HomeMy WebLinkAboutFebruary_3_2004_Briefing_SessionIREDELL COUNTY BOARD OF COMMISSIONERS
BRIEFING MINUTES
FEBRUARY 3, 2004
The Iredell County Board of Commissioners met in Briefing Session on
Tuesday, February 3, 2004, at 5:00 p.m., in the Iredell County Government Center
(South Wing Conference Room), 200 South Center Street, Statesville, NC.
Present were:
Chairman Steve D. Johnson
Vice Chairman Godfrey Williams
Doug Madison
Marvin Norman
Sara Haire Tice
Staff present: County Manager Joel Mashburn, Emergency Management
Director Tracy Jackson, EMS Director Lee Darnell, Library Director Steve Messick,
Finance Director Susan Blumenstein, Planning Supervisor Ron Smith, Chief Deputy
Rick Dowdle with the Sheriff's Department, Support Services Director Jim Vernon,
and Clerk to the Board Jean Moore.
CALL TO ORDER by Chairman Johnson.
PRESENTATION REGARDING THE STATE EMS PLAN & NUCARE
AMBULANCE SERVICES: Joining Emergency Management Director Tracy
Jackson and Emergency Medical Services (EMS) Director Lee Darnell for a discussion
regarding NuCare Ambulance Services was Dr. Steven Folstad, the Medical Director
for the county's EMS and 911 Emergency Communications Departments.
Jackson said that in accordance with state law, Iredell County had to provide the
oversight for all private and rescue squad ambulance services operating within its
territorial jurisdiction. He said the agencies had to meet state standards, as well as any
requirements imposed upon them by the governing unit providing the oversight.
Jackson said NuCare, a private ambulance service operating in Iredell County, had been
apprised of the state and local standards; however, several problems had been
encountered. He said the company was noncompliant in several areas.
Darnell said Iredell County's State EMS Plan had a "solid focus towards patient
safety." He said three different supervisors had been employed at NuCare during the
past year, and all of them had been notified about the compliancy needs. Darnell said
the company's officials ignored the information, even after it was submitted numerous
times. He said a December 31, 2003 compliancy deadline was given, and after this
time elapsed, he made an inspection. Darnell said the agency was still out of
compliance, and the following non -compliancy items were observed.
• No drivers' training
• North Carolina State forms had not been completed
• Narcotics were in an open container
• Lack of paramedic training
• Lack of patient data
He said after this, a 45 day compliancy deadline was given, along with a
statement asking if the company planned to continue its operations in the county, and if
so, at what level. After this, he said the company sent a fax indicating NuCare planned
to continue its services at a paramedic level. He then made an inspection and found the
following problem areas.
• No drivers'training had been accomplished
• Lack of premises reporting
• HIPAA requirements were not being followed
• Odor of cigarette smoke in the vehicles along with cigarette ashes and
patient information lying on the floor boards of the ambulances
• All three of the NuCare ambulances failed inspection
• Drugs were not being properly stored
• NuCare staff had difficulty identifying some medications (Toridal)
Darnell said after this visit, that instead of "shutting the company down on the
spot," he called for a meeting. He was then told that on February 2, 2004, additional
funding would be coming to NuCare, and this would help the company achieve
compliancy. Darnell said a new deadline of February 9 was then given. Mr. Darnell
stressed his concerns, and said the company was a liability on Dr. Folstad and the
county.
Dr. Folstad said it appeared NuCare was basically a "bottom-line company." He
said the company was "miserably out of compliance" and much time had been given to
help it achieve compliancy. Folstad said that if the county took over all of the
ambulance calls there needed to be a balance between 911 availability transports and
the convalescent trips.
Commissioner Williams asked if there were any other companies in the area
providing the services.
Darnell said he wasn't aware of any providing the same types of transports as
NuCare.
Chairman Johnson asked Darnell if the relationship with NuCare could be
severed, and if so, when he felt the county could provide the transports.
Darnell said Dr. Folstad could end the relationship. He estimated the county
could be ready in three weeks. Darnell said NuCare would not share any of its financial
records, but he had reviewed the county's history prior to the company's establishment
in the county. He said that to assume the services, he was estimating the costs to be
around $163,000 for the remainder of this year. Darnell said much of this was set-up
cost including another paramedic truck. He estimated the revenues to be $29,000. He
said another option would be to add another paramedic truck and two prime -time trucks
at a cost of 744,000. Darnell said the rescue squads could be approached about the need
for space. He said grant funds of $219,000 had been identified, and this would lower
the cost to $525,000 through the end of 2003-04. Darnell projected the revenues to be
at $382,000 for both Advanced Life Support (ALS) and Basic Life Support (BLS)
transports.
County Manager Mashburn asked if the county was demanding more from
NuCare than what was necessary.
Darnell said the county had standards pertaining to equipment and drivers'
training, but the state did not. He said Iredell County had always felt that individuals
driving ambulances needed training.
Jackson said the medical community would much prefer to use the county's
services over NuCare.
Commissioner Tice asked about future revenue projections, assuming the county
provided all of the transports.
Darnell said revenues were difficult to estimate. He said two employees were
dedicated to EMS billing, but that most counties had ended up outsourcing this work.
Darnell said technology was always changing, and the county did not have an
in -house -billing expert. He continued by saying that several months ago, a request for
proposals had been sent to billing/collection agencies, and it was discovered the county
could be more profitable by outsourcing -- even after the company took its fee, the
county might be ahead by $500,000 to $600,000.
Mashburn said the county did not make any money on ALS transports.
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Darnell said that much of NuCare's business was with the Veterans
Administration and a paramedic truck was required for these transports.
Finance Director Blumenstein said the county had enough in contingency to
assume the services, if the board decided to do so.
Commissioner Madison said it might be prudent to notify NuCare that if
compliancy had not been achieved by Monday, February 9, 2004, that the company
could expect its business association to end with the county.
The board of commissioners then requested a NuCare update at the February 13
winter planning session, and for the staff to present a budget amendment at the
February 17 regular meeting, if necessary.
ADJOURNMENT: Chairman Johnson adjourned the briefing session at 6:15
p.m.
Approval:
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Clerk to the Board