~ i.- { -li t -. _ .L ..: :L. L :_. ' IrFI @' J'~. I-. L!- ~~. t~` _ +l 11';,1 }d tiU„ r ~')_~ 1{1'11_ NF F'f.l4 rlL. 1-4 C-1 .i~I~fl_~ ,~-ri L l`,I i-!1~, td~~t h'd l.f-'ll :I ~ Ifs 1~+:,(I t 7:~~{t 7 ,t=i _: r; 'i 1 '. I' r.' ~ rl v: l1iY .. ~!-S6~' ]_ Y -. :_. IJ tJ C'1" ~ --._ t},- nr _ _.. `i?Cii A_ tt-i lil nil -S 5; :1. Li 7? P Y ~.' t; J f' ~' p?. p, r~ y - C: C C i'i i t Y? ~ .: ii ,71 ISI l ' 1... (, e l i l C.' Y'+. !. i? ": 'k: a B t _.. , C:-~~-'c unani~ously approved by a vote of 4-0-0, ~~ ~ e:.nra tat i[-- :~ J U., i ai t ~:;ir .. _. fT ~:~m .,.r?~_lar; L. .y .:,.., ., :'~ n:~ir. i.c;'eult:f~: .Z~• 1.. i .,~; ,-. ., ~t~ 1~ t.~~..,,,. M E M O TO: Members of the City Council Q~ fi(~, FROM: Glenn D. Brown, City Manager ~b~-f'1~ DATE: December 17, 1992 SUBJ: RECOMMENDATION ON CONTRACT EXTENSION AND AMBULANCE RATES We received additional information from AMCARE and have had several negotiation sessions over the telephone with Frank Carrubba. The city staff recommends: 1) A 9 percent increase on all ambulance service rates with the exception of the mileage rate; 2) A 21.8 percent increase in the mileage rate from $2.75 per mile (one-way loaded) to $3.35 per mile. This increase will negate the need for a subsidy increase. ..-. It is our understanding that Frank Carrubba is in agreement with the above recommendations. The reason staff is recommending a mileage charge higher than 9 percent is that medicare currently recognizes a mileage rate of $3.35 per mile for this region. Any other rate increases would have to go through a lengthy approval process before medicare would reimburse at the new level, and it would take approximate- ly 18 months before AMCARE would be reimbursed at the new rates. Also, it should be pointed out that it will still be July 1, 1993, before medicare will reimburse AMCARE, even at the already approved mileage rate. The staff is recommending a 9 percent increase in base rates/miscellaneous charges, and the increased mileage charge for the following reasons: -An increase in the mileage rate would offset the need for a subsidy increase and would result in the users of the ambulance service paying the increased cost rather than all taxpayers. -AMCARE's rates would still be below rates chazged by other cities that have private ambulance providers. -AMCARE has been granted only two rate increases in the five and one-half years that they have been servicing Kerrville and Kerr County. The last increase was 17 per- cent in July 1990. The other increase was in December 1988 at the time the contract was amended to require. AMCARE to provide an Advanced Life Support service instead of a Basic Life Support service. At that time the base rate was in- creased 40 percent. There has. never been an increase in subsidy. -Staff has reviewed several CPI indexes from July 1990 through November 1992. These indexes indicate an average 9 percent increase during this time period. -AMCARE has provided documentation to indicate their actual cost of service during the last two and one-half years has increased 12 percent. Attached is the revised contract extension as prepared by the city attorney. The changes Machann.has made are indicated by heavy black lines. All of the revisions to Section 6 have been requested by Frank Carrubba after his initial review of. the contract extension. If you have any questions, please contact. me. be FIFTH AMENDMENT TO AMBULANCE CONTRACT This Amendment is made by and between the CITY OF KERRVILLE, herein called "City", and COUNTY OF KERR, herein called "County", and AMCARE EMERGENCY MEDICAL SERVICES, INC. (previously known as Amcare Ambulance Services, Inc. prior to name change only), herein called "Contractor", to that certain original Ambulance Contract (the "Ambulance Contract") dated December 2, 1988, as follows: 1. Term. Section II (Term) of the Ambulance Contract is amended to extend the term to end on December 31, 1993, unless sooner terminated as provided therein. 2. Payments to Contractor. Section III (Payments to Contractor) of the Ambulance Contract with respect to subsidy payments (as amended by the Second Amendment to Ambulance Contract) by the City and the County shall continue without change at the present total monthly sum of $6,250.00. 3. Contractor's Charaes. Attachment "A" (Contractor's Maximum Charges) and Attachment "B" (Supplies Charges) to the Ambulance Contract are amended and shall be as set forth below: A. Effective January 1, 1993, and except only for the milage rate set forth in subparagraph B. below and the Advanced Life Support base rate charge set forth in subparagraph C. below, each item charge set forth in Attachment "A" and Attachment "B" to the original Ambulance Contract is increased by 9$ from the present schedule of maximum charges, such present schedule of maximum charges being as set forth in the original Ambulance Contract. B. Effective January 1, 1993, the milage rate is increased to the following: Milage Rate (one way, loaded, from patient's origination to destination, minimum two miles) $ 3.35 per mile C. Effective January 1, 1993, the Advanced Life Support base rate is increased to $223.45. D. Item 10 of Attachment "A" is deleted. 4. Return of Equipment. Contractor shall return the two (2) MRL heart monitors/defibrillators that are no longer in service. 5. Service Continuation. Contractor agrees to continue to maintain the level of services it is providing as of the date of this Amendment, including but not limited to the present quantity and quality of ambulances and personnel, with not less than three (3) vehicles as ALS with MICU capabilities. 6. Consultation. The parties agree to exercise diligent, good faith efforts to contract for the services of The 4th Party, Inc. to obtain consultation with respect to the efforts of the City and the County to implement revisions to the EMS system consistent with the existing Interlocal Agreement between the City, the County and the City of Ingram, such consultation to include: defining and/or clarifying a proposed franchise model and defining and/or clarifying the Master Contract for ambulance service consistent with such model; determine the factors contained on the price/subsidy trade-off graph; determine and/or clarify and define funding procedures, if any; determine and/or clarify the role and responsibilities of the KEMSA Administrator; determine and/or clarify the role and responsibilities of the KEMSA Medical Director; determine and/or clarify the role and responsibilities of the KEMSA Board of Directors; determine how to make the transition between the current contract and the Master Contract; and such other matters as the parties may agree. The total cost of such consultant services are not to exceed the sum of $7,000.00, of which Contractor agrees to pay one-half ('~) ($3,500.00) and the City of Kerrville agrees to pay the remaining one-half (~) ($3,500.00). Contributions by the City of Ingram, the County of Kerr, the Kerrville Medical Society, Sid Peterson Hospital or any other source will be used to equally reduce the cost to Contractor and the City of Kerrville. The City of Kerrville will provide to Contractor a detailed itemized bill from the consultant and a list of all contributions made by source. The parameters of the consultation shall be as may hereafter be agreed upon between Contractor, the City of Kerrville and The 4th Party, Inc. (and also the County of Kerr should it elect to participate in such costs). The obligation of the City (and the County of Kerr if it participates) to fund its share of such costs are subject to completion of any budget process requirements. -2- No commitment is made by any party hereto to adhere to or otherwise adopt the recommendations of said consultant, but only to exercise good faith efforts and to cooperate with such consultant in the rendering of his services to the parties hereto. No commitment is made to continue any contractual relationship with Contractor after December 31, 1993, but all parties agree to exercise reasonable efforts in connection with the consultation referenced above to explore the feasibility of Contractor being the contractor under the Master Contract to be developed, subject to such deliberations and recommendations that may be made by the KEMSA Board pursuant to the Interlocal Agreement. Contractor acknowledges the possibility of competitive bidding and/or requests for proposals being utilized following the completion of such consultation and following completion of the deliberations and recommendations of the KEMSA Board. 7. No Other Amendment. Except as amended herein and as amended by the First, Second, Third and Fourth Amendments to the Ambulance Contract, all of the provisions of the original Ambulance Contract, effective July 20, 1987 shall be in effect. Without limitation of the foregoing, nothing contained in this amendment shall be construed to relieve Contractor of its obligation to maintain in force and effect Workers Compensation insurance as required by the Ambulance Contract. EXECUTED this the day of December, 1992. AMCARE EMERGENCY MEDICAL SERVICES, INC. By:_ Name: Title: CITY OF KERRVILLE By: JOE HERRING, JR., Mayor ATTEST: SHEILA L. BRAND, City Clerk -3- APPROVED AS TO FORM: WALLACE, MOSTY, MACHANN, JACKSON & WILLIAMS E. DWAINE MACHANN Date City Attorney COUNTY OF KERR B G~4 ~~ Y~ W. G. STACY, County Judge ATTEST: ~~~ ~J ,~ PATRICIA DYE, Count Clerk APPRO ED AS TO FORM: Coun y Atto C34\67AM2 -4- <<... _~, __ _~..~i ._~-, ~rm ~~ ~ i ur 1^.tKh".'1LLE, I„ TEL Sic-792-585E1 F. 1 DEC 1.6 ' 92 1 1:37 FP.O, dMMJW FIFTH AMEI~MENT ',~Q AMHULI~NCE CONTRACT Postdt'" brand fax transn,,...~~ memo 7671 Hof pages . / ro ~- GLdt_ p ~ co. _ > co. Dept. Phone M r+ Fa%p ~ ~ FecY Thar Amendment is scads by and be:twerp the CITY OF ItERRVZLLI3, herein called "City", and COUNTY OF RERR, herein called "County", and AMCARS EMERGENCY MEDICAL SERVICES, INC. (px'ev~.aurly known as Amoare Ambulance Services, Ina. prior to Hams change only), herein called "Contractor", to that certain original Ambulance Contrast (the "Ambulaasea.CosYtraat") dated Decesaber 2, 1988, as follows: 1. .Term. Seatiom Ii (Term) of the Ambular-oe Contract is amended to extend the term to end sn Draambrr 3I, 1993, unless sooner terminatead as provided therein. 2. ~ t o ,actor. Section III (paymeata to Contractor) o the Ambulancr Contrast with respect to ~aubridy payments (as amended by the Second Amendment to Ambulance Conttract) by the City and the County shall canhinue without ohango at the present total monthly sum of .$6,,250.00. 3. Contractors Charges. Attachme>bment. Contractor chaff return the two (2) MRL heart monitors/defibrillators that are no lazsger in service. •• DE C, 16 '92 16:56 FROM WMMJW TO CITY PRGE.003 5. service Continuation. Contractor agrees to continue to maintain the level of services it is providing as of the -date of this Amendment, including but not limited to the present quantity and quality of ambulances and personnel, with not less than three (3) vehicles as ALS with MICV capabilities. 6. Consultation. The parties agree to exercise diligent, good faith efforts to contract for the services of The 4th Party, Inc. to obtain consultation with respect to the efforts of the City and the County to implement revisions to the EMS system consistent with the existing Interlocal Agreement between the City, the County and the City of Ingram, such consultation to include: defining and/or clarifying a proposed franchise model and defining and/or clarifying the Master Contract for ambulance service consisteat with such model; determine the factors contained on the price/subsidy trade-off: graph; determine and/or clarify and define funding procedures, if any; determine and/or clarify the role and responsibilities of the REMSA Administrator; determine and/oz clarify the role and responsibilities of the REMSA Medical, Director; determine and/or clarify the role and responsibilities of °` the KEMSA Board of Directors; determine how to make the transition between the current contract and the Master Contract; and such other matters as the. paacties may agree. The ,total cost of such consultant services .are not to exceed the sum of $7,000.00, of which~COntractor agrees to pay one-half ('~) ($3,500.00) and the City of Kerrville agrees to pay the remaining one-half (~) ($3,500.00). Contributions by the City of Ingram, the County of`Kerr, the Kerrville Medical Society, Si.d Peterson Hospital or any other source will be used to equally reduce the cost to Contractor and the City of Kerrville: The City of Kerrville will provide to Contractor a detailed itemized bill from the consultant and a list of all contributions made by source. The parameters of the consultation shall 'be as may hereafter be agreed upon between Contractor, the City of Kerrville and The 4th Party, Inc. (and also the County of Kerr should it elect to participate in such costs}.. The abTigation of the City (and the County of Rerr if it participates) to fund its share of such coats are subject to 'completion of any budget process requirements. -2- .- DEC 16 '92 16:56 FROM WMMJW TO-CITY PAGE.004 No commitment is made by any party hereto to adhere. to or otherwise adapt the recommendations of said consultant, but only to exercise good faith efforts and to cooperate with such consultant in the rendering of his services to the parties hereto. No commitment is made; to continue any contractual relationship with Contractor after ;December 31, 1993, but all parties .agree to exercise reasonable efforts in connection with -the consultation referenced above to explore the feasibility.of Contractor being the contractor under the Master Contract to be developed, subject to such deliberations and recommendations that may be made by the KEMSA Board pursuant to the Interlocal Agreement. Contractor acknowledges the possibility of competitive bidding and/or requests for proposals being utilized following the completion of such consultation ..and fallowing completion of the deliberations and' recommendations of the 'KEMSA Board. - . 7. No .Other. Amendment. Except as amended herein and as amended by the First, Second, Third and Fourth Amendments to the Ambulance Contract, all of the provisions of the original Ambulance Contract, effective July 20, 1987 sHall be in effect. Without limitation of the foregoing, nothing contained in this amendment sha1T be construed to relieve Contractor of its obligation to maintain in force and effect Workers Compensation insurance as required by the Ambulance Contract. EXECUTED this the day of December, 1992. . AMCARS EMERGENCY MEDICAL SERVICES, INC. By: Name: Title• CITY OF KERRVILLE By: JOE HERRING, JR., Mayor ATTEST: SHEILA L. BRAND, City Clerk -3- U'EC 16 '92 16:57 FR~~ WMMJW Tr°"'ITY PRGE.005 APPROVED AS TO FORM: WALI,ACE, MOSTY, MACAANN, JACKSON & WTLLLAMS By: E. DWATNE MACI~ANN Date City Attorney COUNTY OF RERR ,. BY = W. G. STACY, County Judge ATTESTS PATRICTA.DYE, County Clerk APPROVED"AS TO FORM: County Attorney C34\67AM2,. -4- "` WALLACE, MOSTY, MACHANN, JACKSON & WILLIAMS ATTORNL•YS AT LAW A PARTN[RSMP OF PROFESSIONAL CORPORATIONS DAVID L JAO'ST1 E Dwna+e hfAOfANN RIOWDGh(OSIY ttzA+n: wnuAa N. Xcrtff WIILAYS " S Pzrstav W4LlA4, Jz TELFI'HONE 512 /876 38 7 1 TIIFFAX572/257-61]9 82D MAIN ST., SUITE 100 I~7t11VIT1,E,'1'EXAS 7801&SY10 October 2b, 1992 HAND DELIVERED Mr. Glenn Brown City Manager City of Kerrville 800 Junction Highway Kerrville, Texas 78028 Re: Medical Director Contract Dear Glenn: In connection with the above, enclosed is a revised draft of the Medical Director Contract. Please note that I have not addressed the issue of Medical Malpractice Insurance. Once you have reviewed the enclosed, please call me so that we can discuss same. Sincerely yours, WALLACE, MOSTY, MACHANN, JACKSON & WILLIAMS E. Dwaine Machann EDbf/gr Enclosure C134\L23 'HM1W CIxt96.D. Fwut, RANCSI COMMOnI ANO.FL~IMI,\L A2nl Flinn ••BO/.tD CLRI%FD. I'iASONAL O+IUtY Tuntlww M E M O TO: Members of City Council FROM: Glenn D. Brown, City Manager ~~ DATE: December 15, 1992 SUBJ: INFORMATION REGARDING SPECIAL MEETING OF DECEMBER 17 TO DISCUSS AMBULANCE CONTRACT EXTENSION Enclosed is the agenda for Thursday's meeting rega=ding. the ambulance contract extension. Attachment I is a proposed con- tract extension between the City of Kerrville, Kerr County, and AMCARE. The contract extension was proposed by Frank Carrubba at the December 7 KEMSA meeting and has been revised by the city attorney. Attachment II is the minutes of the December 7 meeting containing the board's recommendations. The staff does not know what action Kerr County will take on the contract extension. At this-time negotiations are still on-going between the city staff and AMCARE regarding their proposed 9 percent increase in rates and subsidy. We have requested additional information and justification for the proposed 9 percent increase, but this information has been slow in coming from AMCARE. I had a lengthy conversation with Frank Carrubba this morning ar..~'. he promised to supply additional information, but as of the. writ- ing of this memo, it has not been received. The staff will make a specific recommendation regarding the increase prior to Thursday's meeting and also let you know if AMCARE will agree to this figure. I believe that it is imperative that the Thursday meeting take place. I realize we only have 45 minutes in which to meet..; however, if the terms of the contract extension cannot be re- solved, we need to at least briefly discuss. our options. for continuing ambulance service beyond January 1, 1993. Staff believes the options are: (1) Hire a private contractor to run a temporary service while we solicit bids for an ambulance service; or (2) Either temporarily or permanently house the ambulance service in the city`s fire department. One point that I feel needs to be made is that to implement either of these options may very well cost more than the 9 percent in- crease Carrubba is requesting. Attachment III is a letter from Dr. Ottis Layne outlining his proposal for altering his contract with the city if there is a one year contract extension with AMCARE. While this is not a subiect for Thursday's special meeting, the staff wanted the Council to be aware that Dr. Layne is willing to amend his contract and to lower the dollar amount. Staff will. have fur- ther discussions with Dr. Layne regarding his attached letter to determine if additional cost savings can be achieved by Jim -° Harvey performing even more of the functions that Dr. Layne has outlined in his letter. It is our recommendation that this proposal be taken up at one of the January meetings. At that time there may also be a need. to amend the uniform EMS ordi- nance and the interlocal agreement to coincide with whatever arrangement we have for ambulance service after January. In summary, the staff supports the extension of a contract with AMCARE for one year, if the amount of increase can be agreed upon between the City and AMCARE. The negotiations on this matter are continuing with Frank Carrubba. Prior to Thursday's meeting staff will provide a specific recommendation regarding the increase. Regardless, a decision needs to be made Thursday whether to extend the contract with AMCARE or pursue one of the other options. This will allow time for a special meeting next week to formalize one of the options, if this becomes necessary. If you have questions, please call me. be enc. DEC-15 '92 9:33 FP.O,M WMMJW TO-!'ITY PRGE.062 This Amendment is made by nd between the CI ~ OF KEARVILLE, herein called"City", and COUNT OF KERR, herei called "County", and AMCARE AMAULANCE SERVICES, IN ., herein call d "Contractor", to that certain original Ambulance C tract {the ulance Contract") dated Aecember 2, 198&, as follow 1. Term. Section II (Term of th Ambulance Contract is 'amended to extend the to to e d on December 31, 1993, unless sooner terminated s pr vided therein. 2. .Payments to Contractor. Contractor) of the Ambula as follows: "For the services to b period of January 1, 19 3 of Kerrville and the ow monthly sum to Contra or be divided equally b weer County of Kerr. The first and payable the 20 h day month next follow' g the begins) and cont nue on Section .III (Payments to Contract is amended to read dered during the extension December 31, 1993, the City t of Kerr shall pay a total ~f $ , _ said sum to t City of Kerrville and the ?a ent hereunder shall be due of ebruary, 1993 {being the iont in which this extension the same day of each month ide term 'of ,the Ambulance is to be paid. such monthly mon h of service hereunder." thereafter Burin the exte Contract. Such Contractor payment after r Bering each 3. Contractor's C arses. .Attachmen s "A"Wand "8" attached to the Ambulan a Contract are ame Bed and shall be as set ;forth below: A. Each item charge set forth i .Attachment "A" and Attachment "B" to the origins "'Ambulance Contract is increased by ~ from the present schedule of maximum charges, such present chedule of maximum charges being as set forth in the original Ambulance Contract except fo the following .increases previously authorized: 1. Advanced Life Support base rate $ 205.00 2. Milage Rata (one way, loaded, . from patient's origination to ' destination, minimum two miles) $ 2.75 per mile B. 2tem 10 of Attachment "A" is deleted. ATTACHMENT 2 DEC 15 '92 9:34 i FR( WMMJW TO :TY PRGE.003 4. "Return of Equipment. Contractor shall return the two (2) MRL heart monitors/defibrillators that are no longer in service. 5. Service Continuation. maintain the level of date of this Amendment present quantity and q~ with. not less than the capabilities. Contractor agrees to continue to arvices it is providing as of the including but not limited to the ~lity of ambulances and personnel, ae (3) vehicles as ALS with MICU fi. Consultation. The par good faith efforts to c 4tki Party, Inc. to obta: the efforts of the Cit revisions to the EMS sysi Interlocal Agreement bets City of Ingram, such coy and/or clarifying a pz service contract consisi and/or clazify and defi determine and/or clarify the .KEMSA Administrator .role and responsibiliti determine and/or clari the KEMSA Board of D' ec the parties may agr agree to.exer se diligent, tract for the ervices of The consultatioFi with respect to and the CC,oounty to implement i consistent with the existing :n the C~ty, the County and the iltati n to include: defining osecl~ franchise model and a ith such model; determine unding procedures, if any; role and responsibilities of :termine and/or clarify the the KEMSA Medical Director; role and responsibilities of a; and such other matters as The total cost o such co exceed the sumo $7,000.00 "to pay one-half ) ($3,500. agrees to pay ~he remainin provided that he City's poi reduced by anl/ contributions or other organizations. consultation shall be as ma :ltant services are not to of which Contractor agrees i) and the City o£ Kerrville one-half (~)•($3~500.00); pion of such costs will be made by the County of Kerr The parameters of the hereafter. be' agreed upon between Contractor, the City of Kersville~and The 4th party, Inc. (and also the Coun y of Kerr should it elect to participate in such costs) The obligation of the City (and the County of Kerr if it participates) to fund its share of such costs are subj et to completion of nay budget process requirements. No commitment is made by any party hereto to adhere to or otherwise adopt the recommendations of eai.d.consultant, but only to exercise good faith efforts.and to cooperate .with such consultant is the rendering'af his services to the parties hereto. No implication shall .arise as to any -2- :~1 DEC-IS '92 9:34 FRAM WMMJW T~' CITY PAGE.004 commitment to continue any contractual relationship with .Contractor aFter pecember 31, 1993. ,, 7. o Other Amen ent. Except as amended .herein and as amended by the 'rst, Secoad, Third and Fourth Amendments - to the Ambulance Contract, all of the .provisions of the original Ambulance Contract, effective..JUly 20, 1987 shall be in effect. Without limitation of the foregoing, nothing contained in this amendment shall be construed to '• relieve Contractor of its obligation maintain in force and effect Workers mpensation i rants as required by • the Ambulance Contra t. EXECUTED this the da of December, 1992. AMC .AMBULANCE SERVICES, INC. Bys Name• Title: _-. CITY OF RRVILLE By: JOE HERRI ; JR., Mayor ATTEST: ,\ SHEILA L. BRAND, City Clerk APPROVED AS TO FORM: WALLACE, MOSTY; MACHANN, JACX50N,5 WILLIAMS By: E. DWAINE.MACHANN Date City Attorney COUNTY OF KERR By: W. G. STACX, County Judge -3- ' DEC ;,I S ' 92 9:35 FROM WMMJLJ TO C I TY ATTEST: PATAICIA DYE,, County Clerk APPROVED AS TO FORM: County Attorney C34\67AM2 -4- PAGE.005 " Tf7E STATE OF TEXAS COUNTY OF KERB CITY OF KERRVILLE On Monday, December 7, 1992, the Kerr Emergency Medical Servic- es Agency meeting was called to order at 5:30 p.m. in the City Hall Council Chambers, S00 Junction Highway. MEMBERS PRESENT: Mike Reddell Rosa Lavender William Allen Buster Baldwin Martha Carlson 'Layne Herring Rowan Zachry Ottis Layne Lynn LeMeilleur MEMBERS ABSENT: Glenn Holekamp STAFF PRESENT: Glenn D. Brown Dwaine Machann Randy Thomas Jim Harvey Raymond Holloway Linda Sullivan VISITORS PRESENT: Chairperson Vice-Chairperson Member Member Member Member Member Medical Director, Ex-officio Ex-officio Ex-officio City Manager City Attorney Public Services Director Public Safety Coordinator Fire Chief Secretary, Public Services List is on file in City Clerk's Office for review upon request. APPROVAL OF MINUTES Ms. Carlson moved, seconded by Mr. Baldwin, to approve the min- utes of December 2, 1992 as written. Motion passed 5-0 (Dr. Allen and Mr. Zachry arrived after vote was taken.} RESPONSE FROM AMCARE TO PROPOSALS Mr. P,eddell asked Mr. Thomas to give an overview of the propos- al that AMCARE submitted for this meeting. Concerning the proposal, AMCARE submitted the following; -requested a one year extension -requested a 9°, increase across the board ATTACHMEN'T' S 2 `, Page Two KEMSA Minutes December 7, 1992 - requested that Mr. Jack period, for assistance in of the EMS system Stout be hired, during the extension the development and implementation Dr. Layne presented the Board his proposed schedule of imple- mentation of response time standards and clinical performance standards which included phase-in periods (on file in Public Services Division). He advised .the Board that Mr. Carrubba lead a copy also. Dr. Layne agreed that another consultation from Jack Stout would be very beneficial. He also recommended that a one year extension should be given with the proviso that once the proposed contract is ready, there will not have to be a year waiting period for implementation. Mr. Reddell polled members of the Board. Concerns raised were: -9o increase for county and city -expense for Jack Stout - -medical director's role during the extension (It was dis- cussed that the medical director's role would be a separate is- sue during this extension period.) -alterations to Interlocal Agreement and EMS Ordinance (City attorney will work with these documents.) DISCUSSION OF ALTERNATIVE METHODOLOGIES FOR AMBULANCE SERVICE Mr. Thomas reported that staff had made corrections to t(~e Pro- posed Master Contract and submitted this contract as request- ed. Staff also had contacted various ambulance contractors as requested. Mr. Thomas presented Initial Start-Up Costs for EMS/Fire service and Third City Service. Mr. Reddell called for a motion in order for him to be able to present recommendations to City Council. Dr. Allen motioned to consider AMCARE's request for a one year contract extension and to proceed with negotiations, seconded by Ms. Carlson. Motion carried 6-0 (Mr. Baldwin abstained.) ._ Page Three KEMSA Minutes December 7, 1992 At this point, the Board reviewed AMCARE's proposed addendum to the Ambulance Contract. Again, it was felt that all entities could benefit from an ad- ditional visit from Jack Stout. Contract wording should be such that if Mr. Stout would not be able to come to Kerrville the contract would not be invalidated. (Attorneys were to work with the wording.) Other Business No other business. was brought before the Board. Upon motion by Mr. Baldwin, seconded by Mr. Zachry, the Board adjourned at 7:25 p.m. Date Approved: Mike Reddell Chairperson Linda Sullivan Recording Secretary • ~ xErts ~ ~_ SATE; December 7. 1992 ,._ 5:30 p.m. VIS_ l~~s Add_ Tess }~ Pri_~d ,dam -1-J ~, r ~ .----- ,~~o 1~ 2 `l ~~~ _ ( CC Amc~~ ~r~4~~. 7 Lti.owc~~ v ,~1~ , ,_ S 4 ~~ C,0 ~~ 9.~7.c ~,/~~ 10. ~"~LZ ~7~G/'~IC~.,InJ~ 12~~ Y_~ ~~ -- l: } 1 } ~o~ ~~ !~ OTTIS L. LAYNE, M.D., F.A.C.E.P. 116 Pecan Creek Road Fiederickibnrg, 7'exar 78624 (St1J 669-2343 _ December 14, 1992 City Council Kerrville, TX Dear sirs: I am writing in regard to the contract for my position as medical director f or the Kerr Emergency Medical Services Agency. Recent decisions now call for a continuation oL the current con- tract with AMCARE on Jan. 1, 1993, including a continuation of AMCARE's present arrangement for medical direction, thereby re- ducing the requiremeits of my position as medxral director for KEMSA. I want to make several points in regard to this matter. Enclosed is a copy of my most recent communication from the City of Kerrville about my contract. Please note that the date of Mr. Machann's letter is Oct. 26, 1992. Also please note that the effective date for my contract eras to be Nov. 15, 1992, with the financial arrangement being $1250.00 paid on Dec. 1, 1992 and then $2500.00 per month, payable starting Jan. 1, 1993• I ~° also want to point out that this contract was never signed, due to inaction on the part of the city, despite my repeated requests. for it to be completed and signed. To address this situation as well as my duties under an extension of the current ambulance con- tract with AMCARE, I want to propose a three-step ~.im~al:em~entatdon of my contract, as follows. STEP ONE. I ask that the city honor the attached contract retroactive to Nov. 15, 1992 when I was assured it would take effect, and that this contract continue in effect until an adden- dum is signed, as outlined in step two. The justification for this is the fact that this contract should already be in effect and my level of involvemeit with the KEMSA board and the time and effort involved in the meetings with APiCARE and the prepara- tions for medical d.irectivn under the new system as provided for in the EMS ordinance and the Interlocal Agreement are commensurate with the level of remuneration listed in the contract. STEP TWO. Under an extension of the current AMCARE contract the following services listed under "Exhibit A" of the attached contract will still be appropriate duties for me: (1) response time standards should be developed, instituted as possible, and monitored month-by-month. (2) the system standard of care requires extensive planning and preparation and this could be begun even under a continuation of the current ambulance contract. (3) protocols and standing orders should still be developed and implemented as possible. (1~-) control center protocols need to be developed at this time, with implementation as possible. ATTACHMENT = = 2 (5) standards and procedures for medical audits need to be developed. (6) development of certifidation tests can be done prior to implementing ':the new ambulance contract. (8) monitoring response times should be done now. (y) certification of base station physicians needs to be done soon and does not require a new AriCARE contract. (10) system review con still be done. (12) priority dispatch is an urgent need, even under the pres- ent system and it is an area for which A24CARE has indicated its readiness. (13) monthly reports still need to be done. (14) protocols for helicopter use need to be done soon, even with extension of the current contract. Therefore, I propose that as step two my contract be ammended to include the above duties and that the time and effort included by these duties represents a one-third reduction from the level of time and effort as outlined in the original contract. There- fore I request that the compensation be reduced one-third from that originally proposed and that this continue until step three. STEP THREE. 4Jhen the ambulance contract has been completed and if the franchise system is implemented as currently described in the ordinance and interlocal agreement and if my duties will be those described in the original medical directors contract, then I request that simultaneous with the nevr ambulance contract i return to the full duties and same level of compensation as described in the enclosed original contract. If the system er duties are different then new negotiations will ba necessary. Sincerely, Ottis L. Layne, NI. D. WAI,LACE, MOSTY, MACHANN, JACKSON & WILLIAMS By: E. DWAINE MACHANN Date City Attorney OTTIS LAYNE, M.D. C134\67CN1 -3- :/ EXHIBIT "A" SCHEDULE OF SERVICES (1) Recommend for KEDSSA approval medically appropriate response t ime standards for each member of KEMSA; '(2) Establish and update the System Standard of Care, including without limitation standards for ambulance, transfer and first responder vehicles and on-board equipment (provided that for any new or additional equipment, the Medical Director first shall conduct an economic impact study to determine the impact on ambulance, first responder and transfer vehicles and the effect on rates and subsidies of members of KEMSA; and provided further that no requirements for new or additional equipment may be made without the consent of the member s of KEMSA if such would result in any cost to a member or affect the Uniform Schedule of Price/Subsidy Options); _~_ (3) Develop m edical protocols and standing orders for ambulance and first responder services and periodically revise same; (9) Develop control center protocols and periodically revise same; (5) Conduct medical audits and develop standards and procedures for the conduct of such audits; (6) Develop and periodically revise and administer both written and practical tests for the certification and licensing of the base station physician, emergency medical services personnel, including ambulance personnel, first responders, and EMS control center personnel; (7) Conduct or authorize inspections of vehicles, equipment and supplies on both an announced and unannounced basis; (8) Monitor response time performance and to provide monthly reports to each member of KEMSA and to KEMSA; in this regard, the KEMSA's contractor shall be required to furnish such statistical information regarding response time performance as may be requested by the Diedical Director; (9) Authorize the issuance, restriction, suspension, denial, revocation and renewal by municipal members of KEMSA of (a) licenses for ambulance service, (b) permits for ambulance, transfer and first responder vehicles and (c) certificates for base station physicians, emergency medical service personnel (including ambulance personnel, first responders and EMS control center personnel), all on behalf of each municipal member of KEMSA, and all subject to published procedures providing due process as may be developed by the Medical Director or KEMSA and approved by the City Attorney for the City of Kerrville. (10) Periodically conduct intensive reviews of the system's performance relative to specific clinical types and to revise medical protocols and such other standards of the system as may be appropriate in light of the findings; (11} Conduct medical audits of individual cases as requested by KEMSA, by any elected official of a member jurisdiction, by any licensed physiciah regarding a patient of such physician, or by any paramedic involved in the case which is the subject of the audit request; (12) Approve 911 protocols for "Medical Priority Dispatch" {including pre-arrival instructions, priority code "- classifications and whether or not to dispatch a first responder) and to insure that 911 medical requests are immediately transferred, while the caller is still on the line, to the EMS Control Center; (13) Present monthly a written performance report to KEMSA; and present annually a written and oral report to KEMSA concerning the state of clinical and response time performance of the ambulance system; each member jurisdiction shall be informed of the time and place of such annual oral report at least 30 days in advance of that meeting and shall be invited to send representatives, and shall be furnished a copy of the written monthly and annual reports; and (14) Develop approval standards governing the operation of helicopter rescue units, including standards defining the circumstances under which such units may be deployed to emergency scenes; (15) Maintain personal competence in emergency medicine. C134\67CNEXA -2- `~ EXHIBIT "B" MEDICAL DIRECTOR ASSISTANCE To the extent practicable, and subject to approval by the City of Kerrville (herein "Administrator"), ambulance and equipment inspections and certain administrative and other duties of the Medical Director may be performed by an employee of the Administrator. Such employee will be appointed or designated by the Administrator. Such employee will be subject to medical or clinical oversight by the Medical Director in the performance of such duties; but the employee nevertheless will be under the ultimate supervision of the Administrator, as employer. The typical duties of the Administrator's employee may include (but are not necessarily restricted to) the following: 1. Assist in establishing ambulance and equipment standards for ambulance and first responders vehicles. 2. Conduct economic impact study(s) for new or additional equipment under the Contract between KEMSA and its contractor. 3. Assist in development of control center standards and protocols. 4. Administer tests for certification, licensing and permitting. 5. Conduct inspections of ambulances, vehicles and equipment. 6. Monitor response time performance and provide monthly reports to Medical Director and KEMSA. 7. Administrative aspects only of license, permit and certificate issuance, restriction, suspension, denial, revocation and removal. 8. Accumulate monthly performance data for clinical and response dune performance. 9. Analytical work such as price/subsidy chart .and review of Contractor reports. t 10. Interface with t~iedicare and State as necessary, 11. Handle citizen complaints. 12. Act as liaison between KEMSA and the Administrator. 13. Work as staff support for KEMSA with respect to compliance by Contractor with Contract terms. 14. Coordinate interdepartmental actions between KEMSA, First Responders, and Medical Director. C134~67CNEXB -2- ;. ..~~:, _ -: ~' To assist Layne in the performance of his duties, City agrees to provide to Layne the assistance as set forth on Schedule "B" attached hereto and made a part hereof. Layne agrees to devote such time and effort as may be necessary and/or desirable for Layne to perform his duties and obligations in a prompt, efficient and professional manner. 6. Termination. This Contract may be terminated by the City at any time upon written notice from the City to Layne, with or without cause. In such event, Layne agrees to cooperate with the City and the successor Medical Director to minimize disruption in the performance of the duties and responsibilities of Layne as set forth herein. In the event of such termination, City agrees to pay Layne compensation as herein provided through the date of cessation of services by Layne. 7. Resignation. Layne reserves the right to resign from this appointment upon not less than ninety (90) days prior written notice to the City. d. Not An Emnloyee. Nothing contained herein shall be "_ construed to create an employer/employee relationship. 9. No Assignment. City is relying upon the expertise and abilities of Layne, and it is expressly provided that Layne may not assign, in whole or in part, the performance of any of his duties and obligations hereunder. The foregoing will not prohibit Layne from assigning from time to time another physician to be "on call" to provide EMS directives, but only during such time(s) of Layne's occasional absence and unavailability. 1992. Executed and delivered this the day of CITY OF KERRVILLE By: JOE HERRING, JR., Mayor ATTEST SHEILA L. BRAND, City Clerk -2- .~'', ~~/ MEDICAL, DIRECTOR CONTRACT This Contract is entered into this the day of 1992, by and between the CITY OF KERRVILLE ("City") and OTTIS LAYNE, M.D. ("Layne"j. 1. Appointment. City hereby appoints Layne as Medical Director pursuant to EMS Interlocal Cooperative Agreement ("Interlocal Agreement"} by and between the City, the County of Kerr and the City of Ingram and pursuant to City ,of Kerrville Qniform EMS Ordinance No. 92-25 (the "Ordinance"j. 2. Term. The services of Layne hereunder shall commence on November 15, 1992 and shall terminate on September 30, 1993. The appointment and this Contract may be zenewed by the City Council of the City for successive one (1) year terms. Each of such successive terms shall be coincident with the fiscal year of the City, being October 1 to September 30 of the following year, commencing October I, 1993. Any such extension will require the concurrence of Layne. Earlier termination may occur as herein provided. 3. Compensation. For services to be rendered hereunder during the initial term, City agrees to pay to Layne the sum of $26,250.00, payable in ten (10) monthly installments in arrears for the prior month of $2,500.00 each, on the 1st day of each month, commencing the 1st day of January, 1993, and continuing until the 1st day of October, 1993. The sum of $1,250.00 will be payable on the 1st day of December, 1992, for services rendered from November 15, 1992 to December 1, 1992. Compensation for any renewal term shall be as may be set forth in renewal contract by and between the City and Layne. 4. benefits. City shall provide Layne with administrative support, including secretarial support for reports, correspondence and data entry and use of necessary copier, typing and similar office equipment. Further, City agrees to reimburse Layne up to the sum of $500.00 per Contract year for continuing emergency medicine education. No other compensation or benefits shall be payable by City to Layne. "` 5. Services of Medical Director. Layne shall perform and provide to the City and to the Kerr Emergency Medical Services Agency ("KE615A"J those services described on the attached Eihibit "A" Schedule of Services, all in accordancezaith and subject to the provisions of the Ordinance. r--- <. iNE ON OF KERRVILLE, TEXAS November 11, 1992 County Judge William Stacy and Kerr County Commissioners Court Kerr County Courthouse 700 Main Street Kerrville, TX 78028 Dear Judge Stacy: As has been discussed several times over the past few months, by the terms of the Interlocal Agreement that established KEMSA, the city and county will be sharing the administrative related expenses equally. These administrative expenses include the cost of the medical director and the city staff support to the medical director and the KEMSA Board. Below is a breakdown of the administrative expenses totalling $47,750 for the 92-93 fiscal year: Medical Director Compensation $26,250 ill/15/92 - 9/30/93) Continuing Education for Medical Director 500 City of Kerrville Staff Support 21,000* TOTAL $47,750 xThis figure includes one-half of Jim Harvey's salary and benefits, and city staff clerical support. The county's share for 1992-93 would be $?.3,875. The city would appreciate confirmation of these amounts and feedback from the County regarding method of payment, i.e. monthly, quarterly, annually. ca 800 JUNCTION HIGHWAY •KERRVILLE, TEXAS 78028-5069 • 512/257-8000 iwE arv of KERRVILLE, TEXAS County Judge William Stacy November 11, 1992 Page 2 If you should have any questions regarding this, please do not hesitate to contact me. It is a pleasure to continue working with the county on joint projects. Sincerely, _(~ Glenn D. Brown City Manager be 800 JUNCTION HIGHWAY KERRVILLE. TEXAS 78028-5069 512/257-8000