Agenda 12/08/2015 Item #10A'12YS/2015 10.A.
EXECUTIVE SUMMARY
',e":on-.miondaiior tna", "he femporairily extend tl-ie Co-unty's COPUN1 vJtl-i _moo "d Collier
"PC MCA W FOSCue Asuin alt vigh 2'aruz;ry 2 i16, pnov.dc ' nne cooperative
developed.
OB-7F`,CTIVE- T.- extend NIS Nonles CoMer --i-re cont-rol and Rcsc-je Distr--',�ut's COP -N until
-�Jirne Lhe
!-�ta'lff '..can�s for 1-11.e
co'u�nty ]'-"-jI',QIFD a-.,-e e
t -\�J-*:h a
-,he second Warr:
of Count'.),
Ji,i -wary
2016,
CQ'N'S;WT.-7R-A--jION': Collier County and North Naples Fire Control and Rescue District
VORM) 'Lgal counsel' and staff o,.-e -,v,,ork�,sng to o -,-neans f�cjr 'io Advanced
III! Suppoh. xxirth i-ned,'cai responses, but at This no agreu,rnent has been adopted by
' of Co -e C
t1;1' Boa rd -oniniissioncr.
PI--
Theres)VI, it is Ovarmys, nuls U-; u--11TMrW!5' SuMorize �-�-.n "n"' n'sion N jj�\!j 1) -,-,-,7"1 ich
expies on Decenibcr 30, 2015. Unc !rjai-d sncPu:j exond to cwTmt COPCI,,
3 anaaq- 29, 20 -,,6 ,-; )rovide -.. for bc.,ti-, s sta.. 'Cc -"" "heir oarc`.s in
Closed losed door sessions to consider any nevq proposed ALSS provision agreennent.
1- - '- C", ' aff
2009, 'Nlorflh. Naples We Control and Rcscuc apD1,�:-,.,d ',.ro -,,'no ;a,
recornnienned d�-nial. On Octobo- 26. 2010, M ,--.eni -v-t7as -,iaced' on rhe IRM rRenda and was
voted down. This iern 'was' recorisidered and paced on jm-.�jary.25, 2�'Ul i, rC�co:-�i ni ended
denial during the reconsideration based in part on the
)istriei s' -,.bnd=d an application for a nor, - tnansp�,oil, C-t rti-?).ante ofT trlllC Co; ve.-- -,once
and Nicesshy for Vid puTposcs of prodding Advwwed Suppert "Nori - Qxrations
separate and apaj! from the County Mledicaj Director's Ynedical diroction, coo rdina6cii-;', and
comrot solely to the North Naples Fire District. Such separate medical direction is contrary to
the prodsions, and responsibilitics of t1he County's Medical as re,c':-"enced in
'Rorida Stat.u!Lo 401. 265. This ruhng was Wher MAY by a Finai Order issued by the Florida
of licalth, -Iji. Dcp,-,,-.rr--nt of Ficalth case n-urnbcr 20', 0-0040."
.�rc ,-,'idely osed amid aro gCrig-n-all by t'- ,,v,1' oi—i-note
agenVR MuC. types )f can be crafted to rnset specific n,,zu's. the ✓
Counops AWW--'' anu-i 'Jhe INS Napts Fire CoW and ReKm EWct OIN',-,- ) ;isve
I I its ovvr Nlk,,�ica-' Director, this
,jeon unable ',o Succ�essfiully Zoge'LI.'er. Since NNM hired
Que has been resolved.
I -
list orically, the County has approved inter- locals for Advance Life S u pp t
L (AT S) for
I'Jrc L "ics. is
-�pznc'ar'-� ar-, iii iFi :u.nt ;, -noent
cu r"'c I -'vo .:e; ' vva!-d 7 ;'n i/ c S rc -vii s i on IC.!- 1R`i 1111' F rj
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12/8/2015 10.A.
FISCAL IMPACT: To be determined.
GROWTH MANAGEMENT IMPACT: None.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is
approved as to form and legality, and requires majority vote for approval. -JAK
RECOMMENDATION: Recommendation that the Board temporarily extend the County's
COPCN with North Collier Fire Control and Rescue District through January 29, 2016, to
provide time for a cooperative agreement to be developed.
PREPARED BY: Commissioner. Tom Henning
Attachments: A) BCC Oct 26 2010 l OH Agenda Item NNFD
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COLLIER COUNTY
Board of County Commissioners
Item Number: 10.10.A.
12/8/2015 10.A.
Item Summary: Recommendation that the Board temporarily extend the County's COPCN
with North Collier Fire Control and Rescue District through January 29, 2016, to provide time for
a cooperative agreement to be developed. (Companion to Item 12A) (Commissioner Henning)
Meeting Date: 12/8/2015
Prepared By
Name: BrockMaryJo
Title: Executive Secretary to County Manager, County Managers Office
12/1/2015 9:59:43 AM
Submitted by
Title: Executive Secretary to County Manager, County Managers Office
Name: BrockMaryJo
12/1/2015 9:59:45 AM
Approved By
Name: IsacksonMark
Title: Division Director - Corp Fin & Mgmt Svc, Office of Management & Budget
Date: 12/1/2015 11:23:27 AM
Name: KlatzkowJeff
Title: County Attorney,
Date: 12/1/2015 1:44:04 PM
Name: OchsLeo
Title: County Manager, County Managers Office
Date: 12/2/2015 10:48:24 AM
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Agenaa item r4o. curt
October 26, 2010
Page 1 of 7
EXECUTIVE SUMMARY
Recommendation to deny North Naples Fire Control and Rescue District's
Application for a Certificate of Public Convenience and Necessity for an
Advanced Life Support Non - Transport Service.
OBJECTIVE: To proceed in the best interest of public health, safety and welfare as it
relates to Advanced Life Support (ALS).
CONSIDERATION: On September 17, 2009, North Naples Fire Control and Rescue
District ( "Fire District ") submitted an Application for a Certificate of Need to provide ALS
Non - Transport Services ( "Application "). Staff timely conducted a thorough review of the
Application, submitted correspondence for additional information that was not submitted
or incomplete within the application, and met with the District's legal counsel. The
Application was also placed in suspense for a period of time at the request of the Fire
District and then subsequently re- activated at the request of the District's legal counsel.
Staffs basis for denial is set forth in a letter to the County Manager, dated July 1, 2010
(see copy attached). Importantly, staff recommends denial of the Application based on
the following:
• Fire District submitted an application for a non - transport Certificate of Public
Convenience and Necessity for the purposes of providing Advanced Life Support
Non- Transport Operations separate and apart from the County Medical Director's
medical direction, coordination, and control, solely to the North Naples Fire
District. Such separate medical direction is contrary to the provisions, duties,
and responsibilities of the County's Medical Director, as referenced in Florida
Statute 401.265. This ruling was further clarified by a Final Order issued by the
Florida Department of Health, in Department of Health case number 2010 -0040.
(This order is included in the staff response and documentation which due to its
size is too large for mass publication. Copies of staff response and
documentation are available for examination in the office of the Board of County
Commissioners.)
The Application did not provide any empirical data for its particular district or the
County, supporting a Certificate of Public Convenience and Necessity other than
citing references to the 2007 Emergency Medical Service Master Plan document,
which was developed to review and analyze County -wide level of service
standards in support of the Annual Update to Inventory Reporting (AUIR).
Numerous operational changes have taken place since the 2007 report.
The Fire District also failed . to indicate that it would staff the necessary
emergency medical response resources in a manner that would not conflict or
delay a medical call if its personnel and apparatus were responding to or
involved in a fire response.
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Page 2 of 7
FISCAL IMPACT: There is no fiscal impact associated with this Executive Summary.
LEGAL CONSIDERATIONS: Ordinance No. 04 -12, Section 7 states:
`The Board of County Commissioners shall not grant a certificate unless it shall
find, after public hearing and based on competent evidence that each of the following
standards has been satisfied:
(1) The extent to which the proposed service is needed to improve the
overall Emergency Medical Services (EMS) capabilities of the County.
(2) The effect of the proposed service on existing services with respect to
quality of service and cost of service.
(3) The effect of the proposed service on the overall cost of EMS service
in the County.
(4) The effect of the proposed service on existing hospitals and other
health care facilities.
(5) The effect of the proposed service on personnel of existing services
and the availability of sufficient qualified personnel in the local area to
adequately staff all existing services.
B. That the applicant has sufficient knowledge and experience to properly
operate the proposed service.
C. That, if applicable, there is an adequate revenue base for the proposed
service.
D. That the proposed service will have sufficient personnel and equipment to
adequately cover the proposed service area."
Ordinance No. 04-12, Section 8 provides:
"In making the determinations provided for in Section 7 above, the Board may, in its
sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual
findings and conclusions as a result of the hearing. Should a Hearing Officer be
appointed, said Hearing Officer shall render a written report to the Board within 30 days
of the hearing, which report shall contain the officer's findings and conclusions of fact,
and a recommended order. The findings and conclusions of fact shall be binding upon
the Board, but the recommended order shall be advisory only."
Staff response and documentation for this item is too large for mass publication. Copies
of staff response are available for examination in the office of the Board of County
Commissioners. —JAK
GROWTH MANAGEMENT IMPACT: There is no growth management impact
associated with this Executive Summary.
RECOMMENDATION: That the Collier County Board of County Commissioners denies
North Naples Fire Control and Rescue District's Application for a Certificate of Public
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Page 3 of 7
Convenience and Necessity for an Advanced Life Support Non - Transport Service as
there is no public necessity for the service.
PREPARED BY: Dan E. Summers, Director of the Bureau of Emergency Services.
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Cl #7er Ceo n. nty
Services
[AEmarandum
DA7 E:
Nonch Napies Fire Control a.nd Rescue District
12/8/2015 10.A.
Agenua aern i,4o. lut-i
OcFcber 26, 2010
—;v
I -.-e 4 of 7
t" L
;A. 7T.
r" '
The COPCNI filing was originaRy received in your office September 1.9, -000 and submirced by 1.
The oppropriFte
-h-istwher Lornta rd-,, of the North 111-lap!e.ri �vard cf Fire r
f,"-Png -vps
D°17 n ti-le Fev;ekfill c,�ihe nopEc-ition, Mr. Rk-.har ovancfvich becFme agert for -L"s Urq,
Along the cour-Fe thc- review period Vr. '(-:ivpnoviz, re-lug ;ted th.. be p"In"Er"
floe
cu-rent.
IT t h e .41 W C
't1 7c: C rj J0
J Y g "a, n
2. E C: rr e;
many d-!32tes between ti-re A6vance Life Support and Basic Life. Support delivarY rnocAiMes preverred by
On, may �E/7, 2010 Ni,,. Yovanovich notified the County of his dEsir--- to re-open our review of the COPCIq
this
is -E,
flnanc*.a� prcv�,c;-a�, by the North N!'eples Fira and Rescue Ulstrici- was cut-ctf-.J��,'Le with the ie-
by ema-7! k-vfth Mr. F,�nd r-celved +4 latest flrFnc�?,!
n
T GO
", 1 ' - 2-
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Age$ lama ncn i �w. r V rn
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Page 5 of 7
Staff Review- COPCN Application
North Naples Fire Control and Rescue District
July 1, 2010
Page 2
information. i have deemed the application submittal complete, effective June 29, 2010 within the
intent of Ordinance 2005 -16 as required. Mr. Yovanovich has been noted in writing of the application
being deemed complete by my office.
It should be noted that the bulk of the application submission included a copy of the 2007 EMS System
Master Plan prepared by a consultant, in conjunction with discussions associated with a review of the
Annual Update to Inventory Reporting (AUIR). The 2007 EMS Master Plan reviewed data and
projections during the periods of 2005, 2006, and 2007 which were periods of extensive growth'within
the County. Due to changes in the EMS delivery systems, national refinements in best practice, and
population projections, the 2007 Master plan discounts the substance of the application as requested by
North Naples Fire Control and Rescue District in its justification of the COPCN application..
Many factors highlighted by North Naples Fire Control and Rescue District in their application have been
overcome by a number of changes in either delivery of services or are mute with respect to the spirit of
the COPCN supporting county -wide services. They include, but are not limited to, the following:
Absence of growth projections that were predicted during the time of the report.
- Refinements in national standards and academic research verifying the importance of a two -
tiered BLS /ALS system delivery.
Implementation of the Advanced Practice Paramedic (MedCom) in one -man vehicles.
Improved dispatch procedures.
- Cancellation of the AILS agreements at the North Naples and East Naples Fire District.
Ongoing data point analysis by the Blue Ribbon group to further refine system delivery in a
two - tiered fashion.
- . Collier County's extensive network of publicly and privately accessible. Automatic External
Defibrillators and their associated registration ordinance.
Additionally, the COPCN Ordinance in Section 7 states the following: "The Board of County
Commissioners shall not grant a certificate unless it shall find, after public hearing and based on
competent evidence, that each of the following standards has been met." Essentially, there are eight
provisions within Section 7 of the ordinance that have, in my opinion, not been met, further discounting
the award of a certificate.
I have given the application a thorough review based on criteria provided in the ordinance referenced
above. In summary, it is my recommendation that a Certificate of Public Convenience and Necessity
should not be granted to the North Naples Fire Contro( and Rescue District, as it does not demonstrate
better protection for the health, safety and welfare of the residents of Collier County as a whole in
ambulance and ALS matters, by establishing uniform countywide standards, etc., as referenced in
Section 1 of the Purpose statement of the ordinance. In the absence of countywide improvement alone,
.a
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Staff Review- COPCN Application
North Naples Fire Control and Rescue District
July 1, 2010
Page 3
the COPCN application, in my opinion, is not a valid application for services and threatens to increase
risk in the pre - hospital care field environment with separate medical controls.
The COPCN effort is designed for services within the "County' — geographically overall, and in my
opinion, is not applicable for a district. limited type of service as requested by North Naples Fire Control
and Rescue District. North Naples.Rre Control and Rescue District's application provided no indication
that they would provide services outside of their boundaries on a routine basis as opposed to the
current way in which mutual aid is provided on a case -by -case incident basis, therefore not serving the
County as a whole.
Denial of this COPCN application does not prohibit the county or the Medical Director from exploring
other refinements to the two- tiered concept of pre - hospital care delivery involving the Fire services.
Indeed the Fire Service can and does provide important services to the emergency scene. Those efforts
should continue in a fashion that provides prompt BLS support in an environment of reduced risk,
ensuring adequate resources for their primary mission and links in the chain of care that are consistent
standards of practice, and single point medical control.
I look forward to meeting with you at your earliest convenience regarding this discussion.
Thank you.
Attachments: North Naples, COPCN Application
cc: Mr. Scott Teach, Deputy County Attorney
0)
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Page 7 of 7
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
Item Number. 10H
Item Summary: This item to be heard at 1:00 p.m. Recommendation to deny North Naples Fire Control and
Rescue Districts Application for a Certificate of Public Convenience and Necessity for an
Advanced Life Support Non - Transport Service. (Dan Summers, Director, Bureau of
Emergency Services)
Meeting Date: 10/26/2010 9:00:00 AM
Prepared By
Dan E. Summers
Director of Emergency Services
Date
Bureau of Emergency
Services and Emergency
Bureau of Emergency Services and
Management
Emergency Management
10118/2010 3:14:56 PM
Approved By
Dan E. Summers
Director of Emergency Services
Date
Bureau of Emergency
Services and Emergency
Bureau of Emergency Services and
Management
Emergency Management
10/18/2010 3:24 PM
Approved By
Jeff Page
Chief - Emergency Medical Services
Date
Bureau of Emergency
Services
EMS Operations
10/18/2010 3:26 PM
Approved By
Sherry Pryor
Management/ Budget Analyst, Senior
Date
Office of Management &
Budget
Office of Management & Budget
1011912010 11:26 AM
Approved By
Leo E. Ochs, Jr.
County Manager
Date
County Managers Office
County Managers Office
10/19/2010 2:16 PM
Approved By
Jeff Klatzkow
County Attorney
Date
10/1912010 2:47 PM
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