Agenda 01/28/2014 Item #16K31/28/2014 16.K.3.
EXECUTIVE SUMMARY
Recommendation that the Board of County Commissioners approves, and authorizes the
Chair to execute, the proposed Collier County Emergency Services Medical Director
Agreement with Dr. Tober.
OBJECTIVE: To enter into a Medical Director's Agreement with Dr. Tober.
CONSIDERATIONS: Dr. Robert Tober has served for many years as the County's medical
director. A copy of the current agreement with Dr. Tober, as amended, is included in the back up
to this item.
At the Board's March 12, 2013 regular meeting (Item 1I -F), Commissioner Hiller brought
forward a recommendation that the Board of County Commissioners direct staff to prepare
solicitations for the positions of County Medical Director and Deputy County Medical Director.
The Board directed staff to prepare a Request for Proposals (RFP) for both positions.
The Collier County Public Safety Authority reviewed all proposals from interested and qualified
consultants in response to the RFP and presented its rankings to the Board on June 25, 2013
(Item I O -G). The Board voted to direct the Chair to negotiate a contract with Dr. Tober as the
Medical Director and Dr. Lee as Deputy Medical Director.
The Agreement form was taken from Palm Beach County, and modified to comport with the
RFP. Both staff and Dr. Tober had substantial input into and are supportive of the proposed
Agreement. Should the Board approve this item, the County Attorney will utilize this
Agreement as the basis for an agreement for Dr. Lee as Deputy Medical Director.
In that the Medical Director will now report directly to the County Manager, it was felt that both
the annual performance evaluation and proposed goals of the Medical Director should . be
handled by the County Manager, with all performance issues going to the Board of County
Commissioners.
FISCAL IMPACT: The Agreement calls for a salary of $75,000 per year.
GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact associated
with this Executive Summary.
RECOMMENDATION: That the Board of County Commissioners approves the proposed
Collier County Emergency Services Medical Director Agreement with Robert Boyd Tober, Inc,
and authorizes the Chairman to execute same.
PREPARED BY: Jeffrey A. Klatzkow, County Attorney
Attachments:
1. Current Collier County Agreement with Dr. Tober
2. June 25, 2013 Minutes of the Board of County Commissioners
3. Proposed Collier County Emergency Services Medical Director Agreement
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COLLIER COUNTY
Board of County Commissioners
Item Number: 16.16.K.16.K.3.
Item Summary: Recommendation that the Board of County Commissioners approves, and
authorizes the Chair to execute, the proposed Collier County Emergency Services Medical
Director Agreement with Dr. Tober.
Meeting Date: 1/28/2014
Prepared By
Name: NeetVirginia
Title: Legal Assistant /Paralegal,County Attorney
1/17/2014 2:24:28 PM
Submitted by
Title: County Attorney
/1-11N Name: KlatzkowJeff
1/ 17/2014 2:24:29 PM
Approved By
Name: WalkerJeff
Title: Director - Risk Management,Risk Management
Date: 1/17/2014 3:21:37 PM
Name: PriceLen
Title: Administrator, Administrative Services
Date: 1/21/2014 10:13:04 AM
Name: KlatzkowJeff
Title: County Attorney
Date: 1/21/2014 2:05:11 PM
Name: GrafCynthia
Title: Applications Analyst,lnformation Technology
Date: 1/21/2014 3:23:14 PM
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Name: KlatzkowJeff
Title: County Attorney
Date: 1/21/2014 3:34:13 PM
Name: OchsLeo
Title: County Manager
Date: 1/21/2014 5:13:36 PM
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COLLIER COUNTY EMERGENCY SERVICES
MEDICAL DIRECTOR AGREEMENT
THIS MEDICAL DIRECTOR AGREEMENT made this day of
, 2014, by and between ROBERT BOYD TOBER, INC., hereinafter
referred to as MEDICAL DIRECTOR, and COLLIER COUNTY, FLORIDA, hereinafter
referred to as the COUNTY.
WITNESSETH:
WHEREAS, the COUNTY is responsible for emergency services in Collier County,
Florida; and
WHEREAS, Section 401.265, Florida Statutes, requires the COUNTY as a basic and
advanced life support service provider to employ a medical director; and
WHEREAS, ROBERT BOYD TOBER, M.D., is a duly licensed physician in the State
of Florida who is specially trained in the field of emergency medicine; and
WHEREAS, the COUNTY and the MEDICAL DIRECTOR are presently parties under a
Medical Consultant Contract, and wish to continue their relationship under the terms and
conditions set forth below.
NOW THEREFORE, in consideration of the promises and mutual covenants hereinafter
set forth, the parties hereto agree as follows:
ARTICLE 1- SERVICES
The MEDICAL DIRECTOR'S responsibility under this Agreement is to provide
professional services as Medical Director for COUNTY in accordance with Chapter 401, Florida
Statutes and Chapter 64 -J -1, Florida Administrative Code, Rules of the Department of Health, as
more specifically set forth in the Scope of Work and specifications detailed in Article 3.
ARTICLE 2 — SCHEDULE AND RENEWAL
The MEDICAL DIRECTOR shall commence services on the date first written above and
complete all services by two (2) years from date written above. This Agreement may be
renewed for up to three additional one (1) year terms by the Board of County Commissioners
based on satisfactory performance, mutual acceptance and determination that the contract is in
the best interest of the COUNTY. The MEDICAL DIRECTOR shall be given one hundred -
twenty days (120) notice of the COUNTY's intent to renew the contract or to allow the contract
to expire without renewal. Any renewal will be subject to appropriation of funds by the Board of
County Commissioners.
ARTICLE 3 — SCOPE OF WORK
This Agreement is personal to Dr. Tober, and as such the duties set forth herein cannot be
delegated or assigned except as- expressly permitted by Chapter 401, Florida Statutes and
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Chapter 64 -J -1, Florida Administrative Code, Rules of the Department of Health or as otherwise
provided in this Agreement. Exhibit A outlines the specific scope of work and responsibilities of
the MEDICAL DIRECTOR. This does not limit duties to the following requirements, which may
be subject to revision/addition /deletion upon written agreement by both parties. I
ARTICLE 4 — PAYMENTS TO MEDICAL DIRECTOR
The COUNTY shall pay to the MEDICAL DIRECTOR the sum of seventy -five thousand
($75,000) per year, as full compensation for the services rendered herein and no other
compensation. The COUNTY will pay the cost of the professional liability insurance and
reasonable and necessary legal services as set forth below. The MEDICAL DIRECTOR shall
not be eligible for any employee benefits other than this compensation. This sum shall be paid to
the MEDICAL DIRECTOR in twelve (12) equal monthly payments commencing with the
effective date of the Agreement, with each monthly payment being payable by the 100' of each
month. On the date that general wage adjustments (i.e., cost of living adjustments, special study
pay adjustments, etc.) are granted generally to COUNTY employee, the MEDICAL
DIRECTOR'S base salary shall be modified to reflect the general wage adjustment granted to
other COUNTY employees. In addition, on each annual anniversary date during the term of this
Agreement, including any renewal terms, the MEDICAL DIRECTOR will be entitled to a 5%
annual increase upon the written notification to County Manager fifteen (15) days prior to the
annual anniversary date and subsequent approval by the Board of County Commissioners, with
any increase to be retroactive to the first day after the annual anniversary date.
ARTICLE 5 — REPORTING /ANNUAL CONTRACTOR EVALUATION
The MEDICAL DIRECTOR shall report to the County Manager or designee for the
services as MEDICAL DIRECTOR as more specifically defined in this Exhibit A and as set
forth in Section 401.265, Florida Statutes.
The MEDICAL DIRECTOR will submit a contractor self - assessment along with
proposed goals for the next year on an annual basis to the County Manager or designee no later
than the first day of June. The County Manager or designee will review the MEDICAL
DIRECTOR's self - assessment and may request an independent evaluation and recommendations
from a Board authorized Advisory Board. Any performance issue will be taken to the Board of
County Commissioners. An updated contractor evaluation plan may be developed in good faith
between the MEDICAL DIRECTOR and the County Manager or designee and adopted prior to
October 1" of each year for implementation in the next year.
ARTICLE 6 — TERMINATION
This Agreement is subject to termination without cause by either party to this Agreement
upon sixty (60) days written notice. Such notice shall be forwarded by certified mail to the
addresses set forth in Article 19.
This Agreement is subject to immediate termination for cause in the event:
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(a) MEDICAL DIRECTOR fails or refuses to prosecute the Scope of Work or any severable
part, with the diligence that will insure its completion within the time specified by the
COUNTY;
(b) MEDICAL DIRECTOR violates law, ordinances, rules, regulations or any governmental
authority having jurisdiction;
(c) MEDICAL DIRECTOR materially breaches any of the provisions of this Agreement.
ARTICLE 7 — AVAILABILITY OF FUNDS
The COUNTY'S performance and obligation to pay under this Agreement is contingent
upon an annual appropriation for its purpose by the Board of County Commissioners.
ARTICLE 8 — INSURANCE
A. Coverage is afforded under the COUNTY'S SELF - INSURED RETENTION PLAN and
SPECIFIC EXCESS INSURANCE POLICY as follows:
SELF - INSURED RETENTION PLAN
$300,000 each occurrence
SPECIFIC EXCESS INSURANCE POLICY
$2,000,000 each occurrence combined single limit
Coverage is afforded to the MEDICAL DIRECTOR and DEPUTY MEDICAL
DIRECTOR by endorsement. Coverage for back -up physicians shall be subject to the
prior approval of the COUNTY's insurance underwriters.
B. Additional Malpractice Coverage shall also be afforded by the COUNTY hereunder as has
been historically provided by COUNTY to MEDICAL DIRECTOR for activities while
riding as crew member of EMS vehicle as required by this Agreement and by State Law.
C. The COUNTY reserves the right, but not the obligation, to purchase separate liability
insurance on behalf of the MEDICAL DIRECTOR, the Deputy Medical Director and back-
up physicians in lieu of providing the coverage as mentioned above. Such insurance will be
limited to those matters arising out of this Agreement.
D. The requirements contained herein are not intended to and shall not in any manner limit the
liabilities and obligations assumed by the MEDICAL DIRECTOR under this Agreement.
ARTICLE 9 — REMEDIES
This Agreement shall be governed by the laws of the State of Florida. Any and all legal
action necessary to enforce the Agreement shall be held in Collier County.
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ARTICLE 10 — CONFLICT OF INTEREST
MEDICAL DIRECTOR shall at all times act in the COUNTY'S best interest. Nothing in
this Agreement shall be interpreted as preventing the MEDICAL DIRECTOR from operating
any other business or being similarly employed with any other emergency medical service which
is lawfully licensed by the COUNTY (within Collier County, Florida) and the State. However
the MEDICAL DIRECTOR shall not accept any employment or enter into any contractual
relationship which would create a conflict between such interest and the performance of its
duties hereunder. To that end, the MEDICAL DIRECTOR shall promptly notify the
COUNTY'S representative, in writing, by certified mail, of all other prospective employment,
business association, interest or other circumstance which MEDICAL DIRECTOR plans to
engage in throughout the term of this Agreement. Such written notification shall identify the
prospective business association, interest or circumstance, the nature of work that the MEDICAL
DIRECTOR may undertake and request an opinion of the COUNTY as to whether the
association, interest or circumstance would, in the opinion of the COUNTY, constitute a conflict
of interest if entered into by the MEDICAL DIRECTOR. The COUNTY agrees to notify the
MEDICAL DIRECTOR of its opinion by certified mail within thirty (30) days of receipt of
notification by the MEDICAL DIRECTOR. If in the opinion of the COUNTY, the prospective
business association, interest or circumstance would not constitute a conflict of interest by the
MEDICAL DIRECTOR, the COUNTY will so state in the notification and the MEDICAL
DIRECTOR shall, at is option, enter into said association, interest or circumstance and it shall be
deemed not a conflict of interest with respect to services provided to the COUNTY by the
MEDICAL DIRECTOR under the terms of this Agreement.
Nothing in this Agreement shall be interpreted as preventing the MEDICAL DIRECTOR,
a contractual employee of the COUNTY, from being employed in any other capacity, including,
but not limited to the operation of a medical practice, the employment as a staff member of any
hospital, or the serving as a MEDICAL DIRECTOR for any other emergency medical service
which is lawfully licensed by the COUNTY (if located within Collier County) and the State.
Nor shall anything in this Agreement be interpreted as preventing the MEDICAL DIRECTOR
from continuing with any employment or other work in which he was already engaged at the
time this Agreement was entered, which employment or work includes without limitation
employment and work with NCH, The Wound Care Center and The Neighborhood Clinic.
ARTICLE 11— DISCLOSURE AND OWNERSHIP OF DOCUMENTS
The MEDICAL DIRECTOR shall deliver to the COUNTY'S representative for approval
and acceptance, and before being eligible for final payment of any amounts due, all documents
and materials prepared by and for the COUNTY under this Agreement.
The COUNTY and the MEDICAL DIRECTOR shall comply with the provisions of
Chapter 119, Florida Statutes (Public Records Law), HIPAA, HITECH, HIPAA Regulations,
and any other applicable law relating to records and/or confidentiality of records. To that end,
MEDICAL DIRECTOR shall execute the COUNTY's standard Business Associate Agreement.
All covenants, agreements, representations and warranties made herein, or otherwise
made in writing by any party pursuant hereto, including but not limited to any representations
made herein relating to disclosure or ownership of documents, shall survive the execution and
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delivery of this Agreement and the consummation of the transactions contemplated hereby.
ARTICLE 12 — INDEPENDENT CONTRACTOR RELATIONSHIP
The MEDICAL DIRECTOR is, and shall be, in the performance of all work services and
activities under this Agreement, an Independent Contractor, and not an employee, or servant of
the COUNTY. All persons engaged in any of the work or services performed pursuant to this
Agreement shall at all times, and in all places, be subject to the MEDICAL DIRECTOR'S sole
direction, supervision, and control. The MEDICAL DIRECTOR shall exercise control over the
means and manner in which it and its employees, agents, subcontractors, Deputy Medical
Director and back -up physicians perform the work, and in all respects the MEDICAL
DIRECTOR'S relationship, and the relationship of its employees, agents, subcontractors, Deputy
Medical Director and back -up physicians, to the COUNTY shall be that of an Independent
Contractor and not as employees or agents of the COUNTY. The MEDICAL DIRECTOR, the
Deputy Medical Director and all back -up physicians shall comply with all COUNTY policies
concerning conduct and security when performing services hereunder. The MEDICAL
DIRECTOR does not have the power or authority to bind the COUNTY in any promise,
agreement or representation other than specifically provided for in this Agreement.
ARTICLE 13 — LEGAL EXPENSES OF THE MEDICAL DIRECTOR
The County agrees to reimburse the MEDICAL DIRECTOR for any reasonable legal
expenses and costs incurred by the MEDICAL DIRECTOR in the performance of his duties or
resulting from his holding of the Medical Director's position and title, including without
10—N limitation expenses and costs associated with legal opinions or assistance needed in the
interpretation, application and compliance with statutes, ordinances and administrative
regulations, e.g., Chapter 401, Chapter 119 and F.A.C. 64-J -1, and litigation expenses.
ARTICLE 14 — ENFORCEMENT COSTS
If any legal action or other proceeding is brought for the enforcement of this Agreement,
or because of an alleged dispute, breach, default or misrepresentation in connection with any
provisions of this Agreement, each party shall bear its own attorney's fees and costs.
ARTICLE 15 — AUTHORITY TO PRACTICE
The MEDICAL DIRECTOR hereby represents and warrants that he has and will continue
to maintain all licenses and approvals required to conduct his business, and that he will at all
times conduct his business activities in a reputable manner. Proof of such licenses and approvals
shall be submitted to the County Manager of designee upon request. The MEDICAL
DIRECTOR further represents and warrants that he will continue to maintain the requisite
qualifications, knowledge and experience required of a medical director by Section 401.265,
Florida Statutes and Rule 64J- 1.004, F.A.C., and any other applicable laws and regulations.
ARTICLE 16 — SEVERABILITY
If any term or provisions of this Agreement, or the application thereof to any person or
circumstances shall, to any extent, be held invalid or unenforceable, the remainder of this
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Agreement, or the application of such terms or provisions to persons or circumstances other than I
those as to which it is held invalid or unenforceable, shall not be affected, and every other term
and provision of this Agreement shall be deemed valid and enforceable to the extent permitted
by law.
ARTICLE 17 — ENTIRETY OF CONTRACTUAL AGREEMENT
The COUNTY and the MEDICAL DIRECTOR agree that this Agreement sets forth the
entire agreement between the parties, and that there are no promises or understandings other than
those stated herein. None of the provisions, terms -and conditions contained in this Agreement
may be added to, modified, superseded or otherwise altered, except by written instrument
executed by the parties hereto.
ARTICLE 18— MODIFICATIONS OF WORK
The COUNTY reserves the right to make changes in the Medical Director's Exhibit A
Scope of Work, including alterations, reductions therein or additions thereto. Upon receipt by
the MEDICAL DIRECTOR of the COUNTY'S notification of a contemplated change, the
MEDICAL DIRECTOR shall, in writing: (1) provide a detailed estimate for the increase or
decrease in cost due to the contemplated change, (2) notify the COUNTY of any estimated
change in the completion date, and (3) advise the COUNTY if the contemplated change shall
affect the MEDICAL DIRECTOR'S ability to meet the completion dates or schedules of this
Agreement.
If the COUNTY so instructs in writing, the MEDICAL DIRECTOR shall suspend work
on that portion of his duties affected by a contemplated change, pending the COUNTY'S
decision to proceed with the change.
If the COUNTY elects to make the change, the COUNTY shall initiate an Agreement
Amendment and the MEDICAL DIRECTOR shall not commence work on any such change until
such written amendment is signed by the MEDICAL DIRECTOR and approved and executed by
the COUNTY Board of County Commissioners.
ARTICLE 19 — NOTICE
All notices required in this Agreement shall be sent by certified mail, return receipt requested,
and if sent to the COUNTY'S representative shall be mailed to:
Leo E. Ochs, Jr., County Manager
3299 East Tamiami Trail, Suite 202
Naples, FL 34112
And if sent to the MEDICAL DIRECTOR shall be mailed to:
ROBERT BOYD TOBER, INC.
Collier County Emergency Medical Services
8075 Lely Cultural Parkway, Suite 267
Naples, FL 34113
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ARTICLE 20 — REGULATIONS; LICENSING REQUIREMENTS
The MEDICAL DIRECTOR shall comply with all laws, ordinances and regulations
applicable to the services contemplated herein, to include those applicable to conflict of interest
and collusion. MEDICAL DIRECTOR is presumed to be familiar with all federal, state and
local laws, ordinances, codes and regulations that may in any way affect the services offered.
MEDICAL DIRECTOR shall keep all required licenses and corporate records current throughout
the term of this Agreement, and shall on request provide proof thereof.
IN WITNESS WHEREOF, the Board of County Commissioners of Collier County,
Florida, has made and executed this Agreement on behalf of the COUNTY and MEDICAL
DIRECTOR has hereunto set its hand the day and year above written.
ATTEST:
DWIGHT E. BROCK, Clerk
By:
WITNESSES:
Print Name:
Print Name:
Jeffrey A.
County Ai
, Deputy Clerk
and legality:
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
LIM
TOM HENNING, CHAIRMAN
ROBERT BOYD TOBER, INC.
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Robert Boyd Tober, President
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Exhibit A
Scope of Work
A. Attend at least once quarterly a scheduled emergency medical services meeting where
discussions will involve patient care, quality, mandated Paramedic and EMT training,
Paramedic requirements, addition or deletion of equipment available to Paramedics and
EMT's. Ample notice for all such meeting will be supplied by the County Manager or
designee.
B. Except during scheduled vacations or personal emergencies, when the Deputy Medical
Director or other approved back -up physician shall be available via radio or telephone
communication on a 24 hour a day, 7 day per week basis for on line medical control.
Notwithstanding anything to the contrary contained herein, MEDICAL DIRECTOR may use
reasonable discretion in determining the appropriateness of his response to calls.
C. MEDICAL DIRECTOR shall ride as a crew member on an EMS vehicle a minimum of ten
(10) hours annually or as otherwise expressly required by state law to evaluate the skills and
maintain a working relationship with EMT's, assigned Paramedics, and probationary
Paramedics.
D. As part of the quality assurance committee, MEDICAL DIRECTOR shall assist the
COUNTY with obtaining patient outcome information from local hospitals.
E. MEDICAL DIRECTOR shall participate in regular Quality Assurance meetings with
Dispatch personnel.
F. MEDICAL DIRECTOR shall review and participate in the development of the Dispatch
Protocols followed by COUNTY EMS.
G. MEDICAL DIRECTOR shall participate in and direct EMS Advanced Cardiac Life Support
(ACLS) classes, and shall assist the County and EMS Chief in arranging additional training
to meet the needs of the community and the standards of care for the industry. The
MEDICAL DIRECTOR shall, upon request of the County Manager or designee, evaluate
COUNTY EMT's and Paramedical personnel during training exercises. MEDICAL
DIRECTOR shall review and approve the content of EMS training for medical correctness at
the request of the County Manager or designee.
H. MEDICAL DIRECTOR shall be physically present in the COUNTY EMS Administrative
Offices on as needed basis; in order to confer with the EMS Chief and other designated staff.
All official meetings attended by the MEDICAL DIRECTOR which have been approved by
the EMS Chief, will be recognized as part of the normal job duties of MEDICAL
DIRECTOR.
As required under Chapter 401, Florida Statutes, and Chapter 64J -1, F.A.C., MEDICAL
DIRECTOR shall develop, review and authorize use of ALS and BLS protocols which allow
personnel to properly manage medical emergencies. Such protocols shall be specific in
nature and shall provide for managing immediately life - threatening medical emergencies. As
required by Section 401.265, Florida Statutes, and Rule 64J- 1.004, F.A.C, the MEDICAL
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DIRECTOR shall supervise and assume direct responsibility for the medical performance of
,.� all EMT's and paramedics operating for COUNTY EMS, including both ground and aero
medical personnel. MEDICAL DIRECTOR shall develop any other protocols as required by
Chapter 401, Florida Statutes, or Chapter 64J -1, F.A.C., as they may be amended from time
to time.
MEDICAL DIRECTOR shall. supervise the implementation and maintenance of a quality
assurance program as required by Section 401.265, Florida Statutes and Rule 64J -1.004
F.A.C., to include spot - checking medical reports for completion and correctness. The quality
assurance program must cover dispatch, field paramedics, EMT's and Flight Medics.
K. MEDICAL DIRECTOR shall review and provide written affirmation of recertification
training of COUNTY EMS EMT and Paramedic personnel in accordance with Section
401.2715(3), Florida Statutes.
It is understood and agreed between the parties to this Agreement that all of the legal duties
and responsibilities of a medical director as set forth in Chapter 401, Florida Statutes, Rule
64J -1.004 F.A.C., and any other applicable laws and regulations, shall remain with the
MEDICAL DIRECTOR at all times except during scheduled vacations or personal
emergencies, when the Deputy Medical Director or other approved back -up physician shall
be available pursuant to and in accordance with Article 3, Paragraph M.
L. MEDICAL DIRECTOR shall provide the County Manager or designee with a quarterly
report generally describing activities performed, with reference to the requirements of this
n Agreement. COUNTY shall provide administrative support in order for the MEDICAL
DIRECTOR to meet the obligations of this paragraph. Back -up physicians may be used in
lieu of the MEDICAL DIRECTOR and/or Deputy Medical Director upon approval of the
County Manager or designee. Back -up physicians, when used, shall meet all of the
qualifications for a medical director as set forth in Section 401.265, Florida Statutes, and
shall be at no additional cost to the COUNTY.
M. MEDICAL DIRECTOR will coordinate the provision of coverage at all times not available
during the term of this Agreement; during such times, backup coverage may include the
Deputy Medical Director or an approved back -up physician.
N. MEDICAL DIRECTOR shall perform all other services required of a medical director, and
assume all legal duties and responsibilities of a medical director, as provided by Section 401,
Florida Statutes, Chapter 64J -1 F.A.C., and any other applicable laws and regulations, all as
may be amended from time to time.
O. Medical Director shall be available for consultation with the Director of Emergency
Management during activations of the County's Emergency Operations Center or eminent
emergency situation to assist in a public health emergency, disaster, pandemic, or mass
medical event. Such efforts shall be in coordination with the Public Health Director and not
in conflict with public health statutory authority.
P. Medical Director shall receive prior approval from the County Manager or designee
n preceding any COUNTY communication with the media.
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COLLIER COUNTY EMERGENCY SERVICES
MEDICAL CONSULTANT CONTRACT
THIS MEDICAL CONSULTING CONTRACT made this I I K day of
2001 by and between ROBERT BOYD TOBER, INC., hereinafter referred to as
Consultant, and COLLIER COUNTY, FLORIDA, hereinafter referred to as the County.
.. WITNESSETH
VVE]EI EAS, the County is responsible for emergency services in COLLIER COUNTY,
Florida; and
WHEREAS, Emergency Medical Services, (hereinafter "EMS "), are a logical extension
of existing health care services performed by the County in the above described geographic area;
and
WHEREAS, Consultant ROBERT TOBER, MD., a duly licensed physician in the State.
of Florida who is specially trained in the field of emergency medicine; and
WHEREAS, the County and Consultant have previously entered into a Medical
Consulting Contract dated June 18, 1496 which provides for automatic renewal pursuant to
certain conditions; and
WHEREAS, said conditions have been met for renewal of the contract and the parties
hereto manifest their mutual desire to renew same with certain changes contained herein; and
NOW THEREFORE, in consideration of the promises and the mutual covenants
hereinafter set forth, the parties hereto agree as follows:
1. LICENSE: ROBERT TOBER, M.D. is at the present time a duly licensed
physician in the State of Florida and he has agreed to maintain his license in full force and effect
during the term of this contract. If for any reason during the term of this Contract, the County no
longer contracts with DR. TOBER, or if DR. TOBER should lose his license to practice
medicine, this contract shall immediately become null and void.
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2. GENERAL DUTIES: Consultant shall be an independent contractor and shall
be directly responsible to the Division Administrator of the Emergency Services Division for the
performances of services as Medical Director as more specifically defined in this agreement and
as set forth in Section 401 265, Florida Starures. The Consultant shall be responsible for the
implementation of such planning and coordination as may be necessary to deliver advanced life
support by Paramedics (including EMS and Fire District personnel) trained to the level . of
advanced and basic medical technicians, which may require intravenous administration of
emergency resuscitative drugs and the performance of sophisticated technical emergency
procedures.
3. TERM OF COMMACT: The initial term of this contract shall be from October
1, 2000 to September 30, 2001. The parties agree that the term of the Contract shall be
automatically renewed on a yearly basis from October 1, through September 30 with the same
n terms, conditions and obligations as set forth herein, unless terminated by County upon sixty (60)
days written notice to Consultant.
4. COMPENSATION: The County shall pay to the Consultant the sum of
$50,000 per annum, as full compensation for the services rendered herein and no other
compensation. The County will pay the cost of the professional liability insurance. The Medical
Director shall not be eligible for any employee benefits other than this compensation. This sum
shall be paid to the Consultant in twelve (12) equal monthly payments commencing with the
effective date of the Contract, with each monthly payment being payable by the 1& of each
month. The Consultant will be entitled to a 5% annual increase beginning October 1, 2001 upon
written notification by the Emergency Services Administrator by September 150, of each year,
beginning on September .15, 2001, .and upon approval by the Board of County Commissioners.
5. PATIENT RECORDS: The County shall make available, within two days of
request, any and all medical records, reports, documents and other relevant materials, including
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audio and visual tapes requested by the Consultant. This includes all run reports, medical test
results, recordings on tape and any other reasonably available similar information.
6. CONFIDENTIAL COMA MCATIONS: Except as may be provided by
general law, the County agrees to keep all medical records confidential and allow no
communication of records or patient information without a written release from the patient or the
Consultant.
7. REPORT: The County agrees to give the Consultant full and detailed reports
regarding any case which it reasonably believes has the potential for legal action against the
County or its employees pertaining to EMS.
8. DISCIPLINARY ACTIONS: The County agrees to give the Consultant a full
written report of any and all Emergency Medical Services personnel who are known to have
violated any standing or verbal orders. Consultant shall be given full support for removal of any
program participant as provided for in State regulations governing Advanced Life Support
Providers.
9. DUTIES ANIi RESPONSTSILITIES OF THE CONSULTANT:
a. He shall be from a broad -based medical specialty such as emergency medicine,
internal medicine, anesthesiology, or other surgical specialty, with demonstrated
experience in pre - hospital care and hold an ACLS certificate of successful course
completion or be board certified in emergency medicine.
b. He shall demonstrate and have available for review documentation of active
participation in a regional or statewide physician group involved in pre- hospital care.
c. He shall supervise and accept direct responsibility for the medical performance of
the paramedics working for Collier County EMS.
d. He shall develop medically correct standing orders or protocols relating to life
support system procedures when communication cannot be established with a
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supervising physician or when any delay in patient care would potentially threaten the
life or health of the patient.
e. He shall issue standing orders and protocols to Collier County EMS to ensure that
it transports each of its patients to facilities that offer a type and level of care
appropriate to the patient's medical condition if available within the service region.
f. He or his appointee 'shall provide continuous 24 -hour- per -day, 7-day per_week
medical direction which shall include, in addition to the development of protocols and
standing orders, direction to Collier County EMS personnel as to the availability of
"off -Iine" service to resolve problems, system conflicts, and provide services in an
emergency as that terra is defined by section 252.34(3), Florida Statuses.
g. He shall establish a quality assurance committee to provide for quality assurance
review of all paramedics operating under his supervision.
h. He shall audit the performance of system personnel by use of a quality assurance
Program that includes but is not limited to a prompt review of patient care records,
direct observation, and comparison of performance standards for drugs, equipment,
system protocols and procedures. He shall be responsible for participating in quality
assurance programs that may be developed by the department.
i. He shall ensure and certify that security procedures of the Collier County EMS
for medications, fluids and controlled substances are in compliance with chapters 40I,
499 and 893, Florida Statures, and chapter IOD-45 of the Florida Administrative
Code.
j. He shall create, authorize and ensure adherence to, detailed written operating
procedures regarding all aspects of the handling of medications, fluids and controlled
substances by the EMS personnel and comply with all requirements of chapters 401,
499 and 893, Florida Statutes.
4
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lc. He shall notify the Florida Department of Health, (hereinafter the "Department')
in writing when the use of telemetry is not necessary.
1. He shall notify the department in writing of each substitution by Collier County
EMS of equipment or medication.
m. He shall assume direct responsibility for the use by a Collier County paramedic of
an automatic or semi - automatic defibrillator and the performance of esophageal
incubation, and on routine interfacilty transports, the monitoring and maintenance of
non - medicated IN.s. He shall ensure that the paramedic is trained to perform these
procedures; shall establish written protocols for the performance of these procedures;
and shall provide written evidence to the department documenting compliance with the
provisions of this paragraph.
n. He shall ensure that all paramedics arc trained in the use of the trauma scorecard
methodologies as provided in sections 64E -2.017 of the F.A.C., for adult
trauma patients and 64E- 2.0175, F.A.C., for pediatric trauma patients.
o. He shall participate as a crewmember on an EMS vehicle for a minimum of 10
hours per year and complete a mtinimum of 10 hours per year of continuing medical
education related to pre - hospital care or teaching or a combination of both.
p. He shall ensure that aU Collier County paramedics have all proper certifications
and receive all training necessary to maintain their certification.
10. ADDITIONAL DUTIES: Consultant shall also be responsible for assisting in
the following additional duties:
a. Consultation in the planning for Emergency Medical Services Department to be
provided by the County, including the design of vehicles, equipment, supplies,
distribution resources, emergency medical services personnel training and medical
policy, protocol, planning and development.
B
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b. Consultation in the coordination of training of paramedical personnel, including
the determination of training criteria for certification.
c. Organizing, coordinating and participating as an instructor in the in- service
education programs and quality control of the patient care in day - today delivery of
emergency medical services by the County.
d.' Serving as a liaison between the County and the appropriate community hospitals,
medical societies, practicing physicians and training facilities in the area.
e. Providing such assistance as may be required in the preparation and administration
Of any grant programs for the establishment and improvement of the system.
f. All duties outlined in Rule 64-E Florida Administrative Code for Emergency
Medical Services Medical Director that am not specifically set-forth herein and as may
be changed from time to time by the department..
n g. He shall keep adequate records and supporting documentation, which concern or
reflect his services under this Contract.
h. Consultant represents that it presently has no interest and shall acquire no interest,
either direct or indirect, which would conflict in any manner with the performance of
services required hereunder.
11. LIABILITY AND REMEDIES IN BREACH OF CONTRACTS: It is
recognized that the provision of advanced life support services requires that the County have a
Medical Director. Accordingly, the Consultant shall not refuse to perform these services during
the terms of this Contract so long as it is able to so perform, and the County shall have the right
to specific performance of the provisions of this contract. In addition, the Consultant shall be
liable to the County for his unreasonable failure or refusal to perform the services required
hereunder.
6
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No modification, or change- in this Agreement shall be valid or binding upon the parties,
unless in writing, and executed by the party or parties intended to be bound by it.
Unless otherwise specified, the laws, rules and regulations of the Stare of Florida shall
govern this Agreement. Any suit or action brought by either party to this Agreement against the
other party relating to or arising out of this Agreement must be brought in the appropriate Florida
State Court in Collier County, Florida.
12. CONFLICTING EMPLOYIt+IENT OR CONTRACTUAL, NS
Nothing in this Contract shall be interpreted as preventing the Consultant from operating
any other business or being similarly employed with any other emergency medical service that is
lawfully licensed by the County (within Collier County, Florida) and the State. However the
Consultant shall not accept any employment or enter into any contractual relationship that would
create a conflict between such interest and the performance of its duties hereunder.
Nothing in this Contract shall bc interpreted as preventing the Consultant, a contractual
employee of the County, from being employed in any other capacity, including, but not limited
to the operation of a medical practice, the employment as a staff member of any hospital, or the
serving as a medical director for any other emergency medical service which is lawfully licensed
by the County (if located within Collier County) and the State.
13. SUCCESSOR: The Contract shall be binding upon the successors of the County.
This Contract shall not be assignable by ft Consultant.
14. TERMINATION: This Contract may be terminated by either party, with or
without cause, upon sixty (60) days written notice to the other party of such party's intention to
terminate the Contract.
16. PRO - RATIONS UPON TERMINATION: In the event of the termination of
this Contract, the Consultant's compensation due under Paragraph 4 shall b4 prorated on the basis
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of the - number of days elapsed from the effective date of the Contract, divided by three hundred
sixty -fi vc (365).
16. MANUALS: All manuals of procedure and instructional material, which are
created or prepared by the Consultant, shall be and remain the property of the Consultant.
17. ADDTI` ONAL LICENSES: Consultant agrees to obtain and maintain
throughout the period of this Agreenient, all such licenses as are required to do business by the
Consultant in the State of Florida and in Collier County, Florida, including, but not limited to, all
Iicenses required by any State Boards or other Governmental agencies responsible for regulating
and licensing the professional services to be provided and performed by the Consultant, pursuant
to this Agreement.
I8. INSURANCE:
The County shall, pay for, and maintain, during the Iife of this agreement, professional liability
n insurance. Collier County shall be named as an additional insured on the certificate of insurance
for the policy.
/1-N 8
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IN WITNESS WHEREOF, the parties have executed this agreement as of the date first
written above.
ti
WIG M
DHT.F tBR09K, CLERK
of CbVm
'Attest '+li. t0 Cha#ruan's
siymatW* only.
Witnessed b :
Approved as to form and
Legal Sufficiency:
r
CQUtLINE HUB ARD ROBINSON
ssistant County Attorney
WjukidEMS ContmeVroba
McdicM Contact MD1- Revised
BOARD OF COUNTY COMNOSIONERS
OF COLLIER COUNTY, FLORIDA
ROBERT BOYD TOBER, INC.
BY: L,�Iz (/9 W
ROBERT BOYD TOBER, PRESIDENT
Packet Page -899-
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i
w
r
C
-� - 6 K 2
W
rr
FIRST AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES �.
MEDICAL CONSULTANT CONTRACT a Li,
W 5
Ln
This First Amendment to the Collier County Emergency Services Medical Consultant
Contract ( "Amendment') is made this 14th day of October, 2008, by and between Robert Boyd
Tober, Inc. ( "Consultant "), and Collier County, Florida ( "County").
WHEREAS, by agreement dated September 1, 2001, the parties entered into a Collier
County Emergency Services Medical Consultant Contract ( "Agreement'), a copy of which is
attached to this Amendment; and
WHEREAS, at a regularly noticed public meeting on September 23, 2008, the Board of
County Commissioners directed that the Agreement be amended to authorize the Consultant to
be directly responsible to the Board of County Commissioners; and
WHEREAS, the parties believe that such an amendment is in the interest of health,
safety and welfare of the citizens of the County.
NOW, THEREFORE, the parties hereby amend Paragraph 2 of the Agreement as
follows:
"Consultant shall be an independent contractor and shall be directly
responsible to the
Board of Cgm= Commissioners of Collier County, Florida for the performances
of services as .Medical Director as more specifically defined in this agreement and
as set forth in Section 401, Florida Statutes... "
Except as specifically set forth herein, all other terms and conditions of the Agreement
remain in full force and effect.
IN WITNESS THEREOF, the parties have executed this First Amendment to the
Agreement as of the date first written above.
Page 1 of 2 �_^
"7
=lbc/
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P*I(WT.E;BRf.C]
1-i" ,-, "
Approval as to form
and legal sufficiency:
I _
Je ey A. KI kow
County Attorney
08- mA- 00127/2
ROBERT BOYD TOBER, INC.
ROBERT BOYD TOBER, PRESIDENT
BOARD OF COUNTY COMMISSIONERS
OF COLLIER 0 T FLORIDA
By:
TOM HENNINC, CHAIRM
Page 2 of 2
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16K2
r
---- 1/28/2014 16.K.3.
16E g
SECOND AMENDMENT TO COLLIER COUNTY EMERGENCY SERVICES MEDICAL CONSULTANT
CONTRACT
This Second Amendment to the Collier County Emergency Services Medical Consultant
Contract ( "Amendment ") is made this _Q(2 _Nay of 2009, by and
between Robert Boyd Tober, Inc. ( "Consultant ") and Collier Co y, Florida ( "County ").
WHEREAS, by Agreement dated September 1, 2001, the parties entered into a Collier
County Emergency Services Medical Consultant Contract ( "Agreement "), a copy of which is
incorporated herein by reference; and
NOW, THEREFORE, the parties hereby amend the Agreement to add Item 19,
EXPENSES, as follows:
19. EXPENSES. County shall pay expenses for Dr. Tober, and /or his assistant related to County
business, to include, but not be limited to, mailings, office supplies, training, education,
seminars, lodging (actual cost of lodging at single occupancy rate with a cap of no more than
$150.00 per night), air travel (actual ticket cost limited to tourist or coach class fare), and
rental car (actual rental cost limited to compact or standard -size vehicles).
Except as specifically set forth herein, all other terms and conditions of the Agreement remain
in full force and effect.
IN WITNESS WHEREOF, the parties have executed this Second Amendment to the Agreement
as of the date first written above.
TW TNESSES
T WIT S
Type /Print Name
SEWRO W/IIT'NESS
Type /Print Name
CONSULTANT:
ROBERT BOYD T921ER;1I1C .-I
By:
Robert Boyd Tober, President
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16E g
Date: %ulic� 2� Z tx� OWNER:
ATTEST: BOARD OF COUNTY COMMISSIONERS OF
DWIGHT E. ,qP COLLIER COUNTY FLORIDA
CLERK Ort.'COURTS ,
By _C
Dated` BY:
(s�AQ V Donna Fiala, Chairman
Attest 1w 4
S f on&t *t 00 .1
Approved As To Form a d Legal Sufficiency:
County Attorney
477
Print Name: ! %twcj.ti
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IN
THIRD AMENDMENT TO COLLIER COUNTY
EMERGENCY SERVICES MEDICAL CONSULTANT CONTRACT
THIS THIRD AMENDMENT to the Collier County Emergency Services Medical
Consultant Contract is made this 13th day of November, 2012, by and between Robert Boyd
Tober, Inc. ("Consultant "), and Collier County, Florida ( "County ").
WHEREAS, by agreement dated September 1, 2001, the parties entered into a Collier
County Emergency Services Medical Consultant Contract, a copy of which is attached hereto,
together with the First Amendment dated October 14, 2008, and the Second Amendment dated
May 26, 2009 (collectively referred to as the "Agreement"); and
WHEREAS, at a regularly noticed public meeting on October 9, 2012, the Board of
County Commissioners directed that the Agreement be amended to provide for annual
performance evaluations; and
WHEREAS, certain clarifications are recommended as it relates to compensation upon
termination; and
n WHEREAS, the parties believe that such amendments are in the interest of health, safety
and welfare of the citizens of the County.
NOW, THEREFORE, IN CONSIDERATION of the mutual promises and for other
good and valuable consideration, the receipt and sufficiency of which are acknowledged by the
parties, it is agreed that:
1. Paragraph 15 of the Agreement is hereby amended as follows:
15. nRQ RAPO '1S —obi TEMHN 4i on COMPENSATION UPON
TERMINATION:
In the event of the termination of this Contract, the Gem=
effeefi-m date of the Gentrae4; divided Consultant shall be paid only for services rendered
in accordance with this Contract. Compensation due for any partial month's services will
be at a daily rate determined by dividing the annual contract rate by three hundred sixty -
five (365).
2. Paragraph 20 is hereby added to the Agreement as follows:
�1 Words Swaele :Ama h are deleted; Words Underlined are added
I
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20 ANNUAL PERFORMANCE EVALUATION
1128/201416.x.3.
raw
The Consultant
will RE=m as gdormance
self - assessment along with proposed
goals for
the next year on
an annual basis and submit this evaluation to the Public Safety
Authority
(PSA) no later
than the first day of June
The PSA will review the Consultant's
self -
assessment and
will make an indevendent
performance evaluation and recommendations.
which the PSA will forward to the Board of
County Commissioners no later than
the first
& ' o� f July. The
Commissioners will review
both the Consultant's self- assessment
and
assessment. PSA review and recommendations and the individual Conunissioners'
evaluations as an agenda item on the last re -gWar meeting in July. The Commissioners
evaluation elan may be developed in good faith between the Consultant and the County
and adopted by the County prior to October I`t of each year for implementation in the
next yam•
3. Except as expressly provided herein, the Agreement, as amended, remains in full force
and effect according to the terms and conditions contained therein.
IN WITNESS WHEREOF, the Consultant and the County have executed this Third
Amendment to Collier County Emergency Services Medical Consultant Contract as of the date
BOARD OF COUNTY COMMISSIONERS
Clerk COLLIER COUNTY, FLORIDA
By:
A*.tKt;.a!f:.{k�f`{i.` >aeputy 1 FRED W. COYLE, H
WITNESSES: ROBERT BOYD TOBER, INC.
By:
Print Name: Robert Boyd ob , esident
Print Name:
form and legal sufficiency:
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June 25, 2013
Imrnokalee is doing.
CHAIRWOMAN HILLER: It's okay. It's not on the agenda.
COMMISSIONER HENNING: Brad, you can talk to
Commissioner Fiala.
MR. MUCKEL: I'll be happy to.
CHAIRWOMAN HILLER: Let me -- again, I don't want to turn
this into a discussion, because I did commit that we would terminate at
12:15 in order to be back, because we do have a 1:30 time - certain, and
there will be quite a few people attending.
Again, it should be publicly noticed. It should be included in the
backup so that the community has the opportunity to review it.
Let's schedule it for sometime in the fall, and then it will be an
interim report looking forward to a final report in January or February.
And with that, we're going to conclude for now to take a lunch
break, and we will be back at 12:15 (sic) -- I'm sorry, 1:15, and we
have a time - certain at 1:30.
�-. (A luncheon recess was had.)
MR. OCHS: Madam Chairman, you have a live mike.
CHAIRWOMAN HILLER: This meeting is called back to order.
County Manager?
W
Item #1 OG
ACCEPTING THE RANKINGS FROM THE COLLIER COUNTY
PUBLIC SAFETY AUTHORITY REQUEST FOR PROPOSALS
(RFP) #13 -6081 MEDICAL DIRECTOR AND DEPUTY MEDICAL
DIRECTOR AND DETERMINE FINAL ACTION. — MOTION
DIRECTING THE CHAIRWOMAN TO NEGOTIATE A
CONTRACT WITH DR. TOBER AS THE MEDICAL DIRECTOR
AND DR. LEE AS THE DEPUTY MEDICAL DIRECTOR —
APPROVED
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June 25, 2013
MR. OCHS: Yes, ma'am. You have a time - certain 1:30 p.m.
hearing. It is Item 10G on your agenda.
It is a recommendation to accept the rankings from the Collier
County Public Safety Authority for Request for Proposal 13 -6081,
medical director and deputy medical director, and for the board to
determine subsequent action.
CHAIRWOMAN HILLER: Thank you. Before we get started,
County .Attorney, can you clarify for the board what action we're
taking so there is no misunderstanding. You know, obviously there's a
difference between the action we're taking today and the subsequent
action, which is contract related.
MR. KLATZKOW: Well, you're being asked to accept, you
know, the results that occurred with your board, and then to take
whatever action you feel appropriate.
If you decide to go with the -- I'm not sure I'll call it a
recommendation. But if you decide to go a different route with your
director, you can't hire him here. You would have to, in essence,
appoint one of you to negotiate a contract, see if you can come to
terms, and then bring that contract back for a public hearing and
discussion and a potential vote.
CHAIRWOMAN HELLER: So the decision here today is not a
final decision but the first in a two -step process. The first is the
selection of the candidate for medical director and the selection of the
candidate for the deputy medical director, and then at a subsequent
meeting a negotiated contract for each of those positions will be
presented to the board for approval.
MR. KLATZKOW: Assuming that you can get into a contract.
CHAIRWOMAN HILLER: Negotiation.
MR. KLATZKOW: Negotiation, yes.
CHAIRWOMAN HILLER: But that there's a meeting of minds.
MR. KLATZKOW: Yes.
CHAIRWOMAN HILLER: So we're not actually hiring
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June 25, 2013
anybody here today.
MR. KLATZKOW: No, you're not hiring anybody today.
CHAIRWOMAN HILLER: Okay. Thank you. How many
public do we have?
MR. MILLER: We have 10 registered speakers.
CHAIRWOMAN HILLER: What's the pleasure of the board?
Would the board like to hear the public speakers first before we get
into any discussion?
COMIVIISSIONER FIALA: Yes.
CHAIRWOMAN HILLER: So let's go ahead and begin with the
public speakers.
MR. MILLER: Your first public speaker is Eric Eskioglu. He'll
be followed by Edward Morton.
My apologies on the pronunciation of your last name, sir.
DR. ESKIOGLU: No problem, no problem.
Good afternoon, Commissioners. Dr. Eric Eskioglu. I'm the
medical director of the only comprehensive stroke center in Southwest
Florida, and I would like the commissioners to take in the
recommendations of the Public Safety Authority, which is made up by
a lot of smart citizens and also medical professionals.
And we are all -- I'm asking -- and this is for me and my patients
-- is we'd like to have an EMS director that is fair and that is not tied
to any interests or any hospital at this point.
Thank you so much.
CHAIRWOMAN HILLER: And the recommendation of the
PSA, for the record -- County Attorney, would you like to give us the
results of the PSA recommendation for the benefit of the public that
might not have had the opportunity to view the hearing or, I should
say, the interviews and the vote by the PSA?
MR. KLATZKOW: Give me one second.
MR. OCHS: Commissioner, I can do that if you'd like. I have it
in front of me.
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- June 25, 2013
CHAIRWOMAN HILLER: Sure, of course.
MR. OCHS: Yes, ma'am. There were two candidates
interviewed for the medical director position. Dr. James Augustine
received seven first -place rankings by the Public Safety Authority
members present, and Dr. Robert Tober received six first -place
rankings.
CHAIRWOMAN HILLER: So to summarize, the Public Safety
Authority has recommended Dr. Augustine as the --
MR. OCHS He was ranked No. 1 among medical - director
candidate. Dr. Tober was ranked No. 2.
CHAIRWOMAN HILLER: Out of two candidates?
MR. OCHS: Out of two candidates, yes, ma'am. And then --
CHAIRWOMAN HILLER: For the position of medical
director?
MR. OCHS: That's correct, Madam Chair.
And then for the position of deputy medical director, there were
three candidates, and the committee ranked Dr. Jeffrey Panozzo as the
No. 1 ranked deputy medical director candidate; Dr. Richard Judah
was ranked second; and Dr. Douglas Lee was ranked third by your
Public Safety Authority for deputy medical director candidate.
CHAIRWOMAN HILLER: Thank you. And that's for the
benefit of the public so they know what the result of the PSA are,
which we are being asked to approve.
MR. MILLER: Your next public speaker is Edward Morton.
He'll be followed by Dennis Hidlebaugh.
MR. MORTON: Good afternoon. For the record, Edward A.
Morton. I speak here today on behalf of Dr. Robert Tober. I was a
former member of the PSA but could see clearly the political intrigue
that has intervened into what otherwise should have been a very
objective process.
I felt that the sophistry that was being practiced had undermined
the process to the extent that an objective decision could never be
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3une 25, 2013
raised or could never be made.
I think the politics are very obvious. The editorial in the
newspaper called very clear attention to that.
And I am here to give my unequivocal support to Dr. Tober. The
reason why I withdrew from that process, which that vote would have
been, incidentally, 7 -7, was to bring attention to the fact that this
process has become corrupted, and it needed to be brought to the
attention of people that -- someone who has put the kind of effort that
Dr. Tober has placed into this community for 30 years, and to see his
integrity called into question warranted, I think, someone taking a
stand and taking a position in defense of his integrity and his
commitment to this community.
So without any further ado, I would like to give my unconditional
support to Dr. Robert ,Tober. Thank you.
MR. MILLER: Your next speaker is Dennis Hidlebaugh. He'll
be followed by Janet Vasey.
MR. HIDLEBAUGH: I'm Dennis Hidlebaugh. I'm chief of staff,
Physicians Regional Healthcare System.
I'd like to make two points. The first point is that the
recommendation by the Collier County Medical Society president
recently to the commissioners is incorrect. The rank -and -file members
of the Collier County Medical Society and the board did not review
this recommendation, and the rank- and -file members did never -- did
never have a vote for that recommendation.
So I would like to -- my medical staff would like to counter the
president of the Collier County Medical Society's recommendation.
And that No. 2 is that we recommend that the PSA
recommendation should be followed. Thank you.
CHAIRWOMAN HILLER: Meaning you're -- what are -- state
for the record who you are supporting so there's no ambiguity in the
interpretation.
MR. HIDLEBAUGH: Dr. Augustine.
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June 25, 2013
CHAIRWOMAN HILLER: And for deputy?
MR. HIDLEBAUGH: Dr. Panozzo.
CHAIRWOMAN HILLER: Thank you.
MR. MILLER: Your next public speaker is Janet Vasey. She'll
be followed by Doug Fee.
MS. VASEY: Good afternoon, Commissioners. Janet Vasey for
the record.
While I'm a member of your Public Safety Authority, I am
speaking for myself today.
I have serious concerns regarding Dr. Augustine's suitability as
Collier County medical director. He is currently medical director for
four or five organizations in Ohio and Georgia, and he teaches in
Ohio. And my question is, will he be available 2417 to Collier County
EMS?
Your own performance requirement for the EMS medical
director evaluation states, and I quote, county medical director or his
appointee shall provide continuous 24/7 medical direction to resolve
problems, system conflicts, et cetera.
This is what we're used to with Dr. Tober and Dr. Lee, and this is
what we expect in Collier County; people doing our job. To accept
less would reduce our current award- winning EMS service.
Dr. Augustine also had serious training deficiencies during his
tenure as medical director of the DC fire and EMS.
Paramedic training and excellent performance should be job one
for a medical director, yet nine months after Dr. Augustine's arrival in
DC, 92 of 95 paramedics failed an independently administered test by
the University of Maryland using national standards for entry -level
paramedics.
In Collier County we expect paramedic training that is second to
none, and we get it. Dr. Tober requires his paramedics to pass
rigorous one -on -one testing with him personally before they are
accepted as Collier County EMS paramedics. Anyone surviving this
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June 25, 2013
process is considered Toberized.
Patient care comes first in Collier, and poorly trained paramedics
do not come in contact with EMS patients under Dr. Tober's
leadership.
Dr. Tober's been an excellent EMS medical director and should
continue in that capacity. Under his leadership, Collier County EMS
has been identified best in the state and best in the nation.
And just six months ago, EMS received national accreditation, a
feat achieved by only 150 EMS systems in the entire U.S.
Dr. Tober has received numerous honors. He's been Physician of
the Year several times. He's one of the top 10 innovators in EMS per
the Journal of Emergency Medical Services, he has a Lifetime
Achievement Award in emergency medicine, and EMS Medical
Director of the Year for the State of Florida.
You clearly have the best medical director in Dr. Tober. Please
allow him to continue providing us world -class service.
Thank you very much.
MR. MILLER: Your next speaker is Doug Fee. He'll be
followed by Jim Gibson.
MR. FEE: Waive.
MR. MILLER: Doug Fee will waive.
Jim Gibson will be followed by Carlos Portu.
MR. GIBSON: Madam Chair, Commissioners, Jim Gibson, for
the record.
I'm not a particularly articulate speaker, but I do feel strongly
about the need to retain Dr. Tober. Perhaps my best course is to cite
briefly from the Naples Daily News editorial of June 23rd entitled,
"Keep skilled medical leadership at the helm of Collier County EMS."
For the past 35 years, Collier EMS has had Dr. Tober at the helm
of its medical policies and practices. In that time, under Dr. Tober's
leadership, Collier EMS has earned national and statewide honors for
excellence and pioneering with strokes and heart attacks. Even when
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-- June 25, 2013
the ratings involved surprise visits by outside regulators, Collier EMS
excelled.
All the extraneous issues surrounding this retention question
aside, the sole issue in question should be public health and safety.
The title of the position in question is medical director. Medical
director. That is Dr. Robert Tober. Thank you.
MR. MILLER: Your next public speaker is Carlos Portu. He'll
be followed by George Dawz (sic).
DR. PORTU: Thank you, Commissioners. For the record, Dr.
Carlos Portu.
I want to thank you all for the opportunity to address you today
on a topic that truly, I think, impacts the health and well -being of
many of our residents here in the county, myself being one of them.
I was recently upset and dismayed at the letter of support sent to
both you and the Naples Daily News by Dr. Pagliaro, presumably on
behalf of the entire Collier County Medical Society membership. My
disappointment stems from the fact that at no point at any time during
my last three years participating in the Collier County Medical
Society has there ever been an open discussion about our county's
medical director or his ability to actively and appropriately perform
his job duties.
I consider myself rather involved in the medical community. I
have a large medical practice. I'm on the board of directors for a
60- physician group in Collier County. I chair the department of
medicine for one of our two healthcare systems within the community,
and I like to participate in our civic duties, yet at no point was this a
discussion that was ever brought up as part of the medical society.
No emails, no online poll, no phone call, no mention of the issue
until this letter of supposed support was sent to the news press.
Needless to say that the statement of Collier County Medical
Society was more the opinion of a few board members or a president
as opposed to that of our physician community.
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Quite frankly, I respectfully disagree. From the perspective of a
physician who has worked hard to expand our healthcare system
throughout the community bringing quality, affordable and effective
healthcare to thousands of people, many of whom inhabits part of our
community that is not particularly well served by different parts of our
healthcare system, I found Dr. Tober as a medical director to be a very
poor choice. He has been nothing but an obstacle in our quest to bring
innovative services, lines, and nationally recognized care to our
county.
Of what benefit is a leader who creates divisiveness and strife
without -- doing very little to expand quality services in our
community?
I think the testimony you've heard so far is pretty obvious what
the issue is, is that here's an individual, though rightfully probably
qualified, creates a divisive atmosphere that doesn't lead to a cohesive
n healthcare community, and it's something that's very important going
forward, particularly given the challenges that we'll be facing as a
country in the healthcare system.
So I'd encourage you to think of all the perspectives here, not just
necessarily the resume of one particular candidate versus another.
Okay. Thank you.
CHAIRWOMAN HILLER: Thank you.
MR. MILLER: Your next speaker is George Dawz (sic). He'll
be followed by Ron Myers.
MR. DANZ: Madam Chair, Commissioners, my name is George
Danz. I'm a citizen, 813 Charlemage Boulevard. I'm retired from
Broward County where I served as director of emergency services for
many years and also director of the Broward County Trauma Agency.
I am not a member of the public safety committee, but I have
attended all of their meetings, and I have been impressed with their
process.
Dr. -- or Mr. Morton brought up about if he had stayed on, there
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would have been a 7 -7 vote. The process is not perfect, but I think you
have a rounded group of individuals there that are interested, involved
in EMS in Collier County and have a lot of expertise.
I think there's several members of Collier EMS who work
directly for Dr. Tober, and I guess if I was on that committee and
worked for Dr. Tober, I would certainly know how I would express
my views and vote in that open public meeting.
However, I think you've got a good system. I think you have a
good committee, and I think you ought to take the recommendation of
the public safety committee, or either disband the committee, either
one.
CHAIRWOMAN HILLER: So you're recommending Dr.
Augustine and Dr. Panozzo?
MR. DANZ: Yes, ma'am.
CHAIRWOMAN HILLER: Thank you.
MR. MILLER: Your next speaker is Ron Myers. He'll be
followed by Mike Murphy.
MR. MYERS: Madam Commissioner and Commissioners, I'm a
full -time resident, fairly new to the island.
CHAIRWOMAN HILLER: Could you state your name for the
record.
MR. MYERS: Ron Myers.
CHAIRWOMAN HILLER: Ron Myers. Thank you.
MR. MYERS: I moved here a year and a half ago. And I spent
most my life in the private ambulance sector. And I'm a former
president of the Ohio Ambulance Association, the American
Ambulance Association, and I've spent three years on the governor's
EMS Advisory Board in Ohio with Dr. Augustine.
I'm here to endorse him. I've worked with him. He is absolutely
fantastic. And my observations about how this county system's going
-- I've been in 25 systems, I sold our company -- my partner and I had
two large companies, one in Houston, Texas, and Northeast Ohio -- to
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a national consolidator, and I went into several other companies to
look around, and this is really a franchise model here, exclusive,
without a competitive bid.
And part of the things that I hear are routing of patients and
concerns over fairness of distribution of patients. Dr. Augustine, I
endorse. He has no affiliation with either hospital. And one of the
criticisms, I heard he's not available. He said he would give up some
of his other responsibilities to stay here.
I appreciate it.
CHAIRWOMAN HILLER: Thank you.
MR. MILLER: Your next speaker is Mike Murphy. He'll be
followed by Nancy Lascheid.
MR. MURPHY: Good morning, Honorable Commissioners and
general public. My name's Mike Murphy. I'm the fire rescue chief on
Marco Island, and I'm also a member of the PSA for disclosure
reasons.
First off, I am very proud of the volunteer advisory boards that
you've created in this county, and I've had the opportunity, and a
number of citizens, to serve on those boards. And we take it very
seriously. We dedicate a lot of time.
It's a difficult process, and this question was very difficult in
reference to, again, politics and everything else aside.
I think the process that the board went through and vetted -- and
we vetted the process, sent it back to you and brought it back to the
board again. The process they went through was to be -- is and should
be respected. That board did take the time, they answered the tough
questions, the candidates took the time, they came before you, or it
came before us. We went through that entire process, and it was
difficult, it was informative, and a selection was made.
This candidate is one of three candidates, I believe, that are direct
reports to you. The office of the medical director answers directly to
the County Commission. And as we went through that process, we, as
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the receivers and the people out there, actually tried -- who use the
services, tried to get all the questions that you might not have all the
technical knowledge to ask and get it on the board and get it on record.
The candidates that went through it, I think there was a -- that
direct process -- we went through the interview. You need to find out
how this person fits with your philosophy, each one of you
individually, over the next five years; you need to give the process the
respect that it has, and take the selection, interview the candidates, ask
them what they want for the next five years. You're talking a potential
five -year contract, and it shouldn't be based upon, oh, what have we
done in the past or some negative comments somebody says, but it's
how this person aligns with your goals and your objectives and what
you think and expect that person to do over the next five years.
I really believe -- I think it's disrespectful, number one, to the
PSA, to not at least recognize the list that they came up with. It was
vetted, it was argued, it was discussed, and the candidates were rated
just in accordance to what you had asked, and we did that. And then I
think you need to take the time to interview these individuals, and that
selection, you need to choose the leader of who you want to take this
system even further over the next five years.
There's changes in Medicare, Medicaid, there's billing.
And the last thing I'd like to say is, state law indicates that a
medical director acts as a liaison to EMS, training agencies, and
emergency rooms and emergency facilities. And who is that person
that you would like to have sit in that position?
CHAIRWOMAN HILLER: May I ask how you voted on the
PSA?
MR. MURPHY: I voted for Dr. Augustine and Dr. Panozzo.
CHAIRWOMAN HILLER: Thank you.
MR. MILLER: Your next public speaker is Nancy Lascheid.
She'll be followed by Erica Henson.
MS. LASCHEID: Thank you. I'm Nancy Lascheid, and I am a
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nurse. I am here representing myself and my husband to speak to the
credibility and skill level of Dr. Tober.
I've worked with him now for 15 years side by side, and I've been
with him in emergency situations for our patients at the Neighborhood
Health Clinic.
I strongly endorse Dr. Tober to continue as your medical director.
I understand you wanted to look to see what was out there. You
looked. It doesn't get any better. I encourage you to select Dr. Tober
and Dr. Lee.
Thank you.
MR. MILLER: Your final public speaker is Erica Henson.
MS. HENSON: Good afternoon. My name is Erica Henson. I'm
a lifelong Collier County resident, a lifelong Neapolitan, a nurse with
35.years of experience in critical care and emergency care, and I'm
here to endorse Dr. Tober.
As some of you know, I really dislike public speaking, so I'll
make it brief. This is not a public decision that should be made
lightly. It should not be made on politics. It should not be made on
who's friends with somebody. It's not first grade. It's not dodge ball.
We don't pick our friends; we pick the best candidate.
Dr. Tober and I have not always agreed on everything, but I
believe he is truly the best candidate for Collier County. He's brought
lifesaving medicine to Collier County, which stressed me out as an ER
nurse, so that we could go on the forefront of modem medicine with
clot- busting medicines here in the middle of Naples, Florida.
So my endorsement is for Dr. Tober, and I thank you for letting
me have the opportunity to address you today.
CHAIRWOMAN HILLER: Thank you.
MR. MILLER: That was our final public speaker.
CHAIRWOMAN HILLER: Commissioner Henning?
COMMISSIONER HENNING: Well, I read something different
in the Florida Statute than Chief Murphy does. The medical director
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must supervise and assume direct responsibility for the performance of
emergency medicat technicians and paramedics operating for that
emergency medical system, and this being EMS. So, you know, he's
going to train, consult, write the protocol for our EMTs and
paramedics.
And I consider -- one of the things the Florida Statutes provides
is, contrary to what has been publicized, the physician can be
employed by a hospital that delivers inedical hospital -- emergency
medical services, okay.
In this particular case, we're looking at somebody who is going to
train our EMTs and paramedics to deliver to a facility that has
emergency services there.
So that's what we should be looking at is who has the interaction
with the emergency rooms that our patients -- or our citizens are going
to. And, quite frankly, I only see two in all the applicants that we
received, both for medical director and assistant medical director.
Dr. Lee is affiliated with the Trauma Center in Lee County. I'm
sad to see that there's no -- there was no applicant from Physicians
Regional that has affiliation with their emergency services.
So I'm going to make a motion that we direct the chairman to
negotiate a contract with Dr. Tober and Dr. Lee. Dr. Lee being our
assistant medical director, and Dr. Tober being the medical director.
CHAIRWOMAN HILLER: Is there a second?
CONMSSIONER COYLE: I'll second the motion.
CHAIRWOMAN HILLER: Commissioner Coyle?
COMMSSIONER COYLE: I wasn't next. Commissioner --
CONMSSIONER FIALA: I'll go next. That's okay. That's
okay.
One thing that I think we're forgetting to take a look at, that is
right now we as County Commissioners, all of us, have been strongly
encouraging the fire services to not only unite, but to consolidate with
the hopes, with the anticipation that we will then gift them with the
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EMS services so that that can be all one emergency service operation
working together hand in hand, always working together hand in hand.
And what we forget, and what has not been mentioned yet, is all
of these years Dr. Tober has worked against any type of consolidation
between fire. In fact, he's -- he's been actually -- let me say he's been
-- how do I want to say it nicely -- derogatory toward any fire service
and all through the years.
And I don't know what -- how we expect a different outcome
now than has been going on for 30 years. I mean, if he's not wanted to
work with the fire service before and yet we're encouraging that to
take place, how is he going to change now?
And so I cannot vote for him, I'm sorry. I have many other things
to say, but I'll let Commissioner Coyle -- by the way, they're both
outstanding candidates. Don't get me wrong. They're great
outstanding candidates. It's just that I think we need a new face on
this system, because we're designing a new entire department.
Thank you.
CHAIRWOMAN HILLER: Commissioner Coyle?
COMMISSIONER COYLE: Yeah. I think we should be
focused on finding the best qualified person we can find for our
medical director in Collier County. And, in my opinion, there are
certain fundamental requirements.
Number one, I believe that our medical director should be a
practicing physician in our community. I think he should be a
full -time resident of our community. I think that he should be
uncompromising in establishing standards of treatment and training
for the medical personnel under his supervision.
If that means conflict with fire districts, then that's what it means.
Every day of the week I will listen to a physician about medical
standards and practices rather than a fireman, and every day of the
week I will listen to a fireman when it comes to issues related to
fighting fires.
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And I have seen enough of the conflict here to know that
subordinating Emergency Medical Services to a fire district is the
worst thing that can ever be done. The fire districts are moving
toward consolidation now, but it is they who have refused it in the past
and were pushed into it only because of financial pressures.
They refused to participate with Dr. Tober in the ride -along
program to make sure that the fire districts' personnel were current in
the medical procedures.
Commissioner -- or Dr. Tober has been under constant criticism
by fire districts because they wanted to undermine his authority. And,
in fact, the North Naples Fire District has hired their own multiple
medical directors so they can get what they want without having to go
through the county's medical director. That is not the kind of
emergency medical system that we want or need in Collier County.
So if there has been friction, there is enough blame on both sides.
And 1, for one, would rather have a medical director who is
uncompromising in medical standards rather than one that is seeking
to smooth over the political divisions by compromising on those
medical standards.
I think it is unfortunate that there has been so much emphasis on
market share between the two hospital systems here in Collier County.
We, as the Board of County Commissioners, have the authority
and responsibility to assure that that process is done fairly.
And I, quite frankly, don't care whether our medical director is
employed by either hospital. I would hope he would be employed by
one of them and -- because I think that validates credentials, and I just
cannot imagine a medical director who has to spend time in Atlanta,
Georgia, and in Ohio, and still provide medical direction for our
people here in Collier County.
So I believe that the medical director should be a servant of the
people of Collier County. He should not be subordinate in any way to
a fire organization. He should be a servant of the people of Collier
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County, and I believe that we have a winning team in Dr. Tober and
Dr. Lee.
We know what we've got. We know that Dr. Tober has received
national, state, and local awards for excellence in emergency medical
services.
So I don't know why we would like to change horses in order to
get an unknown team, a team that is not proven, a. team that, in fact,
.seems to have some difficulties in other places; but that can be argued,
I'm sure, from both sides.
And the issue of market share between the two hospitals, I have
-- I have gone through the process of establishing these protocols for
stroke alert patients in great detail, and the information that I have
been given clearly demonstrates that Physicians Regional has been
involved in every step of the way in developing those protocols and
training the people.
And the evidence indicates to me that our medical staff has been
diligent in assuring that those medical protocols are followed. And
with the exception of a couple of administrative problems, the division
has favored Physicians Regional.
Now, I've talked with Dr. Campbell or Mr. Campbell, and I know
there's a difference of opinion on that. And I would be happy to sit
down with representatives and try to work that out because, quite
frankly, our record looks as if Physicians Regional has had adequate
and timely input into this entire process, and there's even a meeting
scheduled, I believe, in July to review the most recent data.
So there appears to be an attempt to be fair in that process, but we
have the responsibility and authority to make sure it is fair. So
whoever we select, we will be able to do that.
So my recommendation is, we've got an award - winning team.
We've got a lot of bickering between EMS and fire districts but, my
personal opinion, it's because the fire districts do not want their people
to be subordinate to anybody else, and that is an understandable
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feeling.
When you've got people who have to respond to emergencies,
you need to consolidate responsibility and authority, and it is difficult
for them to deal with a situation where their people are being certified
by someone else not under their control, and that is understandable,
but it is one that cannot stand in the way of us maintaining the high
standards of medical treatment that we have established here in Collier
County. It is solvable, but we've got to get over it.
And that concludes my remarks. I support Dr. Tober and Dr. Lee
as a team that has very well served the people of Collier County as
exemplified by their many awards.
CHAIRWOMAN HILLER: Commissioner Henning?
COMMISSIONER HENNING: I -- you know, at the last
meeting I brought to the board being a partnership or talk to East
Naples and Golden Gate about consolidation and bring recognition to
it. And prior to doing that, I sat down with the East Naples fire
commissioner, the chair, and Dr. Tober, and I said, this is what I want
to bring forward, and I want your input.
CHAIRWOMAN HILLER: And may I ask, just for the record,
that you clarify who the East Naples fire commissioner was that you
met with.
COMMISSIONER HENNING: The chairman.
CHAIRWOMAN HILLER: Jeff Page?
COMMISSIONER HENNING: Yes.
CHAIRWOMAN HILLER: Okay. Just so -- because other
people out there don't know.
COMMISSIONER HENNING: There was no objection from
either gentleman of, you know, the county participating in that, in fact,
encouraged. In the past remarks that I saw from Dr. Tober, he was not
objecting to any consolidation of the fire departments in Collier
County.
So that's my understanding of Dr. Tober's position on fire
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consolidation is not trying to prevent them, but he has absolutely no
objection to it.
CHAIRWOMAN HILLER: Commissioner Nance?
COMMISSIONER NANCE: Yes. I will say I've watched this
situation as a citizen and during my short period of time in service as a
commissioner, and I will tell you that, from my perspective, I think
this is -- this has been the -- one of the most difficult situations that
I've had to consider, and I think it's also one of the most disappointing
for me.
And the reason why I believe that the situation is in -- that we
find ourselves in this position, because of a great deal of self - interest
that's crept into this process.
I have met with absolutely dozens of people in this community in
all lines of work as professionals, seasoned professionals, first
responders, physicians, and all sorts of healthcare- related people that
have, of course, wanted to talk to me about resolving this issue, and I
will tell you that I have a uniform respect for all of them and what
they do individually.
But I find a stunning leadership vacuum among the
administrators of every entity in this discussion as far as moving to
make our operational situation better, and I can find fault with
absolutely everyone.
I think -- I think the intent has been to push issues in a direction
of self - interest, and I think that's a very, very sad situation.
I find everybody's positions unyielding, divisive. It's an
extremely rancorous situation. It's just not a very happy circumstance
that I find myself in or that this board finds itself in.
And the failure, in fact, is with the administration of all the
entities, including the medical director, that are supposed to find a
methodology to move forward towards greater performance to
safeguard public health and safety.
The fact that we have a premiere protocol clearly does not
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guarantee operational success. I think the fact that we're getting the
great results that we are in Collier County is on the backs of the EMS
staff and the fire staff in the field that are doing everything that they
can do to provide service in spite of the direction and lack of
leadership that they're getting from the administration of every entity
under concern.
And Dr. Tober does not -- is not lacking in that way. In my
personal discussions with him, I asked him if he was certain that he
could function in a manner that was going to lead us to be able to get
together in providing these services in a better manner and that my
hopes and expectations were in that direction.
So what the failure of the administration of all these entities has
done is come to this board and place the responsibility on these five
people who have no direct skills or knowledge on this subject seeking
a political solution to a management problem. I think that's absolutely
awful.
Because my fear is that if we -- if we take that route, and we take
a political solution to a management problem, that we will never ever
be able to go back again and make the proper decisions, and that is to
get together as professionals and figure out how to make this work.
That's all I have to say.
CHAIRWOMAN HILLER: Any other comments?
COMMISSIONER FIALA: Yeah.
CHAIRWOMAN HILLER: Go ahead, Commissioner Fiala.
COMIVIISSIONER FIALA: If I may.
CHAIRWOMAN HILLER: Yeah, absolutely.
COMMISSIONER FIALA: I've heard a number of the
comments, obviously, and I don't think anybody -- everybody has
mentioned how outstanding Dr. Tober is, but I don't think anybody's
really talked very much about Dr. Augustine. And I didn't know much
about him myself, to be honest with you, so I made it my business to
start looking in a little bit as to what he's done.
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And I know that he is a member of the medical directors
nationwide, worldw"icte association. I thought that was interesting. I
also know that he teaches once a year at Harvard regarding emergency
medicine. I know that he writes columns every month for Emergency
Medical Service World, which is a magazine that goes worldwide.
He's studying and working very diligently to build collaboration
between all medical services. And, you know, that's something we
really need right now, collaboration, working together, working as a
team, and I don't think we've seen that happen.
And it's always one side pitting against the other, and you're
never productive if you're always squabbling with one other. Look at
how hard our fire departments have wanted to keep the advanced life
services; it's taken away from them, of course, and that's why North
Naples went out and started their own because they were reduced to
basic life service instead of advanced life service.
And they felt that the residents, our people, needed to have
advanced life service. When they're on the spot, they need to be there
right away with all of the equipment needed, and they weren't allowed
to do that.
So I feel that I stand solidly behind a change; that change is Dr.
Augustine.
CHAIRWOMAN HILLER: Thank you.
I'd like to say a few words, and the first thing is I'd like to address
what the Naples Daily News said in their editorial. They incorrectly
stated that the reason I had brought this forward was for political
reasons, and it isn't. It has nothing to do with North Naples Fire.
I did receive a donation from that union, but I also received a
donation from EMS's union. In fact, as I've said before, I was very
honored to be endorsed by public safety across the board. I was
supported by fire, by EMS, and by the police, and there's a reason. It's
because I support all of them, and I support them all equally. They're
tremendous individuals in every way.
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And, in my opinion, the number one obligation of the Board of
County Commissioners is public safety. That is our duty. We are
here to make sure the public is safe above and beyond everything else.
And so that is why, through the course of my tenure on this board, I
have constantly advocated policies that promote the public safety.
And we, for example, through Mr. Casalanguida, installed a
different lighting system so we could be assured that our emergency
service vehicles can get through traffic and get a patient to care as
quickly as possible.
Our AUIR, which is our -- basically our level -of- service
standard, suggested that our EMS staffing was not adequate to allow
for our providers to get to a scene quickly enough. So we began to
approve ALS service through fire.
Commissioner Coyle made a comment that North Naples had
their own medical director. Well, they're required to by law. Any --
the statute is very clear. The statute requires that any organization, be
it public or private, that provides BLS transport or ALS services must
have their own medical director.
And the medical director of these institutions, again, be they
public or private, work to the statute and work to the standard that we
have set in Collier County. There is no medical director in Collier
County that works to a different standard other than the uniform
standard that we have established.
And they have worked hard to achieve that uniformity so that all
the citizens in the community have the same level of care when faced
with an emergency situation.
So, again, going to what the paper said, completely false and,
quite frankly, they need to retract. But what the paper does is they
veil everything in opinion and, because it's opinion, it doesn't have to
be fact.
The reason I brought this forward was the exact opposite of
politics. We have a process in Collier County where we require all of
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our contracts to go out to bid, and there's a reason for that. I mean,
could you imagine if we hired a road contractor and just gave him
every single contract to build every road in Collier County without
ever exploring if there was a better contractor out there or, in the case
of that kind of service, you know, the same level of service at a better
price?
It's our obligation as members of the board to ensure that when
we make a decision that we do look at what is out there in the
community, and what is out there in the community may prove to tell
us that who we. have is, in fact, the best or -- for the benefit of the
public or, to the contrary, it might prove that there is someone out
there who is better.
Everything we do is in the public's interest. Dr. Tober's contract
was an evergreen contract. And my request to bring this forward to
consider that it be competitively let and allow for the community to
know that we do or don't have the best medical director was done
through the process that was approved by this board.
So there's nothing political. It is 100 percent intended to allow
the process to work for the benefit of the public to ensure that we are
making the best selection for the benefit of the public as it relates to
the role of the medical director and what the medical director does.
There were several other issues that were brought up, but I don't
think we really need to get into that. There was a letter received,
again, from two other doctors that indicated they couldn't be here. So
the board has received a copy of it when I received it, and it will be
entered into the record. It's from Dr. Zeitler, M.D., and Dr. Diorio,
M.D., and I'll just summarize, and it will be a matter of public record
so you can, you know, pull it and read it at your leisure.
But, in essence, it basically says that the -- well, should I read it?
COMMIISSIONER COYLE: No.
CHAIRWOMAN HILLER: No. I won't read it. But anyway --
basically that the -- that they're responding to the letter sent on behalf
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of the members of the medical society, the Collier County medical
board, that they're actually board members themselves.
And they did not discuss -- they said that the qualifications of the
candidates were not discussed, etcetera, et cetera. But, essentially,
that, you know, the letter, as presented, doesn't represent the views of
them or the society.
Then they also talked about Dr. Tober's qualifications,
recognizing his -- that he's qualified as a doctor, however, that they
had a concern because Dr. Tober is employed by NCH Healthcare and
that that is -- that can be construed as a conflict of interest, as there is
more than one hospital in the system.
And so they asked that -- to discourage any semblance of bias or
favoritism of one hospital system over the other, they feel that, you
know, there should be independence and that Dr. Tober would need to
separate himself, or said another way -- and I'm paraphrasing this --
that the medical director should not be allied with one hospital over --
to the exclusion of the other.
And so they say that they could only endorse Tober if he
relinquished contractual and financial obligations with NCH.
So that's, in .essence, what that letter says. So I'll just introduce it
in the record since they couldn't be here.
So in short, you know, from my standpoint, I don't agree with
evergreen contracts, and I would hope that when our purchasing
ordinance comes back to the board for approval that one of the
conditions in there makes it clear that, as a matter of public policy, we
will not support evergreen contracts because it is against the public's
interest not to go through the bidding process and, in this case, the
interview process.
This is a very difficult decision because, in my opinion, I think
every single physician that was interviewed is outstanding, they're
outstanding medical professionals, and they each bring tremendous
experience to the table.
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The point you make, Commissioner Fiala, is a very important
one, and that is that having someone who can unify and not divide
with respect to the issues in this county is very important.
And Dr. Tober has had, I would say, a very difficult relationship,
not just with fire but also with the other major hospital in the county,
which is Physicians Regional.
And so it's extremely important that whoever we recommend as
medical director gets along with everybody who services the EMS
system, you know, not only the multiple fire districts. You know, it
seems that -- it looks like he's developing a positive relationship with
East Naples, and that's nice to hear but, you know, it's been negative
with other districts, and we've got, you know, a positive relationship
with one hospital but it appears what looks like a negative relationship
with the other hospital.
And we need someone who can really work with everybody in a
positive way for the benefit of the public.
So like I said, I think very highly of Dr. Tober. I think he's done
some marvelous things, and I think very highly of the other candidates
as well, and I'm thinking very seriously about this decision.
So -- yeah, go ahead. Commissioner Nance.
COMMISSIONER NANCE: I think that applying -- I do believe
that this, indeed, since it's landed on the desk of the Board of County
Commissioners has become political beyond what's healthy for our
community. And I believe that the relationship that Dr. Tober
currently enjoys with Naples Community Hospital to the exclusion of
others is problematic. I believe the leadership vacuum from the
hospitals as well as the fire districts is no less problematic than Dr.
Tober's weaknesses.
At this point, I am going to support the motion with very, very
severe reservations for the simple reason that I do not believe there's
an alternate that is any better. I believe an alternative solution will
strictly be political, and it will gloss over and let the wounds that we
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currently have lie underneath the scab that will never heal.
That having been said, I can also not support a long -term contract
under an arrangement that is dysfunctional. So I will simply not
support a long -term contract if I'm forced to make that decision. I
think the contract should be very limited and give everybody a chance
to take a deep breath and do what they're supposed to be. doing to
begin with, and that is getting together and working out this problem.
This problem cannot be worked out by this board. This is a .ridiculous
-- absolutely ridiculous situation to put any one of these people in.
CHAIRWOMAN HILLER: If I may comment.
COMMISSIONER NANCE: I will -- I will be looking forward
to discussions on it, but I don't think that making a change that let's
everybody off the hook is the way to go. And I've thought about it.
I've taken it under very, very serious advisement. And what I'm
telling you is, I don't see -- I don't see honor anywhere -- and I'm most
upset with everyone.
So I don't know if that helps anybody out, but I'm going to
support the motion with very, very serious reservations.
CHAIRWOMAN HILLER: If I may say one thing,
Commissioner Nance. Commissioner Coyle would like to speak. But
I do want you to understand that we are obligated with making the
decision. You do understand that?
COMNIISSIONER NANCE: Oh, I understand that.
CHAIRWOMAN HILLER: Okay. Because you keep saying,
like, they're putting us in a --
COMMISSIONER NANCE: Oh, I just think it's a ridiculous
situation. I understand. I just told you what my decision was. I will
support the motion, but I find it very, very poor form on the
administrative leadership of everybody concerned. I think it's
ridiculous, and I think it's shameful.
CHAIRWOMAN HILLER: Commissioner Coyle, and then
Commissioner Fiala.
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COMMISSIONER COYLE: Yeah. I have to share some of
those sentiments, but I would like to add something for your.
consideration.
Some of these issues probably cannot be worked out without the
board's involvement. A competition between hospital systems here is
way beyond the capability of a medical director or EMS department.
I think the board needs to continue to work with the staffs of both
hospitals to sort out this differing, vastly differing interpretation of
facts, of data, I should say, because, depending upon what subset, of
the data one presents, you can draw different conclusions, and we
need to clarify that, and we need to reach agreement between the two
hospital systems about how we should report these various
classifications and the reasons why we direct people to certain of the
hospitals for treatment, because that will help us refine our assessment
effectiveness.
And so I think that will also resolve this particular issue and give
Physicians Regional some comfort that there is no one who is trying to
assure that one hospital system benefits over another. And I think we
have that power and responsibility.
So with that, I would be happy to see the motion called.
CHAIRWOMAN HILLER: Commissioner Fiala would like to
speak, but before --
COMMISSIONER FIALA: Just a fast one.
CHAIRWOMAN HILLER: Yeah, but I would like to just say
one thing. We have an ongoing investigation into the issue of the shift
of -- or the statement made about market share, and you had indicated,
Commissioner Coyle, that you have information on that.
Leo, when are you going to bring that forward? We've got the --
you know, you've given us the investigation on the Minnard case,
which the board still has to address. I mean, we've received it, but it
needs to be put back on the agenda and probably should be put back
on the July agenda, but that's more of an operations issue.
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And just one clarification, Commissioner Nance, the medical
director is not responsible for operations. The medical director is
responsible just for protocol and training and should not be involved
in operations.
But, Leo, when are you going to bring that investigation back,
since Commissioner Nance had -- and the board supported you doing
that internal investigation on that --
MR. OCHS: Yes, ma'am.
CHAIRWOMAN HILLER: -- market -share issue?
MR. OCHS: I was planning to bring that back in September.
You had asked me to not only touch base with the PSA and the
hospitals, but, you know, do my own review, and I want to make sure
that I cover all of those bases thoroughly for the board.
CHAIRWOMAN HILLER: The second meeting or first
meeting?
MR. OCHS: I don't know, ma'am. Whenever it's ready. It will
be no later than the second meeting.
CHAIRWOMAN HILLER: Okay. That's fine then. I just
wanted to --
COMMISSIONER HENNING: You're not planning on taking a
vacation or anything, are you?
MR. OCHS: No. It will be a working vacation, yes, ma'am.
CHAIRWOMAN HILLER: Cancel that trip to Vegas.
Okay. I just - and maybe, if we could all have whatever you've
got on that investigation, Commissioner Coyle. You said you had
studied it yourself and you had information that showed there were no
issues, if you could provide that to the board.
COMMISSIONER COYLE: I didn't say it showed there were no
issues. The information tends to show that the information presented
by Physicians Regional at this board meeting last time was incorrect
and also outlines the number of meetings by date and the people
attending those meetings representing both Physicians Regional and
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NCH and our EMS personnel and what they did or accomplished or
agreed to.
So I'll be happy to provide that information to you.
CHAIRWOMAN HILLER: That's great. Provide it to all the
board and to Leo, and that would be the best.
COMMSSIONER COYLE: Yes, okay.
CHAIRWOMAN HILLER: Commissioner Fiala, and then
Commissioner Nance.
COMMISSIONER FIALA: Yes. You know, I used to work for
NCH, right? I still have some great friends that work there or that are
involved there. So to me it's just about seeing these departments that
are in emergency medical services handling the job that our people
expect them. It doesn't make any difference to me, one hospital or
another. I'm just mainly concerned that our residents get the service
that they not only desire, but that they should demand for their own
health.
And Commissioner Nance said he feels this whole thing, the way
it's run right now is distasteful, ridiculous, and disgraceful. Then why
would you vote that way? Do you expect a different outcome if
you've got the same people running it and felt it was not right before?
That doesn't make any sense to me. But that's just a rhetorical thing to
say, I guess.
CHAIRWOMAN HILLER: And I just want to ask one question.
Commissioner Nance, what is your opinion of the vote of the
PSA? I mean, the PSA is supposed to represent the community. And,
you know, I personally had said it should not go to the PSA, but you
and the other members of the board said it should go to the PSA, and I
was concerned about, you know, conflicts in the process, and you -all
said it was good. And now the PSA comes back, and the PSA's
recommendation is for Augustine and Panozzo, but you're sitting here
now -- after having said that the process properly should be that it
goes to the PSA, now you're saying the PSA should be ignored and
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that that process is no good and that we should disregard what the
PSA says.
COM11iIISSIONER NANCE: No. I'm not saying we should
disregard what the PSA says. The PSA was a 17- member board, 13 of
which voted. One of the people that voted was one of the candidates
for the deputy medical director. So the PSA --
CHAIRWOMAN HILLER: He didn't vote for himself, though.
COMMISSIONER NANCE: No, he voted for Mr. Augustine,
okay.
CHAIRWOMAN HILLER: Is there a problem with that?
COMMISSIONER NANCE: Well, I think there is a relationship
between those two individuals. And what I'm saying is, to me, that's a
no decision. That's a tie vote or less than a tie vote. So I don't think it
was anything indicative that the PSA had any real strong feeling.
CHAIRWOMAN HILLER: How is it a tie vote?
COMMISSIONER NANCE: Had Mr. Panozzo, who is a
candidate, abstained, it would have been tied at six apiece.
CHAIRWOMAN HILLER: Let me ask you this question.
COMMISSIONER NANCE: No, I really don't want to engage in
that conversation. What I am doing here is trying to say that I don't
believe that this board making a political decision is going to change
the workings of the ladies and gentlemen out here that are going to
have to make this thing work.
If they do not change their management style and learn to work
together, it's not going to get any better. We can have any medical
director we assign that will give one political advantage to one or the
other or a different. And it's not going to -- it's not going to result in
any better service to my district, I can tell you that. My district is the
most remote one, the ones where the service times are the longest and
the facilities are the scantest.
So I'm imploring the ladies and gentlemen and professionals,
each of which I respect -- and I don't mean to go on a rant here and
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imply to you that I do not respect you, because I respect each of you.
I am imploring you that you have to step up and you have to craft a
way to make this work.
This board cannot make you function together. And until you
function together, it's not going to get any better despite our best
wishes. We can select a new medical director every year; we're going
to find ourselves in the same situation.
So I'm sorry that Commissioner Fiala thinks that one little change
of one person is. going to make a big difference, but I'm here to tell
you, look at all of you that are involved and tell me that any one
individual is going to make that change. It's not going to happen. It's
like Solomon trying to split the child in half. It will not.
So I am throwing the ball back in your court, ladies and
gentlemen. The citizens of Collier County are looking forward to a
referendum in the year 2014 to talk about working towards a more
cohesive, managed first responder system as a whole, and that's what
I'm expecting that they're going to continue to demand.
So you guys are going to have to step up. The decision is not
going to be made by this board. The decision is going to be made by
you. You can blame it on this board if you'd like, but seek your
hearts, and you know you're going to have to step up and get it done,
and that includes Dr. Tober.
Dr. Tober writes the protocols. We could have the best protocols
in the world, but if they can't be delivered at the date and time of the
emergency, they're not effective.
So he has got to craft, together with you -- I'm chastising all of
you together.
I call the question.
COMMISSIONER HENNING: Yeah, it's my motion. I think I
can call the question, right?
COMMISSIONER COYLE: Yeah. You can't, but the chair can.
But I would like to make a response to a comment that was made
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that I think really needs -- is important. It won't take long.
Why do we make the same decision and select the same people
that have been responsible for the system not being functional and
expect a different result, okay.
It's real simple. We're keeping that portion of the system that is
the only thing that has been functional. The people who are
responsible for us having one of the best emergency medical systems
in the nation and the State of Florida are the medical director and all
of those people that the fire district and in our EMS departments who
are out there on the ground treating people in emergencies. Those
have been the only people that have really been making this system
work.
As Commissioner Nance has pointed out, there are a lot of people
at higher levels who want to build empires and want to manage things
in a different way and want to consolidate their control over things
that are causing the problem. And as long as we yield to those people
in creating our emergency medical system, we will fail, and we'll
continue to have this kind of disorder.
It's amazing to me that our EMS people on the ground have been
able to do such a wonderful job in view of all of this bickering.
So you're absolutely right, Commissioner Nance. What we're
doing is keeping the best part of what we have, I hope, and we're
challenging the rest of you to get on board, and that includes the PSA.
And I share Ed Morton's assessment of that. It is a failed
organization. Why is it a failed organization? Because we apparently
picked a group of people among whom were some that don't have the
backbone to stand up for principle. They want to avoid confrontation.
They want to avoid argument. They want to be nice to each other all
the time. And that's not how you get a good system.
You know, the old story about an elephant is a horse designed by
a committee --
CHAIRWOMAN HILLER: So I understand now why Coyle
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fights with me all the time. I didn't realize. I get it. That's how -- his
justification, it's for the good of the system.
COMNIISSIONER COYLE: So the more we compromise with
things in committee -type work, the more distorted the process
becomes. So what we're really doing is keeping what's good and
challenging the rest of you to get on board and let's start working
together. and get the job done.
CHAIRWOMAN HILLER: All right. We are going to call the
question. I just want to make one last statement just to your point,
Commissioner Nance.
I was the one who said the PSA had conflicts, just to make a
point. Mr. Dutcher is the chief operating officer for NCH. Mr. Tober
-- or Dr. Tober works for him. So, I mean, now we're back to 7 -6.
So the point being is .everybody disagreed with me, and I guess
now everybody agrees with me. I think it's kind of funny.
Okay. I'm going to go ahead and call the question, but I'd like to
suggest that we truncate the question because there are two separate
positions that are being considered here. The first position is that of
medical director. The second position is that of deputy medical
director. So I think we need to have two separate votes. There are
going to be two separate contracts.
We have a different structure now because we have bifurcated
the positions and, as I said, two separate positions.
So, Commissioner Henning, would you kindly amend your
motion so we have first a vote on the position of the medical director
and then we have a second vote on the position of deputy medical
director? And keep your motions the same but just do first -- you
know, your first motion is medical director.
COMMISSIONER HENNING: Is there any debating this
motion?
CHAIRWOMAN HILLER: No. I mean, do you want to debate
it?
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COMMISSIONER HENNING: No new debate?
CHAIRWOMAN HILLER: No, I don't think -- I mean, we don't
have to.
COMMSSIONER HENNING: You know, I think we abused
this topic so much we better call the sheriff over here to do something
about it, but --
CHAIRWOMAN HILLER: Commissioner Henning, I have the
-- we have not had any discussion --
COMMISSIONER HENNING: If we're not having any debate,
I'll go ahead and do that, make a motion --
CHAIRWOMAN HILLER: And let me just confirm that nobody
wants -- because we haven't had any discussion about deputy.
Everybody just focused on the medical --
COMMISSIONER NANCE: I would support bifurcating it.
CHAIRWOMAN HILLER: Okay. But let me ask this. Is there
any desire to have discussion on the second question, which is the
position of deputy medical director? Because we've only talked about
the medical director, even though the motion, originally as presented,
considered both.
Commissioner Coyle?
COMMISSIONER COYLE: Well, there are some unanswered
questions in that respect, but I understood Commissioner Henning's
motion to be to support the existing team that we have, Dr. Lee and
Dr. Tober, and there's a good reason for retaining the team. They
work well together. They are both eminently qualified for the
position.
And if we are going to bifurcate them and bifurcate their
contracts as an administrative procedure, I see nothing wrong with
that. But if we're going to start thinking about having someone else be
the assistant medical director, one has to give consideration to the
authority of the medical director to direct his assistant, and that would
include, I presume, either dismissing him and asking for a replacement
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and/or recommending that person for retention in the future even with
a salary increase.
So those are things that we haven't really worked out, but I would
hope that we wouldn't have two medical directors, one a primary and
one an assistant, who both report to the Board of County
Commissioners, and then we would have to evaluate them both even
though they're working as a team.
So I don't think the board has considered that sort of thing. But if
the objective is to nominate both men, one as medical director and one
as assistant, I am certainly amenable to proceeding in that direction.
CHAIRWOMAN HILLER: Commissioner Nance?
COMMISSIONER NANCE: No comment.
CHAIRWOMAN HILLER: Commissioner Fiala?
COMMISSIONER FIALA: Its fine with me to bifurcate it.
CHAIRWOMAN HILLER: You want to bifurcate, but do you
want to have discussion on the deputy, or do you just want to --
COMMISSIONER FIALA: Well, yeah, because we haven't
really discussed who we want, I mean, actually, by name.
Commissioner Coyle said keep them together, but we haven't even
discussed anybody's qualifications.
CHAIRWOMAN HILLER: What's your position, Commissioner
Nance?
COMMISSIONER NANCE: I'm ready to vote on it.
CHAIRWOMAN HILLER: On --
COMMISSIONER NANCE: Both of them.
CHAIRWOMAN HILLER: On both of them as one?
COMMISSIONER NANCE: Yes, ma'am. If you want to
discuss it, I'll proceed -- I'll support the discussion if somebody would
like to talk about it.
COMMISSIONER HENNING: My motion stands as stated.
CHAIRWOMAN HILLER: Okay.
COMMISSIONER COYLE: Yeah.
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CHAIRWOMAN HILLER: In that case, all in favor?
COMVIISSIONER COYLE: Aye.
CHAIRWOMAN HILLER: (No verbal response.)
COM lSSIONER NANCE: Aye.
COMMISSIONER HENNING: Aye.
CHAIRWOMAN HILLER: Any opposed?
COMMISSIONER FIALA: Aye.
CHAIRWOMAN HILLER: Motion carries 4-1, with Dr. Tober
and Dr. Lee being selected.
COMMISSIONER COYLE: Can I go home now?
COMMISSIONER FIALA: Yes.
COMMISSIONER HENNING: We want to communicate with
you first.
MR. OCHS: Madam Chair, the next step, then, would be for
county attorney to present contracts and bring them back to the board
or --
CHAIRWOMAN HILLER: The next step would be to designate
the chair to negotiate the contract terms and bring those negotiated
terms back to the board for approval.
COMMISSIONER HENNING: You're going to work with the
County Attorney's Office, correct?
CHAIRWOMAN HILLER: Always.
COMMISSIONER HENNING: Always.
CHAIRWOMAN HILLER: Always.
COMMISSIONER HENNING: It's just an assumption.
MR. KLATZKOW: May I just get -- may I just get a little
clarity, because Commissioner Coyle raised a very viable point here.
CHAIRWOMAN HILLER: Yes.
MR. KLATZKOW: Is your deputy going to be separate?
CHAIRWOMAN HILLER: Yes. We made that clear, and the
board approved that as part of their motion.
MR. KLATZKOW: So your deputy's not going to report to --
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CHAIRWOMAN HILLER: We can structure it that the deputy
reports to the medical director, but we have to have two separate.
positions, because we can't have the situation we have -- we have
currently, which is one entity that basically hires both, and then
something happens to that entity, and we're with nobody.
So we have to have two individual contracts. We can,
organizationally, structure it that the deputy answers to the medical
director, and the medical director answers to the board, but we have to
have two separate contracts.
MR. KLATZKOW: At the end of the day, can the medical
director fire the assistant without your permission?
CHAIRWOMAN HILLER: No, no, absolutely not, and nor can
the medical director hire without the commission. The commission
both has the ability to hire and terminate, but in terms of answering
within the hierarchy, it's to the medical director.
MR. KLATZKOW: Okay. Thank you.
COMMISSIONER COYLE: The medical director could make a
recommendation to the board --
CHAIRWOMAN HILLER: The medical director can say
whatever they like to the board. I mean, that's their right. But at the
end of the day, we have to retain the ability to hire and fire the deputy.
COMMISSIONER COYLE: I'll support that.
Item #I OJ — Continued from earlier in the meeting
BOARD OF COUNTY COMVIISSIONERS TO CONSIDER
AUTHORIZING THE CHAIRWOMAN TO SEND A LETTER TO
REGULATORY AGENCIES RESPONSIBLE FOR PERMITTING
AND REGULATION OF OIL EXPLORATION AND OIL WELL
EXTRACTION OPERATIONS IN COLLIER COUNTY TO
INSURE THAT COLLIER COUNTY CITIZENS; COMMENTS
AND CONCERNS ARE GIVEN CAREFUL REVIEW AND
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