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Agenda 10/26/2010 Item #10HAgenda Item No. 10H October 26, 2010 Page 1 of 7 EXECUTIVE SUMMARY Recommendation to deny North Naples Fire Control and Rescue District's Application for a Certificate of Public Convenience and Necessity for an Advanced Life Support Non - Transport Service. OBJECTIVE: To proceed in the best interest of public health, safety and welfare as it relates to Advanced Life Support (ALS). CONSIDERATION: On September 17, 2009, North Naples Fire Control and Rescue District ( "Fire District ") submitted an Application for a Certificate of Need to provide ALS Non - Transport Services ( "Application "). Staff timely conducted a thorough review of the Application, submitted correspondence for additional information that was not submitted or incomplete within the application, and met with the District's legal counsel. The Application was also placed in suspense for a period of time at the request of the Fire District and then subsequently re- activated at the request of the District's legal counsel. Staffs basis for denial is set forth in a letter to the County Manager, dated July 1, 2010 (see copy attached). Importantly, staff recommends denial of the Application based on the following: • Fire District submitted an application for a non - transport Certificate of Public Convenience and Necessity for the purposes of providing Advanced Life Support Non - Transport Operations separate and apart from the County Medical Director's medical direction, coordination, and control, solely to the North Naples Fire District. Such separate medical direction is contrary to the provisions, duties, and responsibilities of the County's Medical Director, as referenced in Florida Statute 401.265. This ruling was further clarified by a Final Order issued by the Florida Department of Health, in Department of Health case number 2010 -0040. (This order is included in the staff response and documentation which due to its size is too large for mass publication. Copies of staff response and documentation are available for examination in the office of the Board of County Commissioners.) The Application did not provide any empirical data for its particular district or the County, supporting a Certificate of Public Convenience and Necessity other than citing references to the 2007 Emergency Medical Service Master Plan document, which was developed to review and analyze County -wide level of service standards in support of the Annual Update to Inventory Reporting (AUIR). Numerous operational changes have taken place since the 2007 report. • The Fire District also failed to indicate that it would staff the necessary emergency medical response resources in a manner that would not conflict or delay a medical call if its personnel and apparatus were responding to or involved in a fire response. Agenda Item No. 10H October 26, 2010 Page 2 of 7 FISCAL IMPACT: There is no fiscal impact associated with this Executive Summary. LEGAL CONSIDERATIONS: Ordinance No. 04 -12, Section 7 states: "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: (1) The extent to which the proposed service is needed to improve the overall Emergency Medical Services (EMS) capabilities of the County. (2) The effect of the proposed service on existing services with respect to 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 existing hospitals and other health care facilities. (5) The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. B. That the applicant has sufficient knowledge and experience to properly operate the proposed service. C. That, if applicable, there is an adequate revenue base for the proposed service. D. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area." Ordinance No. 04 -12, Section 8 provides: "in making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed, said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only." Staff response and documentation for this item is too large for mass publication. Copies of staff response are available for examination in the office of the Board of County Commissioners. —JAK GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with this Executive Summary. RECOMMENDATION: That the Collier County Board of County Commissioners denies North Naples Fire Control and Rescue District's Application for a Certificate of Public Agenda Item No. 10H October 26, 2010 Page 3 of 7 Convenience and Necessity for an Advanced Life Support Non - Transport Service as there is no public necessity for the service. PREPARED BY: Dan E. Summers, Director of the Bureau of Emergency Services. Agenda Item No. 10H October 26, 2010 Page 4 of 7 CO 7eY County Bureau of Emergency Services Memorandum TO: Mr. Leo Ochs, County Manager FROM: Dan E. Summers, Direct DATE: July 1, 2010 RE: Staff Review - COPCN Application North Naples Fire Control and Rescue District Enclosed is the Certificate of Public Convenience and Necessity filed by the North Naples Fire Control and Rescue District, along with a compilation of written communication involved in the review. The COPCN filing was originally received in your office September 18, 2009 and submitted by J. Christopher Lombardo, Chairman of the North Naples Board of Fire Commissioners. The appropriate filing fee was also received. During the review of the application, Mr. Richard Yovanovich became the principal agent for this filing. Along the course of the application review period Mr. Yovanovich requested the application be placed "on- hold ", as numerous discussions and meetings were held at their request regarding the current Advanced Life Support Interlocal Agreement(s) which were considered. for amendment in lieu of the COPCN process. These lengthy discussions with Mr. Yovanovich, the Medical Director, and others at various boards and committee meetings as well as the Blue Ribbon Study group, did not resolve the many debates between the Advance Life Support and Basic Life Support delivery modalities preferred by North Naples. On May 17, 2010 Mr. Yovanovich notified the County of his desire to re -open our review of the COPCN application. Days following this notification, written communication was transmitted to Mr. Yovanovich, acknowledging his re- activation of the application along with additional requests for information to help provide a thorough review of the application. Subsequent to the additional information referenced above, it has come to my attention that the financial information provided by the North Naples Fire and Rescue District was out -of -date with the re- opening of the COPCN. I communicated by email with.Mr. Yovanovich and received the latest financial CS 8075 Lely Cultural Parkway • Naples, Florida 34113.239- 252 -3600 • FAX 239 -252 -3700 • www.collierem.org Agenda Item No. 10H October 26, 2010 Page 5 of 7 Staff Review- COPCN Application North Naples Fire Control and Rescue District July 1, 2010 Page 2 information. I have deemed the application submittal complete, effective June 29, 2010 within the intent of Ordinance 2005 -16 as required. Mr. Yovanovich has been notified in writing of the application being deemed complete by my office. It should be noted that the bulk of the application submission included a copy of the 2007 EMS System Master Plan prepared by a consultant, in conjunction with discussions associated with a review of the Annual Update to Inventory Reporting (AUIR). The 2007 EMS Master Plan reviewed data and projections during the periods of 2005, 2006, and 2007 which were periods of extensive growth within the County. Due to changes in the EMS delivery systems, national refinements in best practice, and population projections, the 2007 Master plan discounts the substance of the application as requested by North Naples Fire Control and Rescue District in its justification of the COPCN application.. Many factors highlighted by North Naples Fire Control and Rescue District in their application have been overcome by a number of changes in either delivery of services or are mute with respect to the spirit of the COPCN supporting county -wide services. They include, but are not limited to, the following: Absence of growth projections that were predicted during the time of the report. - Refinements in national standards and academic research verifying the importance of a two - tiered BLS /ALS system delivery. ^ Implementation of the Advanced Practice Paramedic (MedCom) in one -man vehicles. Improved dispatch procedures. - Cancellation of the ALS agreements at the North Naples and East Naples Fire District. Ongoing data point analysis by the Blue Ribbon group to further refine system delivery in a two- tiered fashion. - . Collier County's extensive network of publicly and privately accessible. Automatic External Defibrillators and their associated registration ordinance. Additionally, the COPCN Ordinance in Section 7 states the following: "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence, that each of the following standards has been met." Essentially, there are eight provisions within Section 7 of the ordinance that have, in my opinion, not been met, further discounting the award of a certificate. I have given the application a thorough review based on criteria provided in the ordinance referenced above. In summary, it is my recommendation that a Certificate of Public Convenience and Necessity should not be granted to the North Naples Fire Control and Rescue District, as it does not demonstrate better protection for the health, safety and welfare of the residents of Collier County as a whole in ambulance and AILS matters, by establishing uniform countywide standards, etc., as referenced in Section 1 of the Purpose statement of the ordinance. In the absence of countywide improvement alone, Agenda Item No. 10H October 26, 2010 Page 6 of 7. Staff Review- COPCN Application North Naples Fire Control and Rescue District July 1, 2010 Page 3 the COPCN application, in my opinion, is not a valid application for services and threatens to increase risk in the pre - hospital care field environment with separate medical controls. The COPCN effort is designed for services within the "County" — geographically overall, and in my opinion, is not applicable for a district limited type of service as requested by North Naples Fire Control and Rescue District. North Naples. Fire Control and Rescue District's application provided no indication that they would provide services outside of their boundaries on a routine basis as opposed to the current way in which mutual aid is provided on a case -by -case incident basis, therefore not serving the County as a whole. Denial of this COPCN application does not prohibit the county or the Medical Director from exploring other refinements to the two - tiered concept of pre - hospital care delivery involving the Fire services. Indeed the Fire Service can and does provide important services to the emergency scene. Those efforts should continue in a fashion that provides prompt BLS support in an environment of reduced risk, ensuring adequate resources for their primary mission and links in the chain of care that are consistent standards of practice, and single point medical control. 1 I look forward to meeting with you at your earliest convenience regarding this discussion. Thank you. Attachments: North Naples, COPCN Application cc: Mr. Scott Teach, Deputy County Attorney 0) Agenda Item No. 10H October 26, 2010 Page 7 of 7 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS Item Number: 10H Item Summary: This item to be heard at 1:00 p.m. Recommendation to deny North Naples Fire Control and Rescue Districts Application for a Certificate of Public Convenience and Necessity for an Advanced Life Support Non - Transport Service. (Dan Summers, Director, Bureau of Emergency Services) Meeting Date: 10/26/2010 9:00:00 AM Prepared By Dan E. Summers Director of Emergency Services Date Bureau of Emergency Services and Emergency Bureau of Emergency Services and Management Emergency Management 10/18/2010 3:14:56 PM Approved By Dan E. Summers Director of Emergency Services Date Bureau of Emergency Services and Emergency Bureau of Emergency Services and Management Emergency Management 10/18/2010 3:24 PM Approved By Jeff Page Chief- Emergency Medical Services Date Bureau of Emergency Services EMS Operations 10/18/2010 3:26 PM Approved By Sherry Pryor Management/ Budget Analyst, Senior Date Office of Management & Budget Office of Management & Budget 1011912010 11:26 AM Approved By Leo E. Ochs, Jr. County Manager Date County Managers Office County Managers Office 10/19/2010 2:16 PM Approved By Jeff Klatzkow County Attorney Date 10/19/2010 2:47 PM