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Agenda 05/13/2013 Item #10G5/14/2013 10.G. EXECUTIVE SUMMARY Recommendation that the Board of County Commissioners clarify its intent /direction with respect to the role of the PSA in the evaluation of applicants for the position of Medical Director/Deputy Medical Director. It was neither the intent, nor the direction of the Board of County Commissioners to have county staff, nor the PSA, develop ranking criteria and score the applicants. In fact, according to Ed Morton of the Blue Ribbon Committee, the Blue Ribbon Committee did not envision the PSA being the selection committee for the position of Medical Director/Deputy Medical Director; the PSA would be conflicted in such a role. The Board of County Commissioners requested that the PSA provide a list of the top ten candidates, unranked, along with the applications of all other candidates. Had the Board of County Commissioners wanted rankings based on scored criteria, the commissioners would have defined the criteria and the weighting. This was intentionally avoided to ensure fairness in the process, since criteria and weightings could be skewed so as to benefit or prejudice a particular candidate. Given that there are five applicants that have submitted for the position of Medical Director/Deputy Medical Director, the PSA should be given the opportunity to meet the applicants and then forward the list of all rive candidates, unranked, to the Board of County Commissioners along with PSA comments /observations (taken as a whole) that would allow the Commissioners to make a well informed final decision. OBJECTIVE: That the Board of County Commissioners clarify its intent/direction with respect to the role of the PSA in the evaluation of applicants for the position of Medical Director/Deputy Medical Director. It was neither the intent, nor the direction of the Board of County Commissioners to have county staff, nor the PSA, develop ranking criteria and score the applicants. In fact, according to Ed Morton of the Blue Ribbon Committee, the Blue Ribbon Committee did not envision the PSA being the selection committee for the position of Medical Director/Deputy Medical Director; the PSA would be conflicted in such a role. The Board of County Commissioners requested that the PSA provide a list of the top ten candidates, unranked, along with the applications of all other candidates. Had the Board of County Commissioners wanted rankings based on scored criteria, the commissioners would have defined the criteria and the weighting. This was intentionally avoided to ensure fairness in the process, since criteria and weightings could be skewed so as to benefit or prejudice a particular candidate. Given that there are five applicants that have submitted for the position of Medical Director/Deputy Medical Director, the PSA should be given the opportunity to meet the applicants and then forward the list of all five candidates, unranked, to the Board of County Commissioners along with PSA comments /observations that would allow the Commissioners to make a well informed final decision. CONSIDERATIONS: The Chair of the PSA has requested clarification of the role of the PSA in the selection process of candidates that have applied for the position of the county government's medical director /deputy medical director. It was not the intent of the Board of County Commissioners that the PSA rank the applicants based on weighted criteria since to do so would create a conflict for the PSA whose role it is to provide oversight and guidance to the Office of the Medical Director. This was made clear by the Blue Ribbon Committee and Packet Page -178- 5/14/2013 10.G. reminded to the PSA by Ed Morton, a lead member of that earlier committee. The Board of County Commissioners requested that the PSA submit all applications received to the Board of County Commissioners, noting the top ten (unranked), if there were more than ten applications. Since five applications have been received, the PSA need only meet the candidates and submit the unranked list with any comments the PSA (as a whole) would like to share that would benefit the County Commissioners in the selection process. FISCAL IMPACT: None LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, raises no legal issues, and requires majority support for approval. -JAK RECOMMENDATION: That the Board of County Commissioners clarify its intent/direction with respect to the role of the PSA in the evaluation of applicants for the position of Medical Director/Deputy Medical Director. It was neither the intent, nor the direction of the Board of County Commissioners to have county staff, nor the PSA, develop ranking criteria and score the applicants. In fact, according to Ed Morton of the Blue Ribbon Committee, the Blue Ribbon Committee did not envision the PSA being the selection committee for the position of Medical Director; the PSA would be conflicted in such a role. The Board of County Commissioners requested that the PSA provide a list of the top ten candidates, unranked, along with the applications of all other candidates. Had the Board of County Commissioners wanted rankings based on scored criteria, the commissioners would have defined the criteria and the weighting. This was intentionally avoided to ensure fairness in the process, since criteria and weightings could be skewed so as to benefit or prejudice a particular candidate. Given that there are five applicants that have submitted for the position of Medical Director /Deputy Medical Director the PSA should be given the opportunity to meet the applicants and then forward the list of all five candidates, unranked, to the Board of County Commissioners along with PSA comments /observations (taken as a whole) that would allow the Commissioners to make a well informed final decision. PREPARED BY: Commissioner Georgia Hiller, Chair - District 2 Packet Page -179- 5/14/2013 10.G. COLLIER COUNTY Board of County commissioners Item Number: 10.10.G. Item Summary: Recommendation that the Board of County Commissioners clarify its intent /direction with respect to the role of the PSA in the evaluation of applicants for the position of Medical Director /Deputy Medical Director. It was neither the intent, nor the direction of the Board of County Commissioners to have county staff, nor the PSA, develop ranking criteria and score the applicants. In fact, according to Ed Morton of the Blue Ribbon Committee, the Blue Ribbon Committee did not envision the PSA being the selection committee for the position of Medical Director /Deputy Medical Director; the PSA would be conflicted in such a role. The Board of County Commissioners requested that the PSA provide a list of the top ten candidates, unranked, along with the applications of all other candidates. Had the Board of County Commissioners wanted rankings based on scored criteria, the commissioners would have defined the criteria and the weighting. This was intentionally avoided to ensure fairness in the process, since criteria and weightings could be skewed so as to benefit or prejudice a particular candidate. Given that there are five applicants that have submitted for the position of Medical Director /Deputy Medical Director, the PSA should be given the opportunity to meet the applicants and then forward the list of all five candidates, unranked, to the Board of County Commissioners along with PSA comments /observations (taken as a whole) that would allow the Commissioners to make a well informed final decision. (Commissioner Hiller) Meeting Date: 5/14/2013 Prepared By Name: BrockMaryJo Title: Executive Secretary to County Manager, CMO 5/8/2013 8:59:31 AM Submitted by Title: Executive Secretary to County Manager, CMO Name: BrockMaryJo 5/8/2013 8:5933 AM Approved By Packet Page -180- Name: OchsLeo Title: County Manager Date: 5/8/2013 9:58:09 AM Packet Page -181- 5/14/2013 10.G. 5/14/2013 10.G. 3/12120113 10. HI. EXECUTIVE SUMMARY Recommendation that the Board of County Commissioners direct staff to prepare solicitations for the post of County Medical Director and Deputy County Medical Director; that the positions of County Medical Director and Deputy County Medical Director be posted to accept applications by April 1. 2013: further, that staff bring back the state of all applications received for the board's review and consideration by the first board meeting in May, 2013. The solicitation for the position of County Medical Director shall provide that the applicant shall not be affiliated directly, nor indirectly with any loeal hospital. The County Medical Director approves the county's emergency service protocols and as such all conflicts of interest in appearance and in fact must be avoided for ethical and legal reasons. OBJECTIVE: That the Board of County- Commissioners direct staff to prepare solicitations for the post of County Medical Director and Deputy County Medical Director: that the positions of Countv Medical Director and Deputy County Medical Director be posted to accept applications by April 1, 2013: further. that staff bring back the slate of all applications received for the review and consideration by the first board meeting in May. 2013. The solicitation for board' I The position of County Medical Director shall provide that the applicant shall not be affiliated directly, nor indirectly with any local hospital. The County Medical Director approves the county's emergency service protocols and as such all conflicts of interest in appearance and in fact must be avoided for ethical and le-aal reasons. CONSIDERATIONS: The Board of County Commissioners owes the community the duty to ensure that it is staffing the county at the administrative leadership level with the best and briahiest. The board further owes the community the assurance that the staffing of leadership positions within the county s top administration is such that the individuals selected have no conflicts of interest in appearance or in tact, to ensure that the decisions made by such individuals doesn't unfairly inure to the benefit or detriment of any special interest or the public in general. As such, the board in good conscience shall post the position of County Medical Director and Deputy County Medical Director to seek applicants that can provide the highest level of emergency service leadership, and in the case of the County Medical Director, (the decision maker as to county emergency service protocols). that there be no conflicts of interest. Such conflicts of interest are avoided by requiring the Counn,, Medical Director be completely independent of any local hospital. FISCAL LNIPACT: None LEGAL CONSIDERATIONS: ' This item has been approved by the County Attorney and raises no legal issues at this time. Dr. Tober's contractual issues will be addressed at such time. if anv, the Board elects to retain a different County Medical Director. This item requires majority vote for approval. -JAK RECOMMENDATION: Recommendation that the Board of County Commissioners direct staff to prepare solicitations for the post of Count-,.r Medical Director and Deputy Counter I Packet Page -586 - Packet Page -182- 5/14/2013 10.G. 3/12/2013 10. H. Director; that the positions of County Medical Director and Deputy County Medical Director be posted to accept applications by April 1, 2013: further, that staff bring back the slate of all applications received for the board's review and consideration by the first board meeting in May. 2013. The solicitation for the position of County .Medical Director shall provide that the applicant shall not be affiliated directly, nor indirectly with any local hospital. The County ;Medical Director approves the county's emergency service protocols and as such all conflicts of interest in appearance and in fact must be avoided for ethical and legal reasons. PREPARED BY: Commissioner Georszia Hiller. Chair - District 2 Attachments - County Medical Director Contract Packet Page -587 - Packet Page -183- 5/14/2013 10.G. March 12, 2 013 coming back. Because as Commissioner Nance says, we want to not only do it quickly but more importantly we want to do it correctly. COMMISSIONER N ANCE: When I see Mr. Sheffield walking around with a carbide light on his hat, I know it's getting late in the day. Thank you, sir. CHAIRWOMAN HILLER: I've never seen him do that. What are you talking about`? No, that's great. So if you make sure you post that for us, that we're aware of, you know, where you are in our requests, that's positive, r MR. OCHS: Will do, thank you. CHAIRWOMAN HILLER: Thank you. Item 4 1 OH STAFF TO PREPARE SOLICITATIONS FOR THE POST OF COUNTY MEDICAL DIRECTOR AND DEPUTY COUNTY MEDICAL DIRECTOR; THAT POSITIONS FOR COUNTY MEDICAL DIRECTOR AND DEPUTY COUNTY MEDICAL DIRECTOR BE POSTED TO ACCEPT APPLICATIONS BY APRIL 11 2013; FURTHER, THAT STAFF BRING BACK. THE SLATE OF ALL APPLICATIONS RECEIVED FOR BOARD REVIEW AND CONSIDERATION BY THE FIRST BOARD MEETING IN MAY, 2013. THE SOLICITATION FOR THE POSITION OF COUNTY MEDICAL DIRECTOR SHALL PROVIDE THAT THE APPLICANT SHALL NOT BE AFFILIATED DIRECTLY, NOR INDIRECTLY WITH ANY LOCAL HOSPITAL, OR, IN THE ALTERNATIVE, MUST BE AFFILIATED WITH ALL LOCAL HOSPITALS (PER AGENDA CHANGE SHEET). THE COUNTY MEDICAL DIRECTOR APPROVES THE COUNTY'S EMERGENCY SERVICE PROTOCOLS AND AS SUCH ALL CONFLICTS OF INTEREST Page 120 Packet Page -184- 5/14/2013 10.G. March 12, 2013 INAPPEAR.A.NCE AND IN FACT MUST BE AVOIDED FOR ETHICAL AND LEGAL REASONS - MOTION FOR STAFF TO PREPARE RFP FOR BOTH POSITIONS, ELIMINATING THE AFFILIATION REQUIREMENT AT THIS TIME AND TO BE BRING BACK AT THE SECOND MEETING IN MAY — APPROVED MR. OCHS: That takes us to Item I O.H on your agenda, Commissioners. It is a recommendation that the Board direct staff to prepare solicitations for the post of County Medical Director and the Deputy County Medical Director; that the positions of the County Medical Director and the Deputy County Medical Director be posted to accept applications by April 1, 2013. Further, that staff bring back the slate of all applications received for the Board's review and consideration by the first Board meeting in May, 2013. The solicitation for the position of County Medical Director shall provide that the applicant shall not be affiliated directly nor indirectly with any local hospital. And also as a result of this morning's change sheet Commissioners, that portion of the recommendation will be modified to add that in the alternative that the Director must be affiliated with all local hospitals. CHAIRWOMAN HILLER: Thank you. N4R. OCHS: That's Commissioner Hiller's item, Commissioners. CHAIRWOMAN HILLER: Yeah. And I believe we have how many public speakers? MR. MILLER: Two. CHAIRWOMAN HILLER: Two. Who are the two public speakers? MR. MILLER: The public speakers are Janet Vasey and Michael Pettit. CHAIRWOMAN HILLER: Okay, thank you. Page 121 L-- Packet Page -185- 5/14/2013 10.G. March 12, 2p 13 And Michael Pettit is the attorney who represents -- MR. MILLER.- Says on the sheet Dr. Tober, Incorporated. CHAIRWOMAN HILLER: Right, that's my understanding. n Is Janet here on behalf of the public services -- Janet, are you here? Are you here on your own or representing the advisory board", MS. VASEY: I'm here on my own. CHAIRWOMAN HILLER: Okay, just for the record, Mrs. Vasey is here on her own, not representing the advisory board. The reason I brought this forward is Dr. Tober has provided tremendous ser-N, ice to the community over the years. He has been in the Office of the Medical Director as the county's Medical Director under contract directly to the Board for about 34 years. And we have not put this position out to bid in an obviously very, very long time. As a consequence, in the interest of the public, it's important for us to be aware of who's out there that might be able to serve our current needs. And maybe at the end of the day it turns out that Dr. Tober ends up being the right person again. But we will not know that unless we go into the community and solicit for the post of the County Medical Director, as well as the post of the Deputy County Medical Director. Right now the position of the Deputy Director falls under Dr. Tober's contract. Basically he has assigned someone who works for him as the deputy. And there is a problem with that. Because now we have both those positions wrapped up in one entity. And if that entity and the Board decide to part company, we're left with nobody. By having the Medical Director and the Deputy Director as two separate contract employees, if one or the other chooses to leave for whatever reason, the county is not left without continuity. And that's extremely important. The second issue is with respect to conflicts of interest. The Medical Director, unlike the Deputy Director, actually sets protocol Page 122-2 Packet Page -186- 5/14/2013 10.G. March 12. 2013 with respect to how the emergency services in the county are to be provided. And to that end, it's important that the Medical Director be independent both in appearance and in fact, which is why I suggest that the solicitation provide that the Medical Director either not be affiliated with any of the county hospitals or be affiliated with all of them. We currently have two hospitals, Physicians Regional and NCH, and so there are doctors who do have privileges at both institutions, and that works. Again, all with the intent of there not being any conflict of interest with respect to protocol decision- making. And just so you understand what that means, for example, a protocol could be set that would shift for example emergency transport to one hospital over another for a particular type of medical condition which could result in one hospital getting for example more stroke business than another hospital or, you know, one hospital getting all the heart attacks versus another hospital not getting them, or more so than another hospital. And obviously what matters is patient care. It shouldn't be about which hospital gets more business but rather all about patient care and getting the patient to the best facility to provide the medical treatment that that patient needs to receive as quickly as possible. So what I have recommended is that we -- and by the way, the Deputy Medical Director does not have a conflict issue because he does not set protocol. So what I've recommended is that we request the county's purchasing department to put out an RFP to solicit for the post of the Medical Director and the Deputy Medical Director. Since I had put this item on the agenda, I have gotten some feedback from the community asking what my position was with respect to the involvement of the Public Safety Advisory Board that we have recently established. And my recommendation with respect to that is that the y should be involved. And this is how they should be PaLye 123 Packet Page -187- 5/14/2013 10.G. March 12, 20131 member of the Board who would like to speak, I'm going to ask that the -- that we turn it over to the public speakers and let Mr. Pettit and Mrs. Vasey speak. But first I'm goinc, to allow Commissioner Covle to speak. COMMISSIONER COYLE: No, I'll wait'til after the speakers. CHAIRWOMAN HILLER: Okay. MR. MILLER: Madam Chair, your first public speaker is Janet Vasey, and she'll be followed by Michael Pettit. CHAIRWOMAN HILLER: Michael, why don't you come up to the opposite podium. That way you can start speaking as soon as Mrs. Vasey is done. MS. VASEY: Could I use the visualizer? MR. OCHS: Yes, ma'am. Hello. Good morning,, Commissioners -- afternoon I guess. CHAIRWOMAN HILLER: Welcome back, and welcome back from all your travels. MS. VASEY: Thank you, thank you. CHAIRWOMAN HILLER: I understand you're headed out again soon. MS. VASEY: Tomorrow morninor at 6:00. CHAIRWOMAN HILLER: Well, you just made it by the skin of Page 124 Packet Page -188- 5/14/2013 10.G. March 12, ?013) your teeth. MS. VASEY: Well, I'm here today -- for the record, I'm Janet Vasey, I'm the Vice Chair of the Public Safety Authority. And while I'm not speaking for the Authority, they have not had an opportunity to review this, I have made observations during my time on the committee, and I'd like to offer those to you. First I would like to say that I applaud you, Chairman Hiller and Commissioners, for your foresight in creating the Public Safety Authority, because it's designed to address some of these issues you're talkin-c, about right now. It's particularly well suited to evaluate protocol chancres, and in fact we're doing that right now. Let me just draw your attention to the -- to your ordinance. And the ordinance here, basically the ordinance says that the PSA will evaluate issues -- let me see it too affecting pre-hospital emergency medical services within all of Collier County. And that committee is made up of amazing people. You've got doctors, . you've got hospital administrators. In fact from the two hospitals you have one ER doc from each one, you have one hospital administrator from each one, you have two other doctors that hold the COPCNs in Collier County. You have the Sheriffs Office, you have several paramedics, EMT's. You have a wide variety of people. Sheriffs Office, police departments. This is a committee that is very much able to deal with these issues. Right now I wanted to tell you about something we're looking at 9 1 - - and that is a protocol change for EMS on how to handle stroke victims. And basically Physicians Regional came in and showed us that they are now a comprehensive center for stroke victims. So they have more capabilities than NCH does. So they wanted to have a new procedure on how the paramedics and EMS would transport the patients. And they had a new procedure called LAMS. The L-A -- CHAIRWOMAN HILLER: L-A-M-S. MS. VASEY: Yeah, it's the L-A-M-S. It's the LA Motor Skills Pate 125 Packet Page -189- 5/14/2013 10.G. March 12, 2013 Test. And depending on how that test is ranked, the idea would be if you're a more severe patient, a stroke victim, you would be taken to Physicians Regional. Otherwise you would be taken to the closest hospital. That came before the Public Safety Authority. It went into the Medical Director's committee which has, you know, four doctors, couple of paramedics, couple of EMT's. There was a meeting between that committee and NCH and Physicians Regional, but it's in process now of being looked at. And my point in telling you about this is that the Medical Director, Dr. Tober, does not make the final decision on this. This is going through the review of the medical directors, it's going -- committee. It's going to go then to the full public safety authority for whatever recommendation comes out of the Medical Director's sub-committee, and then it will come to you. Something as big as changing protocols will come to you for a decision. And your ordinance clearly covers all these issues, you've got all the right people in place, and it's not -- you don't have the conflict of interest and the leoal issues because you have multiple people, includincr both hospitals fully represented in looking at these issues. So they will be making their cases, as well as anyone else who would like to. So I feel like as a person, not as a committee, and you might want to check with what the PSA thinks, but I think that this is a very comprehensive program that will eliminate any problems of conflict of interest and legal issues because those changes, those major chancres between hospitals, are not going to happen alone. CHAIRWOMAN HILLER: Thank you. Just for the record. County Attorney, the advisory -- the PSA is strictly an advisory board, correct' MR. KLAT&OW:'Yes. CHAIRWOMAN HILLER: Thank you. Page 126 Packet Page -190- 5/14/2013 10.G. March 12, 2013 And what that means is that as an advisory board nothing that the PSA provides is binding on the Medical Director or the Board. So while it's very important input, it will not guard against what you're suggesting it will. But thank- you. MS. VASE: But it would come to vou. After it comes to the PSA and is voted on, something like this change would come to you and you would have an opportunity to say yes or no. CHAIRWOMAN HILLER: Understood. But again we're in a position where we have to have whoever represents to us free of conflict, both in appearance and in fact in the PSA. While it will help to maybe highlight something like that, doesn't guarantee that it will prevent it. But thanks. MR. MILLER: Your next public speaker is Michael Pettit. MR. PETTIT: Good afternoon, Commissioners. Michael Pettit here for Dr. Tuber, Inc. and Dr. Taber. Ms. Vasey said much of what I was going to say. She said it better than I probably can. But I think that we shouldn't lose sic, 1h t of the fact of how transparent the PSA process is. Commissioner Hiller, in fact you're welcome or any member of the public is welcome to come tomorrow when this is voted on and reviewed and discussed among doctors from multiple hospitals in the community. CHAIRWOMAN HILLER: You know, I want to make sure that Mr. Pettit gets additional time for anything I say, but I do want to respond, if I may, to what you just said. I'm very well aware of how important the PSA is. In fact, the structure that was ultimately adopted by the PSA in terms of its representation from the various medical constituencies and emergency service providers came about as a consequence of a committee that I actually led that involved all the players other than the county. And we proposed it at a workshop that was then finally adopted by the Page 127 C� Packet Page -191- 5/14/2013 10.G. March 12, 2013 Board. So the structure is very familiar to me and the importance of the transparency of the structure is something that I have long supported. So thank you for commenting on that. And I do endorse your position on that committee. MR. PETTIT: It's certainly our position that that Sunshine effect from the PSA would alleviate any purported concern about conflicts of interest. And I think the only other thing I have to say, and I wrote to search of you individually last week asking that this matter be put over for a couple of meetings so that we could have further investigation and full public comment on the criteria you had proposed. Now, those criteria changed this morning. But they still appear to have the potential to screen out highly qualified applicants. And so we would again request that this item be continued and that we give additional opportunity to talk about the criteria. And I do want to make it clear that we're not here -- I'm not here on behalf of Dr. Tober to object to a competitive process, but we want to be sure it's genuinely competitive. CHAIRWOMAN HILLER: I appreciate it, thank you. Any other public speakers? MR- MILLER: No, ma'am. CHAIRWOMAN HILLER: In that case, I'd like to turn to the Commissioners, but first ,ll:,,w,,6,u--ld,";li�,,e to.m a e a m, c ti n. =that we Board 'in a Is that the did we say yeah, by ' V e rst meeting, the first meeting in May. And actually, let's make that the second meeting. the second Board meeting in May, to give us more time so 1 Page 128 Packet Page -192- 5/14/2013 10.G. March 12, 201 3 PSA has the opportunity to review -- MR. OCHS: Thank you, ma'am. CHAIRWOMAN HILLER: with adequate time. MR- OCHS: We have a -- I'm sorry for the interruption, but this -- back to Commissioner Nance's point, this is one of those where we have a 21 -dav advertising requirement. Once we put the solicitation on the street we still have to develop the specifications. CHAIRWOMAN HILLER: Of course. So how much time would you like" Let me put it to you that way. You tell me. 4R. OCHS: Well, I would appreciate the second meeting of May -- CHAIRWOMAN HILLER: Sure. MR. OCHS: -- at the earliest, if that's -- CHAIRWOMAN HILLER: Let's do that then. Let's make the second meetino, in May to be brought back before the Board of County Commissioners. MR. OCHS: Thank you. COMMISSIONER FIALA: Commissioner, I will second your motion, but there were a couple things that I had concerns with, but I'll ask -- CHAIRWOMAN HILLER: Sure. COMMISSIONER FIALA: -- when my turn comes up. I think Commissioner Coyle -- CHAIRWOMAN HILLER: Would you like to speak now? COMMISSIONER FIALA: I think he was first. CHAIRWOMAN HILLER: Okay, Commissioner Coyle" COMMISSIONER COYLE: Yeah, I think that the most important thing we can do is get the best qualified person for Medical Director that we possibly can find. And we're certainly not going to find the best qualified person by ignoring all those who are affiliated with hospitals in the county. I am greatly concerned that this appears to be an attempt to steer Pace 129 Packet Page -193- 5/14/2013 10.G. March 12, 2013 the selection of Medical Director to a single person or perhaps organization. We are screening out all qualified people who have affiliations with hospitals in Collier County. CHAIRWOMAN HILLER: No, that's not correct. COMMISSIONER COYLE: Or they must be affiliated with all local hospitals. CHAIRWOMAN HILLER: That's correct. COMMISSIONER COYLE: And those are very, very difficult requirements. That means you're going to lose a lot of very qualified people. And where would f like for their experience to be`?� In Collier County, not somewhere else, in Tennessee or New York. And to emphasize more directly my concern, Commissioner Hiller, would you be willing to revise this requirement so that the applicants would not be affiliated directly nor indirectly with any fire district? Okay? CHAIRWOMAN HILLER: Sure. COMMISSIONER COYLE: Because I am concerned that the way it is currently set up, that we'll screen out all those who are not affiliated with all the local hospitals and we're going to be left with one person perhaps to choose from. And when you cut the pool to that level, we're not getting the most qualified Medical Director to do the job. I think there is no problem here. I think this is a process of manipulation which is not necessary. We do not have a conflict of interest. If we have a conflict of interest, we have the mechanism in the ordinances and the organization to deal with it. So I think that we're trying to address an imagined issue here with an extremely restrictive qualification that will deprive us of the best possible candidates for a County Medical Director. CHAIRWOMAN HILLER: Let me address what you said with respect to eliminating candidates affiliated with the fire departments. First of all, that actually is irrelevant to the discussion for the Page 130 Packet Page -194- 5/14/2013 10.G. March 1. 2, 2013 following reasons: Number one, the fire departments are not providing transport. Number two, we do not steer business to the fire departments for medical care. The protocols will affect the hospital's bottom line if a protocol is adopted that shifts business by virtue of a protocol to one hospital over another rather than a protocol that addresses what's in the best interest of the patient. -And, you know, I'm looking at an email here that Dr. Tober wrote where he talked about essentially -- and I'll introduce in the record -- where essentially adopting the LAM score would divert about 40 percent of the patients currently going to NCH et cetera, et cetera. I mean, the fact that that even is included in an email in a consideration is unbelievable. It's not about whether 40 percent of some hospital's business is being diverted as a consequence of a protocol. The protocol shouldn't even be considering whether it diverts business from one hospital over another. It should absolutely be considering what is in the best interest of the patient and that is all that this is about. So I appreciate your comment, but it doesn't hold water. COMMISSIONER COYLE: Well, I -- CHAIRWOMAN HILLER: Commissioner Fiala? COMMISSIONER COYLE: I haven't finished yet. CHAIRWOMAN HILLER: Okay, sorry, Commissioner. COMMISSIONER COYLE: What vou've said is not correct. There are fire districts who are aggressively pursuing transport responsibilities and will do so even more aggressively in the future. And there's just as much of an opportunity for conflict of interest for a Medical Director at a fire district to influence things that benefit the fire district as there is for a Medical Director who is affiliated with one of the hospitals. It is a serious issue and I would hope that the public would look very, very closely at this manipulation of the selection of our Medical Pate 131 Packet Page -195- 5/14/2013 10.G. March 12 .2 013 Director for Collier County'. CHAIRWOMAN HILLER: And really, the manipulation is coming from your side because 1 will say, number one, there is no fire department that has transport; none that has come before us requesting transport. So, you know, doing something in anticipation of what might be is not appropriate. What I will say is that if there was a Medical Director affiliated with any fire district and they did receive transport, I would find that to be a conflict. And I would take exception to that, if that were the reality. And if that were the case, I would certainly ask that Medical Director to quit the district or resign as Medical Director. Commissioner Fiala. COMMISSIONER FIALA: Yes, I agree that we need the very best possible person. Sometimes a doctor maybe doesn't have the ability to run a whole department of ambulances. I don't know that. So you're absolutely right, we want the very best outcome for the patient and that's what's most important. What I've been thinking about, though, is the wording of this. Now, I only worked for the hospital in a different capacity, in a worked there for 13 years and I was in the capacity of a community outreach person. But from what I saw, every doctor had some sort of an affiliation with different hospitals. They had a patient that got sick, even if thev didn't work in a hospital they had to get them over there. Same with -- some doctors had -- didn't want to work with two hospitals because then they were on call. You know, they'd have to work emergency and so forth, so they would only want to work with one and not the other. So it would be difficult for them to work for two hospitals. I don't know what we can do to adjust that. Those are questions that I have, But we want to make this totally fair. We want to make this selection in a totally fair way so that you and me and you get the very best medical care on our way to being, transported to the hospital. And Page 132- Packet Page -196- 5/14/2013 10.G. March 12, 2 013 if the doctor only works for one hospital and only works there part-time but he's the very best selection that we could come up with, Great. I'm not so much worried about the affiliation as to making sure that we choose somebody who can run that department. Thank you. CRAJRWOMAN HILLER: Thank you. Commissioner Henning" COMMISSIONER HENN-ING: Well, I think the item on the a. - agenda is very noble, We've had a long -term contract with Dr. Tober, and I can see Where it would be a benefit to have a Medical Director affiliated with both the hospitals. So I think the item is an appropriate item. However, I have all the confidence in Dr. Tober. The only thing I see wrong with Dr. Tober is he's just not political and he says it like it is, you know, and we see it in the paper all the time. And I cringe but that's Dr. Tober. = And one thing that I believe that we must do is provide the health and safety of our residents. And I feel confident that Dr. Tober is the right person. And I don't think it was any kind of an agenda, Madam Chair, I just can't support it. Thank you. CHAIRWO-NLAN HILLER: Commissioner Nance? COMMISSIONER NANCE: Yes, I'm going to try to craft a middle ground here because I have a couple of expanded concerns that may not be directly applicable to this recommendation, but I think are going to come up in the end. tn And that is, you know, we've got a Medical Director here that's served us very capably for a very, very long period of time. And I don't think any remarks that anybody makes here should be a critique of that aentleman. He's proven himself, he's been awarded. I've heard nobody say anvthincF but absolutely the greatest compliments to Dr. Tober, I think that not only is it appropriate, however, to look at who we have available but I think we also have to look at how we consider our -"� n Pa=ge, 13 Packet Page -197- 5/14/2013 10.G. March 1?, 20'1 3 Medical Director as a whole. I think it- may well be appropriate to update how we see our Medical Director, what we expect our Medical Director to do, what relationships we indeed expect him to have as well as not have. Because although we have listed hospitals in this recommendation, I think that we are acquiring in our area other areas of specialty care; for example, Bascom Palmer, that we may well have an emergency where we need to actuall-v take that person there rather than to a hospital or to another center of care. So I would prefer, Madam Chair, in your recommendation, I think we should withhold how we evaluate the affiliations with the hospitals, but we should delineate in our requests for applicants to tell which ones they do have or would be interested in having and address those in that way. That way I think we are open to as many applicants as possible. I would hate to screen somebody out because of a restriction that we put in our request. So I would be in full support if you could expand that to include as many people as possible. And I certainly hope that Dr. Tober will be among those. And, you know, I could support it in that way. I want it to be inclusive rather than to exclude somebody at this point. If the Public Safety Authority feels there's an issue that will give them a chance to weigh in on it, and of course this Board will ultimately make the final selection. So I don't think we should screen them in the application, I think we should screen them in our final determination. CHAIRWONLAN HILLER: I don't have a problem with that. I think that's a very fair proposal. And screening them at the end as opposed to in the beginning works. COMMISSIONER NANCE: But we should ask for a declaration with all their -- C1-LA,IRWO-T\4AN HILLER: Yes. COMMISSIONER N.ANCE: -- you know, with all their affiliations, and not only just hospitals, but other centers of excellence Pate 134 Packet Page -198- 5/14/2013 10.G. March 12, 2013 CHAIRWOMAN FILLER: And just if I may, in terms of the role of the Medical Director, that's statutorily defined. So we're not going to redefine or expand or anything like that. I mean, we're going to follow the law. Because that role is clearly defined for us. COMMISSIONER NANCE: And narrowly defined. We don't want to define it any other way? Are we sure? CHAIRWOMAN HILLER: County- Attorney, can we change the role of the Medical Director as it's statutorily defined in terms of what we want to do? Because I'm not sure that we want to create any MR. KLATZKOW: You don't want to be in conflict with the statute. CHAIRWOMAN HILLER: That's my concern. I think it's a big mistake. 'We're MR. KLATZKOW: But that's not what we're talking about here. COMMISSIONER NANCE: Excuse me, Madam Chair. I wasn't -- perhaps I didn't make myself clear. Maybe not in the requirements of the Medical Director, but in the contract we have with our Medical Director and what our expectations are in our contract for service may require something in addition to what is statutorily required by the state. In other words, not just their qualifications, but our request and how they react in Collier County with our EMS or with our first responders as a whole. Because I think that's a very fast changing subject right now, as we all realize, that the Medical Director deals not only with EMS and protocols and so on and so forth but with our other first responders. CHAIRWOMAN HILLER: County Attorney? COMMISSIONER NANCE: And I'm not trying to make it needlessly complicated. If that makes it needlessly complicated then MR. KLATZKOW: You've got a two -part process here. Your Page 13 Packet Page -199- 5/14/2013 10.G. March 12, 2013 first -- the first part of this process is a motion to basically put this on the street to get applicants back. Commissioner Nance has expanded the scope of what you're looking for, to go through your Public Safety Authority to get recommendations. The issues raised by Commissioner Nance can be addressed if you decide to make a change with the new contract. CHAIRWOMAN HILLER: So you can research that and bring back to us -- MR.. KLATZKOW: We have time. CHAIRWOMAN HILLER: -- to what extent that could be doable. MR. KLATZKOW: Yes. CHAIRWOMAN HILLER: All right, let's -- now what I'm going to do is as long as we consider -- COMMISSIONER NANCE: Would that answer your concerns, Commissioner Coyle? COMMISSIONER COYLE: Well, I think yes, it will. I mean, here's the point that I think you just made: We have a Public Safety Authority, and whatever the Medical Director does has to merge seamlessly with that Authority. So if we start the process out by getting the Public Safety Authority involved in writing or structuring the RFP and the range of duties that will be defined for the Medical Director and how he will interact with the Public Safety Authority, then we can advertise. But the problem right now is we're rushing out to try to get something on the street without even going through the appropriate reviews. And I think what You observed was that we were to go through the Public Safety Authority and get this thing properly coordinated. While we won't necessarily chance the nature of the definition of a Medical Director, we will necessarily have to define how that director is going to work with the Public Safety Authority. Page 136 Packet Page -200- 5/14/2013 10.G. March 12, 2013 CHAIRWOMAN HILLER: Well, I think that's already defined in the ordinance that created that advisory board. And again that is an advisory board. And the relationship between the advisory board and the Medical Director is explicit. So I think that's not necessary. COMMISSIONER COYLE: But your CHAIRWOMAN- HILLER: And again, in terms of the RFP, we are going to be limited to what the statute provides, and that the role of the Medical Director is clear. I want to get back to what Commissioner Nance is proposing. I absolutely have no p roblem whether we put the consideration of conflicts at the beginning of the process or at the end of the process, as lone, as it's included in the process and as long as there's full disclosure on the part of every applicant of every medical institution they are affiliated with, whether it's a hospital or Bascom Palmer or a hospital outside of the county. Like, for example, you know, if we transport our trauma patients up to Lee to the trauma center, COMMISSIONER NANCE- Exactly. CHAIRWOMAN, HILLER: So I don't have a problem with that. And so I will amend my motion to require -- to eliminate the conflicts requirements at this point and to require full disclosure of all hospital affiliations, directly or indirectly, and to provide that then when we bring the candidates before us that we consider the potential third conflicts as a consequence of affiliations. COMMISSIONER COYLE: Once again, the Public Safety Authority provides the mechanism to identify and to resolve those kinds of issues. The fact that they are an advisory board has absolutely nothing to do with the ability to identify and correct any conflicts of interest. They will review the medical protocol changes that the Medical Director will wish to make and then they will make recommendations concerning those. And if they feel that there is some conflict of interest, it's a public hearing, people will be able to make their arguments there and it will come to us for a final decision. Pa,c,,,r- 1371 Packet Page -201- 5/14/2013 10.G. March 12, 2013 So the issue of conflicts is an imaginary one and simply will not exist with a Public Safety Authority that is transparent in their recommendations. And that's what we intend to do with it. CHAIRWOMAN HILLER: Commissioner Fiala? COMMISSIONER FIALA: Yes, thank you. I think as we look through this, we also have to think of what does affiliated really mean, what does a conflict of interest really mean. Now, you know, I don't know that many doctors in town but I know a few. And I would give to you right this very moment if some doctor who was making the calls could see that that patient is a stroke victim and he needs to go to Physicians Regional, that's where he's going. The doctor doesn't care about his hospital. And if it's a heart patient, he needs to go to NCH, that's it, period. Because they're the best hospitals for those particular serious health issues. CHAIRWOMAN HILLER: And that's exactly how it should be. It should be like that. COMMISSIONER FIALA: And so if they're affiliated with one hospital or one eye doctor or whatever, I think that our doctors here are above reproach. I don't think we have to worry too too much about them. But if we want to give it some kind of a definition as far as affiliated or conflict of interest, fine. But we also have to Give them some credit too. CHAIRWOMAN HILLER: Absolutely. And that's what we'll do in the final selection process. I have amended my motion. Would you be willing to amends Yours? COMMISSIONER FIALA: Oh, yeah, absolutely. OCHS: Madam Chair) CHAIRWOMAN' HILLER: Yes. MR. OCHS: I'm sorry, I don't mean to belabor this. I know you have a time hearinc, PaLye138 Packet Page -202- 5/14/2013 10.G. March 12, 2013 CHAIRWOMAN HILLER: We do. N 'M . 0C Sr - -13ut I want :to make sure'I'm �l:early following the COMISSIYONER HILLER: Include all of them but just rank the top 10. MR. OCHS: Yes. And send all the proposals and the ranked proposers to the Board; is that -- CHAIRWOMAN HILLER: No, everything -- you're correct except sending the RFP to the PSA. Because the RFP is very straightforward. The RFP basically has to propose what the statute provides is the role of the Medical Director and the role of the Deputy Medical Director. So there's really no debate as to, you know, what is a medical director for this county. Now, having the PSA review the candidates, certainly. But, I mean, there is really -- I mean, the RFP is very basic. There is no debate. And it shouldn't be expanded in any way. I mean, it should be what the statute provides, just as the County Attorney has provided. COMMISSIONER NANCE: Excuse me, Madam Chair, just for clarification, are we -- we're also bifurcating the Deputy Medical Director from the Medical Director -- CHAIRWOMAN HILLER: Right. COMMISSIONER NANCE: -- so we're not going to have the Deputy Medical Director be an employee of the Medical Director. CHAIRWOMAN, AIRWOMAN HILLER: No. COMMISSIONER NANCE: We're going to bifurcate those into two separate and distinct -- Page 139 Packet Page -203 5/14/2013 10.G. March 12. 2013 CHAIRWOMAN HILLER: Right. COMMISSIONER NANCE: Okay. CHAIRWOMAN HILLER: Two independent parties. And the reason again being from what I said in the beginning is that. e company, If , you know, right now they're all wrapped under on that one company goes, the county has no continuity. If we have two separate contracts with two separate individuals, if the Medical Director goes, we have the Deputy Medical Director who stays, or conversely. So we're never dependent just on one entity or one individual, which I think is rislc-y, for that office. Because we by law can never be without a medical director. COMMISSIONER NANCE: But we are going to be all inclusive CHAIRWOMAN HILLER: COMMISSIONER NANCE: to declare -- Yes. -- but we're croinc, to require them going CHAIRWOMAN HILLER: Yes. COMMISSIONER NANCE: -- all affiliations and associations with hospitals, medical centers -- CHAIRWOMAN HILLER: Yes. COMMISSIONER NANCE: -- centers of excellent -- CHAIRWOMAN HILLER: Correct. COMMISSIONERNANCE: And so on and so forth. And I think that can be a positive thing. CHAIRWOMAN' HILLER: Yes. Yes, that's exactly correct. MR. OCHS: Correct. Then the scope of the RFP will essentially be the -- CHAIRWOMAN HILLER: MR. OCHS* -- statute. CH AIRWOMAN HILLER: under the statute. MR. OCHS: Okay. The statute. Correct. And the requirements Page 140 Packet Page -204- 5/14/2013 10.G. March 12, 20 1' ) CHAIRWOMAN HILLER: No? MR- KLATZKOW: It's up to you. CHAIRWOMAN HILLER: Yeah. That's what it should be. That's what we're hiring. That's what we have to do by law. COMMISSIONER COYLE: So we are excluding the PSA from having any input on the solicitation process itself. I think it's a big cr mistake. I"- CHAIRWOMAN HILLER: No, they are very much involved in the solicitation, but the solicitation from the standpoint of interviewing the candidates and ranking the resumes in terms of how they qualify against the statute -- we cannot be without a Medical Director. We cannot be dependent on a single Medical Director who also controls the Deputy Director or we're without a Medical Director if that Medical Director leaves, which again goes contrary to law. And the role of the Medical Director is statutorily defined, and that is what we are seeking to satisfv. I mean, that is the criteria. COMMISSIONER, COYLE: There's no argument on the issue of bifurcating the Medical Director and the Assistant Medical Director. There is only a proposal that we send the information to the Public Safety ., Authority before we release an RFP to solicit applicants. There are things that the Public Safety Authority could do to help improve the solicitation process. CHAIRWOMAN HILLER: I'm not sure what. It's statutorily designed. COMMISSIONER COYLE: And the statute simply does not -- it does not deal with all of the internal operating procedures of our Public Safety Authority and the methods of reviewing and vetting medical policies. t1- CHAIRWOMAN HILLER: Well, that's again already legally defined in the ordinance. COMMISSIONER COYLE: No, it's not. CHAIRWOMAN HILLER: Yes, it is. Page 141 Packet Page -205- 5/14/2013 10.G. March I "', 2013 COMMISSIONER COYLE: No, it's not. CHAIRWONLA.NTHILLER: It is. MR. OCHS: Commissioner, my only concern was since you're soliciting for independent contractor services of a physician, that a group of physicians reviewing that solicitation before it went out may, be able to add some perspective or value added on the approach, not necessarily changing obviously any of the statutory requirements. So it's a recommendation you can take or leave. CHAIRWOMAN HILLER: The only reason I say leave it is because first of all the PSA has very few physicians. MR. OCHS: Well, they have at least four on their medical directory subcommittee, ma'am. They have two ER does, plus they have the current Medical Director and the holder of the North Naples Fire Department COPCN. CHAIRWOMAN HILLER: Again, I just don't see anv value add. I mean, if I believed that they would actually add value to the process, I would completely support it. But since it's very clearly defined, you know, the statute dictates, you know, what we're looking for, that's really what we should be soliciting to. I mean, I don't think that, you know, any -- what I don't want to see, and this is my concern, I don't want to see any politics in this. And when you start massaging what the statute provides by adding this or qualifying that way, you basically are starting to manipulate the selection process and turn it political. I would like to leave it as neutral and as generic as possible so that we get all possible applicants. Because I agree with Commissioner Fiala, you know, our goal is to get as many qualified people as possible, have the PSA altogether interview these candidates, because this individual will be working with all the representatives in the PSA that are there on behalf of their respective agencies, and that way you really have the fairest, most clean process. I would actually -- this is the last comment on this subject. Palle 142 Packet Page -206- 5/14/2013 10.G. March 12, 2013 Commissioner -Nance? COMMISSIONER NANCE: Yes, I agree completely with Commissioner Coyle. You know, I felt like Commissioner Coyles efforts were to take the qualifications out of the solicitation, and I don't think there's anything cleaner than what's been proposed and that is just to take it based on the qualifi -- based on statute, and the statute defines who a Medical Director can be. And it's actually pretty broad. It's physicians associated -- associations of physicians, corporations, all sorts of things. We Just have to -- you know, if we do our job well and advertise it well and get it out to people, I think we'll get a bunch of solicitations and then we can see what we get. How could it be any broader? CHAIRWOMAN HILLER: Right. And it's COMMISSIONER NANCE: -Am I missing something" If I am. I don't know what it CHAIRWOMAN HILLER: I think it's very apolitical in this matter. COMMISSIONER COY LE: Then how could it hurt to send it to the PSA for review before it goes out? CHAIRWOMAN HILLER: Because it's unnecessary. TV - • Page 143 Packet Page -207- 5/14/2013 10.G. March 121. 20 13 CHAIRWOMAN HILLER: Motion carries 4-1. And we encourage everybody who feels they're qualified and who will serve the best interest of the communit.,y, by way of providing emergency service protocols apply. Thank You. MR. OCHS: Madam Chair, that moves us to your 2:00 p.m. time certain hearing. Normally you would have taken a short break before that hearing for the court reporter, but we've been advised that the court reporter is swapping out with the replacement at 3:00 and she's indicated a willingness to keep going 'til that break, but we would ask for a short break at 3:00, ma'am. CHAIRWOMAN HILLER: Thank you. Item #913 ORDINANCE 2013) -24: PUDZ-A-PL20-120000726, THE TOP HAT AUTO COMMERCIAL PLANNED UNIT DEVELOPMENT (CPUD), AN ORDINANCE OF THE BOARD OF COUNTY COMMISSIONERS OF COLLIER COUNTY, FLORIDA AMENDING ORDINANCE 2004-41, AS AMENDED, THE COLLIER COUNTY LAND DEVELOPMENT CODE, WHICH ESTABLISHED THE COMPREHENSIVE ZONING REGULATIONS FOR THE UNINCORPORATED AREA OF COLLIER COUNTY, FLORIDA, BY AMENDING THE APPROPRIATE ZONING ATLAS MAP OR MAPS BY CHANGING THE ZONING CLASSIFICATION OF HEREIN DESCRIBED REAL PROPERTY FROM THE PRINCESS PARK PLANNED UNIT DEVELOPMENT ZONING DISTRICT TO A COMMERCIAL PLANNED UNIT DEVELOPMENT (CPUD) ZONING DISTRICT FOR AN 11.3 6T /- ACRE PARCEL TO BE KNOWN AS THE TOP HAT AUTO CPUD, TO ALLOW CONSTRUCTION OF AN AUTOMOTIVE SALES FACILITY WITH ASSOCIATED REPAIR SERVICES, ON PROPERTY Pate 144 Packet Page -208- 5/14/2013 10.G BrockMaryJo From: Reg Buxton [nnjoumal@mmcast.net) Sent: Tuesday, May 07, 2013 9:20 PM To: OchsLeo Cc: PriceLen Subject: PSA BCC reg At its May 7"' meeting concerning the candidates for Deputy Medical Director and Medical Director; the following three motions were passed by majority vote. 1 Motion If the BCC does not want the PSA to rank and score the proposals, no meeting should be held 2 Motion Request the BCC to allow the PSA the time to meet with and ask questions of candidates and provide those answers ( minutes and transcripts ) to the BCC for their use in selecting the appropriate candidates . Suggestion is for meeting sometime after May 28 3 Motion Request the BCC provide a liaison to the PSA who can coordinate with County Departments ( Legal, Purchasing, etc ) similar to that of other committees There are two different interpretations on the PSA as to how the BCC wanted the PSA to proceed with the Deputy and Medical Director process One was that the applicants for both positions were checked that they met the criteria as stated in the Florida Statues for each position and those that did were to be listed in alphabetical and sent to the BCC The other was that the PSA was to score and rank each candidate and than send a list for both positions as they were scored and ranked. It is requested that a clear concise direction be given the PSA by the BCC on how this should proceed Reg Buxton Chair PSA 1 Packet Page -209 - h