I N U T E S
City Council/Springfield City Council/
Board of County Commissioners/Lane Rural Fire Rescue Board of Directors
Emergency Services Center—1705 West Second Avenue
CITY COUNCILORS PRESENT: Andrea
Ortiz, George Poling, Betty Taylor, Alan Zelenka, Mike Clark, Chris Pryor,
CITY COUNCILORS PRESENT: Christine
Lundberg, Hillary Wylie, Joe Pishioneri, Dave
Ralston, John Woodrow
PRESENT: Faye Stewart, Peter
Sorenson, Bill Fleenor, Rob Handy. Bill
Dwyer was excused.
RURAL FIRE/RESCUE BOARD
DIRECTORS PRESENT: Larry vonMoos,
Ray Brown Kevin King, Marvin King, Pete Holmes.
LeDuc, Director, 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
Honor Mayor Kitty Piercy opened the meeting of the Eugene City Council and
thanked everyone for their attendance.
Honor Mayor Sid Leiken convened the meeting of the Springfield City Council.
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
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.
LeDuc introduced Springfield Fire Chief Dennis Murphy.
COMMENTS—Springfield Fire Chief Dennis Murphy
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 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
Eugene/Springfield Metropolitan area
fire departments were the first to develop programs in advanced 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.
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 stated in 1998 when Congress passed legislation that
began a reduction of reimbursement for ambulance services, followed by a
subsequent reduction in 2003. The
reductions followed 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 in 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
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.
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?
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 transports.
Decreasing federal money to pay for
Increasing state requirements for EMT
County designated metro/rural ASA, one
level of service.
Medical Control Board established
Calls for ambulance transport services
had increased over 40 percent since 2003.
Effects of under
Costs of increased technical
sophistication and equipment.
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.
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.
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.
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 ambulance resource
based had inadequate capacity to keep pace with the current call volume and
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
provided by Eugene were now provided to the new River Bend campus by
Groves reviewed the three types of units used by the 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 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.
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
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?
Murphy explained by 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.
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,
simultaneous demand in Eugene did not occur during simultaneous demand in
Springfield, providing the ability to provide backup for the other jurisdiction.
Borland averred the 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 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?
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
Tax payments—57 percent.
Ambulance Revenue—45 percent.
Borland reviewed trends and solutions for regional ambulance transport service:
Calls for service were increasing.
Operating and administrative costs were
Medicare age population was growing.
Number of uninsured and underinsured
patients was growing. Increased
on-scene triage resulting in fewer transports.
Increase ambulance transport fees.
Tax support (General Fund).
First response fees.
non-emergent transports freeing up fire based resources.
Higher ambulance transport fees.
Consolidate/merge department functions.
Create ambulance service taxing
Create a fire district or authority
that incorporated ambulance transport into its base budget.
Continue Congressional lobbying efforts
to increase Medicare/Medicaid payments.
Reconfigure ASA boundaries (urban/rural
Develop an alternative service delivery
New membership initiatives/programs.
V. SCHEDULED SPEAKERS
LeDuc introduced the evening’s scheduled speakers:
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 was committed to working with chiefs and
community leaders to find a way to make a sustainable EMS system.
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 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.
Olmos, President, 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 that he represented, and had been so for too long. Many patients
had the means to pay for ambulance transport service and the once adequate
source of funding could not 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 appropriately.
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
The City must immediately discontinue
dispatching Eugene paramedics outside of the Urban Growth Boundary (UGB).
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.
Robinson, representing Oregon State Ambulance Association, provided a PowerPoint
presentation that highlighted the funding challenges association members faced
and the medical free schedule. Changes
in service levels and fee schedules implemented in 2003 have had a significant
impact on ambulance service revenues. Possible solutions included:
Reduced response time requirements.
Other expense reductions.
LeDuc thanked the presenters.
group took a break from 6:30 p.m. to 6:45 p.m.
VI. QUESTIONS AND ANSWERS
LeDuc reconvened the meeting and explained the ground rules for the Questions
and Answers 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 Griffith, Chief
Executive Officer, Life Flight; Mike Collins, Pacific Northwest Division General
Manager, Rural/Metro Ambulance; Dr. Eric
Spencer, McKenzie Willamette Medical Center; Maurine Cate, Chief Executive
Officer, McKenzie Willamette Medical Center.
Groves summarized 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 next substantial steps to address the problems on a regional basis by
the end of the meeting.
Gary Young, Medical Director of the Emergency Department at SHMC, represented
Eugene Emergency Physicians who provided 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
the ER visits. He supported 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.
thanked Life Flight for providing air ambulance services and critical ground
support to the community.
Sorenson asked if raising fees for service was not the answer, was Lane County
using its taxing authority to levy a real property tax in support of ambulance
EMS was an option.
Groves responded 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 rate 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.
Sorenson asked how much of a property tax was needed to prevent a fee for
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.
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.
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
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.
Fleenor asserted costs could be reduced by increasing response time.
He asked who established minimum response time requirement standards.
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
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.
Fleenor, at the risk of stating the obvious, asked theoretically if the budget
could be balanced by increasing the response times.
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.
Fleenor asked how often policy makers met to consider the response time issue.
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 City of Eugene and City of Springfield City Councils met
five times on the issue since 1981 and had made adjustments.
Groves said for Eugene’s ASA, and a population approaching 190,000 people, the
City of Eugene had three ambulances. He
said that capacity was exceeded last night due to a critical incident and that
occurred frequently. He opined the
department was already marginally staffed.
Clark thanked the 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
Murphy said the BCC determined the ASA borders.
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 issues were 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.
Murphy stated 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.
Groves said a challenge for 9-1-1 was they could only deal with the information
they were given, which often was very little, and people in the field were good
Ortiz thanked everyone for attending yet another evening meeting.
She asked the BCC to place looking at 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.
Grey said Springfield’s ambulance capacity fit the City’s needs.
Ortiz asked if Lane Rural Fire/Rescue District had the capacity to infill the
areas between the UGB and designated service areas.
Borland responded although the district did not currently have the staffing to
provide the service it could review the issue for future implementation.
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.
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 wide issue rather
than focusing on the three districts represented tonight.
He asked if a county wide 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 may 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. Diminished service would impact life and death.
Groves clarified that while the City of Eugene billed $12 million, only 44
percent was collected. He
acknowledged going county wide was worthy of consideration.
The proposal was brought forward from ASA 4, 5, and 8 as a means to start
Murphy thought the proposed LCOG study would reveal the cost would be less than
$.75 per thousand assessed property value.
Zelenka was intrigued by Commissioner Stewart’s proposal.
He asked how the governance in such a system would work.
He asked what were the implications of the ASAs and pulling them back to
the UGB which he assumed would result in more ASAs that would be predominantly
rural. He asked who determined the level of service in each ASA.
Groves said the governance structure would be research 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.
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 in 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 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.
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.
Murphy said the response in the Cougar area was 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 generally could 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.
Griffith said if Life Flight was by a fire department to transport a patient and
the patient was put on an aircraft it was a billable event.
He said for 9-1-1 protocol called for transport of patients to the
closest medical appropriate 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.
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.
Piercy asked for a definition of the legal meaning of core services.
Before changing the ASA, she wanted to be sure that what happened in any
“give and get” negotiation, the current system which seemed to be working
well was not 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 a good enough job of educating the public was done for other
ways they could get information about the state of their health other than going
to the ambulance service and emergency room.
Groves did not know if there was a legal determination for core services.
Core or essential services consisted of anything the provided for the
health and welfare of the community.
Murphy said CAHOOTS was an example of alternative delivery that was working.
He thought there was a place for CAHOOTS in Springfield as a smart
alternative service provider.
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 the fire and EMS personnel and ER staff for the efforts on
behalf of the community. The community had one of the finest EMS systems around.
He appreciated the efforts of the fire
administration and union members for working together to develop a solution on
the problem rather than being at logger heads as in the past.
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
Groves said the chiefs had had those discussions and were looking for common
points for Eugene and Springfield to come together, including training and Fire
Marshal, to gain efficiencies and improve services, especially during times of
Murphy suggested options could be offered to the City Councils that would not
lead to service reductions or increased fees.
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 may be three or four years before we see some improvement.
Trying to form a county-wide district was pie in the sky and it was not
reasonable to think we 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.
We need to live within our available resources today, reallocate our
resources and expectations today. The
current fiscal environment was not suitable to talk about expansion.
Ortiz sought an explanation of the contract for non-emergency transport and the
practice of advising people at the scene what the cost of transport would be.
Groves said advising people at the scene what the cost of transport would be
came about from 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.
Ortiz asked where the contractor would be staged, how many people would be able
to use them, and how would the public contract them.
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.
Murphy said the skilled nursing facilities were currently clustered around the
SHMC University District but this may change over time with the opening of the
SHMC River Bend 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.
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 did not ask for or want an ambulance and was
transported, was still responsible for paying the bill.
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.
Handy thanked Councilor Ortiz for understanding the urgency 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.
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 compression related to Ballot
Measure 50 would be on other services.
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 needed
to 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 from the local
governments with its own board and administration.
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
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 may be easier for 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 a core service 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
that should be funded with the first dollars they pay in taxes.
He averred additional support from the General Fund was in order.
VII. FOLLOW-UP/NEXT STEPS
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
LeDuc thanked everyone for coming tonight and wished them success in addressing
the issues before them.
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.
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
Sorensen adjourned the Board of Commissioners at 8:17 p.m.
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.
by Linda Henry)