ORDER NO.29330
APPROVAL OF EMS CONTRACT
Came to be heard this the 22nd day of August, 2005, with a motion made by
Commissioner Baldwin, seconded by Commissioner Letz. The Court
unanimously approved by vote of 3-0-0 to:
Accept and approve the Contract as presented, subject to the review of
the County Attorney.
_ _ --Y---
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COMMISSIONERS' COURT AGENDA REOUEST
PLEASE FURNISH ONE ORIGINAL AND NINE COPIES OF THIS
MADE BY: H.A. "Buster"
MEETING DATE: August 22, 2005
OFFICE: Commissioner, Pct. 1
TIME PREFERRED:
SUBJECT: Consider and discuss EMS Contract and take appropriate action thereon.
EXECUTPJE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT: Commissioner, Pct. I
ESTIMATED LENGTH OF PRESENTATION:
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in
accordance with Title 5, Chapter 551 and 552, Government Code, is as follows:
Meeting scheduled for Mondays:
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON:
5:00 P.M. previous Tuesday.
~-

All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepazed for the Court's formal consideration and action at time of Cour[
Meetings. Your cooperation will be appreciated and contribute towazds you request being
addressed at the eazliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.
DRAFT
Proposed members for EMS Study Committee:
1. James A. Murphy 2. Gordon Morgan
3. Joe Herring, Jr. 4. Ray Lehman
5. Walter Schellhase
Statement from Ken County Commissioner's Court:
Kerr County Commissioners Court desires to maintain a very high standazd of medical
caze and service in Kerr County. The Commissioners Court further believes, to the extent
possible and practical, that the EMS service provided in Kerr County should strive to be
financially self sustaining. With these goals in mind an assessment of the following
items by the above appointed committee will be of great service to the residents of Kerr
County.
1. Assess function and viability of an Emergency Service District (ESD)
a.) County-wide ESD including the City of Kerrville.
b.) County-wide ESD excluding the City of Kerrville.
Note the two current ESD's in the county may be excluded under either scenario
2. Review and make recommendation on the billing system and rate structure under the
current EMS contract with the City of Kerrville.
3. Review and make recommendation on collections system under the current EMS
contract with the City of Kerrville.
4. Review and make recommendation on an equitable funding formula between the City
of Kerrville and Ken County for funding any fmancial shortfall under the current EMS
contract.
5. Review and make recommendation on other EMS issues that affect quality of service,
cost effectiveness or other matters that may improve EMS service in Kerr County.
Committee to report back to the Commissioners' Court not later than Mazch 1, 2006 with
its findings.
Ken County hopes the City of Kerrville will join in approval of this committee to help
develop a long range plan for the continued high quality of EMS service throughout Kerr
County.
~~~3C~
INTERLOCAL AGREEMENT
FOR EMERGENCY MEDICAL SERVICES
STATE OF TEXAS §
COUNTY OF KERR §
This Interlocal Agreement for Emergency Medical Services and Management of
the County First Responder Program (this "Agreement") is made and entered into
between the City of Kemille, Texas ("City") and Kerr County, Texas ("County") and
shall be effective as of October 1, 2005, for the term stated below.
WHEREAS, County desires to provide emergency medical services with First
Responders to the specified unincorporated areas of Kerr County, hereinafter called
Service Area and more particularly described and depicted in Exhibit A, in order to serve
and protect its citizens; and
WHEREAS, City is willing to furnish equipment, trained medical technicians and
services to said Service Area and providing Management of the County First Responders
for the consideration hereinafter provided;
NOW THEREFORE, in consideration of the mutual covenants and agreements
herein expressed, it is agreed as follows:
L TERM
The term of this Agreement shall be from October 1, 2005 through September 30, 2006
("Initial Term"). This Agreement shall remain in full force and effect through its Initial
Term, provided that either City or County may terminate this Agreement upon ninety
(90) days written notice to the other party. This Agreement may be terminated by mutual
agreement at any time upon such terms and conditions as the parties agree. This
Agreement may also be terminated by either party for cause, provided that in the event of
the breach, the non-breaching party shall give written notice to the breaching party
specifically stating the provision of this Agreement alleged to have been breached and the
factual basis underlying the alleged breach. Within thirty (30) days after receipt of
notice, the breaching party shall: i) cure said breach; or ii) contest the alleged breach.
Failure to cure the breach or contest the alleged breach within this thirty (30) day period
shall be deemed a material breach of this Agreement and shall authorize the non-
breaching party to unilaterally terminate this Agreement, upon delivery of written notice
of termination via certified mail or personal delivery, to the breaching party. Termination
shall be effective upon receipt of said notice.
Page 1 of 6
The parties agree that this Agreement shall renew automatically for a one year period
following the first year subject to the payment adjustment provisions of Section III
below. All terms and covenants of this Agreement shall apply to the renewal period.
II. SERVICES TO BE PROVIDED
A. During the Initial Term of this Agreement, or any extension provided for herein,
City agrees to furnish emergency medical services ("EMS") to the Service Area
and Management of the County First Responder Program.
B. For purposes of this Agreement, "EMS" shall include both responding to calls for
emergency medical assistance and providing medical transportation services, as
well as rescue/extrication services for automobile accidents. The amount and type
of equipment and number of personnel actually furnished in response to any
emergency call shall be determined solely by City and its duly appointed agents,
officers, directors, employees or subcontractors. It is understood and agreed that
City will give priority to calls within its own jurisdictional boundaries; however,
City will use their best effort to make a timely response to each request for
services within the Service Area.
C. For the purposes of this Agreement, "Management of the County First Responder
Program" shall mean and include the following services: The City shall manage
the operations of the First Responder services, on a contract basis, by maintaining,
ordering, storing and restocking equipment and supplies; request and manage the
budget expenditures, in addition to grant writing and proposals to obtain
Automated External Defibrillators or other non-budgeted equipment; assist
personnel by managing and/or administering the medical continuing education
program, teaching and coordinating education classes; file and maintain patient
care reports, ensuring performance improvement through periodic run review with
the Medical Director, and ensure the compliance with the EMS protocols and
Standard Operating Guidelines. The EMS Coordinator shall also be the Infection
Control Officer, HIPAA Privacy Officer and representative to the Medical
Director and Fire Department Personnel.
D. In the performance of this Agreement, City shall observe and comply with all
federal, state and local laws, rules, ordinances and regulations in any manner
affecting the provision of services under this Agreement.
E. It is expressly understood that in the performance of the obligations taken under
this Agreement, City is an independent contractor with the sole right to supervise,
manage, control and direct the provision of EMS. Further, County shall look to
the City for performance only and shall have no right at any time to direct or
supervise the City, its agents, officers, directors, employees or subcontractors.
Nothing in this Agreement shall constitute or be construed to create a partnership
or a joint venture by and among the parties.
Page 2 of 6
F. City shall make reasonable efforts to maintain emergency response times for the
Service Area at an average of ten (10) minutes for all calls within the Service
Area. The City shall make reasonable efforts to provide at least two (2)
ambulances manned 24 hours per day 365 days per year capable of responding to
City and County calls for service. The ambulances will be staffed with a
minimum of two certified medical personnel at all times. City shall continuously
monitor its compliance with this provision. However, such response times may
be waived in times of natural disasters or other catastrophic events which limits or
renders performance standards substantially impossible.
G. City shall maintain its EMS vehicles at or above the Texas Department of State
Health Services EMS provider rules and regulations at all times, and will provide
patient care supplies, medical equipment, vehicle maintenance and regular
equipment and vehicle inspections, calibrations and checks as determined by City
to be appropriate.
H. The provision of EMS under this Agreement shall be directed, supported and
supervised by a licensed physician who shall be designated by City as its Medical
Director for EMS.
I. City shall maintain insurance for the EMS at the following levels:
1. General Liability
$1,000,000 each occurrence and $2,000,000 annual aggregate
2. Errors and Omissions
$1,000,000 each occurrence and $2,000,000 annual aggregate
3. Automobile Liability
$1,000,000 per occurrence; $25,000 medical per person
4. Property/Auto for physical, catastrophe, and mobile equipment
Agreed value
5. Combination crime
$50,000
6. Personal property
$1,000,000 per loss occurrence
J. City shall provide quarterly run reports to County regarding the number of EMS
responses made within Service Area. Such report shall be a summary of the
response codes obtained from "Emergency Response Report" provided as part of
the EMS software used by the City. County may request additional reports as
needed as long as the information sought does not impinge on required patient
confidentiality, violate federal or state law and County pays the cost of producing
such additional reports.
K. In carrying out EMS, City shall provide vehicle extrication, additional manpower
and establishment of landing zones for helicopter services as needed as
Page 3 of 6
determined by the incident commander. In furtherance of meeting its obligations
under this Agreement, City may enter into such contracts and interloca]
agreements with local governmental entities and/or private companies as they
deem necessary or appropriate to provide the services and coverage required.
L. If personnel and equipment are available, City shall provide one (1) non-
dedicated, stand-by ambulance at community events and activities within City or
its Extraterritorial Jurisdiction (ETJ) upon fourteen (14) days written notice of
such request by County at no additional cost. It is understood and agreed that an
ambulance providing such service will remain available to respond to calls for
services anywhere within City or the Service Area and will leave the assigned
event when required for such calls. No replacement ambulance shall be provided
for the event during the periods when the ambulance is being otherwise utilized.
M. Should County desire a dedicated ambulance for a community event or activity,
County must request such in writing with City a minimum of fourteen (14) days
prior to the event or activity and pay an additional hourly charge for such
dedicated service as is outlined in Exhibit B. If available, City shall locate an
ambulance at the event or activity for its duration unless or until a transport from
the event is needed. The hourly charge for this service begins from the time the
ambulance arrives at the designated standby until it is released from the event. It
is further understood should another ambulance not be available to transport a
patient from the event the assigned ambulance may be required to depart the
assigned area. In such case upon the departure of the assigned ambulance no
replacement ambulance shall be available until such time as the assigned unit
returns.
III. PAYMENT BY COUNTY; PROVIDER CHARGES
A. In exchange and consideration for the City's provision of EMS under this
Agreement during the Initial Term, County agrees to pay City $189,377.00 for the
Initial Term, which fairly compensates City for providing EMS. Such fee
represents, after applying the revenues otherwise generated from billing patients
for such EMS, the estimated costs to City of providing EMS to County within the
Service Area. Such costs include but are not limited to costs relating to personnel,
medical supplies, licenses, insurance, fuel, maintenance, fee collection, medical
director, facilities, as well as other related expenses and funding for the Capital
Equipment Replacement Program based on mileage utilization of such equipment.
County additionally agrees to pay to City $10,780 for the Initial Term, which
fairly compensates City for providing Management of the County First Responder
Program. The total of these two fees, being $200,157.00, represents the "annual
fee" referred to throughout this Agreement.
B. Should this Agreement be extended beyond the Initial Term as authorized by
Section I above, the annual fee that the County shall pay the City under this
Agreement shall be increased annually by the greater of 1) five percent (5%), or
Page 4 of 6
2) the average of sixty percent (60%) of the Medical CPI and forty percent (40%)
of the Transportation CPI during the most recent twelve month period for which
published figures are available for the U.S. ([Formula: Medical CPI x 60%] +
[Transportation CPI x 40%] / 2 = % to increase annual fee). City shall conduct
such analysis and report its findings in writing to County on or before June 15`h of
each year.
C. Payment for the Initial Term shall be due and payable on or before October 1,
2005 with any subsequent payments being due on October ls` of the applicable
year in which a subsequent term begins.
D. City, including any and all of its agents and subcontractors operating hereunder,
shall be entitled, in their sole discretion, to separately charge the patient/customer
for their services based on the prices set by the City. Prices charged shall be
based upon a number of factors, including but not limited to location of the call,
level of service provided, type of care rendered, supplies used, personnel used and
other mitigating or contributing factors to include cost of Medicare disallowance,
cost of collection and other related costs. Any and all costs provided for herein
shall survive the expiration of this Agreement.
IV. MISCELLANEOUS
A. For purposes of this Agreement, all notices required hereunder shall be delivered
to the following addresses of the respective parties via hand delivery or first class,
prepaid mail:
For the City of Kerrville:
City of Kerrville
c/o City Manager
800 Junction Highway
Kerrville, TX 78028
For the County:
Kerr County
c/o County Judge
Kerr County Courthouse
700 Main Street
Kenville, TX 78028
with copy to: City of Kerrville
c/o Fire Chief
87 Coronado
Kerrville, TX 78028
B. This Agreement supersedes all written or oral representations of the parties as to
the content, obligations or performance of the provision of emergency medical
services by City to County. Any modification to this Agreement shall be of no
force or effect unless in writing and signed by both parties. Each party hereto
certifies that the covenants and obligations stated in this Agreement constitute the
Page 5 of 6
duly authorized act and agreement of the respective entity and that the persons
affixing their signatures below have obtained all requisite approvals for the
execution of this Agreement.
C. The validity of the Agreement and any of its terms or provisions, as well as the
rights and duties of the parties, shall be governed by the laws of the State of
Texas. Exclusive venue for any action concerning this Agreement shall be in
Kerr County, Texas.
D. Neither party may assign any right under this Agreement, and any purported
assignment will be null and void and a breach of the Agreement.
E. Notwithstanding any provision to the contrary, it is agreed that none of the
obligations contained within this Agreement shall run to or be enforceable by any
party other than a party to this Agreement.
F. In the event either party pursues litigation in order to enforce the provisions of
this Agreement, the prevailing party shall be entitled to recover its reasonable
attorney's fees, in addition to any and all other remedies, costs and damages
permitted by law.
''[[ th
Dated this ~.%`f' day of , 2005
ATTEST:
2G„Lr~2 ~ , (/«tl
Brenda G. C ~ ,City c
CITY OF KERRVILLE, TE AS KERR COUNTY, TEXAS
.~~ , ~ ~ ~,
Eug ne C. Smith, Mayor ~--~at Tm ey, Judge
APPROVE AS FORM:
Michael C. Hayes, City ttomey
ATTEST:
annett Pieper, County Jerk
APPROVED ORM:
merson, County Attorney
Page 6 of 6
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Su'~(~~emer~f
AMENDMENT TO THE KERRVILLE/KERR COUNTY/INGRAM EMS
INTERLOCAL AGREEMENT
The following amendment of the EMS Interlocal Agreement by and between the
City of Kerrville ("Cit}~'), the County of Kerr ("Count}') and the City of Ingram
("Ingram") is hereby agreed to by all parties, on the date reflected below.
The parties acknowledge the existence of an agreement between Kerr County and
Kimble County EMS whereby Kimble County agrees to provide ambulance service, both
emergency and transport to Kerr County residents in the extreme northwest portion of the
county, in a service azea described and delineated on the attached Exhibit A. Upon
receipt of a call for EMS service in this area, the Kerrville dispatch service will forward
such calls to Kimble County, which will then be responsible for dispatching Kimble
County EMS and any First Responder for the azea included in Exhibit A.
The parties agree that within this described service azea, Kerrville EMS shall have
no duty to respond pursuant to this Agreement. Any response by Kerrville EMS that may
occur pursuant to any Interlocal Mutual Aid Agreement between Kerrville and Kimble
County will be at the direction of and on behalf of Kimble County EMS.
EXECUTED in multiple originals this the day of~~-~ 2004.
CITY OF MLLE
By:
P. Fine
Mayor
ATTEST:
COUNTY OF KERR CTI'1' OF INGRAM
~ ey ~ Monrce Schlabach
County Judge Mayor
ATTEST:
ATTEST:
Brenda G. C ,City k
APPROVED AS TO ORM:
By.l~ c'
Michael C. Hayes
City Attorney
[~~Y'~
nnett Pieper, County Jerk Jann Bullock, City Clerk
APPROVED AS TO FORM: APPROVED AS TO FORM:
Dav)dMotley Danny wards
County Atto y City Attorney
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IBIT A
EXHIBIT "B"
2005 APPROVED EMS FEE SCHEDULE
Dedicated Standby
For first two hours (per hour) $100.00
Per hour after first two hours $ 75.00