HomeMy WebLinkAboutAgenda - 06-12-1989 APPROVED: 8-1-89 MINUTES
ORANGE COUNTY BOARD OF COMMISSIONERS
BUDGET WORK SESSION
JUNE 12, 1989
The Orange County Board of Commissioners met on June 12, 1989 at 6:30 p.m. in
Superior Courtroom, Hillsborough, N.C. for the purpose of holding a work session on the
Manager's proposed 1989-1990 budget.
BOARD MEMBERS PRESENT: Chairman Moses Carey, Jr. , and Commissioners Shirley E.
Marshall, Stephen Halkiotis, John Hartwell and Don Wilihoit.
ATTORNEY PRESENT: Marilyn Tomei
STAFF PRESENT: County Manager John Link, Assistant County Managers Ellen Liston and
Albert Kittrell, Purchasing Director Pam Jones, Emergency Medical Services Director Nick
Waters, Budget Analyst Donna Wagner, Health Director Dan Reimer, and Clerk to the Board
Beverly Blythe.
Chairman Carey called the meeting to order at 6:30 p.m. The specific topic of
discussion for this meeting was EMS services and user fees for the coming year.
Chief Ray DeFreiss of the South Orange Rescue Squad stated that he believed the
outcome of this issue would determine the quality of EMS in Orange County. An equitable
solution needs to be found to this problem. He stated that additional information needs
to be gathered before a decision is made. Hopefully, volunteers could be included in the
further study of this issue with a final decision being withheld until sometime next
year.
Mr. Dan Cowhig, an EMS volunteer, stated that the real issue is how to provide the
best EMS service at the least cost to the taxpayer. He mentioned that voluntary
contributions make up most of the squad's budget. They collected $145,000 last year. He
pointed out that for two-thirds of the week EMS is covered by volunteer rescue squad
members. He indicated he believed that charging a fee for the EMS services would reduce
the amount of financial contributions, as well as the number of volunteer hours worked by
EMS volunteers. He suggested as an alternative to the user fee proposal having a
voluntary "check" box on a bill, such as the county water bills, where citizens could
indicate if they want to make a voluntary contribution to EMS. He also mentioned a
system in operation in Fairfax County, VA. , where subscriptions are sold to the citizens.
Those that do not subscribe and need to use the service are billed in full for the cost
of the service. He pointed out that the savings in labor costs for volunteer paramedics
alone totals approximately 1.5 million dollars a year. Many of the cost savings are
impossible to calculate. The volunteers are a diverse group and include many health care
professionals in their ranks. Their contributions are varied and would be impossible to ,
replace with paid professionals because of the cost. He suggested forming a committee
consisting of paid EMS staff, volunteer EMS members, hospital employees, citizens, and
County financial staff, to look at EMS as a whole and come up with a workable solution.
Ms. Clara Heck, a paramedic with South Orange Rescue Squad, stated that she had
researched the insurance issue. The average deduction on major medical is now
approximately $250.00 for major medical. This trend will continue with deductibles of
$500.00 in individual and group policies in the near future. It is a misconception to
assume that an EMS charge would normally be paid by insurance companies. She pointed out
that the most important issue is the volunteer spirit. Orange County has been a leader
in starting rescue squads with volunteers in North Carolina. That leadership trend is
continuing. Many of the volunteers have reached the highest level of certification at
the national level. She mentioned she felt that the User Fee Study neglected to take
into consideration the financial and labor input by EMS volunteers. It only begins to
address the economic impact on the volunteer squads and does not examine other
alternatives to fund the cost of EMS. .
Ms. Barbara Overby, a volunteer paramedic with South Orange Rescue Squad, spoke in
opposition to charging a fee. She indicated that volunteers with the Orange County
rescue squads pursue advance training to reach the paramedic level which enable them to
provide life saving fluids, drugs and cardiac techniques prior to arrival at the
hospital. She stated that the User Fee Study needed to include volunteer and citizen
input. She also stated that her belief is that donations will plummet of user fees are
implemented. Recruitment of new volunteers will decrease. Rapport with the community
will be damaged, other forms of commitment and support in the community will drop off,
and current members will leave.
Mr. Bobby Green stated that the Orange County Rescue Squad was founded in 1968, and
the South Orange Rescue Squad was founded in 1971. The volunteers have served the county
since that time. He stated that he did not understand why the philosophy behind the EMS
is any different than the philosophy behind fire and police service. He suggested that
other alternatives to the user fee be pursued. Alternatives include (1) leave the system
as it is, (2) institute an EMS tax, (3) use the water bill as a means of allowing
citizens to indicate willingness to donate a specified amount of money, or (4) ask
citizens to subscribe.
PRESENTATION BY COUNTY MANAGER
John Link stated that the first part of his presentation would be information
previously requested by the Commissioners. He used overheads to show the breakdown
between paid staff and volunteers. Copies of these "overheads" are incorporated herein •
by reference and may be found in the permanent agenda file in the Clerk's office.
•
Chairman Carey asked the rescue squad volunteers to understand that the
Commissioners and county staff recognize the high quality of service they provide. They
realize that throughout North Carolina, and elsewhere, Orange County's rescue squads set
an example of rescue service at its best. The fee for service proposal is one way the
county could assure that high quality service would continue into the foreseeable future.
He mentioned that the rescue service in Fairfax County, Va. realized that EMS service is
not a free service. The issue of .how the service will be financed is one that must be
addressed. He encouraged the EMS volunteers to share other "models" with the
Commissioners so that a well-informed decision may be made.
Commissioner Wilihoit stated that when this issue came up in 1980 it was because the
squads had difficulty in finding volunteers during the day. Therefore, paid staff were
hired and a fee for service was initiated to recoup the cost of salaries.
Commissioner Hartwell indicated that he and Bobby Strayhorn agree that the service
is not free. They also are in complete agreement that they do not want to do anything
that would lower the quality of service in the County. However, Mr. Strayhorn felt that
having the charge for this service show up in his tax bill and knowing that the main
thing he is doing is subsidizing the insurance companies is not the way he would like to
go. He feels that the goal of everyone in the room needs to be (1) to acknowledge that
it is not free, (2) to honor the volunteers and the role they play in delivering the
quality of service they now offer and to avoid negatively impacting that, and (3) to stop
subsidizing the insurance companies at the expense of the Orange County taxpayer. This
issue will be successfully resolved if those three goals are reached.
Commissioner Halkiotis stated that he is undecided on the fee for service issue. He
mentioned that the philosophic reasons behind volunteering makes what those people do
very special. He wants to be certain not to do anything to damage that volunteering
spirit. He indicated that this issue needs to be thoroughly studied. He endorsed the
concept of waiting and setting up a task force to look at this issue. He suggested that
the rescue squad workers get insurance information and process the forms themselves.
Chairman Carey pointed out that the user fee issue needs to be resolved so that
implementation would be applicable to the 1989-90 budget. One alternative is to charge a
fee as the Manager has proposed, or to charge a fee for part of the service. Another
solution would be to charge no fee but to put it on the tax bill and designate it as
such. He also indicated that he found it difficult to continue to subsidize insurance
companies.
Commissioner Marshall stated that she felt very strongly in support of the
volunteers. The reason that this issue must be addressed now is because of the Federal
Government and their mandate to the counties about the way they are trying to bring •
services to the poor who do not have insurance. As the County picks up the medicare B
under catastrophic health insurance, and pay medicaid for more women and children, the
money the county must contribute is increased greatly.
Commissioner Wilihoit indicated that one problem is that the fee does not cover the
entire cost. He suggested compiling figures to show what money would be needed if the
fee for service was not implemented and present that at the Public Hearing. He stated
that the hazardous materials team have in the past responded to incidents on 1-85
involving the transport of hazardous materials. He indicated this type of service does
not need to be subsidized by the county. He asked for a breakdown of the number of EMS
calls on 1-85 as compared to local roads.
Link indicated that he would support the idea of pursuing a separate tax for EMS.
The state statutes provide for there to be a separate EMS district tax Countywide. It
could be specified on the tax bill that 2.6 cents be earmarked for EMS services. Next
year the Commissioners can pursue the alternative of establishing a separate countywide
EMS tax or pursue other alternatives.
Chairman Carey clarified that the proposed user fee is an attempt to recoup part of
the County's direct and indirect costs. The County is not attempting to collect on the
value of the services of the volunteers.
An unidentified volunteer asked for clarification of how raising money through a tax
would work and if it would be earmarked for EMS.
Chairman Carey indicated that it would go to offset those direct and indirect costs
that he just mentioned.
Mr. Herb Barlow of the South Orange Rescue Squad stated he believes the insurance
companies would raise their rates if claims were filed for rescue service. He mentioned
that although the majority of reasons that the rescue squad opposed this idea were
philosophical, he believed there were an equal number of fiscal reasons.
•
Chairman Carey stated that it was clear that the majority of the reasons the rescue
squads were against "fee for service" were philosophical. If a comprehensive study is
done and the recommendation is to begin charging a fee, this will need to be addressed.
Mr. Jim Greenleaf, a paramedic from South Orange Rescue, stated that he was
primarily against the fee for service because of fiscal reasons. He indicated that
having to charge a fee would make the efforts of the EMS squads toward collecting
contributions very difficult. He agreed with the suggestion of using a tax to pay for
this service.
Ms. Jeffries spoke on behalf of the citizens of Orange County. She pointed out that
if she was severely injured she may need to travel in an ambulance as many as four or
five times. She indicated that she would not be able to afford to pay these bills.
There being no further comments, the meeting was adjourned.
Moses Carey, Jr. , Chairman
Beverly Blythe, Clerk