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WHATCOM COUNTY COUNCIL
Finance and Administrative Services Committee
December 7, 1999
The meeting was called to order at 12:06 p.m. by Committee Chair L. Ward
Nelson in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
Also Present: Absent:
Tom Brown None
Robert Imhof
CONSENT AGENDA
9. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO AN
INTERLOCAL AGREEMENT AMONG WHATCOM COUNTY, LUMMI
NATION, NOOKSACK TRIBE, PUBLIC UTILITY DISTRICT NO. 1, AND
THE CITY OF BELLINGHAM TO ESTABLISH THE NECESSARY
ADMINISTRATIVE PROCEDURES FOR FINANCIAL ADMINISTRATION,
CONTRACT EXECUTION, AND ADMINISTRATION OF THE WRIA 1
WATER MANAGEMENT PROJECT (AB99 -471)
Bruce Roll, Water Resources Manager, stated there is a draft version of the
interlocal agreement. The Planning Unit and a number of the initiating
governments (IG) had comments on the drafts, and a substitute version was
distributed. There was a concern by Planning Unit members that the decision -
making process hadn't been formalized and, therefore, those references in the
document had been struck from this version. This issue deals specifically with
funding allocation under the interlocal agreement.
Nelson questioned the budget process on page three of the substitute
agreement. He asked for Roll's concept of the budgeting process. Roll stated there
hasn't been a formal scope of work written for this year, in which they have all the
pods of work clearly defined. Instead, they are going to come back to the Council
as the work is more clearly defined and the scopes of work for specific tasks are
defined. The costs will be brought forward as a supplemental budget request. Most
of the work, other than the contracts that are currently ongoing, will be coming
back for budget appropriation.
Nelson asked if it would go back to the initiating governments for
implementation. Roll stated that was correct.
Nelson asked how that works on an annual basis, when they specify that the
joint board shall adopt the budget for the coming year. Roll stated that, as they
move further into the process, they would be able to anticipate what is going to
occur. When they go into the budgeting process with work that is clearly defined,
they will provide the information the Council needs. At this point, they don't have
that. He wanted to work toward that next year.
Finance and Administrative Services Committee, 12/7/99, Page 1
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Nelson asked when that would be introduced to the various councils. Roll
stated it would be introduced during the budget process next year.
Nelson asked if he was planning on November. Roll stated that was correct.
Nelson stated that may be late to look at that type of issue. They may want
to do it earlier as a separate part of the function and funding. He was concerned
about this. He would like to set July as an appropriate time to look at projects for
the coming years.
Brown stated he envisioned a budget process coming forward a year down
the line and items would come in from the Planning Unit. He didn't see how the
Planning Unit fit into the projects that will come forward. The Council would go
through a process with administration to provide input. It would evolve into this
proposal. He asked if the projects would come from the Planning Unit. Roll stated
they will go thorough the initiating governments. In this case, they are discussing
what happens when the others agree upon a project, speaking with one voice in
dealing with the issue of the five IGs when they sit down to approve and expend
funds for a particular project. As they proceed into next year, what they are
discussing will be worked out. They haven't clearly defined how the decision -
making process is going to connect all the pieces as they move forward.
Jeff Monsen, Public Works Director, stated this section doesn't replace the
County budgeting process. It only describes that the five IGs must deal with
budgeting matters together.
Nelson stated that is why this should be done earlier in the process.
Monsen stated that is one of the reasons they meet monthly with the
Council. Secondly, they will adopt something sometime during the County's annual
budget process. This doesn't presume there won't be supplemental requests.
Imhof stated that, as they go through the budget, they would address
ongoing projects. As they develop new projects throughout the year, funding
requests will come back via a supplemental budget.
Nelson stated an adopted budget should be based on input with some design
intent, not on a piecemeal basis with supplementals. Monsen stated that would
depend. The only example is the budgeting they've done for the year 2000. They
have only asked for items that are certain to be underway.
Nelson asked about the year 2001. Monsen stated he envisioned it would be
the same. The items they mutually agree on and that are ready to move ahead will
be budgeted. The items they don't agree on will not be budgeted.
Nelson questioned whether the agreed -upon items have already been before
the councils. Monsen stated they would have those discussions before a formal
Finance and Administrative Services Committee, 12/7/99, Page 2
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budget comes forward for County approval because they are one of the initiating
governments. Second, the County Council will see a project as a part of the budget
process.
Dawson stated she was not comfortable with the process either. The policy
direction is not included in this. She proposed, "The budget document, based on
policy direction unanimously agreed on by the initiating governments, may be
modified, altered, or expanded...." They can't separate policy and budget. They go
together.
Dan Gibson, Senior Civil Deputy Prosecutor, stated the budget is addressed.
In RCW 39.34, which provides for interlocals, budget is one of the items that must
be addressed. The question is how to address it. It is an interactive process.
There are points they will have to concede as the process takes greater shape and
is fine -tuned so that the granting Council is comfortable with the budget allocation.
That is what the language in the agreement provides. On an annual basis, there is
a broadly scoped budget. It may be modified during the year if there are specific
projects that require further fine - tuning so this Council feels comfortable with
allocating the money.
Brenner stated that may be the intent but it wasn't clear to her. She hoped
to put this off until the worksession on January 18.
Monsen stated they hoped to move forward with this document because the
other four initiating governments are moving forward soon.
Brenner stated what she read in the agreement doesn't clearly state the
intent. She assumed this was in response to past problems. The problem is
internal and has to do with getting information to the County Council. She didn't
see any answers to that problem in this document.
Gibson stated the IGs, as a joint administrative board, do not generate
money. They spend money generated elsewhere. Most of the money comes
through the Board of Supervisors. Consequently, in talking about their budget,
they are talking about something different than how the money gets to them to
spend, which lies within the power of the Board of Supervisors. Their budget
adoption does not commit the Board of Supervisors to allocating money. The
County has a representative on the IGs, but the money gets there from the Board
of Supervisors only if the Board of Supervisors approves of how to allocate the
Flood Control Zone District's money.
Brown stated it seems they would have the funding approved before they
adopt the budget. That is part of the process. This would probably work fine, but
there is nothing that states it directly. Gibson stated that is correct.
Monsen stated the Council is part of the decision - making process, unless
they agree that a decision is to not move ahead.
Finance and Administrative Services Committee, 12/7/99, Page 3
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Nelson stated he understood the process, but was uncomfortable with the
timelines. For budgeting processes, it would help if they knew earlier the
anticipated needs for the following year. He encouraged that this process be
undertaken by the joint body and start earlier in the year.
Imhof stated the County Council will be updated monthly to keep them
abreast of what is coming up the following year.
Nelson asked if the budget process is yearly or monthly. Monsen stated, as
this was drafted, the vision was they would have an annual budget process that
resembles the normal County process.
Nelson questioned the purpose of the monthly meetings. Monsen stated the
monthly updates might include discussion about the budget.
Nelson questioned whether they would have two processes. Monsen stated
the monthly meetings would deal with budgetary matters at times. Once per year,
they will consider an annual budget. Supplemental budget requests are clearly
available, as they normally are.
Imhof stated the Council could request the department bring forward the list
of programs for the following year, prior to the budget cycle, in July or August.
Roll stated the planning group, as well as the IGs, are working on a scope of
work to better lay out these issues. They hope to have a document available in
February or March that is all- encompassing and will produce the answers to their
questions.
Imhof moved to recommend approval of the substitute agreement.
Tom Anderson, Public Utility District (PUD) #1 Manager, urged approval in
light of the fact that this is the agreement between the IGs, which is a group that
does include the County. It has to come back to the Council as the Board of
Supervisors. The Board of Supervisors can dictate what the IGs have to present to
the Board of Supervisors and when it has to be presented, in order to achieve
approval. Those are two separate things. The document addresses how the IGs are
going to act as a joint board. It does have specific information on how the IGs
request funding.
Dawson stated other jurisdictions could take offense if it isn't spelled out.
Anderson stated he didn't believe that was an issue. This resolves the primary
issues that some of the IGs have had. The issue of long -term funding will be more
complex because, eventually, not all the funding will come from the Flood Control
Zone District. Eventually some will come from other sources. He was not
concerned about the need to spell that out at this time.
Brenner stated they should be concerned. She was shocked it created a
problem. She would like to see that spelled out. Anderson stated he wouldn't spell
Finance and Administrative Services Committee, 12/7/99, Page 4
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it out, but instead keep it as their prerogative. They have a right, as the Board of
Supervisors of the Flood Control Zone District, to define the requirements people
must meet to access those funds.
Brenner questioned why they wouldn't include that language.
Imhof stated it gives the Council more flexibility.
Nelson stated there are two separate entities and processes.
Brown suggested that they add an additional "WHEREAS" that included the
resolution number that was passed to clarify that agreement.
Nelson questioned whether they have any flexibility to change the proposed
document, since it is also going before the other initiating governments.
Gibson stated that the more input each group has, the more times they go
back and forth to the table. At some point they have to say it is close enough to
achieve the purpose.
Skip Richards, citizen, stated he attended the interlocal agreement meetings.
If there are concerns, they must be addressed. In terms of the timeframe, this is
the last County Council meeting this year. He has meetings scheduled this month
that will have to be cancelled because some IGs will not participate until the
interlocal agreement is approved. Scheduled meetings are to deal with scope of
work, instream modeling, and the Planning Unit. Until the agreement is sorted out,
the project is going to be pushed back.
Brown questioned whether anything would go forward if they don't sign this.
Richards stated most of the procedural matters have been addressed. They want
to get down to the bulk of the work. Unless representatives of all five initiating
governments are present at the work sessions, nothing will get done. The primary
author of the scope of work will not participate if this interlocal issue is not resolved
in some away. If the agreement isn't approved at this, the last meeting of the
year, they will lose another couple of months before they can get going. It is hard
for him to put time into these meetings and then take it back to his members and
bill them for the time that was a waste. Unless all the relevant parties are engaged
in the discussions, nothing is going to get done. He thought this was settled, and
hoped they could settle the concerns with as few changes to the text as possible.
Any change in the language will require that it go back to the other signatories.
Brown questioned whether the others have agreed to this wording. Richards
stated they have. The Planning Unit intent was to defer a discussion until later on.
In the meantime, since this agreement is only between the IGs, the Planning Unit
doesn't have to be involved in it. The language doesn't reduce the County Council's
involvement. He hoped the budget matters come up during the monthly meetings.
Finance and Administrative Services Committee, 12/7/99, Page 5
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Motion to recommend approval of the substitute agreement carried
unanimously.
COMMITTEE DISCUSSION AND RECOMMENDATIONS TO COUNCIL
1. ORDINANCE AMENDING THE 1999 BUDGET, REQUEST NO. 10 (AB99-
460)
Imhof moved to recommend approval for the entire amount of $88,193.52.
Brenner questioned whether they were still planning a portico for the south
entrance.
Dewey Desler, Deputy Administrator, stated they are going to try a power
door option instead. It would be far less expensive than a portico. They think this
will work, then they can use the doors in a portico later on if it doesn't work.
Brenner questioned whether they could still use the doors after hours with a
key.
Desler stated they could still use the key. The automatic opener will be
deactivated at the end of the day.
Brenner stated she was not strong enough to open that door on her own
during a windy day on the weekends.
Desler stated they could program the door so that a key could activate it.
The issue is that the door will be power opened and power closed.
Brenner stated that when the door is opened, everything down the hall gets
blown around.
Brown asked if the power door is fairly fast or is slower. The current
handicap door does not work well.
Mike Russell, Acting Facilities Management Manager, stated that the time it
takes for the door to open and close is regulated to meet Americans with
Disabilities Act (ADA) requirements. Both doors will be powered.
Brenner questioned whether there is any way to change the keying to be on
the automatic sensor rather than the door itself. Russell stated they are in the
process of installing the proximity lock cards, so they won't need a key. Their keys
will not be used.
Motion carried unanimously.
Finance and Administrative Services Committee, 12/7/99, Page 6
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COUNCIL "CONSENT AGENDA" ITEM
1. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO A
CONTRACT AMENDMENT BETWEEN WHATCOM COUNTY HEALTH &
HUMAN SERVICES AND ST. JOSEPH HOSPITAL — RECOVERY CENTER,
TO PROVIDE FUNDING FOR THE CHEMICAL DEPENDENCY CASE
MANAGEMENT PROJECT, IN THE AMENDED AMOUNT OF $19,694 FOR
A TOTAL AMENDED CONTRACT AMOUNT OF $120,443 (AB99 -464)
Brown moved to recommend approval.
Motion carried unanimously.
2. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO AWARD BID #99-
107 TO THE LOWEST RESPONSIVE BIDDER, DIEHL FORD, FOR NINE
POLICE SEDANS TO BE USED BY THE SHERIFF'S OFFICE, IN THE
AMOUNT OF $207,323.01 (AB99 -465)
Brown moved to recommend approval.
Brown questioned whether these are traded in or go to auction.
Mary Ewing, Equipment Rental and Revolve Manager, stated they go to
auction.
Brown questioned whether they could be traded into the deal. Ewing stated
the dealers are usually not interested because the vehicles have a police package.
Brown stated people usually use them for taxies. Ewing stated the taxies are
the ones that purchase the vehicles most often.
Brown questioned where the money goes. Ewing stated the money goes to
the Sheriff's equity account, which is an ER &R fund.
Deane Sandell, Undersheriff, suggested approval be changed to "up to nine"
vehicles. If they can order fewer vehicles, they will.
Imhof offered a friendly amendment to approve up to nine police sedans.
Brown accepted the friendly amendment.
Motion carried unanimously.
3. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO AWARD BID #99-
129 TO THE LOWEST RESPONSIVE BIDDER, FARMER'S EQUIPMENT
COMPANY, TO PURCHASE TWO 3 -AXLE PONY TRAILERS TO BE USED
BY PUBLIC WORKS M &O, IN THE AMOUNT OF $57,026.20 (AB99 -466)
Finance and Administrative Services Committee, 12/7/99, Page 7
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Imhof moved to recommend approval.
Nelson stated he believed this was for two trailers, with one going next year.
Mary Ewing, Equipment Rental and Revolve Manager, stated this is for two
trailers. If they purchase two this year, they will not purchase two next year.
Brown questioned whether these are replacements or additions to the fleet.
Ewing stated they are fleet additions.
Motion carried unanimously.
4. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO AN
INTERLOCAL AGREEMENT BETWEEN WHATCOM COUNTY HEALTH AND
HUMAN SERVICES AND BELLINGHAM HOUSING AUTHORITY, TO
PROVIDE FUNDING FOR A PART -TIME WELLNESS OUTREACH
WORKER, CHILDCARE, AND TRANSPORTATION, IN THE CONTRACT
AMOUNT OF $29,200 (AB99 -467)
Imhof moved to recommend approval.
Councilmember Brenner stated she had a problem bringing on a .5 full -time
equivalent employee (FTE).
Nelson stated the person is already on staff.
Brenner stated she would rather a .5 FTE be used for something other than
this. She supported the childcare and transportation costs. People in public
housing don't have a greater need than other people for drug intervention. Drug
intervention is now supplied through different agencies. In light of I -695, they
should not spend money to add an FTE. She would rather spend the money on
transportation and childcare.
John Hooper, Human Services Manager, stated the funding is from a federal
grant received by the Housing Authority. They will subcontract out the position.
During the past year it was subcontracted out to SeaMar. The grant is for a .5 FTE
to outreach to the Housing Authority projects.
Brenner stated this was not a County employee, it will be contracted out, and
the position will be gone if there is no money. Hooper stated that was correct
Motion carried unanimously.
S. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO A
MODIFICATION TO AN AGREEMENT BETWEEN WHATCOM COUNTY
AND THE CITY OF BELLINGHAM FOR EMERGENCY MEDICAL CARE AND
TRANSPORTATION SERVICES (AB99 -477)
Finance and Administrative Services Committee, 12/7/99, Page 8
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Nelson stated this was addressed during the budget process. There are
several people who wish to speak to this.
Dewey Desler, Deputy Administrator, stated the administration supports the
proposed changes, as well as a fee schedule that would adjust the rates consistent
with the rates proposed by the City of Bellingham. There is an association that is
looking into the future of Medic One and emergency services in the county. They
County needs to monitor that review. Recommendations are contained in an
attached memo sent to the Council on December 3.
Nelson stated he wanted to hear from the various agencies involved.
Dave Hammers, Bellingham Fire Department Medical Officer, stated they
hadn't had a fee increase since 1995. A few years ago someone suggested they
increase fees on an annual basis, instead of having a large fee increase every few.
(Clerk's Note: End of tape one, side A.)
Hammers continued to say that is an option. Because the way the interlocal
agreement works, they recapture 50% of the program from fees. It is monitored
constantly to determine whether the 50% balance is achieved. First of all, the call
volume has continued to go up and the revenues have gone up, but the expenses
have not gone up that much. To offset inflation over a five -year period, a 10%
increase would be in line. In addition, they have had increased call volume of
about 40% since they put on the third medic unit, which increases their supply
costs. They have invested in new technologies. The new technologies become care
standards. That is a second element to why they would see the fees as they were.
Part of the discussion regarding medic four ties into the increased demand for
service. Third, there were site location costs for medic four. The fourth element is
a change in that they tried to hold to a 50% level. The Executive asked them to
bring back more options that would mitigate the impact of increased costs. They all
felt that, to keep the Medic One program a unified system, a fee increase created
another element to the fee structure. There are four components. Those are the
four things that impacted the fee increase.
Nelson questioned whether they are stating that they need to increase fees
due to an increase in inflation and volume. He asked if insurance reimburses them.
Hammers stated they do. However, insurance rates have not gone up. Different
carriers handle reimbursement more. Some carriers are good about paying fees in
full, but others are not. With both major insurance carriers, Group Health and
Northwest Medical Bureau, they've had a negative reimbursement impact.
Nelson questioned about their reimbursement overall. Hammers stated they
had a reduction with both Group Health, because of the way they've chosen to
reimburse, and Northwest Medical Bureau, because of their merger with Skagit
County Medical Bureau. They have delayed reimbursement and there is a big
account receivable.
Finance and Administrative Services Committee, 12/7/99, Page 9
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Nelson stated increased volume returns greater dollars. He expected better
utilization of the equipment and greater investment on the equipment because of
the increased volume. Hammers stated they are generating more volume and fees,
but on the other hand, reimbursement has not matched the costs. There have
been negative impacts in the way carriers reimburse.
Brown stated they did experience increased revenues from increased call
volumes. If they have been increasing revenues, he didn't understand the need for
the increases. The medic unit cost is $5 per mile. He also didn't agree with striking
language that fees must not exceed cost. An increase of $5 per mile is not realistic.
He didn't want the elderly and the sick to carry the burden the of users of this
service when the County is supporting less viable programs.
Brenner stated the user would pay 55% rather than 50 %. Hammers stated
that was correct.
Brenner stated she would support what the Council agrees on for an interim
agreement. This is a totally necessary service. The County subsidizes programs
that are not more of life -or -death issues than this. This is a life -or -death issue. She
had a problem raising the cost to individual people. She asked why the language
regarding the fees and costs was stricken. Hammers stated they were capped at
50% of the costs of operating. Because they put forward a fee schedule that was
55 %, they had to amend the interlocal to change the cap. The interlocal
agreement holds them to 50% of the costs of the operation.
Brenner asked why they wouldn't change it to 55% rather than eliminate it
altogether. Hammers stated they could.
Brown questioned when the medic four unit would go into action. Hammers
stated they haven't brought anyone on for the medic four unit. A fourth unit has
been operating much of this year, but not as a result of the budget. They were
staffed because of the City of Bellingham fire department staffing level. Bellingham
provided the department incremental staffing in advance of a new fire station.
They have been using those people whenever possible to staff a fourth medic unit.
Brown questioned whether the medic unit being used now would become a
medic unit and when. Hammers stated that if the Council approves the budget,
they would provide four of the nine needed to fund that unit. That will give them
the additional staff along with the staff they have in place now to run that unit. It
will not run 100 percent of the time. It is a department decision about whether or
not that can happen, because it is not totally funded. They hope to have the
financial resources to run the unit throughout the year. They have implemented a
committee to do a site location study for that unit. That won't be implemented until
the middle or third quarter of next year.
Brenner suggested they lay out the county population to see where this
should be located in relation to the population. She questioned the payment
default rate percentage on people who use the services. Hammers stated the
Finance and Administrative Services Committee, 12/7/99, Page 10
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overall collection rate is about 76 percent of everything they charge. Raising the
rates might make the collection rates go down.
She questioned whether that was factored in. Hammer stated that next
year's projection was based on a 75 percent collection rate. They historically run
closer to 80 percent. They are currently at 77 percent.
Brenner stated the agreement is that the proposals have to be reviewed or
approved by the Executive, not the County Council.
Dewey Desler, Deputy Administrator, stated the author that drafted this
twelve years ago put the language in.
Brenner stated they should clarify that the Whatcom County Council reviews
and approves the agreement.
Desler stated they would propose to review the agreement in the year 2000.
That might be an item to adjust.
Hammers stated this document has been around for 25 years. This proposal
has been to affect the immediate need of the budget. They will review the
interlocal agreement.
Nelson stated he wanted the information on the third -party reimbursement
rates. Hammers stated he has information that they will make available.
Mike Lee, Bellingham Fire Department Fire Chief, stated there is information
they provided to the Council. He questioned whether they have any concern about
the quality of service that Medic One has provided for the past 25 years.
Brown stated the concerns were not regarding the quality of the services or
personnel. He was concerned about escalating costs. He received information that
they may be able to provide effective service at half the cost, and felt the County
should look into it. It is the County's fiscal responsibility to look into the
affordability of the services in that the people could afford this service. No one is
saying the service is bad.
Lee stated this model has been in place for 25 years and is one that is looked
at nationally. The model is a unified service. It avoids redundancy in equipment
and services because there is one service provider that is the fire service of the
County. It is a partial fee for service, so people don't have to pay the full freight of
the cost. Those that use it pay more than those who don't use it. It has a
government subsidy and is a partnership between the city and county. It is an
excellent model. Running the service is not cheap. Government subsidies exist
because it is difficult for an entity to provide 24/7 response without a subsidy when
a call for help comes in. They have never failed to not respond to a request for
help. When they presented this information to the City Council, they had the same
reaction. They were concerned the additional cost was going to fall on those who
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use the service. They were reluctant to approve the increase in fees. They told the
City that they met with the County and had direction from the County to do this.
This was a need that the County had to increase the fees and have a zero increase
in the subsidy, and the County was taking this position. The City stated they didn't
want to create an issue, so they approved the increased fees. This process has
been interesting in political terms.
Brenner stated she didn't know the County gave that direction. She wasn't
comfortable raising the fee to the private individual.
Nelson stated the direction was given during the strategic planning process.
Brenner stated that direction was for general stuff, but this is a life -and-
death issue. Generally, they don't want to increase subsidies. Also, she's never
heard any complaints about the quality of service.
Lee stated medic four would be located somewhere in the county. It will be
located in an area that will provide the best response for the volume of calls. The
area of the community that will benefit most by an additional medic unit is the
county.
Brown stated that from time to time they need to examine what is going on
and see if there is room for improvement and room to integrate other activities.
They have an integrated police force in the county. It is possible that some of the
private ambulance services could be integrated into the program. He didn't want to
exclude them arbitrarily. Lee stated other communities have found that a public
emergency service is one that has staying power. There is a very important role
that the private ambulance has played in the community. That is for the non -
emergency transports. It doesn't require a depth of response, and they can
schedule the time a unit is available. All the billing information is available. It is a
good, sound way to stay in business in a planned method. In an emergency arena,
one doesn't know if a patient is at the location stated, if the patient will be able to
pay the bill, and there are many variables that come into play that make it more
difficult.
Dawson supported Councilmember Brown's position. She was also concerned
about the rising costs for the public.
Brenner stated she wanted the committee to look into utilizing private
carriers.
Dave Williams, Fire District #4 Commissioner, stated those in the fire
districts need to make sure the Council is getting the information it needs. The
Commissioners' Association will make an effort to ensure they have ongoing
information. He provided his professional background. He is currently a fire district
volunteer. He is also currently serving on the governor's state EMS trauma steering
committee, representing the State Fire Commissioners' Association. The technical
committee that looks at Whatcom County's emergency medical services for the
Finance and Administrative Services Committee, 12/7/99, Page 12
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future includes nine people who represent the organizations. The committee has
had several meetings and is meeting every other week to address the specific
issues that have been discussed by the City and County councils. The current
system has been in place for over 25 years. It includes the system based on
population density, growth management, transportation corridors, tourist influx,
and a variety of other things that have happened in this county. To fix any
identified shortcomings can't be done in a week or two. It has to be a planned
program action. The committee is looking into current call locations, staff, depth of
coverage, primary response, backup coverage, and compatibility with existing
services. There is a fire -based EMS system in the county. If someone calls 911,
the dispatch center will dispatch the closest fire response agency. That fire
response agency is used to functioning within a certain command structure within
the fire service. It is important to maintain that level of authority. The local fire
districts currently have the authority to provide transport within their district.
However, it is not their job to get into the patient transport business. If his district
chose to contract with a private service, they could do that. There is nothing that
prevents a fire district from providing for the life, safety, and welfare of the citizens.
At this point, the fire services is saying this is the system the fire commissioners
have determined as the best system to protect their constituency. Their job is to
specifically look at fire and life safety. A component of that is transporting
someone to the hospital once they've been hurt. That is the medic one system. He
addressed the points that have come up regarding integration of other services for
better utilization. The problem with including a new service is that a private service
is staffed and geared for a certain level of service. If they received an emergency
call, it messes up their system. Another issue was the fee for service. Medicare,
Medicaid, and private insurance companies will provide a certain reimbursement
rate for a paramedic or other services. They will generally provide reimbursement
for mileage. Ten dollars to eleven dollars per mile is well within the reimbursement
schedule of Medicare, Medicaid, and third -party reimbursement. The impact might
not be as big as they perceive. If they don't have insurance, they don't pay for it
anyway.
Brown questioned whether he was suggesting that uninsured people not pay
their medical bills. Williams stated a lot of people do not pay their medical bills.
Brown stated a lot of people do consider their obligations. Williams stated
that as a private ambulance service owner, they always wrote off a certain amount,
understanding they wouldn't be reimbursed. The other component is that the
County is currently providing a subsidy. If the concern is that they don't want to
increase the citizen's fee, then the Council can chose to increase the subsidy.
Nelson questioned whether there is a reason rural fire districts can't
undertake these services. Williams stated that if there is a serious case, the local
fire district would drive the patient to meet the medic unit. The ongoing delay isn't
what people necessarily perceive. The patient is being treated by state licensed
people capable of providing care. Many of the Whatcom Medic One paramedics live
in the outlying areas of the county, and many of the fire districts provide dense life
support services.
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Brown stated the services are very good. The question is whether they can
integrate and use other services to lower the cost. Williams stated there is a place
for every component of the EMS system, including private service, helicopter, ski
patrol, mountain rescue, fire departments, and Whatcom Medic One. The issue is
that they cannot undermine the total credibility of the public's welfare without
looking at the pluses and minuses of the entire system. He urged the Council to
approve the fee increase and give the committee the opportunity to do its job.
They will keep the Council informed on a regular basis of what is going on.
Nelson questioned why the private sector is not represented on the
committee, if the committee's intent is to provide the best possible package
integrating the whole system, including the private sector. Williams stated the
technical advisory committee was put together as a group to represent the first
response system to the citizens. They looked at bringing other members into the
committee, and had a discussion about inviting the City and County finance
managers to attend all the meetings. The feeling was that bringing those people in
on every meeting is not appropriate.
Nelson questioned why they wouldn't include the private sector, since they
are a part of the integration and this committee was to look at how to provide
service. Williams stated he couldn't speak for the group as a whole. The private
sector has not approached the committee and asked to be a member of the group.
The Fire Commissioners' Association has included the private ambulance service on
their routing mailings, so all the activities of the association is provided. As an
individual, he can't include or exclude any participation. It is the committee's
function on how they wish to handle that.
Nelson questioned whether the committee has precluded them from
participating. Williams stated they have not included or excluded them. They are
not going to include or exclude any particular group in advance of knowing what
they need to accomplish. There is a Whatcom County EMS Council, which is a
subdivision of the Regional Council, which is a subdivision of the state organization.
The council is composed of the Red Cross, hospital, private sector, and others.
Whatcom Medic One is a part of that council as well. There is almost $500,000 in
dispatch fees that is part of the funding they are providing. Integrating private
service would necessitate addressing how that money will be generated, to dispatch
the fire departments to the public.
(Clerk's Note: Imhof left the meeting at 1:30 p.m.)
Rick Kowsky, Cascade Ambulance Service, stated it isn't their desire to tear
down the existing system. Part of the problem they have to deal with on a daily
basis is that they are shackled to a legacy of an ambulance service that went out of
business 25 years ago, in which they are constantly being compared. Their
business is not to support or not support the fee schedule. There are issues that
should be addressed. There is a planning process right now with the Chiefs'
Association and the Commissioners' Association. The current EMS strategic
Finance and Administrative Services Committee, 12/7/99, Page 14
1 planning process is fire based, which excludes agencies like private services, which
2 are the private sector ambulances, and physicians. The local and regional EMS
3 councils are not represented on that committee. So far, the EMS system, the Medic
4 One program specifically, are not held accountable for their actions or their
5 performance, which is the responsibility of both political and administrative leaders
6 in local City and County government.
7
8 (Clerk's Note: End of tape one, side 8.)
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10 Kowsky continued to state that the county chiefs and commissioners have
11 seen a need for change and are responding to that need with their current push to
12 do a system analysis. There needs to be an objective approach to do an evaluation
13 of the system. There are many ways to do that. One of the objective ways would
14 be to hold local governments and medical authorities responsible. There are eight
15 essential performance measures to which the EMS system should be held
16 accountable for. Those include the level of clinical capability and reliability of
17 service, level of response time performance and reliability, cost per response, cost
18 per unit hour, productivity (unit hour utilization ratio), total system cost per capita,
19 local tax subsidy per capita, and subsidy price trade -off analysis. They are done on
20 a national basis to evaluate systems. The only way to do an analysis is to hold to a
21 performance based standard. The key tasks that can improve the current process
22 is to utilize an experienced EMS system designer to evaluate this process, establish
23 a blue ribbon citizen task force to be involved in the process, perform site visits to
24 successful systems serving comparable areas, study available resources and
25 potential design options, present system design and procurement options to elected
26 officials, and complete industry- specific assessment tools. Their desire is to be a
27 participant in the system design and expansion. He requested that the County
28 Council give consideration to support and recommend that the private service is
29 included in the evaluation process, so that an objective look can be given rather
30 than operating on the status quo. There may be a better way to look at things.
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32 Anson Chamblin, Cascade Ambulance Service, stated their purpose is not to
33 bash the current system. He has used the service, and it is gold - plated. As the
34 Council has perceived, it is also very expensive to maintain that high standard.
35 They have had 25 years of successful service. They need to look at how long it
36 would take an ambulance to get to a call. They are concerned about where medic
37 four will be stationed. They have distributed the response times and the call
38 volumes from 1998 data. They can look at it to see longer response times farther
39 away from Bellingham, and these factors need to be included. There are a lot of
40 alternatives. Many systems can depend on public /private cooperation. They work
41 together. The local EMS visioning and strategic planning process has specifically
42 excluded private ambulance service. When this process started, the basic mission
43 statement was that this would be a fire -based program exclusively. Skagit County
44 has a hospital -based system and it is one of the finest in the state. It is an
45 alternative. Other jurisdictions all provide alternative systems.
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47 Brown questioned whether they could draw up a proposal that would
48 integrate a private system into the current Medic One system. Kowsky stated it
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would be inappropriate for them to step in at this part of the process. There are
different programs that can be put together, and they can do that.
Chamblin stated the hospital depends on a private service to do its non -
emergent discharges and out -of -town transports. It would be difficult to juggle
emergency calls with scheduled service. Certainly any service that would attempt
to cover all those bases with one single resource would be opening themselves up
to that problem. Their service has attempted to meet the needs of their primary
clientele, but they would not argue that their current service is adequate to meet
911 referred calls from the public sector. That is one of the reasons they've gone
ahead to add an advanced life support paramedic staffed unit in the county at Wiser
Lake. That unit is largely for training rather than performing transports. They have
been told time and time again in their negotiations with the Bellingham City Fire
Department that they can't use a private service that isn't fully equipped to deliver
service. It is a chicken - and -an -egg conundrum. The private sector could be a tool
in the fire chiefs' toolkit. One way to not balance out the system is to make turf
and politics the prime consideration.
Brenner stated she wanted to see the Council add an amendment to the
agreement that says the private service will be included in the committee
evaluation process. In addition, the Council should consider establishing a blue
ribbon citizen panel. She appreciated that the committee is up and going. She
understood that some people on the committee who are going to try and be
inclusive. She wanted to see that happen. The best way to have that happen is to
have a representative of the private service included.
Nelson questioned whether the response time took into consideration the
response times of the local fire volunteers in rural area. Chamblin stated the
numbers were from a handout distributed by Chief Lee and Division Chief Hammers
in their presentation to the county chiefs and county commissioners. He has taken
the Bellingham Fire Department data.
Nelson stated the data was only for the Bellingham Fire Department, and
response times could be skewed. Chamblin stated the data included two
responses. The first response was from the local fire district. The second response
was from the Medic One response.
Kowsky stated Whatcom County is very fortunate in terms of its structure.
There are many fire districts that provide an excellent level of surface on initial
responses. They are speaking primarily to licensed transport ambulance response.
Williams stated Brenner's suggestion to include the private service is well
taken, but the technical committee is representative of the Chiefs' Association, the
Commissioners' Association, and the Bellingham Fire Department as the
administrator for Whatcom Medic One. The committee is representative of those
parent organizations and it does not have the authority to do anything other than
take a look at and make recommendations back to their parent organizations. The
governance of how a local taxing jurisdiction, such as a fire district, and how they
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decide to do their strategic planning should be left up to the district. It would be
inappropriate for a fire district to suggest that the Council include a subcommittee
in which the Council has purview.
Nelson stated they do that all the time. Williams stated the reality is that
Whatcom County is a fire -based EMS system. If the request is that the private
service be incorporated into what the committee is looking at, then he assured the
Council it is already on their agenda.
Nelson asked the purpose of the technical advisory committee. Williams
stated the purpose is to look at the existing system and see if it is functioning
efficiently based on the current model, or if there are more effective models that
they can look at. They haven't even gathered all the data to evaluate what the
model may be.
Brown stated that if they don't include the private sector, they would be
excluded from the start. Williams disagreed. They are already looking at it. He
doesn't work for the fire department. He works for the citizens that elected him.
There are some members on the committee that work for fire departments, and
they will probably be very slanted toward the fire service orientation.
Nelson asked who put the committee together and why. Williams stated the
Fire Commissioners' and Fire Chiefs' associations identified a concern about
response times in various areas of the county. The executive committee of those
organizations was charged with developing a process to develop a strategic plan
that would recommend what the model for EMS ought to look like in the County.
Brown stated this boils down to looking at something in the future to see if it
will fit in. They are not going to make a change now.
Williams stated that if the committee makes a recommendation to the
Council that isn't founded on reality and that failed to look at options and to
integrate all the options, the Council has the option to not fund them at all. As a
responsible member of the committee and his district, he will make sure that all the
options are evaluated.
Kowsky stated current EMS strategic planning is solely fire based. There
should be private sector input. That is a decision they recommended and the
Council has to pass along if that is its choice. Regarding the big picture, the
Washington Ambulance Association has been named as a member of the State EMS
911 Advisory Board. The association is comprised solely of private ambulance
services statewide. They operate in excess of 400 ambulances statewide. The
lobbying efforts they provide do a lot for ambulances, but there was a lot of
downfall to public agencies. He pointed out that there was desire from the
beginning to be an active participant in the program to evaluate the EMS program
in Whatcom County. They were requested not to participate any longer. When
they attempted to participate, they were excluded and were asked not to
participate.
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David England, Fire District #13 Fire Chief and Chiefs' Association President,
stated the Chiefs' reason for spearheading the EMS steering committee was
because they have been frustrated that they were not included in any Medic One
planning. They wanted to include input because the Chiefs' Association is
composed of fire chiefs from 17 fire districts and two municipal departments in the
County. Anything that affects EMS, particularly funding, directly impacts the fire
district. EMS is a very important component of their operations. All the members
are thoughtful, careful planners who want to make decisions based on facts, not
probabilities or suppositions. To do that, they began a strategic planning process
two years ago. EMS was the first priority on the list. They decided to ordain a
committee that would include the Commissioners' Association. They decided to be
in partnership with the Commissioners' Association. The commissioners are the
policy makers and the chiefs run the day -to -day operations. Because Medic One is
a big stakeholder, they were included. The purpose was not to exclude others who
would be critical of the decision - making process, but to create a workgroup that
sorts the data and then puts together a plan that could be brought to the policy
makers.
Brenner stated they are not demanding the private group be included. They
are only requesting. England stated they are being excluded because of the
intimidating factor and because they are involved in litigation.
Dave Hanson, Whatcom County Fire Commissioners' Association, stated he
was happy to bring in the private sector. There are other private sector companies
besides Cascade Ambulance. Right now Cascade Ambulance is involved in litigation
with the City of Bellingham.
Brown moved to forward this without a recommendation.
Motion carried 2 -0 with Imhof absent.
6. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO AN
INTERLOCAL AGREEMENT BETWEEN WHATCOM COUNTY AND THE
CITY OF BELLINGHAM FOR THE COUNTY TO PROVIDE CRIMINAL
JUSTICE SERVICES (AB99 -468)
Brown moved to recommend approval.
Brenner questioned whether the City of Bellingham would pay their costs.
She also questioned whether it was correct that, if the costs were higher, they
would be paid the next year.
Dewey Desler, Deputy Administrator, stated that was correct, but that
proviso doesn't kick in until next year.
Motion carried 2 -0 with Imhof absent.
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7. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO A
CONTRACT BETWEEN WHATCOM COUNTY AND TEAMSTERS SHERIFF'S
SUPPORT STAFF COLLECTIVE BARGAINING AGREEMENT (AB99 -469)
Brown moved to recommend approval.
Motion carried 2 -0 with Imhof absent.
8. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO A
CONTRACT BETWEEN WHATCOM COUNTY HEALTH AND HUMAN
SERVICES AND LAKE WHATCOM RESIDENTIAL AND TREATMENT
CENTER, TO PROVIDE SUBSIDIZED LIVING RESIDENCES FOR 50
MENTALLY ILL CONSUMERS, IN A CONTRACT AMOUNT OF $69,000
(AB99 -470)
Nelson moved to recommend approval.
Motion carried 2 -0 with Imhof absent.
9. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO AN
INTERLOCAL AGREEMENT BETWEEN WHATCOM COUNTY AND THE
CITY OF FERNDALE FOR LEACHATE PRE - TREATMENT AND DISPOSAL
AT THE FERNDALE WASTEWATER TREATMENT PLANT (AB99 -472)
Brown moved to recommend approval.
Motion carried 2 -0 with Imhof absent.
10. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO AN
INTERLOCAL AGREEMENT BETWEEN WHATCOM COUNTY AND THE
CITY OF BELLINGHAM FOR SOLID AND HAZARDOUS WASTE
PROGRAMS IN THE AMOUNT OF $247,000 (AB99 -473)
Nelson moved to recommend approval.
Motion carried 2 -0 with Imhof absent.
11. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO A
SERVICE AGREEMENT BETWEEN WHATCOM COUNTY AND JOHNSTON
AND CULBERSON, INC. FOR THIRD PARTY ADMINISTRATION OF
WHATCOM COUNTY'S WORKERS' COMPENSATION PROGRAM IN THE
APPROXIMATE AMOUNT OF $21,223 (AB99 -474)
Nelson moved to recommend approval.
Motion carried 2 -0 with Imhof absent.
Finance and Administrative Services Committee, 12/7/99, Page 19
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12. REQUEST AUTHORIZATION FOR THE EXECUTIVE TO ENTER INTO A
CONTRACT BETWEEN WHATCOM COUNTY AND WHATCOM
COUNSELING AND PSYCHIATRIC CLINIC FOR THE PURPOSE OF
PROVIDING PSYCHIATRIC SERVICES FOR INMATES IN THE JAIL, IN
THE CONTRACT AMOUNT OF $20,460 (AB99 -475)
Brown moved to recommend approval.
Motion carried 2 -0 with Imhof absent.
OTHER BUSINESS
1. DISCUSSION REGARDING ESTABLISHING SERVICE FEES AND
SETTING A FEE SCHEDULE RELATED TO AMBULANCE SERVICE
CHARGES (AB99 -447A)
See discussion in Consent Agenda item five, above.
ADJOURN
The meeting adjourned at 2:05 p.m.
Jill Nixon, Minutes Transcription
ATTEST:
Dana Brown - Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
L. Ward Nelson, Committee Chair
Finance and Administrative Services Committee, 12/7/99, Page 20