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Agenda 03/12/2013 Item # 6C 3/12/2013 6.C. Office of the County Manager • Leo E. Ochs, Jr. FJ.r,l;tt" C)(10:‘ 3299 Tamiami Trail East,Suite 202•Naples Florida 34112-5746•(239)252-8383•FAX:(239)252-4010 March 6,2013 Mr.Charles Minard 5120 Coral Wood Drive Naples FL 34119 Re: Public Petition request from Charles Minard requesting changes at the State and Local levels in regard to Emergency Medical Services. Dear Mr. Minard, Please be advised that you are scheduled to appear before the Collier County Board of Commissioners at the meeting of March 12,2013,regarding the above referenced subject. Your petition to the Board of County Commissioners will be limited to ten minutes. Please be advised that the Board will take no action on your petition at this meeting. However,your petition may be placed on a future agenda for consideration at the Board's discretion. If the subject matter is currently under litigation or is an on-going Code Enforcement case,the Board will hear the item but will not discuss the item after it has been presented.Therefore,your petition to the Board should be to advise them of your concern and the need for action by the Board at a future meeting. The meeting will begin at 9:00 a.m. in the Board's Chambers on the Third Floor of the W. Harmon Turner Building(Building"F")of the government complex. Please arrange to be present at this meeting and to respond to inquiries by Board members. If you require any further information or assistance,please do not hesitate to contact this office. Sincerely, r Mike Sheffield Business Operations Manager MJS:mjb cc: Len Price,Administrative Services Administrator Dan Summers, Bureau of Emergency Services Director Walter Kopka, EMS Chief Jeffrey Klatzkow,County Attorney Debbie Wight, Legislative Affairs Coordinator Packet Page-25- 3/12/2013 6.C. COLLIER COUNTY Board of County Commissioners Item Number: 6.6.C. Item Summary: Public Petition request from Charles Minard requesting changes at the State and Local levels in regard to Emergency Medical Services. Meeting Date: 3/12/2013 Prepared By Name: BrockMaryJo Title: Executive Secretary to County Manager, CMO 3/6/2013 9:11:55 AM Submitted by Title: Executive Secretary to County Manager, CMO Name: BrockMaryJo 3/6/2013 9:11:57 AM Approved By Name: SheffieldMichael Title:Manager-Business Operations, CMO Date: 3/6/2013 11:50:29 AM Packet Page-26- 3/12/2013 6.C. Office of the County Manager Request to Speak under Public Petition FER 28 20 Action Please print Name: (� ro-le S Q`t t(\a t--) Address: 5120 (arc/ ( T htcx A r 34t lig Phone: 2.3y-S .-974129 Date of the Board Meeting you wish to speak: //2.// Must circle yes or no: Is this subject matter under litigation at this time? Yes No Is this subject matter an ongoing Code Enforcement case? Yes l No Note: If either answer is "yes", the Board will hear the item but will have no discussion regarding the item after it is presented. Please explain in detail the reason you are requesting to speak (attach additional page if necessary): $ 0 -41 cernun-kk6J 1'y /t - tia 1:!e, oC- rwr s Ori cz riot ÷-0 rAa caivrises /I *it Ad_ tp la-4)5 c((tier CoLAf4-y • Oul 2.s 'c,r 6y50:1 j/t. DC. 2/) 2o12_ oI 4-9 eroat°s 6y 3 ell F ren c- lend r 4.4 Is +iv - 44`42..-Si..?c 5C44. �a 5 Q c�'t Imo'✓cs • e L ut Fau.� �- rs / 4 Ag?x ar 0,A13,1:7 r�ibbio tv1 Per at (ear'- G ye4r.s out-sons rjse flikc r,t5 ((Paniivi vn•troxi,n, 1M1 an,►.(er-d t #4' r cJ 4 i -fors. Please explain in detail the action you are asking the Commission to take (attach additional page if necessary): T `L c;,r Cc funs ss;oA rs fo ' ill 44--4reykttr to°Jerno r- cY 5c0-44- 119 o K A(`m .7L-F. aej GP arn.r :N.>-� D R. SI- if `7<MM,Z8 `;. f�Q t� Ski e&s-ts c S OU{ , ice 4- 1 Cal) ,fat' i{c t, 5pef, fa I C` Sts . To a. ctttl.�S I r;s - trluzr `' r CHI(42 rev,� ` ,,� ,► CASE rr - it f r I.fJ' g i° r C K S re b Teens"(plc r tit-s . ��'s ad'4f1S• H:■Mary-Jo\Public Petition Request Form-2008 new form doc Packet Page -27- r� � ; . 3/12/2013 6.C. rt #jam h't :4?-.;"'.7' : , � B j 3 :r ' t S r ',,,,t ,„fl r . i,,,,i va^xe;ri..„2, y :,- i � ? . a s "r a tys y . „: .„,,..,:.„...” i:H:' ".1447” Pre erred „"...„ ,„..,.., . , .. ., ."' '`' � �'' F F Amendments to §768.28 Florida Statutes y � ) 3 :'le t -., �� y t r t;,., i v .,�.. , During the last session, the Florida Legislature ,1.4 p ,fiaW �a 4 t`�Lr. .-Vq„: %,F to a�� ' ,�x amended §768.28, F.S. which provides for a ;` �, yap a ;. �V ` f e�� -6ri r (, - limited waiver of sovereign immunity for tort "` �`' claims against the State, it agencies, and ,r t^ r Nr political subdivisions. Specifically, the monetary M b limits on liability set forth in that statute were ,�,�k "4 : increased from the existing limits of$100,000 ,,a , x,x . '. a a per person and $200,000 per occurrence, to the l,,,,, a r, ,-.r new limits of$200,000 per person and $300,000 ri p�yy.'p'� :� : 1 per occurrence. This amendment, which was I4?ri*4'h d .. a is , . ; , w signed into law by the Governor, takes effect on �� 4s4 #w October 1, 2011 and applies to claims arising on .1 4x ° or after that date. Otherwise, the statute remains s r fr b�*4+Wi+,xiiw'*ww , � 'u�4•����� ,° °A �d�.� � �� unchanged. t lie= ��� ,�� � r °� `t �s { M On its face,this may appear to be a rather modest increase in governmental tort µ; �, f4 vi liability, especially when one considers that the current caps have been in place for ;; :$ ' .. E.'° '1' 30 years. Additionally, the liability caps are still fairly conservative when compared 4� ' , r sir ,, r to similar limitations on governmental tort liability which exist in other states, i.e., �� , '` , '� _� � R " :,., Indiana- $7.00,000 per person and $5 million per occurrence; Nebraska -$1 million «°fir r�� 1'` + '*ar t'� t ��'` V ��, � , � � per person and $5 million per occurrence; Maine-$400.000 per darn; Idaho- 1' . ' :: ; ,1.g ; n,, ; abolished to the extent of insurance or$500,000 per occurrence. {' � ;„ �* 4 However, the Legislature, • •its •infinite wisdom, has certainly chosen an unusual Y 'V'''�, 4 y e r g y , ���,, as r, , t ,, ` , time to impose this increased financial obligation upon the public sector. This ' '� �' .. change in the sovereign immunity limits, which essentially amounts to an ax tn.'��t7yay/,rit r,� � ._,�_ � ,r s* ,, ,1x unfunded mandate, will almost certainly result in increased expenses for Florida's � . , � �, r x/f ' governmental entities in the form of increased litigation, larger settlements and � , , v t om, i ., ,� ,: , verdicts, and corresponding higher insurance costs. Given the financial challenges .7,4 ' 1 ; '. ng � ,,., already facing Florida's public sector due to changes in the tax structure and �af ' 0 ��V � „ prevailing economic conditions, it seems anomalous indeed that the Legislature °' � �` would choose to further exacerbate the situation, at this particular time ,,, "::`,...;:wx rii,t r # ' ¢ y r„ y Aside from the philosophical debate regarding the wisdom and timing of this � y1 r k '.� � action, this amendment also raises certain risk management concerns which must x >£ .,: �° be considered carefully by each public entity. Many of the existing policies or ° � � g,�,r� •x�v_ �,. • Y y P y Y 9 P , _ �, r insuring agreements which have been purchased by governmental entities in this �';' '` State establish the insurer's indemnity obligation, through September 30, 2011. by A . reference to the existing sovereign immunity limits, i.e. $100,000/$200,000. This x";: raises the potential for a "gap" in coverage for the public entity in those scenarios .'` r. t> � 4, `;� , where the relevant occurrence takes place prior to October 1; 2011, but the 4,� � a ' " claimant's cause of action does not accrue until after October 1, 2011. Packet Page-28- _ 3/12/2013 6.C. COVER STORY CONTINUATION... Amendments to §768.28, Florida Statutes Admittedly, in most instances, a claimant's cause of action will accrue on the same date on which the relevant incident occurred, i.e., automobile accident resulting in personal injuries. However, since under Florida law, a cause of action does not accrue until the last element constituting the cause of action occurs, there can be limited circumstances when a claimant's cause of action will accrue on a different date than the occurrence of the incident giving rise to the claim. The most obvious example of this scenario would be a claim for wrongful death where the accident occurred on September 30, 2011 but the claimant's death did not occur until sometime after October 1, 2011. In that situation, the cause of action for wrongful death would not accrue until the death occurs. See Fulton County Administrator vs. Sullivan, 753 So.2d 549 (Fla. 1999).Accordingly, the claim for wrongful death would be subject to the increased sovereign immunity limits of the new statute, since this claim did not arise until after October 1, 2011. A similar situation could also occur in the case of "continuing"torts,i.e., trespass, nuisance, pollution, etc., depending upon the particular circumstances. In the scenario outlined above, if the insuring agreement, which likely has the date of occurrence as the "trigger"for coverage, limits the insurer's indemnity obligation to $100,000/$200,000, the entity could have up to a $100,000 "gap" between its potential tort exposure and its available coverage. Accordingly, in order to insure full coverage, the public entity should confirm that its insuring agreement extends coverage equal to the monetary limitations set forth in whichever version of§768.28, F.S. is applicable to a claim brought against said entity. Likewise, it would be important to confirm that the insurer will apply the"occurrence" date of the insuring agreement, to provide for coverage up to the increased sovereign immunity limits which may be applicable to this type of claim. The public sector should also be on notice that there were significant legislative efforts to further seriously „ems undermine the protections of sovereign immunity. There were several House and Senate Bills which were introduced, but which did not become law, seeking to effect much more drastic changes in Florida's sovereign immunity law. For example, during the legislative process, there were bills introduced which sought to effect the following changes to Florida's sovereign immunity laws: 1. Remove counties, municipalities and other local units of government from the umbrella of sovereign immunity protection. 2. Remove the per occurrence limit entirely. 3. Award Plaintiff's attorneys an additional 5% in fees for appeals and any post-judgment actions (Claim Bills). 4. Provide for an annual increase in the liability limits based upon a component of the Consumer Price Index (CPI) and the CPI Medical Component. Fortunately, those efforts were ultimately unsuccessful but obviously any single one of those proposals outlined above, if adopted,would have much more significantly altered the sovereign immunity landscape and further exacerbated the adverse economic consequences to the public sector. We would fully expect the plaintiff's bar and other special interest groups to continue their lobbying efforts to further erode the existing sovereign immunity protections, and we would encourage Preferred's membership to remain vigilant for those future efforts. Packet Page-29- Cu!lier County EMS adds anotnner ambulance in Naples in effort to decrease arrival times.Naples Daily Ne 3/12/2013 6.C. Ai - - r .Cow Read more at napE:snears corn Collier County EMS adds another ambulance in Naples in effort to decrease arrival times By AARON MALE Originally published 03:50 p.m.,April 21.2011 Upctooted G .;0?_ n.m, April 21. 2C 11 NAPLES — Call it subtraction by way of addition. Collier County EMS, which has been under fire for slow response times in the city of Naples, added another ambulance unit within city limits on Thursday to decrease on- scene arrival times. Officials say the extra unit, which brings the total number in the city to three, should result in better patient outcomes. The move came weeks after complaints over county-run EMS response times in the city, in some cases surpassing 15 and 20 minutes, spilled into public discourse. On Monday, the Naples City Council called for a committee to explore alternative hospital transport options. These concerns became public after outcry over a 911 call on March 19. In that call, Collier EMS ambulance got lost on its way to a patient, 82-year-old Daisy May Cannon, who was complaining weakness and loss of appetite. EMS personnel arrived at the 13th Street North address nearly 15 minutes after the emergency call was placed and 10 minutes after city of Naples firefighters arrived. Cannon eventually died after cardiac arrest in the ambulance while in transport to the hospital, according to county reports. In another case, it took EMS personnel more than 20 minutes to reach a patient at a Third Street South restaurant. The patient was suffering from low blood pressure, coming in and out of consciousness and vomiting, according to city and county reports. City and county officials have blamed those embarrassing calls on everything from poor communication to congested traffic, a lost sense of urgency to inadequate resources. In the fallout, Naples officials have been flirting with the idea of starting a new ambulance service. Packet Page -30- uv v.naolesnews.ccrninav oni ..,,, ,,,-__ ._ a_ _. Coliter County EMS sacs another ambulance in Naples in effort to decrease arrhfal times:Naples DailyNt 3/12/2013 6.C. Naples City Councilman Doug Finlay points out the city pays nearly $2.7 million to the county for EMS service and is not seeing a fair return. However, Steve Mclnerny, chief of the city of Naples Fire Rescue Department, said the additional ambulance in Naples is a "good step forward" toward improving emergency response in the city. The fire department works in coordination with Collier EMS to respond to medical emergencies, but only EMS can transport patients to the hospital. "I think it will definitely enhance the overall response times to scenes," Mclnerny said. The move does not bring an additional vehicle or staffing to Collier County. Rather, EMS officials moved an ambulance away from a station at Pelican Bay in North Naples, which previously had two. Now the Medic 1 station at Eighth Avenue South will have ambulances. "I'm just moving pieces around the checkerboard," said Jeff Page, chief of Collier EMS. Currently, Collier EMS runs 23 ambulances full-time in the 2,000-square-mile county, in addition to several part-time units. Page called the move a "temporary fix" in the middle of ongoing talks between county and Naples city officials. Meanwhile, the city continues to explore long-term solutions to its EMS concerns. Finlay said that exploration could include the city seeking to establish its own ambulance service or, as Page has suggested, adding a unit staffed with one Naples firefighter-paramedic and one EMS personnel. So far, Finlay said, he has been pleased with how the Collier County government has initiated changes since reports of slow ambulance response times have arisen. "They have been very responsive to our concerns," he said. Two weeks ago, County Medical Director Dr. Robert Tober ordered a change in EMS protocol aimed at promoting faster response times. He suspended a previous rule that EMS vehicle travel without lights and sirens when responding to low priority medical calls. Tober has also called for greater communication between first responding agencies (fire departments, county EMS and law enforcement) and a standardization on how each agency responds. Tober will offer his recommendations to the Collier County Commission at the regularly scheduled meeting Tuesday, April 26. This item is scheduled to be discussed around 1 p.m. Packet Page -31- unannrnanlocnrnc ',"'IJ Collier County EMS adds another arnou ante in Naples in effort to decrease arrival tuns Naples Daily,N, 3/12/2013 6.C. Connect with Aaron Hale at http:/!www.naplesnews.com/staff/aaron-hale gimp 2013 Scripps New spaper Group—Online iI II Packet Page-32- vwwv.naolesnewscun no,e�r)mv,.,.,o,; it __ _. vvrorig aooress leads to 13-minu!e response time to baby's drowning :Naples Daily Nev„ 3/12/2013 6.C. ` Read more a1 naplesnews corn Wrong address leads to 13-minute response time to baby's drowning Bs7 k, Cl F.: v GOLDEN GATE ESTATES— Sobbing as she attempted to revive her lifeless 15- month-old daughter Tuesday morning, Randi MacLeod waited for more than 13 minutes after calling 911 for the first Collier County sheriff's deputy to arrive at her home. The Sheriffs Office released a copy of the 911 call on Friday. It took Collier County EMS paramedics another nine minutes— 22 minutes after the initial 911 call —to arrive at the scene of the drowning, according to EMS records. But the Collier County Sheriffs Office said the reason for the delayed response was due to the 911 caller — presumably MacLeod, 25 — giving dispatchers the wrong address. She had only lived in the Golden Gate Estates home for less than a week. It took us about five minutes using the technology that we have to figure out the correct address," Sheriffs Office spokeswoman Michelle Batten said. A few minutes into the 911 call, dispatchers also lost their connection with MacLeod. "There's no way to tell if she lost service or if she hung up," Batten said. It took us seven phone calls to get her back on the line." Ave Grace Slaby, MacLeod's 15-month-old daughter. was pronounced dead shortly after paramedics arrived at a home at 4290 26th Ave. SE. the Sheriff's Office reported. The caller said the house was located at 9240 26th Ave. N.E.," Batten said. Dispatchers used mapping tools and databases to locate the correct home, the Sheriffs Office reported. The 911 call came in at 8:43 a.m. on Tuesday, and was dispatched at 8:49 a.m. Paramedics arrived on scene at 9:05 a.m. — 16 minutes after they were dispatched, said Collier County EMS Deputy Chief Wayne Watson. It is about a 12-mile drive between Collier County EMS' station near the intersection of Golden Gate Boulevard and 13th S,.' and MacLeod's home on 26th Packet Page-33- unwdnanl0cr$M r uninmee YJ^.l,r&-a A noh,, .. (I . uru;woaovs Growling •Naples Daily Nevus Avenue Southeast. 3/12/2013 6.C. "Preliminary, looking at it on a map, from where that station is to where the call is, it is an extensive distance," Watson said. Deputy Chief Dan Bowman, also with Collier EMS, said he just started reviewing the case. We understand that there was some sort of a delay associated with the call," Bowman said. "We are inquiring with the Sheriffs Office as to what exactly the issue was." When she called 911, a distraught MacLeod told dispatchers her daughter drowned, she wasn't breathing and her lips are blue." Incident reports have not detailed the cause of the drowning. However, family members have said Ava drowned in the bathtub after MacLeod left her alone to put food in her dog's bowl, check on something in the microwave, and grab a towel. When asked by the dispatcher if she had taken her daughter out of the tub, MacLeod said "Yes, I took her out." A couple of minutes into the call, a dispatcher starts giving MacLeod mouth-to-mouth resuscitation instructions. About 30 seconds later dispatchers lose their connection with MacLeod, and don't get her back on the phone for more than two minutes. They began cardiopulmonary resuscitation instructions about six minutes after receiving MacLeod's 911 call. "When I did the CPR thing to her; she's making this weird noise," MacLeod said. A dog can be heard barking in the background about 13 minutes and 20 seconds into the call, as Deputy Patti Villa arrived on scene. The Sheriffs Office is continuing its investigation into the drowning death. The Collier County Medical Examiner's Office will determine cause of death for Ava Grace Slaby, born Nov. 3, 2009. The Sheriff's Office will determine criminal culpability, if any. _Connect with Ryan Mills at www.naplesnews.com/staffiryan-mills/ MP ©2013 Scripps Newspaper Group—Online www.napiesnevt.comhnews/2011/feb!18/b a by-dr ovvni ng-911-wrong-addr€Packet Page-34- mar;a- oilier EMS told to run with ftgh!s and sirens after slow Naples call responses Naples Dal ly News 3/12/2013 6.C. n ►n 1 `corn Read more at napiesnews cons Collier EMS told to run with lights and sirens after slow Naples call responses B. AARON HALE Friday e;.i"r,l a. K11 NAPLES — Following reports of some 15- to 20-minute ambulance response times for Naples emergencies, officials from Collier County and Naples have been scrambling to find solutions. Their aim has been to stanch the loss of precious minutes during responses to medical emergencies —a time when those minutes can be the difference between life and death. For now, Collier County EMS Chief Jeff Page and Naples Fire Chief Steve Mclnerny have worked out some short-term fixes to address concerns in Naples. And Collier Emergency Medical Director Dr. Robert Tober this week initiated changes in countywide response protocol. The changes for now amount to placing a Band-Aid on the problem, but will involve sending ambulances to calls more often with lights and sirens blazing. Page, Mclnerny and Tober all concede there are long-term issues that still require work with multiple agencies to ensure first-response times don't start hemorrhaging minutes once again. When a restaurant patron passed out with difficulty breathing at Ridgway Bar and Grill on Third Street South at lunch hour on March 28, an employee called 911. It took a Naples fire engine, staffed with a paramedic, five minutes to arrive on scene. The 84-year-old man was suffering from low blood pressure, coming in and out of consciousness and vomiting, according to correspondence between city and county officials. It took the Collier County EMS ambulance 21 minutes to get to the patient. Dan Bowman, deputy chief of Collier EMS, reported that the Collier County Sheriff's Office dispatch center sent the ambulance five minutes after the Naples dispatch center sent the city's fire engine. A dropped call between the two dispatch centers lengthened the response. Bowman also reported that heavy congestion slowed the ambulance and that paramedics were given the incorrec Packet Page -35-e "Rita Way Bar." ,s Collier EMS told to run with l'9 3/12/2013 6.C. h ts and sirens after slow Naples cal.responses Naples Daily News Paramedics finally were guided to the correct location by a bystander. Reports suggest that Naples firefighters didn't directly communicate with the ambulance to address the severity of the emergency. The 21-minute response came less than two weeks after it took a county ambulance 16 minutes to respond to a medical call in Naples that ended with a fatal heart attack. In that response, paramedics initially went to the wrong part of a street that is divided by Goodlette-Frank Road. Last week, Naples City Councilman Doug Finlay told the Daily News that he would explore the idea of creating a separate city ambulance service due to a troubling pattern with at least four late county ambulance responses in three months. Tober, the medical director for the county's ambulance service, responded to concerns this week by temporarily halting aspects of the county's medical response protocol. Recent incidents of delayed ambulance response were from calls coded "alpha," or non-urgent medical calls by dispatch officers with the Collier County Sheriff's Office. On alpha calls, Collier ambulances don't respond "hot" — using lights and sirens at intersections — but instead go "cold," or roll with traffic. EMS officials have argued that lights and sirens can endanger other drivers and its not worth the risk on minor calls such as sprains or dizziness. But last week, Mclnerny criticized the "alpha" code response protocol for not giving patients the best response available. "What happened to erring on the side of the patient and ensuring that you have done everything within your power to provide outstanding medical treatment and transport to the closest appropriate facility?" Mclnerny asked in an email to county officials. Tober reversed his past position this week by temporarily suspending "cold" runs to minor calls, according to a letter he sent to the Collier County Commission. Tober said there needs to be a review to ensure calls are correctly coded. In a meeting Wednesday, Page and Mclnerny also addressed challenges that arise from the agencies using separate dispatch centers for the same emergency calls. The Sheriff's Office provides dispatch service to all first-response agencies in the county except for Naples municipal agencies, which are directed by a city of Naples dispatch center. Tober explained that when 911 calls are placed in the city of Naples, the city's dispatch first receives the call. The dispatcher immediately gets the address of the emergency and notifies the appropriate city agency—which in the case of medical emergencies are the Naples advanced life ci,rinnrt fire engines. Packet Page -36- Collier EMS told to run with lights and sirens after slow Naples call responses:Naples Daily News 3/12/2013 6.C. Those firefighters immediately respond with lights and sirens to the address, Tober said. In the meantime, the caller is transferred to the Sheriffs Office dispatch center. A dispatch officer retrieves details of the emergency from the caller before coding the call's priority (alpha, beta, Charlie, delta and echo) and dispatching an ambulance. Sheriff's Capt. Roy Arigo, a supervisor for the dispatch center, said calls are coded based on caller response to questions. The answers are entered into a software program that uses an algorithm for coding. Tober said this process sometimes can take as many as five minutes. In response, Page announced the county would install Naples dispatch radios in the Naples EMS stations. The move ensures that county EMS paramedics will get emergency call information at the same time Naples firefighters do. In addition to the immediate changes, Tober also has suggested-the dispatch center send ambulances first, and ask questions about coding later. The medical director is calling for better communication between agencies countywide and a standardization in how each agency responds. In his letter to commissioners, Tober wrote, "It is imperative that all agencies within the county are singing to the same hymn book and set of rules for consistency, safety and effectiveness." 2—War ©2013 Scripps Newspaper Group—Online Packet Page-37- www.naplesnews.rrmvnp„.rr7r,i r, rno, _. ___ __ , 214113 Slow EMS response to fatal heart attack call In Naples prompts poccyretiewrvLL y 3/12/2013 6.C. " uat Storm Shield .tee ann�fidv 111 having a sophisticated , 9P .weat#tie rradioonyairaPhone, , peSneW Lorn . SLOW EMS RESPONSE TO FATAL HEART ATTACK CALL IN NAPLES PROMPTS POLICY REVIEW POLL By AARON HALE Published Saturday,April 2,2011 Editor's note: The original story incorrectly estimated that the city of Naples pays $12.6 million in EMS fees to Collier County. City officials said the city pays about $2.6 million annually. The story has been corrected below. NAPLES _ In pre-hospital emergencies, professionals often say that "seconds count." But seconds turned into minutes in a fatal March 19 medical call, when a Collier County EMS ambulance crew arrived on scene nearly 15 minutes after the 911 call was placed and 10 minutes after Naples firefighters arrived. Collier County Emergency Medical Services officials deny the ambulance's response time directly led to the patient's death. Still, this case and other reports of delayed ambulance response times in the city of Naples are leading to questions on how ambulances are dispatched and the effectiveness of communication between the multiple agencies charged with responding to medical emergencies. • Policies for emergency response are under review and might be changed. "I worry that if these issues continue. a patient could directly and significantly suffer." wrote Dan Bowman, deputy chief of Collier EMS in a March 31 email to the head of county EMS. Jackie Dean of 13th Street North called 911 after her 82-year-old mother, Daisy May Cannon, complained of weakness and began vomiting on March 19. After Naples firefighters arrived first and took her mother's vital signs, Dean said she had to wait too long for an ambulance to arrive for hospital transport. The delayed response was due in part to the -alpha" or low-priority label given to the call, according to official reports. Ambulances don't respond "hot" with lights and sirens for alpha calls. To further complicate matters, the EMS ambulance, which left from a station neighboring the Naples fire truck, initially went to the wrong address, and ambulance personnel were unable to reach Naples firefighters by radio to clarify directions. according to an EMS report. Thirteenth Street North is split. One portion is west of Goodlette-F rank Road, but that segment doesn't Packet Page-38- 1;4 2/14/13 Slow EMS response to fatal heart attack cal!in Naples prompts policy review POLL»Naples Daily News Mobil 3/12/2013 6.C. intersect with Goodlette-F rank Road. The other portion is east of Goodlette-Frank. According w use report, one paramedic thought he knew where the call was coming from and directed the driver to the wrong portion of 13th Street North. ,0""`, After the ambulance finally arrived, the patient was loaded onto a stretcher. According to reports, Cannon went into cardiac arrest while being transporting to the hospital. She later died. Bowman said initial reports reveal the patient didn't display "serious medical problems' until she was in the ambulance. He also said pending a quality assurance investigation into the matter, there is no evidence to suggest the delayed ambulance response time contributed to the patient's death. Dean, still angry Friday over the delayed response, said her mother actually may have "died from fright." She explained that her mother was scared of the medical personnel on scene and panicked as she was strapped into the stretcher. However, Bowman admitted the issues of the ambulance going to the wrong place and the lack of communication between agencies are concerning. The paramedic who directed the ambulance driver to the wrong location was disciplined by the agency. * * ** * Doug Finlay, a Naples councilman, said that by his count there are at least four instances, including the March 19 call, of slow EMS arrivals in the city. He pointed to a similar nonfatal case on March 28 at a Third Street South restaurant. In that call, a patron was suffering from dizziness, was in and out of consciousness, and vomiting, according to city emails. Although Naples firefighters arrived five minutes after the initial 911 call, an apparent miscommunication between dispatch and EMS led to an ambulance arriving 21 minutes after the call, Naples Fire Chief Steve Mclnerny said. "This entire medical episode took place in front of a very busy lunch hour crowd. employees and manager," Mclnerny wrote in an email to EMS Chief Jeff Page. "It appears we have a real problem," Finlay said. Finlay's chief complaints are the prioritization of medical calls and the frequency of ambulances "getting lost" on emergency calls. Collier County emergency personnel operate on a two-tiered structure. which is designed for firefighters or law enforcement to arrive first on scene to a medical emergency, with EMS paramedics following behind in more severe cases. Packet Page-39- 214/13 Slow EMS response to fatal heart attack call in Naples prompts poiicyreaewP0LL Naples Daily News Mobil 3/12/2013 6.C. As part of the tiered emergency response system, medical calls are prioritized by urgency by olspatcn officers at either the Collier County Sheriffs Office or Naples Police Department. Bowman explained that it would be inefficient and too expensive to have an ambulance arrive to even the most minor medical calls. For priority calls, Bowman explained, ambulances go "hot" — meaning drivers fire up the lights and sirens and take the right of way at intersections. On alpha calls, however, ambulances travel without emergency lights and are available to respond to other medical emergencies. They may not even arrive on scene if first responders can handle the call. "This policy is widely utilized throughout the EMS industry in order to decrease the risk to the responders and (the) public from ambulances that are unnecessarily spreading through traffic and intersections," Bowman explained. Prioritization also leaves ambulances available to respond to more severe calls However, Mclnerny said. there is some failure of under-prioritizing calls. This call was a priority," Mclnerny said of the Cannon call. "This taxpayer, this resident, deserved a better response." Bowman defended the protocol and his EMS personnel. He pointed out that Naples firefighters didn't directly communicate via radio to EMS staff in either case, making it more difficult for them to know the severity of the case. Bowman suggested that instead of changing the entire system, officials need to re-examine how calls are deemed low priority. He said first responders also need to communicate directly with ambulance units if a call is more severe than initially diagnosed. Mclnerny, who insisted there is a good relationship between EMS and the Naples fire department, said there is room for both agencies to improve communication. Bowman said that while EMS officials are reviewing the concerns in Naples, they may decide to temporarily drop alpha call protocol and go "hot" to all medical calls. Meanwhile, Finlay said he just wants to see an end to the string of delayed responses. He estimated the city pays the county $2.6 million annually for ambulance service. "I do think for all the money we send to (Collier) EMS, the Naples residents should get more than what we seem to be getting in return," Finlay said. He added that he is taking steps to explore the idea of implementing a city-run ambulance service, but is still in the beginning stages of that exploration. Connect with Aaron Hale at http:iiwrw.naps/esnews.com,''staff.aaron-hale post lz tweet email Packet Page -40- rn nanincfID.,c nnmna+.c")M 1 far,R17:irrJiinr_n,n_r_ar..nncya.<v,_....n..r..__,..-...,.,n..ry oc.Tr.ha, Zr,; 2/34/13 Slow EMS response to fatal heart attack call in Naples prompts policy review POLL»Naples Daily News Mobil, 3/12/2013 6.C. 67 COMMENTS Collier ready to try out new guidelines for sending out EMS, fire units Published Aug 28,2011 Collier EMS, Naples leaders make progress in improving communication Published May 11,2011 Web: Check out the City of Naples" Web site Collier County Emergency Medical Services Web site Chase bank program helps Collier wounded soldier own first home mortgage-free Published 5 a.m. Utilities, again — Marco Island City Council workshop delves into water and sewer issues Published 1:12 p.m. Search) 1c, full riR kto;: Scripps Interactive Newspaper Gro p: 1.2013 The E.W. Scripps Cc. Packet Page-41- m nanips nPWC np 17(111ian. r,.:..... . . 14/1J Woman ejected during Collier ambulance trip sues county:Naples Daily News 3/12/2013 6.C. COM Road more at napiesnews corn Woman ejected during Collier ambulance trip sues county 5unc;r : t0,1y '? ,'CO? An Immokalee teenager ejected from an ambulance while en route to a Naples hospital to deliver a baby in 2004 is suing Collier County, the driver and the ambulance manufacturers over permanent injuries she blames on speeding and a faulty stretcher restraint system. Darling Elie, now 20, filed her lawsuit this month in Collier Circuit Court, listing as defendants: Collier County government, county Emergency Medical Services driver Bernice Forester, and the manufacturers of the 1999 Freightliner vehicle and restraint system — Freightliner LLC, American LaFrance LLC, and DaimlerChrysler Corp. Faulty restraint systems and driver training have been blamed for deaths and injuries in ambulance crashes nationwide. In 2001, an 11-year study of fatal ambulance crashes determined that the most serious and fatal injuries occurred during emergencies and involved rear passengers and improperly restrained occupants. Settlements in such cases nationally have reached at least $3.6 million. Elie's attorney, William Ponsoldt Jr. of Stuart, couldn't be reached for comment. Assistant Collier County Attorney William Mountford said the county was served with the lawsuit last week, but will dispute whether Elie suffered permanent back injuries. "Collier County is subject to sovereign immunity," Mountford added. Because the county government has sovereign immunity protection, the laws says the maximum amount Elie can receive is $200,000, unless a jury awards a higher amount and the state Legislature approves a larger award. That would only occur if Elie pursued a "claims bill" v ith the Legislature, which a legislative member would have to file. An accident report by the Collier County Sheriff's Office shows Forester, 41, a county Emergency Medical Services employee, was westbound on rain-slicked lmmokalee Road, with lights and sirens activated, at 11:55 p.m. Oct. 11, 2004, heading to Naples Community Hospital, now called NCH Do',nmtov^rn Naples Hospital. As she drove through a large puddi �� Packet Page -42- began to hydroplane, prompting wowr.naclesnews Li I4!1.3 woman ejected during Collier ambulance trip sues county Nap=es Dally News 3/12/2013 6.C. Forester to try to steer out of the spin. The report says the front tires caught the right side of the road and the ambulance traveled off the north shoulder as Forester steered back onto the roadway. The ambulance began turning sideways, the report says, and when its tires slid in the soft ground, the ambulance overturned, rolling 11/2 times and ejecting Elie, and paramedic Manuel Morales, 29, of Naples, who was sitting in the front passenger seat. Another man, Jean Bazile, 21, of Naples, a friend of Elie's, wasn't ejected. The report says road conditions were wet and that area wasn't well-lit. The ambulance was totaled. Elie was flown to Fort Myers to Lee Memorial Hospital and delivered her baby boy, Jadarrien, who wasn't injured. Elie then remained there for rehabilitation. Morales also was flown to Lee Memorial and treated for his injuries, while Bazile, who suffered minor injuries, was treated and released from the Naples hospital. Forester wasn't issued a citation. County court records show she has a clean driving record. She no longer works for Collier County EMS, an employee said, declining to release information about when or why she left. Elie's lawsuit alleges that Collier County was negligent and is responsible for Forester's actions, which caused Elie and her baby to suffer injuries, pain, suffering, disability, disfigurement, mental anguish, and loss of enjoyment for life. The lawsuit says she had to pay hospitalization, nursing care, and medical expenses due to the crash. Elie, a Burger King employee at the time, also suffered a loss of earnings and ability to earn money, the suit says. The suit contends Forester was grossly negligent and reckless, ignoring road and weather conditions, and also seeks a "filial consortium" claim— damages for her son —against all defendants, alleging her son will suffer from the loss of her companionship and services in the future and has in the past. The product liability claim involving the ambulance manufacturers alleges that the stretcher restraint system was defective and unreasonably dangerous and fails to protect patients in crashes "given the high rates of speed that ambulances travel." American La-France LLC, founded in 1873, is one of the nation's oldest emergency vehicle manufacturers. In 1995 it was purchased by Freightliner LLC, a subsidiary of DaimlerChrysler, which transferred ownership to a New York company two years ago. In 2002, a 38-year-old Illinois man who suffered a skull fracture that caused brain injuries settled for S3.2 million with the ambulance company and manufacturers. according to statistics by Jury Verdict Research in Horsham, Pa. His lawsuit alleged that the ambulance cot wasn't properly secured and it dislodged while he was on it. Jury Verdict Research data shows relatives of a 59-year-old Hawaii man, a paraplegic who died after a crash, settled a lawsuit for $3.6 million in 1997, with most of it paid by Packet Page -43- vw.w.nap]es news.comn�n� rxi:,,a 177h.(mo.. a .._:.-- iw i� Woman ejected during Collier ambulance trip sues county:Naples Daily News 3/12/2013 6.C. a city. His lawsuit said he wasn't properly restrained and suffered spinal cord injuries. Neither case involves the manufacturers in Elie's lawsuit. Centers for Disease Control and Prevention statistics show that from 1991 to 2000, 300 crashes occurred involving occupied ambulances. The National Institute for Occupational Safety and Health initiated a study in 2004 due to the high number of fatalities and injuries and because ambulance patient compartments are one of the few passenger areas exempted from certain safety standards and not subject to crash tests. The institute's fatality database was set up to study why accidents occurred and to determine preventative measures for drivers and manufacturers. In January 2002, a month after a $655,000 wrongful-death settlement involving a 1998 fatal crash caused by a speeding county ambulance, commissioners in Delaware County, Ohio, voted to limit ambulances from speeding during emergencies —except for a 22-mile stretch of highway where drivers would be allowed to exceed the limit by 10 mph. That limit is common among many fire departments and ambulance services. But two months later, after paramedics complained that it slowed average response time by one minute, 13 seconds, commissioners revoked the policy, allowing drivers to determine how fast they should drive considering traffic and road conditions. Collier County EMS does have guidelines involving speeding — taking into account factors that include weather conditions and traffic— but specifics were not immediately available. @air- ©2013 Scripps Newspaper Group—Online Packet Page-44- www.naolesnev„s rnm-na. r,nm . . , . 214113 Deadly delay?Friend questions what could hake saoea man wno oleo d,u s du kJ..n.o v.." ""r""'..•■.,•—... 3/12/2013 6.C... : h �1 i € Rt,,,2d n'' a:naFtr_ :it r;S corn, 1,,' ',': a Deadly delay? Friend questions what could have saved man who died after ambulance wait By KELLY FARRELL. LIZ FREEMAN ,, „r;:tn'F C,ctoner 17 331 1 Bob Rowe doesn't know what more he could have done to save his friend's life. Paul Anderson, 80, died earlier this month after suffering a stroke inside his Marco Island home. But it was the 40-minute wait for an ambulance, after Rowe dropped Anderson off at Marco Island Urgent Care, that has Rowe questioning if his friend died due to squabbles between NCH Healthcare System and Collier County EMS. "I was all that he had, and I let him down," Rowe said. Rowe said he got a call from Anderson, a seasonal resident. just before 8 a.m. on Oct. 2. Anderson told him he was dizzy and didn't feel well. Rowe dropped off Anderson at Marco Island Urgent Care sometime after 8:30 a.m. Over the next 40 minutes, at least three EMS ambulances were called to the scene and then canceled. 911 recordings indicate that at least one Collier dispatcher believed NCH would transport Anderson to the hospital. Two other recordings indicated EMS would handle the transport. As he waited, Anderson's condition deteriorated into unconsciousness. "I believe in my heart of hearts it cost the man his life," Rowe said of the delay. Rowe is digging for answers about whether NCH Healthcare System's reported unpaid bills to Collier County EMS, policy disputes about transporting NCH patients from one hospital to another, poor communication to ambulance drivers and a late driver that day may have led to Anderson's death. If I had called 911 instead of taking him to Marco Island Urgent Care, he would still be . alive," Rowe said. At about 8:45 a.m. Rowe ran across the street to a Marco Island fire station looking for an ambulance to take Anderson to the nearest hospital in Naples. At the same time Marco Island Fire Rescue Deputy Chief Chris Byrne reported that dispatch requested transport of Anderson from Marco Urgent Care to NCH Downtown Naples Hospital. Packet Page -45- _.. ,a__ai..� i ..(. ..a 4,� . d�_ti�.c:_rna;7nr,ntoI 1f( 2/14/13 Deadly deiayo Friend q uestiuns vain;could have sawed man wno oleo attar a}ru,ulot■t.r vv.t A rescue unit responded. but was immediately canceled, Byrne reported. It was n( 3/12/2013 6.C. stated in Byrne's report or discussed in dispatch recordings why the ambulance was canceled, but another EMS unit was then dispatched several minutes later, at 9:19 a.m. MedFlight was also on standby and, according to county records, another EMS unit from Isles of Capri was dispatched. All the while, an ambulance, normally operated by NCH beginning at 9 a.m., sat without a driver in front of Marco Island Urgent Care. That NCH driver finally arrived, and, according to Rowe, was not only late but seemed to have little care for Anderson. She (the NCH driver) sashayed across the parking lot at 9:22 a.m ... getting her snacks together," Rowe recalled. Rowe told the arriving driver his friend really needed her help. He was dying. "She told me to back off or she wouldn't be taking anyone, anywhere." When the Isles of Capri ambulance arrived, the NCH ambulance was already leaving with Anderson, records said. Anderson died the next day. His family flew his body home to Minnesota, and is continuing to learn what happened. Rowe said he isn't vindictive, but he said he isn't going to let this issue die. "My passion is my dedication to my friend," he said. "At the very least, no one will die at the hands of the incompetent fools that managed (Anderson's) life so poorly." In a prepared statement, NCH spokeswoman Debbie Curry said the hospital considers all lives precious, and extends its sympathy to Anderson's family. "We are currently reviewing every aspect of this matter to determine what can be done to continue to ensure excellent care is provided at all times," she said in the statement. Questions about the ambulance response to the Marco center coincides with a county decision to stop helping NCH when patients need to be transported from one hospital to another, effective Oct. 1. That new policy did not affect how EMS handled the 911 call to the Marco center, county spokesman John Torre said. EMS interim operations chief Walter Kopka spoke twice to NCH's transport manager and was told NCH's ambulance would take the patient to the hospital, Torre said. The hospital system has had a limited ambulance license since 2004 for transferring Packet Page-46- ._..__. 2)14/13 Deadly delay?Friend questions what caula haw saved man' no oleo alter arrlUUrdlnl o wdn•"•dpw ' 'r^�•^ 3/12/2013 6.C. patients from one NCH hospital, including the Marco center, to another NCH hospi EMS would help out when asked by the hospital. "I can only presume if NCH wasn't handling it, EMS would have been there in a matter of minutes," Torre said. The dispute over "intra-facility" trips arose when NCH stopped paying for the help. NCH owes the county $178,742 from July 2010 to the present. County Manager Leo Ochs made the decision, with EMS, after meetings with NCH to try and solve the billing dispute. "Their lawyers have said that the county should be billing Medicare, Medicaid or the patient (instead of the county)," Torre said. Och informed Dr. Allen Weiss, president and chief executive officer of NCH, of his decision in a Sept. 9. letter. Ochs' letter said the county had been agreeable in the past to providing occasional assistance as long as NCH paid. A county resolution passed in 2008 says hospitals that request ambulance service from EMS will be billed on a monthly basis. "We regret being forced into this action, but we regret even more having to use public tax dollars to subsidize these transports," Ochs wrote to Weiss. So far, the county has turned over to an outside collection agency $138,606 that NCH owes, Ochs said in a Sept. 14 email to county commissioners. Weiss could not be reached for comment. Anderson's only local family member, grandson David Anderson, 30, of Goodland, described his grandfather as an active 80-year-old. David had cooked his grandfather's dinners the last four nights of his life. Paul Anderson frequently went fishing and played golf, family members said. He had just bought a new laptop to take classes in Naples. "He had 10 years left in him, or at least he thought he did," said Kathy Rauth, one of Paul Anderson's four surviving children. "Someone has to tell us what happened and why," she said. "We're not litigious people. but someone has to tell us what the hell happened. What if this was an 11- year-old or a 16-year-old hit by a car?" "And tc hear that it was a squabble over money between these two entities (EMS and NCH)," Rauth said. "Let's get them to talk." NCH is not alone in owing money to the county; Physicians Regional Healthcare System owes $431,853 for ambulance service between its hospitals at Pine Ridge and Collier Boulevard, Ochs' email told commissioners Packet Page -47- uw.vnaniPCna aiav-irienn- cnun-na SAW>>nrirt=1 3t4 2/14/13 a Deadly delay?Friend questions wt-:at could have saved man who died alter ambulance wait.Naples uaioy[New 3/12/2013 6.C. Physicians Regional paid invoices from January 2010 to June 2010 totaling $313,1..., ., then stopped paying until August 2011 when it made two payments of $12,500, the email said. Physicians Regional has not received a letter that the county would stop transports from one hospital to another. spokeswoman Taylor Hamilton said. "Our leadership received a letter from the County last month expressing concerns related to intra-facility transports," Taylor said in an email. "Since that time, we have spent many hours in productive conversations with the Collier County administrators and remain hopeful that a positive resolution is imminent." rn ©2013 Scripps Newspaper Group—Online mill■-"11111 Packet Page -48- IAMA rnanlFcnews rrvrunevFt711111rrt/13iriear+.luri F4air frienri-r; un_rta sacvi7nrint=1 4/4 Cltb/1 J Collier EMT arrested for stealing from Walmart-WFTX-Tv Fort Myers/Naples,FL 3/12/2013 6.C. r'r PRINTTHIS Collier EMT arrested for stealing from Walmart By Matt Grant CREATED FEB.25,2013 NAPLES, Fla.-ACollier County paramedic has been arrested for stealing items at Walmart. According to the Collier County Sheriffs Office, Serina Krauss,43,was arrested Sunday for stealing $46 worth of makeup and hair products from a Walmart on Collier Boulevard. The arrest report says Krauss slipped the items in her purse. She was arrested charged with retail theft.She was released on a $2000 bond. Fox4 reached out to Collier County for comment.Aspokesman for the city manager tells us, in part: "Al county employees are required to conduct themselves in a lawful and proper manner both on and off the job.The allegation involving an off-duty county employee is being reviewed and will be addressed consistent with county policy." The county would not say if Krauss will be suspended or fired. Matt Grant mgrant @fox4now.com Find this article at: http://w w w if ox4now.convnew stlocal/193186581.htrri Check the box to include the list of links referenced in the article. Packet Page-49- wwvw.prinths.clickahilitvcn ice± .�o ,. _o.:.__� , .- 3/12/2013 6.C. NAPLES, Fla. - A Fox 4 investigation into the death of a Collier County man uncovered documents showing emergency officials failed to follow proper procedures. Sixteen days after we began asking questions on behalf of the Minard family after their son died in December, Collier County EMS officials are finally breaking their silence. A Fox 4 investigation discovered an ambulance crew waited 5-6 minutes after being dispatched before leaving the station. Documents show the county didn't follow proper procedure and there are ongoing prolUie dispatch system meant to save your life. Collier County EMS quietly wrapped up its internal investigation into what happened. But they don't want you to know what they found claiming the report can stay secret under Florida law. But we got our hands on documents showing repeated problems with the radio system that EMT's didn't appear to be listening to in the first place. "Do you think if the ambulance would have got here quicker that your son's life could have been saved?," asked Fox 4 reporter Matt Grant. "Yeah I believe so," said Charles Minard. "Maybe he wouldn't be 100 percent but I believe he would be here." Minard was promised answers after his son died last December. But nearly two months later the Minard's are in the dark so we did our own digging. Fox 4 discovered a series of failures resulted in medic crews not leaving the station until 5-6 minutes after they were dispatched. Medic Station 42, which is 3.5 miles away from the Minard's home, was dispatched at 11:04 a.m. on Dec. 14. But EMT's never got the call. According to documents we obtained through a public records request the "station received no (radio) tones...and no information" through their handheld tablets. Documents show the crew also might not have been paying attention because they were "in separate areas of the station cleaning and running the vacuum." Packet Page-50- 3/12/2013 6.C. In one email, a battalion chief writes: "Medic 42 did not respond on the radio for the dispatch. I contacted them via...phone to notify them of them of the emergency call." According to the county's handbook, a follow up call is required to be made "within two minutes" if an ambulance crew doesn't respond to dispatch. But we discovered the county didn't follow its own procedures - waiting four minutes - to check in after the crew failed to respond. And we discovered problems with ambulance crews receiving radio dispatches occurred on Dec. 12, two days before the Minard's called 911. We discovered there were also problems reported with radio tones on Feb. 3. Four different medic stations reported problems with their radios and at least three had to be notified of emergencies by landline. In a statement, Collier County EMS finally responded to our investigation telling us they are "conducting a thorough review of the events" and are "committed to maintaining a system that is focused on safe, efficient and quality care." But that's not good enough for the Minard's who say it shouldn't take Fox 4 making public records requests for their family to find answers. "I still don't have any answers," said Minard. "I have a dead son and no answers." Matt Grant mgrant @fox4now.com Packet Page-51- 2^''i3 . � Statutes constItato, View Statutes Our:neS,nshrne 3/12/2013 6.C. Select Year: 2012 : Go The 2012 Florida Statutes Title XLV Chapter 768 View Entire Chapter TORTS NEGLIGENCE 768.28 Waiver of sovereign immunity in tort actions; recovery limits; limitation on attorney fees; statute of limitations; exclusions; indemnification; risk management programs.— (1) In accordance with s. 13, Art. X of the State Constitution, the state, for itself and for its agencies or subdivisions, hereby waives sovereign immunity for liability for torts, but only to the extent specified in this act. Actions at law against the state or any of its agencies or subdivisions to recover damages in tort for money damages against the state or its agencies or subdivisions for injury or loss of property, personal injury, or death caused by the negligent or wrongful act or omission of any employee of the agency or subdivision while acting within the scope of the employee's office or employment under circumstances in which the state or such agency or subdivision, if a private person, would be liable to the claimant, in accordance with the general laws of this state, may be prosecuted subject to the limitations specified in this act. Any such action may be brought in the county where the property in litigation is located or, if the affected agency or subdivision has an office in such county for the transaction of its customary business, where the cause of action accrued. However, any such action against a state university board of trustees shall be brought in the county in which that university's main campus is located or in the county in which the cause of action accrued if the university maintains therein a substantial presence for the transaction of its customary business. (2) As used in this act, "state agencies or subdivisions" include the executive departments, the Legislature, the judicial branch (including public defenders), and the independent establishments of the state, including state university boards of trustees; counties and municipalities; and corporations primarily acting as instrumentalities or agencies of the state, counties, or municipalities, including the Florida Space Authority. (3) Except for a municipality and the Florida Space Authority, the affected agency or subdivision may, at its discretion, request the assistance of the Department of Financial Services in the consideration, adjustment, and settlement of any claim under this act. (4) Subject to the provisions of this section, any state agency or subdivision shall have the right to appeal any award, compromise, settlement, or determination to the court of appropriate jurisdiction. (5) The state and its agencies and subdivisions shall be liable for tort claims in the same manner and to the same extent as a private individual under like circumstances, but liability shall not include punitive damages or interest for the period before judgment. Neither the state nor its agencies or subdivisions shall be liable to pay a claim or a judgment by any one person which exceeds the sum of S200,000 or any claim or judgment, or portions thereof, which, when totaled with all other claims or judgments paid by the state or its agencies or subdivisions arising out of the same incident or occurrence, exceeds the sum of $300,000. However, a judgment or judgments may be claimed and rendered in excess of these amounts and may be settled and paid pursuant to this act up to $200,000 or $300,000, as the case may be; and that portion of the judgment that exceeds these amounts may be reported to the Legislature, but may be paid in part or in whole only by further act of the Legislature. Notwithsta-"`- waiver of sovereign, immunity provided www.lea.state usistatt tftGllnfloX fm7Qnn mvia=rlicn au eta,rto£�o,. ;Packet Page -52- ..�.,..-r --„non n�nn�n�ao;c..,..:...__,..nvr.e nn�.__, statutes t,onsutution view Statutes:()nine 5t,nsn ne 3/12/2013 6.C. herein, the state or an agency or subdivision thereof may agree, within the limits of insurance coverage provided, to settle a claim made or a judgment rendered against it without further action by the Legislature, but the state or agency or subdivision thereof shall not be deemed to have waived any defense of sovereign immunity or to have increased the limits of its liability as a result of its obtaining insurance coverage for tortious acts in excess of the $200,000 or $300,000 waiver provided above. The limitations of liability set forth in this subsection shall apply to the state and its agencies and subdivisions whether or not the state or its agencies or subdivisions possessed sovereign immunity before July 1, 1974. (6)(a) An action may not be instituted on a claim against the state or one of its agencies or subdivisions unless the claimant presents the claim in writing to the appropriate agency, and also, except as to any claim against a municipality or the Florida Space Authority, presents such claim in writing to the Department of Financial Services, within 3 years after such claim accrues and the Department of Financial Services or the appropriate agency denies the claim in writing; except that, if: 1. Such claim is for contribution pursuant to s. 768.31, it must be so presented within 6 months after the judgment against the tortfeasor seeking contribution has become final by lapse of time for appeal or after appellate review or, if there is no such judgment, within 6 months after the tortfeasor seeking contribution has either discharged the common liability by payment or agreed, while the action is pending against her or him, to discharge the common liability; or 2. Such action is for wrongful death, the claimant must present the claim in writing to the Department of Financial Services within 2 years after the claim accrues. (b) For purposes of this section, the requirements of notice to the agency and denial of the claim pursuant to paragraph (a) are conditions precedent to maintaining an action but shall not be deemed to be elements of the cause of action and shall not affect the date on which the cause of action accrues. (c) The claimant shall also provide to the agency the claimant's date and place of birth and social security , . number if the claimant is an individual, or a federal identification number if the claimant is not an individual. The claimant shall also state the case style, tribunal, the nature and amount of all adjudicated penalties, fines, fees, victim restitution fund, and other judgments in excess of $200, whether imposed by a civil, criminal, or administrative tribunal, owed by the claimant to the state, its agency, officer or subdivision. If there exists no prior adjudicated unpaid claim in excess of $200, the claimant shall so state. (d) For purposes of this section, complete, accurate, and timely compliance with the requirements of paragraph (c) shall occur prior to settlement payment, close of discovery or commencement of trial, whichever is sooner; provided the ability to plead setoff is not precluded by the delay. This setoff shall apply only against that part of the settlement or judgment payable to the claimant, minus claimant's reasonable attorney's fees and costs. Incomplete or inaccurate disclosure of unpaid adjudicated claims due the state, its agency, officer, or subdivision, may be excused by the court upon a showing by the preponderance of the evidence of the claimant's lack of knowledge of an adjudicated claim and reasonable inquiry by, or on behalf of, the claimant to obtain the information from public records. Unless the appropriate agency had actual notice of the information required to be disclosed by paragraph (c) in time to assert a setoff, an unexcused failure to disclose shall, upon hearing and order of court, cause the claimant to be liable for double the original undisclosed judgment and, upon further motion, the court shall enter judgment for the agency in that amount. Except as provided otherwise in this subsection, the failure of the Department of Financial Services or the appropriate agency to make final disposition of a claim within 6 months after it is filed shall be deemed a final denial of the claim for purposes of this section. For purposes of this subsection, in medical malpractice actions and in wrongful death actions, the failure of the Department of Financial Services or the appropriate agency to make final disposition of a claim within 90 days after it is filed shall be deemed a final denial of the claim. The statute of limitations for medical malpractice actions and wrongful death actions is tolled for the Packet Page-53- www.Ieg.state.fl.usrstatutes;indexcfm7App_rxxie=Display_statute&st;,art > n7Fa=cam+ cIn7"�a hf,,, Jtatutes 6 GOnsututlon:view Jtatutes:vni',ne Junsntne 3/12/2013 period of time taken by the Department of Financial Services or the appropriate agency to deny tha He provisions of this subsection do not apply to such claims as may be asserted by counterclaim pursuant to s. 768.14. (7) in actions brought pursuant to this section, process shall be served upon the head of the agency concerned and also, except as to a defendant municipality or the Florida Space Authority, upon the Department of Financial Services; and the department or the agency concerned shalt have 30 days within •which to plead thereto. (8) No attorney may charge, demand, receive, or collect, for services rendered, fees in excess of 25 percent of any judgment or settlement. (9)(a) No officer, employee, or agent of the state or of any of its subdivisions shall be held personally liable in tort or named as a party defendant in any action for any injury or damage suffered as a result of any act, event, or omission of action in the scope of her or his employment or function, unless such officer, employee, or agent acted in bad faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety, or property. However, such officer, employee, or agent shall be considered an adverse witness in a tort action for any injury or damage suffered as a result of any act, event, or omission of action in the scope of her or his employment or function. The exclusive remedy for injury or damage suffered as a result of an act, event, or omission of an officer, employee, or agent of the state or any of its subdivisions or constitutional officers shall be by action against the governmental entity, or the head of such entity in her or his official capacity, or the constitutional officer of which the officer, employee, or agent is an employee, unless such act or omission was committed in bad faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety, or property. The state or its subdivisions shall riot be liable in tort for the acts or omissions of an officer, employee, or agent committed while acting outside the course and scope of her or his employment or committed in bad faith or with malicious purpose or in a manner exhibiting wanton and willful disregard of human rights, safety, or property. (b) As used in this subsection, the term: 1. "Employee" includes any volunteer firefighter. 2. "Officer, employee, or agent" includes, but is not limited to, any health care provider when providing services pursuant to s. 766.1115; any nonprofit independent college or university located and chartered in this state which owns or operates an accredited medical school, and its employees or agents, when providing patient services pursuant to paragraph (10)(f); and any public defender or her or his employee or agent, including, among others, an assistant public defender and an investigator. (c) For purposes of the waiver of sovereign immunity only, a member of the Florida National Guard is not acting within the scope of state employment when performing duty under the provisions of Title 10 or Title 32 of the United States Code or other applicable federal law; and neither the state nor any individual may be named in any action under this chapter arising from the performance of such federal duty. (d) The employing agency of a law enforcement officer as defined ins. 943.10 is not liable for injury, death, or property damage effected or caused by a person fleeing from a law enforcement officer in a motor vehicle if: 1. The pursuit is conducted in a manner that does not involve conduct by the officer which is so reckless or wanting in care as to constitute disregard of human life, human rights, safety, or the property of another; 2. At the time the taw enforcement officer initiates the pursuit, the officer reasonably believes that the person fleeing has committed a forcible felony as defined in s. 776.08; and 3. The pursuit is conducted by the officer pursuant to a written policy governing high-speed pursuit adopted by the employing agency. The policy must contain specific procedures concerning the proper method to initiate and terminate high-speed pursuit. The law enforcement officer must have received instructional W rwl egstate.8.usistatutes'inoey.cim? rnoce=D!solav Statute&S,�a�Packet Page 54-�70c �P._ .. ,,,,.., ,,., f=(7�f>A;,arhnns/O7RA7Rhfnof •in o:r,«,,m,a LA.)!raVttitl r v■ew�ru,uaes urvne au•snrne 3/12/2013 6.C. training from the employing agency on the written policy governing high-speed pursuit. (10)(a) Health care providers or vendors, or any of their employees or agents, that have contractually agreed to act as agents of the Department of Corrections to provide health care services to inmates of the state correctional system shall be considered agents of the State of Florida, Department of Corrections, for the purposes of this section, while acting within the scope of and pursuant to guidelines established in said contract or by rule. The contracts shall provide for the indemnification of the state by the agent for any liabilities incurred up to the limits set out in this chapter. (b) This subsection shall not be construed as designating persons providing contracted health care services to inmates as employees or agents of the state for the purposes of chapter 440. (c) For purposes of this section, regional poison control centers created in accordance with s. 395.1027 and coordinated and supervised under the Division of Children's Medical Services Prevention and Intervention of the Department of Health, or any of their employees or agents, shall be considered agents of the State of Florida, Department of Health. Any contracts with poison control centers must provide, to the extent permitted by taw, for the indemnification of the state by the agency for any liabilities incurred up to the limits set out in this chapter. (d) For the purposes of this section, operators, dispatchers, and providers of security for rail services and rail facility maintenance providers in the South Florida Rail Corridor, or any of their employees or agents, performing such services under contract with and on behalf of the South Florida Regional Transportation Authority or the Department of Transportation shall be considered agents of the state while acting within the scope of and pursuant to guidelines established in said contract or by rule. (e) For purposes of this section, a professional firm that provides monitoring and inspection services of the work required for state roadway, bridge, or other transportation facility construction projects, or any of the firm's employees performing such services, shall be considered agents of the Department of Transportation while acting within the scope of the firm's contract with the Department of Transportation to ensure that the project is constructed in conformity with the project's plans, specifications, and contract provisions. Any contract between the professional firm and the state, to the extent permitted by law, shall provide for the indemnification of the department for any liability, including reasonable attorney's fees, incurred up to the limits set out in this chapter to the extent caused by the negligence of the firm or its employees. This paragraph shalt not be construed as designating persons who provide monitoring and inspection services as employees or agents of the state for purposes of chapter 440. This paragraph is not applicable to the professional firm or its employees if involved in „n accident while operating a motor vehicle. This paragraph is not applicable to a firm engaged by the Department of Transportation for the design or construction of a state roadway, bridge, or other transportation facility construction project or to its employees, agents, or subcontractors. (f) For purposes of this section, any nonprofit independent college or university located and chartered in this state which owns or operates an accredited medical school, or any of its employees or agents, and which has agreed in an affiliation agreement or other contract to provide, or permit its employees or agents to provide, patient services as agents of a teaching hospital, is considered an agent of the teaching hospital white acting within the scope of and pursuant to guidelines established in the affiliation agreement or other contract. To the extent allowed by law, the contract must provide for the indemnification of the teaching hospital, up to the limits set out in this chapter, by the agent for any liability incurred which was caused by the negligence of the college or university or its employees or agents. The contract must also provide that those limited portions of the college, university, or medical school which are directly providing services pursuant to the contract and which are considered an agent of the teaching hospital for purposes of this section are deemed to be acting on behalf of a public agency as defined ins. 119.011(2). Packet Page-55- vm ieg.state.fl.us/statutesiindexcfm?App mode=Disolav Statute&Sear,,,, .,.,,.n,— ..n70xrm7RA,C4,r;r,.,exmaa�a�+ °1"° btatules s L.onst:tution:View Statutes:Online Sunshine 1. For purposes of this paragraph, the term: 3/12/2013 6.C. a. "Employee or agent" means an officer, employee, agent, or servant of a nonprofit independent college or university located and chartered in this state which owns or operates an accredited medical school, including, but not limited to, the faculty of the medical school, any health care practitioner or licensee as defined in s. 456.001 for which the college or university is vicariously liable, and the staff or administrators of the medical school. b. "Patient services" mean: (I) Comprehensive health care services as defined in s. 641.19, including any related administrative service, provided to patients in a teaching hospital; (II) Training and supervision of interns, residents, and fellows providing patient services in a teaching hospital; or (Ill) Training and supervision of medical students in a teaching hospital. c. "Teaching hospital" means a teaching hospital as defined in s. 408.07 which is owned or operated by the state, a county or municipality, a public health trust, a special taxing district, a governmental entity having health care responsibilities, or a not-for-profit entity that operates such facility as an agent of the state, or a political subdivision of the state, under a lease or other contract. 2. The teaching hospital or the medical school, or its employees or agents, must provide notice to each patient, or the patient's legal representative, that the college or university that owns or operates the medical school and the employees or agents of that college or university are acting as agents of the teaching hospital and that the exclusive remedy for injury or damage suffered as the result of any act or omission of the teaching hospital, the college or university that owns or operates the medical school, or the employees or agents of the college or university, while acting within the scope of duties pursuant to the affiliation agreement or other contract with a teaching hospital, is by commencement of an action pursuant to the provisions of this section. This notice requirement may be met by posting the notice in a place conspicuous to all persons. 3. This paragraph does not designate any employee providing contracted patient services in a teaching hospital as an employee or agent of the state for purposes of chapter 440. (11)(a) Providers or vendors, or any of their employees or agents, that have contractually agreed to act on behalf of the state as agents of the Department of Juvenile Justice to provide services to children in need of services, families in need of services, or juvenile offenders are, solely with respect to such services, agents of the state for purposes of this section while acting within the scope of and pursuant to guidelines established in the contract or by rule. A contract must provide for the indemnification of the state by the agent for any liabilities incurred up to the limits set out in this chapter. (b) This subsection does not designate a person who provides contracted services to juvenile offenders as an employee or agent of the state for purposes of chapter 440, (12)(a) A health care practitioner, as defined in s. 456.001(4), who has contractually agreed to act as an agent of a state university board of trustees to provide medical services to a student athlete for participation in or as a result of intercollegiate athletics, to include team practices, training, and competitions, shall be considered an agent of the respective state university board of trustees, for the purposes of this section, while acting within the scope of and pursuant to guidelines established in that contract. The contracts shall provide for the indemnification of the state by the agent for any liabilities incurred up to the limits set out in this chapter. (b) This subsection shall not be construed as designating persons providing contracted health care services to athletes as employees or agents of a state university board of trustees for the purposes of chapter 440. Packet Page -56- ww.ien.state.A,us/statuteslndyx rn A pp mode. Statut &Sep al .,,,,,,,,_ .. _ UtOWLCO a Ul LL10,_11 v.CW Vnt,ne aunsn!ne 3/12/2013 6.C. (13) Laws allowing the state or its agencies or subdivisions to buy insurance are still in force dl u errect and are not restricted in any way by the terms of this act. (14) Every claim against the state or one of its agencies or subdivisions for damages for a negligent or wrongful act or omission pursuant to this section shall be forever barred unless the civil action is commenced by filing a complaint in the court of appropriate jurisdiction within 4 years after such claim accrues; except that an action for contribution must be commenced within the limitations provided in s. 768.31(4), and an action for damages arising from medical malpractice or wrongful death must be commenced within the limitations for such actions in s. 95.11(4). (15) No action may be brought against the state or any of its agencies or subdivisions by anyone who unlawfully participates in a riot, unlawful assembly, public demonstration, mob violence, or civil disobedience if the claim arises out of such riot, unlawful assembly, public demonstration, mob violence, or civil disobedience, Nothing in this act shall abridge traditional immunities pertaining to statements made in court. (16)(a) The state and its agencies and subdivisions are authorized to be self-insured, to enter into risk management programs, or to purchase liability insurance for whatever coverage they may choose, or to have any combination thereof, in anticipation of any claim, judgment, and claims bill which they may be liable to pay pursuant to this section. Agencies or subdivisions, and sheriffs, that are subject to homogeneous risks may purchase insurance jointly or may join together as self-insurers to provide other means of protection against tort claims, any charter provisions or taws to the contrary notwithstanding, (b) Claims files maintained by any risk management program administered by the state, its agencies, and its subdivisions are confidential and exempt from the provisions of s. 119,07(1) and s. 24(a), Art. I of the State Constitution until termination of all litigation and settlement of all claims arising out of the same incident, although portions of the claims files may remain exempt, as otherwise provided by taw. Claims files records may be released to other governmental agencies upon written request and demonstration of need; such records held by the receiving agency remain confidential and exempt as provided for in this paragraph. (c) Portions of meetings and proceedings conducted pursuant to any risk management program administered by the state, its agencies, or its subdivisions, which relate solely to the evaluation of claims filed with the risk management program or which relate solely to offers of compromise of claims filed with the risk management program are exempt from the provisions of s. 286.011 and s. 24(b), Art. I of the State Constitution. Until termination of all litigation and settlement of all claims arising out of the same incident, persons privy to discussions pertinent to the evaluation of a filed claim shall not be subject to subpoena in any administrative or civil proceeding with regard to the content of those discussions. (d) Minutes of the meetings and proceedings of any risk management program administered by the state, its agencies, or its subdivisions, which relate solely to the evaluation of claims filed with the risk management program or which relate solely to offers of compromise of claims filed with the risk management program are exempt from the provisions of s. 119.07(1) and s. 24(a), Art. I of the State Constitution until termination of all litigation and settlement of all claims arising out of the same incident. (17) This section, as amended by chapter 81-317, Laws of Florida. shall apply only to causes of actions which accrue on or after October 1, 1981. (18) No provision of this section, or of any other section of the Florida Statutes, whether read separately or in conjunction with any other provision, shall be construed to waive the immunity of the state or any of its agencies from suit in federal court, as such immunity is guaranteed by the Eleventh Amendment to the Constitution of the United States, unless such waiver is explicitly and definitely stated to be a waiver of the Wit. immunity of the state and its agencies from suit in federal court. This subsection shall not be construed to mean that the state has at any time previously waived, by implication, its immunity, or that of any of its agencies, from suit in federal court through any statute in existence prior to June 24, 1984. Packet Page-57- vww.leg.state.ft.us?statutes/indexcfm?App_mode=Display Statute&Sears,., ,..,, _., ,_....w..#7acon7Ap' -t;nnc/n7Rft 7R r,...,1 .`R JtrswiGS o,L unsutunon view Jtatutes:Unbne Sunshine 3/12/2013 6.C. (19) Neither the state nor any agency or subdivision of the state waives any defense of sovereign immunity, or increases the limits of its liability, upon entering into a contractual relationship with another agency or subdivision of the state. Such a contract must not contain any provision that requires one party to indemnify or insure the other party for the other party's negligence or to assume any liability for the other party's negligence. This does not preclude a party from requiring a nongovernmental entity to provide such indemnification or insurance. The restrictions of this subsection do not prevent a regional water supply authority from indemnifying and assuming the liabilities of its member governments for obligations arising from past acts or omissions at or with property acquired from a member government by the authority and arising from the acts or omissions of the authority in performing activities contemplated by an interlocal agreement. Such indemnification may not be considered to increase or otherwise waive the limits of liability to third-party claimants established by this section. (20) Every municipality, and any agency thereof, is authorized to undertake to indemnify those employees that are exposed to personal liability pursuant to the Clean Air Act Amendments of 1990, 42 U.S.C.A. ss. 7401 et seq., and all rules and regulations adopted to implement that act, for acts performed within the course and scope of their employment with the municipality or its agency, including but not limited to indemnification pertaining to the holding, transfer, or disposition of allowances allocated to the municipality's or its agency's electric generating units, and the monitoring, submission, certification, and compliance with permits, permit applications, records, compliance plans, and reports for those units, when such acts are performed within the course and scope of their employment with the municipality or its agency. The authority to indemnify under this section covers every act by an employee when such act is performed within the course and scope of her or his employment with the municipality or its agency, but does not cover any act of willful misconduct or any intentional or knowing violation of any law by the employee. The authority to indemnify under this section includes, but is not limited to, the authority to pay any fine and provide legal representation in any action. History.--s. 1, ch. 73-313; s. 1, ch. 74-235; ss. 1, 2, 3, ch. 77-86; s. 9, ch. 79.139; s. 1, ch. 79-253; s. 284. ch. 79.400: s. 1. ch. 80-271; ss. 1, 2, ch. 81-317; s. 1, ch. 83-44; s. 1, ch. 83-257; s. 1, ch. 84-29; s. 1,ch. 84-335; s. 21, ch. 86.183; s. 1, ch. 86- 184; s. 3, ch. 87-134; s. 2, ch. 88-173; ss. 55, 61, ch. 89-300; s. 92, ch. 89-360; s. 8, ch. 90-192; s. 3, ch. 91-209; s. 112, ch. 92- 33; ss. 2, 11, ch. 92-278; s. 1, ch. 93-89; s. 34, ch. 93-129; s. 1, ch. 94-76; s. 2, ch. 94-147; s. 70, ch. 94-209; s. 21, ch. 94-321; s. 428, ch. 96-406; s. 34, ch. 97-93; s. 1809, ch. 97.102; s. 4, ch. 98-402; s. 289, ch. 99-8; s. 9, ch. 2000-155; s. 97, ch, 2002-20; s. 24, ch. 2002.183: s. 2, ch. 2002-401; s. 9. ch. 2003-159; s. 1903, ch. 2003-261: s. 1, ch. 2003-290; s. 67, ch. 2003-416; s. 1, ch. 2006-234; s. 1, ch. 2010.26; s. 1, ch. 2011-113; s. 3, ch. 2011-219; s. 126. ch. 2012-184. Copyright 0 1995-2013 The Florida Legislature • Privacy Statement • Contact Us wvvd.leg.state.fl.usrstatutesindexcfr ? Packet Page -58- App_male=OIsr aV Statute.&Sear.,. ,,,,,.,-tat, .-V V‘/- 9ti4 7fiR� ar fi rinc 1(17AR')R hr J -_ 3/12/2013 6.C. BowmanDan • From: SalmonsJessica Sent: Friday,December 28,2012 1126 AM To: GinterMartha;BowmanDan Subject: "'CONFIDENTIAL PT 1NFO' ll Due to the incompatibility of the Incident Report Document with our tough book computer, the below information is written in free form. Dear DC Bowman, • On 14DEC12, Medic 42, was called to a possible...P. However, the station received no tones and the tablet received no information. We were listening to our radios but in separate • areas of the station cleaning and running the vacuum, there was also a lot of radio traffic, this call was in place of zone 46' and the fire apparatus' had excessive traffic switching from GGFD 73 to GGFD 71 taking their place. I thought'they had toned .Medic 46 to a call. Simultaneously, at approx 1198 we received radio 'contact from Control North, Nextel contact from another unit and tones for acknowledgment in the station for the call, asked for the information to be pushed to our tablet and immediately responded from our station. Within a couple of minutes we were advised that CPR was in progress. FROM INITIAL DISPATCH TIMES NOTED IN REPORT TO EMS PT CONTACT WAS 13 MINUTES. We arrived on scene within a few minutes of EN71. Upon pt contact, in a small garage turned bedroom and storage room, there was approximately 3 feet x 6 feet for access to the pt, with three firefighters already in the room, one ask one utilizing wit and the other manning the AED and giving me a quick report. Lt. Trent stated that the pt was lying on his left side on a mattress placed on a sheet of plywood on top of boxes approx three feet high. They pulled the pt off of the mattress, laid him on the ground and immediately mamorilM11111a►as well as 11111111111.01111111111.1111101111111110111111Pand was advised no shock. In my Primary, Secondary and repeat assessments of the pt I did not see any bruising to his head, or on any other parts of his body. I am unsure and did not ask in regards of the timing of CCSO's arrival and if they started CPR. There were approximately four deputies on scene when we arrived and at least three family members that were very distraught and emotional and could not truly answer any required questions. We did get ROSC with this pt just prior to our arrival at PRMC-PR and he maintained while we were still at the hospital for cleanup and restock, ultimately being removed to the ICU, but I do not know the overall outcome of the pt. Jessica LM Salmons, EMT-P Collier County EMS 8075 Lely Cultural Parkway • Naples, Florida 34113 Offc: 239.252.3740 Cell: 239.287.7843 "As we express our gratitude, we must never forget that the highest appreciation is not to . utter words, but to live by them." -3ohn Fitzgerald Kennedy From: GinterMartha Sent: Friday, December 28, 2012 8:49 AM Packet Page-59-