Memo Of The Week

MEMO OF THE WEEK

Mendocino County Fire Chiefs' Association

President: Larry Tunzi; Vice President: Mike Suddith, Secretary/Treasurer: Jeff Schlafer

PO Box 164, Comptche, CA 95427

September 4, 2013

TO: Carmel J. Angelo, Chief Executive Officer, Mendocino County, 501 Low Gap Road, Ukiah, CA 95482

Dear Ms. Angelo,

The Mendocino County Fire Chiefs' Association (MCFCA) has read the July 29, 2013 Fitch Report and is providing the following comments. First, the MCFCA commends the Board of Supervisors for recognizing that the emergency medical services system in Mendocino County is at a critical stage. As identified in the Fitch Report, there are significant areas of Mendocino County that are underserved or are facing significant future staffing and financial challenges. The MCFCA does not challenge the report's findings of inconsistency, unreliability, and instability in the county's EMS system. As has been noted before, the volunteer agencies in this county fulfill a vital role in providing critical emergency services. Changing social structure, increasing workload, additional training demands and fiscal limitations are pushing the volunteer agencies to the breaking point.

A single failure in the existing system will have a domino effect that will impact the entire county. Unfortunately, the general public does not realize the fragile nature of the system. It is the responsibility of both the MCFCA and the County to ensure that the system is sound and sustainable. It is critical that the board and MCFCA work together to develop a plan of action that will resolve the current issues and provide a foundation for an inadequately funded system that meets the public's expectations for quality service.

The MCFCA has found that there are a number of factual errors in the statistical data supplied in the report. However, none of these errors detract from or alter the findings within the report. Therefore, we will not attempt to enumerate each error. Clearly, as identified in the report, the costs associated with providing EMS in the county far exceed revenue generated. Not noted in the report is the fact that the future margins between revenues and costs will only deteriorate. An example of this trend is the recent announcement of a 10% reduction in Medi-Cal reimbursements.

The MCFCA recognizes the historical contribution of the County's ambulance providers. These providers have operated under very challenging conditions and have shown a commitment to providing the best possible service to the citizens of the county. Nevertheless, we feel that the present operational model for the county is not sustainable over the long haul. The report pointed out the extremely varied level of service in the county and identified large areas of the county that operate at a minimal basic life support level. The report states, “patients who require ALS interventions when ALS is unavailable are less likely to have positive outcomes.”

The MCFCA believes that Advanced Life Support should be the standard throughout the County of Mendocino.

The report identifies the fact that, “in many areas of Mendocino County, residents cannot reliably expect an immediate ambulance response to the 911 request.” We recognize that few areas within the county have call volumes which will independently support a 24/7 ALS provider. We also recognize that the areas outside the main population centers do not have the private or public organizations that can financially sustain an ALS service. The California Health and Safety Code section 1797.200 states that, “each county may develop an emergency medical services program.” The MCFCA believes that the county has committed to a program through its agreement with Coastal Valleys EMS as its EMS agency. It is further stated in section 1797.206 that, “the local EMS agencies shall be responsible for implementation of advanced life-support systems.”

The MCFCA believes it is the obligation of the County of Mendocino to implement and support a reliable advanced life-support system in all areas of the county.

Mendocino County has a long history of community independence and self-sufficiency. The historical economic base and social structure of the county his change significantly over the past 20 years. The more rural of the county's communities no longer have the local job base for economic stability to maintain independent EMS systems. The MCFCA supports the report's finding that, “It is clear that without action, there will be a continued disintegration of the Mendocino County EMS system and that the result will be lower levels of care, and in many instances, extremely long response times to emergency events.”

The MCFCA supports an EMS system that integrates the strength of a locally based provider with the economic stability of a countywide system.

The report has recommended the establishment of exclusive operating areas (EOAs) as an operational model for the county. The report further identifies the need for the selected providers to work with existing ambulance services to develop agreements that will provide for the utilization of local resources.

The MCFCA supports the concept of establishing an exclusive operating area for ALS response and ambulance transport. The MCFCA supports the establishment of a single exclusive operating area with the inclusion of cooperative agreements with the existing EMS providers in the underserved areas.

The MCFCA recognizes that funding is the key issue in any attempt to bring Mendocino County EMS system up to an acceptable standard. The report concludes with the statement, “In order to ensure access countywide to reliable responses and access to advanced life support level of care, it will be necessary to develop a long-term funding solution.”

The MCFCA and county staff worked for a number of years to develop a countywide funding source for emergency services. This Ad Hoc committee, established by the Board, identified the same issues that have been included in the two Fitch Reports. The committee held numerous meetings over several years and had developed specified recommendations. Ultimately, funding became the key elements that needed to be resolved before any progress could be made. The committee reviewed a number of options including Proposition 172 (Prop 172) funding, a parcel tax through County Services Area #3 [areas of the County not already covered by existing fire taxes/fees], and a Sales Tax increment. In 2011 the committee was prepared to recommend to the Board of Supervisors that they implement County Service Area #3 and establish a parcel tax. Unfortunately, at the same time, the State Legislature imposed within the County the State Responsibility Area (SRA) fee. It was then the decision of the committee not to make the recommendation based on the unlikely approval of the parcel tax by the voters.

The committee had also considered a sales tax increment. State law does not allow the establishment of a county sales tax that does not include the incorporated cities. At the same time, each of the cities within the County had a reliable ambulance service and a local sales tax. It was the conclusion of the committee that the inclusion of the cities would make it impossible to establish a countywide emergency services sales tax.

During the early phases of the committee, the MCFCA had recommended a revenue-sharing plan for Proposition 172 money. In 1993 the Local Public Safety Protection and Improvement Act was approved by the state's voters. This Act established a statewide half-cent sales tax dedicated to local public safety including fire and EMS. In Mendocino County, the entire proceeds from the tax have gone to law enforcement. The MCFCA proposal was to allocate the annual increase in revenue to fire and EMS. The existing law-enforcement portion would have stayed constant until the Fire-EMS portion reached a cap at 25% of the total revenue. This proposal was not pursued because of opposition by the Sheriff and county staff. The MCFCA believes but a revenue-sharing plan for Prop 172 money remains the most appropriate method for funding emergency services.

The MCFCA maintains its long-held position that Proposition 172 money should be shared. This is consistent with the intent of the proposition to support the County EMS system. The Fitch Report findings substantiate this allocation of these funds.

In 2011 Measure A was placed on the ballot to add a 1/8¢ sales tax to support the library. This measure passed with a 75% approval. The sales tax was estimated to raise $1.3 million. A similar sales-tax dedicated to emergency services would provide funding to adequately support a countywide ALS system.

As an alternative to the appropriation of Proposition 172 funds, the MCFCA proposes the county place before the voters a proposal to adopt a 1/8¢ to 1/4¢ sales tax for emergency services. The MCFCA further recommends that the Board of Supervisors take the necessary steps to place this proposal before the voters at the earliest possible date.

The MCFCA recognizes that the establishment of an exclusive operating area will represent a significant departure from the historical participation of the county in providing emergency services. The increasing number of calls for service, the evolving expectations of the public, and the social changes with within our communities leave us with few alternatives. Ensuring that the citizens of Mendocino County have access to the best possible emergency medical services should be one of the county's highest priorities.

As an initial step, the MCFCA recommends that the Board of Supervisors reconvene the joint County/Fire Chiefs committee to develop a specific plan for the implementation and operation of a sustainable countywide ALS system.

The MCFCA recognizes that the county has entered into an area that will be extremely challenging. However, we feel that at this time there is no choice but to address these issues and to develop a new system in the shortest possible time. The MCFCA looks forward to working closely with the county toward the development of a quality EMS system that will best serve the public.

Sincerely, Larry S. Tunzi, President, MCFCA