, Gundersen/Lutheran, Tri-State Ambulance and Franciscan Skemp

§         Pre-mediation session with Howard Bellman and also Cathy Etter, State of WI EMS Coordinator

§         Each party met separately with mediator to make their own determination about continuing – all four parties agree to hire Bellman, splitting cost of up to $20,000

§         Bellman to track proposals and was authorized to talk with parties jointly or separately

§         July 24, 2007 – Half-day of individual and combined meetings with mediator – Procedural ground rules adopted

·         Participation is voluntary

·         Any party can withdraw from process at any time

·         Process is confidential

·         Any agreement would be presented to the public for comment before adoption

§         Important Fact Revealed: Tri-State’s internal study shows need for an additional ambulance in 2010

§         Major points of contention:

·         What role, if any, should the City play in the delivery of EMS services?

·         What should be the make-up of the body that oversees EMS delivery?

·         How should that body establish standards to govern the quality of service?

§         August 20, 2007 – City’s First Proposal

·         City would provide up to two ALS ambulances

o        One unit for the City – would be primary response for city calls

o        One unit for the region where needed

o        The City or County would dispatch

o        City and Tri-State would provide mutual back-up

·         City would set standards for its jurisdiction

·         Essential concept was two independent operations

·         September 12, 2007 – Tri-State’s First Proposal

o        Establish a governing board with 5 licenses physicians and 4 elected officials.  Also non-voting ex officio members

o        Governing board would decide who gets next ambulance

o        Tri-State would permit City paramedics to “ride-along” in Tri-State units

o        Standards based upon Tri-State’s existing performance

o        Essential concept was Tri-State dominated model to promote unified delivery of services

·         September 26,2007 – County and Franciscan meet with mediator to discuss middle ground

·         October 15,2007 – County FSMC Proposal developed

o        Governing board made up primarily of elected officials

o        City of La Crosse gets next ambulance

o        Would be operated as an integrated system with the County as hub

·         November 6, 2007 – County/FSMC meet with mediator to discuss how to present proposal

·         November 28, 2007 – County/FSMC hold back-to-back meetings with City and Tri-State – Each side raises concerns

·         December 13, 2007 – County/FSMC meet with mediator to fine-tune new proposal

·         EMD issue is resolved and program implements

·         Money for mediator runs out

o        City agrees to continue funding

o        Tri-State rejects continued expense of mediation – concern over change of success, not criticism of mediator – agrees to continue informal talks

§         2008- County becomes mediator

·         February 7, 2008 – County/FSMC meet with Tri-State to discuss modifications to proposal

·         February 28, 2008 – County/FSMC meet with City to discuss modifications to proposal

·         April 24, 2008 – County convenes meeting with both parties to identify remaining areas of dispute

·         April – June 2008 – Telephone and email communications to try to reach resolution – all four parties involved and also occasional one on one meetings

§         June 6, 2008 – Mayor agrees to proposal offered by County Board Chair – Proposal is not binding upon City or County unless adopted by Council and Board – Proposal is presented to Tri-State

·         There are more areas of agreement than disagreement

·         Key provisions of Proposal

o        City and County would each adopt reciprocal ordinances that define – EMS Commission membership – EMS Commission authority – Standards of quality and Guarantees of transparency

o        All parties agree with most of the terms

·         EMS Commission

o        Ten members

§         County Board Chair or designee who is a Supervisor

§         County Board First Vice Chair or designee who is a Supervisor

§         La Crosse Mayor or designee who is a Council Member

§         La Crosse Common Council member

§         La Crosse Citizen member appointed by Mayor

§         Onalaska Mayor or designee who is a Council Member

§         Village President or designee

§         Town Board Chair or designee

§         Representative from Gundersen Lutheran

§         Representative from Gundersen Lutheran

§         Representative from Franciscan Skemp

o        Tri-State would add two doctors

o        EMS Commission Authority – Commission is authorized to:

§         Set standards based upon State regulations

§         Designate EMS Medical Director(s)

§         Establish Pre-Hospital Medical Care Protocols

§         Ensure closest ambulance response regardless of jurisdictional boundaries

§         Set personnel standards

§         Set response time standards

§         Enter into Mutual Aid Agreements

§         Set vehicle and equipment requirements

§         Oversee EMS System communications and standards

§         Establish quality assurance programs

o        All parties agree with these terms

o        EMS Transparency – Commission to develop standards regarding content and frequency of reports on:

§         Calls

§         Response times

§         Clinical quality

§         Skills proficiency

§         Patient satisfaction

§         Vehicles and equipment

o        All financial and operational information of ambulance providers shall be available to the Commission and the Public

o        All parties agree to these terms

·         The major area of disagreement

o        The City of La Crosse shall own and operate the next ambulance added to the County EMS System

o        Tri-State Ambulance Service will be authorized to provide the second ambulance

o        Tri-State wants the Commission to decide who gets the first ambulance

·         Considerations

o        La Crosse County is not bound by any proposals made by its representatives

o        Next move is the City’s

o        It is not the County’s decision as to whether the City of La Crosse gets into the ambulance business

·         What is the significance of the proposal?

o        It is simply a proposal of the Mayor and the County Board Chair – it is not an endorsement by any County or City committee

o        The County does not have an official position on the proposal

·         Why do I support the proposal?

o        It allows the City to determine whether or not it should offer EMS through the Fire Department

o        It allows the municipalities outside the City of La Crosse to know that quality, efficiency and cost will not be sacrificed through a fragmented system

City of La Crosse Presentation on Ambulance Service Proposal

Power point - Mayor Mark Johnsrud

·         His attempt is not to compete, but to cooperate

·         City Police Department got out of the ambulance service in 1977 

·         EMT – Fire rescue is used today

·         City’s Mission – To enhance the quality and delivery of emergency medical services within the City and County of La Crosse and to provide these services in a cost effective manner to those who live, work or visit our community.

·         Four Principles

o        Regional approach

o        Enhance clinical quality and patient safety

o        Control health care costs

o        Collaborative effort and provide inclusivity

·         City/County Proposal

o        Joint Emergency Medical Service Commission

§         County Board Chair

§         County Board First Vice Chair

§         Mayor of the City of La Crosse

§         La Crosse Common Council Member

§         Citizen Member – La Crosse

§         Mayor of City of Onalaska

§         Town Board Chair

§         Village President

§         Representatives from Gundersen/Lutheran and Franciscan Skemp

o        Joint Emergency Medical Services Commission

§         Collaborative Emergency Medical Services Program

§         Oversight of Emergency Medical Services

·         Training and Protocols

§         Consistency in the quality and delivery of EMS

o        LCFD ambulance and paramedic first response in 2010

o        Next system ambulance for Tri-State as determined by Commission

o        Enhances the stability, accountability and transparency of EMS services

o        LCFD Paramedic First Responders

§         Patients will receive rapid access to advanced life support services (IV therapy, medications, advanced airway management, advanced medical procedures)

§         LCFD firefighter EMTs currently assist Tri-State staff (auto extrication, lifting patients, hazards control, patient stabilization, technical rescue)

§         LCFD provides firefighter EMTs to Tri-State during patient transport – future paramedic level

o        LCFD Ambulance

§         Operational in 2010

§         Staffed by two LCFD fire fighter – paramedics

§         Closest ambulance response

§         Not restricted by jurisdictional boundaries

o        LCFD Ambulance Estimated Five Year Costs

§         Paramedic Training    $  72,000

§         Wages/Benefits                  $587,420

§         Vehicle/equipment     $530,000      

§         Operating                $  25,000

§         Total five year cost     $1,214,420

o         LCFD Ambulance Estimated Five Year Revenue

§         4,000 ambulance transports over 5 years

§         Current Medicare reimbursement rate $365

§         Current Medicare mileage rate $6.55

§         Medicare pays 80% of both rates

§         4,000 transports with allowable increases and mileage over five years = $1,219,440

o        Cost recovery in Five Years

§         Revenue $5,020

§         No impact to property taxes

o        Clinical quality

§         Nationally Registered Paramedics

§         Certification/recertification in accordance with State of Wisconsin

§         Paramedics trained through Western Technical College

§         Joint Emergency Medical Service Commission provides common medical direction and protocols

o        Too many paramedics in the current system for skill retention

§         Based on current analysis, the system requires an additional ambulance and paramedics in 2010

§         Continued growth in the demand for emergency medical services

o        There are 20 cities in Wisconsin with FD ambulances

o        System Benefits

§         Emergency Medical dispatch System

§         Creation of EMS Commission

§         FD paramedics for rapid access advanced life support services

§         Integrated fire /paramedics service delivery

·         City/County Philosophy

o        Maintain a regional approach

o        Enhance patient safety, clinical quality and customer service

o        Control costs

o        Promote inclusivity in the delivery of EMS services

o        Cooperation and collaboration not competition

Mayor Johnsrud and Fire Chief Cleveland elaborated on the above proposal and made it known that the City is not trying to put Tri-State Ambulance out of business.  They feel the system is a good one and works well.

Tri-State Ambulance Presentation on Ambulance Service Proposal

Matt Zavadsky spoke on behalf of Tri-State Ambulance

·         Gundersen/Lutheran and Tri-State have been in this process for over a year and now feel it is time for the public to be heard.  Mr. Doyle did a good job but left out hat the proposal was not suppose to go forward without the consensus of all parties.

·         Nothing is wrong with Tri-State’s system.  We have great paramedics and first responders which produces one of the best EMS Systems in the country.  Both La Crosse hospitals share in the medical oversight and training for Tri-State and first responders.

·         Handout – “2007 community Report” – He encouraged citizens to read the report.  An example from the report shows that the cardiac arrest survival rate is nationally at 5.4%.  Tri-State’s 2007 rate was 14.4% and in 2008 is 16.7%.  This is one of the only measures they have to evaluate how well they are doing.

·         Tri-State is not in this business for the money, they hardly break even.    They are committed to the area and want to work in a system that gives fanominal care along with the first responders.  They work together to bring an enhanced level of service at not cost to the taxpayer.  When working in the red they do not go to the taxpayer for money, so there is no risk involved.

·         Their cost of one ambulance for one year is $651,000