EMS Policy Minutes 11/18/2011 runnvEl
November 18,2011
BY:
MINUTES OF THE COLLIER COUNTY
EMERGENCY MEDICAL SERVICES POLICY ADVISORY BOARD
EMERGENCY MEETING
November 18, 2011
Naples, Florida
LET IT BE REMEMBERED that the Collier County Emergency Medical Services
Policy Advisory Board, having conducted business herein, met on this date at 4:00 PM
in EMERGENCY MEETING SESSION, at the Neighborhood Health Clinic,
12 Goodlette Road N.,Naples, Florida, with the following Members present:
Chairman: James Talano,M.D.
�✓ Vice Chair: Chief Robert Metzger
Fiala ✓ Battalion Chief Tabitha Butcher
Hiller
Rennin Rosemary LeBailly, RN
9 'r
Coyle r (Vacancy)
Colette
Misc.Corres:
Date: 3i 13/12.
Item# ic:oz2AI �
ALSO PRESENT: Copies to:
Dr.Robert Tober, Collier County Medical Director
Walter Kopka, Interim Chief, Bureau of Emergency Services
Maria Franco, EMS Administrative Assistant
Jorge Aguilera, Deputy Chief, Medical Services/Community Relations
1
November 18,2011
1. CALL TO ORDER:
Chairman James Talano called the meeting to order at 4:07 PM.
A quorum was established. Four members were present.
(Note: Jerry Pinto's term of office expired.)
Chairman Talano noted the emergency meeting was called to comply with a directive from
the Board of County Commissioners.
Chief Kopka stated the Commissioners asked if the EMS Policy Advisory Board had reviewed
and voted on the COPCN application from Ambitran. When it was noted the EMS Board had
only reviewed and discussed the Ordinance,the BCC requested the Board to review it again and
take a vote.
Chairman Talano expressed concern that approving a contract was not within the scope of the
Policy Advisory Board's responsibilities.
Vice Chairman Metzger stated the EMS Board was asked to review the changes to the
Ordinance,which is not a contract. He further stated the EMS Board has previously reviewed
other Ordinance drafts that related to EMS services.
Chief Kopka confirmed it was within the Policy Advisory Board's purview to review all factors
that relate to pre-hospital emergency care.
The Pledge of Allegiance was recited.
2. AGENDA AND MINUTES:
A. Approval of Agenda
Vice Chairman Metzger moved to approve the Agenda as submitted. Second by Battalion
Chief Butcher. Carried unanimously,4—0.
B. Approval of Minutes: November 4,2011
Vice Chairman Metzger moved to approve the minutes of the November 4,2-011 meeting
as submitted. Second by Rosemary LeBailly. Carried unanimously,4—0.
3. OLD BUSINESS:
A. Ambitran's COPCN("Certificate of Public Convenience and Necessity")Application
Review and Recommendation to the Board of County Commissioners
Chief Kopka reviewed the changes to the enabling Ordinance as follows:
• Page 2. "K": (The item was added.)
Chief Kopka stated Ambitran was issued a Permit in October 2011. The
Ordinance was changed because Ambitran did not fall into any of the categories
within the COPCN. He noted the COPCN allowed inter-hospital transport services.
Ambitran is a private company that provides transport services but is not hospital-
based.
He further stated Commissioner Hiller asked for data concerning how the new
service(Ambitran)would affect the current service,i.e.,how many ambulances
would be needed,how many patients Ambitran would transport. She wanted to
2
November 18,2011
know what NCH had done,what was EMS doing, and what would be done by
Ambitran.
Chairman Talano stated his understanding that NCH provided only facility-to-
facility transfers,and Ambitran would provide transfers only from facility to
facility.
Chief Kopka stated EMS was still providing transfers to Physicians' Regional
Hospital.
Chairman Talano asked if Ambitran would provide service to both NCH and
HMA.
Chief Kopka confirmed that was the goal although EMS realizes there will be
occasions when Ambitran will not be available and EMS will provide the
necessary service.
Vice Chairman Metzger stated the Ordinance opened the door for a private
sector transport company,which would not be problematic as long as the provider
remained viable. His concern was that the EMS system would be altered to
accommodate the private sector and, if the provider failed,EMS would be
required to alter its system again to absorb the absence of the private sector
provider,
Chief Kopka reminded the Board that EMS was forced into providing service on
October 22,2011 when NCH sent an email at 4:00 PM announcing it would no
longer provide facility-to-facility transports.
• Page 2,Section Two, "B":
Chief Kopka stated Paragraph"B"summarized and combined the two stricken
subparagraphs(2 and 3.)on Page 3 in an effort to simplify the document.
o .The"Class-2"will provide post-hospital inter-facility medical transfer
services within and outside the County.
o If requested by a Class 1-ALS Rescue Operator(i.e.,EMS),the"Class-2"
will also provide emergency pre-hospital backup service.
o The"Class-2"may provide their Medical Director who will work
cooperatively with the County's Office of the Medical Director.
o The"Class-2"will comply with all guidelines and policies approved by the
Collier County Board of County Commissioners.
o The"Class-2"will notify all hospitals and facilities of the services it provides
and will work cooperatively with them.
Chairman Talano pointed out the reference to Florida Statutes, Section 401.265
and to the Florida Administrative Code,Chapter 64J-1.004(4)(a)had been eliminated.
Suggestion: Insert a comma and the phrase,"as set forth in Florida Statutes,
Section 401.265 and the Florida Administrative Code, Chapter 64J-1.004(4)(a)"
following the word"utilized"at the end of the last sentence in Paragraph B.
(Dr. Robert Tober arrived at 4:25 PM.)
3
November 18,2011
• Paragraph G- "Certification:"
Chief Kopka noted clarification was needed. He suggested changing the
underlined portion of the second sentence to read as follows: "Each Collier
County EMS Paramedic and Class-2 Operator Paramedic who contracts with the
County for Medical Director services must work ..."
• Page Four,Section Sixteen:
Chief Kopko noted the word"Central"had been stricken from the title"Place of
Business"as well as from the first sentence of the paragraph.
Public Speaker:
Deputy Chief Jorge Aguilera stated North Naples concern was Item"K"on Page 2. He
referred to the current Ordinance and cited from Section Seven:
"The Board of County Commissioners shall not grant a Certificate unless
it shall find,after public hearings and based on competent evidence,that
each of the following Standards has been satisfied: (a) that there is a public
necessity for the service.
In making such determination, the Board of County Commissioners shall
consider as a minimum the following factors:
1. The extent to which the proposed service is needed to improve the
overall Emergency Medical Services capabilities of the County;
2. The effect of the proposed service on existing services with respect
to the quality of service and cost of service;
3. The effect of the proposed service on the overall cost of EMS service
in the County;
4. The effect of the proposed service on the existing hospitals and other
health care facilities;and
5. The effect of the proposed service on the personnel of the existing
service and the availability of sufficient,qualified personnel in the local
area to adequately staff all existing services."
He stated the information requested in Item"K"already exists within the Ordinance. He
stated he was not sure if Commissioner Hiller was aware of this section within the
Ordinance.
He further stated the Applicant did not respond to the questions in the COPCN application,
nor did it provide any evidence.
He continued Item"K"was redundant since there were several other sections within the
Ordinance which required the Applicant to produce evidence.
4
November 18,2011
He reiterated North Naples' objection and noted the reason for revising the original
Ordinance was to clarify that the provider was not associated with any local hospitals. The
initial Ordinance specified that the private provider must be associated with a local hospital
in order to provide transport services.
He concluded North Naples requested deletion of Item "K"since it had no bearing on the
reasons why the Ordinance was revised.
He also suggested requesting a review of one of the changes, i.e.,the inclusion of the
reference to the Florida Statutes and the Florida Administrative Code, by the County
Attorney's Office since it may be problematic for the COPCN provider under its quality
assurance program because it required sharing documents with the County. He stated it was
a problem when North Naples applied for its COPCN.
It was noted that Ambitran was issued a Certificate to Operate despite not answering the
questions.
Vice Chairman Metzger stated he supported removing Item"K"from the revised
Ordinance.
Battalion Chief Butcher asked if Ambitran was required to provide ride time.
Chief Kopka confirmed it was not required to do so.
Vice Chairman Metzger moved to approve the revisions to the draft Ordinance as amended
by discussion by the Policy Advisory Board,to wit:
• To strike Item"K"on Page 2;
• To insert a comma and the phrase"as set forth in Florida Statutes, Section
401.265, and Chapter 64J-1.004(4)(a)of the Florida Administrative Code."
following the word"utilized"at the end of the last sentence in Paragraph B
o Interim Chief Kopka will submit the revision to the County
Attorney's Office for review.
• Paragraph G,"Certification:" The underlined portion of the second sentence is
changed to: "Each Collier County EMS paramedic and Class-2 Operator's
paramedic that contracts with the Countyfor Medical Director services must
work with a ...."
• Paragraph H,"Ride Time Requirement:" the underlined portion of the first
sentence is changed to: "that has entered into a contract with the Countyfor
Medical Director services ..."
• Section Sixteen: Strike the word"Central"from the title"Place of Business"as
well as from the first sentence.
Second by Battalion Chief Butcher. Carried unanimously,4—0.
Vice Chairman Metzger moved to approve providing advance approval of the revised
Ordinance pending the determination by the County Attorney's Office and any changes
suggested by the County Attorney's Office relative to the portions concerning inclusion of
the reference to Florida Statutes and the Florida Administrative Code.
Second by Battalion Chief Butcher. Carried unanimously,4—0.
5
November 18,2011
4. NEW BUSINESS:
(None)
5. STAFF REPORTS:
(None)
6. PUBLIC COMMENT:
(None)
7. BOARD MEMBERS DISCUSSION:
Chairman Talano:
• suggested changing the meeting time during"Season"from 3:30 PM to 5:00 PM.
Dr.Tober concurred,stating it would be impossible for him to arrive earlier than
5:00 PM.
Consensus: Meeting will begin at 5:00 PM only during"Season."
ChiefKopka:
• noted Jerry Pinto's term as a member of the Policy Advisory Board has expired and
he has not submitted an application to renew his membership.
• He suggested changing the representative category from"Pharmacist"to"Physician"
or"ER Physician."
• It was noted nominations would be made by the Medical Society.
Vice Chairman Metzger moved to approve revising the Committee's composition by
replacing the position of"Pharmacist"by a "Physician Trained in Emergency Medicine"
as nominated by the Medical Society. Second by Rosemary LeBailly.
Carried unanimously,4—0.
Chairman Talano suggested contacting Margaret Eddington at the Medical Society for
potential candidates.
Staff will prepare a notification letter to the Board of County Commissioners petitioning for
a change of composition of the Policy Advisory Board.
Consensus: The Committee approved allowing the Chairman to sign the letter to the
Board of County Commissioners without their prior review.
Vice Chairman Metzger:
• Stated there was an error of interpretation in the Minutes of the November 4th
meeting concerning the use of 12-lead technology by North Naples.
Vice Chairman Metzger moved to approve authorizing North Naples to use 12-lead
technology under its protocol. Second by Battalion Chief Butcher.
Carried unanimously, 12—0.
6
November 18,2011
8. NEXT MEETING DATE:Friday,January 20,2012 at 5:00 PM
There being no further business for the good of the County,the Meeting concluded by
order of the Chair at 4:45 PM.
COLLIER COUNTY EMERGENCY
MEDICAL SERVICES POLICY ADVISORY
BOARD
James
it
ano, .D.,Chairman
The Minutes were approved by the Board/Committee Chair on JCt VV, ak, eav ,20];1,
"as submitted"[K] OR "as amended" LA
7