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Minutes 10/12/1982 Naples , Florida October 12 , 1982 e. . • LET IT BE REMEMBERED, that the Emergency Medical Services Advisory Council met on this date at 4 :00 P.M. in the Fifth Floor Conference Room, Building "F" of the Courthouse Complex with the following members as indicated below: CHAIRMAN: Egon Hill MEMBERS : Jan Fillinger (Absent) Dr. Hanns Ehrhardt Sgt. Richard Davidson (Absent) Chief Jim Billman (Absent) Mr. David Graham Mr. Marvin Cecil (Excused) Mr. Biff Comte Mr. Richard Akin (Excused) EX-OFFICIO MEMBERS : Chief Norris Ijams Dr. John Adams for Dr. Wm. Cox C. G. Whidden for (Excused) Sheriff Rogers STAFF ADVISORS : Dr. John Adams Douglas Greenfield Dr. Robert Tober (Absent) W. Neil Dorrill ALSO PRESENT: Karen Coccio, Joan Hamilton, Michael Jones, and Billie Moyer AGENDA I. Roll Call II. Reading and/or approval of minutes a) Regular meeting of August 10, 1982 III . Advisors Reports IV. Old Business V. New Business a) Certificate of Necessity and Convenience - Air Ambulance, Ambassador Airway, Inc (Neil Dorrill) VI. Adjourn EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 APPROVAL OF MINUTES OF AUGUST 12 , 1982 : Minutes of the meeting of August 10 , 1982 were approved to include the following amendments : Page 2/Paragraph 1 - changed to read: Dr. Ehrhardt remarked, "Is it not surprising that we have such an increase in our collec- tion rate despite the increase in charges. " Page 2/Paragraph 2 - to include the County Manager's correction that: "While the Board does not have a specific policy requiring that we collect a certain amount, it specifies that the amount of 40% of EMS revenue does come from User' s Charges as a result of the adopted budget. " ADVISORS REPORTS: Mr. Dorrill reported the adoption of an Emergency Ordinance allowing the Board of County Commissioners to continue to have a regulatory capacity relating to non-emergency transport service. This , he said, came about as a result of our becoming aware of two particular non-emergency transport services based in Ft Myers now operating here and/or advertising locally the availability of their services. Upon learning of this, Mr. Dorrill stated, we immediately contacted Dr. Adams , our local HRS representative, as well as the State HRS Licensure Division and complained that these services were violating state regulations as well as county regulations . Recognizing that the State had elected as of October 1 to no longer regulate non- emergency transports as is related to obtaining a Board authorized Cer- tificate of Convenience and Necessity, we elected through the County Attorney 's office to make this a requirement in order to operate in this county. Mr. Dorrill said that in addition to meeting the requirements of - 2 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 our existing EMS Ordinance 81. 75, a satisfactory petition including information as outlined in this Ordinance must be submitted to his office for his review after which he will subsequently make recom- mentation to the Board of County Commissioners . Recalling that the meeting of September 21 was not held because we had no quorom, Mr. Dorrill advised that a discussion had been held among those present relating to a petition received from Ambassador Airways, Inc. to establish the first air-ambulance service in Collier County. Mr. Dorrill said that recognizing that we had already twice postponed the petition after accepting an application fee of $250 , and realizing that EMS Ordinance does not require the Emergency Medical Services Advisory Council to review the petition, he at his discretion felt it would be appropriate to forward it to the Board for their action. It was unanimously adopted and the service is now licensed to operate in Collier County. Doug Greenfield said the owner had come to his office after the inspection to report the lack of some equipment required by the State for BLS and had asked to borrow this equipment from the County until he was able to purchase his own. Mr. Greenfield said he told the owner he did not think this was the way the State intended it to be whereupon the owner returned to Dr. Adams who furnished him with the name of a vendor. Doug added that he had not seen the owner since • that time. Dr. Adams advised that until such time as the required equipment was obtained, the owner is still not licensed to transport anyone from this county on a frequent basis, but that he does not need a license to transport into this county. - 3 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 Dr. Ehrhardt made a motion that for the record it be stated that EMSAC had no chance to advise on this petition because the BCC has already acted in granting the Certificate. Mr. Hill asked that this be recorded as part of the minutes but did not feel it was necessary to vote on it. Doug Greenfield stated there seemed to be some discrepency in the Emergency Ordinance with the item concerning conflict and sever- ability mentioned on the last page - Section 26 in relation to correlation with the existing County Ordinance and recommended that some research be made on it. Mr. Dorrill said that the actual Ordinance was prepared in its emergency nature by the County Attorney and that he would be happy to report back to the Council at the next meeting if a discrepency were found which required Board action. A lengthy discussion began at this point regarding the petition from Ambassador Airways, Inc. , with Mr. Graham objecting strenuously to its having been "rushed through for no apparent reason" and asking to go on record as stating that he sees it as an "unwarranted intru- sion on private industry, since we are not dealing with emergency vehicles here, but with taxis. " He further stated that he felt someone was trying to hide something by not allowing the EMSAC to review and discuss it before going before the Board. Mr. Dorrill reminded Mr. Graham that this particular advisory council does not have the right under the existing Ordinance to review a Certificate of Need and Necessity, since the State law provides that this is up to the sole discretion of the Board of County Commissioners and added that in this case it is not legis- lature but merely a petition to operate in this county. - 4 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 Mr. Graham said he was concerned about the County regulating an industry for no other reason than to regulate it and remarked that he has a basic dislike for government getting into private industry because any time this happens the cost goes up and the efficiency goes down and added that he saw no reason for ambulance service for non-emergency transports when a public service such as a taxi could do as well , and cheaper. Mr. Hill asked that another topic be addressed at this point. The discussion continued however when Doug Greenfield asked to speak on the comment made by Mr. Graham referring to "something shady being pulled. " He said he had made an emergency petition to the Board for support of special legislature in June of this year to have a continuation of Chapter 401 and that although this was decided on June 21st, we did not get our new rules from the Senate (Senate Bill 19H) until the end of July. It was in reading this Bill , Doug said , that he learned it was to be state-wide in all coun- ties that these particular agencies would no longer be regulated at the local level and a meeting was arranged between himself , Neil Dorrill, Mr. Norman, and the County Attorney. We asked the County Attorney if the existing local Ordinance and Need and Necessity requirements , refer- ring to one particular paragraph, protected this County from anyone coming in here and setting up shop with non-emergency transport vehicles . It was the feeling of the County Manager, under the section where the Ordinance identified those who would be exempt of having to acquire a Certificate of Need and Necessity, that there existed some doubt as to the legal clarity of one specific clause relating to non-emergency type transports. - 5 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 Mr. Greenfield stated that his particular reason for requesting this administration and the County Attorney to look into the overall effective interpretation of this existing County EMS Ordinance, as it related to non-emergency transport providers, was to insure that the County had clear control of these services before they had an open opportunity to step into operation after October 1, 1982 . Mr. Greenfield advised that Ms. Nancy Lee McKay, of Hillsboro County EMS, will be at the next meeting to talk with us as a group about some of the problems in that county and how they have dealt with them. Mr. Hill asked for the latest information on collections. Mr. Dorrill said that we do not have the final printout, but recalled the amount to be $470 ,000, which is $70 , 000 over the amended figure we presented to the Board during the budget process . He advised he would have the final printout by the next meeting. Mr. Greenfield next spoke of two particular areas he plans to attack strongly in his department; one being training at the basic level, which he feels the paramedic does not get enough of, and the other being alternatives in managing the system on different levels. In doing this, he said, he has asked Keith Finlayson, senoir paramedic , with a broad background in emergency medicine, to put together a resume of a philosophy of non-emergency transports in the Immokalee area and alternatives which might be used. Since Ms . Finlayson has worked in the Immokalee area and he feels that her information would be well done, Mr. Greenfield said he plans to study her perspectus and deliver a report on it at a future meeting. - 6 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 Mr. Greenfield further stated he would like to put together a workshop to see if we have any alternatives to follow in cases where many of the non-emergency transports from Immokalee were persons on welfare who had no family doctor and were simply using the non-emergency transport service as a means of seeing one when they were sick. To Mr. Greenfield ' s comment that these same people always seem to find a way back home, Mr. Comte replied that this is not always true, since the hospital spends a lot of money each year on taxis and buses to send them. Mr. Greenfield expressed his concern over the resignation of Mr. David Shockey, EMS Coordinator with HRS, Tallahassee, whom he feels has been the most participating Coordinator we have ever had at state level, and also of the change in positions made by the Assis- tant Director in Tallahassee. Doug said he feels this breakup in HRS will be very important within a year when the legislature is asked to decide who will be the authoritative licensure for the state of Florida. Will it be HRS or DPR (Department of Professional Regulations) . He mentioned also a petition which is now going around the State from the Fire Marshall and Sheriff's Commission office asking that it be put in their control since they are an emergency agency and indicated that he would report back to the Council as soon as he hears more on the controversy concerning this item on the agenda. NEW BUSINESS: Mr. Hill asked that the nominating committee made up of Chief Ijams, Dr. Ehrhardt, and himself meet in Chief Ijam's office on Friday, October 15, to select nominees to fill the three (3) -vacan- cies now on the Board. - 7 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL October 12 , 1982 NEXT MEETING: The next meeting of the Emergency Medical Services Advisory Council will be held on Tuesday, November 9, 1982 , at 4 : 00 PM, in the 5th floor Conference Room. ADJOURNMENT: There being no other business to come before the Council, the meeting was adjourned by Mr. Hill at 4 : 55 PM. Egon Hill, Chairman Minutes prepared by Billie Moyer - 8 -