Report to the County:Report to the County:Emergency Medical ServicesEmergency Medical Services

Steve DoyleSteve DoyleCounty Board ChairCounty Board Chair

August 6, 2008August 6, 2008

There is no “Agreement”There is no “Agreement”

All that exists is a All that exists is a PROPOSAL PROPOSAL to be to be introduced by two individuals – the introduced by two individuals – the Mayor and the County Board ChairMayor and the County Board Chair

The earliest the Council will vote is The earliest the Council will vote is 55 weeksweeks from now from now

The earliest the County Board will vote is The earliest the County Board will vote is 1010 weeksweeks from now from now

History of EMS in La CrosseHistory of EMS in La Crosse

Pre-1980’sPre-1980’s Police car, private vehiclePolice car, private vehicle

1980’s1980’s Two ambulance providers – Tri-State Two ambulance providers – Tri-State

and Medstarand Medstar Battle over Basic Life Support versus Battle over Basic Life Support versus

Advanced Life Support/ParamedicAdvanced Life Support/Paramedic

January 1, 1990 – contract between County and January 1, 1990 – contract between County and Tri-StateTri-State Contract covered most municipalities in the CountyContract covered most municipalities in the County Eventually all joinedEventually all joined

1995 – G/L purchased Tri-State1995 – G/L purchased Tri-State New contract 1-1-96New contract 1-1-96 Extended several timesExtended several times

2002 – City conducts study on taking over 2002 – City conducts study on taking over ambulance serviceambulance service

December 31, 2007 – EMS contract expiredDecember 31, 2007 – EMS contract expired

We presently have no EMS contractWe presently have no EMS contract

Important ConsiderationsImportant Considerations

There is no mandatory duty for a County There is no mandatory duty for a County to provide EMS servicesto provide EMS services

Each municipality has the right to provide Each municipality has the right to provide its own EMS services. its own EMS services.

The County’s goal has been to provide The County’s goal has been to provide integration, stability and efficiency by integration, stability and efficiency by having one system and one 9-1-1 servicehaving one system and one 9-1-1 service

There is presently There is presently nono tax subsidytax subsidy

Current SituationCurrent Situation January 28, 2006January 28, 2006

Mayor Johnsrud is quoted in the media about Mayor Johnsrud is quoted in the media about City’s intention to get into ambulance serviceCity’s intention to get into ambulance service

““War of words” begins as issue is debated in the War of words” begins as issue is debated in the mediamedia

March 16, 2006March 16, 2006 City announces hire of Gregg Cleveland as Fire City announces hire of Gregg Cleveland as Fire

ChiefChief March 29, 2006March 29, 2006

County Board Chair sends letter to Mayor County Board Chair sends letter to Mayor expressing concern about ambulance service and expressing concern about ambulance service and asks for meeting.asks for meeting.

May 17, 2006 Meeting on EMSMay 17, 2006 Meeting on EMS

Attended by La Crosse County, City of Attended by La Crosse County, City of La Crosse, Gundersen-Lutheran/Tri- La Crosse, Gundersen-Lutheran/Tri-State, Franciscan SkempState, Franciscan Skemp

Agreed on four main principles:Agreed on four main principles: Must consider a regional approachMust consider a regional approach Should enhance clinical quality and patient safetyShould enhance clinical quality and patient safety Strive to control healthcare costsStrive to control healthcare costs Be a collaborative effort and provide inclusivityBe a collaborative effort and provide inclusivity

Interim Agreement – 4 pointsInterim Agreement – 4 points

1.) County will extend Tri State contract for 1.) County will extend Tri State contract for one year – to December 31, 2007one year – to December 31, 2007

2.) Fire Department and Tri –State will 2.) Fire Department and Tri –State will work together to examine options/modelswork together to examine options/models

3.) Parties will refrain from further debate 3.) Parties will refrain from further debate in the mediain the media

4.) The group will meet again in the fall to 4.) The group will meet again in the fall to determine the next stepsdetermine the next steps

Several Months of Little ProgressSeveral Months of Little Progress

City and Tri-State representatives City and Tri-State representatives hold several meetings and make site hold several meetings and make site visitsvisits

No agreement as to comparabilityNo agreement as to comparability County makes several unsuccessful County makes several unsuccessful

attempts to get original group back attempts to get original group back togethertogether

Continued debate in the mediaContinued debate in the media

Tri-State proposes EMDTri-State proposes EMD April 30, 2007 – Public Safety Communications BoardApril 30, 2007 – Public Safety Communications Board

““Emergency Medical Dispatch”Emergency Medical Dispatch” Pre-arrival instructions by a trained dispatcherPre-arrival instructions by a trained dispatcher No tax subsidyNo tax subsidy City concerned Tri-State is trying to lock in its role as providerCity concerned Tri-State is trying to lock in its role as provider Advisory committee established to review the ideaAdvisory committee established to review the idea

May 15, 2007 – County proposes outside mediatorMay 15, 2007 – County proposes outside mediator Mayor makes similar proposalMayor makes similar proposal Administrator offers names of several professional mediatorsAdministrator offers names of several professional mediators

Mediation beginsMediation begins

““Pre-mediation meeting” is June 12, Pre-mediation meeting” is June 12, 20072007

Howard Bellman is mediatorHoward Bellman is mediator Four parties:Four parties:

MediationMediation

June 12, 2007June 12, 2007 Pre-mediation session with Howard Bellman and Pre-mediation session with Howard Bellman and

also Cathy Etter, State of WI EMS Coordinatoralso Cathy Etter, State of WI EMS Coordinator Each party met separately with mediator to make Each party met separately with mediator to make

their own determination about continuingtheir own determination about continuing All four parties agree to hire Bellman, splitting All four parties agree to hire Bellman, splitting

cost of up to $20,000cost of up to $20,000 Bellman to track proposals and was authorized to Bellman to track proposals and was authorized to

talk with parties jointly or separatelytalk with parties jointly or separately

MediationMediation

July 24, 2007July 24, 2007 Half-day of individual and combined meetings Half-day of individual and combined meetings

with mediatorwith mediator Procedural ground rules adoptedProcedural ground rules adopted

Participation is voluntaryParticipation is voluntary Any party can withdraw from process at any timeAny party can withdraw from process at any time Process is confidentialProcess is confidential Any agreement would be presented to the public Any agreement would be presented to the public

for comment before adoptionfor comment before adoption

Important Fact Revealed:Important Fact Revealed:

Tri-State’s internal study shows Tri-State’s internal study shows need for an additional need for an additional

ambulance in 2010ambulance in 2010

MediationMediation

Major points of contention:Major points of contention: What role, if any, should the City play in the delivery What role, if any, should the City play in the delivery

of EMS services?of EMS services? When should that decision be made? By whom?When should that decision be made? By whom?

What should be the make-up of the body that What should be the make-up of the body that oversees EMS delivery?oversees EMS delivery?

Elected officials?Elected officials? Medical professionals?Medical professionals? ““Pro-City” versus “Pro Tri-State” balancePro-City” versus “Pro Tri-State” balance

How should that body establish standards to govern How should that body establish standards to govern the quality of service?the quality of service?

MediationMediation

August 20, 2007 – City’s First ProposalAugust 20, 2007 – City’s First Proposal City would provide up to two ALS ambulancesCity would provide up to two ALS ambulances

One unit for the City – would be primary response One unit for the City – would be primary response for city callsfor city calls

One unit for the region where neededOne unit for the region where needed The City or County would dispatchThe City or County would dispatch City and Tri-State would provide mutual back-upCity and Tri-State would provide mutual back-up

City would set standards for its jurisdictionCity would set standards for its jurisdiction Essential concept was two independent Essential concept was two independent

operationsoperations

MediationMediation

September 12, 2007 – Tri-State’s First ProposalSeptember 12, 2007 – Tri-State’s First Proposal Establish a governing board with 5 licensed Establish a governing board with 5 licensed

physicians and 4 elected officials. Also non-voting physicians and 4 elected officials. Also non-voting ex officio membersex officio members

Governing board would decide who gets next Governing board would decide who gets next ambulanceambulance

Tri-State would permit City paramedics to “ride-along” Tri-State would permit City paramedics to “ride-along” in Tri-State unitsin Tri-State units

Existing contract Standards would applyExisting contract Standards would apply Essential concept was Tri-State dominated model Essential concept was Tri-State dominated model

to promote unified delivery of servicesto promote unified delivery of services

MediationMediation

September 26, 2007 – County and September 26, 2007 – County and Franciscan meet with mediator to discuss Franciscan meet with mediator to discuss middle groundmiddle ground Ideas later circulated by phone and emailIdeas later circulated by phone and email

MediationMediation

October 15, 2007 – County/FSMC Proposal October 15, 2007 – County/FSMC Proposal developeddeveloped Governing board made up primarily of elected Governing board made up primarily of elected

officials throughout the Countyofficials throughout the County City of La Crosse gets next ambulanceCity of La Crosse gets next ambulance Would be operated as an integrated system Would be operated as an integrated system

with the County as hubwith the County as hub November 6, 2007 – County/FSMC meet with November 6, 2007 – County/FSMC meet with

mediator to discuss how to present proposalmediator to discuss how to present proposal

MediationMediation

November 28, 2007 – County/FSMC hold November 28, 2007 – County/FSMC hold back-to-back meetings with City and back-to-back meetings with City and Tri-StateTri-State Each side raises concernsEach side raises concerns

December 13, 2007 – County/FSMC meet December 13, 2007 – County/FSMC meet with mediator to fine-tune new proposalwith mediator to fine-tune new proposal

End of 2007End of 2007

EMD issue is resolved and program EMD issue is resolved and program implementedimplemented

Money for mediator runs outMoney for mediator runs out City agrees to continue fundingCity agrees to continue funding Tri-State rejects continued expense of Tri-State rejects continued expense of

mediationmediation Reflected concern over chance of success, not Reflected concern over chance of success, not

criticism of mediatorcriticism of mediator Agrees to continued informal talksAgrees to continued informal talks

20082008

County becomes mediatorCounty becomes mediator February 7, 2008 – County/FSMC meet with February 7, 2008 – County/FSMC meet with

Tri-State to discuss modifications to proposalTri-State to discuss modifications to proposal February 28, 2008 – County/FSMC meet with February 28, 2008 – County/FSMC meet with

City to discuss modifications to proposalCity to discuss modifications to proposal April 24, 2008 – County convenes meeting April 24, 2008 – County convenes meeting

with both parties to identify remaining areas with both parties to identify remaining areas of disputeof dispute

April – June 2008April – June 2008

Telephone and email communications to Telephone and email communications to try to reach resolutiontry to reach resolution

All four parties involvedAll four parties involved Occasional one on one meetingsOccasional one on one meetings The discussions have never stoppedThe discussions have never stopped

June 6, 2008June 6, 2008

Mayor agrees to proposal offered by Mayor agrees to proposal offered by County Board ChairCounty Board Chair

Proposal to be introduced by Mayor and Proposal to be introduced by Mayor and County Board ChairCounty Board Chair

Proposal is not binding upon City or Proposal is not binding upon City or County unless adopted by Council and County unless adopted by Council and BoardBoard

Proposal is presented to Tri-StateProposal is presented to Tri-State

There are more areas of There are more areas of agreement than agreement than disagreementdisagreement

Key provisions of ProposalKey provisions of Proposal

City and County would each adopt City and County would each adopt reciprocal ordinances that define:reciprocal ordinances that define: EMS Commission membershipEMS Commission membership EMS Commission authorityEMS Commission authority Standards of qualityStandards of quality Guarantees of transparencyGuarantees of transparency

All partiesAll parties agree with most of the terms agree with most of the terms

EMS CommissionEMS Commission Ten members:Ten members:

County Board Chair or designee who is a SupervisorCounty Board Chair or designee who is a Supervisor County Board First Vice Chair or designee who is a County Board First Vice Chair or designee who is a

SupervisorSupervisor La Crosse Mayor or designee who is a Council MemberLa Crosse Mayor or designee who is a Council Member La Crosse Common Council memberLa Crosse Common Council member La Crosse Citizen member appointed by MayorLa Crosse Citizen member appointed by Mayor Onalaska Mayor or designee who is a Council MemberOnalaska Mayor or designee who is a Council Member Village President or designeeVillage President or designee Town Board Chair or designeeTown Board Chair or designee Representative from Gundersen LutheranRepresentative from Gundersen Lutheran Representative from Franciscan SkempRepresentative from Franciscan Skemp

Tri-State would add two doctorsTri-State would add two doctors

EMS Commission AuthorityEMS Commission Authority Commission is authorized to:Commission is authorized to:

Set standards based upon State regulationsSet standards based upon State regulations Designate EMS Medical Director(s)Designate EMS Medical Director(s) Establish Pre-Hospital Medical Care ProtocolsEstablish Pre-Hospital Medical Care Protocols Ensure closest ambulance response regardless of jurisdictional Ensure closest ambulance response regardless of jurisdictional

boundariesboundaries Set personnel standardsSet personnel standards Enter into Mutual Aid AgreementsEnter into Mutual Aid Agreements Set vehicle and equipment requirementsSet vehicle and equipment requirements Oversee EMS System communications and standardsOversee EMS System communications and standards Establish quality assurance programsEstablish quality assurance programs

All partiesAll parties agree with these terms – agree with these terms – Tri-State has additional ones alsoTri-State has additional ones also

EMS TransparencyEMS Transparency Commission to develop standards regarding Commission to develop standards regarding

content and frequency of reports on:content and frequency of reports on: CallsCalls Response timesResponse times Clinical qualityClinical quality Skills proficiencySkills proficiency Patient satisfactionPatient satisfaction Vehicles and equipmentVehicles and equipment

All financial and operational information of All financial and operational information of ambulance providers shall be available to the ambulance providers shall be available to the Commission and the PublicCommission and the Public

All partiesAll parties agree to these terms. agree to these terms.

The major area of disagreementThe major area of disagreement

The City of La Crosse shall own and operate the The City of La Crosse shall own and operate the next ambulance added to the County EMS next ambulance added to the County EMS System.System.

Tri-State Ambulance Service will be authorized Tri-State Ambulance Service will be authorized to provide the second ambulance.to provide the second ambulance.

Tri-State wants the Commission to decide who Tri-State wants the Commission to decide who gets the next ambulance added to the gets the next ambulance added to the system.system.

ConsiderationsConsiderations

La Crosse County is not bound by any La Crosse County is not bound by any proposals made by its representativesproposals made by its representatives

Next move is the City’sNext move is the City’s

It is not the County’s decision as to It is not the County’s decision as to whether the City of La Crosse gets into whether the City of La Crosse gets into the ambulance businessthe ambulance business

What is the significance of the What is the significance of the proposal?proposal?

It is simply a proposal of the Mayor and It is simply a proposal of the Mayor and the County Board Chair – it is not an the County Board Chair – it is not an endorsement by any County or City endorsement by any County or City committeecommittee

The County does not have an official The County does not have an official position on the proposal position on the proposal

Why do I support the Proposal?Why do I support the Proposal?

It allows the City to determine whether or It allows the City to determine whether or not it should offer EMS through the Fire not it should offer EMS through the Fire Department – it’s their decision, not the Department – it’s their decision, not the County’sCounty’s

It allows the municipalities outside the City It allows the municipalities outside the City of La Crosse to know that quality, of La Crosse to know that quality, efficiency and cost will not be sacrificed efficiency and cost will not be sacrificed through a fragmented systemthrough a fragmented system

What’s Next?What’s Next?

Visit the County’s website to view this Visit the County’s website to view this presentation and the proposed ordinancepresentation and the proposed ordinance

Attend public hearings that City and Attend public hearings that City and County will each hold once the proposal is County will each hold once the proposal is introducedintroduced