1 2 3 4 5 6 KERR COUNTY COMMISSIONERS COURT 7 and 8 KERRVILLE CITY COUNCIL 9 Joint Meeting - EMS Contract 10 Friday, August 19, 2005 11 10:00 a.m. 12 Commissioners' Courtroom 13 Kerr County Courthouse 14 Kerrville, Texas 15 16 17 P R E S E N T 18 Kerr County Commissioners Court: 19 PAT TINLEY, Kerr County Judge 20 H. A. "BUSTER" BALDWIN, Commissioner Pct. 1 WILLIAM "BILL" WILLIAMS, Commissioner Pct. 2 21 JONATHAN LETZ, Commissioner Pct. 3 DAVE NICHOLSON, Commissioner Pct. 4 22 Kerrville City Council: 23 CARL MEEK, Councilperson, Place 2 24 DAVID WAMPLER, Councilperson, Place 3 DON DAVIS, Interim City Manager 25 2 1 On Friday, August 19, 2005, at 10:00 a.m., a joint 2 meeting of the Kerr County Commissioners Court and Kerrville 3 City Council was held in the Commissioners' Courtroom, Kerr 4 County Courthouse, Kerrville, Texas, and the following 5 proceedings were had in open court: 6 P R O C E E D I N G S 7 JUDGE TINLEY: Let me call to order the joint 8 meeting of the Kerr County Commissioners Court and the City 9 of Kerrville City Council. This is a special meeting posted 10 for this date and time, Friday, August the 19th, 2005, at 11 10 a.m. It's a few minutes past that now. We do have a 12 quorum of the Commissioners Court present. All members of 13 the Court are here. Present from the City Council -- at 14 present, we do not have a quorum. Mr. David Wampler and 15 Mr. Carl Meek are representing the City of Kerrville at this 16 time, and I think there are other City staff members present 17 as probably resources in connection with this, if I'm not 18 mistaken. The posted agenda item for the Kerr County 19 Commissioners Court is to consider and discuss an EMS 20 contract -- the EMS contract and take appropriate action 21 thereon, so I will open it up with that. I would note that 22 we have some participation forms, and at the appropriate 23 time, I will inquire of those individuals if they wish to 24 speak and give them that opportunity. 25 COMMISSIONER BALDWIN: I've got a question. 8-19-05 jcc 3 1 (Several people entered the courtroom.) 2 (Discussion off the record.) 3 JUDGE TINLEY: I think that's where you 4 belong, Mr. Davis. 5 MS. DAVIS: Thank you. 6 COMMISSIONER LETZ: Don, how are you doing? 7 MS. DAVIS: Sorry we're late. 8 JUDGE TINLEY: You had a question, 9 Commissioner Baldwin? 10 COMMISSIONER BALDWIN: I do. Are we open, 11 ready to go? 12 JUDGE TINLEY: Yeah. Yeah, we're ready to 13 go. 14 COMMISSIONER BALDWIN: I just have one 15 question about the -- about the contract, and that's the 16 issue of -- of the purchase of the ambulance. And hopefully 17 we can get -- if I can get through my question, I may get up 18 and leave and go watch Tivy scrimmage. The -- my question 19 is, is when the ambulance is purchased, half by the City and 20 half by the County, will the County's name be on the title 21 along with the City's? And then, next year or the year 22 after, if the County decides to do something new and 23 different and pulls out of the contract, does the County get 24 our half of the ambulance? I mean, do we get tires and 25 motors, or the box, or what part of it is -- do we get? 8-19-05 jcc 4 1 And, when we get it purchased, I'd like to come over and use 2 it every once in a while to go drive around the county and 3 look at the county roads. You guys are welcome to ride with 4 me if you want to. 5 COMMISSIONER LETZ: Only if it's posted. 6 COMMISSIONER BALDWIN: Huh? 7 COMMISSIONER LETZ: Only in a posted meeting. 8 COMMISSIONER BALDWIN: Posted meeting, yeah. 9 We can do that. But I guess my real question -- 10 MR. MEEK: If I might interject -- 11 COMMISSIONER BALDWIN: -- is the ownership of 12 the ambulance. Is our name going to be on the title? 13 MR. MEEK: If I could say something, Buster, 14 I hope you're not in that ambulance in this next year, 15 because if you are, you're probably going to be in a prone 16 position. 17 COMMISSIONER BALDWIN: I want to drive. I 18 want to drive it. 19 MR. MEEK: Hope that's not the situation. 20 COMMISSIONER BALDWIN: Me, too. But I want 21 to drive; that's the only way I want to get in it. So, I -- 22 you know, I know that I'm being cute and all that, but 23 that's a real, live question. What happens to the ownership 24 of the ambulance, if we're buying half of it? 25 COMMISSIONER WILLIAMS: I think it goes to 8-19-05 jcc 5 1 the question that the City Manager raised, in that it has to 2 do with ownership or partnership versus being a client for 3 services. And if we're a client for services, I think there 4 are a lot of analogies that indicate that the client doesn't 5 necessarily buy the equipment, but we might pay for it 6 through the rates somehow. But -- in terms of rate 7 structure over the long haul. But there's also another 8 analogy, and that has to do with the library, and the County 9 doesn't own the building or the facilities or the equipment, 10 but we do participate in the operational expenses. And so, 11 you know, I think there are some analogies there, and there 12 might even be a strong case to be made that the County 13 shouldn't be participating in the outright or direct 14 purchase of equipment through capital recovery which is 15 proposed in the -- in the City's contract offer. So, I 16 think it's one of the issues that's kind of a sticking point 17 that probably ought to be talked about. 18 COMMISSIONER LETZ: I think the issue -- and 19 I've talked to both Carl and David one-on-one about most of 20 what I'm going to say today, probably. But the -- if you go 21 back, it's very difficult to take EMS or fire, some of these 22 things, and do them 100 percent as a contract -- as you do 23 in the private sector, a contract you're kind of running in 24 the private sector. These are not services that are readily 25 available. And it's -- you know, I understand the desire to 8-19-05 jcc 6 1 run it as a -- as the City does what they want and they send 2 us a bill, but there's problems with that, in my mind. And, 3 one, when it was started, as I understand the EMS -- and 4 Chief Holloway, I believe, was around at that time, and it 5 wasn't a partnership, but it was a joint decision. It was 6 kind of done because what was working there before didn't 7 work. And I think the County and the City -- and I wasn't 8 around -- decided that the City-run system or City-operated 9 system was certainly the best. A contract was negotiated. 10 There was a subsidy intended at that time from the County, 11 and it was just left alone for way too long, and that's how 12 we got where we are today. 13 So, you know, to me, it's very difficult to 14 say it's just a -- well, it's been very difficult the way 15 the City has reacted to our -- to the original proposal and 16 our counterproposal, because, for example, I have asked for 17 information and I haven't been able to get it because I'm 18 asking for things that are -- I've been told by the City 19 Manager that these are things related more to 20 administration, and that's really not on the table; that's 21 the City's department. I think David's mentioned the same 22 basic concept in that, you know, we shouldn't be concerned 23 about what the administration costs are and the collection 24 costs and all the other costs; that we should just say yes 25 or no based on the amount and the number that we're being 8-19-05 jcc 7 1 given. And I -- I just have a real hard time with that 2 concept, that I can't ask whether -- when it's public 3 information, especially, and get an answer as to what the 4 breakdown of administration costs are. 5 So, I don't -- I think it's very difficult to 6 operate anything jointly with the City and the County in a 7 manner like the City wants to do this. And I think it was a 8 good idea; I think we were all in a meeting of the minds a 9 year or so ago. "Hey, let's try to -- maybe this will help 10 our relations." But I think it's just real difficult to 11 operate governments like you do in the private sector there, 12 and in that regard, you know, it's been very difficult for 13 us to give proposals back to the City in the way they 14 evidently wanted the proposal to come back to the City, you 15 know. I listened at our first meeting -- joint meeting that 16 we had with the City Manager and David Wampler, and listened 17 to it, and the problems that I heard is that it costs more 18 to run ambulances into the county. Okay, I accept and 19 believe that. Collections are running around 75 percent, 20 which everyone thought is good. And then there are issues 21 with the disallowables and reimbursements and collections 22 and all that, that side of it. 23 Our proposals to the City said let's 24 charge -- both proposals, you know, different ways of doing 25 it -- said let's charge more for runs into the county that 8-19-05 jcc 8 1 cost more. Let's see if we can get the county people at 2 least paying more pay-as-you-go. Let's see if we can get 3 together and discuss collections and figure out how to 4 improve collections, and let's see if we can look at the 5 billings, over how things are being billed. And we were 6 just told, "No, those aren't on the table. You need to 7 accept our offer or not." I just don't understand that. I 8 mean, we are -- our last proposal even offered to take 9 billing completely out of it and we'd take that over 10 ourselves and leave the service exactly as it is. I have no 11 problem paying what it costs, and if it's close to 50 -- I'm 12 not a person that splits hairs. If the run time, which is 13 the basis of most of the operations, most of the dollars, is 14 roughly 50-50, fine; 50 is fine with me. 15 But billings are an example that are clearly 16 driven by volume, not run time, and I don't know why the 17 County should be asked to pay for 50 percent of the whole 18 billing structure when we're only using maybe 25 percent, 19 based on the numbers we've been provided by the City. So, 20 this just didn't make sense to me. And what I have 21 concluded, and I've told -- I think -- I know I told David 22 this, that it appears to me, after our second rejection of 23 our counterproposal, that the former City Manager who put 24 together the proposal decided how much money they wanted and 25 created a proposal that matched -- that brought in that 8-19-05 jcc 9 1 amount of money. And nothing's on the -- I mean, nothing is 2 open for negotiation, and I just have a -- a difficult time 3 with that, and that's kind of where I am. 4 And I guess the final thing I'll say is I've 5 heard from every member of City Council. I've heard from 6 the City Manager about the -- there is the issue of double 7 taxation by residents of the city, 'cause they also pay 8 county taxes, and because of that, we shouldn't object to 9 having to fund a little bit more than 50 percent out of the 10 budget. That wasn't actually said, but that was the 11 implication that I received when I've been told that. That 12 being said, I'll make a -- in my -- just from me, another 13 proposal to the City. Join us in forming a county-wide 14 emergency services district that will solve that problem 15 once and for all. If you all commit to doing that today, I 16 think we'll be well on our way to solving the problem. That 17 will completely solve the issue of double taxation, and it 18 doesn't hurt the problem. I mean, y'all can still have your 19 own EMS service if you want; it can be run through an ESD. 20 It can be a county-wide system. It can be structured any 21 way you want, but if we do an emergency services district, 22 that would totally solve the problem of that double 23 taxation. It's not going to solve the problem of me wanting 24 information from the City. 25 COMMISSIONER NICHOLSON: Okay, Commissioner, 8-19-05 jcc 10 1 I want to take a shot at it now. I think if we agree on one 2 principle, that administrative costs, the percent of runs, 3 the capital costs, who owns the ambulance, all that would 4 wash out. And before I say what I think the principle ought 5 to be, I want to say that, come October 1, I intend to -- 6 there's going to be EMS services throughout the county. 7 I'm -- that's not at risk here, from my point of view. That 8 we begin this contract where the revenues equal the costs. 9 There was no cost to either entity when the contract began. 10 Sometime after that, costs accelerated more rapidly than 11 revenues did, so if we could agree to a user-pay principle, 12 that we're going to raise our rates to a point where costs 13 and revenues are neutral, then all the rest of this would 14 wash out. There wouldn't be anything else to talk about. 15 Now, when you think about doing that, the 16 demand for these services is inelastic. There are -- there 17 are currently a few people who choose not to use the 18 service. They'll go to the hospital by private car, and for 19 two reasons -- one of two. One, they think they can get 20 there quicker; it's better, or they want to avoid the cost. 21 If we'll just simply increase those rates to a point that it 22 would be -- a significant increase to a point where the 23 revenues equal the costs, then all these other issues will 24 wash out, and the taxpayers will save $400,000 a year. I 25 want to save the taxpayers $400,000 a year. That's all. 8-19-05 jcc 11 1 COMMISSIONER WILLIAMS: I think it's 2 important to note, particularly for the public at large who 3 has a major concern about -- about this issue, that 4 Commissioners Court has never once been critical of the 5 level of service that's delivered by the ambulances once 6 they are dispatched to pick up a patient and deliver them 7 wherever. That's not the issue at all. The preponderance 8 of the calls that I've had from people who have -- who want 9 to buy into this dispute or this argument or debate, 10 whichever -- whatever you want to call it, are -- have to do 11 with the administrative side, not the service side. And 12 people tell me claims are mishandled, they're miscoded, the 13 billing process needs some attention, and the follow-up to 14 the billing process definitely needs attention, because 15 there's money being left on the table. And if there's money 16 being left on the table on the front side of the 17 administrative equation, that hurts the client. That hurts 18 the patient. And so I think that's something that we have 19 wanted to see addressed, but thus far, we haven't had any 20 indication that anybody was willing to address those 21 particular issues. But I just want to make it perfectly 22 clear that we are not critical of the service that's 23 delivered. The folks that do that and drive that box, pick 24 up that patient and take them where he or she -- wherever 25 they go, they do an absolutely super job. 8-19-05 jcc 12 1 JUDGE TINLEY: I have a -- 2 MS. DAVIS: Jonathan, I've got copies. 3 JUDGE TINLEY: -- a technical question that 4 it's probably going to take the Chief to answer. What is 5 the in-service amortization on one of those units? Five 6 years? Three years? What's the normal life of those? 7 MR. HOLLOWAY: Well, when we first took over 8 EMS, we thought an ambulance would last about five years. 9 We discovered that we're putting more miles on than we 10 thought. And the hills in this area, especially when we go 11 back and forth to San Antonio, are putting a lot more wear 12 and tear on the ambulances, so we try to replace them about 13 every four years. Because of the budget constraints and 14 some problems we've had with the revenue, we haven't been 15 able to do that. In fact, we've got one ambulance now that 16 has over 200,000 miles on it. We have another one that has 17 about 150,000 miles on it, and those need to be replaced. 18 And we haven't been able to replace those units, because 19 there hasn't been enough money in the budget to do that. 20 Now, the three ambulances that we replaced prior to that 21 were through grants. The E.I.C. purchased one, and the 22 Peterson Foundation has purchased two. So, yeah -- so we've 23 been having problems replacing the ambulances, and we really 24 need to replace them now. And one clarification on that 25 $37,000 that's in there. That's only a fourth of the cost 8-19-05 jcc 13 1 of that ambulance. The other 50 percent was going to be 2 paid for out of our transfer service, and 25 percent out of 3 the emergency service, and 25 percent we're asking for y'all 4 to help pay for part of that. As far as ownership of the 5 ambulance, I don't think there was any intention of any 6 ownership on that ambulance. And if Buster wants to drive 7 an ambulance, all he has to do is become an EMT, because 8 they won't allow a private citizen to drive one. And we 9 have a class coming up pretty soon, Buster, if you'd like to 10 get in that. And I hope to never see any of you guys in 11 those ambulances, because -- 12 COMMISSIONER NICHOLSON: I've been in. 13 MR. HOLLOWAY: -- if you are, you're going to 14 be in some serious business. But if we do pick you up, I 15 promise you, you'll get the best service there is. 16 COMMISSIONER LETZ: One of the things that I 17 have been confused about all along is -- and I never -- in 18 the proposal and in how EMS is run, how -- my understanding 19 is that the transfer portion, which are two ambulances that 20 are kind of off-duty -- 21 MR. HOLLOWAY: Right. 22 COMMISSIONER LETZ: -- are out of this 23 contract. 24 MR. HOLLOWAY: That's correct. 25 COMMISSIONER LETZ: Whereas the -- the two 8-19-05 jcc 14 1 that are on call all the time are in the contract. Is that 2 correct? 3 MR. HOLLOWAY: That's correct. What we 4 decided to do -- because most of the calls that are made in 5 the county are emergency calls, so we thought it wouldn't be 6 fair to put the transfers in there, so we compared apples to 7 apples. All the calls are emergency calls that are in this 8 proposal in the city limits and the emergency calls into the 9 county, and that's where that came from. 10 COMMISSIONER LETZ: How did the -- 11 MS. DAVIS: However, the revenue from the 12 transfers are in here. 13 MR. HOLLOWAY: In y'all's proposal, that's 14 correct. 15 MR. WAMPLER: The transfer is a direct 16 subsidy to the EMS budget, so those numbers are accounted 17 for in this proposal. 18 MR. DAVIS: But the revenue is; the calls are 19 not. I mean, the -- the patients are not. 20 MR. HOLLOWAY: Well, in the expenditures of 21 the -- 22 COMMISSIONER LETZ: The calls are not, but 23 the -- 24 COMMISSIONER BALDWIN: What about the 25 mileage? 8-19-05 jcc 15 1 MR. HOLLOWAY: No, mileage is not in there. 2 MR. WAMPLER: None of the measurement metric 3 for the purposes of trying to determine runs in the city 4 versus runs in the county are in the numbers that you have. 5 However, the budget information you have accounts for the 6 dollar -- 7 MR. HOLLOWAY: The total dollars. 8 MR. WAMPLER: -- the total dollar amount, 9 including transfers. So, in other words, transfers account 10 for a subsidy. Whatever revenue EMS earns as a result of 11 the transfers goes into the budget and really counts as a 12 subsidy for emergency services. 13 COMMISSIONER LETZ: But the -- on the 14 expenditure side, the -- the EMT's and the techs and all 15 that are in or not? 16 MR. HOLLOWAY: Yeah, they're in the overall 17 budget. 18 COMMISSIONER LETZ: Because they're -- I 19 mean, from a -- okay, that answered it. 20 MR. HOLLOWAY: 'Cause if you took the 21 transfers completely out of all this, then the shortfall 22 would be a whole lot greater than it is. Be almost twice 23 what's in the -- 24 COMMISSIONER LETZ: Right, but I guess my 25 point was -- and the -- I don't think it really changes a 8-19-05 jcc 16 1 whole lot the way you're telling me it's being done. From a 2 volume standpoint and statistics, they're not in there, but 3 the operational part is in there. 4 MR. HOLLOWAY: That's correct. 5 COMMISSIONER LETZ: And the revenue's in 6 there, and that's -- that makes sense. 7 MR. HOLLOWAY: Yeah. 8 COMMISSIONER WILLIAMS: Just -- just to round 9 out, the problems that I have in trying to find a solution, 10 and I sincerely hope you can do that, have to do with a 11 couple things which I believe really are the policy of City 12 Council. And I clearly understand why you might set policy 13 the way you do for the operation of your departments, but 14 when we're doing business on an interlocal agreement, I 15 wonder why that policy should transcend over and be imposed 16 on the other party. And that goes to not only equipment, 17 but it goes to the 5 percent fund balance requirement. If 18 this -- if the subsidy the City is looking for from the 19 County were absent, if we were to take out the piece of the 20 5 percent fund balance requirement, which would be about 21 $43,000, $44,000, plus the 37,5, that you're asking for on 22 equipment, I'd be on your page right now. 23 COMMISSIONER LETZ: I guess another -- I'd 24 like to ask a question to -- I don't know if it's to someone 25 in the City. It's been obvious that you haven't liked the 8-19-05 jcc 17 1 way we've done our proposals up to date, because they get 2 rejected with no comment other than the original proposal is 3 on the table, so it's been hard for me to figure out what we 4 should try to do. Are you looking for us to give you a flat 5 dollar proposal back? Is that -- you know, and -- or are 6 you just looking to say if it's not 200,000, we're not doing 7 it? 8 MR. WAMPLER: Speaking for myself, I'm not 9 asking -- we did ask, and I did ask you, Jon, for a 10 counterproposal at our first meeting, and -- and we received 11 those and considered those and rejected both of them. And 12 at this point, I'm not asking -- I'm not expecting you to 13 give us a counterproposal with regard to a specific dollar 14 amount, and that's really never been my intention. My 15 intention in asking for a counterproposal had more to do 16 with the fact that during our last meeting, there was no 17 unanimity in terms of how to measure the service and 18 allocate costs to that measurement standard, and I was 19 interested to see how you all as a group would look at what 20 your counterproposal was with regard to assigning costs to 21 the service. 22 COMMISSIONER LETZ: Well, I think unan -- and 23 I can't say the word, whatever it is. 24 COMMISSIONER BALDWIN: Unanimity. 25 MR. MEEK: That "U" word. 8-19-05 jcc 18 1 COMMISSIONER LETZ: Yeah, that "U" word. 2 MR. WAMPLER: There was no consensus. 3 COMMISSIONER LETZ: Well, but two proposals 4 came out, and it's -- we are focusing on basically the -- 5 the reserve issue, 'cause we keep our own reserves. 6 MR. MEEK: What reserves does the County 7 shoot for? 8 COMMISSIONER LETZ: We deal -- 9 COMMISSIONER BALDWIN: 25 percent of the 10 overall budget. 11 COMMISSIONER LETZ: Of our operating budget. 12 MR. MEEK: But you would object to a 13 5 percent on EMS? 14 COMMISSIONER WILLIAMS: Yeah, because it's 15 not going in our budget; it's going to yours. 16 COMMISSIONER LETZ: Well, the difference is 17 we're already having -- 18 MR. MEEK: Well, is it going into our budget, 19 or is that a -- that would carry over into the beginning of 20 the next year's budget. It wouldn't be 5 percent each year. 21 That would be a one-time carry over, I would think. 22 COMMISSIONER LETZ: I guess the -- well -- 23 MR. WAMPLER: We have a policy of trying to 24 -- trying our best to maintain a 5 percent fund balance in 25 all of our budgets, in our general fund, our EMS fund, golf 8-19-05 jcc 19 1 course fund, what-have-you. And, to some extent or another, 2 we're successful, depending on the operations of that 3 individual fund. From the standpoint of EMS, despite the 4 fact that it is a government service at this point, the fact 5 is, is that we're running a business operation. We are 6 providing a service. We have to stay equipped and -- and 7 have adequate personnel to provide the service required both 8 in the city and the county, and that 5 percent fund balance 9 is a hedge against unforeseen billing issues, lower 10 reimbursement going forward from the government, a crash of 11 a vehicle that we have to replace. Yes, we're insured, but 12 it's -- it's nothing more than a balance as a -- as a 13 cushion or contingency in this operation of that operation 14 or business, however you want to put it. And to the extent 15 that that's going into our budget and we're somehow in 16 control of that, that's absolutely correct, but we have 17 gotten behind. As the chief said, we have equipment now 18 that needs to be replaced, and that equipment replacement is 19 a critical piece of the operation to maintain the level of 20 service that we provide. 21 COMMISSIONER LETZ: But if there was -- if 22 the intent for the reserve is to have a -- you know, to 23 build a balance to use for things in the future, and the 24 County -- and this is a one-year deal for us, do we get half 25 the reserve back at the end of the year? 8-19-05 jcc 20 1 MR. WAMPLER: No, and it doesn't necessarily 2 have to be a one-year deal. We'll have a one-year contract; 3 we'll look at it again next year, but the 5 percent fund 4 balance, whether we fund it ourselves out of our own 5 operations or the County and City jointly fund it going 6 forward for joint service, is something that we're going to 7 continue to maintain. 8 COMMISSIONER LETZ: Well, but what I'm saying 9 is that, I mean, the County is, I think, clearly in motion 10 in going towards an emergency services district in the 11 county, and we hope to cover the city as well, because I 12 think it's a benefit to all the taxpayers. But, say, two 13 years from now -- because it takes some time to get that set 14 up. If we decide to opt out, then we should get half of 15 that fund balance back, or at least what we've put into it. 16 MR. WAMPLER: If you had engaged -- 17 (Cell phone rang.) 18 COMMISSIONER BALDWIN: That's a $25 fine, 19 Carl. 20 MR. WAMPLER: If you engage a private 21 service -- you know, private EMS service today, you would, 22 in essence, be paying into a fund balance of some sort, or 23 profit that you wouldn't get back, even if it was a one-year 24 contract. This is clearly not profit. But in the context 25 of private enterprise, you would be paying that anyway. 8-19-05 jcc 21 1 So -- 2 COMMISSIONER LETZ: I disagree. 3 MR. WAMPLER: Well, are you saying that if 4 you contracted with a private carrier, there wouldn't be 5 profit involved? 6 COMMISSIONER LETZ: I think there is -- 7 MR. WAMPLER: There wouldn't be a fund 8 balance? There couldn't be a contingency fund built into 9 that business that you would be paying into? 10 COMMISSIONER LETZ: It may be hidden in 11 there, but it's not a direct -- 12 MR. WAMPLER: Well, that's the difference 13 between private entities and public entities. We've shown 14 you where the numbers are. You would still be paying it. 15 MR. MEEK: I would say we'd want to sure keep 16 it a 5 percent fund balance. Last thing -- when you're 17 dealing with a critical emergency service, we wouldn't want 18 to have to part with one of those boxes because we ran out 19 of money. People's lives are at stake. I think that needs 20 to be taken into consideration. 21 COMMISSIONER LETZ: I don't mind a fund 22 balance in the agreement, but I think the County -- when we 23 opt out of it, we should get part of it back. I don't -- I 24 don't see the reason why you would want to keep -- I mean, 25 the County is giving a -- putting our reserve dollars in the 8-19-05 jcc 22 1 City's fund. Why wouldn't we get it back out if -- when we 2 opt out of the contract, if we ever do? 3 MR. WAMPLER: As far as an emergency services 4 district goes, and -- and the County's intention to pursue 5 that option, I'd remind everybody here, including the 6 Commissioners, that we notified you one year ago of our 7 intention to renegotiate this contract. So -- 8 COMMISSIONER LETZ: And, as I told you, Dave, 9 we received the contract in May, and there was some delay in 10 the Commissioners Court -- 11 MR. WAMPLER: We told you a year ago of our 12 intention to renegotiate. 13 COMMISSIONER LETZ: And we've asked for 14 information starting in January. 15 COMMISSIONER WILLIAMS: Well, David, the same 16 thing applies to the library; we haven't had a response back 17 from you either, so that's kind of a quid pro quo. 18 JUDGE TINLEY: Let me, if I might -- we've 19 had some individuals who have expressed a desire to be heard 20 and have their viewpoints taken into consideration here, and 21 I'd like for them to have the opportunity. Mr. Jim Murphy? 22 Be pleased to hear from you, sir. 23 MR. MURPHY: I've got a cheat sheet here, 24 'cause I'm not the best long-term speaker, and I'm not going 25 to speak very long anyhow. But I'm Jim Murphy; I live at 8-19-05 jcc 23 1 203 Riverhill Boulevard. First thing -- Carl just brought 2 this up. Have you thought about what this pertains to? The 3 whole thing pertains to saving lives. And in this city and 4 this community -- and I know you're all well aware of this, 5 but prior to 1994, we had the sorriest EMS service. I was 6 on the City Council at that time. They had untrained 7 personnel, poor equipment. They had a book that thick that, 8 when they drove out in the county, that they had one guy who 9 sat there on the righthand side and flipped pages trying to 10 find out where they were going. That's what's going to 11 happen to you if you put a new service in. You're not going 12 to get somebody that comes in here and can drive to -- to 13 Deer Trail just like that, like these people that presently 14 are on the city service. But they had two dilapidated 15 ambulances that they used. They were always having problems 16 with equipment. They were extremely slow to respond, and 17 they didn't have a responder program at that time, which you 18 have now, and it's a good program. 19 City Council was concerned about this, so 20 Council and Joe Herring, who's here in the back seat, and I 21 drew up a plan for an EMS program manned by the Kerrville 22 Fire Department. It has been refined over the years 23 considerably, and is now one of the best in the state. I 24 know that you're all aware of this, 'cause it has already 25 been mentioned. Depending on the outcome of this meeting 8-19-05 jcc 24 1 today, there's insufficient time to have the County set up 2 an EMS program, and I have two proposals. One is to extend 3 the contract for a period of three to six months. There's a 4 group of us four -- four that are willing to volunteer our 5 service as mediators to try to work out an amicable solution 6 if you can't come up with one, and that's myself, Ray 7 Lehmann, Gordon Morgan, who are former County Commissioners, 8 and Joe Herring and I, who are former City Council members. 9 Do you have any questions? Thank you very much. 10 JUDGE TINLEY: Thank you, sir. We appreciate 11 your input today. Mr. Morgan. Gordon Morgan. 12 MR. MORGAN: I guess part of our concern is 13 the fact that, as gray-haired and as old as we are, we -- we 14 may need this service, so that was one of our concerns. The 15 other thing is that I, unfortunately, had the opportunity a 16 year or two ago to have the service. And the service was 17 great, but it was unfortunate that my wife got so sick. So, 18 we were involved in transfer -- we were involved in transfer 19 from the hospital here to San Antonio, and from San Antonio 20 back, two different ambulance services. It gave me some 21 insight into how the system was working. And there seemed 22 -- I can say that I pursued the issue of being refused 23 payment from Medicare on some services, and I pursued it and 24 did obtain the money that -- that was not being pursued by 25 the administration part. And there are a lot of reasons for 8-19-05 jcc 25 1 that, and it's a very difficult thing, but if you do pursue 2 it, you can get it. 3 And probably the other thing is that, in some 4 of our sitting down and -- and, as old men do, talk about 5 how they can solve all the young fellows' problems, it seems 6 that one could designate areas from the center part of the 7 city, and give the area out in the very west as one -- A or 8 B or C, whatever number; one for the east, one for the 9 south, and one for the north. And then you could have the 10 central one in the middle, and could you assign those as 11 areas, and then set a rate based upon each of those areas 12 and then charge a flat different rate in each of those 13 areas. And that would make up for the difference between a 14 run in town and the time and the gasoline and that sort of 15 thing, and would seem pretty fair. So, one could assign 16 rates, and I think that would help solve this problem. 17 The other thing is, it's obvious there seems 18 to be two issues; one, the immediate issue to solve the 19 problem of having service continue, and then a long-term 20 plan that's based on putting all of the figures that are 21 there, put those all together, look at them, hopefully as -- 22 as unbiased as possible, and try to come up with something 23 that seems reasonable and workable and fits in with what 24 costs are at other places, and the decisions about a reserve 25 fund, whether it's 5 percent or 2 and a half percent for 8-19-05 jcc 26 1 each entity or whatever. Those things should easily be 2 worked out with -- with just unbiased -- sit down and come 3 to something that'll work for the citizens. And that's just 4 basically it. 5 COMMISSIONER NICHOLSON: Can I ask you a 6 question, Dr. Morgan? 7 MR. MORGAN: Yes, sir. 8 COMMISSIONER NICHOLSON: When you used the 9 service, would you have been willing to pay 60 percent more 10 than it costs at that time? 11 MR. MORGAN: I -- sure, I would have. But 12 there are some that probably, you know, don't have the money 13 to afford the other 60 percent. If 60 percent is required 14 and that's necessary, then it has to be. I -- I do not know 15 what the percentage is, but I would -- I would predict 16 there's probably 10 or 15 percent of the billings that -- 17 that are collectible, that at this time are not collectible. 18 If you remember San Antonio, on their tax issues down there, 19 they hired a law firm -- and there's some question on that, 20 but they hired a law firm to do collections for them. But I 21 think that if -- if that were -- was set aside as -- as 22 important to collect the money, then -- and you could 23 reduce -- I don't know what those gross amounts are, but 24 10 percent of $1 million or whatever it might be is a 25 significant figure, and it certainly would well pay for the 8-19-05 jcc 27 1 salary of some person that would devote their time and 2 effort to get that collection done for the people in the 3 community, as well as for the service. Any other questions? 4 COMMISSIONER NICHOLSON: Thanks. 5 JUDGE TINLEY: Thank you, sir. Thank you. 6 We appreciate your input. Mr. Scott Gross. 7 MR. GROSS: Morning. I'm Scott Gross. I've 8 lived in the county since 1990, been a First Responder since 9 1994. In 1985, my wife and I brought Church's Chicken to 10 town. It's a fowl operation. (Laughter.) 11 COMMISSIONER NICHOLSON: I didn't hear that. 12 You brought what? 13 MR. GROSS: Church's Chicken. 14 COMMISSIONER NICHOLSON: Oh. 15 COMMISSIONER BALDWIN: He said it was a fowl 16 operation. 17 COMMISSIONER NICHOLSON: Okay. 18 MR. GROSS: Thanks for interpreting; I 19 appreciate that. I only mention that for one reason, and 20 that is when we instituted delivery, we hired the drivers of 21 the former ambulance company, for two reasons. One, they 22 kind of knew the territory, and two, they really needed the 23 money. In business there's a saying that you can have 24 quality, price, and service; pick any two. It's hard to 25 have all three. And we have a quality service right now. 8-19-05 jcc 28 1 The price we can talk about. We have a quality service 2 right now, and I think we need to keep it. We don't really 3 have a lot of alternatives, and the reason we don't is 4 because ambulance runs don't come on a regular basis. You 5 can't schedule them. Two nights ago I had a call at 9:18 at 6 night. It was an infant who was having epileptic seizures. 7 About 35 minutes later, we had another call. It was for a 8 suicide attempt. Now, if we had a county system -- or a 9 private system, which one of those runs would you have 10 sacrificed? If you need two ambulances on one side of the 11 county at the same time, you better have somebody located in 12 the city. 13 The most logical -- seemingly illogical, but 14 the most logical place to base a county-wide ambulance 15 service is in the city, and the reason is because you have 16 the ability to swing either way. I've seen three, even four 17 ambulances in one part of the county at one time. So, I'm 18 suggesting that to not come to an agreement would be 19 unconscionable. You can argue the little stuff. The big 20 stuff is, we're talking about saving lives. And as much as 21 I appreciate volunteers, since I am one, volunteers have a 22 tendency to be the bottom of the medical barrel. I know 23 when I attend a scene, I get out of my car -- of course, my 24 car now says "Sporty's Restaurant" on it. People can't tell 25 if I'm coming to save the day or cater the event. 8-19-05 jcc 29 1 (Laughter.) They do look at me, though, and half the time 2 they think I'm a doctor because I have silver hair and all 3 my teeth, which is a huge qualifier. But the point is 4 simply this; we have to have a decision, and this is based 5 on people's lives. Worry about the details -- and I don't 6 think a private service provider is what we're looking for 7 here, because in order to get the quality, we're going to 8 have to pay the price. If you're going to pay the price, 9 you might as well pay the people who are already doing a 10 great job. 11 COMMISSIONER LETZ: I think the -- I mean, I 12 like the ideas that I'm hearing, and I think that they're 13 reasonable. And I'm just as -- I'm not making this as a 14 motion, because I really -- well, I don't know if I want to 15 make a motion today or not, 'cause I notice the Council 16 that's here isn't a quorum, so we can't decide anything, but 17 I like the idea about extending the contract. And I would 18 be willing, individually -- not to speak for the four people 19 over here -- even to pay the amount the City's requesting 20 for three months, prorated, as long as the City will 21 seriously enter into negotiations with the County to look at 22 the billing system, the rate structure, and establishing an 23 emergency services district. If they will commit to 24 seriously look at those and work with the County to try to 25 better the system, those three areas, you know, I'm all for 8-19-05 jcc 30 1 paying what y'all want the for three months. And, hopefully 2 in a three-month period, we'll have a direction we're going, 3 and adjust the contract at that time that -- if both sides 4 agree. 5 COMMISSIONER WILLIAMS: I'd like to offer a 6 comment or two. I appreciate the comments of all the 7 gentlemen out there, and it is not my position that we 8 should be looking to go outside the county for service. I 9 think the service that's in here is good, and we should 10 continue that and find a way to make it work. We had 11 suggested, although it wasn't -- isn't -- I don't believe it 12 was in the formal proposal that we gave back to the City, 13 but we had suggested zones with different rates. I think 14 that really makes a lot of sense, because that -- that helps 15 you deal with the time -- time and mileage issues, loaded 16 mile issues and the time, and all that's good stuff. And 17 you do that by zones, and I think that's an excellent way to 18 look at it. But I think -- I think what we have to do today 19 is agree -- and I'm with Commissioner Letz on this. I don't 20 know if we're going to make -- do it as a motion today or 21 not, but we need to take care of the short-term while 22 working to -- to alter or amend or improve on the long-term 23 solution. I don't want to see Kerr County uncovered. I 24 don't want to see Kerr County going outside our geographical 25 borders for private service unless it is absolutely 8-19-05 jcc 31 1 necessary and there's no way that we can resolve the issues 2 on a long-term basis. The emergency service district -- 3 creation of an emergency service district does a lot of 4 things. It spreads the cost across all taxpayers and 5 eliminates the argument of double taxation, which we've 6 heard often. It also allows both the City and the County to 7 take out of their tax rate that which is appropriated for 8 emergency services and spread that cost all the way across 9 the county. To me, that's a win-win situation. And for my 10 support on this, I'm willing to go along those lines, and I 11 would like very much to see joint resolutions come out of 12 City Council and Commissioners Court setting up a task force 13 to do just exactly that, work out the details for an 14 emergency service district that covers as much of Kerr 15 County as is -- as humanly possible to do, and then work 16 together for the passage of that initiative with the voters. 17 COMMISSIONER LETZ: I think I might make a 18 comment, just to make sure everyone in the audience is 19 aware. An emergency service district doesn't mean there'll 20 be any change in the City of Kerrville providing the 21 service, necessarily. The emergency service district is a 22 board that will oversee it, and they can contract with -- 23 you know, and I think the obvious way you do it initially 24 would clearly be to contract with the City of Kerrville to 25 provide the service county-wide. But then it's taken out of 8-19-05 jcc 32 1 the City's budget and the County's budget; any subsidy is 2 funded, and decisions on the costs and things of that nature 3 are made by a board. That, you know, depends -- I'm sure 4 there's -- it can -- the makeup of the board can be agreed 5 upon, I would think, by the City and the County, but they 6 are one piece to that. 7 COMMISSIONER NICHOLSON: I want to express 8 some reservations about an emergency service district, and 9 the same reservations would apply to any new taxing entity. 10 What I would expect to see if we created an emergency 11 service district or a library district or whatever is that 12 -- that they would collect an additional 400,000 or 500,000 13 a year, in the case of the EMS district, in taxes, or 14 another 800,000 a year, I guess it would be, for the 15 library, and then the City budget and the County budget 16 wouldn't go down. That would be additional taxes paid by 17 the taxpayers. If you give politicians money, they spend 18 it. And -- and the tax burden would increase by having a 19 special taxing district. 20 COMMISSIONER WILLIAMS: Doesn't have to be 21 that way, Commissioner. 22 COMMISSIONER NICHOLSON: Doesn't have to. 23 COMMISSIONER BALDWIN: My comment is, I 24 wanted to -- Mr. Murphy was talking about putting -- when 25 the emergency service was put in the fire department, I was 8-19-05 jcc 33 1 even part of it a little bit before it got to you guys. I 2 was on the committee that -- that did the study and took a 3 hard -- peeked under the hood of the former provider, and we 4 drove to San Antonio and looked at numerous services and 5 just did a study. Of course, the former provider was 6 difficult to see what the real problem was when there was 7 probably two sets of books and -- total nightmare. And so I 8 was part of that committee that voted to ask you guys to put 9 together the program, move it into the City of Kerrville 10 Fire Department. Excellent move. Best thing we've ever 11 done, and I still agree with that. I think -- I still think 12 it's the best thing to do. So, because of that history and 13 my knowledge of that, I'm -- I'm not in favor of contracting 14 with any company to come in and service either, but I do 15 like Dr. Morgan's thought of forming a study committee of 16 you geezers. All four of you are well aware of -- I mean, 17 very in tune of what the program is and what it's been 18 about, the history of it, and where you think to go, and I 19 think it's always wise to include citizens to take a peek at 20 things like that, particularly when you have four guys that 21 know as much as anybody else in the county about what the 22 system does and what it should do. I really like that idea, 23 and I like the idea of contracting for three months until 24 you do that study, just to help government -- the two 25 government bodies dot the I's and cross the T's properly. 8-19-05 jcc 34 1 And I just think that would be a wise thing to do for all of 2 us. It's not a hit on anybody. I just think it's a smart 3 thing to do. 4 MR. MEEK: I'd like to say something. First 5 of all, I'd like to ask a question of Raymond or Don, 6 whoever would like to respond. What are -- I would think 7 three -- a three-month extension would leave an awful lot of 8 questions in both of our budgets, and I would like any -- 9 any feedback from either one of y'all, the difficulties that 10 might bring. 11 MS. DAVIS: Well, it leaves us still with an 12 unknown factor. The -- I think the only thing that I know 13 we can do is just go ahead and prepare the budget on a 14 12-month basis. 15 COMMISSIONER BALDWIN: What kind of basis? 16 MS. DAVIS: Twelve-month. You know, and go 17 ahead and establish that, with the idea that after -- 18 whether it's three months or six months or whatever the time 19 frame is, that you'd -- Council would be looking at possibly 20 some budget amendments, which is certainly legally provided 21 for, so you could do that. I might also add that I'm not 22 sure that three months would be an adequate period of time. 23 That may not be enough time, I guess, depending upon what 24 kind of structure is undertaken, to get all this done. So 25 that's a -- a two-bit editorial, I guess. 8-19-05 jcc 35 1 COMMISSIONER LETZ: I thought the three 2 months could start on October 1. 3 COMMISSIONER WILLIAMS: Well, I think both 4 the Councilman and Don raise good points. I don't think 5 three months is enough time either. 6 MS. DAVIS: Let me just say, I'm basing that 7 on a conversation that we had with a state agency out of San 8 Antonio that offered to help write some specifications and 9 do some of these sorts of things. And they were thinking 10 it, you know, would probably take three months just to kind 11 of formulate that, so you would have in addition, you know, 12 any sort of study, if, in fact, you were looking at going 13 out for proposals again, which may not be the plan. 14 COMMISSIONER BALDWIN: But these are not only 15 geezers; these are our geezers. They can do it in three 16 months. 17 MS. DAVIS: Fast-working geezers. 18 COMMISSIONER BALDWIN: Fast-working geezers. 19 COMMISSIONER WILLIAMS: Well, I think if -- I 20 think the relationship should be extended, and it should 21 probably be extended for a 12-month period, 'cause that 22 coincides with our budget, and we can determine what that -- 23 if we can get on the same page with the dollars. But -- 24 'cause it's going to take more than three months to -- to 25 sort it out, if we want a task force, if you do joint 8-19-05 jcc 36 1 resolutions and work out the details, and it's going to take 2 a good, long time thereafter, if we're on the same page for 3 an ESD, to properly inform and advise the public of what the 4 issues are and the reasons why it makes good sense, if it 5 does make good sense. 6 COMMISSIONER LETZ: I think there's two 7 issues here, though, and I think the committee can 8 certainly -- if it's formed, can help on both. But one 9 issue is to look at the current -- the problems that I have, 10 I think Commissioners Court as a whole has, of the contract 11 on the establishing zones and some different -- and 12 billings, adjusting billings in the county and looking at 13 the collections and that whole system, and -- and looking at 14 how the breakdown -- whether it's truly equitable to break 15 every item out 50-50, or if it should be, you know, 45-55, 16 or if you should do 50 percent on this part and 25 percent 17 on this part. And I don't think those numbers -- it's not 18 that complicated to come up with numbers that way. I know 19 Councilman Wampler said I was picking and choosing; I don't 20 look at it that way. I mean, we're talking about two 21 categories or three categories, and I think those things can 22 be worked out in three months. And I don't -- like I said, 23 I don't have a problem with going with the requested subsidy 24 that the -- as asked -- as requested by the City for three 25 months, but I'm a little bit leery of going -- signing a 8-19-05 jcc 37 1 12-month contract committing to that subsidy that I have a 2 fundamental problem with the way it was derived. 3 JUDGE TINLEY: The -- you know, there are a 4 number of items that probably we can point to on either side 5 of the fence where things were not done as well as they 6 should have, were not done in as timely a manner as maybe 7 they should have been. But I think we're -- we're maybe 8 looking at the wrong priorities for the subject we're 9 dealing with. I don't think cost is the primary priority. 10 Number one is quality of service when you're dealing with 11 emergency medical services and lives of our citizens, 12 particularly with our demographics that we have. The second 13 issue -- the second priority, I think, would be the 14 reliability and continuity of that service. You know, 15 mentioning that there are things that could have been done 16 differently or more information developed or -- or 17 refinements, efficiencies, rate structures, you can talk 18 about all those things at this juncture, but I think I'm on 19 the same page with Dr. Morgan. 20 I think we've got to look at -- we've got two 21 solutions to achieve; one's a short-term, one's a long-term 22 solution. And right now we got the short-term solution 23 ahead of us, and we've got an obligation to our constituents 24 and citizens -- a lot of whom are the same, as a matter of 25 fact -- to give them some peace of mind and comfort zone 8-19-05 jcc 38 1 that they've got quality service, reliable service, and that 2 there will be no interruption in that kind of service. And 3 I think appointing a group such as Mr. Murphy recommended of 4 individuals who have prior governmental experience in both 5 the city and the county I think is a wonderful idea. I 6 don't think three months is adequate. I think it's going to 7 take at least six to really take a hard look at it. I don't 8 want to tie their hands where they're looking at, do we 9 tweak the administrative costs? Do we -- how do we do rate 10 structures? Or do we look at an emergency services 11 district? I think until they develop all that information, 12 they're not going to have an idea what -- which way they 13 think is the best way to go. But in the interim period of 14 time, we owe it to the citizens of this county to give them 15 the appropriate assurance that they've got service in place. 16 Now, from a budget standpoint, if -- if 17 you're looking at a six-month, for budgetary purposes, you 18 just create an obligation twice that, because you're 19 budgeting for a year; you really don't have any other 20 choice. But what I don't want to have happen is that we -- 21 we try and move forward on a -- on an organized basis in 22 that manner, and be in a situation where we -- we're not in 23 a position to go forward for some additional period of time 24 if it's necessary. But I -- I don't think the thing should 25 be cost-driven. The quality of service and the reliability 8-19-05 jcc 39 1 and continuity of service is what the citizens deserve. If 2 something else has to suffer, so be it, but we've got to get 3 there and we got to get there quick, and I don't think we 4 have the luxury of the time and the ability to put together 5 an outside service to come in here and even remotely 6 approach the level of service that we've got in place right 7 now. So, whether we like the position we're in or not, 8 that's where we are. We got to play the hand we're dealt, 9 and we need to -- we need to get in the game and get this 10 behind us so that the citizens know what we got. 11 COMMISSIONER LETZ: Judge, I don't -- you 12 know, I don't disagree with you. Much. 13 (Laughter.) 14 COMMISSIONER BALDWIN: Just daily. 15 COMMISSIONER LETZ: Daily. 16 COMMISSIONER WILLIAMS: Or often. 17 COMMISSIONER LETZ: But I guess my reason for 18 not wanting really to do -- and you didn't say -- I'm not 19 disagreeing with you. I think it was Commissioner Williams 20 who said 12 months, something like a 12-month period. If we 21 extend the contract for 12 months, we're going to be back 22 here next August, same thing again in the middle of budget 23 when we're both rushed if we don't set a deadline, like a 24 six-month period, to have this resolved and implemented, you 25 know, from a -- this -- I'm talking about the 8-19-05 jcc 40 1 administration, not the ESD. Just looking at the contract 2 side of it and seeing if there -- if it's even possible for 3 the City to have a different rate structure in different 4 areas. If we can't -- I mean, those things can -- I just 5 cannot imagine they can't be done in three months, but I'd 6 be willing to go to six months. I think that we're just 7 having -- asking for the continuation of the same problem, 8 being around the same table in 12 months, if we don't get 9 this resolved before next budget year, and well before next 10 budget year. 11 COMMISSIONER NICHOLSON: Commissioner, if 12 both government entities could agree to the user-pay 13 principle, me and Mr. Holloway could have a contract ready 14 for you to sign in 72 hours. 15 MR. HOLLOWAY: Can I make a comment? I 16 know -- 17 JUDGE TINLEY: I think it calls for one from 18 you, Chief. 19 MR. MEEK: Either that or leave. 20 MR. HOLLOWAY: To begin with, on the 21 different zones, it -- you know, say we go to west Kerr 22 County, because they're the farthest out. We're going to 23 charge them $1,000. The problem is, Medicare is only going 24 to pay about $300. Doesn't matter what you charge; they're 25 only going to pay about $300. And 70 percent of the -- our 8-19-05 jcc 41 1 patients are Medicare, Medicaid, or V.A. patients, and they 2 will only pay a certain amount of money, so that leaves 3 30 percent of our population -- of our calls that are not 4 Medicare-driven. So, you know, we looked at raising rates 5 25 percent. That increases our Medicare disallowed by a 6 quarter of a million dollars, and it doesn't really help as 7 much as we thought it would, because most of our patients 8 are not. 9 As far as doing a budget for three months, 10 six months, that would be a nightmare for me, 'cause I have 11 employees that I have to wonder, in three months or six 12 months from now, am I going to have to let some employees go 13 because I don't know what's in the contract? I really 14 need -- y'all have to decide this, but I really need to know 15 what it's going to cost, how much money I'm going to have to 16 operate for a whole year. It would be like me telling one 17 of y'all, you know, you've got 20 guys out there that are 18 working, and in six months we may decide that we're not 19 going to give you enough money to -- you're going to have to 20 let some of them go. So, I've got people I have to worry 21 about. I have my contract and different things that we have 22 in the budget. You know, and I would really hope that y'all 23 would decide to -- to fund this for at least a year, you 24 know. If y'all want to get a committee together to look at 25 this, you know, whether it's six months -- you know, six 8-19-05 jcc 42 1 months is a short period of time. I mean, it seems like a 2 long time, but it really is a short period of time. You 3 know, you're going to have -- I'm sure that you're probably 4 going to have to be sitting here again this time next year, 5 or maybe a little sooner, and looking at what we're going to 6 do next year in the contract. 7 COMMISSIONER NICHOLSON: Raymond, every 8 medical service provider is faced with the same issue, with 9 Medicare -- 10 MR. HOLLOWAY: Sure, that's right. 11 COMMISSIONER NICHOLSON: -- and deadbeats. 12 And whether it's a local physician over here in private 13 practice or Sid Pete, they all handle it the same way. They 14 set their fees at a level that takes into account the 15 deadbeats and Medicare. And the other thing they do is, 16 when I pay my mother's bills, who's on Medicare, they 17 don't -- Medicare doesn't pay it; they always send me a bill 18 and I pay it. 19 MR. HOLLOWAY: Well, they pay 20 -- and we do 20 go after that, that 20 percent that Medicare doesn't pay. 21 COMMISSIONER NICHOLSON: I see no -- this is 22 a medical -- we're a medical service provider, just like 23 other medical service providers, and we ought to use the 24 same strategy they do to either make their profit or cover 25 their costs. 8-19-05 jcc 43 1 MR. MEEK: Dave? 2 MR. HOLLOWAY: And we have been a user-pay 3 system since 1994. 4 COMMISSIONER NICHOLSON: We are a user-pay 50 5 or 60 percent system. 6 MR. MEEK: I have -- 7 MR. HOLLOWAY: I won't debate that. 8 MR. MEEK: Don't sit down yet. 9 COMMISSIONER NICHOLSON: We got 2 million -- 10 excuse me. We get -- our operating capital costs are about 11 $2 million, and our billings are about $2 million. 12 MR. HOLLOWAY: Our collection rate is about 13 54 percent if you take the Medicare out. 14 COMMISSIONER NICHOLSON: Yeah. 15 MR. MEEK: I have a question. I had heard a 16 figure of 60 percent to break even. I've also heard 17 80 percent. Do you have any update on what it would take? 18 MR. HOLLOWAY: Well, if we raised the rates 19 about 80 percent, based on the Medicare disallowed and the 20 bad debt and all that going up, we probably could get by 21 without any subsidy. 22 MR. MEEK: Okay. What -- the point I wanted 23 to make there is -- and it is a question for both entities 24 to look at and hopefully get some insight from our potential 25 committee over here. That's part of the important minutiae 8-19-05 jcc 44 1 that the two bodies would have to work out at some period of 2 time, and that is, is user-pay what we can agree to? Or is 3 there a benefit to people county-wide, whether they live in 4 the city or not, to having that service in place, if they 5 use that service that calendar year or not? I believe there 6 is a benefit. But these are some very important details 7 that these two bodies will be faced with deciding. I, 8 speaking as one councilman, am very interested in hearing 9 ideas -- good, bad, or otherwise -- that have a potential 10 for improving our bottom line. There's no question we have 11 a wonderful service now. Whether it is ideas on 12 collections, ideas on rate adjustment, you don't have to 13 wait till August or June or -- you can -- we can be getting 14 together any time during the year. I understand Jonathan's 15 point; you know, what's the incentive if you have a whole 16 year to get together? But you have my commitment as one 17 individual that I -- I want to solve this long-term, and 18 I'll -- I'll look at any viable solutions. I don't care 19 what month it is. And I think if the two groups can take 20 that kind of attitude to heart and live up to it, then it's 21 a matter of making the best solutions. 22 COMMISSIONER WILLIAMS: I think that's -- 23 once we work our way through the minutiae, using your word, 24 Councilman, that's why the emergency service district really 25 becomes important, because -- because if we never -- if the 8-19-05 jcc 45 1 system never gets to total user-pay, as my colleague would 2 like to see -- I don't know if that's a possibility or 3 not -- spreading the cost across the entire tax base makes 4 sense. If I never have to use that box personally or for a 5 member of my family, it's worth something in my tax rate to 6 know that it's available when I need it -- when and if I 7 need it. And I think that's an argument that can be made to 8 the public, and they will understand it. And I think that's 9 why it's important for both of us to join together with that 10 view in mind as a long -- part of the long-term solution. 11 COMMISSIONER LETZ: I think maybe Chief 12 Holloway misunderstood. What I was saying is for the 13 six-month period. I don't mind committing for service; I 14 understand you have personnel that's using that for a year. 15 I want a commitment from the Council that at the end of 16 three months or six months, they will in good faith -- I 17 don't mean them personally, but they will in good faith see 18 that these issues that we have -- the County has -- are 19 looked at, and consider changes if -- if it's agreeable. I 20 mean, I haven't been able to get enough information to know 21 if what I'm asking to look at is even plausible. It may not 22 be, and it may be in six months I'll say, "The City's doing 23 everything they can; let's leave it the way it is." And it 24 may be in six months I say we need to establish -- "I think 25 we need a zone thing." And that's all I'm saying, is that I 8-19-05 jcc 46 1 don't mind committing to a contract for 12 months; I just 2 want a six-month period that we can get a commitment out of 3 the -- from City Council that they're going to look at these 4 issues, from user-pay to collections to everything, and see 5 if there is a way to improve. 6 MR. WAMPLER: We don't have any objections at 7 all to analyzing, looking at the operation, looking at our 8 administrative services, our billing, our collections, and 9 we do that on an ongoing basis. We have every interest, as 10 -- as do you, to run as efficient an operation, as 11 well-staffed and service operation as we possibly can for 12 the benefit of all the citizens, and we believe that we've 13 done that. As -- as has been talked about around this 14 table, there's no quibble whatsoever with regard to the 15 quality of service, level of service, call times, 16 what-have-you, so I think it's premature from my standpoint 17 to say what the Council might do going forward with regard 18 to emergency services district or any other solution to the 19 mutual issues that we're talking about today. What I came 20 here to do today was to talk about the proposal that's on 21 the table now, to see what is going to happen with regard to 22 the short-term issue. Personally, I -- you know, I welcome 23 the opportunity to sit down and talk about some of the 24 long-range issues that we're discussing today and those that 25 we face. But from the standpoint of today, obviously, we're 8-19-05 jcc 47 1 short-handed; we can't commit the Council. I'd like to -- 2 to focus on the contract at hand and get past that, and then 3 come back to -- at some future date and talk about, you 4 know, future communications. 5 COMMISSIONER LETZ: I'm not sure if -- from 6 what all you said, if you're agreeable to my suggestion or 7 not. 8 MR. WAMPLER: Well, I'll let you come to your 9 own conclusion about it. 10 COMMISSIONER NICHOLSON: I think he said, 11 "Trust me." 12 MR. WAMPLER: I said that I'd be willing and 13 welcome the opportunity to sit down and discuss those issues 14 in the future, but that we -- that I came here today to talk 15 about the proposal that's on the table. 16 COMMISSIONER WILLIAMS: Well, in that 17 regard -- in that context, is there any movement on the part 18 of the City with respect to some of the items included in 19 the amount of subsidy you're requesting from the County, or 20 is your position fixed? 21 MR. WAMPLER: My position is fixed. I'm 22 speaking as one Councilmember. 23 COMMISSIONER LETZ: That's why, in my 24 opinion, I don't mind -- I mean, that's why I'd rather go 25 with three months, 'cause I disagree with the $200,000 8-19-05 jcc 48 1 number, but I'll go along with that if they'll just commit 2 to at least, you know, in good faith look at it. And that's 3 not accepting the proposal, but it's accepting it for a 4 third of the -- or a quarter of the year, or even up to half 5 a year I'd probably go. I just want to -- you know, I just 6 want a good faith effort to try to solve the problem. You 7 know, if y'all want to subsidize the way y'all are doing it 8 in the city limits, that's just -- and don't want to get 9 into an ESD, that's a City Council decision, 100 percent. 10 But I don't understand why the City doesn't want the County 11 to try to get the county portion into a user-pay and not 12 change the service. I just don't see how that is anything 13 negative to the city side. You know, maybe if the billing 14 stays in the city, it's a little bit more work, 'cause 15 things have to be coded, okay, instead of -- there's going 16 to be two rate structures, something like that. But I just 17 don't understand how -- why the City won't even agree to 18 discuss that. And that's -- 19 MR. MEEK: Let me make a comment here, 20 Jonathan. I have no idea whether an ESD is a -- is viable 21 or not. I like the idea of trying to find whatever format 22 is the most fair to everybody. That may have the potential 23 of doing that. Don't know all the details. But as long as 24 we have -- the people in the city limits actually are paying 25 about three-fourths of the total bill, then it's us against 8-19-05 jcc 49 1 -- it's two entities that are trying to balance a fund that 2 can never be balanced on a purely fair basis. If we did 3 have an ESD in place, then we wouldn't be quibbling over the 4 -- the details quite as much, because whatever it is, it 5 would be fair to everyone. 6 COMMISSIONER LETZ: Quick comment on that, 7 and I can't let it go, is on the -- you said 75-25. I know 8 you're rounding off numbers, -- 9 MR. MEEK: Very much rounding off. 10 COMMISSIONER LETZ: -- but I think the City 11 Council has to understand that all of the shopping and 12 stores in Kerr County are in the city of Kerrville, and 13 there's sales tax. The City gets three-to-one sales tax 14 dollars compared to the County. So, while, yes, the -- 15 MR. MEEK: That's true. 16 COMMISSIONER LETZ: -- the city residents 17 subsidize the county on services that are inside the city 18 provided by the county, the county residents subsidize the 19 city budget through sales tax. And I -- I don't know if 20 it's a wash exactly. I guess one of these days I'm going to 21 have to sit down -- go to the Comptroller's office and 22 figure out exactly what the breakdown is. It may not be 23 50-50; I don't know. But -- I don't know how you break it 24 down, but I know it's not 75-25, because the sales tax is a 25 good portion of your revenue. And I just think that's got 8-19-05 jcc 50 1 to be on the table, so I can't just let it go on -- that 2 property tax is the only thing that funds either of our 3 budgets. 4 COMMISSIONER WILLIAMS: I wondered when you 5 were going to get there, Commissioner. 6 MR. MEEK: You're a little behind schedule on 7 that one, Jonathan, actually. Well, I hear what you're 8 saying, but I'm also hearing that everybody sitting around 9 this table and probably in this room is interested in a 10 solution here. And, you know, I like what I've heard -- 11 I've heard here today, but we really don't have the luxury 12 of time to solve the problems now. We do, hopefully, need 13 to move forward. It's -- I don't -- I just don't think 14 there is enough time to make adjustments to this contract, 15 and that -- that's why the City has placed an acceptance 16 deadline on the contract as offered to the County. And we 17 sincerely hope the County accepts this offer. My door will 18 not be closed, and I doubt that the other people in the 19 City's door will be closed. Bring us good ideas. Any 20 dollar that's saved for the County is also a dollar saved 21 for the City. And, as I said, I commit to work on this, but 22 I sincerely hope y'all can move ahead, accept the offer that 23 is on the table, and then go after the solutions. 24 COMMISSIONER WILLIAMS: Is there any magic in 25 that deadline that was -- that was put out of the 23rd, I 8-19-05 jcc 51 1 believe? 2 (Mr. Davis nodded.) 3 COMMISSIONER NICHOLSON: There is magic in 4 that deadline? 5 MS. DAVIS: No, I'm saying the 23rd was the 6 deadline. 7 COMMISSIONER WILLIAMS: Okay. The reason I 8 asked is because we have a full day of workshops coming up 9 the next day on budget matters, and I'm wondering whether or 10 not -- 11 MR. MEEK: Bill, would this help you to know 12 where it was going when you're working on your budget? 13 COMMISSIONER WILLIAMS: Sure. 14 COMMISSIONER LETZ: It will affect -- 15 definitely affect the budget. 16 MR. MEEK: Wouldn't you want to know before 17 you went into those budget meetings? 18 COMMISSIONER WILLIAMS: It's part of the 19 decision making, and has to be, as we put all these pieces 20 of the puzzle together. If we give the City $200,000, we 21 may have to tell the Sheriff he can't have some of these 22 things. 23 MR. MEEK: I understand. 24 COMMISSIONER BALDWIN: We have -- 25 MS. DAVIS: I think the deadline, to answer 8-19-05 jcc 52 1 your question, Mr. Williams, was established because the 2 Council was meeting Tuesday night. 3 MR. MEEK: That's right. 4 COMMISSIONER BALDWIN: We have an agenda 5 item, I think, that's styled that we could take action if we 6 so chose to. 7 JUDGE TINLEY: We do. 8 COMMISSIONER BALDWIN: And we also have one 9 for Monday -- this coming Monday of our regular 10 Commissioners Court meeting. 11 JUDGE TINLEY: Yes. And I have -- in my 12 opinion -- the County Attorney may have a different opinion, 13 and certainly I would have to defer to his, but I think 14 the -- I think the -- that it's styled in such a manner that 15 if we wanted to, for example, appoint this committee, at 16 least from our standpoint, we have a quorum. The City, of 17 course, does not and cannot take official action, but we 18 could do that either today or Monday, as far as that goes. 19 COMMISSIONER BALDWIN: The committee itself? 20 JUDGE TINLEY: Yeah. 21 COMMISSIONER BALDWIN: Appointing the 22 committee? 23 JUDGE TINLEY: Yeah. 24 COMMISSIONER LETZ: I think the -- I mean, I 25 think it's -- if the committee's not appointed jointly, it 8-19-05 jcc 53 1 doesn't do a whole lot of good, 'cause the City has the 2 information. 3 MR. WAMPLER: I would say also, just -- just 4 from a practical standpoint, it would be unlikely that the 5 Council would be able to act on a committee for some period 6 of time, you know, with regard -- we have to appoint an 7 interim mayor; we have to appoint another councilmember. 8 Probably want to include them in this decision. So I 9 wouldn't be able to say today when we might be able to act 10 on appointing a committee, if at all. 11 COMMISSIONER BALDWIN: See, that just clearly 12 points out how good the city government is. We can do that 13 today. 14 MR. WAMPLER: We could have done it today if 15 we had a full staff. 16 COMMISSIONER BALDWIN: Well, I tell you what; 17 I'm in favor of appointing the committee. I'd rather see 18 five than four, in case there was some kind of tie thinking. 19 I know you guys don't tie, but I'd rather see five. But I'd 20 really like to see the committee put in place; I really and 21 truly would. I think it would be important. Whether the 22 City goes along with it or not, they could -- we could use 23 them as a sounding board and advise Commissioners Court, if 24 nothing else. 25 JUDGE TINLEY: Okay. 8-19-05 jcc 54 1 COMMISSIONER BALDWIN: Is that sign language? 2 JUDGE TINLEY: Yeah, it is. It was intended 3 to be. 4 COMMISSIONER BALDWIN: Okay. 5 MR. HAYES: I missed something. 6 JUDGE TINLEY: Do you have access to 7 Mr. Bock? 8 MR. HAYES: No. He told me last night he 9 probably wouldn't be here, and he would call if he was going 10 to be here. 11 JUDGE TINLEY: Okay. 12 COMMISSIONER LETZ: We can do it today. I 13 mean, I can certainly have a motion -- we can do a motion 14 today. If Commissioner Baldwin wants to make one, I 15 certainly will second something, but I think we can wait 16 till Monday, too. You know, I think that I -- I like the 17 idea, and I think there is some -- I think how the committee 18 is -- I guess the charge of the committee would vary, 19 whether the City wants to participate or not. I think that, 20 from my standpoint in the county only, I would like to have 21 a committee give us some advice on ESD's and where the 22 County should go long-term, and I would like to have city 23 and county input on that, so I'm in favor of that. If we 24 expand the committee to also look at the current agreement 25 and relationship and look at some of -- billing, some of 8-19-05 jcc 55 1 that, I think it's fruitless to do -- to give that charge 2 unless the City's going to join in it. 3 COMMISSIONER WILLIAMS: I agree. 4 COMMISSIONER BALDWIN: I agree with that. 5 MR. WAMPLER: Just to be clear, Judge, even 6 if Todd were here, I'm not sure that I could support doing a 7 committee today because of some of the issues that Jonathan 8 mentioned with regard to the charge of the committee, the 9 form, what responsibilities and what-have-you. That's 10 something I'm going to have to consider and think about, 11 personally. I'm not prepared to make a decision on that 12 today, even if we had a quorum. 13 COMMISSIONER WILLIAMS: I understand that. 14 COMMISSIONER LETZ: Lunchtime yet? 15 COMMISSIONER BALDWIN: Close enough. 16 COMMISSIONER LETZ: Scrimmage time. 17 JUDGE TINLEY: Does any member of the Court 18 have a motion to offer in connection with the agenda item 19 today? Hearing none, any further discussion on the agenda 20 subject that's before the Court? 21 COMMISSIONER WILLIAMS: I just want to thank 22 the members of Council for coming here to this meeting 23 today. I think it's important that we sit face-to-face and 24 talk about these issues. And perhaps part of the problem is 25 we haven't done that often enough in the past. And I 8-19-05 jcc 56 1 appreciate Council and staff coming to our little bailiwick 2 here and joining us in this discussion. 3 COMMISSIONER BALDWIN: I agree. 4 COMMISSIONER LETZ: Right. 5 JUDGE TINLEY: Anyone on behalf of the City 6 have any other comments they wish to offer? 7 MR. WAMPLER: Thank you for your hospitality. 8 Good to be here. Good to see you guys, and second what Bill 9 said. 10 MR. MEEK: I just encourage you to make good 11 decisions. 12 COMMISSIONER NICHOLSON: There aren't any 13 good options available. 14 JUDGE TINLEY: Thank you for being here. We 15 appreciate it. We'll stand adjourned. 16 (Joint meeting adjourned at 11:15 a.m.) 17 - - - - - - - - - - 18 19 20 21 22 23 24 25 8-19-05 jcc 57 1 STATE OF TEXAS | 2 COUNTY OF KERR | 3 The above and foregoing is a true and complete 4 transcription of my stenotype notes taken in my capacity as 5 County Clerk of the Commissioners Court of Kerr County, 6 Texas, at the time and place heretofore set forth. 7 DATED at Kerrville, Texas, this 23rd day of August, 8 2005. 9 10 11 JANNETT PIEPER, Kerr County Clerk 12 BY: _________________________________ Kathy Banik, Deputy County Clerk 13 Certified Shorthand Reporter 14 15 16 17 18 19 20 21 22 23 24 25 8-19-05 jcc