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February 8, 2005 Special meeting minutes

February 8, 2004

Ms. Roberts called the meeting to order on Tuesday, February 8, 2005 at 7:45 p.m. at the East Windsor Town Hall Annex.

Linda Roberts, First Selectman
Al Regina, Selectman
Kenneth Crouch, Deputy First Selectman
Thomas Sinsigallo, Selectman
Michael Balf, Selectman

Also present Board of Finance members:  Jack Mannette, William Dove, Edward Farrell, Denise Sabotka, Mary Szabo, Gil Hayes, Paul Catino; and
Thomas Clynch, Chief East Windsor Volunteer Ambulance

See attachments for back up provided and explained in detail by Mr. Clynch.

Ms. Roberts outlined that there is no written contractual relationship between the Town and the East Windsor Ambulance Association to outline the relationship between the Town and this agency.

Mr. Clynch stated that the Association has a lease agreement for the building, they are named in the charter, it is a non-profit 501E organization and it has a Board of Directors.  Members who belong to the ambulance are paid part time employees.   The Board of Directors are elected by the members, the employees are all members. There have been no changes to the by-laws.  Chief Clynch does the day to day operations and the book keeping is done in-house by personnel on duty.  Mr. Clynch indicated it is the same relationship that has existed since 1978, an annual contribution and ambulances from the Town – the difference is now it is billed and a lot more runs are made.  

Mr. Clynch does an annual analysis of how to staff vehicles appropriately based on call ratio.  As a volunteer unit they did about 600 runs, now it is 1800, with 1500 in town.  He keeps an eye on revenue and call volume and they do not pass on a lot of calls.  

The Town is concerned as there is no formal agreement which outlines the expectations, what the Town is responsible for and what is expected of the Town and, likewise, what the Ambulance Association is responsible and what is expected.

Ms. Roberts indicated the recent letter to the editor was a poor tactic and not a recommended way to communicate.  

Time was spent discussing budgets and how the revenues generated are distributed.  The billing received is collected as revenue and deposited in the bank book.  The book keeper pays the bills and payroll.  The rates are based on the State rate schedule (attached).  The charge begins from where the patient is picked up to the hospital.  Bundle bill agreements were explained and how they work.    The ambulance cannot do transfer calls, i.e. dialysis, etc. as those are profit based – this ambulance can only field 911 calls and transport to a hospital.

In general 85% of the billed out charges are collected.  A hypothetical scenario was put into play:  if 100% collection of billable revenue was brought in, the Ambulance could purchase its own ambulance.   Mr. Clynch outlined how the revenue made through mutual aid staffs the other ambulance (memo attached)

When asked what the five year forecast presented, it was hard to know what to expect as it is unknown what will be produced by the Town.  Mr. Clynch tried to work with Enfield, but they have gone to a per capita charge – self governing.   He intends to generate as much revenue as possible. Currently five paramedics live in town – the goal is not to pass on calls, East Windsor is covered and helping neighbors generates revenue.  As other Towns change, for example Enfield, it will effect the revenue East Windsor had previously collected, so adjustments are made.    They would like to get an ambulance stationed in Broad Brook.  

The mutual aide and what scope is covered is determined by the Chief.  An instance of coverage in Granby could be that all available ambulance near that area are occupied, so East Windsor will cover if needed.  

Investigation into making the Ambulance a town agency could be considered.  Mr. Clynch outlined that current staff (40 ± part-time) equal 16 full time people.  Currently the ambulance does not pay for benefits, it is an hourly pay rate.   Also if it is a Town agency it can work with other agencies and develop a synergy in services for the Town.  First responders were discussed, as residents have expressed concerns seeing fire engines at all ambulance calls, and under the Incentive Program firefighters are paid for such calls.   This is an item the Public Safety Committee can address, who is necessary at a call, who first responders should be.   Mr. Clynch pointed out that the fire department does not need to be at such calls and no matter who is there,  ambulance personnel will still be needed to staff the ambulance, additionally,  police officers may be on scene, they will not carry the stretcher or be able to drive the ambulance to the hospital.  

The avenue of fund drives and donations to raise revenue was discussed. Mr. Clynch outlined that often people do not donate to something they have to pay for.  Enfield's donations were compared to East Windsor’s donations and the difference in how much Enfield acquires was significant. Mr. Clynch outlined that Enfield has a greater population and just recently started billing, so that will probably change.  The rationale people carry regarding donations with an ambulance that bills is “I donated, then went on the ambulance ride and had to pay”.   It was questioned if it was possible to raise more money by fund-drives and/or donations and when doing so, to put a more positive spin on the letter requesting funds – rather than a negative letter about Town funding.  

The population of East Windsor, due to work force, dramatically increases during working hours.  

The costs associated with this ambulance if out of town runs were eliminated and a staff maintained for what is needed to cover East Windsor needs to be explored.   Can the sizable staff be eliminated if there is no more out of Town service.  It would be good to see a projected revenue and expense sheet minus out of town service, and maybe this could accomplish what the Town wants.  

There is no shift coverage with how the system is current set, there is round the clock coverage with the 40± part-time people.  

Mr. Catino acknowledged that there are numerous choices with how the Town and the East Windsor Ambulance Association can work together. One extreme is to do nothing, no agreement in place and have no  understanding between the entities, and to exist as is, or the other extreme is to become a full-time Town agency.  The goal needs to be somewhere in the middle.  It would be wise to look to other towns to see what the relationship is between towns and their ambulance associations – and to also use some innovative thinking and brain storming to come up with a  plan.  Mr. Clynch indicated that currently other towns look to East Windsor’s service as to how patient care is handled.  

Ms. Roberts indicated presented two possible ways to fund an ambulance service – a per capita flat grant or they operate on their own and the Town provides an ambulance (capital purchases).  The idea of the Town doing the administrative portions through the Treasurer, such as billing, accounting and payroll was put on the table.   A subcontractor to do this service retains 10% of collected revenue (standard rate is 9 ½ - 11).  Quality Assurance of billing is important, currently there are manual systems in place, but, for a cost and much less work, other systems can be put into place.  

If  town service providers go their own way there can be problems with insurance carriers covering them under a Town policy.   
The mutual aide requirements were discussed.  Basically if East Windsor needs help we call out, if someone needs help, they call us – if East Windsor is not available, okay, if they are available they cover.  This was put in place as part of Homeland Security provisions and disaster plan mandates which must have back up provisions.  If a mutual aide call comes in and we have an ambulance staffed and available, it goes, there is no option to turn it away.  There have been times when both ambulances have been out of town.  

An issue is if East Windsor raises its service, how much does it benefit East Windsor and how much does it benefit other communities.  Do we get mutual aide call volume because we have a great ambulance.  Mr. Clynch felt that every penny earned in revenue helps have another ambulance available.  It was again suggested if the call volume and revenue generated in East Windsor itself, the Association might be self sustaining.  Mr. Clynch indicated that the extra revenue generated does not go toward paying people, but to expand hours.  

The ideas of posting different rates for out of town calls was discussed and is to be investigated.  Perhaps a separate agreement with other towns – we provide paramedic intercept for a fee, or a sliding scale concept.  If East Windsor is called frequently because of the increased skill and service, this might be a way to recoup some costs.   As the Association makes a revenue, citizens want to know where the monies earned are going.  

At this time Bill Loos, former Broad Brook Fire Chief, addressed the Boards to state that under the term of former first selectman, Jack Rajala, when researched, AMR ambulance service would service the Town for no cost, they only required a heated space.  The cost for residents for the service would be the same.   

The issue of granting or denying the East Windsor Ambulance Associations request for funds for an ambulance has to be determined.  Discussions went on at length as to procedure for this, indicating that the Board of Selectmen handle procedure and the Board of Finance handle the fiscal portion, but the two need to work together – if the Board of Selectmen give a green light for purchase of an ambulance and approve a memo of understanding that has prices within it, the Board of Finance has to be part of those discussions.  It would be futile for the Board of Selectmen to fashion an agreement with the Ambulance Association that the Board of Finance will not fund.  The need for two ambulances has to be discussed, as does the need for replacing current equipment and using vans versus the big bus type.  Vans are used by commercial ambulances and there is a big difference in cost between the two types.   The big boxes are good for triage, it  was asked if triage can be done in one of the big fire rescue trucks.  Mr. Clynch pointed out that the commercial vans do not have a long travel time, wherein East Windsor has three techs and the travel to the hospital can be lengthy.  

If there was no funding in place, Mr. Clynch indicated they would run the ambulance until it was no longer functional.  It takes 90-120 days to order and obtain a new one.  

As so many issues remain outstanding and numerous factors are involved in creating a memo of understanding between the Town and the Ambulance Association, it was suggested that a temporary committee meet and hash out an agreement and present it to the Board of Selectmen.

MOTION: To establish a temporary sub-committee to consist of two members of the Board of Selectmen, two members of the Board of Finance and two members of the East Windsor Ambulance Association to research options for a Memo of Understanding between the Town of East Windsor and the East Windsor Ambulance Association, to reports its recommendation(s) to the Board of Selectmen at the second regular March meeting.
Made by Mr. Crouch, seconded by Mr. Regina

The members of the above committee will be:  Board of Selectmen (Roberts, Crouch); Board of Finance (Dove, Farrell); and Ambulance Association (Clynch, Henry). These members will meet on a mutually agreed upon date and time.

No action was taken regarding “replacement of current equipment” pending recommendations brought to the Board of Selectmen by the above mentioned subcommittee.  Item tabled by consensus to the March 15 meeting to see what direction the Town will be taking in this regard.

MOTION: To adjourn at 9:50 p.m.
                Made by Mr. Sinsigallo, seconded by Mr. Regina.

Respectfully submitted

Cynthia D. Croxford
Recording Secretary