 It's six o'clock, and I will call the first committee of the whole meeting to order And I would like to thank all our guests for being here tonight And the purpose of this meeting is to discuss information given by our fire department Older person Montemayor is sitting in today taking notes for Alderman Hannah is missing tonight Would you like to call the roll? Yes, of course Alderman Warren here Alderman Bowk here Alderman Serda Alderman Gisha here Alderman Hannah excused Alderman Heidemann Alderman Kittlesen Alderman Clayunas Alderman Manny excused Alderman Meyer here Alderman Montemayor here Alderman Rindfleisch excused Alderman Ryan Alderman Vanderweel Alderman Verhasselt Alderman Wongerman There's a quorum quorum is present Moving on to item number three on our agenda It is public input, and we ask that you limit your comments to five minutes per person And we will go in order of the sign-up sheet Dr. Susan Martins Not yet. How about Laurie Selman? Thank you. Um Jerry Isville signed you up here, which is fine I just need your address 2763 County Road I Sockville. All right, you'll have five minutes Good evening. My name is Laura Selman S is in Sam turn it on Bora la you are a Selman S is in Sam ELL mann I I'm here addressing you as a president of Orange Cross ambulance As you know, we do provide a quality a high-quality pre-acute service to the city To the city of Sheboygan citizens as well as part of the county We've done this since 1979 and quit work quite proud of what we do I know you'll be hearing a presentation from the city's fire department later this evening on transferring the 9-1-1 calls From for the city to their pros proposed paramedic units and considering this proposal. I ask you to ponder the thought the following thoughts Orange Cross ambulance has provided the service to the city at no cost to taxpayers What will you do if the projections that you see tonight are not accurate? Many of our paramedics and their families are residents of the city What will you say to them as you eliminate their jobs? We have approximately 40 employees in The post 9-11 world and even in the view of the recent landmark Fire have you considered the impact of eliminating 40 EMS? Professionals from our emergency medical system these EMS professionals do not cost taxpayers a penny But they are available and during the time of the landmark fire. We experienced eight ambulance calls from Sheboygan residents Can you be absolutely sure that the high quality level of paramedic services provided to your citizens will be duplicated or in a year or Two will the fire department face what the police department is facing today as all the persons You must give consideration to these thoughts and others before you rush into it changing a system that is working extremely well One that is vital to the safety of our citizens Thank you Dulce Johnson I Have your address Chairman Meyer and committee of the whole I Appreciate the opportunity to speak with you because when issues are handled the way the ambulance issue has been handled I see lots of red flags Frantic actions in an attempt to pass documents with the greatest possible speed a Document of major significance introduced not by the chairman of the appropriate committee But by an alderman an office for only two weeks with the intent of suspending the rules and no Opportunity for public input. Is it a slam dunk? Has the vote already been taken? You also have a document authorizing the transfer of funds from the 2007 budget for the purchase of three ambulances and supplies And for salaries and benefits while the document to transfer ambulance service to the fire department hasn't even been voted on officially I Understand that the plan is to take five hundred thousand dollars from the eight million dollar public work slush fund to purchase the ambulance and Transfer three hundred thousand dollars from the general fund to train for paramedics and purchase ambulance supplies. I Thought the two thousand and seven budget was a bare bones budget a zero percent tax increase budget My taxes went up several hundred dollars in the two thousand and seven bare bones zero percent tax increase budget So of course, I'm upset to learn that there's evidently an extra three hundred thousand dollars hidden in this bare bones budget Which raises the question how much more is hidden? Your constituents deserve better Your constituents deserve and expect open and honest government Why is the fire department so anxious to assume the ambulance service? I've heard that when firemen have assisted at an emergency They've asked persons to write a letter to the newspaper or call their alderman about their service When there was concern in 2005 That the new fire station and the far south side would not be built I remember then chief Zyer saying that the city wouldn't have to hire any more new firemen because he had three in the payroll that he Could just transfer right over there. I talked with Don Van Akron at that time as he was chairman of salaries and grievance and Suggested that the TO needed to be changed to delete three unnecessary firemen. Of course nothing happened When the ambulance issue was discussed in 2005 Chief Zyer said he would only have to hire five more people to run the ambulance service Now we're told there's only need to for three or four Does anybody really know? It is apparent that we have too many firemen with not enough to do But somehow it doesn't make sense to me to hire three or four or five more people with not enough to do and pay them High wages and exceptional benefits Obviously firemen are not fighting fires 24-7 and ambulance personnel are not answering emergency calls 24-7 The result is that you are hiring more people with not enough to do One of the alderman I spoke with even talked about providing service for the rest of the county You can't be serious. Is this another primrose path another too good to be true money-making idea Remember the marina We were told that someone would pay the city a million dollars to operate the marina The result is that the city is paying skipper bud to run it and the taxpayers are subsidizing it Remember blue Harbor blue Harbor is losing money big time and then there's the recent municipal court Which I'm told is costing the city money because people aren't paying their fines Well previously the city received half a million dollars from the county with no expense to city taxpayers now We pay for a judge and support staff Violators are not paying their fine, and I presume that this means contracting with the collection agency to collect them What about the bad debts for an ambulance service that will surely add up because people won't or don't pay their bills as Was the experience with the police department when they ran the ambulance service Will it require another taxpayer subsidy for a service that is now tax-free? Perhaps we can put the firemen to work helping with police duties reading meters keeping neighborhoods safe, etc There are communities that use police and firemen in dual roles I'm told that the fire chief is willing to make concessions, but what happens after five years Will they then expect to recoup all of their concessions? Why fix something that isn't broken? Orange Cross is doing a good job Their response times are well within their contract and the service doesn't cost the taxpayers a dime Governments should not be in the business of providing services that private enterprise can provide Thank you for your time. Thank you Dr. Martins, could you give me your address when you get here 38 Lake Breeze Lane make Lake Breeze Lane? I'd like to thank you for this opportunity to address the council. I'm Dr. Suzanne Martins I'm the EMS medical director Fitz St. Nicholas emergency department Orange Cross ambulance and the majority of the EMS agencies in the county My background is an emergency medicine. I'm also have had the unique opportunity to do EMS graduate work, and I've also just completed my master's in public health administration The topic I would like to address is the importance of heart attack care in this county Over the past six months, there has been a unique joint and cooperative effort made between both medical facilities st. Nicholas Hospital and Aurora Schwoigen Memorial Medical Center as well as the EMS agencies in this county To form a joint effort in treating heart attacks in this county Excuse me Schwoigen County EMS Providers encounter about 500 patients annually having chest pain about one-third of those are 130 patients are within the city itself Of those patients, practically five percent will be actually having a full heart attack something that is a true medical emergency You often see Ambulances driving lights and sirens Typically, that's not actually indicated. This is one of the few indications for actual emergency care The way that we diagnose heart attack is we have special equipment That does an electrocardiogram or an ekg now many of you may have had an ekg done Most of the time it shows a normal reading or something that's non-diagnostic As I said occasionally we find people who are actually having a true heart attack The indications for treatment for a true heart attack is rapid transport and immediate treatment the rapid transport includes Transfer to a facility that can do interventional cardiology We do not do that on an emergency basis in this county Time is of the essence and heart attack patients the american heart association has established a time goal We try to get the patients into A situation where they can be treated within 90 minutes of diagnosis of a heart attack For anyone who's had emergency care, you know that that is not an easy goal Every delay of 30 minutes can result in up to a 42 percent chance of dying every 30 minutes And even if you survive the first part of the heart attack over the next year Every 30 minute delay can result in up to an 8 chance of dying over the next year due to the incurred damage It is estimated that by direct transfer to a cardiac facility Which in our case would either be to st. Mary's ozaki or do st. Agnes and fondu lack would Save about an hour of death time in your heart As I said, this is a unique cooperative effort It's one of the first joint efforts that's been made by both medical facilities and throughout the ems community We have invested probably over $50,000 in equipment and unknown hundreds of manpower hours in training Part of this effort is also a qa process All of our chest pain patients over the past seven years have been aggressively treated and every single case has been reviewed The qa process in ems is something that is not very well defined Is one of the few things that I emphasize in our program and it is very closely scrutinized by the ems providers in this county Thank you Thank you We will be moving on to number four on our agenda and that is a presentation Regarding city fire department Providing ambulance service to the citizens of shabuigan Thank you Good evening everyone My name is fire chief jaylis tuski and I would like to thank a mayor parez chairperson meyer and members of the council and the citizens for this opportunity to present information tonight I would like to just introduce our staff members here who Have worked very diligently on this project And who will be trying to answer questions and going through some of the information On my left is commander jeff herman. I'm a right commander chuck butler And seated back with the audience's deputy chief Steve cheffner and deputy chief steve shark as chief of our department along with my staff We feel that it's really our responsibility and obligation to bring forth a viable alternative to our current ems system Um, this is something that we look very closely at in this time of Revenue sharing cuts and and and taxpayer concerns And with the hope of trying to maintain level of services And yet do that in a manner that is cost effective to the citizens We have put together this proposal We're very confident as we are with every other Other type of operation that we've overtaken throughout the years whether it goes back to fire prevention first responder Public education fire response technical rescue We've always approached all these Different avenues and areas of our our profession in a very professional way And a very dedicated way and we look at this proposal in the same manner I think there's a Real concern and and I understand the concern that this has been a fast-track kind of fast moving Not very well thought out proposal And I think it's very important for us to lay the groundwork of how we got to our current point in time here and I'm going to try to do it with Uh As uh short as possible But the history goes all the way back to 1988 When the fire department put forth the 32 page proposal To take over and assume the ambulance responsibilities back in in 1988 at that time For whatever different reasons The decision was made to go to a private entity and there was A number of five-year contracts between that time and our present time where this This ambulance Provision of service was was reintroduced and looked at and and decisions were made to extend contracts in 2002 We provided a Ambulance contract proposal for the fire department to run the 911 service for the city of Sheboygan And at that time After an extremely Heated process That bordered not bordered. It was ugly Commander Herman myself were A part of that process There was a lot of pain inflicted on both sides of the fence Orange Cross ambulance personnel Sheboygan fire department personnel and public uneasiness in the way that the Um The process was approached and we were very committed to not have that occur again When we re-looked at this this topic in 2007 here in the aftermath of that 2005 proposal Chief then chief xire and I attended a meeting To dedicate the new ER room at st. Nicholas hospital At and this was I don't have the exact date on it, but it was post The 2002 proposal and the decision for the new orange cross Contract and our discussions at that time with some of the hospital administrators Was such that they they said they were not opposed to the fire department providing the ambulance service They thought we could do a good job. They were impressed with With our level of service and abilities But there was a very much of a concern for the provision of service for inter-facility transports and And county 911 calls which was not included in our proposal So as we pondered that over the next few years When I became chief and in january 1st of 2006 I had a meeting with mr. Bonk from aurora Who discussed the fact that in most aurora served areas Fire department based ems was providing service to those areas And with the information from that meeting that I had with mr. Bonk We moved forward as a staff and tried to look at a way that we could approach this That would eliminate or at least certainly mitigate The ugliness and and a painful process that we went through the last time when When this ambulance situation came forward With that information in hand we made many meeting We we decided to look at the model that manitowoc fire department had used to consolidate The private ambulance service into the fire department in manitowoc. This was done in about 2003 By all apparent accounts. It was very successful both financially And as far as a level of service provided We made numerous trips up to manitowoc and met with their staff the financial director of manitowoc And the mayor of manitowoc to ensure that we were on the right track in approaching This from the perspective that we were Looking at And we took into consideration the concerns regarding city and county nine own on an inner facility transport And we intended to identify a process that we could move forward and try to work through that In fall of 2006 A presentation was given by commander butler and myself at dr. Coolis's office to Mr. ed bradley michelle wustike and loris selman of the orange cross-border directors at that time We provided An array of information regarding our level of training from for our current people A kind of general proposal on what we were looking to do and and move forward the process of A consolidated service much like was Being accomplished up in manitowoc There was some discussion on that and a joint decision was made at that meeting to continue on with the process of looking at that option And one of the important things that came out of that meeting is that we had a great concern For the viability of the current ambulance system if this information That we were working on that project and moving forth that project would come become public that there was a concern that Orange cross ambulance's viability in the next year may be compromised due to to current employees seeking other employment and There was a concern on both parties That we keep this confidential and close to the vest until we had an opportunity to work through all the issues related to the consolidated ambulance service On december 19th of 2006 commander butler Mayor Perez and I attended a A meeting with the full orange cross board of directors and hospital administrators for both hospitals A full presentation was given to them at that time Very similar to the previous one with more detail And uh, there was a consensus of the meeting to allow the sheboying fire department and orange cross board of directors To investigate the process for for future consideration On that same day on december 19th 2006 that same presentation was given to sheboying county board chairman bill gearing On january 18th of 2007. I'm just going through this timeline So you have an understanding of how we how we got to where we are today on january 18th 2007 a meeting was held where uh Several members of the orange cross border directors submitted specific written questions related to the consolidation process And a general discussion was held regarding the possible acquisition of orange cross ambulance equipment And the incorporation of some of the orange cross personnel into our our department One of the last lines written in that um written communications Was as follows Both the st. Nicholas hospital and aurora memorial medical center border directors are agreeable to evaluate the possible acquisition of orange cross ambulance by the sheboying fire department On january 31st of 2007 a written statement of a reply was sent to the orange cross border directors and answering um The questions that they had brought forth Um in the previous communication On march 6th 2007 a follow-up meeting was held in mayor pares's office that included mayor pares I believe it was ed bradley michelle oustike and i Conversations on that they included again the possible acquisition of vehicles and how that process would work And discussion from the orange cross border directors perspective Regarding the possibility of the requirement to provide severance packages for some of their employees It's our understanding that following that meeting that Several members of the orange cross border directors traveled to manitouac to discuss the consolidation process That occurred in manitouac And feedback from that meeting At least to the best of my knowledge was that the discussions were positive in nature Over the following weeks after that um We attempted to make a few additional contacts and they were not responded to And this process that we were working through Apparently was terminated on april 24th 2007 when ed bradley and there may have been someone else with him members of the border directors notified mayor pares That they were no longer willing to move forward with this process And had decided to seek a tenure contract Based on that situation and based on the fact that um the timeline for the process of um a new contract and or The shibuya fire department providing ambulance service January 1st 2008 our staff Made a little uh direction change as far as what Alternatives we could provide to the council that was within the council control And that is the proposal that's that's put in front in front of you tonight and that you've received last week And this proposal addresses the portion of the animal and transport service that is within the control of the council As this process has been a lengthy one and with the thought in mind that there's a lot of work to be done Including vehicle and equipment acquisition state licensure protocol development hiring process Training issues we ask that whatever decision is made is done in an expedient manner if we're Looking to begin this service beginning january 1 of 2008 This is a process that we need to move forward quickly as you can tell there's been a lot of thought Um a lot of background put into this process our department has prepared itself over the years even though We were not Awarded the ability to provide Ambulance service to the community We continue to prepare ourselves with a trained personnel To a higher level than we needed to be trained at the time in order to position ourselves So we would have the availability to do this service at some point in time and we feel that time is now I guess I would like to Turn the mic over to commander herman who would walk you through the The financial proposal that's in front of you I think before I get into the uh five or so pages of the exact figures of our Proposal which I think everybody wants to scrutinize. I'm going to try to put it in the uh Very simplest of forms as to why This will work financially for the city If the city and a private enterprise we're going to begin ambulance service on january 1st 2008 and we each had to Provide buildings we each had to purchase equipment And we each had to hire employees There is no doubt that the private company could do it cheaper than the public than the fire department The difference between that scenario and what we are proposing is What this what's the same is we have the buildings in place We don't need to go out and get buildings The equipment that each service needs to Have to provide this service is the same the equipment is the same the cost is the same The difference is we are proposing to take on this service with only four additional employees That's the difference between The two proposals. That's why it makes financial sense for the city And I can begin by going through The numbers and I think I'll go through page by page and commander butler will put them up on the screen And I think if you have questions as we go through it probably is best that you ask them Right away so that we're not jumping back and forth If you look at page one, which is the full pay firefighter wage projection We have a signed labor agreement that takes us through the end of 2009 So we're able to Accurately give you the numbers for 2008 and 2009 Beyond 2009 2010 11 and 12 we've projected those numbers and the increases are listed in the columns So if you look at 2008 the starting firefighter wage Would be $35,682 Now as that firefighter keeps his employment in year number two it increases to the 43,000 And so on down the line to the right Now as we're in the first column again going down the line number two Wisconsin retirement fund that is the pension That needs to be paid for that employee And it increases as his tenure in the service increases The third line is health insurance And we use the blended rate because from our past experience and again We're talking about adding four firefighter paramedics Our past experience is we've been getting in two single firefighters and two Married firefighters. So we blended Two family rates and two single rates to come up with that number The fourth line Represents the employee's share and again, that's contractual as to how much they have to pay And we did project it out again into the year 2012 The next line is the Subtotal of the health insurance The first year we do not pay any uniform allowance Because we don't pay it until a person passes his probation That's why on the second year in 2009, you'll see a higher amount. That's actually two years of clothing The uniform allowance The next line is workers compensation insurance and we receive that number from the city's insurance carrier, which is sieve mick I believe it's 0.145 percent Of the firefighters wage Next line down is medicare. That's a federal amount that's taken off And the the next line down is the total of the firefighters wages and fringe benefit package And as you move to the right that's it goes down as its tenure increases Next line down is times four for the four new hires And then the following line is our overtime that we've projected And the reason that that number We did not increase it as the years go on Is that we felt that the first year of our service there may be times when Our staffing may we may have the right amount of people there But we may not have enough paramedics there that we're going to have to call back Paramedics on overtime And we're also going to be very cautious on that first year to make sure that as we're running a new service That we have enough coverage So we feel that as we move into the service Our costs go up but our amount of overtime usage should go down And then the bottom line is the total Amount for the wages and benefits with the overtime included The next page is the exact same figures Alderman borne Thank you, madam chairman What's the current blend of the fire department as far as family versus single coverage? I without looking it up. I couldn't give you the exact It is higher than the 50 percent. Okay Also, then when you when you use the The term firefighter for wages at 35682 I'm assuming that's firefighter slash paramedic that that's a correct somebody coming on board that's Qualified for both correct. Thank you The second page is exactly the same thing as the first page. Excuse me commander. We have one more. Okay, um I've got a question as far as the wages are concerned Most of the departments that already handle this Ambulance service are those Employees that are paramedics are they paid at a different rate than a normal firefighter? Typically throughout the state you'll see an average of between probably four and six percent as a premium pay for paramedic That is not figured into this proposal Simply because that's a negotiated item if we put a set dollar in here that would really tie our hands as far as negotiating We do have an assurance from the local firefighters union that they will work with us to implement it and some site Some type of a step in phased in program Okay, so then after Since we're only looking at a three-year contract here So then there's a possibility that We go into negotiations after the three years are up And the union says well, we want to have more money for those paramedics And we come to a situation where we can't meet to resolve you can't department heads and We can't work it out to keep it at the same rate. It goes to arbitration Where do you think that's going to come down if you want to look at we did figure it out in the Worst case scenario or the average which would be probably a five percent premium pay at a full paid firefighter Would be roughly 35 000 dollars for a year For everybody for everybody. Yes Okay, olderman bulk. Did you have a question? I do. Thank you This goes up the pay goes up 70 percent over a four period set of years Is that is that typical for a new firefighter hires our remarkable increase? I'd like to sign up for that plan our starting pay is relatively low compared to the statewide average I can assure you that the next five years after this does not go up at that rate this their next period pay raise after this is at 10 years Okay, and that's consistent with whether they're a firefighter or whether they're qualified as well. Thank you Okay, thank you you can continue The second page contains all the same figures as the first page only The starting firefighter Wage is projected out through all five years So each column has what the starting firefighter would make in that year Because our turnover is an average of three people per year retire and we hire three new So what we typically always have somebody at that lower range of our pay scale We believe that the actual amount of the cost is a blend somewhere between these two pages But for the sake of Costing out this proposal. We did use the higher Full paid firefighter wage, which is the far right column on that first page Moving on to the third page miscellaneous expenses and revenues disposable medical supplies was taken off of the current providers Numbers and that's at $30,000 and we did increase that by three percent each year the fuel was estimated at 10 miles per call And multiplied by the 2,200 calls that we anticipate And then there also was a small amount of savings figured into there for Taking one fire rig out of service while we're running the one of the ambulances And that again was increased by three percent each year training cost was for Uh, every other year refreshers for the paramedics and emt's And that was figured at $500 per new employee The routine vehicle maintenance is $2,700 that was $900 For each vehicle of the three ambulances and that was for oil changes windshield wipers just the normal maintenance And that again is increased by three percent the non routine vehicle maintenance There's no number in the first three years because the vehicles would be under warranty And then years four and five we did add $1,200 each year for things that weren't covered under warranty Ambulance insurance again is a number that we received from the city's insurance company and that's at $800 per vehicle And the liability insurance again From the city's insurance company. That's a thousand dollars Our billing costs we have a quote Minute commander Hold him in bulk Just a couple of questions about liability Is that The ambulance insurance is that liability on if something happens to the the vehicle itself? The ambulance insurance The that is the line above it the ambulance insurance Okay, so that's if the ambulance gets in a wreck and has to be in place the liability insurance. That's a thousand dollars What is that insurance? for That's in addition to the city's liability policy that they now cover their employees for That's putting the ambulance rider on on top of that. Okay, and is that and I don't know if this question is more appropriate for turning McLean and maybe this isn't the right time to ask that But are we taking on an incredible amount more of liability by taking the service on and would that change our payment to however We pay for our insurance Cover Liability if we provided an ambulance service in house, I believe a lot of the sydnic Municipalities that are covered by sydney that are Who run their ambulance service through uh through fire departments and believe I looked at the last of today There are some exclusions, but the the exclusions have exclusions for ambulance service so I have Checked with something but it's my understanding that if we provided City fire department based Angle and service that would currently Be within the policy Which is same premium for how A million dollars with the covers and there's an eight million dollars well Okay As far as liability Certainly more activities to engage in the city more possibility to get the claim medical areas One that is right for that Some exclusions some protections recreational one of these one Made help to avoid paying out insurance Also the sydnic policy We've got to turn But the fact that we're taking on so much more potential for disaster That's all covered as you see it in the civic sydnic policy as it exists today Well to eight million dollars and I think it's You know, that's in the egg. We're good. I believe it's too many dollars for a currency Okay, thank you. Thank you Please continue The billing cost is a quote that we have from the Manitowoc fire department at 18 dollars per bill that's 18 times the 20 Roughly 2100 calls I believe comes up with the 35,000 And that again is increased Just a minute Olderman born Well commander Herman finish your explanation on the on the billing costs and then I have a question If you have anything else you wanted to add to that or Just that it's increased as we go down the year by the amount of projected increases in call volume For that. Thank you, madam chair for that 18 dollars. What Exactly what services are Manitowoc going to provide? Who's going to do the initial billing input into the Manitowoc system? Is there going to have to be a Person in your department that ants that wants to missus Jones that wants to ask why isn't her bill being paid by her insurance or medicare Kind of run me through the scenario of what we're going to get for the 18 dollars And if you anticipate having to do anything locally I'll refer that question to commander butler As we as we understand it currently from Manitowoc fire department They currently use a software program up there. They have people in house for their billing The 18 dollars basically what we would have to do to input information into the system for billing is we use field data system It's basically a remote access to their billing system. Everything is done through data link All of the information is properly coded sent directly to Manitowoc fire department And they would handle all of the initial billing requests And the invoices and things that are sent out The only thing that's not really included in that system would be what the city would decide to do with bad debt collectibles We would be able to use a service of our choice whether it's local or whatever And then that that would be our decision how we handle that Who would who would do that locally then? I mean would Would there be another clerical person that would would handle that or going after bad debts? How would that be handled? We anticipate using an outside firm Of the council's decision or choice. I mean it's not really our decision to make Whether uh, whether the council would decide to use somebody locally or otherwise Right and the actual the actual coding and the input is actually done by the paramedics when they do a When they fill out a run sheet if they would actually go on a call when they put that information into their computer The information is automatically coded To meet the needs of medicare medicaid and all of the insurance companies and and that information is forwarded directly So there'll be no no additional personnel needed for our local Billing service other than the outside private collectible agency and you'd have you would have policies established as to when Debt's become old and when you want to put them out for collection and all that that all has to be done as far as your ongoing policies what you're going to develop then Absolutely, that's that's obviously out of my hands But I fully expect that the council and the rest of our staff would have been put into our philosophy on collection And there are certain things that you don't want to push too hard You know it's something that we would have to absorb as as maybe a negative influence on the department or a negative view by the public Certainly that would be something we'd be very concerned about Thank you Thank you alderman born Alderman mani Thank you, madam chair Would it be possible for orange cross to be the building agent given the technology that you'd be using? That would be possible I guess if they wanted to give us a bid that is cheaper than the $18 We only went out and got one price. So I think before we Did ultimately choose to use mani talk. We would shot that price around Okay, thank you. Please continue commander herman The next line down is firefighter personal protective gear That's what we refer to as the firefighters turnout gear his boots as cold as pants and his helmet That is at $2,500 times the four new employees The reason that it's not included in any of the succeeding years is because that is done As a normal part of the fire department budget when we have Three to four people retire and replace them every year. That's already included in our budget The next line is ems equipment and repair That's if somebody drops a radio or drops one of the monitors That's for the repairing of that equipment and again, we did Think that we were very cautious on that amount and and did put a sufficient amount in there Next line down is an amount that's only in the first year and that's to purchase a reserve ambulance A fourth ambulance to be kept in the city We did go out and look at what's available There are ambulances available anywhere from $7,000 up to $50,000 We felt that $35,000 Was a very fair amount to put into the expense portion Next line down is the total miscellaneous expenses Alderman gisha Just a quick question Commander on this page FAP funds from state Can you explain what that is, please? Again, I'll turn that over to commander bottler The FAP funds are actually They're funds used for reimbursing training costs and things like that from the state of wisconsin They use a An equation to determine that and what individual service would get that They currently those funds go out to ambulance service providers Um, I believe the equation is something in the area of three cents per capita of the response area And then there's a flat fee that gets figured when they disperse the funds And then addition to that number of personnel And we actually used the $11,000 I believe is a number that we got from anatoch fire department Given the average size of their response area and what we could generally expect for those Are those funds currently not coming into our area these state aides? That is correct. They come currently to the current provider Because they are dispersed only to the ambulance service provider So orange cross currently receives some funds from the state. I believe that's correct. Yes Thank you. You may proceed The next line below the FAP funds Where we have the question mark in in that line Is non transport revenues and those are When an ambulance responds And the person is not transported to the hospital whether it's a diabetic call or Or some other call where you may be treated on the scene but not transported There typically is a fee for that service. We had no way of knowing What that amount exactly is looking through the current providers financial numbers that look like it ranged Anywhere from $4,000 to $8,000 but once again being conservative we did not include that in On our revenue projection Moving on to the next page is our call volume projections Um, we took these numbers from the fire department records And from the quality assurance commission We did a factor in a 3% increase in call volume every year Um, the past five years the fire department has seen about a 4 0.4% Increase in our call volume City of Manitowoc is experiencing Roughly the same Again, we were conservative in our numbers and figured in a 3% increase The number that you see in that same box in the the bold number That is the actual Number of transports. Uh, what we're typically seeing Is 15 of the calls the person is not transported to a hospital So the bold number is the one that actually could be billed for Alderman clayhunis. Thank you. I just asking Based on the increasing numbers of calls each year Are you basing it on the an aging population or what? What means what causes you to increase in numbers because the city is not increasing in population what um, I guess I couldn't tell you exactly what the number is we just uh Took that increase from going back five years and looking what has been happening in the past five years And from talking to other cities to see what the what the average has been The next box down is where we Factor in the rate that is charged For the ambulance call and again, we took the numbers off of the current provider's rate schedule And we did freeze the rates From the year 2006 To Starting in 2008. We kept the same rate Going back seven years the Current provider has raised the bls rates 105 percent in seven years and the al s rates 64 percent In the last seven years That's an average of actually higher than the 9.2 percent, but that's what we use to Raise our rates as we project it out into the into the future Again allowing with a two-year freeze of the rates And as we'll show you uh later on we did also do some projections with Projecting rates that did not increase by the 9.2 percent because we did not feel that that was a justifiable number Alderman borne thank you, madam chair The those rate increases that uh orange cross has been experiencing those rate increases have anything to do With any reduction in medicare or medical assistant reimbursement What's what has been the trend on those reimbursements the last Four or five years have they been staying the same or they've been going down? What's the experience been? It's my understanding that that's a fixed rate For the medicaid medicare and the how much you raise the rates does not affect how much you get back from Medicaid medicare That doesn't answer my question The rate increases that orange cross has had now the last few years. What relation to those increases does The medicare medicaid reimbursement factor in has has what the government's been reimbursing for medicare I understand it's 337 a call has that been staying the same or has it been going up or down what and also with With medical assistance. What's what's the relationship between the rate increases and what we're getting from the government for those calls? That the medicaid medicare rate has been going up approximately three percent a year Medicare and medicaid you're correct. Okay. Thank you Did I answer your question? Yes. Thank you. Thank you Please go on moving on to the next box is a revenue projection based on the percentage of al s and bls calls and From our from our research with other departments and talking to manatoch because Our proposal is not taking in account Interfacility transports which are between nursing homes, which are almost always a hundred percent medicaid medicare They expect us to see um About a 60 40 split is that correct? On the al s bls. We figured in a 50 50 Just to be conservative again So if you multiply our amount of Transported calls, which are the bold letters on the top By the rates For bls and al s you will come up with the numbers that are the revenue projection Then the next box below that is the loaded mile revenue projection And that is the amount of the charge for revenue based on The amount of miles between when you pick the person up and you get them to the hospital We projected that to be three miles per call Times the in 2008 would be 1951 calls And that comes to the 58 530 And then we estimated a 25 Bad debt, which is people that don't pay which brings us to the 43 897 The reason we didn't figure in the 52 bad debt, which we do figure for every other call is The medicaid medicare Reimbursement for mileage is almost always at a hundred percent Moving on to the next page, which is our projected revenues If you multiply the revenue projections on the previous page By the 48 percent and that's what we're Assuming is aren't going to be our collection rate only 48 percent. That is where you come up with our projected revenue Again, that's increased as we move from year to year And then again below is carrying through the funding assistance Program of 11,000 Olderman gisha. Thank you. Sorry to stop you. You were kind of on a roll. Nobody bothered you. It's okay A lot has been I know I've received a lot of calls about it and emails And you've now mentioned it a couple times talking about not only the medicare medicare reimbursement, but Bad debt and how all that clumps together basically in one big receivable or non-collectible Um, I've received communication that your initial numbers of 15 percent all inclusive Were we're not accurate and I think some of that was misinformation Kicking around can you just for just a second focus in on the fact of it's my understanding that your projections Are looking at 50 not of every dollar bill. We're only going to get 48 48 cents out of that's correct When manate walk does not experience that percentage, correct? They are they are at a higher rate They had a high rate of collection collection. So So, uh, you're using a safer number we're using more cushion in it. We actually took um, and I may have confused these numbers but manate walk is projecting that will probably be at a 60 percent because we're not doing the Transports between the nursing homes, which is always paid at the lower medicaid medicare rate That we won't have as many of those as what they're seeing. So they're predicting will be at a 60 40 the 48 percent Uh collection rate we actually took right off of the current provider's document that they provided to council I believe last monday Stating that they are at a 48 percent collection rate. So that's what we used We firmly believe it's going to be a little bit higher than that. Thank you Thank you Again the fap program 11 000 dollars. We carried that through the mileage revenue carried that over to this page for a total projected revenue of 675 235 dollars If you go down our employee costs of 271 thousand dollars and again if you look back to The first page that's column number one That's at the bottom of there And then our miscellaneous expenses of 130 thousand 218 dollars our equipment lease of 78 269 dollars Is a back loaded lease of three brand new ambulances Um a seven-year lease program that amount is due at the end of the year So there aren't as much upfront costs at the end of the seven years It's a lease to own program the ambulances are ours So the total projected expenses is 479 thousand 487 dollars When you subtract that from the 675 thousand 235 you come up with a projected total net revenue of 195,748 And unless there's any questions, I think I'll have commander butler hand out And again, this is projected at The first year would be at the frozen 2006 collection Rates, um the following figures are at a 9.2 percent rate increase and we don't believe that that is a Fair amount and again that would be subject to council approval We have run projections out at increasing The rates by three percent and five percent And again that will show as a projected net revenue in the succeeding years Thank you Question, how will you track this? Within the fire department budget You know because sometimes the paramedics will be doing fire calls. How will you be able to show? That this is where you're at. This is what we're doing. These are expenses. This is our income How will that be tracked? Do you have a separate? Accounting system you have set up for this or how do we do that? That's why this is one of the easiest way to show Whether or not this is going to make money or lose money You already know what the fixed expense is for your fire department in this city You'll be able to see we can see what our fixed expenses are for providing the additional service Once you subtract that from the amount that is actually paid in That's going to be your additional cost And if revenue if I can if I can add that's what the city of man. I talked it as well and there was a Great concern obviously when they took on that consolidated ambulance service that there would be Um Very detailed accounting of what those additional costs and revenues are so they actually separated out to two separate budgets They're existing fire department operations and then what they called their consolidated Operations and they track their costs and revenues and Have accounted for that separately over the past five years and have shown a Positive revenue stream there, but they're even discussing the possibility of Of merging the two budgets together because they feel after tracking it for for five years now or four years That they're comfortable knowing what those marginal costs actually are And also one thing I I might add in regards to the equipment lease These these least ambulances are going to be state-of-the-art ambulances. We utilized The equipment list that orange cross ambulance provided to the council last week to spec out A fully equipped ambulance including communications technology computer equipment to allow us to essentially have a unit that's that's ready to go upon Accepting delivery So all those costs are built into the lease program Thank you, madam chair Um, I don't know if this is appropriate time, but we're almost at the end and everybody's looking at these sheets I I did want to explain why my name isn't on this the document that we're looking at tonight It is because I was unable to look at the proposal before we had to get this document to sue Richards And since alderman rainflesh is my vice chair and he was able to look at it We put him on the document instead There's no other reason than basically for convenience And um Since history shows we usually debate this here and then we'll debate it on council floor also And in an attempt to maybe limit the debate here, I'll make a motion to uh, send Items number five and six those two resolutions to council with a favorable recommendation Second The second We have a motion and a second on the floor to send Items four and five well the resolution items five and six To council with a favorable recommendation All in favor of the motion say aye under discussion Sorry under discussion. Sorry Alderman mani Thank you, madam chair I have about seven issues listed on my piece of paper some are Philosophical issues some are pragmatic concrete detail issues So i'll start with a detail issue and then turn the floor over to someone else And certainly we'll have a lot of questions voiced and a lot of information shared In this next half an hour to 45 minutes. I trust or longer perhaps So one simple detail question is um If the fire department does begin service On january 1st 2008 In effect orange cross becomes a potential Competitor for a service within the city There would be no reason why they could not so serve if they were first call 911 calls would come directly to the fire department for response but um How big a factor might that competition be where people don't have an emergency But they have a need And they have a tradition with orange cross and a trust with the orange cross And therefore they call call orange cross instead of 911 And in effect then Adversely affect the bottom line in revenue That's certainly a possibility Um, I've worked in systems where that's been the case before Um, it is certainly within the right of every individual in the city every citizen to call who they would like to have for their service um 911 is a system that we've been taught from little on In the case of an emergency you call for 911 Um Again, I accept the fact that there would be and we certainly agree that there is that potential People have a relationship with that organization. And if they're still in place, they're absolutely welcome to call We still advocate the use of 911 for emergency calls and If there was some sort of a concerted effort by the current provider to actually advertise Opposite of that That would be viewed in my eyes as unethical and unnecessary 911 is absolutely the system in place and uh In that bad situation, you certainly don't want to confuse people Whether they be elderly or injured or that's a bad time for anybody Um, so again, that's everybody's right, but There's really no way to project that at this point Alderman Berhasselt Thank you. Thank you, mr. Chair. Um, I guess we've got a number of personnel here from orange cross tonight I think it may be appropriate to open the floor at this time And I'd like to make such a motion to open the floor to orange cross to answer to any of these Numbers pieces of information There's a motion and a second under discussion Oh, wait a minute. Who just buzzed? We're here, Gisha Yes, Alderman Gisha Um, I appreciate the motion to to open the floor. Um I'm just afraid that this gets into a situation of orange cross good Fire department bad fire department good orange cross bad and I don't think that serves A discussion like this at all. Um I think that uh, it's It's their night to do their thing and um And it the this proposal has to stand on its own merits or fall on its own merits And I would like to see a a clear discussion on this and I too Alderman Manny have A few more questions and things on on my plate as we Move along with this and I would like to use the time to extract Just as much information about this proposal and deal with this proposal We do not have a proposal from orange cross except an extension of the same contract for 10 years I think we pretty well know where that that stands. That's that's excellent But I would just Alderman born Thank you, madam chair, uh, the equipment lease The first the first payment on the equipment. The equipment lease would be during 2008 is that correct? Excuse me. We have a motion To open the floor which is taking precedence over. I'm sorry And we have to vote on that motion unless we have further discussion Alderman Manny, thank you, madam chair I would prefer to have all of our questions asked first from the council floor And then perhaps open that up to orange cross for their comments basically Related to technical evaluation of that which is before all of us on the fire department proposal Thank you. Oops time. Sorry motion. Thank you Alderman for hassle. Thank you, madam chair I can certainly appreciate what alderman geisha stated. However, I mean as a decision maker for my constituents I think it's always important to hear both sides of any issue I don't know how I could make a quality decision otherwise. So I guess I'd like to I can agree with alderman mani that if we can move ahead with Answering the questions directed at the fire department, that's fine But at some point in this meeting I would like to hear from orange cross because the motion on the floor is a fairly powerful motion And that we're providing a favorable recommendation back to the council In the next seven days, and I think it deserves The timeliness of that motion deserves that we hear from orange cross sooner rather than later Okay, thank you Alderman bander wheel thank you, madam chair As the motion was stated, I would not Agree with it if it was stated that One representative from orange cross if we would hear If we would have a question answer period with them, I would be in favor of it But an orange cross in general we could have Five six people up here, but if we would state that one Representative then I would agree to the motion Thank you Alderman gisha I want to thank alderman mani for stating it better than I and And alderman for hassle for for allowing me to clear I would agree with alderman mani if we can get through this. I have no issue with with Gathering information from orange cross. That's why I was there at their office at 7 30 friday morning They're wonderful people with a lot of great data information I'd love to hear from them even more than I did last friday But if we could if you wouldn't mind amending your thoughts to Ending one and then starting another if that would be appropriate. I would I agree with alderman mani. That would be a wonderful opportunity okay alderman bulk I was going to Support alderman for hassle in that we would want to hear from them before moving on because this is such a powerful Issue before the city and the city cares a great deal about it. I think we've come to a place where we can vote no now And then invite them up later Hold them in for hassle Thank you Again, so are we holding off on the motion to move ahead because the motion on the floor the other motion previous motion is to Move ahead with a favorable recommendation is the suggestion that we Vote on that motion and then come back to orange cross because that would seem to defeat the purpose Of putting them on the back end of the discussion if we're going to decide on sending a favorable recommendation Onwards, then I think orange cross needs to come before that is that Maybe y'all don't get you could you clarify is that your intention or your your hope? Good question You're right there is does seem to be some conflict Based on alderman van de Wils motion to move it ahead with a favorable Without hearing from orange cross I would assume from a parliamentary standpoint we have to go back and get rid of that and then My suggestion would be to finish with the questions from all the alderman for the fire department And then bring up orange cross and then perhaps move back to alderman van de Wils proposal if that makes any sense That's perfectly still Alderman van de Wils thank you, madam chair If i'm wrong with the statement anyone is free to correct me, but I believe that as a chair You could hold the motion To open the floor till the fire department has done discussion Then as part of discussion on my motion Then we can move to open the floor and then it could all just be part of the discussion because open the floor is just part of the Discussion anyway Sounds good We're still in discussion So we still have the motion on the floor to open to orange cross So we will hold that motion Until we are finished with the discussion from the fire department All right Is that okay? All right And we're holding our motions for a little bit At some point as part of our presentation Our medical director dr. Coulis is here and we'd like to invite some comments from him as well Dr. Coulis would you be available to do that at this time? Thank you for the privilege of being up here to speak this evening for those of you who don't know me My name is louis coolis. I'm a clinical cardiologist and I've been in this community about going on 15 years I've had the opportunity to be involved with emergency care specifically for cardiac patients during this time Um, and I've been involved with the orange cross in one way shape or another On and off during this period of time I became medical director for the fire department and I know this is a very emotionally charged Issue this evening, but I became a medical director of the fire department because From my standpoint while this is a system that does provide care It's not an optimal system and I think that what you have before you this evening Is an opportunity to change the paradigm in which care is delivered in this community And what I did see this evening was everybody going through line by line of what things cost What's going to be the projection? How are things going to run? This is accountability And this is what you should have from the folks who are providing your care in the community And this is something that I think was actually positive this evening What I see here is that you're already paying for the talents of these gentlemen So to say this doesn't cost you anything is really not completely accurate It does cost you because you are paying for the salaries for the benefits of these gentlemen You are paying for the resources through which they work and you are paying in some degree for their talents So to me and I'm very simple. I look at things simply amounts will get the most bang for your buck And utilize them to their fullest extent and I think that we the community should look at developing a system By which you bring these gentlemen into the fold To provide you the full level of resources for the money that you're paying as taxpayers I've seen this firsthand. I really wonder how many of you in this room Have ever seen emergency care delivered right in front of your eyes I've seen it several times in my own facility Where we have one two three groups of people showing up to provide care for the patient And well this person can't do this because we have to wait for this person to show up And then this person can't do it because we have to wait for this person to show up Which ultimately is orange cross And really what this is is a system of inefficiency. It's inefficiency. It's a system of redundancy And in health care that doesn't fly very well. It means cost It means not necessarily always the best outcomes possible So as you look at this this this whole issue this evening I think you need to separate out a little bit the emotional issues and sit down and look at what is it that you're asking Look which already paying for and ask yourself Are you getting the most bang for the buck and separate out? What's the cost of health care versus? What's the price of health care because that's really what you're looking at It's not just the bottom line that you're seeing in this proposal tonight But what else are you getting for the money and are you optimizing those resources? And that's what the people of sheboygan are asking and really that's what the people of sheboygan county should be asking So that's all I have to say. I keep it simple. I know you guys got a lot to talk about. Thank you. Thank you Alderman mani Thank you madam chair With that fine introduction that brings up an issue that i'm very concerned about And that is the apparent and oftentimes real duplication of services that we're currently providing which is the inefficiency Many firemen are full paramedics and cannot offer the talent that they have When they arrive first on site because they're not so authorized to go beyond a certain point So in those situations And I think the fire department has statistics an orange cross has statistics that would be helpful for us to understand Who's there first how often things along those lines? But there's also a further issue here. I think complicating the whole territory and that is The response methodologies that we're using for 9 11 calls And I need further education about that. I believe the monikers would be emd That would define or summarize the response Prioritizing that's an industry standard perhaps I'm wondering if a sharp or use of that methodology might erase some of the current inefficiencies I'm just throwing this out there as the devil's advocate if we didn't change current status Would utilizing emd or the appropriate Procedural policy would that better improve the efficiency of what we're currently doing? So I'm beginning to get nebulous about this, but You know at least what I'm talking about now. So some comments along these lines would be helpful. I think Well, I think in either system whether it's our existing one or Change the fire department proposal fire-based ambulance The emd system probably would Accomplish what you're talking about and I don't know that it would particularly Be beneficial in either one or the other system What I look at is and I think dr. Coolis touched on it very well Is that we currently have a vast pool of resources? Available to the community that are untapped. We currently have 40 42 Um, emt's 42 are excuse me two IVs tex and 11 paramedics that at this point in time are only allowed to work to the level of first responder and to me that's at it's a Again a large untapped pool of resources it to me It's a it's a crime that we're not fully utilizing these people The fire service has changed so much over Over the years that paramedic firefighters is is the rule not the exception Sheboygan is one of the The odd ducks out. I guess if you want to look at it as far as fire fire-based dms in the state You know, I've heard different numbers, but roughly 50 of the 53 major cities in the state of wisconsin Are running fire-based ambulance services at this time So we're not looking to do something that is unique to the service And we're looking to actually fully utilize and and realize The resources that we do have available now that we're not able to To realize because of the limitations based on provider licenses and such Thank you Holderman clayhunis Thank you chairperson One thing the emd which is means emergency medical dispatch We I do we have the software and the capability of doing that right now That is there's a dispatcher. Does anybody can speak to that from dispatch that In other words when a call comes in there's a series of questions that the person would be asked and it would What do you call it triage The case so that in other words this is this is a this is a case where there's a danger of fire or rescue as well as a danger of health an injury or this is just a case of an injury and You know, maybe it's You know, someone scraped their knee Someone can go into a panic for that that somehow that this could be delineated so that we don't have three vehicles running to This scene of a skin knee Because it's been triaged out that this is all we need. Can we do that now? Are we working toward that? It's my understanding that the city police department dispatch center has Some documentation and some Items to assist them in making those decisions on there. I do not believe that they are officially trained and in place to do emd right now at this point They do is the best they can with what they have to work with I do believe it Within the police department budget has been somewhat cost prohibitive for them That is something that we also would like to take a look at on a more casual not quite as formal level of emd Bringing the ambulance service into the control of the fire department here in the city allows us the ability to between active units and response units We can send the appropriate by just conversation face-to-face or by our shift commander Appropriating the property resource based on how the call comes in so in a contractual situation You're kind of left to whatever it comes in you have to respond a certain way to it And that's how we respond is code 3 to those types of calls Whether they're emergency or whether they're in question as being emergency so To answer your question. I guess going back. I do not believe they are officially in place to do emd But with further training that would certainly be something we could do Alderman bulk. Thank you, madam chair With regard to the competitive pressure question are there benchmarks out there? Are there municipalities that have fire provided ambulance and a commercially available service and can we know what that How often people dial the commercial service instead of 911? Is that a number we can know better than we do right now? I know the milwaukee area is one where there has been some issues with that and I guess I can't answer any specific question on how many calls are diverted But I can just tell you from 28 years of experience When people want someone to respond they call 911 They don't go to the refrigerator to look for refrigerator magnets or or Page through a phone book to to find that number to call A special provider I would believe that We probably get more 911 calls than we should People call 911 for all different reasons that aren't emergencies. I would expect that if there was a A advertising campaign by the private provider There might be some impact on some of the borderline calls. I don't believe that the 911 system would be compromised as such I think it would be Not in the best interest of the hospitals and the private provider to do something like that and again ethically I would question whether that'd be the the right process to go And that's something that they're going to have to make a decision on but specifically How much of an impact that would have I I can't answer that Okay, but for non-emergent cases where it's a transport for instance There have to be statistics out there because you guys are asking to go into business and in business we we use numbers And and so I would encourage you to find out what that number is Work with the orange cross people to find out how often non-emergent numbers get dialed Someone mentioned there's a relationship in this town with orange cross and in the business world that equity means something And I would just like to know what that equity is worth in the town of sheboygan And that'll help us all feel better about the value of your numbers For this proposal only we're talking about emergency calls just 911 calls Very good So it is thank you Thank you Alderman gisha You answered a lot of my questions. I had three pages full and I thank you for the the presentation And I also want to thank dr. Coolis for addressing the council and also for reminding me that It isn't always just about numbers I tend to get wrapped up in that and Because we've been talking numbers on this for the last couple weeks, but it is about efficiencies, but it's about the people who call 911 and Whether it be orange cross Because they've said wonderful things to me about the fire department Well, it's the fire department who said wonderful things to me about orange cross These this is a group in this room of caring people have cared for this the citizens of sheboygan for a long time And and dr. Coolis brought that back to me. So that being said now. I'm going to ask about some numbers What if you're wrong? Perhaps you can address there was a word guarantee and I always liked that That was in the original resolution. Perhaps you can explain that a little bit. I think it's the last And I don't have the resolution in front of me, but I believe it's the last Therefore We have given the council a guarantee And This is not something that The three of us sat together here and just came up with I went to Many many seminars five years ago When this proposal came forth and it was something that was pitched To fire departments as a way of integrating this service by giving a guarantee that says If we do lose money providing this service You can take it out of our budget Now the other half of what I learned at seminars was They told us to you should stop right there. Well, I'm going to go on because To tell the council that if we do make money it stays in the fire department budget We chose not to do that What happened in other cities was the fire department made Quite a bit of money providing this service and their budget was rich other city departments were jealous and it caused nothing but problems We gave the guarantee to the To the council because we researched this so well We don't believe it's going to lose money. That's why we gave the guarantee if it does We'll take it out of our fire department budget doesn't come out of the out of the dpw Doesn't come out of the pd comes out of the fire department budget If we do make a revenue which we Are sure we're going to it goes into the city general fund or wherever the council feels fit to put it Looking thank you looking throughout wisconsin are there other cities in wisconsin What percentage I guess of cities in wisconsin Like size or uh, or at least generally the size of chevrolet can have a county versus private run ambulance service Are we the oddball because we don't have it or are we the oddball because we might the city run ambulance service We're the oddball because we don't the only other two that do not are aphelton and lacrosse and lacrosse is Currently in the same Part of the process that we are looking at switching it over uh a speaker and i'm sorry Forget her name from orange cross and the opening announcements uh kind of mentioned The landmark fire maybe we can use that as an example where Instead of having orange cross coming in the fire department now We have the fire department's last ambulance service Coming in mass with early only four additional guys using that as kind of a worst-case scenario when it comes to People because there was you know hundreds of people that he moved around um Maybe you could address how it changed like this would or wouldn't affect your response to that type of emergency Uh emergency response staffing is is really based on risk management There's no city anywhere that could afford to staff a fire department to fight the landmark fire Every day of the year That just doesn't happen that often um If we take on this service our response will be Changed will be altered to provide for Dedicated response to med calls and dedicated response to fire calls We are going to have to supplement our fire Service our fire calls with a more aggressive call back and overtime procedure to make sure that we have enough people for that Okay, the uh, i'm sorry to keep rambling on but uh, I guess that's what this is for um There's been some talk and i've been received some communication regarding county service and uh If for instance the county came to the city of shabuigan and said hey, why don't we? Why don't we contract with the city for instance for ambulance service? Does that possibility exist? I believe that's part of the resolution. We did leave the door open to that. We are willing to expand into that area um Obviously the system would have to be expanded with it speaking of that resolution like to throw an idea at you and this would be Potentially in the form of an amendment if in fact this moves through and onto the council floor And that would be an amendment um Stating that beginning january 1 2008 and ending december 1 or 31 2012 a hiring freeze Is to be in place for the shabuigan fire department? This freeze can only be altered if the geographic service area of the fire department and ambulance service were to be expanded hence county service Your reaction to such an amendment If you're referring to a hiring freeze meaning that Our staffing levels will be frozen at what they are at plan at at at this plan on january 1st I think that would be totally appropriate I think we're comfortable looking at the the system as it exists now or as it exists the way we're proposing it With the staffing levels that we're proposing that we would be able to provide that service During that time frame at those service levels Just a couple final questions having to do with some of the great comments we had by at the citizen input side The the frantic action that was noted or the haste I appreciate your timeline. I know those things are tedious to go through and it's hard to follow sometime But from what you described to me Not only is this frantic pace pace been Going on for about 15 years Would that be the the shabuigan version of frantic pace? I would guess. Okay. Is that a fairly accurate? 15 years worth actually it's longer than 15. It goes back to 1988 and maybe even before that but you know more actively we've we've pursued this and like I had said prepared ourselves For this for a long period of time One of the the system benefits to moving forward with our proposal is that You know one of the positives of the fire-based dms is that we have a great history of retention of employees And and the idea that this system Not only is going to incorporate our existing people at the current levels that they are But that it will grow to be a system where you'll have many more trained paramedics in the system than what we have current if you look at the the way ashkosh Proceeded with their development over many many years Is that you know they started with a paramedic ambulance service? And evolved over time with attrition of employees to to provide A first response paramedic service that the first unit on scene is able to to start paramedic treatments And the transport becomes almost secondary in that Those those abilities and capabilities are there on first response and that's how we look at the system expanding Over over the years Initially we're going to be able to upgrade Our first response level like we had said earlier to to at least an EMT level from from all of our first response vehicles In addition to the ALS ambulance But eventually that whole system will slide and move toward the paramedic level And I think it'll be a great benefit to the community and and the area actually to have that resource available That is not available now final point Well at least for the moment I'm sorry to hear that your timeline which I believe You noted over the last about 13 months With dealing with a lot of other entities to kind of bring this forward I'm very sorry to hear that for whatever reason Somebody backed out or decided it was not in their interest or for whatever reason I Don't know why and I guess it really doesn't matter why it happened and we're here um, I also don't appreciate And sometimes you get the information where people are making some assumptions one assumption is and has been Touted and sent to writing. I think to every single alderman that is that Manitowoc really you guys are wrong Manitowoc really doesn't make any money And uh, and I'd like you to address that that's been stated several times to me As recently as last friday afternoon We had a phone conversation with the Manitowoc finance director and it was asked point blankly to him Strictly from a financial standpoint Are you still happy that the Manitowoc fire department took up this service and his answer was absolutely It's bringing in positive revenue and you do note that I don't know if that's been released to the the public But a nice letter here from Manitowoc and their finance director and so forth um That's all the questions I have just a quick comment and that is uh Regardless of the end the result of this um having A department come forward like this To propose to be more efficient to propose to be revenue enhancing And to go through the work that you guys did is something Isn't necessarily a challenge to every department head, but something I would love to see more often Um, so your other department heads are going to be ticked at you because you you now put them in the spotlight But uh, I I appreciate regardless of what happens The the quality of of work because I have run your numbers 15 different ways, and I'm confident your numbers are accurate if not understated So from a number strictly numbers standpoint, uh They are very good. You have some advantages over Orange Cross as described by Yourself as well and that's It's unfair, but it's true. We already own the bodies. We already own the buildings. We already own the Mechanics we already own this and that does in this particular instance put a public sector company at a disadvantage So regardless of that I want to thank you for the work you've put into this and the dedication Thank you very much And I think if I can add to the perceived haste to this that was never our intent um The reason that we have a timeline is it takes approximately six months to build an ambulance We're getting up to that six months before the end of the year and we need to get those vehicles in place here So our paramedics have time to train on them before we actually put them on the street So that's why our timeline is what it is Thank you next is alderman mani Thank you, madam chair two things the first is a question related to um Flexibility and response when you're overtaxed and personnel needs call-ins How much Emergency latitude do you have with numbers? What size emergency perhaps could you respond to if necessary with callbacks? Maybe something concrete like that would help us hold on to that and understand it But Every day half of our off-duty firefighters are on call So those are available to us immediately and we also have mutual aid packs with all the surrounding community fire departments Second question It's a broader question related to the county An ongoing service that orange cross would be immediately providing Four county 911 calls um The question would be and maybe you can't answer this directly But we are a part of the county and their costs Are also our costs And the quality of service that orange cross provides is also our concern So in that broader context, what quality of service will they be able to maintain for county residents? With cost constraints With reduced call volumes and thus reduced revenues They'd be going through downsizing. Perhaps it's very difficult to project But I think at least we need to note that reality and consider its impact Finally speaking, we are taxpayers for the county service as well. Whether that be just or not Um, I think that's a question you probably need to ask them But again, um, our proposal calls for an alternative of we're here if you need us for the county Uh, just to clarify one thing. I I've had some discussions with people that um so often we use the term ambulance in county and things like that But when we refer to the county, we simply refer to the surrounding communities that are within the current responders response district We're not we're not anticipating entire county's obviously other ambulance services within the county to provide that service as well So the immediate areas surrounding the city of shabuigan that are within the reach of a Legitimate response are the areas we're talking of when we speak of the county My orderman want to mayor. Thank you. Thank you chairman Meyer Having talked with commander butler and gone to ems meetings. I found I've learned that There are other fire department ambulances operating in this county And I'm sure commander butler can tell us exactly what areas in shabuigan county are already covered by other fire department ambulances While there's actually a combination of fire department and private service ambulances Plymouth ambulance Um covers their service area toward the west side of the county Northwest part of the county actually has a portion that is covered by keel ambulance Currently under some discussion at the ems council level regarding Plymouth ambulances response to that area as well Because their service has been upgraded usberg provides their own ambulance service And a random lake fire department also provides their own ambulance service And uh city of Plymouth fire department also has an ambulance It's currently not the primary response ambulance for that area, but um, they do respond if necessary in that area as well Yes, thank you hold them in ryan Thank you, um This is a thorny issue to say the least philosophically You hate to take a private sector Enterprise and turn it into a public entity um However, I would like to see some more numbers from orange cross. I believe that The shabuigan fire department I commend you on really Sticking your necks out you're putting your reputations on the line And you may be putting your careers on the line in order to do this That's commendable Because if you get in a situation where this is not making money In your department Can not provide proper service because you're not getting any more funding for you to put this together is Commendable to say at least um that said I guess the big question is Are you going to provide? The same level of service as orange cross or a better level of service in the future um And is it going to make money that not being said? when the Landmark fire Uh, which was a couple months ago What percentage of your reserves were called in from the fire department people on call that we're not currently on duty was it Half of our on call crew came in which That consists of actually 25 of our off-duty people. It's only 25 of your off-duty people So you still had people in reserve. We still had three quarters of our off-duty people were still not called in Okay, um I have the manatee lock numbers here and Actually, I think your numbers are conservative on your revenues Um, I would like to see more solid numbers on orange cross and what you know, we've we've got some very vague figures here On what orange what actual orange cross revenues their their percentage of collection Etc etc I would like to see those before this goes to the council Is coming this next monday for vote if they could provide those to us because I the numbers that we have here are very vague I believe the numbers that you have provided your your estimates Um Are in line. I think they are conservative. I don't think they're inflated whatsoever I think you can realize these numbers But you know, it's it's a big issue. I think we do need to utilize What we have in the city Um, we are in a budget shortfall to say the least if By your numbers You can be an asset to the revenues of the city I believe that's a good thing um It doesn't appear that staffing issues will be a problem If only 25 of your People on reserve were called in for the landmark fire But I would like to hear from orange cross Because they have 40 employees That if this happens, uh, they will still be covering the county But it's my understanding that the majority of their Revenues are from the city And the question is well provided That this council grants the shabuagan fire department Uh the contract Will we in turn be subsidizing the county for orange cross Uh will they survive? Or if they do not will The shabuagan fire department be able to cover Those areas of the county be able to offer that service Um, and that's why I think we do uh need to hear from orange cross That's all. Thank you. I think just to speak to you You bring up the numbers of our proposal and as three people that sit up here and have served this community for collectively probably 60 70 years. I don't know what it is. I hate to date myself here, but um It's hard for us to just look at this as a numbers proposal Because it's our belief that we can make a good system even better By putting us into it and we also believe that this really would be the beginning To shared services to the surrounding communities. It's really just the start Thank you And I would like to ask mr. Isbell if he would get the numbers that alderman ryan is requesting But you can talk after the meeting and and get that arranged. Thank you Alderman van der wil Thank you, madam chair. Um, I just wanted to touch on some things alderman. You should have said But um tell them and ryan. I think I still have the original proposal from five years ago from orange cross and uh Five years ago rumors and misinformation were a constant force and in the community and the longer we put this off the more it'll continue and uh I wanted to touch on the landmark issue again because I've gotten people asking me questions about it in the community and And I'll just ask you a question. You can agree or disagree If we have a landmark fire type again Will the ambulance be a priority will you make sure staff so that we can um so So it can be used at that time and You will you use mutual aid if you need it Um again, you know the landmark is probably a once in a lifetime thing But we can't say it'll never happen again because it may We will always have our dedicated medic units for ems responses What occurred and what's been spread around during that fire was that we had no vehicles available That's true. We didn't have any vehicles available for first response And that may happen again if there's a big fire. That's no different But we will have our medic units available to run on ambulance calls alderman wongerman Thank you, madam chairman Uh We've been costing a lot of numbers around tonight It's alderman balk said before in business, of course numbers are what makes things go, you know And i'm a little bit concerned That there's such a wide difference between the numbers from the fire department and numbers from orange cross As far as revenue goes it looks like it's quite a bit of difference And uh, I guess I would like to see an answer to that I Been inundated with sheets of numbers and I've got a whole bunch of stuff here from Orange cross and so forth and uh when it comes to looking all these things I gotta admit I'm not the brightest candle on the cake, but uh I would like to see some clarification as to why there's such a wide difference Well, first of all one number we're going to have to look at is our our paper budget for this year because we've We've killed a lot of trees going through this process Oh commander herman would you like to comment on? Um, I I think our revenue projections are actually lower than orange crosses because we were so conservative Um, and I do have their numbers which I've looked at and I'm very confident that When we've run them ours are Very close to what theirs are when we get down to the final figure Alderman balk I would like to uh discuss the potential for that alderman ryan brought up for There are a couple of things that could happen when orange cross focuses on the county one There could be uh not enough businesses to sustain their business model and they will need a They will need money from the county to supplement that to keep them uh to keep them operating That would end up in a de facto tax increase on shabuigan city taxpayers because the county would have to raise the taxes that city Residents pay so are you prepared? I know you have Something modeled out. Are you prepared to be able to offer county? Residents a competing business model that makes it so the city of shabuigan taxpayers will not have to supplement The county the potential that orange cross goes away you pick up that business Does that model still does it still make money the manning and the ambulances that you would need to To man that does that still make money at a rate that is more competitive than orange cross We did run those numbers on taking over the entire system And we have assured the county that if what you're explaining does come to play That we would be able to offer The system to them the service to them without Um a subsidy and yes, we did run the numbers and there is sufficient Revenue projected profit in there for us to do that system also and does that make more money? Yes, it does. Okay Thank you, and the other question or a comment I'd like to make is there's this other there are all kinds of numbers Running out there some of them accurate some of them not another number that's out There is that the city of manatee walk lost somewhere between 400 and 500 thousand dollars last year And I know alderman geisha has some insights on that because it deals with this area of expertise Do you want to explain to a No, do you want to explain to a shabuigan city taxpayers who believes that we are engaging in a money losing activity? Why that number is false for the city of manatee walk this year? Well, don't quote me on this I too uh reviewed manatee walks numbers They're right here It uh, it seems to me that what they did financially was Well, first of all the fire department proposal shows capitalizing the ambulance over a seven-year period through lease Uh, in other words, you pay an end payment each year let the revenue stream catch up time to pay Read it out the check do that for seven years the end of seven years you pay them a buck you own the ambulance Uh, manatee walk went and was originally going to do that And then they decided the revenue stream was sufficient and exceeding per their letter here Their projection so they decided to pay for it all in the first year or during that time period Rather than amateurize it out or uh capitalize it over a longer period of time So they took their money and they thought it's tracking. Well, let's just pay it all off now and get it off the books Does that make any sense? Perfect sense companies do it all the time. It's a very fair practice And I just I just really am disappointed that there are people out there who would use that number Because it's an irresponsible number to use to say manatee walk lost $400,000 last year They made an accounting choice that was in their financial interest and on the books It appears that they lost $400,000 But it was an accounting choice just like a family might choose to pay off their car Early or their their house payment a few months early that that was a very sound financial choice And it shouldn't reflect poorly on our The fire department and the fire chief That number shouldn't be used against them when it's really a false accounting number Thank you Do you have any more comments? Okay Olderman heidemann Thank you, chair There are 50 other communities to have an ambulance service within their fire department Uh now We're we're talking about manatee walk and that's fine because they're just north of us, but all those other 50 communities Do they all make these projections? Do they do they all get the same level of income into their budget? Or is it are there some or what percentage of those communities are actually paying for that service? because The majority if not all of those cities have had The ambulance and the fire department together for so long. It's virtually impossible to separate It out To see which one is drawing the revenue which one is costing every fire department across the state cost the city money So it's hard to project if it's been melded together for so long. It's hard to separate the two out Where that's why we've used manatee walk as a comparison because they were Able to separate those amounts out because they had an existing fire department And added an additional ambulance service to it and that's why it is so It's easier and cleaner for us to be able to do it by Um starting up that separate account to track income and Expenses okay, so then in 2008 we're expected to get this additional income and for the for the next five years But then in those other communities does it start costing them money? I believe if it was costing them money, they wouldn't be in the business. I would I would think so too Okay, thank you Thank you, madam chair. I've got several questions. I want to go back to the one. I was going to ask originally Uh, we have the ambulance lease cost for 2008 at 78 269 dollars That should be able to that should be able to be paid on the revenue streams for the ambulance From 2008 the resolution that was before the finance committee and I was unable to attend finance on friday night I was out of town. So perhaps alderman gisher alderman clay units can can Can give me this information if we can wait to pay this lease payment until 2008 of the 78 269 It seems to me that this resolution for the 500 thousand dollars for the transfer Could be adjusted because apparently I I think some of the thought was that we were going to be purchasing ambulances And we would have that huge up upfront cost Which apparently will no longer have and what was the rest of the 500 thousand dollars for And should we adjust should we adjust the? The request of the five thousand five hundred thousand dollars downward because of the lease payments I can take that We did have a meeting with the city finance director mr. Gebhardt And he wanted the opportunity to to explore whether it was better off in the city's Side to purchase versus lease so he wanted to leave his options open And that's why that amount was put at that and the additional amount over actually I think the purchase price of three ambulances is about 420 thousand dollars that additional amount was Um a couple of the disposable supplies Band-aids Whatever and also the first three months of salary for those additional four firefighters to cover that before our revenue stream began coming in City of shubwagon they currently obviously respond to the 9-11 calls They do swat standby fire standby drug enforcement standby And hazmat standby Will your services be doing those additional standbys besides the just the 9-11 calls? Yes Some additional services that they provide Which they call private party calls including cancer patients to treatment Dialysis doctor appointments Critical care standbys hospice care Inter-facility Transports nursing home transports IV starts return home Road america standby contracted medical transports contracted sports sport coverage citywide Confirmation Medic alert responses ALS on scene services BLS onsite on scene services And invalid assist Would you would you are you going to provide any of those services? And are any of them potential money makers many of those things that are listed on there? We are already responding to or standing by at in addition On the same train of thought that was brought up before on whether somebody could choose to call not call 9-1 One and call orange cross for an emergency transport The citizens will have the same option of Inter-facility transports, which is some of the things you're talking about there I'm not choosing to call orange cross and choosing to call the fire department instead that option will be there for them At the present time though, I think I heard earlier tonight that you're not planning on doing nursing home transports Our initial proposal is just for the 9-1-1 emergency calls in the city But we are open to doing inter-facility transports if people choose to use us Okay If you if you are not going to do Inter-facility transports or no nursing home transports Who would do that would that be have to be another Another would orange cross have to do that or would there have to be another service to provide that? Yes, there would have to be another service to provide that but again, we are offering that service. Okay. Thank you Uh Currently, uh, dr. Coolis is your is your medical director for the fire department If you indeed get the ambulance service, you're also going to have uh, you're going to have to have a medical director. I believe at the hospitals Would uh, dr. Coolis wouldn't wouldn't be able to continue on in the capacity Of the medical director as he is right now am I correct in that? I believe dr. Coolis would continue as our medical director Obviously, we would have some sort of relationship with the receiving facilities And we continue to look for that cooperation between us and the medical facilities If we file an operational plan with the state of wisconsin which we propose to do We do also have to have buy-in from both of those receiving facilities to at least provide medical control online If our paramedics would happen to call those hospitals. I see no reason why those hospitals would not participate in that when they read our operational plan Um, I have there's nothing in my mind that says our paramedics are going to be any less qualified And and I do believe those hospitals would honor that request That was a very contentious contentious point Back when Curtis ambulance, uh, was the provider here in sheboygan and let's cut to the chase The reason that Curtis failed is lack of cooperation from the two hospitals They went out of business after six months because the hospitals would not cooperate with them What assurances are you going to have that the hospitals are going to cooperate with you? I guess for a point at answer none I would put that to the hospitals and their medical direction in their emergency facilities Um, we're a professional organization. Again, I would expect our paramedics to be no less qualified In fact in the long run, I would expect them to be more qualified Um, just because of the amount of time that they'd be on the job Which would equate to better medical control and a more familiar Um rapport between the medics and the medical control at the hospital, so Do we have a guarantee no, but I would uh call upon those hospitals to step up as well and you know, they talk about patient care I guess that would be the only thing I could hang my head on Thank you, uh some questions that I've gotten from constituents Will the fire department be starting out january 1st with two paramedics, uh on board on the ambulances Yes Okay Will the uh, will the fire department be held to the same standards for response times as orange cross? Absolutely Uh, who will oversee and monitor the quality of the fire department ambulance service? um Is it I would imagine it's going to be a continuation of the oversight committee that we have now in some shape or form Um, I certainly anticipate an internal Review of all of our call responses and our medical care In conjunction with our medical director in in conjunction with both facilities In addition to that I would expect that there would be a committee set up within the city that would include members from our department include members from Both medical facilities. We would review responses. I would I would anticipate no less Scrutiny in fact at this point I would expect quite a bit more At least initially and uh those plans would be included in our operational plan, which we'd file at the state of wisconsin And there we fully expect to um have a oversight committee Whether that would there be a council decision as to how that would be structured and Where that would be located in the in the council? Structure, uh, it could be a subcommittee of the public protection and safety It could be a different standalone committee, but that would be up to make up and And location of that committee would be up to the council to decide and we would definitely work cooper Cooperatively with the council to do that Who would you uh, who and who in the fire department? Is going to be responsible then for the overall ambulance service Would that be a duty of a deputy chief or what what who would be responsible actually for the ambulance service? Um, it will be an administrative staff person Which rank at this point hasn't been determined. There is going to be some Staff changes as far as administrative structure in the next year not positions, but assignments and that assignment would be Adjusted and identified by person with highest qualifications and ability to to do that job Thank you Let's see here I guess my final one then is What if any additional exposure do you anticipate for workers compensation losses? Is it a factor? I know right now you're you're you're at most of the calls Do you think there's any additional exposure there there for the department? We don't believe that there will be any additional because it's not like we're adding additional call volume to our department We've already been going to these calls We will continue to go to these calls. I think if there was any additional exposure there, it would have been reflected in our rate from Sivmic Thank you very much Thank you, mr. Bourne alderman Bourne. Um, and I believe with the numbers that we have appropriated for our resolution An item number six. I believe on the council floor. We can adjust those numbers And I think by Monday we'll have a little more information that we can possibly do that Alderman clayhunas Thank you chairperson Let's get philosophical A little bit Alderman mani did I see this as a city getting seriously involved in medical care And we are not at that point the medical care is private in the city And the ambulance service is a is medical care. It's not rushing through the city In you know to get there as quickly as possible It's giving medical care right away and I I see it as a serious question. The city is getting into medical care Um in a very deliberate way and I just pose that as a comment The second thing. Um, I've always asked and I've asked chief Lysovsky a couple times Your professional firefighters I wish this the fire department could somehow use its skills which they have lots of For the underserved areas of the county in fire protection Um, you have equipment you have training you have training that no one else has in the county And why we can't somehow look at how the fire department can expand its services to the county in underserved fire areas I I can't believe some of the areas in our our county that are you know, uh, great distances between them And a fire department a volunteer fire department I offer that as another way to look at this that I think the fire department is underutilized very talented underutilized But could it be used In in in the fire protection area and I know this gets into government and sharing everything But that's another way of looking at shared services where we had the expertise technology equipment How can we expand in that way And you know consider that we're looking at health care and I just I I pose that as another challenge All the person claimants I think I can address a little bit about your Your concept and your philosophical view if you will EMS is nothing new to the fire service um medical care provided free hospital in the field has been a part of The fire department since emergency for people that remember watching that show. This is nothing new pre-hospital care field medic care in the military This is something we train for currently tech schools right now. They recognize the uh the shift In how fire departments operate and the level of care that is provided by those individuals Tech schools right now the the norm Is fire medic programs? That's what they're developing That's what they're doing because they recognize the need to put that medical care Immediately at the patient's side We are medical professionals as well. It is what we do. Um, I've been in this field a very long time um I think that that is A little bit of a misunderstanding about some people in the public is the what the fire departments can do Because I've heard that comment a few times from people that say Boy, you know, I hope those firemen know what they're getting into. This is medicine Well, yeah, we've been studying medicine for a very long time in pre-hospital Um, and as far as your question regarding Sharing our resources Um, we absolutely look forward to doing that. We have we have medical excuse me many Um resources through grant programs We have a great deal of equipment in the city based on the response for the city We recognize that surrounding communities in this area don't have the resources necessary to put those things in place We welcome the opportunity to Through this ambulance proposal Um to actually get out to those other communities and do some training with their first responders Which we would also then just by nature of what we do bring along our technical expertise in a lot of areas And it builds relationships between us and the surrounding communities I um, I think this is a wonderful conduit for us to actually be able to open dialogue with these surrounding communities and actually be able to get a better relationship as far as Um providing something they need to us where they don't feel this intimidation by You know, we don't really want to call the city fire department You know should we call that but if I know somebody at x fire department's first name and I work with them on a day-to-day basis Um, I'm actually going to be very comfortable in calling and I do believe that we have a lot to offer those surrounding communities And and I think this is the this is the beginning of being able to do that better Thank you Alderman Verhassel. Thank you, madam chair A comment and then a question from a comment standpoint I just want to point out from my standpoint my need for more information whether it be from orange cross or anyone outside the fire department I hope is not construed as a judgment on the fire department or any three of you because I think the three of your quality people I think you put these in these numbers down in good faith, and I think you've tried everything you can To give us a reasonably clear picture. So I just want to point that out from my standpoint I'm just an information driven person. So I appreciate your patience Now my question is an alderman bulk and alderman ryan sort of touched on it But I'm curious as to any three of you can answer this question. How you think this will play out Across the county because what we decide here tonight Obviously is going to have implications elsewhere around the county whether orange cross and the neighboring communities Some of those implications could come back on the taxpayer and I think alderman manny pointed that out How do you think what's your I know you don't have a crystal ball But how do you think this will play out based on what you know other communities have done? And what your peers and your Your accomplices are around the county. How do you think this will play out? Well, we don't believe that there will be a tax implication to the county and to us because we have offered that other possibility of expanding We believe and we hope I guess that and what we've seen in other communities is Once it started up in the city it has expanded out into the outlying areas It just took place in ash gasha a number of years ago when it was very very successful We As we started this process. We wanted this to be a cooperative effort to make a better system For the users for the taxpayers. That's what we ultimately hope continues to happen with this process Thank you Thank you. I think we still have a motion on the floor We can go back to that for opening up the floor to orange cross alderman ver hassle Did you still care to pursue that motion? Okay, and we had a second Okay, so under discussion to open the floor to orange cross Would you like a roll call? I might as well Alderman boran hi Alderman bauke Alderman serda Alderman gisha Alderman heidemann Alderman kiddelson Alderman clayunas Alderman mani hi Alderman mayer hi Alderman montemire hi Alderman ryan Alderman van der wheel Alderman ver hasselt Alderman wangeman Mr. Isbell would you Why don't you come up frontier, please um and the motion carried. We will open the floor to To mr. Isbell Jerry is about to make this director with orange cross just a couple of quick clarifications Turn that off so it's not in his eyes We can turn that off so it's not in your eyes He's got it here Mr. Isbell, please come closer to and speak into the mic you did not anticipate the four to six percent premium pay in your proposals at correct Correct. We did give you what that figure was. It's approximately 35 000 but from a negotiating standpoint that ties The negotiators hand sure Um, you mentioned the loaded mile for medicare medicaid pays at a hundred percent I said close to a hundred percent. I believe we we ran our rate at ten dollars per mile It's just a little bit short of that. It's what they're it's six twenty five dollars a loaded mile That medicare pays so that's there's that's almost fifty percent less than you're projecting So it is six twenty five Okay, okay, um alderman ver hasselt. Did you have some questions? Just a minute Okay, and thank Would you like to continue mr. Isbell? Well, I would like to have you ask the questions and then mr. Isbell can give further information after all the questions have been answered Okay, there's thank you There's a couple of things that I just need to have clarified from both sides before I would be comfortable making a decision One is um medicare medicaid reimbursement rates. That's a big part of this equation And the discuss I've heard from both sides saying one says the trends are going downward reimbursement rates are falling others are saying it's going up Can you shed your opinion on this? Yeah our actual figures And this is another clarification. I was going to ask I think you clear you mentioned 25 percent For write-offs for medicare medicaid. No, I said 52 Oh, okay, we're showing 32 percent with medicare medicaid our total allowances are 40 percent So that includes bad debt and things like that is what number 40 40 percent total allowances Now that's including everything That's everything bad debt and medicare medicaid. That's all the calls. We do county city Okay, so our number should be more than adequate. Yeah very much so The other thing I guess is and I asked the question to the three of them How do you see this thing playing out from your perspective if The city successful in taking over the ambulance service. Could you shed any opinion or prediction on it? Well, obviously my opinion is Not good. I don't agree with government taking over private enterprise. We're doing a very good service We've been in the system since 1979 And as Dr. Martin's alluded to She's behind our qa program 100 percent In believes in our service. Otherwise she wouldn't be there I guess maybe misunderstood the question. I'm not asking whether I'm not questioning your quality of service and I'm not Asking for your opinion on the concept is I guess I'm wondering how you think orange cross will play a role In years to come if the city takes over the portion because I believe it's about one third of the calls Of your total calls come from the city. So we're taking 33 of your base away It is about a third of the calls and at this point there's no decision been made Regarding what the board's decision would be on that issue Okay, so we're not sure at this point I guess a kind of a related question is could you foresee what impact that would have on your rates again? Taking one third of your calls away If that would dramatically increase your rates Hopefully not because a citizen pays for it, but we probably would be discussing subsidy Which would affect everybody in the city of sheboygan in the county Okay, last question or at least one of my last questions is some some Citizens have asked me on this whole concept of urgency and again I would like to see this thing resolved tonight and move on to the council next week But from an urgency standpoint just to put this in perspective Does orange cross need a contract to operate after december 31st? No, we don't need a contract in fact most privates don't have a contract with the city or county that they Okay Oh, I'm sorry one other question. I have here a big part of the projection here. I mean it starts out At 195,000 dollar profit. I believe and it moves up closer to a half a million dollars 400,000 A big part of that increase or almost more than half of it is the projected call increases Can you give me any history on call numbers over the last five ten years? Where does that move? I mean is that a static number? Alderman client has pointed out there where population is pretty static here in the city of shaborgan Is there a reason to believe that those numbers will continue? Have you seen them continuing the projection? I believe they use three percent That's what we typically budget for Can you explain that at all? I think more people do call 911 these days because they're asked to do so I think through education. They think they need to call 911 American Heart Association advocates calling 911 for the both of stroke and the heart attack victims So that could contribute to that. Okay Thank you. Is that all okay. Thank you Alderman bulk I uh, I want to talk philosophically for a moment to uh, like alderman clientis did because Jerry brought up a very good point about governments taking over private industry And uh, I know in my race. I I was the big capitalist in the group and and my constituents are sending me emails and phone calls saying What are you thinking? And so I want to be very clear about philosophically why this may turn out to why I believe this may turn out to be a good idea for us Uh, orange cross is filled with wonderful people who've provided a wonderful service They are however at a one million dollar disadvantage to our friends in the in the fire department They have a million dollars in fixed assets on their financial statements that are buildings and people And and the reason this business model works that it might turn out to be a good idea for our fire department to take this over Is because they they don't have that million dollar disadvantage They need three ambulances and four people To be able to provide the same level of service The other point is our friends at orange cross don't pay anything to the city There's no no revenue benefit to the city because there are 501c3 tax exempt organization So there's no revenue stream to the city if we believe the numbers that the fire department have put together Even if it's only a hundred or two hundred thousand dollars a year over the long haul We've accomplished two things one of those things is We've brought in one or two hundred thousand dollars a year into our coffers for the general fund The other is we've taken our fixed assets our men and women of the shabuigan fire department And we've put them to more and busier use and putting fixed assets to use Unused assets or unhappy assets and so we we can there are two business reasons why this can make sense So I am not fond of government taking over private industry But I think there are compelling reasons why in this instance it may make sense And the second point is I want to offer mr. Isabel the opportunity he mentioned that the The ten dollars per loaded mile might be a little too high And so if we take 60 of his 58 thousand number that costs us call it 20 thousand dollars of the fire fire department's numbers Are there any other fundamental material numbers you would disagree with in the material you've seen tonight? Um, I haven't had the opportunity to look at the proposal I would you would you follow up that that I think would be the most Important thing you could do in the next six days would be to go through these numbers And if you see anything that is materially that you have material differences with bring that to our attention So we can make the best decision next week. Yeah, we enjoy that opportunity Couple things what's your viewpoint if citizens do call 911 and ask for orange cross Do you think that's I don't believe that's how the system works as far as our perspective the 911 service is set up to Provide that emergency response. It's not a call funneling agency to Uh Shift the responsibility to to somebody else So I don't believe that would be appropriate if people call a private party number for orange cross I would assume that It's within orange crosses Right in obligation to respond to that but 911 calls that come into the city I believe would be directed to the 911 provider, which would be the shabuagan fire department And I would like to get through the questions from the alderman first Please because we have four more four more people waiting Alderman van der wil Thank you, madam chair. Um, I agree with alderman bow. He's a very smart man And and thank you for pointing that out because it seems that we're kind of having A debate this guy's discussion going back and forth with orange cross in the fire department And and I don't really uh agree with that But I do want to state that That I think the orange cross does an excellent job and I've um, I've visited your facility last time And I've enjoyed our relationship in the ambulance coalition. We've worked together and the meetings aren't two hours long and And it's it's been a good thing And I I don't ask you this question Negatively I just ask you for my own knowledge Five years ago. There was an advertising campaign. There was maintenance. There was billboards I ask is your organization preparing to do that this time over in the future For the same issue That decision hasn't been made yet and that's a board level discussion that will take place All right Okay, thank you alderman van der wil Alderman ryan. Thank you. Uh, mr. Isbell You had uh disagreed with part of the fire department's numbers if we were to provide you with their proposal their numbers Their projected revenues. Would you provide us with uh with you know, not delving into your private? Enterprise with those numbers, but your actual numbers Like for like on you know, because right now right now the numbers that we have Are very vague as far as other expenses, etc That we could compare those to their numbers. Yeah, we'll certainly take a look at that and we won't criticize However, we will give you our information from real data That we've haves to to do that you will not we will you will absolutely. I'm sorry. Yeah, great. Sounds good. Thank you Thank you alderman ryan Alderman clayhunas my question was answered. Thank you. Okay. Thank you And we have alderman verhaselt my question was answered as well. Well, thank you And I would I agree with alderman van der wil We do not want this to turn into a debate between the fire department and orange cross And I know you have some discrepancies with the numbers that the fire department has given So I would ask you to please review the information And present that information back to us by monday and at that point we would be able to see The differences Would that be yeah, okay? Well, thank you very much and we have been to any more questions So Oh, excuse me. Is this for okay? Alderman geisha. Thank you one quick comment orange cross has been very Accommodating if you wanted to go to their office and view additional information or have meetings. I just want to make it clear I assume the doors are still open if alderman wish to come and talk with you and I know it was very helpful for me Thank you for that information Okay, moving on to the next motion we have on the floor And that was to Send the two items item five and item six the resolution by alderman rindflesh Authorizing the city of shaboygan fire department to provide ambulance service to its citizens beginning january 1st 2008 And item number six a resolution by alderman hannah authorizing the transfer of appropriations in the 2007 budget Do we have any further discussion on these items? Alderman for hassle. Thank you, madam chair. I just want to point out I'll be voting no to send it on with a favorable recommendation But not because I think it's a bad idea because I think the numbers are questionable. It's quite the contrary I just would like to give orange cross the respect of letting them put their information in front of us on the council meeting On monday night before I give it the green light Thank you Alderman borne Thank you, madam chair. I'm going to Vote yes on number six for the transfer of the funds with the idea that we're going to Modify that at the council meeting on monday night. Yes, you may amend that on the council level. Thank you Any further discussion on the motion? Seeing none all in but do we want to do a roll call? I think so. Okay. We will do a roll call Alderman borne Number five well, we were gonna vote there the motion is for both of them together Alderman bow Alderman serda Alderman gisha Alderman heidemann Alderman kittleson Alderman clayunas Alderman mani Alderman meyer. Hi Alderman meyer montiney or I Alderman van der wheel Alderman for hassle. No Alderman wangeman Motion carries Alderman ryan. Yes Thank you Motion carries Moving on to item number seven. I would like an motion for adjournment All in favor I And thank you chief listuski and commander herman and commander butler for your information tonight