MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:
NOVEMBER 24, 2008
TABLE OF CONTENTS
Page
Discussion: Fiscal Year 2010 County Budget............................................................................ 1
Medical Examiner (10)................................................................................................ 1
Ambulance (01).......................................................................................................... 5
Emergency Medical Services (31).............................................................................. 12
Ambulance Special Revenue Fund (56)...................................................................... 12
Discussion: Fiscal Year 2010 County Budget.......................................................................... 13
Chairperson Sullivan called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 9:02 a.m. Members present were: Larry Meyers, Terrence Neuzil, Sally Stutsman, and Rod Sullivan; absent: Pat Harney.
Medical Examiner Administrator Michael Hensch said the line by line increase is not that large. The main increases are in office supplies and medical supplies. Part of the office supplies increase is because he is asking for the administrative assistant that is currently working part-time at the University to become full-time with the County. Currently she is using office supplies from the University, which have been donated by the University. He said medical supplies increase by about $4,300 simply because of an increase in volume of disposable supplies. Hensch said they have to increase the postage budget due to the County paying for postage rather than the University. Hensch said that for a few years, the County has gotten a free ride from the University for office supplies and postage. He said there is a cell phone increase because Hensch wants to get broadband access out in the field so they can send their reports to the University directly.
Hensch said there has been an increase of about $7,000 for the Medical Examiner, which is external. That is the money for Chief Medical Examiner Dr. Stephen Scheckel. Hensch said it is because Scheckel works so much that the amount of money going to the medical examiner at the University has now been properly reallocated. Hensch said they worked really hard to keep the autopsy expenses as low as they possibly could, and that is where the majority of the decrease is.
Stutsman asked about the employee at the University and if she will become a County employee. Hensch said they have a person in the University that they pay one third of her salary, who is the secretary in the Department of Emergency Medicine. He said they have always had her since the program switched over from the prior Medical Examiner to what it is now. Her workload has increased with the County's workload, so now she spends about 60% of her time doing Medical Examiner work but the County is only paying one third of her salary. Hensch said she is receiving a lot of pressure at the University that that is not going to happen anymore, plus they have no control over her time when she's at the University. He said they supervisor her, they assign her workload, they evaluate her performance. It has been a very good deal for the County because obviously they have someone who is working most of the time on County work yet the County only pays one third of her salary. Hensch said that the employee is also using some of Emergency Medicine supplies and postage. He said the downside with this arrangement is they have a split location. He said County records and her work are at the University and it is very inefficient. Hensch said access to County records during evenings and nighttime is unavailable. He said they need to have a full-time employee. Since Hensch can't assign the employee additional work, he goes into the office every weekend to do the work.
Stutsman asked if making this employee full-time as a County employee is in the budget. Hensch said yes. He said that is a dollar for dollar offset, and that there is no increase in the budget. He decreased other areas of the Medical Examiner's budget in order to fund her full-time. Hensch said that covers her salary plus benefits, plus the money set aside to purchase a new truck for transport. R. Sullivan asked if Human Resources has gone through the job description for the split time employee. Hensch said he is working with Human Resources Coordinator Vanessa Wierman but doesn't have the formal job description yet. He is working with Wierman to get comparable job descriptions so he knows what the range will be. R. Sullivan asked if this specific employee is interested in this specific position. Hensch said yes, but until she goes through the hiring process he doesn't have much to comment on. Neuzil asked what the position this employee is currently in at the University Hospitals and Clinics. Hensch said she is an Administrative Assistant for the Emergency Medicine Department. Stutsman said the employee will not do any work for the University if she becomes a County employee. Hensch said that is correct and that she will just do medical examiner work. Stutsman said she isn't interested in subsidizing help for the University. Neuzil asked if the medical records will stay at the University. Hensch said they are the County's property and will be moved. Stutsman asked if the aforementioned employee will be located in the remodeled offices.
Stutsman asked if Hensch's office does anything with burials. Hensch said that if there is an unclaimed body, state law requires the County Medical Examiner's Office to make sure the body is buried. He said an indigent will be referred to General Assistance or Veteran's Affairs, because they fund indigent burials, depending if they are a veteran or not. Stutsman asked if this falls under the Social Services budget. Hensch said Social Services or Veteran's Affairs if the deceased is a veteran. There is a higher reimbursement for veterans so they try to turn the veterans over to Veteran's Affairs right away. Hensch said the reimbursement is a couple hundred dollars difference and the bodies are buried in the VA Cemetery in Rock Island, Illinois or in Des Moines.
Stutsman asked if they have seen an increase too. Hensch said yes and that burials are expensive. He said many of the families live paycheck to paycheck and don’t even have $2,000 for the minimum cost of a burial. Stutsman recommended that Budget Coordinator Richard Claiborne talk with Correia when that issue comes up. She said the funeral homes are expected to carry more and more of these costs, and she doesn't know what they can do about it. Stutsman asked if anyone has any thoughts concerning the topic. Hensch said he thinks every couple of years, it is necessary to reevaluate where the reimbursement level is at. He doesn’t know if that would be renegotiated. Stutsman said one important fact is that families can't contribute at all. Hensch said it is very limited. Hensch said that families can make some contribution up front. He said funeral homes have families pay upfront for flowers or musicians or the official presiding over the burial service. Hensch said funds are pretty limited in order to guard against families using the County as a subsidy for a better funeral.
R. Sullivan said the costs are essentially covering the physical labor of placing the body in the ground. Hensch said every couple of years they need to reexamine the burial guidelines. R. Sullivan said line item 33 goes up $7,700, but then line item 28 goes down $15, and wondered if that is some of the problems Hensch was referring to earlier. Hensch said the account name is Medical Examiner B, U of I Internal. He said that is because the two positions, with a University position employee cannot be paid directly. He said they also write the check to the University and then the University pays the employees. Hensch said the Medical Examiner External line item is for Dr. Scheckel who works at Mercy, so they can pay him directly and he sometimes works 3 to 3 1/2 weeks per month.
Stutsman asked what will happen if the Board doesn’t approve that. Hensch said they will muddle through. R. Sullivan asked about the position at the University. Hensch said he is not sure and that he has no control over her hours. He said if the University tells the employee she can’t do Medical Examiner work a particular day and she needs to do a different project, then she can’t. Hensch said timeliness is a big part of what they do, because reports have to get to the State, the County Attorney, and law enforcement. Hensch said death certificates must also be issued to families so they can proceed with life insurance claims.
Stutsman asked if Hensch can generate any of those reports. Hensch said the program is on the computer at the hospital and he could do the work but it adds to his other responsibilities. Stutsman said she is asking because no one knows how the budget year is going to shake out. Hensch said if they lost the employee’s position over there, then it would be impossible. Hensch said it is really heavy-duty production stuff. He said is like typing five or six reports a day and making 50 copies. Stutsman asked how much of this is Johnson County’s responsibility and not just the University of Iowa Hospital. Hensch said it is entirely the County's. He said they've had 550 cases, which means they need to generate 550 reports and 550 death certificates. Stutsman asked how many of those cases are actual residents of the County. Hensch said about 60% of their caseload is out of Johnson County. Hensch said they collect about 100% for the out-of-county cases. Hensch said they collect every bill they send. He said they charge an hourly fee for everything. Hensch said they have had some complaints but people are still paying.
Neuzil said it is a proactive move to try to pursue the position, and that he agrees with Stutsman. He said the Board needs to be cautious with their budgets. Hensch said that the dollar amount covers her salary and benefits. Stutsman said the other thing is that it is an ongoing liability when hiring an employee and she thinks they have to take that into consideration. She said from all indications this year may be worse, but nothing compared to the years to come. Hensch said the UI doesn't consult with Hensch about employee time and staffing needs.
Hensch said there is an increase of about $30,000 in revenues and he is pretty comfortable with that. There is a revenue increase in the Department of Corrections and they receive 100% of those plus 100% reimbursement on all autopsies and out of county deaths and cremations. Claiborne said they originally budgeted $151,000 and now he's up to $181,000.
R. Sullivan asked about capitol technology. Hensch said they rent a 1991 Ford F150 with a half-ton pick-up truck. The arrangement was put together by former UIHC Department of Emergency Medicine Administrative Director Jeffrey Gauthier without input from anyone else and it was not set up correctly. Hensch said the truck is under sized, it is only a two-wheel drive, and is completely inadequate on County roads during the spring thaw and icy winter. Hensch said they have muddled through the last seven years because that's what they had and it was not fiscally responsible to make changes. He reminded the Board that every year the amount of rent goes up. Hensch said they have already paid for the truck and now they will be paying even more. Fiscally it doesn't make sense to be paying rent on a vehicle that is totally depreciated. Hensch proposed purchasing a four wheel drive, three-quarter ton pick-up, with a lower profile fiberglass shell so it doesn’t pick up the wind so much.
Hensch said in FY08, they made about 30 trips to Ankeny transporting bodies. He said it is much cheaper for them to pick up the bodies and transport them to a funeral home because funeral home prices are so high. Hensch said an in-town transport one way is $325 to $375. Hensch said the cost to transport a body one way to Ankeny is $500 to $800. He is asking to have $25,000 set aside next year so the year after they will have an equivalent amount and then they can buy the Ford pick up. Neuzil asked what the total cost will be. Hensch said close to $50,000 for an F250 with an extended cab. Hensch said he estimated the life on the truck to be ten years, so they could just put a moderately small amount aside every year. R. Sullivan said it is a lot easier to stomach $5,000 a year for ten years than trying to pay all at once.
Hensch said he has laptops under the current fiscal year for a laptop PC for secretarial and administrative assistant position and a laptop for the field investigator position. Neuzil asked if that is all taken care of. Hensch said yes. He said in the decision packet, he tried to give the Board a solid description of what he is asking for. Stutsman asked Hensch what is his top priority. Hensch said his top priority is the new administrative assistant position. Stutsman asked if Hensch is doing anything in the department outside of what is required by the code. Hensch said not really. He said they struggle just to keep up with the required services and they do a really good job of it. He said they would love to do more. Stutsman said the Board doesn't want them to do more right now. She said the Finance Committee has talked about reviewing each departments budget during an off budget year.
Ambulance Director Steve Spenler said the increases in the decision package are almost all due to inflation and also an increase in call volume. Spenler said fuel is also a significant increase and they have already spent 47% of the 2008 budget. He said fuel is a moving target and it is hard to predict for the future. Spenler said he calculated that number based on a 10% increase for next year, and will bump it up to 500 gallons from the $3.75 a gallon the last month. He said the average has been just a little over $3 a gallon. Spenler said 98% of fuel is diesel. Spenler said he thinks the high has been $4.23 a gallon, and that now they are down to under $3.00 per gallon. He said medical supplies are in direct correlation to the cost of fuel. Spenler said there is also an increase in call volume at 51% for 2008 medical supplies, which is something they have always had a good handle on with the cost of things. He said they no longer have a handle on it. He said management registration has always been somewhat under budgeted, and the $5,000 increase will only be for three or four years.
Spenler said he wants to send all management staff to a service management course in Kansas City. He said it is a six-month long certificate course with two weeks of the class scheduled on site in Kansas City and the rest is done online. Spenler said as they move forward with increased call volume they are moving in a much different dimension and the managers need a much more broad based education and a sense of what the profession is. Spenler said as they get busier and busier, sending managers to a course like this will allow them to network with peers and bring back knowledge of best practices. He said the cost of $2,300 would be a good investment for the management staff. Spenler said one manager will be taking the class this spring. Spenler said all the managers in the Cedar Rapids and Davenport area have taken the course, and he has received some really good feedback.
Spenler said he is throwing out the $6,000 as the cost of rent. He said if and when they put a fourth truck on, he would like to house the ambulance at the Iowa City Fire Department's new station on the west side, or the current Coralville location. Spenler said they will move the new Coralville truck to the new station north of the interstate. He said it is his understanding that the construction bid should be going up sometime in December 2008.
Spenler said the supplement on the coverage during peak times on the west side of the City is going to be very beneficial. Spenler said they are now projecting for 2009 and the year after that they are going to need additional staff during peak times, or else they will need to give calls away. Stutsman asked if Ambulance has always had this high rent. Spenler said they pay basically a cost-of-living fee to the Coralville Fire Department, which covers utilities for the year. Stutsman said it seems like it is pretty high. Spenler agreed and said he doesn’t expect it to be that much for the west side location. He said the number that was thrown out by Iowa City Fire Chief Andrew Rocca was $750 a month. Spenler said Rocca made sure he knew that was a starting rate. Spenler said they have not negotiated. Meyers said it was only $100 or $150 more than Coralville. Spenler confirmed it is $150 a month more than Coralville. Neuzil asked about housing the truck at SEATS or Secondary Roads. R. Sullivan said it is not that far away from there. Spenler said he didn't realize that would be an option. Spenler said they will need some kind of office building to stage at when staff is not on call. They will need a refrigerator and a somewhere private where employees can do their documentation.
R. Sullivan said he finds the number frustrating because no one benefits more than the City of Iowa City for having an ambulance on the west side. Spenler and Stutsman agreed. Neuzil said he doesn't have a problem with paying Coralville for utilities. Spenler said the $750 is based on them being there 24 hours a day seven days a week, and that is not going to happen. He said he agrees it is high, and that Rocca told him repeatedly that is just a number they have started with. Neuzil asked if peak times are Friday and Saturday night. Spenler said he will get into that more tomorrow, but that they have seen growth throughout the week. Peak times are Monday through Thursday from 8:00 a.m. to 5:00 p.m. and then Thursday, Friday, and Saturday nights are fairly busy. Spenler said their busiest hours are still early Saturday morning between 1:00 and 3:00 a.m. In 2007 they ran about 150 calls during those two hours.
R. Sullivan said that is one of the reasons why that $6,000 grinds on him. He said those 1:00 to 3:00 a.m. calls are not in Coralville, Tiffin, Oxford, Solon, or Hills, they are in downtown Iowa City. That is part of the drinking culture and that grinds him all the more that this is an Iowa City problem and they want to charge $6,000. Meyers said the $6,000 covers both Iowa City and Coralville. Spenler said that would be an increase. Stutsman asked if Kempf should get an estimate for an ambulance for each department. She said she doesn't know how the rest of the Board feels about it and she knows Kempf is busy until the end of December 2008. Spenler said they are not talking about the 2008 Fiscal Year. R. Sullivan said it will be ideal to be at the fire house instead of SEATS or Secondary Roads. He said he in terms of coordinating with the other emergency responders, it seems more convenient. Spenler said SEATS/Secondary Roads location allows for easy access to Highway 218 and in addition, Camp Cardinal Road has good access to a lot of different places. Neuzil said there has to be a plan for future growth out there.
Stutsman asked if socialization would be an issue. She said employees can get pretty isolated at the SEATS/Secondary Roads location especially on the weekends, and she can see the advantages of being housed in a firehouse. Spenler said there is good and bad with that scenario. R. Sullivan said it really troubles him that Iowa City gains the most from having the Ambulance out there during peak call times. Spenler said call increases are not just from downtown Iowa City, calls from Coralville have increased too. Spenler said most of the increase has come from the south east quadrant of Iowa City, and they are not all directly related to alcohol. Spenler said when they receive 70 to 75 calls from those busy areas between 1:00 a.m. and 3:00 a.m. it is concerning to him that all the department resources are tied with those calls because they do cover all of Johnson County and people do get sick during that time. He said they are running out of trucks. Stutsman asked Spenler if he spoke with Rocca to see if that is what he has budgeted in his budget for income. Spenler said as far as revenues, no. Stutsman asked if Spenler just estimated based on his conversations with Rocca. Spenler said yes. He said he has been discussing this with Rocca. Stutsman asked Spenler to tell Rocca that the Board is still discussing this and she is concerned about him budgeting a large amount for this only to find out the money might not be there.
Stutsman asked if revenues would offset the Medicare expenses. Spenler said the University of Iowa standby fees are predominately from athletic events, as well as graduations, and it is just a cost-of-living increase that is passed on every year. Spenler said University of Iowa call fees have been renegotiated for mobile care including the two ambulances the County manages for the University of Iowa Hospitals. He said there is an increase in fees expected from that mobile care operation.
Spenler said average cost for transport has been projected onto the FY10 budget at a five percent increase which is probably a little conservative. Spenler said he also projected a three and a half percent increase in cost of living for the fees, and then projected an average charge in order to calculate the difference in revenue. He said he is also projecting a 60% payment, which is also a little conservative. He said additional revenues should be about $173,000. R. Sullivan asked Spenler how that 60%-40% compares to what is collected overall. Spenler said the FY08 to date is about 62%. R. Sullivan said those numbers are really close. Spenler said they will probably end up at about 65%.
Spenler said they are doing things to try to combat against those increases. He said they are working with both Mercy Hospital and University of Iowa Hospitals to get correct addresses and follow up with people as quickly as possible. Spenler said the next day after a pickup the hospitals are faxing their information and it is helping considerably. He said they were getting stacks of bills back with wrong addresses and that cuts down on returned bills. Spenler said the sooner they get the bills out the better. Spenler said cooperation in handling all of the little issues helps get the bills out quicker. He said this is particularly important in Iowa City where the population is so transient. Stutsman asked Spenler how he has dealt with revenues in the past. Spenler said revenues in the past have been somewhat under-budgeted. He said he thinks it has been fairly significant and he is doing a better job of being a little closer to actual revenues. He said he still tries to be a little conservative and accurate as possible.
R. Sullivan said they know Spenler made an adjustment last year which the Board appreciates. He said it is important to project revenues as close to reality as possible. Spenler said currently Ambulance is probably four or five percent over budget on revenues. He said the increase in call volume for FY08 is just under $300,000 more than this time during the last fiscal year. Spenler said that is a 60% increase and should be an additional $110,000 in revenue. He said the $110,000 increase is just from the start of this fiscal year through October 31, 2008 and therefore it will be more than that by the end of the fiscal year.
Spenler said Ambulance is asking for two full time paramedics and a 0.4 full-time equivalent part-time paramedic position. He said the last time Ambulance added staff was in 2005 and by the end of FY08, call volume was up about 25% from FY05. Transports are up about 10% already in FY09 and Spenler projects transports will be up 31% by the end of FY09. Spenler said he thinks it is important to staff an extra truck during peak times. He said the two full time positions would allow them to do that but they will not necessarily work together.
R. Sullivan asked if the total cost of the two positions would be $112,000. Spenler said that amount will be for the full time positions and an additional truck. He said the part-time position will be a separate issue. R. Sullivan asked Spenler what he anticipates for the cost for the 0.4 part time position. Spenler said the wage would be $17.12 an hour. Spenler said the field supervisors would be in the office from 3:00 p.m. on Friday to 7:00 a.m. Sunday. He said this would extend those hours to 11:00 a.m. on Sundays. R. Sullivan asked if they are talking about roughly $15,000 a year. Spenler said he knows it is not a good year to ask for additional staff but he did not ask for the education position even though he feels it is needed. R. Sullivan clarified that Spenler is asking for $127,000 for the increased cost for the new positions, but revenue will be generated from the increased volume of calls.
Spenler said right. He said they are going to be getting more calls and will try to handle them no matter what. R. Sullivan asked if there would be less overtime due to the additional employees. R. Sullivan said he doesn't think the expense for their salaries is a total expense without any income attached. He said he thinks there are some offsetting revenues and the question is how much. Spenler said to a certain degree it is offset. He said it will be difficult to directly relate it to actual calls.
Spenler said the problem is as the call volume increases, they run out of trucks during peak times. He said unfortunately they don’t have a dispatch system that can triage calls and prioritize them. Basically dispatchers take calls as they come in. Spenler said if they have two calls simultaneously then they prioritize them based on need. He said if they determine there is going to be a significant delay, they call on southeast Iowa for back up support. That has occurred four or five times in the last three or four months. Spenler said they will continue to see an increase in call volume next year and will have to rely on southeast Iowa more frequently. He said they need a concrete systematic plan to address the call increase. Spenler said right now the plan is haphazard. Spenler said the triage service is Mercy Medical dispatch and it does prioritize the dispatch code. He said Johnson County Ambulance does not have a system to determine which calls can wait and be put in a queue for 45 minutes. He said if an ambulance is requested in the County the dispatcher will not question the severity of the emergency before sending an ambulance. Spenler said there are dispatch systems around the country that will take calls and go through a list of criteria with the caller to determine if the call needs emergency attention.
Stutsman asked if the Communication Center is planning to develop a system like this. Spenler said he doesn’t believe the Communications Center has discussed this and does not think they are on target for one, but that it would be nice. R. Sullivan said it is a huge trend in the Ambulance industry. He said people call 911 for everything. Spenler said the norm for big systems is when ambulances go out of the hospital they have 15 minutes turn-around time because they have another call waiting. He said the County does not have a system to prioritize calls by which ones can wait and which ones need immediate attention. Spenler said Johnson County is not adequately prepared to make the determination about who to prioritize for service. He said it is something they need to address for the future.
Meyers asked if a full-time position was required in order to address the call volume increase and prioritize calls. Spenler said a full-time person is not necessarily needed. He said they can have conversation on this issue after the director of the Joint Communications Center is hired and the users group starts meeting in January of 2009. Stutsman said she is conflicted with this. She said she supports having an ambulance go out for any call. She asked if staff is required to keep the current level of service or if they should consider triage. Stutsman asked if a minor injury such as a sprained ankle warrants the same immediate response as someone in a car accident. Spenler said they need to be careful with this, they do have a standard of care and a duty to act. Spenler said the standards they have always had is that they go out and take care of people’s problems. Stutsman said that is a policy decision that the County has made. She said it is time to re-evaluate the policy decision.
R. Sullivan said this issue is probably one of the goals for next year. He asked Spenler to give the Board his professional opinion on this. Meyers said it seems reasonable to be looking at this issue. He said he can understand a problem with calls being cancelled after an ambulance is sent to a location. Spenler said those calls are not increasing and the problems are the transports. He said they spend time in transport for the convenience of the caller even if it is not medically necessary. Spenler said it is difficult to tell someone that what they consider a medical emergency is, in fact, not. He said Ambulance responds to every call, but there are times when calls could be put on hold for 45 minutes. Meyers said if they aren’t doing anything at the moment then it is okay to go to those calls. Spenler said the person sitting on the pager does not have the ability to see everything that is going on and cannot delay with the “lesser” emergency calls. Spenler said it is difficult for them to decide which emergencies constitute importance over the others. He said they need to develop a protocol for prioritizing the calls. M. Sullivan said it is not uncommon for police departments to place calls in a queue in order of importance but those police departments have a protocol. Spenler said they do get a lot of legitimate calls, and the acuity level and the number of advanced life support calls have increased. He said they receive many calls that aren’t that severe, but the increase is in sick people, transports, and calls that take on average 55 minutes total time before staff is available for another call.
R. Sullivan said they could justify adding staff this year. Spenler said they could justify an extra truck at peak times now. Stutsman asked if Spenler included that in the budget. Spenler responded no. Neuzil asked how long it has been since a new ambulance was added to the fleet. Spenler said they added a new truck in FY07. Neuzil asked if they paid that back in full last year. M. Sullivan said no. Neuzil said they have been setting money aside. Spenler said he does not believe money was set aside for it. He said every year in his budget he includes a replacement schedule and requested funding but he does not believe it has been funded. He said last year $115,000 was spent on the truck.
Neuzil said normally they would save for a couple of years. M. Sullivan said Spenler has always had this scheduled. Stutsman asked if the $125,000 has been included the budget every year. Spenler explained he includes a replacement schedule in every year, but it is never funded. Neuzil asked Claiborne how much was spent on Ambulance vehicles last year. Claiborne said he would have to look up the information and get back to the Board. Spenler said $115,000 was allocated for Fiscal Year 2008. Neuzil said that was to purchase one vehicle. Neuzil said they put $115,000 in for the vehicle. R. Sullivan said Ambulance has six vehicles and they are replaced over an eight year period. He said, essentially, they are setting aside replacing the cost of one vehicle a year or getting close to replacing one vehicle.
Neuzil asked if they have six vehicles now. Spenler said yes. Neuzil asked Spenler what is being added to the budget. Stutsman said Spenler will be adding staff but not a truck. Spenler said yes, they are adding staff for a fourth truck. Spenler said he will have a fourth truck staffed. Neuzil asked if they are planning to buy a new truck. Spenler said no, adding a truck means putting another truck on the street, not buying a new truck. He said the sixth truck was purchased because of the perceived need for a fourth truck during peak times, for standby, and to be a replacement when other trucks are in maintenance. R. Sullivan asked Spenler if he is comfortable with the funding in terms of capital being close to paying for an ambulance in a year. Spenler said yes and that he presents the replacement schedule every year but it has never been fully funded.
Neuzil asked how much money is being put away each year for vehicle replacement. Neuzil asked if the $125,000 a year is for replacement during a one year period. Spenler said correct, that is what has happened. Stutsman said it is working. Meyers said that is all that can be done if all replacement is one year apart. Spenler said they aren’t all quite one year apart. Stutsman asked if Spenler is asking for a specialty response vehicle this year. Spenler said that request is for the replacement of the field supervisor vehicle. He said the current vehicle was purchased four years ago and it has a little over 100,000 miles and he plans on replacing it with a used vehicle. Claiborne said there is a reason they budget year to year. He said they always have had the money to replace the vehicle but have not saved up. M. Sullivan said when the budget was prepared the idea was to set aside money in increments with a target replacement date in mind. M. Sullivan said it may be easier to get $5,000 a year for a certain number years but it gets a little more expensive when talking about an ambulance. He said Spenler has always been very accurate about the cost of ambulance replacement. Spenler said the price of the vehicles has really jumped and there are problems with that. He said Ford switched to diesel engines two years ago and instead of a 6 liter engine Ford is going to 6.4 liter engine. The problem is they can’t put a 6.4 liter engine in the E-Series Chassis. Spenler said this may be the last year they will be able to buy a Ford. He said if they continue with that series of chassis they will have to change to a gasoline engine. Stutsman asked if it would be better to buy diesel. Spenler said they do. He said he will not get gasoline because of the idle times and use of the truck.
Meyers clarified that the issue is that Ambulance needs to buy a new vehicle now but a new vehicle will not fit in the garage and if they wait the garage doors will have to be replaced. Meyers asked if the garage door situation were different, how would that affect the price of the other types of ambulances. Spenler said price will probably not change but they would not have to worry about the 350 E-Series ambulance fitting in the garage. He said they have less than a six-inch clearance now and there is no way to store anything bigger. Spenler said they are already at weight capacity with the chassis. He said they need to go to a bigger series chassis, but the bigger ones won't fit in the garage. Meyers asked if there is a significant price differences. Spenler said he thinks they will be more because the 450 is a bigger chassis, although he is not sure of the cost.
Neuzil said it appears as though the cardiac monitors will not be replaced. Spenler said correct, he just wanted to show that is what they should be setting aside. He said when the monitors are replaced they will get competitive bids. Spenler said the cardiac monitors are all on the same replacement schedule.
Spenler said he would like to buy three cots in FY09 for the three units that are running most of the time. He said these cots are becoming the standard for the industry and many people use them. The cots are a power assist and use a battery system. Spenler said it is safer for staff, safer for patients because it will lift up to 700 pounds. He said they have done a lot of research showing these cots have reduced the cost of workman’s compensation. Spenler said in the last two and a half years, they have spent approximately $18,000 in workman’s compensation claims for the lifting injuries. He said he does not believe the cots would have reduced that figure to zero, but even if it was reduced by half over the life of the cots for ten years, they would basically pay for these claims.
Meyers asked Spenler for clarification on how the County pays for workman’s compensation costs. Spenler said the County pays for the cost of the claims for lifting injuries for Ambulance service employees. Meyers asked if that is covered by insurance. Spenler said yes. Stutsman asked if the premiums go up when claims are filed. Spenler said sure. Meyers asked if reduced rates are available for employees who keep their injuries to a minimum. Spenler said he thinks that is done to a certain degree. He said they look at the total claims and adjusts the whole amount.
M. Sullivan said that any time the County is negatively impacted by work comp claims or expenses there is always the chance that the premiums will increase. The purpose of the pool is to minimize the risk. Spenler said claims for a herniated disk would cost $60,000 to $100,000 per injury. He said anything they can do to alleviate lifting stress should be considered. Spenler said they still have not heard from the firefighter grant for FY09 for lifting equipment. Once they receive that they plan to put together a program for lifting, health, and nutrition.
Stutsman said she wants to know the actual cost of running the Emergency Medical Services department. Claiborne said he talked with Deputy Auditor Dana Aschenbrenner about moving that to the Auditor's budget in FY2011. R. Sullivan said there will probably be more people asking about the efficiency of the County-run Ambulance department versus the county-run Treasurer's Office. Spenler said the Johnson County EMS Association has traditionally used the County to obtain grant funding in lieu of them becoming a non-profit corporation with their own tax identification number.
Spenler said they expend funds for education and equipment for the first responder agency. He said they get grant money from the State and they have built up their checking account to a point where they can pre-pay a lot of their expenditures. Stutsman asked if they do any fundraising. Spenler said no, but some individual departments do fundraising. He said the only fundraising Ambulance does is with the education conference every February. He said individuals who live outside of Johnson County are charged a nominal fee that goes into the Association's checking account.
Spenler said there are two grants from the State. He said the first one is the general education grant, which is non-competitive and based on County populations. The second grant is the Health Resource Service Administration grant. He said in the past few years this has been based on preparedness education for mass disasters. Spenler said 90% of responders are certified in mass disasters education.
Spenler said budget line 56 is an ongoing line for every time they get a donation from an individual or from an agency. He said they will put the donation into the Ambulance Special Revenue Account and then use it for public relations events, returning education, and public training. Spenler said some of it is used to help remodel the Ambulance exhibit at the Iowa Children’s Museum. He said every year the Women’s Club gives $50 to this account. He said M. Sullivan set everything up with County Treasurer Tom Kriz many years ago. R. Sullivan said this fund is an area where a grateful patient or survivor could make a donation. Stutsman asked if a fund like this would be better placed with the community foundation. She said there is more visibility and funds are managed. R. Sullivan said it’s not a bad thought and he thinks Aschenbrenner would probably like to eliminate this line item.
Claiborne said the laptops the Board has are on loan from Information Services (IS), and are leftovers from the election. Claiborne said he can put the files on the Supervisors desktops after they are updated and ready for the next meeting. Neuzil said he would like an update email with the date and the file. He said he would also like the decision package emailed to him and he hopes all the decision packets are in the same format. Stutsman said she would like to see a running list of each request. Claiborne said he will do that. Neuzil said each time they have a discussion of a FY10 it would be great to have a detailed running tab along with the dollar amounts of what each department received in 2009 and what they requested for FY10.
R. Sullivan said he was trying to do Spenler a favor by talking about the income for these positions. He said this was successful with Facilities Manager Dave Kempf who requested two full-time custodians. He said Kempf was able to show the cost of those positions is $75,000 but that $59,000 will not be paid to Midwest Janitorial. R. Sullivan said Kempf needs to give the Board that information in terms of the requested positions otherwise the Board has to view it as the full $127,000 in funding. Neuzil said Kempf is hiring in December of 2008. Meyers said that those costs are offset by what is not being spent somewhere else. Neuzil said it is helpful to have all the details laid out in front of them like what Hensch just did by showing the Board what is paid to the University. R. Sullivan said he would still like to see hard numbers. M. Sullivan said something more quantitative would be helpful.
Stutsman said they haven’t done anything with GASB45. The County is assuming some liability with each new employee regardless of whether it is offset. Meyers said Stutsman is right because he believes they are going to start dealing with GASB soon. Neuzil said he thinks they are going to start struggling with all the financial issues very soon. Neuzil said there have been requests from Ambulance that obviously is not met. He said the Board has to figure out priorities. He said he thinks they will have to make a decision or have a conversation pretty soon or let Spenler know his budget must be kept neutral.
Stutsman said she thinks the Board needs to start thinking about its priorities. She thinks there are some decisions to be made, such as if they really do want an Ambulance to respond to every call. She said she hates to say that some people are going to have to wait. Neuzil said hospital emergency rooms establish priority. Stutsman agreed. M. Sullivan said that is Spenler’s point. He said they need to have a protocol in place because the current law is they have a duty to act when providing 911 services. He said they have to respond. Neuzil said there is going to be a conversation about this with the new dispatch staff. Meyers said there was a discussion about triage not being able to take all calls and having to pass them off to another ambulance service which means the County loses that revenue. Stutsman said that has happened only four or five times in the last month. Meyers said at the rate Ambulance calls are increasing that is probably going to start happening more often. Neuzil said they might be able to start some things on January 1, 2010 rather than July 1, 2009. Stutsman said they have to be cautious about that because while this Fiscal Year they will probably be okay, if the economy continues to slow down there is uncertainty about upcoming years. R. Sullivan said part of the goal he has for Spenler is to figure out all the pros and cons.
Neuzil said when they get into the priorities, Spenler has a 31% increase in call volume since he has had additional employees. M. Sullivan said that is incredible. Stutsman asked if Ambulance revenues are third party revenues. She asked if the County is assuming more liability for people that don’t have health insurance. M. Sullivan said it depends on how long the economic downturn lasts. He said if it goes on for a long period of time it will trickle down and increase write off’s. M. Sullivan said Title 19 reimbursements are minimal at best anyway. R. Sullivan said there are a lot of unknowns with a new administration such as how Medicaid and Medicare will be managed.
Neuzil said the Board is not going to say yes or no right now, but there are some expenses that could be held off for a year. Stutsman said it is going to be hard to come up with $55,000. Neuzil said he was thinking more like $20,000 for a specialty response vehicle that could be partially funded in FY09.
Claiborne said at the meeting last week with M. Sullivan and Spenler, they said that the increased revenues will offset costs. He said Spenler said no. Claiborne said he asked Spenler what will happen if they don’t get the positions and Spenler said Ambulance will still have to take the call. R. Sullivan said they will have expenses in overtime. Claiborne said due to scheduling it is not considered overtime. He said Spenler said if the growth continues in the coming years, then they will need to start giving the calls to other ambulance services. M. Sullivan said Spenler is budgeting staff to provide coverage for peak times. Stutsman asked what kind of calls come in during the peak times and if they are heart attacks or stomachaches. R. Sullivan said Spenler said the number of non-emergency calls has not changed but the number of serious calls has actually increased.
Neuzil said they told department heads to keep the budget neutral. Neuzil said that a 31% increase is a huge number and the Board will have to decide if there will be special circumstances they will have to consider. R. Sullivan asked what would happen if Ambulance got one full-time and one part-time staff or two full-time and no part-time staff. Stutsman said Johnson County has always had an incredible level of service and that has always been a goal, but perhaps they can’t do that anymore. Neuzil said he would like an updated document at each meeting that reflects the requests and changes from the last meeting. Neuzil said for example, since the last meeting, they have questions about parking fees that Kempf has put into his revenue and the expense section of City Carton needs to be adjusted. He said it would be nice to have these kinds of questions answered. R. Sullivan agreed and said they need specific answers. M. Sullivan said the Board should keep the FY2010 budget on the agenda for every meeting. R. Sullivan said there should be an automatic response from department heads addressing questions from the previous meeting. Stutsman said the Board wanted to talk about burial fees with Social Services Coordinator Amy Correia when her budget comes in.
Stutsman said she thought Medical Examiner Mike Hensch was supposed to reduce his weekend hours when they made that part timer full time. Neuzil said he thinks they did but there are still just two people. Claiborne said Hensch must respond to all Medical Examiner calls during the day, and at night the rest of the staff is available. He said Hensch comes in on weekends to catch up on departmental billings and vouchers. Claiborne said Hensch was planning to ask the Board if Board Secretary Jo Hogarty could help with some of the administrative work. R. Sullivan said he was thinking about that also. Stutsman said she thinks that would be impossible. Claiborne said he would hope Hogarty won’t expect him to get all the phone calls then. He explained that it seems like if Hogarty has one thing to do beyond what she is used to doing, he becomes the secretary. Neuzil said the Board has had some discussion in the past about employee sharing. He said they may find it in the budget or in someone's request for additional administrative staff. He said if an individual is working 60% or so, they may want the other 40%. Neuzil said maybe that can be filled in but maybe there is an opportunity for some sharing.
M. Sullivan said before they go any further with this planning, he needs to discuss this with Human Resources Director Lora Shramek because there is the delicate issue of keeping people in their job description, especially in collective bargaining units. Stutsman said checking in with Shramek is a plus. She said they need to be creative as well, considering if it is okay for Hogarty or anyone else, to do billing and answer phones. Stutsman said she thinks Supervisors are underutilized for answering phones. She said Supervisors should be prepared to answer the phones. R. Sullivan said even an hour a day could work. Stutsman said she thinks they need to brainstorm with those types of ideas.
Neuzil said he has a few other questions under Ambulance that he needs to follow up on. He said one is the area of the rent Spenler listed at $6,000. He said there needs to be better clarity about that line item. Neuzil said they need to figure out if the SEATS garage facility is an option for ambulance storage. He said he thinks it going to be an option, but they need to let people know now. R. Sullivan said it is pretty important because they are building the driver lounge out right now. Meyers said they need to get some kind of idea as to what facilities Ambulance would need out there. He said they may be able to get it down to $2,500. Stutsman said $6,000 is yearly. Meyers said it is an opening negotiating number. He said it could end up at $2,500 and it would be nice to know how that compares with what it costs to put in extra facility at SEATS. R. Sullivan said they already have the restrooms and the kitchen area. Neuzil said the other option is to explore the Communications Center. He said it is right across the street and it is emergency related.
M. Sullivan said the only issue with that is the truck will need to be indoors during the winter otherwise the items in the back of the truck will freeze. Neuzil asked if the Communications Center is getting a garage. M. Sullivan said he did not think so. Stutsman said she doesn’t think the garage is equipped to have someone sleep in. M. Sullivan said he will take care of the SEATS issue and the employee time share issue. He said he will work with Claiborne to have those questions answered by the time of the next budget meeting.
Claiborne asked for Supervisors network password so he could update their computers. Claiborne said he will put the Budget meetings in folders on the desktops. Neuzil said it might be easier to attach it to an email. Claiborne said he feels it is best to put the updates directly on the desktops.
Stutsman said she will not be at the Budget meeting on Monday, December 8, 2008. Neuzil said he knows they have a Strategic Planning meeting on December 17, 2008. He said they will need to think about prioritizing budget issues. M. Sullivan recommended the Board focus on just a couple of those budget issues at the Strategic Planning meeting.
R. Sullivan said he isn’t sure how Linn County is able to have roll-back numbers. M. Sullivan said Johnson County roll back numbers have come out already. Stutsman said all of Linn County's revenues are listed also. M. Sullivan said Linn County projects the entire budget and they don’t do it as definitively as the Johnson County Board does. Claiborne said Johnson County does not have absolute evaluations that can be taxed on until mid to late December. He said that is why every year he has trouble defining a solid number. R. Sullivan said he doesn’t know what numbers Linn County has. Neuzil said they need to communicate with Linn County and ask them how they have come to these conclusions already. Neuzil asked Claiborne to forward roll back information to the Board as soon as he has it.
Adjourned at 11:10 a.m.
Attest: Tom Slockett, Auditor
By Kaitlyn Dodds, Recording Secretary