In July 16 IssueBy Kim GrahamNews-Register Reporter
With the interlocal agreement deadline three months away, Russell County Ambulance Board heard the county judge executive's proposal to restructure 911 Dispatch at their meeting last Tuesday.
Restructuring in the proposal gives the county control of daily dispatch operations, creates a 911 Board with oversight of operations, and modifies the LINK Board to supervising and advising only.
The proposed plan lists the same contribution of funds from all entities as the current interlocal agreement.
The budget to run 911 Dispatch will be comprised of $113,000 in CMRS money, $25,000 each from the Cities of Russell Springs and Jamestown and Russell County EMS, and the remainder of funds contributed by the fiscal court.
Russell County Deputy Judge Executive Chris Ramsey presented the proposed Enhanced 911 Organizational Restructure document to the board and answered questions regarding its implementation.
First and foremost, the ambulance board was concerned about their lack of representation on the Enhanced 911 Board of Directors.
"I think the question's already been brought to Chris (Ramsey) and Gary (Robertson) but obviously if we're paying, could or should we have a member on this board making the decisions and I think Chris said that's doable if we want to do that," Gray said.
Ramsey said a standing position for the ambulance board chairman on the Enhanced 911 Board of Directors could be added to the proposal.
"This (presentation of the restructure summary) is exploratory, this is a starting point and I'll also be presenting this to all the city councils as well," Ramsey said.
He said the fiscal court is seeking a verbal agreement from all entities prior to presenting a draft interlocal agreement based on the restructure document and constructed by the county attorney's office.
All governing bodies within the county and the ambulance board must agree to support the intent of the document or 911 Dispatch will leave the county Ramsey said.
Answering a question regarding the duration of the agreement, Ramsey recommended consideration of more than one year.
"We've got to get away from just focusing on year to year operations county government wise," said Ramsey. "We need to start looking at long term planning."
"If we can look at 3 to 5 that would be good or if it's a one (year plan) it's all negotiable."
He said a plan that can function well into future administrations is preferable.
Some options for long term solutions are dependent on elected officials voting to institute or raise taxes.
Ambulance Board Chairman James Gray said one option is the Kentucky legislature could vote to raise cell phone tax to increase the amount of Commercial Mobile Radio Service (CMRS) money.
Another option is the possibility of a tax on land line telephones in the county.
"Every other county around here has a 911 tax on (land line phone bills)," said Gray. "Most of them are from $4 to $8 and I think one or both of those (tax options) would be the long term solution to make everybody happy."
RC Fiscal Court would have to vote to implement a county land line tax.
"Whether either one of those (taxes) would pass, I don't know but that would solve the (911 Dispatch) money problems," said Gray.
Currently, those options are not available leaving only an interlocal agreement to share in dispatch expenses or go with a regional dispatch system contracted through another county.
"The primary option is to keep (911 Dispatch) in the county," said Ramsey. "The other option that's on the table is we have been contacted by other groups who do 911 and they're looking at doing regional concepts."
One bid is in but details of amount of the bid or call volume rates were not disclosed. When asked, Ramsey indicated the amount of the bid is comparable to the current amount budgeted to run dispatch.
A regional option would mean 911 Dispatch will leave Russell County and the county will lose oversight of the department Ramsey said.
He said once 911 Dispatch leaves the county it's hard to reinstate and the CMRS money will be difficult to renew.
Regional packages also mean that each entity will be billed for 911 Dispatch based on call volume.
"What (Judge Robertson) told me was if any of the three (entities) say no (to the proposed restructuring), (911 Dispatch) is going out of the county…and (the entities) will get a bill every month for whatever their part is."
Gray said he thinks if EMS is paying another county who is billing based on call volume, it's probably EMS will pay more than $25,000 per year for dispatch service.
Concerns were also voiced by the board regarding regional dispatch and drawbacks to moving 911 dispatch out of the county.
"If (dispatch) leaves the county you'll lose control of (operations), you'll lose your CMRS money and you won't get it back," Popplewell said.
EMS staff expressed concerns that long term funding to keep dispatch in the county has not been considered or other funding options explored.
"One of the things I have a problem with is October of last year we knew then that there was a year (agreement)," said Hancock. "If they would have went into January and set up a committee…and looked at every option available, even the phone tax, whatever, but they come back now in July and say these are the only two options we've got…I think a lot of stuff has not been explored…for whatever reasons."
"Somebody needs to figure out how (dispatch is) going to be funded if it's going to stay in the county."
Concerns from staff members also surfaced regarding the possibility of the need for EMS to raise taxes to cover the loss of funds in their budget over time.
"We can sit back and pay $10,000, $20,000, $30,000 or whatever…but what comes out of (EMS's) budget we have to bring back to offset a shortfall so we may have to go back in two or three years when (EMS) is lower on money and say we need a tax increase for EMS base to cover all this extra stuff that's getting pulled out of our budget for 911 (Dispatch)," said Russell County EMT Zach Burton.
Board members said they were hesitant to accept a proposed multi-year interlocal agreement because an extended commitment to pay $25,000 a year for dispatch may stop any progress toward other long term options available.
In an effort to keep dispatch local, Russell County Ambulance Board unanimously accepted the intent of the Enhanced 911 Organizational Restructure document with two caveats: the agreement is for one year only and the ambulance board has representation on the Enhanced 911 Board of Directors.
In response to the board's request to identify criteria for non-emergency runs to possibly discontinue from services, Director Hancock presented his findings thus far.
Hancock said he spoke to Adair County Ambulance Service (ACAS) Director Terry Akin who said ACAS has a policy that they do not transport patients for non-emergency doctor's office visits with few exceptions.
"(Adair County EMS) does it pretty much across the board but they do take (patients to doctor's office visits) on occasion because they've got some people that, like I said last time, (EMS) is the only option (some patients) have."
When ACAS receives a call to transport to a doctor's office, their staff notifies the caller that the appointment should be rescheduled with the doctor to meet at an Emergency Room (ER) because insurance only pays when patients are transported to a hospital Hancock said.
He suggested a similar policy should be in place at Russell County EMS but there will be exceptions at times.
"There are going to be some we're going to have to (transport) when they have no other means or they have to have a stretcher (to travel)," said Hancock. "Most of those times we can get approval from Medicare, Medicaid or (other insurance)."
Board members and staff discussed concerns about patients who regularly require transport and how those cases will be handled with a new non-emergency run policy.
Prevailing in the discussion was the need to serve the county and keep EMS financially solvent at the same time.
"We're not trying to make a profit…we're just trying to at least pay our expenses," Gray said. "If we can pay our expenses and help people out, I'm all about that."
Hancock advised the policy will need more work and implementation will require a significant amount of adjustment in the community.
"I would like to caution y'all we are going to meet some resistance - especially locally when they hear about it," Hancock said.
Popplewell indicated the financial stability of EMS is vital to continuing service to the county.
"We're trying to keep the doors open and people in jobs," said Popplewell. "If (EMS) keep (transporting) for free, you can't do it.
"I don't mean to be hard hearted, that's just the bottom line."
In other business:
• Russell County Attorney Kevin Shearer was instructed by the ambulance board to pursue litigation against former collection agency, MGM Collection Agency, in an attempt to recover billing payments and unpaid account records from the company.
• EMS staff notified the board that Kentucky Retirement Systems (KRS) representative, Nadine White will visit the EMS office within the next month to review and advise on sick leave and retirement policy.