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HomeMy WebLinkAboutCC Minutes - 01/27/09 Joint Elected OfficialsM I N U T E S Joint Elected Officials Eugene City Council/Springfield City Council/ Lane Board of County Commissioners/Lane Rural Fire Rescue Board of Directors Eugene Emergency Services Center—1705 West Second Avenue January 27, 2009 5:30 p.m. EUGENE CITY COUNCILORS PRESENT: Andrea Ortiz, George Poling, Betty Taylor, Alan Zelenka, Mike Clark, Chris Pryor, George Brown. SPRINGFIELD CITY COUNCILORS PRESENT: Christine Lundberg, Hillary Wylie, Joe Pishioneri, Dave Ralston, John Woodrow COMMISSIONERS PRESENT: Faye Stewart, Peter Sorenson, Bill Fleenor, Rob Handy. Bill Dwyer was excused. LANE RURAL FIRE/RESCUE BOARD OF DIRECTORS PRESENT: Larry vonMoos, Ray Brown Kevin King, Marvin King, Pete Holmes. I. CONVENE Andre LeDuc, director of the University of Oregon Emergency Management Program, introduced himself and announced he would serve as the facilitator of this evening’s Joint Elected Officials (JEO) Meeting. He looked forward to sharing useful information and having a lively discussion about ambulance transport service, an important issue for the community. II. CALL TO ORDER—FOUR GOVERNING BODIES Her Honor Mayor Kitty Piercy opened the meeting of the Eugene City Council and thanked everyone for their attendance. His Honor Mayor Sid Leiken convened the meeting of the Springfield City Council. Board of County Commissioners Chair Peter Sorenson called the board back into session from earlier in the day. He stated that Commissioner Dwyer had a meeting conflict and was excused from the JEO meeting. President Larry vonMoos called the Lane Rural Fire/Rescue Board of Directors to order. He expressed the appreciation of the board for this evening’s meeting. Mr. LeDuc introduced Springfield Fire Chief Dennis Murphy. MINUTES—Joint Elected Officials— January 27, 2009 Page 1 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils III. INTRODUCTORY COMMENTS—Springfield Fire Chief Dennis Murphy Chief Murphy reviewed the history of ambulance service for the area.. On May 1, 1981, Eugene, Springfield and Central Lane County witnessed the collapse of the regional service system that had been operated for over 26 years by a private company. In just a few hours, local fire departments pooled their resources and initiated emergency ambulance operations. In 1983, the fire departments, working together, won a state award for top performance and in 1985 were named number one in the nation for advanced life support ambulance systems. Additional accomplishments included: ? Eugene/Springfield Metropolitan area fire departments were the first to develop programs in ad- vanced cardiac care that were adopted statewide, nationally and internationally. ? The FireMed system was initiated to ensure that all people, regardless of their income, could afford to call for 9-1-1 ambulance service without worrying about the cost. FireMed had since spread to over 80 ambulance service areas in Oregon and California. In 1997, Fortune magazine recognized this area as one of the ten best areas to live for people who were at risk of suffering sudden cardiac arrest. The purpose of this evening’s meeting was to review issues that unless resolved, could lead to a destabilization of one of the nation’s premier emergency medical service systems. The current financial crisis started in 1998 when Congress passed legislation that began a reduction of reimbursement for ambulance services, followed by a subsequent reduction in 2003. The reductions following the negative impacts of the current economy must be dealt with to ensure the quality of service continued. Although each local jurisdiction had already taken steps to address the problem, tonight a new effort of joint problem-solving commenced. It was fitting that a regional problem was dealt with collaboratively by the region’s governments with the strength of past partnerships that had resulted in the program’s success. He noted the appropriateness of the scheduling of tonight’s meeting, because January 27, 2009, had been declared by Oregon Governor Ted Kulongowski as Fire Service Appreciation Day. IV. POWERPOINT PRESENTATION Eugene Fire Chief Randy Groves expressed his appreciation to those in attendance and acknowledged that elected officials were called upon to spend their evenings working for the betterment of the community. He reiterated the long-standing tradition in the central Lane County area of working together to build a world class emergency medical service (EMS) system that provided an experienced, stable workforce which brought a host of clinical sophistication to bear on medical emergencies. Chief Groves offered an overview of the issues before the JEOs with a PowerPoint presentation entitled Central Lane County Ambulance Service Summit. He said there were several policy questions to be addressed: ? Was ambulance transport considered a core service for local governments to provide? ? What level of pre-hospital care should be provided for our communities? ? Was there a more appropriate delivery model for our system? ? Should ambulance transport fees continue to augment general fund fire and rescue services? ? How should the ambulance transport system be funded? MINUTES—Joint Elected Officials— January 27, 2009 Page 2 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Chief Groves emphasized the importance of the three fire and EMS agencies working collaboratively and why it was important to deal with the problems together. Current issues facing the agencies included: ? Medicare and Medicaid reduced reimbursements accounted for more than 65 percent of all trans- ports. ? Unfunded mandates: Decreasing federal money to pay for federal programs. o Increasing state requirements for EMT recertification. o County designated metro/rural ASA, one level of service. o Medical Control Board established protocols/procedures. o ? Calls for ambulance transport services had increased over 40 percent since 2003. ? Effects of under-insured/uninsured/indigent patients. ? Costs of increased technical sophistication and equipment. Chief Groves noted the region’s ambulance transport system had evolved over time and was completely integrated with the community’s fire, rescue, hazardous materials, and emergency medical response programs, thus enhancing the entire system’s response capabilities. Chief Groves reviewed the emergency tiered response that consisted of: ? Advanced Life Support (ALS)/Basic Life Support (BLS) First Response—provided by a fire suppression company. ? ALS Medic Unit (ambulance)—provided treatment and transport. ? Air Ambulance—provided patient transport via helicopter. Chief Groves said emergency medical calls were resource intensive, adding patients received critical care in the field which had proven to decrease morbidity and mortality. He said there were eight Ambulance Service Areas (ASA) in Lane County designated by the BCC under the authority of the State of Oregon. The areas under discussion tonight included ASA 4—Eugene; ASA 5—Springfield; and, ASA 8—Lane Rural Fire and Rescue. Chief Groves provided a review of Lane County ASA 4. ASA 4 covered 432 square miles, and responded to 17,213 calls for service in FY08. System issues facing Eugene, similar to Springfield and Lane County, included: ? Eugene’s current fee-supported Ambulance Transport System (ATS) was not sustainable long term, with operating costs outpacing revenues. ? Eugene’s existing resource-based ambulance service had inadequate capacity to keep pace with the current call volume and workload. ? Calls for service were increasing. ? Ambulance transports were decreasing due to a state requirement that patients be advised of the cost of transport, better scene triage, and some transports to Sacred Heart Hospital previously pro- vided by Eugene were now provided to the new RiverBend campus by Springfield. Chief Groves reviewed the three types of units used by Eugene Fire and EMS: three dual-role medic units, two single-role medic units, and one overload company. Approximately 44 percent of dollars billed were MINUTES—Joint Elected Officials— January 27, 2009 Page 3 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils collected and fund reserves had steadily declined since 2000, with the exception of 2006, when a rate increase was implemented. Funding sources for FY09 consisted of: ? General fund: 75 percent. ? Ambulance Transport Fund: 21 percent. ? Other funds: 4 percent. Chief Murphy asserted the City of Springfield faced similar challenges to those of the City of Eugene and provided a review of Lane County ASA 5. ASA 5 consisted of a large rural area that covered 2,000 square miles and responded to 8,557 calls for service in FY08. System issues facing Springfield included: ? Operating expenses continued to outpace revenues. ? Revenue from FireMed and contract billing was used to help offset the inadequate Medicare and Medicaid reimbursement for ambulance services. ? Ambulance personnel were essential for minimum firefighter staffing. ? If not for ambulance user and membership fees, what other sources of revenue could be used to provide the current level of fire department incident response coverage? Chief Murphy explained that the Springfield Fire and Life Safety operated with three multi-role medic units and one overload company. Approximately 38 percent of dollars billed were collected and fund reserves had steadily declined since 2000. Funding sources for FY09 consisted of: ? General fund: 61 percent. ? Ambulance Transport Fund: 31 percent. ? Other funds: 8 percent. Chief Murphy emphasized the three ambulance companies backed each other up with borrowed equipment which provided significantly enhanced depth that would otherwise not be available. Statistically, demand in Eugene and Springfield did not occur simultaneously, providing the ability to provide backup for the other jurisdiction. Chief Borland averred Lane Rural Fire/Rescue faced similar challenges to those of the cities of Eugene and Springfield, and provided a review of Lane County ASA 8. ASA 8 consisted of a large rural area that covered 2,000 square miles and responded to 2,294 calls for service in FY08. System issues facing Lane Rural Fire/Rescue included: ? Department’s current fee-supported ATS was not sustainable long term. ? At what level should the general fund continue to support medical response and transport? ? Were there alternative funding sources? Chief Borland explained Lane Rural Fire/Rescue operated with two dual-role medic units and fire suppression and emergency medical response provided by approximately 60 volunteer firefighters. Approximately 45 percent of dollars billed were collected and expenditures were outpacing revenues. Funding sources for FY09 consisted of: MINUTES—Joint Elected Officials— January 27, 2009 Page 4 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils ? Tax payments: 57 percent. ? Ambulance Revenue: 45 percent. Chief Borland reviewed trends and solutions for regional ambulance transport service: Trends: ? Calls for service were increasing. ? Operating and administrative costs were increasing. ? Medicare age population was growing. ? Number of uninsured and under-insured patients was growing. Increased on-scene triage resulting in fewer transports. Potential Short-Term Solutions: ? Increase ambulance transport fees. ? Tax support (General Fund). ? First response fees. ? Sub-contracting inter-facility, non-emergent transports freeing up fire based resources. Potential Long-Term Solutions: ? Higher ambulance transport fees. ? Consolidate/merge department functions. ? Create ambulance service taxing district. ? Create a fire district or authority that incorporates ambulance transport into its base budget. ? Continue Congressional lobbying efforts to increase Medicare/Medicaid payments. ? Reconfigure ASA boundaries (urban/rural split). ? Develop an alternative service delivery model. ? New membership initiatives/programs. V. SCHEDULED SPEAKERS Mr. LeDuc introduced the evening’s scheduled speakers: Robert Leopold, EMS Director, Oregon Department of Health and Human Services, said when someone in Oregon called 9-1-1, they expected to have a competent, trustworthy person show up with correct equipment. That person also needed to be able to communicate with the hospital emergency department to ensure care initiated in the field continued at the hospital. It was extremely important to maintain these systems which the citizens relied on 24 hours a day. Funding health care was a challenge nationally, even before the current economic crisis. Rural communities that provided care entirely through volunteer systems in Oregon were finding the systems were not sustainable and urban areas were facing funding crises. The Oregon EMS and Trauma Systems Program were committed to working with chiefs and community leaders to find a way to make a sustainable EMS system. Tim Herrmann, Hospital Administrator, Sacred Heart Medical Center (SHMC) University District, stated SHMC was experiencing many of the same challenges expressed by the chiefs. He offered a PowerPoint presentation which illustrated those challenges. SHMC was also on a capitated payment schedule for Medicare and Medicaid resulting in reimbursements that were below costs, which was not a sustainable MINUTES—Joint Elected Officials— January 27, 2009 Page 5 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils trend. SHMC was challenged by approximately $66 million annually of charity bad debt. Additionally, the increased number of surgery centers in the area shifted patients with the ability to pay for services out of the hospital. Peace Health provided a majority of the behavioral health services for the region which were threatened by inadequate funding. Scott Olmos, president of the International Association of Fire Fighters (IAFF) local 851, representing Eugene and Lane Rural firefighters, welcomed elected officials to the summit and thanked Mayor Piercy, Councilor Ortiz and Chief Groves for recognizing the gravity of the situation. He represented a highly trained professional work group of Eugene firefighters and paramedics who responded to thousands of calls annually. Many citizens who had inadequate or no health care relied on EMS transport as their first line of health care. Capacity and workloads were at an unmanageable level for all firefighters and paramedics whom he represented, and had been for too long. Many patients had the means to pay for ambulance transport service and the once adequate source of funding could no longer sustain EMS in the Eugene area. The City, the union and the stakeholders had previously met to discuss the situation, and the union had determined there was only one viable alternative to solve the EMS crisis in Eugene. EMS must be designated as a core essential service. EMS transport must no longer be funded from an enterprise fund. The current system did not differentiate between various types of calls. Highly trained paramedics who responded to life threatening injuries and illnesses were also dispatched to inter-facility and non-emergency medical calls for which the department no longer had the capacity. The City of Eugene deserved an ambulance transport system to focus on life threatening emergencies. The current practice of sending City of Eugene paramedics well into the county was no longer a sustainable practice. Public safety was not and should not be in the business of making money and saving lives and was not an enterprise. He urged adoption of the following: ? Designation by the City Council of ambulance transport as an essential service funded appropriate- ly. ? Eugene Fire Department paramedics must continue to provide first response advance life support services and advanced life support transport. ? The City must expand its contract with private providers to include non-emergency, BLS support transportation and inter-facility transports. ? The City must immediately discontinue dispatching Eugene paramedics outside of the Urban Growth Boundary (UGB). Kevin Grey, IAFF local 1395, representing Springfield firefighters, welcomed everyone in attendance. The impacts of the decisions that came out of this forum would last for many years. He believed Springfield provided the highest quality of care on the streets which could not be matched by any other service provider. Capacity issues had been addressed by Chief Murphy and the Springfield City Council. Ambulances on the street had increased since 2003 to meet the community’s demand. There was an economic climate as well as the Medicare/Medicaid reimbursement issue that needed to be faced by everyone. Currently, Springfield had the capacity to handle the call volume and was not as stressed with the workload issue as Eugene. Springfield currently operated the best system possible with the dollars spent and any reductions would be detrimental to patient care. He looked forward to a positive outcome from the forum and did not want to see any drastic changes to the system. Susie Robinson, representing Oregon State Ambulance Association, provided a PowerPoint presentation that highlighted the funding challenges association members faced and the medical fee schedule. Changes MINUTES—Joint Elected Officials— January 27, 2009 Page 6 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils in service levels and fee schedules implemented in 2003 have had a significant impact on ambulance service revenues. Possible solutions included: ? Rate increases. ? Subsidies. ? Reduced response time requirements. ? Other expense reductions. Mr. LeDuc thanked the presenters. The group took a break from 6:30 p.m. to 6:45 p.m. VI. QUESTION AND ANSWER SESSION Mr. LeDuc reconvened the meeting and explained the ground rules for the Question and Answer session. He introduced resource people in attendance: Dr. Melissa Doherty, supervising physician for Eugene Fire and EMS; Dr. Rob Rockstroh, director, Lane County Health and Human Services; Mike Griffiths, chief executive officer, Life Flight; Mike Collins, Pacific Northwest Division general manager, Rural/Metro Ambulance; Dr. Eric Spencer, McKenzie Willamette Medical Center, and Maurine Cate, chief executive officer, McKenzie Willamette Medical Center. Chief Groves said the goal of the meeting was to educate the policy makers on what the problems were, present some potential solutions, and be able to identify substantial steps to address the problems on a regional basis by the end of the meeting. Medical Director of the Emergency Department at SHMC Dr. Gary Young, said he represented Eugene Emergency Physicians who provide emergency care at both SHMC campuses, and Peace Health Sacred Heart. He acknowledged there had been significant changes in 2008 with the move to RiverBend. He noted that emergency rooms (ER) at both campuses were staffed with ER physicians and nurses, and assured everyone that patients brought to the University District campus would receive the same high level of care as those taken to the RiverBend campus. He opined some of the more stable patients could be taken to the University District facility. He thanked the paramedics and others involved in the EMS system and apologized for any difficulty that may have occurred during the transition period. He noted the City of Eugene supported CAHOOTS, which responded to many behavioral and social problems. He thought if Springfield and other local governments would support CAHOOTS, it would take away many of the calls responded to by paramedics that were not medical in nature. He thanked those present for treating everyone the same which was a core value of our health care system. He encouraged everyone to support national health insurance to provide access to care for everyone thus preventing many calls to 9-1-1 or ER visits. He supported these comments offered earlier: ? First responder fees for 9-1-1 which do not result in ambulance transport to a hospital. ? Ambulance service should not extend beyond the UGB. ? Support for subcontracting for BLS, interfaculty transfers and non-emergency calls between hospitals and hospitals and nursing homes. He thanked Life Flight for providing air ambulance services and critical ground support to the community. MINUTES—Joint Elected Officials— January 27, 2009 Page 7 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Commissioner Sorenson asked if Lane County using its taxing authority to levy a real property tax in support of ambulance EMS was an option since raising fees for service was not the answer, Chief Groves responded that Lane County providing taxing authority would be addressed through creation of an ambulance service district. Raising current rates was not cost effective because it cost six dollars to increase rates one dollar. Additionally, as rates increase, the service would become less affordable for more people, turning the cost from a debt that could be paid to a bad debt. Commissioner Sorenson asked what amount of property tax was needed to prevent a fee for service increase. Chief Groves said the number was not available. However, the Lane Fire Defense Board, an organization comprised of all of the fire chiefs in Lane County, had agreed to contract with the Lane Council of Governments (LCOG) to conduct an ambulance district study. The study was deferred until after the Ambulance Transport Summit to have some direction from the elected officials. Chief Murphy observed the Western Lane Ambulance District was funded by the district’s tax support, user fees, and a program that cooperated with FireMed called Life Care. Commissioner Fleenor thanked Mayor Piercy and Councilor Ortiz for arranging for the summit. He asked why the reasonable charge method was changed to a fee for service method. Chief Murphy said reasonable charge and fee for service were Medicare terms. Reasonable charge was equivalent to reduced Medicare reimbursement rates across the board. Medicare broke the bank. He suggested elected officials would need to compare all ALS ambulances in Lane County with ambulances that were BLS with a driver who was not even a basic Emergency Medical Technician (EMT) and response times not considered legal in Oregon on the east coast of the United States to determine if charges were reasonable. He opined Congress’ intent was not to pick on 9-1-1 services, but rather balance the entire Medicare system. Commissioner Fleenor asserted costs could be reduced by increasing response time. He asked who established minimum response time requirement standards. Chief Groves stated local jurisdictions set the standards by working with the local medical control boards. There were longer response times related to how far people lived from service providers. Outcomes for critical care cases were proportional to patients’ distance from service providers. Chief Murphy added the BCC through its ambulance service area designation established response time standards for urban, suburban, rural and frontier locations. Those standards were currently realistic and followed by the providers. In order to save a life, the agencies were heavily dependent on first responders in seventeen rural fire districts surrounding central Lane County that provided care prior to arrival of ambulances from the urban area. Inside the cities, by ordinance, the response times were set by the cities of Springfield and Eugene. Commissioner Fleenor asked theoretically if the budget could be balanced by increasing the response times. MINUTES—Joint Elected Officials— January 27, 2009 Page 8 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Chief Murphy said it was more than a theoretical concept, and the answer was yes, it could be done and it was a matter of public policy from a standpoint of resources. The cities and the county had set an expectation. He added it was also a matter of public policy on what should be done to save lives when it took longer to respond. Commissioner Fleenor asked how often policy makers met to consider the response time issue. Chief Murphy said the ambulance service area was initiated in compliance with state law in the early 1980’s. The system had been upgraded and response time standards for urban, suburban, rural and frontier locations had been reset twice since then. The Eugene City Council and Springfield City Council had met five times on the issue since 1981 and had made adjustments. Chief Groves said for Eugene’s ASA, and a population approaching 190,000 people, the City of Eugene had three ambulances. He said that capacity had been exceeded the previous night due to a critical incident, and that occurred frequently. He opined the department was already marginally staffed. Councilor Clark thanked fire personnel and staff and other providers for attending this evening’s meeting to help elected officials identify the issues. He averred ambulance transport was a core service. He asked who decided the ASA borders and what percentage of the calls were social and behavioral issues that could be better served by other responders. Chief Murphy said the BCC determined the ASA borders. Chief Groves added although coding issues made it difficult to make a precise assessment, the number of responses for social and behavioral issues was increasing as there were more people on the streets and down on their luck. As the social service systems in the country and the community continued to crumble, the problem was getting worse. The social and behavior issue calls were frequently given to CAHOOTS. It was not productive use of the EMS system, including the hospitals, to take social and behavioral patients to the ER. EMS personnel attempted to direct people to other sources of help including Buckley House. Chief Murphy stated that over 25 percent of the time when called out, his agency did not do transports. The system responded in good faith to 9-1-1 calls where initial triage occurred with final triage occurring at the scene. Chief Groves said a challenge for 9-1-1 was that they could only deal with the information they were given, which often was very little, and people in the field were good with triage. Councilor Ortiz thanked everyone for attending yet another evening meeting. She asked the BCC to place the ASA on a future agenda for reevaluation. She did not support a fee for 9-1-1 calls that did not result in transport noting that people often waited for a long time before calling. Based on her professional experience in hospital emergency rooms, sick people who should have called 9-1-1 drove themselves when they should not have. She emphasized the need to continue to lobby the Congressional delegation for higher Medicare reimbursement. She observed Springfield had a lower population than Eugene while it had the same number of medic units. Mr. Grey said Springfield’s ambulance capacity fit the city’s needs. MINUTES—Joint Elected Officials— January 27, 2009 Page 9 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Councilor Ortiz asked if Lane Rural Fire/Rescue District had the capacity to infill the areas between the UGB and designated service areas. Chief Borland responded although the district did not currently have the staffing to provide the service it could review the issue for future implementation. Councilor Ortiz appreciated the comments from the IAFF representatives and supported continuing to provide adequate EMS to the community. She agreed ambulance transport service was a core service. The voters in Eugene expected a high quality of service and as an elected official she would do her best to ensure it continued. Commissioner Stewart appreciated this conversation. He said some of the small rural districts he represented struggled with the same issues brought forward tonight. He asked if it was possible to look at the issue as a Lane County issue rather than focusing on the three districts represented tonight. He asked if a countywide ambulance district would be the answer for everyone’s problems. Based on the finance information presented he thought a $1.28 per thousand assessed property value might be a viable figure to provide ambulance service countywide for $32 million. He asserted ambulance service was a core service. Increasing response times to balance the budget was not acceptable when every minute counted. Dimi- nished service would impact life and death. Chief Groves clarified that while the City of Eugene billed $12 million, only 44 percent was collected. He acknowledged going countywide was worthy of consideration. The proposal was brought forward from ASA 4, 5, and 8 as a means to start the conversation. Chief Murphy thought the proposed LCOG study would reveal the cost would be less than $.75 per thousand assessed property value. Councilor Zelenka was intrigued by Commissioner Stewart’s proposal. He asked how the governance in such a system would work. He asked what the implications of the ASAs were and if pulling them back to the UGB, which he assumed would result in more ASAs, would be predominantly rural. He asked who determined the level of service in each ASA. Chief Groves said the governance structure would be researched and determined at a later date. Chief Groves said the standards were developed by the BCC but the individual city councils established their own targets for levels of service based on the BCC requirements. Chief Murphy said Salem was surrounded by nine ambulance districts and did not provide the level of service provided by Lane Rural Fire/Rescue. The Stayton BLS was all volunteer personnel. If the ASAs were pulled back to the UGB, the Lane County system would resemble that of the Salem area. The level of sophistication in Lane County was unmatched in the state. Many off-duty firefighters volunteered in the rural districts and provided paramedic care in first response situations. The rural life support project was founded in Lane County in 1983 and exported around the state and the country. It provided a talented group of providers who offered care before arrival of ALS and had reinforced the existing system. The high cost of providing ambulance service was left to those who had the financial means to pay for it, and MINUTES—Joint Elected Officials— January 27, 2009 Page 10 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils the first response was affordable for the rural areas. Ambulance providers pooled a revenue source in FireMed and funded the medical care equipment fund for central Lane County. Councilor Pishioneri asked if calls for service in the rural areas that resulted in Life Flight being called by Springfield EMS was a billable event for Springfield EMS. Chief Murphy said the response in the Cougar area was provided by the United States Forest Service (USFS) group called the Emergency Action Service. They were a rural non-profit organization that provided first response in rural areas staffed mostly by USFS personnel. They could generally respond 40 minutes before the Springfield EMS and would make an initial assessment. If Life Flight was called, Springfield EMS would be waived off before arrival. Mr. Griffiths said if Life Flight was requested by a fire department to transport a patient, and the patient was put on an aircraft, it was a billable event. He said 9-1-1 protocol called for transport of patients to the closest appropriate medical facility as decided by medical control. Fixed wing aircraft currently were not used for 9-1-1 calls in this area, but typically were used for inter-facility transports for longer distances or those that were not suitable for helicopter transport. Chief Murphy said Life Flight contributed over $100,000 to the local fire departments to offset any lost revenue. He added his department could bill if it was called and rendered care prior to the arrival of Life Flight. Mayor Piercy asked for a definition of the legal meaning of core services. Before changing the ASA, she wanted to be sure what happened in any “give and get” negotiation. The current system seemed to be working well and should not be compromised. She asked if that system would be compromised in a quest to deal with financial issues. She would be concerned about sharing jurisdictional oversight with an ambulance district and supported the proposed LCOG study. She asked if the public was well enough educated about ways to get information about the state of their health other than going to the ambulance service and emergency room. Chief Groves did not know if there was a legal determination for core services. Core or essential services consisted of anything provided for the health and welfare of the community. Chief Murphy said CAHOOTS was an example of an alternative delivery that was working. He thought there was a place for CAHOOTS in Springfield as a smart alternative service provider. Councilor Poling shared the following observations: ? He hoped any discussion at the City of Eugene would be about decreasing rather than increasing response times. Monetary gain from increasing the response time did not come anywhere near the cost of a life. ? Since starting his law enforcement career in 1972, he had seen great improvements in emergency medical care. He thanked Fire and EMS personnel and ER staff for their efforts on behalf of the community. The community had one of the finest EMS systems around. ? He appreciated the efforts of Fire administration and union members for working together to develop a solution on the problem rather than being at loggerheads as in the past. MINUTES—Joint Elected Officials— January 27, 2009 Page 11 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils ? He thanked the City of Springfield for handling 850 calls annually outside of its ASA, the majority of which were likely in the City of Eugene. ? He agreed with Commissioner Stewart’s suggestion of expanding EMS throughout the county. ? He asked if any of the three chiefs saw tonight’s conversation growing into a conversation to expand into all Fire and EMS services. Chief Groves said the chiefs had had those discussions and were looking for common points for Eugene and Springfield to come together, including training and the Fire Marshal, to gain efficiencies and improve services, especially during times of tight finances. Chief Murphy suggested options could be offered to the city councils that would not lead to service reductions or increased fees. Commissioner Fleenor was for saving lives with available resources but regardless of resources people died. There were a limited amount of resources in Lane County and they were becoming less every day in the current economy. It could be three or four years before improvement is seen. Trying to form a countywide district was “pie in the sky” and it was not reasonable to think the jurisdictions could provide a response time that was appropriate in the rural communities. The issue needed to be looked at from a view of what was reasonable today and not next year. He felt everyone needed to live within available resources. The current fiscal environment was not suitable to talk about expansion. Councilor Ortiz sought an explanation of the contract for non-emergency transport and for the practice of advising people at the scene what the cost of transport would be. Chief Groves said advising people at the scene what the cost of transport would be had started with a change in the state law to inform patients. The non-emergency transport contract for the City of Eugene was a cost avoidance model to reduce costs for non-emergency transports from skilled nursing facilities since over 80 percent of the skilled nursing facilities in the area were located in the Eugene ASA which created a lot of transports between the care facilities and the hospitals. Staff was in the process of negotiating a contract with Rural/Metro Ambulance that would help alleviate the call load and free up limited emergency resources. In response to a question from Councilor Ortiz, Mr. Collins explained calls for Rural/Metro Ambulance service would be routed to a number other than the 9-1-1 system, where they would be dispatched directly from Rural/Metro’s site to the calling agency or individual. Chief Murphy said the skilled nursing facilities were currently clustered around the SHMC University District but this might change over time with the opening of the SHMC RiverBend campus. Springfield Fire and Life Safety would reevaluate the situation and be prepared to respond to those changes. He supported the decision by Eugene and thought it a smart business decision. Councilor Taylor did not think a district would work and people would not want it. She asked if the mileage was included in the cost of transport. She asked if universal health care would solve the problem. She asked what happened when people who were not indigent and did not have health insurance did not pay the bill. She asked if a person who did not ask for or want an ambulance but was transported, would be responsible for paying the bill. MINUTES—Joint Elected Officials— January 27, 2009 Page 12 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Chief Groves explained there was a base rate and a mileage factor used to calculate the cost of transport. Universal health care would go a long way in solving the problem. Unpaid bills were turned over for collection. Staff tried to work with people to satisfy the obligation before turning accounts over for collection. People could decline service. However, if a person was unconscious, under state law, that was implied consent, and they were treated and transported on the theory they wanted to be saved. Commissioner Handy thanked Councilor Ortiz for understanding the urgency of the situation in the community. He said the County needed to live within its means, and he was hearing that from the community. At the same time, people also wanted services. The County was looking for things to bubble up from the grass roots to bring issues to the BCC and put on the ballot. It was important to work with the state legislature and federal partners. A hospital was needed on the west side of Eugene to deal with transport distances. City services were excellent and should not be compromised. Urban services not going outside of the UGB needed to be looked at. If a countywide district was considered, a tiered structure should be considered to address urban/rural interface. He wanted to know what the impacts of compres- sion related to Ballot Measure 50 would be on other services. Mayor Leiken said Chief Murphy had always encouraged the City Council to talk with him, the IAFF president and the City of Springfield firefighters. This was a unique culture and allowed the council to make educated decisions for the community. He concurred with Commissioner Handy that compression should be considered. He asked what would be the difference between an ambulance authority and a special district. He understood a special district would be a separate entity than the local governments with its own board and administration. Chief Murphy cited the Metropolitan Wastewater Management Commission (MWMC) as an example of how a fire service authority could operate through an Intergovernmental Agreement (IGA) with partner agencies. He explained fire service authorities were in place in Washington and California, noting Livermore and Pleasanton, California, which were very similar to Eugene and Springfield, with the exception that their populations were closer in size, was a consolidated agency. The Livermore-Pleasanton Fire Department was an unqualified success. Chief Murphy said Lane County had a unique opportunity facing it. Many veteran Fire and EMS personnel were reaching retirement age presenting an opportunity to combine services while not requiring service reductions. While none of the solutions would be easy or fast, he asked the BBC, the City Councils, and Fire Boards to collaborate on developing a solution. He opined he and Chiefs Borland and Groves were dedicated to developing a slate of options for the JEOs to achieve consensus. Mayor Leiken said although the JEOs were talking about costs, the public was demanding highly trained professional paramedics who saved lives on the scene and transported people to the hospital, compared to 30 years ago. Costs continued to rise with training and equipment. He looked forward to continued conversations on Fire and EMS and believed it was a core service. He asserted this issue was about peoples’ lives and the elected officials needed to continue to hammer on the federal delegation. The federal government had been turning its back on the cities for decades. Commissioner Stewart, as a member of the MWMC, concurred with Chief Murphy that there were successful models in place for a fire authority. He hoped all of the elected officials came tonight with an open mind to solve problems for the community. MINUTES—Joint Elected Officials— January 27, 2009 Page 13 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Commissioner Sorenson said one of the advantages of a small group was it could make decisions quickly. He said the ambulance transport service issue would be placed on an upcoming BCC agenda. ASA options would be reviewed by the County’s Public Health Advisory Committee and BCC. There was not much “buy in” from the public if it perceived a district levy would benefit the County government in some way, so it would be important to have sufficient support from all jurisdictions for placing a measure on the ballot. Fire and EMS were among the most popular services provided by government so it might be easier to pass as a ballot measure. He said compression was always a concern and it would impact many taxing districts. Ballot Measures 5, 47 and 50 would not be modified until the Legislative Assembly referred a measure to the voters or the citizens initiated something that modified those measures. Councilor Clark clarified his statement that identifying Fire and EMS as core services identified those services as ones people wanted to see funded first and thoroughly. He saw it as a core service that the elected officials could not afford to get wrong. He thought establishing a special district would be difficult because the public would have a difficult time with additional tax obligations for something they perceived should be funded with the first dollars they paid in taxes. He averred additional support from the General Fund was in order. VII. FOLLOW-UP/NEXT STEPS Chief Groves thanked everyone for taking their time to discuss important issues. The issue had been called out for many years, and the agencies could not continue if a viable path was not identified. He suggested that each of the jurisdictions appoint one or two elected officials to begin working with the chiefs and labor to formulate a series of proposals to bring back to either the JEOs or individual elected bodies to discuss and act upon. VIII. CLOSING REMARKS Mr. LeDuc thanked everyone for coming tonight and wished them success in addressing the issues before them. IX. ADJOURN Mayor Piercy thanked everyone for their efforts and looked forward to taking the next steps. She said everyone was proud of the services and the work of the people who provided those services. She thought there was a strong desire for the jurisdictions to work together and was optimistic a solution would be found. She adjourned the meeting of the Eugene City Council at 8:17 p.m. Mayor Leiken thanked Mayor Piercy, the Eugene City Council and Eugene staff on behalf of the City of Springfield and the Springfield City Council for hosting the event and for the excellent information provided. He adjourned the meeting of the Springfield City Council at 8:17 p.m. Commissioner Sorensen adjourned the Board of Commissioners at 8:17 p.m. Mr. vonMoos thanked everyone for their participation and said the Lane Rural Fire/Rescue Board of Directors would assist in any way it could. He adjourned the Lane Rural Fire/Rescue Board of Directors at 8:17 p.m. MINUTES—Joint Elected Officials— January 27, 2009 Page 14 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils Respectfully submitted, Jon Ruiz (Recorded by Linda Henry) MINUTES—Joint Elected Officials— January 27, 2009 Page 15 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils