Selectboard Meeting Notes – AP Triton Brattleboro EMS Report Presentation

The Brattleboro Selectboard held their final regular meeting of 2022, taking up issues of finance, cannabis, and EMS services. The AP Triton report gave the board four options of EMS services. The top recommendation of the consultants, though, was to get Brattleboro Fire Department up to national performance standards asap.

The board also heard a well argued critique of their recent police budget discussions.



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  • Preliminaries

    Pre-meeting talk about Kwanza, Liz, her mic, who is at fault…

    Chair Ian Goodnow – A regular meeting! Two remarks – first is my tradition to talk about elections – March Town Meeting Day is coming up – petitions for positions are available at Town Clerk’s office – (school board, RTM, etc.). Second, a moment of appreciation with Interim Town Manager Patrick Moreland – he stepped in in June and I can speak for myself are incredibly appreciative for him stepping up into that position. We are excited for John Potter – Patrick will help him.

    Interim “soon-to-return-to-Assistant” Town Manager Patrick Moreland – thanks for the kind remarks. It has been a challenging 6 months and I appreciate getting to know you and your support, and we’ve carried on despite challenges. One piece of business – some folks noticed, the lights in High Grove are out and it is very dark at night. In the last snowstorm, a vehicle hit the electrical panel, and we are working to get that repaired. Until then, it is dark so please be careful.

    Liz McCloughlin – happy holidays, peace on earth, goodwaill to all…

    Jessica Gelter – I attended the memorial for ray McNeill and was impressed with all the love in the room. There is the idea of a third space – home, work, and a third space… for community. McNeills was that place and it was an incredible celebration. people grew up there, performed there… a meaningful tribute and I’ll share a little ditty – this is part of a sing I hear at McNeills and it stuck with me – sings- “I am lookin at a with hazel, blooming’ in the garden…”…

    Tim Wessel – hard not to say happy holidays , happy solstice, kwanza, Christmas, hanukah – it has been a rough year in the positions we take but I feel good about what’s to come.

    Public Participation –

    Johnathan Elwell – I watched last week’s meeting and had some thoughts. I wrote it down… after the police presented their pilot program and it was asked how it fits with the community safety review – she said it was a pilot program, she also said people have changed their mind about the community safety review, and happy that police handle things. That it happened two years ago that it is less valid is concerning to me. We were told to wait for gradual application and we’ve been patient, but now the passage of time is being used against us. Chief Hardy and Evans say they here some want more policing. The community safety review never claimed universal support. Recommendations were based on this most impacted. The CSR process is being dismissed. Police are asked to do things outside their purview. That just means the community has unmet needs. The police budget presentation mentioned housing and how that makes it hard to get more police officers to move here, not how housing insecurity contributes to difficult conditions and additional harm. More police doesn’t make us safer. NO meaningful correlation between police on staff and crime rates. It’s a narrow view of safety – sexual harm up 26% is alarming, but it doesn’t mean more police will reduce it. The vast majority aren’t reported to the police, and those reported often aren’t convicted. Incarceration sucks resources from the community. More policing means more people behind bars. “

  • Consent Agenda

    Errors and Omissions – Assessor’s Office

    Patrick explains it and why it is important.

    So consented…

  • Theory Wellness Tobacco License – Approve

    Patrick Moreland – Theory Wellness, located at 728 Putney Road, have applied for a cannabis retail license from the State and need a tobacco license in order to sell certain products like rolling papers. Checks out.

    Liz – I asked about state cannabis licenses…

    Ian – tell us about your business…

    Teva Smith – I work for Theory Wellness since July 2017 in the Berkshires, and now oversee retail operations in VT and MA. Privately owned, craft cannabis. Social Justice. Quality service and product. Three dispensaries in MA and four in ME. This will be our first in VT. Here today because we hope to sell tobacco paraphernalia and substitutes and happy to answer questions.

    Liz – licensing is a state activity and the town has no role.

    Ian – the town has an option to create a commission/board and so we haven’t taken that up yet. I’m curious if the board would like to discuss it in the future. It would be mostly ceremonial, for the public to hear about a business.

    Patrick – the law… a zoning permit will be in planning, and this is tobacco her tonight.

    Tim – I recommend we discuss it sometime, warned on the agenda.

    Dick Degray – does the town have the ability to limit the number of licenses, or is that controlled by the state?

    Ian – the state, I think… we could deny zoning…

    Daniel Quipp – the zoning designation, it gets zoned retail, like any other retail. No ability for us to say no in this body.

    Dick – state does background checks…

    Tim – it is pretty robust, but town doesn’t have much control. So would a local cannabis commission be worthwhile?

    Dick – you can shut a bar room down if there are numerous violations… if there is a problem the state will handle it? But what could the local governing body do? Second question – what is the revenue kickback?

    Tim – there is no local share unless local option tax, so we get that 2/3 of 1%

    Dick – the legislature is keeping it all for themselves?

    Tim – yes.

    Dick – how did our local folks vote?

    Tim – worked out in committee.

    Liz – are we discussing the license? There doesn’t seem much in the tobacco license – who are you and what do you want to do? Why would one be rejected?

    Patrick – I don’t know.

    Daniel – Mr. Smith – how is the licensing process?

    Smith – I haven’t been as involved in the state licensing process… others have been more involved that me. It is a robust process and from what I’ve heard it is certainly a robust process. My main role has a lot to hiring the team, training the team, procuring product, following regulations, and so I would not do justice to speaking about the application process. I can have someone come speak to that if you’d like…

    Ian – we’ll get answers from the Town Atty.

    Daniel – there is one other retail cannabis establishment. There is a lot to do just to get in the door… professional and responsible.

    approved 5-0

  • Financial Reports – Finance Director Kimberly Frost

    (FYI, above… It is 768 Putney Rd…)

    (i) Audit and Financial Statements for FY22

    (ii) Single Audit for FY22

    (iii) Monthly Report for November of 2022

    Kimberly Frost – so, tonight I present you with the audited financial statement and the single audit. There are copies for everyone. The auditors did an in-depth review of our financial statements. They test our controls and review our compliance. They say we present fairly with no findings. The board and public can have confidence. I commend my staff. They contribute a lot to make it happen. If you have questions, contact me.

    Jessica – congratulations – no findings is great and is positive about the practices of the finance department.

    Liz – I also congratulate you. Internal controls are very important.

    Ian – your first audit? Learn anything?

    Kim – yes! We did learn so long term solutions – our software is very antiquated and we should look at that. It helps with built-in internal controls. We have separation of duties and that is in great shape and that was here before I was here. Staff is diligent about complying.

    Rikki Risatti – I’m looking at the report and on page 8 there are other expenses described and says there is an accepted increase. We would like more either expenses in the general fund to be itemized… it is over $1 million that isn’t very itemized. The FD is responsible for that. Deparrtments need finance director permission to account for dog waste materials. WE’d like to double that budget but..

    Daniel – you refer to page 8.. I see two graphs…

    Rikki – I’m looking online, and the FY23 budget has an intro budget message… it is a verbal description.

    Ian – the budget…

    Kim – the FY23 budget…

    Ian – we are talking about the FY22 audit tonight…

    Rikki – the audit wasn’t sent to the representatives – I don’t see the audit report.

    Daniel – that’s the budget, and we’re talking about FY22…

    Rikki – when could I speak about my concern?

    Ian – rec and park budget time… in January sometime… mid January.

    Rikki – they aren’t responsible for the detail – will Kim come back when Rec and Parks come back?

    Ian – email us and we’ll make sure you know when …

    Rikki – I did ask for that in a private email but…

    Ian – maybe we’ll see if that gets replied to.

    Kim – we also have the monthly financial report. It is for Nov 2022, and we’re 42% of the FY completed – all trending well. $4.1 outstanding loans and $137k available to grant or loan. 25 active grant and 7 in the application process. The full list of funds and balances are all there now. Community Safety and climate funds…I can include this info monthly, but we make transfers once a year.

    Daniel – thanks for being responsive. Once a year is too infrequent. It wouldn’t hurt to have it there every month. I do have questions. The UDAG…

    Patrick – UDAG – urban development action grant – received from US housing and urban development office in the 80’s. Used to built the holstein property and holstein… no… Marlboro College. Holstein had to repay the town and they purchase and investment instrument to repay the town 2.2 million coming into majority in February. The initial plan, from the 80’s would be it would return to the revolving loan fund. We looked at what else it could be used for… the short answer is use it like CBDG dollars – similar requirements.

    Daniel – so when it is available we should discuss how to use it. $2 million for housing wouldn’t hurt the community.

    Liz – I’d like to have that discussion.

    Ian – C’mon down!\

    Dick – how much in the Nelson Withington Fund?

    Patrick – managed by the VT community foundation.

    Dick – we have two reps on that fund, appointed by the board, I believe. Peter Richards and.. it has strict criteria what it can be used for and strictly recreational

    Patrick – and trees…

    Dick – when we look at the park project, and ARPA funds, and other sources. Trying to roll the disc back – the board didn’t approve… you could apply for money.. I thought about applying to do flowers in West Brattleboro.

    Liz – Carol says she applies to it, but it is private.

    Ian – but we have reps on it.

    Dick – it is a local fund and we had two Brattleboro reps for the fund.

    Liz – it is a private charity.

    Jessica – Utility Fund and Parking fund expenses… should we track income of those funds?

    Daniel – it is in there…

    Jessica – in the memo

    Kim – I could put it in the memo… sure.

    Ian – the memo will be as long as the report.

    Liz – the transportation center is no longer rented…

    Daniel – page 1 of the parking fund – total revenue – $250k, expense – $321k… I should pay for parking more often.

    Liz – that’s a lot of parking.

    Tim almost sings the long motion, but we are denied his heavenly intonations.

    accepted and approved!

  • EMS Feasibility Study – A.P. Triton

    Ian – the EMS Feasibility Study Report! Rich has about a 30 minute presentation then we can ask questions, then the public can ask questions. It became available at 5 pm tonight so we had a chance for a quick pursue but no deep dive. No decisions tonight on anything. Might have follow up questions. And we’ll talk about next steps.

    Rich – (sets up his slide show) Thanks for having me back. It is a complicated subject. Mostly last minute due to me, but helps me walk you through it better. Let me finish the presentation and ask questions after. Our team is made up of professionals from across the country with conflicting opinions from across the country. You want this. The consensus was the same, but everyone was involved. We were tasked with – coming up with options for EMS. We looked at 4 options, but it was really 50 options. We give you a foundation then you can do what you want. First is options with highest level of service when the ambulance shows up. Are the options sustainable? We want a high level of performance and national standards. And fiscal responsibility using tax money wisely. How to fund?

    – Level of care. All paramedics come from the same point – national registry of paramedics. National certification. They all come from the same place. All under the same protocol. paramedics don’t hold licenses, but physicians dictate protocols that can be done. District 13 has the same protocols. All agencies have the same medical director. We saw no deficiencies in patient care before or after the switch to Golden Cross. Good care regardless of the model you take. Some Rescue Inc members have a critical care endorsement – for interfaculty transfers. An excellent program. Takes critical patients and facilities moving them to somewhere away from BMH. That’s out of the scope of what we are discussing no bearing on the 911 system here. You have 1 6-8 minute transport right now. Don’t need that advanced CCP care locally. There were only 4 skills sets that most critical care used – a ventilator for interagency transfers – Rescue will keep doing it most likely. Some situations require a transfer with registered nurses, but care will be consistent with all four options. What this shows, is what paramedics did in Brattleboro. Routine skills and skill sets for most cases.

    – Sustainability – I enjoy this topic. When I travel, a private ambulance has little sustainability. It is a business. Not the case here. Rescue Inc has been around since 1966 it is sustainable. Golden Cross was started in 1962 – you ma have two of the oldest private ambulances. Town of Brattleboro has been here even longer. Sustainability would be an issue for you.

    – Responsive performance – does EMS response matter? private ambulances want to say it doesn’t matter. Slower response means more profit. Some emergency – like trauma – have no leeway. It has to be fast. Seconds count. If you have a heart attack – the moment you have it to the time you have care, every second counts. Strokes go the same way. Every second matters. Here’s the problem. These problems can manifest in 1/3 of all calls – chest pain could be in many calls. Cardiac events start as something else, and so on. Many emergency events change. Your dispatch is doing very well. Hardly any delays. Even so, with the call volume they have, you’d need to spend a lot in DLS – but you aren’t big enough to require it. Responsive performance is a standard requirement.

    – You need tools to make good decisions.. Sometimes you will hear average response time is… X. It is a fallacy. National standards do not use averages. If someone says the standard is an average of 6.5 minutes, a bunch might be 7, 8, 9… then one is a 1 minute… it can throw off perceptions. National standards go by percentiles. How many people get that level of service? You can decide what percentile you want to be at. I come from Denver. They can’t have 90%, because they’ll have a blizzard… that is a standard you can adjust. You don’t have any performance measures. Failure to meet the expectations means fines or contracts ended. Compare apples to apples. Brattleboro doesn’t have any standards, but it shows that care did not go down after June. We looked at BFD, Rescue and Golden Cross.

    – We recommend you build a foundation, then decide on a system. We gave you a sample draft resolution that sets benchmarks and goals for BFD. You need to decide the level of service and what you will pay for it. Your city attorney could write it better than I did. You could include law enforcement. Set minimums, then select an option. Your constituents – 31% wanted gems within 4 minutes. 41% said within 6 minutes… this doesn’t support a conclusion, but is shows what they want.

    – Fiscal responsibility – the effort of BFD and finance dept was amazing – we got lots of information that was useful and we can give you a clean and successful options and predictions. To do this system, we look for a cost of providing services. It is critical to find out the cost of service. Then we look at Payor mix – how much money you can get back – you are 50% medicare – that’s good Private ambulances don’t like this, but it is very predictable. We worked with other billing companies and have an accurate evaluation of the community. We also look at billing rates and billing policies – take these three items.. policy changes everything. Every person must receive a bill. Each entity will pay a certain percentage. Municipality and private companies decide what to do with others – you can stop collecting at some point. You can do a subscription program like Rescue Inc. You can be sent to collections. You can pick and choose your billing policy. One place does a separate tax… subscriptions programs are fantastic and work. This all turns into how much money you will make from this system. You are either losing money or not, subsidizing a program or not. This happens a lot. 80% of the time, the income doesn’t match the cost. There is a gap. You need to know exact costs before doing this. You could do a third service EMS (fire, police, EMS) and then the general fund covers the costs. It doesn’t go to other services…

    – Cost of services – it would cost Brattleboro about $1.2 million to run an EMS transport system, which is about $70.73 unit cost per hour. (17,520 hours a year). Golden Cross is at $68.20, for example, but you are sharing responsibility abilities with them. The reason it is low for you is you have the infrastructure – an attorney, a finance department, etc.

    – We know how many of your folks are medicare, medicaid, and how many calls are made. We put it all together – you had 1776 transports. Medicare and Medicaid and Veterans have fixed rates – you will get $538. That’s it. Supplemental programs can apply… the bill should be about $1500 minimum for an ambulance. Blue Cross and will cover the full cost… if you send them a $500 bill they get a break. Your constituents might have a high deductible. What to do about the remaining balance? You get to choose a philosophy. Golden Cross would do well to change their pay structure. Rescue seems to be at the $1400 mark. We calculate that we want you just under the national average at $1400 per trip. You should bill $2.4 million if done correctly. Medical billing isn’t hard for EMS. The city can do the billing. Out of that, you’d collect about $935k. You charge $1400 per trip, and collect $534.03 for transport. Some don’t have insurance and won’t pay at all.

    – The $935k – everyone gets a bill, but you decide how to enforce payment.

    – – So, you have the revenue and costs required, and we looked at four models, regardless of costs. #1 – negotiate a contract with Rescue Inc – 60 years of good service. Cons – lack of transparency and controls, short term contracts, requires $288k. That number needs to be validated.

    – #2 is a fire based system, 2 versions – a 24 ambulance with firefighters + 10 hr day car ambulance. Quality care, additional 10 firefighters required (you aren’t up to national standards! you need to get closer to 12), control of public safety, no 3-5 year contracts. CON – $92k per year, decrease in services from 2 full 24 hr ambulances, capital expenses to buy ambulances.

    – #3 is current system, and I’d discourage it. It compromises effective response force and it can get firefighters killed. I’d choose one of the other three. $125,000 per year, contract repeats.

    – Option #4 – all fire based with 24 hour ambulances fully staffed – 12 additional firefighters, you get control, cost $309k per year. Cost of buying ambulances.

    – Financial statements show the four options. All are possible. All good possibilities. WE didn’t expect that. Option 1 with Rescue is $288k subsidy. Option 2 is $402k year one. Option 3 is $629k year one. Option 4 is $826k for year one. In year two, Option 2 and 4 go down because of income from billing. #3 is $92k and #4 is at #309k. It shows the impact at year one for capital equipment, too… you’ll get good care all around. What is the level of service you want, create the resolution, then decide how to allocate money.

    – Recommendations – I don’t live here, so your constituents will help you decide. Your effective response force – BFD is below national standard of 17 people. You need to get closer to 12. Fix it soon. Level of EMS care will be high no matter what. All are sustainable. Determine services you want first, then pick options. You can take pieces of each one – you could have option 2 – private public mix. You have the tools to make the decisions now. Now, any questions?

    Ian – usually we take a break at 8 pm. We’ll be back at 8:20.

  • G'night...

    They’ll be back, but I won’t…

    I am curious about who will be rejected from the fine list of Charter folks…

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