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HomeMy WebLinkAboutAgenda - 12-01-2008 - 3eORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: December 1, 2008 Action Agenda Item No. 3 ~E..- SUBJECT: Final Report for Orange County Rescue Squad, Inc. DEPARTMENT: Emergency Services PUBLIC HEARING: (Y/N) No ATTACHMENT(S): 1. Final Report -Orange County Rescue Squad, Incorporated Stand-down Status 2. EMS Compliance Verification Form 3. Memo from County and Staff Attorney INFORMATION CONTACT: F. Rojas Montes de Oca 919-245-6100 PURPOSE: To provide a verbal and written report to the Board updating the status of the Orange County Rescue Squad and the decision to return the Rescue Squad to service within specific parameters. BACKGROUND: The Orange County Rescue Squad (OCRs) was placed on stand-down June 27, 2008 by the Director of Emergency Services due to safety and operational concerns. The decision was based on written and verbal reports and observations. The report was submitted to the County Manager, and following a discussion the stand-down was ordered. Area fire departments provide extrication rescue services and provide a mutual aid system to each other to ensure countywide coverage. Emergency Services has been working with the OCRs to obtain and review rosters, training documentation, update mandatory classes and inspect vehicles and facilities to comply with state and local requirements. OCRs will be allowed to return to service providing special event medical support and land search-and-rescue services. In addition, we will be recommending an amendment to the Franchise Agreement allowing OCRs to provide medical surge support. Following several meetings between the Chief of OCRs and the Emergency Services Director, it was agreed further work is necessary to assist OCRs transition to a service model that meets the changing needs of the community. Orange County Emergency Services (OCES) is committed to assisting OCRs transition to a delivery organization that provides services such as incident command support and incident rehabilitation. FINANCIAL IMPACT: The current contract calls for rent and stipends totaling up to $48,908 annually. This amount may change as services formerly provided by OCRs will no longer be needed by OCES. RECOMMENDATION (S): The Manager recommends the Board accept the report and supporting documentation. a ~:: -~ . ~, ~x °= .~ `~~rNi QnC°~`` ORANGE COUNTY EMERGENCY SERVICES Interoffice Memorandum TO: Board of Orange County Commissioners VIA: Laura Blackmon, County Manager FROM: F. Rojas Montes de Oca, Jr., Director DATE: December 1, 2008 SUBJECT: Orange County Rescue Squad, Incorporated Returning to Service On July 1, 2008 I submitted a document to you entitled "Preliminary Report - Orange County Rescue Squad, Incorporated". That document, which highlighted safety and operational infractions, was the basis of my decision to order the Orange County's Rescue Squad's stand-down. The authority was exercised as provided in the Ordinances of Orange County. At the direction of and advice from you and the Board of Orange County Commissioners, Orange County. Emergency Services (OCES) and Orange County Rescue Squad, Incorporated (OCRs) staffs have worked in tandem for three months to searching through and reconstructing OCRs documentation to ensure they were in compliance with state and local rules and regulations. Included with this report is the compliance verification document developed by OCES staff to confirm, with reasonable certainty, all factors analyzed to ensure the public's safety as well as the safety of all field personnel and first responders throughout the County. Based on the documentation reviewed during the assessment period .and the assurance of the Chief of OCRs, that OCRs will continue working with us to address franchise requirements, I will be returning the unit to service within specific parameters. Page 2 Care • Serve • Survive 3 December 1, 2008 Orange County Rescue Squad, Incorporated Returning to Service Rather than attempting to find fault, both entities have agreed to move forward. Failure existed at both ends of the responsibility spectrum. However these recent efforts to bring a community asset back in service has illustrated the need for OCES to do a better job of maintaining the fidelity of a system that resembles a quilt of first responders, career and non-career people dedicated to protecting the community. Shortly after the first of the year, I will bring to you for consideration language that will update the franchise ordinance, which has not been updated since 1993. As Staff discussed recently, the North Carolina Office of EMS is reported to be updating complete rules of system operations and compliance within the next 60 days. Once apprised of how the changes will affect the County's system, franchise language updates will be necessary to ensure compliance by all agencies. Chief Matthews indicated the .future focus and goals of OCRS may transition from "heavy rescue" provider to one in which they will offer an array of services from special events medical support, incident management. support and land search-and-rescue. OCRS's also would like to be affiliated with other like agencies such as the Civil Air Patrol. This evolution will most certainly require constant communication and compliance oversight to ensure the safety of OCRS members and of competent service delivery to the community., One of the troubling aspects of this series of discussions has been the fiscal health of OCRS. While this may be considered an internal issue, further discussion is necessary on this matter. In the unfortunate event OCRS became insolvent, that may have negative effects on the entire system. There are logistical issues to address prior to placing OCRS back in the computer-aided dispatch (CAD) system such as making sure proper procedures of data collection and related operations are in place. On November 18, 2008, staff met with Chief Matthews, to discuss several topics including returning. OCRS to service and the future of OCRS. I advised Chief Matthews OCRS would be brought back online to provide special events coverage and medical surge transport backup but would need to continue working on rescue capabilities. Chief Matthews agreed that with every fire department providing or soon to be providing extrication service the need for another similar service would be duplicative. I was encouraged by Chief Matthews' candor and willingness to explore ways in which OCRS could reinvent itself. OCES is committed to assisting OCRS in finding ways to keep their membership engaged as it discovers new ways to serve the community. Page 3 Care • Serve • Survive December 1, 2008 Orange County Rescue Squad, Incorporated Returning to Service If progress continues, I will bring the OCRS back online as a special events medical support the week of December 1St and will propose an amendment to the Franchise Agreement to have OCRS provide medical surge support soon thereafter. During my discussions with Chief Matthews we have had candid, productive conversations regarding the capabilities of and future service delivery by OCRS and its place within the system. We are both looking forward to continued discussions to ensure the viability and future of emergency services in Orange County. We will continue meeting to ensure open communication and fruitful dialogue and will keep you and the Board of County Commissioners apprised of our progress. We have participated in thoughtful discussions and consideration of the events leading up to the unit's stand down and their reestablishment. I believe this event has made our unique system stronger through a process of open communication, mutual respect and careful consideration of the needs of the community. Should you have further questions, or desire additional clarification, I welcome the opportunity to discuss this further with you. cc: Gwen Harvey, Assistant County Manager Brian Matthews, Chief -Orange County Rescue Squad, Incorporated Care • Serve • Survive a ~~ ~Q a~ 0 U v .~ @ a E 0 U X .t.~+` ~. IC V @ E@ a d d Z E m ~ r Z r z ~ z N } z ~ 1 7 ~ ~ ~ ~ Q C q-i 4-. 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N G C g V ~ ~'~ ~ ~mro tn ~ v ~ i w~ a ~ c .~ m`stLO o c ° o~ a. ~'o m a c ~ m ti m ~~ ' `° ~ m ~ o ~ ~ ro ~ c w c ~ °, .M r ~ r ~ r 0 r N N a ~~ MEMORANDUM TO: Orange County Board of County Commissioners FROM: Geof Gledhill, County Attorne Annette Moore, Staff Attorne RE: Orange County Ambulance Franchise Agreement Date: November 24, 2008 Statement of the Issue The Emergency Services Department ("ES" or "the ES Department") provided a report to the Board of County Commissioners ("Board") at a recent Board work session on the Orange County EMS and Rescue Squad (the "Rescue Squad)," a franchisee of rescue squad and ambulance services and thereby a part of the County emergency management system. As part of this report ES Director, Colonel Montes de Oca, presented an update on the events surrounding the "stand-down" of the Rescue Squad, which occurred June 27, 2008. Also at the meeting, Brian Matthews, the Rescue Squad Chief, provided the Board with a document, "Chapter 14 Emergency Management and Emergency Services." Chief Matthews stated it was his view this document conveyed the Rescue Squad with "due process" prior to suspension or termination of the Rescue Squad's Franchise Agreement. The Board asked the County Attorney for an analysis of the Rescue Squad's due process contention and the authority of the ES Director to issue a "stand-down" order. We have reviewed these issues. Simple Answers The "Ordinance Regulating Emergency Medical, First Responder, and Rescue Services and Granting Franchise and Contract to the Operators in the County of Orange" (the "Franchise Ordinance") does not expressly provide for due process when terminating a franchise agreement. However, a franchise agreement is a grant by the government of an interest in property. The government cannot deprive the holder of "the property" it granted without notice and an opportunity to be heard.t On the other hand, each component part of the County's emergency management system is under the direction of the ES Director. The E'S t North Carolina Constitution, Article I, Section 19. a~ Director has the authority without notice and an opportunity to be heard to "stand-down" the Rescue Squad as a participant in the County's emergency management system. The stand- down order was not a suspension or termination of the Rescue Squad's franchise agreement and thus did not deprive the Rescue Squad of property without due process under the law. Background The Emergency Medical Services Act of 1973 (the "Medical Services Act") provides for the establishment of a comprehensive Emergency Medical Service System (the "EMS System").2 An "EMS System" is a "coordinated arrangement of resources (including personnel, equipment, facilities) organized to respond to medical emergencies and integrated with other health care providers and networks." 3 The Medical Services Act provides for a statewide system of support for emergency medical services throughout the State.4 The Department of Health and Human Services through the Office of Emergency Medical Services (the "OEMS") is responsible for the EMS System. The Medical Services Act also provides the County shall ensure emergency services are provided to its residents.s The County is required to establish an emergency management system.6 The North Carolina Medical Care Commission establishes rules and regulation for local EMS Systems. In order to have an emergency management system the County must have its system plan approved by the OEMS every six years.$ The EMS System Plan coordinates all resources and operations for emergency services activities within Orange County. The Board has approved three Ordinances governing Emergency Services in Orange County: (1) An Ordinance Regulating Emergency Medical, First Responder, and Rescue Services and Granting Franchise and Contracts to the Operators in the County of Orange adopted Apri120, 1993; (2) The Emergency Management Ordinance adopted September 18, 1990 and (3) An Ordinance Authorizing the Proclamation of a State of Emergency and the Imposition of Prohibitions and Restrictions During a State of Emergency adopted September 18, 1990. Chapter 143, Article 56 et. seq., of the North Carolina General Statutes. a l0A NCAC 13P.0110 a G.S. §143-507 s G.S. § 143-517 6 l0A NCAC 13P.0201(a) G.S. 143-508(b) a l0A NCAC 13P.0201(b) Page 2 of 7 An Ordinance Re ug lating Emergency Medical First Responder and Rescue Services and Granting Franchise and Contracts to the Operators in the County of Orange adopted April 20 1993 (the "Franchise Ordinance") The Medical Services Act requires each county in North Carolina to "ensure that emergency medical services are provided to its citizens."9 State law further authorizes the County to enact a franchise ordinance for ambulance services in the County.10 On March 1, 1981, the Orange County Board of Commissioners adopted "An Ordinance Regulating the Operation of Ambulance Services and the Administration of Emergency Medical Assistance in Orange County, North Carolina" which provides for the franchising of ambulance services in Orange County. This ordinance was later repealed and on April 20, 1993, the Board adopted the current ordinance, An Ordinance Regulating Emergency Medical, First Responder, and Rescue Services and Granting Franchise and Contracts to the Operators in the County of Orange ("the Franchise Ordinance"). The purpose of the Franchise Ordinance is to govern "the granting of franchises for emergency services and other prehospital emergency medical services." The Franchise Ordinance provides upon application and public hearing the Board may grant a franchise for ambulance, first responder or rescue services if the County finds: (a) The applicant meets county/state standards outlined in the franchise ordinance. (b) The proposed service will fit within the existing services so as not to adversely affect the level of service or operations of other franchisees to render services. (c) A need exists for the rendered service in order to improve the level of service available to residents of the County helping to ensure the provision of adequate and continuing service which preserves, protects, and promotes the public health safety and welfare and that granting the franchise is a cost effective and reasonable manner of meeting the need.ll The Franchise Ordinance also provides for a five year term for a franchise agreement approved pursuant to it and the notice requirements for a franchise holder to surrender the franchise to the County. The Franchise Ordinance indicates the Office of Emergency Management (now ES) is the body responsible for enforcement of the Ordinance, including 9 G.S. § 143-517 10 G.S. § 153A-250 " Operation of Ambulance Services and the Administration of Emergency Medical Assistance, Section VI. 6.4 Page 3 of 7 ~3 inspecting "the premises, vehicles, equipment, and personnel of franchisees to assure compliance to the Ordinance."12 Emergency Services is also charged with receiving "complaints from the public, other enforcing agencies, and services regarding franchise infractions."r3 In addition, ES may recommend to the Board of Commissioners the temporary or permanent suspension of a franchise in the event of noncompliance with the franchise terms."~4 The Board of Commissioners has the authority, after a recommendation by ES to terminate the franchise agreement for "noncompliance with the franchise terms." Orange County Emergency Management Ordinance The purpose of the Orange County Emergency Management Ordinance is to establish an office "that will insure the complete and efficient utilization of all of the County's resources to...administer the daily function of the Orange County Emergency Management."15 The Orange County Department for Emergency Management (now ES) is the "coordinating agency for all activity in connection with emergency management" within the County.16 The ES Director is delegated the authority under the Ordinance for "all phases of emergency management activities within the County" including the planning, coordination, and aeration of those activities. (Emphasis added.)17 An Ordinance Authorizing, the Proclamation of a State of Emergency and the Imposition of Prohibitions and Restrictions Duri~ a State Of Emergenc~(the "State of Emer~ency Ordinance") The County is authorized to enact an ordinance designed to permit "the imposition of restrictions and prohibitions during a state of emergency."18 This State of Emergency Ordinance enables the County to prohibit or restrict: 1. The movements of people in public places; 2. The operation of offices, business establishments, and other places to or from which people may travel or at which they may congregate; 3. The possession, transportation, sale, purchase, and consumption of alcoholic beverages; ~' Id. at Section XN.14.1 (d) is Id. at Section XN. 14.1 (g) 14 Id. at Section XIV. 14.1 (e) is Orange County Emergency Management Ordinance, Article 1', Section 2.1. ib Id. at Article I, Section 2.2 17 Id. at Article I, Section 5(1) 's Article 36A of Chapter 14, Chapter 166A, and Chapter 153A of the North Carolina General Statutes Puge 4 of 7 ~~ 4. The possession, transportation, sale, purchase, storage, and use of dangerous weapons and substances, and gasoline; and 5. Other activities or conditions the control of which may be reasonably necessary to maintain order and protect lives or property during the state of emergency.19 This Ordinance authorizes the Chair of the Board of Commissioners to limit by proclamation all or part of restrictions or prohibitions contained within the Ordinance. Analysis At the Board's Work Session, Chief Matthews read from a document identified as "Chapter 14 Emergency Management and Emergency Services" which was retrieved from the Internet Municode Library.20 Documents on Municode are not official copies of County ordinances and in many cases do not accurately reflect the contents of County ordinances. North Carolina General Statute § 153A-49 provides that "the County may adopt and issue its code of Ordinances." However, Orange County has not codified its ordinances into a Code of Ordinances. Official copies of Ordinances adopted by the Board are "kept and maintained" in the Office of the Clerk to the Board of Commissioners.21 Municode has not been reviewed by the County for accuracy or by the County Attorney for legality and is not followed in reviewing the law as it pertains to County ordinances. Therefore, we look to the Ordinances maintained in the Clerks Office for an official review of what the Board has adopted. Orange County approved, December 14, 2004, an EMS Franchise Agreement (the "Agreement") with the Rescue Squad providing it with a "nonexclusive Franchise to operate and maintain EMS Services." The Agreement, which terminates on or about December 13, 2009, authorizes the Rescue Squad to provide the following "EMS Services": (1) Rescue Services, including light and heavy vehicle extrication, underwater (dive) rescue and wilderness and land search and (2) Primary Ambulance Provider (Special Events Only). The Ordinance, defines "rescue service" as the system of personnel, vehicles and equipment "required to respond to situations where persons or victims are missing or cannot escape an area through the normal exit or under the own power."22 A "primary ambulance provider" is i9 G.S. 14-288.13(b) '0 http~l/library3 municode.com/default/DocView/131.66/1/1.32 '' G.S. 153A-48 "Defined at Section 3, EMS Services Franchise Agreement Puge 5 of 7 as the "system of personnel, EMS transport system vehicles and equipment normally dispatched on a first call response."23 Some of the responsibilities included in the Agreement are: the Rescue Squad was to comply with the Franchise Agreement; maintain in good standing the State drivers license for members of the Rescue Squad and the Rescue Squad's privilege license to operate either its ambulances or EMS services; provide the highest level of care at all times; and comply with the County's official written EMS System Plan. The Franchise Agreement cannot be terminated or suspended without approval of the Board of County Commissioners. At a minimum the County must provide "due process" before terminating or suspending a franchise. The North Carolina Supreme Court has recognized "a franchise as property, the use and enjoyment of which is entitled to protections as any other property right.24 The granting of such right is "not a mere license, but a property right protected by the Constitution from arbitrary revocation or destruction, and may not be taken without due process of the law." 25 Due process requires, prior to termination or suspension of a franchise under the Franchise Ordinance, the County provide notice and an opportunity to be heard by the franchise hoider.26 The Board has not approved a termination or suspension of the franchise and the Rescue Squad's Franchise Agreement is still in effect. On June 30, 2008, the Emergency Services Director issued a "stand-down" of the Rescue Squad. The stand-down, had the effect of taking "out of active work or service" the Rescue Squad vehicles in the emergency services system. It did not however suspend or terminate the Franchise Agreement of the Rescue Squad:27 The Rescue Squad is one of eight licensed EMS providers who operate as part of the overall EMS System in Orange County.28 In the EMS System Plan for Orange County, dated June 30, 2003 (updated December 20, 2004) (the "EMS System Plan"), the Rescue Squad can provide, "EMT-Basis coverage at special events, extra personnel for OCEMS street-duty trucks during time of unusual demand (weather emergencies), light and heavy extrication, '3 Defined at Section 3, Emergency Services Franchise Agreement '`~ 36 Am.Jur.2d Frariclzises §5 (1968), Stallings v. City of Winston Salem 311 NC 689, 692, 319 S.E.2d 233, 236 (1984) zs Boyce v. City of Gastonia 227 N.C. 139, 145, 41 S.E.2d. 355, 359 (1947) '6 See Paul v. Davis, 424 U.S. 693, 96 S.Ct. 1155, 47 L.Ed.2d 405 (1976); Wuchte v. McNeil, 130 N.C.App. 738, 505 S.E.2d 142 (1998); Howell v. Carolina Beach, 106 N.C.App. 410, 417 S.E.2d 277 (1992). '-7 stand down. Dictiouary.com. Dictionary.cvnt. Unabridged (v 1.1). Random House, Inc. htt~Udieticmary;,re:ference.com/brtiwselstand down (accessed: October O1, 2008}. '8 EMS System Plan, June 30, 2003 p. 1-2 Page 6 of 7 a,.~ and land search." The Rescue Squad's EMS personnel are scheduled in advance for duty at various special events or are radio-pager-dispatched on an incident-by-incident basis. Calls are dispatched through the Orange County Emergency Communications Center which is the primary emergency medical dispatch service in Orange County. Resources are assigned to medical calls based on the Priority Dispatch System protocols and response determinants pre-defined by the Medical Director. Guidance is also provided in operation policies that ensure that EMS resources are deployed efficiently to scenes and to ensure that mutual aid resources are requested promptly when the system is overloaded.29 All of this is part of the EMS System Plan. The Rescue Squad was taken out of active service for medical dispatch. This falls within the authority granted to the ES Director by the Orange County Emergency Management Ordinance and does not equate to a termination or suspension of a franchise under the Rescue Squad's Franchise Agreement. The stand-down also does not have the effect of terminating any other obligations or agreements Orange County may have with the Rescue Squad. Conclusion Due process requires the Board, prior to terminating or suspending a franchise agreement, to give the holder notice and an opportunity to be heard. The ES Director has the authority, pursuant to the Orange County Emergency Management Ordinance and the ~ EMS System Plan, to issue astand-down order when coordinating the operation of emergency services activities within the County. This action does not operate as a suspension or termination of a franchise holders franchise agreement. '9 Orange County Emergency Medical Services Unit Deployment and Mutual Aid Request. Page 7 of 7