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Mayor's Board Room
Thursday, March 24, 2011, 01:00 PM
Book: 65, Page: 1

Special Meeting

Called To Order The meeting was called to order by Council President Stan Snapp at 1:03 PM

Roll Call
    Stan Snapp, Council Member, Fourth Ward
    Michael Lilliquist, Council Member, Sixth Ward
    Barry Buchanan, Council Member, Third Ward


Bellingham City Council Emergency Medical Services (EMS) Ad Hoc Committee meeting

Other participants: Chief Dave Ralston (South Whatcom Fire Authority), Chief Tom Fields (North Whatcom Fire and Rescue); Chief Bill Boyd, Roger Christiansen (Bellingham Fire Department); Kelli Linville.

Stan Snapp opened the meeting at 1:03.

Dave Ralston reviewed the recent history and current governance structure for the EMS system. In December a decision was made by the County Council to terminate the existing interlocal agreement that provided EMS services, but also to authorize the fire districts and fire departments to negotiate new agreement if possible.

The City and County Councils are the authoritative bodies for the current system as they provide the tax funds for it. The EMS council, with representatives from the Fire Departments, City of Bellingham, St. Joseph’s, Ambulance Advisory Board, 5 members at large, and a private ambulance service, helps create a regional plan that is forwarded to the State Department of Health for approval. The current Ambulance Advisory Board was set up by an interlocal agreement, and provided recommendations on operations. The Medical Program Director oversees components of service delivery. In 2005 there was a shift to Fire Districts and the City of Bellingham doing more life support transports. The Medical Director also advises the Ambulance Advisory Board and the EMS Council.

The new EMS planning committee must get approval from both Councils on the planning process as it moves forward. The public and labor representatives have participated in the process. The broader planning committee has met twice and the subcommittees have met more frequently.

Participants in the planning process are looking to identify high-level critical elements for the planning process, and of the new system. Critical elements identified thus far are:
    1. New governance independent of Bellingham and Whatcom County with all stakeholders fully represented and involved in the budget process.
    2. A paramedic training program open to all employees regardless of employment or union representation.
    3. Development of a 6 year EMS funding and operational plan.
    4. Development of long-term stable funding. This is likely to involve a new funding model.
    5. Countywide EMS delivery.
    6. Mitigation of Unfair Labor Practice (ULP) risks from loss of union jobs.
    7. A system should be designed to result in best patient outcomes.
    8. Each agency will retain administrative oversight of its own employees.

Bill Boyd clarified the City’s position by noting that the City will not put itself at legal risk by giving away a bargaining unit’s work.

Dave Ralston noted that time is a factor because of deadlines for possible dissolution of the system. The target is April for agreement from the City and Council on the planning process to develop a new system. The goal would be to have agreements come together at the end of this year. If agreement does not come together the County will need time to staff and implement a new system. The City already has elements in place to serve its own residents. Paramedic training is done at Western, and Bellingham Technical College will not be ready to train new EMT’s until 2012. Options for the County include hiring EMT-trained people, and adding a training protocol for new hires. The next steps are to get Bellingham City Council and County Council agreement on the makeup of the planning committee by April.

Stan Snapp noted that the City Council has added Finance Chair Michael Lilliquist to its EMS committee, and stated that it is likely everyone could agree on 3 of the critical elements as goals for the system: a countywide system; best outcomes for patients; and maintaining contract obligations to City and District #7 employees.

Dave Ralston. The goals should not be a hang-up. The purpose is to get guidance from the City Council to take back to the larger group. The intent is not to create separate systems.

Barry Buchanan noted that governance of the new system is not very detailed yet. The open training goal is also not well specified. These are details that would need to come out of a process to identify a system designed for best patient outcomes.

Tom Fields. Creating the governance structure will be some work. The critical elements were put forward by the County Council. Eastside fire districts are especially concerned about patient outcome issues and who responds where.

Dave Ralston. There were initially more critical elements but these were narrowed down.

Roger Christiansen. Each EMS is different across the state. Ours is characterized by a small number of EMT’s seeing a large number of patients. The goal is to find a system that gives the best patient outcomes.

Kelli Linville. Fiscal responsibility and an affordable system are not specified as one of the goals.

Tom Fields. The long-term stable funding task really gets at the efficiency issue.

Barry Buchanan. A split v. a unified system would have different efficiencies.

Stan Snapp. The system is now deficit-funded.

Tom Fields. We may need to revise or refine the critical elements slightly. Various elements will be developed by the subcommittees. We will be developing a governance plan. More details may be brought back to the Councils as they are developed, not after everything is finished.

Stan Snapp. The hospital needs to be part of planning process.

Barry Buchanan. Does the Bellingham City Council agree with the planning committee makeup? We need wider representation in the planning process. In the last planning process we had citizen and hospital input, and also in the levy process.

Michael Lilliquist. We will need more people to be involved to have enough people to work in the subcommittees.

Tom Fields. New voices and people can be added as we get to the details of the planning process in subcommittees. But the last EMS planning process was criticized as having too many people.

Bill Boyd. Right now there are 8 Fire District reps while the City and County have fewer reps. The City has a large stake in this process from a capital and operational standpoint.

Barry Buchanan. The planning process is very heavily weighted on the Fire District side.

Dave Ralston. The last planning process was heavy with Fire Districts as well.

Stan Snapp. The City has most of the experience in running this type of system yet is hardly involved in the planning process. The hospitals and ambulance advisory board and ambulance companies are involved in the current EMS Council so it’s been more balanced.

Tom Fields. What we are putting together is the committee to direct the planning, this is not the governance board. The governance board would be elected officials.

Dave Ralston. The City has been involved throughout the project.

Bill Boyd. An overarching planning committee to make recommendations to the City Council and County Council needs to be more inclusive. Right now the same people will be serving on all the subcommittees. The old process was big but it was very well run and the planning process moved quickly.

Michael Lilliquist. I thought that what you were saying was that the ratio of representation on the planning committee and the governing body might be quite different. The fear is that two will be reflective of each other.

Barry Buchanan. I don’t see that the new governance structure is defined at all.

Tom Fields. The subcommittee creating a new governance structure would need to have everyone represented and need to have consensus.

Roger Christensen. I’d recommend that the Council request that the EMS planning committee be more representative.

Stan Snapp. It has to have people with experience running a system. On training, the County Council wants anyone who comes in the door asking to be able to become a paramedic. The training needs to be part of the system and reflect the need to keep skills up and other considerations. I don’t want to see us create a system that will be at a lesser standard than the current system.

Tom Fields. These discussions will occur in the group that will look at education and training. The planning role is to facilitate the process not dictate the outcome. Decisions will be made by the Councils. I don’t see the planning committee being a decision-making body.

Dave Ralston. If we can’t come up with something different by the end of the year the County will have to do something different.

Stan Snapp. We need a package that our Council can buy into. Right now we have a system that works well and it was not created by politicians.

Dave Ralston. Can you give additional recommendations for structure and process that can be brought back to the Councils? The County has a similar work group to consider the issue.

Michael Lilliquist. There are 8 proposed critical elements. One of the things you are looking for is a nod on the critical elements. A 9th element is the makeup of the planning committee.

Dave Ralston. Let us know what you’d like to see in this planning process.

Stan Snapp. I argued we should agree on 2-3 goals and develop what we do under that.

Michael Lilliquist. Stan is arguing that a few of these are critical elements and the others are nested underneath.

Dave Ralston. We want to know which critical elements you agree with in the planning process.

Stan Snapp. I don’t think an open training program is a critical element.

Dave Ralston. This was brought up by the County Council.

Barry Buchanan. An important element is the collection of sales tax and how the RCW says it is distributed. Right now it is 60-40 collection and 40-60 distribution. Perhaps an independent accounting look at the books of the current system would facilitate the planning process.

Dave Ralston. That could be part of the process and part of the funding work group.

Barry Buchanan. The accounting work could provide a basis for understanding regarding proportionality.

Stan Snapp. We need an agreement on funding. There will be no blank checks from the Councils. We need someone to look at those things and give us a recommendation.

Tom Fields. If we can get past annual funding by City and County the problem will be solved. A countywide EMS levy could work. A lot of strife over payment issues could go away.

Bill Boyd. It is too early to address funding.

Stan Snapp. The Councils will not give up authority over the dollars.

Bill Boyd. I wouldn’t make the leap to a County EMS levy yet. We need to look at all available funding options, as in 2005.

Michael Lilliquist. There is a need for some technical working groups. Long-term funding and governance should go together. Otherwise the governance may not match available dollars. Patient care and quality of service also need to be lumped together.

Dave Ralston. There are 12-15 people available in the County with the right expertise. Many groups will overlap. Efficiency and funding will be addressed.

Stan Snapp. We need buy-in from those operating the current system.

Dave Ralston. There is a lot of work to be done on a funding model. What do we need to do with sales tax and general funds from the City and County?

Michael Lilliquist. You are looking at a nod on the 8 critical elements and the makeup of the planning committee. The planning committee needs more City representatives. And Stan is concerned that 8 critical elements are too many for agreement. These may need to be tiered or ranked.

Stan Snapp. If you are going to look at training then you need to look at the hospital, dispatch, etc. Three are goals, others are issues to be worked out.

Barry Buchanan. I see three levels of issues in this list, some are goals, some are concepts like governance, and some are operational details like training that need to be worked out.

Stan Snapp. If training is included we need additional City involvement.

Barry Buchanan. Training is a lower down issue.

Michael Lilliquist. Stan do you see these elements as equal?

Stan Snapp. Three of the most important goals are system design for best practices, countywide EMS, and stable funding.

Barry Buchanan. The problem with this list is that the elements are not all at the same level. Training and governance are not at the same level.

Dave Ralston. The County came up with the elements. The City can make its own recommendations.

Stan Snapp. I would rather agree on 3 goals and then work on other issues rather than 8 we don’t all agree on.

Dave Ralston. Let us know what we need to look at. We do have this timeline and I’m concerned about how long this might take.

Barry Buchanan. For some of these, when the next level of detail gets developed that would be a good time for Council buy-in. We all agree a system should be countywide, and be designed for the best outcomes for patients. Governance and training is good to work on but we need the next level of detail.

Bill Boyd. There is a legal issue. If the outcome is unfair labor practices, that is not acceptable to the City.

Tom Fields. How can we plan under the threat of an Unfair Labor Practice?

Bill Boyd. We’ll participate and if we don’t agree we’ll go on record and say we don’t. We don’t know how the issue will shake out in the process.

Barry Buchanan. This committee will decide how to bring the issue to the whole City Council.

There being no further business, the meeting adjourned at 2:21 PM.

Stan Snapp, Council President

ATTEST: Mark Gardner, Policy Analyst

This is a digital copy of an original document located at Bellingham's City Hall. The City of Bellingham specifically disclaims any responsibility or liability for the contents of this document. The City of Bellingham does not verify the correctness, accuracy, or validity of the information appearing in this document.