Selectboard Meeting Notes – EMS: Municipal Revenue Projections

selectboard may 16 2023

A combative public greeted the selectboard to kick off their Tuesday night meeting. The quick version: downtown is unsafe and your website sucks.

After that was out of the way, the board was treated to a discussion of I-91 exit 1 bridge repairs next spring and summer, emergency housing plans, and about EMS transition items such as potential municipal revenue, the RFI process, and a new project-related website.

Comments | 8

  • Preliminaries

    The zoom connection is started late. “The host will let you in soon” 6:18…

    Chair Ian Goodnow – I have no remarks.

    Town Manager John Potter – The first thing – a pitch for a new podcast to update people about what people are working on and it is called Town Matters and in all podcast places. The purpose is to help give people give an idea of what’s going on at this meeting in a different way. Very simple. What happens at this meeting and the next. The second thing, the board retreat is June 3rd at Holton Hall and on BCTV. Warning will go out next week. Dog licenses were due. Any unlicensed dog will go on the warrant, and potentially fined. Then a couple of things – cameras at the transportation center has been ordered and is awaiting installation – complete coverage with 13 cameras. Also, we’ll bring a proposal at June 6 about DPW staff dedicated to the transportation center, and hiring security services to supplement police patrols. It would be our eye and ears… security will be a positive benefit for the place.

    Ian – when?

    John – as soon as we can put together a procurement…

    Ian – board?

    Peter Case – in light of what happened at the Transportation Center yesterday, I met with some people to discuss a plan to rollout some safety concerns and they will revolve around kids and safety zones for kids to feel safe in. We are focusing on a pilot program for the transportation Center – it is a land use issue for the town. There are things in place for us to enforce. This has my full attention. My 85 year old father parks his vehicle there. Let’s make this a child safe zone. That is something I’m actively working on.

    Franz Reichsman – I wanted to address a question I’ve seen here and there and that is the process that we are taking a step further tonight – EMS revenues and a request for information. This is repetitive- I want to rest my faith in the process and it will be open to lots of public participation. It can take many forms. It can be in selectborad meetings, meetings with me, the new town web page specific for comments and interaction , there is social media. We are going to try to keep an eye on all of this stuff and try to take this very seriously. We invite everyone to participate fully. I don’t think this will be jury at all. It will be clear and there will e lots of ways for express themselves, and I want to hear from you.


    Dale Joy – I am white, …

    Ian – I will interrupt you and if we do the same dance as last time. If you want to talk to any other item…

    Dale Joy – I am white, black and native american and I request people from the town resign for illegal manipulation of civil rights going on at this level, how can anyone trust anyone in the legal system. Ian Goodnow, John Potter, Norma Hardy, …

    Mark Younger – John – I spoke to you a month and a half ago, just after you came here and I spoke about how bad downtown is with drug addicts and begging for money. I will elaborate – we need more foot patrol, actual cops, not hired second-hand … what will you hire at the garage?

    Ian – make you comment…

    Mark – back in the 80’s we had the Chief and others on foot patrol. I don’t see any foot patrol. That’s the problem with so many drug addicts, begging for money. Why don’t we have a police office in the parking garage, somebody on foot going up and down the streets, and why not cancel the people begging for money. Is that something you have to say yes or no to as a group. You see them at Hannaford. They almost get hit running for dollars. And it’s your fault in the car. Make that happen. Why isn’t it happening? Why not hire more? Work out of the ticket area? Have a presence with police…

    Ian – thanks…

    Mark – the top of garage had 150 people on top doing some kind of rally. One kid look liked he was going to fall off the edge. They said they’d call back but I have yet to hear from them. 150 people on top of the garage! Was that illegal happening?

    Ian – okay. Thank you very much. That’s a lot of comments and we can’t answer them all tonight, but we an address a few briefly.

    Potter – we will expand our ability to know when something is happening, so the police can be called in. We are filling vacancies and we will have foot patrols downtown as we augment the ranks.

    ian – we have multiple potential officers in the pipeline. It takes a long time. We are working toward that and we have the funding, but they are going through academy. We made changes to make retention more likely. We have two officer June 1 coming back to the department.

    Potter – we hoped to hire two for the summer. It’s hard to come back after retirement. That’s why we pivot to the security system.

    Ian – when will we see that? No decision has been made yet. It will come to the board. I want to move on.

    Potter – the police chief can address some of these matters

    Chief Hardy – Okay, hello. Some things need to be clarified. The gentleman had valid things to pint out, but they aren’t completely true. I personally walk downtown. I stop in and see businesses. I’ve been to the Transportation Center. As to the number of police officers, I’d love to cover the Transportation Center, but I’ve been down in staff so much. Just starting to fill the ranks and we answer calls all over town. Security isn’t instead of police, it is in addition to police at the transportation center.

    Daniel Quipp -the gather at the top… I can’t say with certainty, but it may have been a parade in mourning of a beloved community member. Whether they had a permit for the gathering, I can’t say, but I heard it was peaceful…

    Franz – I’d like to invite you to my office hours speaking here at the board, often people can’t get into the details of what they want to say. I might not be the best to answer, but come and meet with me… happy to have a longer conversation and answer some of you questions.

    Dick Degray – A year ago I was here and two cast members are different and I asked for cameras to get on the agenda. It took six weeks. I was encouraged, but discourage that retired police officers. Liz supports cameras and what you present in June should have cameras for downtown and anywhere the police chief needs them. IN two weeks, the damage downtown – the horrific acts Sunday. I’m concerned for the community. It’s great that you met about the Transportation center, Peter, but there are others downtown. There are businesses with plywood. There is graffiti -I asked for the ordinance to be brought forward for those posting event notices. We aren’t going to take it anymore. I travel all over. Our town is the worst looking town I’ve been to in the last two years and you are doing nothing to curb the activity. Businesses are getting broken into and nothing has happened here. Business people came in November and 7 months later, no cameras. How disappointing is that? People come and ask for your help. It’s hard to support you when there is so much inactivity you have shown the town.

    Ian – thank you.

    (?) – I always wanted to ask. Widham and Windsor Housing – what tax rate do they pay? Municipal and school? I work at Holstein Association and there was a drug raid in the apartment adjacent. They arrested three people. They’ve bee let back in .. drug activity is still going on. Police know. If they aren’t paying 100%, can you put pressure.. it’s many of their apartments.

    Ian – contact the Town manager’s office for the tax mix tomorrow.

    Dora Bouboulis – two weeks ago in the last selectboard meeting, something really disturbed me. I was really shocked. It was the discussion of the EMS issue and Peter Case asked a simple question – shouldn’t board members do research, and he was told staff does the research and gives the info. We are in a democracy. Minority opinions get to be expressed and allowed to be considered. They board is expecting the town staff to do all you r work. It’s not their job to do the work for you. You should do research and bring info to each meeting. Town staff have their own agenda. It’s how government works. If you are to get all the info you need, you need to go our and get it and share it with the other board members. Anyone should be able to request something be put on the agenda. We are a democracy in Brattleboro. Every issue needs vigorously debated. You need different opinions, otherwise you have an autocracy. I’ve watched the last two years and haven’t seen much independent research, – and if you did it on your own it would violate open public meeting…

    Ian – any member of the public can request something be put on the agenda. The agenda setting committee decides if it gets placed on the agenda…. that’s how it has always been, at least since I’ve been on the board.

    Liz – I want to clarify – when Peter akee, he was asking for an outside meeting about experts and we thought it be better it be held at a selectboard meeting, but Ian said anyone could call anyone, and the Fire Chief would ask similar towns and would report that to the Selectboard.

    Peter – that’s how I understood it. I went ahead and did it anyway… : )

    Carol – I’d like a clarification. You’ve ordered 12 cameras and they will be installed. Will activity be monitored via the cameras. Is security guards coming up at anther meeting, or is it decided?

    Ian – not on an agenda, no decisions made. More to consider. We have cameras currently we are upgrading them. As to whether they can do live monitoring, they would be able to. I will regret this will be others want to speak? Keep it brief Tim…

    Tim Wessel – Hey folks. Ian, You assume I can’t be brief? I want to reassure everyone. I travel a bit, getting back to paying work, and an increase in crime and petty crime is everywhere right now. It is not just Brattleboro. Also, I’m relived and surprised that people are interested in private security. ia advocated it and it anded like a lead balloon with fellow board members. I’ll leave you with a request – I also said we should consider selling the parking garage. I feel we are not particularly god at being landlords at that location or managing safety and security.

    Ian – thank you Tim. Always has to remind us…

    Dick – social media is wonderful thing. The town does not play for flowers downtown. DBA pays for them, and by donation. Figure out who to blame when making claims…

    Ian – okay… I’m going to move on…

    Mary Casey – I can hear you. We’re talking about the cameras I spoke to you about a year ago Ian. Maybe when you are considering porta potties or housing, or an organization for a public interest project that you consider security, and have it addressed before you approve new housing projects. There is a new project up near my neighborhood. The question of security isn’t make it to the list. We are playing catch up after these issues were brought to you. With her recent murders in town, we are at the bottom. let’s get it together a little bit.

  • Consent Agenda

    A. The Good Spot Annual Entertainment License – Approve

    B. Retreat Farm Second Class Liquor License – Approve

    C. Local Emergency Response Plan – Approve

    D. Vermont Food Bank Grant – Authorize Application

    E. Financial Report and Financial Management Questionnaire and Internal Controls – Accept Report

    F. Financial Management Questionnaire and Internal Controls – Authorize Response

    So consented.

  • Cemetery Ordinance Change – Second Reading and Possible Adoption

    Brian – we added natural burials, and changes in prices to reflect market prices, and changed a name to garden of peace.

    Liz – I remain very supportive and thank Brian for his work, and the Cemetery Committee.

    Ian – I echo Liz and the quick changes based on feedback. Good to see things working well like that.

    Amendments approved!

  • VTrans Project Informational Meeting for I-91 Bridges Rehabilitation, Exit 1

    Robert Klinefelter from the Vermont Agency of Transportation,

    Ian – no motion, just hearing information.

    Bob K – thanks for letting us peak. We are here to talk about I91 over Canal Street at Exit 1. It starts later this year. WSP is the design consultant and they’ll take over.

    (slide show)

    Tim Folsom – I’m the consultant

    Delia – I’m the public info consultant doing public outreach.

    Tim – we’ll go over project details and the schedule. First, bridge terminology – the deck, the girders, the substructure, the abutments, the bearing area… the bridges I-91 northbound and southbound. It’s a deck replacement plus other repairs to the piers and abutments. Some changes to the offramp and safety improvements on Canal Street. Existing conditions – built in the 1960’s, inspected in 2022. This rated 5 fair condition. Significant decay. Needs to replace the decks and the substructure is satisfactory but we will rehab. The southbound bridge paint is failing, rat is showing through, pieces falling off, concrete cap is cracking… pier cap shows exposed inside. Paint failing, rust and cracking. The abutment has cracking and it will be addressed. How will we do it? We’ll close bridges one at a time, have traffic cross over. First the southbound bridge next spring 2024… one lane will be north and south for about 56 days – March and may. The second bridge will be done next – it is wider. We’ll close the southbound ramp. We’ll have two lanes going north. Memorial Day and 4th of July will be two lanes in each direction. The crossovers will be in place while we work on the bridges. Southbound on ramp will be temporarily closed. There will be a concrete barrier between the lanes during the single lane periods. Work will be done with alternating one way traffic with restrictions – weekday rush hours and weekends daytime. There will be lane shifts on RT 5, too. The southbound on ramp closing, but temporary southbound on ramp will be in place. The construction schedule – will be advertised in the next month, contract in late summer, some earthwork done this fall, real work next spring and summer. Completed fall 2024.

    Delia Makhetha- as we move into construction we are ramping up public information. Anyone with questions, reach out to me or Maria. You can reach us at any time. We have direct contact with VTrans and the contractor. We’ll be in touch ahead of things stared. We’ll send weekly construction updates, and traffic alerts when lanes shift. You can call or email us. 603-263-8881

    Ian – thanks so much.

    Liz – Thank you all for coming and presenting to us. I understand that maintaining RT 91 is a safety measure for us and the state. There is no match required. It is all a VTrans operation. Will there be noise?

    Bob – not any permanent piles, but maybe some temporary support. It shouldn’t be long duration. There are noise restrictions in the contract. the town has a noise ordinance.

    Liz – the NH bridge has a lot of pile driving. No adjacent home owners.

    Ian – beside scanning the code, how can people get on the weekly list?

    Delia – it is on the VTrans fact sheet. The QR code is a sign up.

    Bob – it will all be on the project website.

    Ian – we might want it for our website

    Delia – we’ll be in touch to share the updates with the Town… whatever is most convenient

    Ian – are you doing RT 30? I don’t know how I got on that list.

    Daniel – there are other VTrans projects impacting large numbers of people. Making it as easy as possible to get this updates is good. I never signed up but I get them. Generally, VTrans doing good communication more of the the easy access and press releases, something we can stick on Instagram…

    Ian – one thing I’ve hear about Rt 30 – damage to vehicles and tires – it is an active work zone. Do you anticipate that?

    Bob – there can always be nails or screws. It will all be paved. Rt 30 is reclaimed project. We have public protection in the contract. They can’t have concrete dripping on cars.. They have to give us a plan that has safety measure for the public at all times.

    Dick Degray – sounded like both sides would take 56 days?

    Tim – one side is 56 and the other is 49 days.

    Dick – finished before Labor Day?

    Tim – yes – both will be completed on I-91 prior to Labor Day.

    Bob – if they get done a week early they get maximum incentive; if they go over, they pay a penalty by the hour.

    Dick – the gateway to VT is through I91. July to October…bridges have been worked on all the way up. How about Exit 2?

    Bob – not aware of it. There were all built at the same time. There could be a project…

    Kate T – Brattleboro has 3 exits on 91 – will there be signage to direct people to the downtown?

    Bob – as far as the… we’re not closing any ramps…

    Kate – permanent signs for the future.

    Bob – out of the scope of this project. Don’t know. I could ask around. I’ll look into it and get back to you.

    Ian – thanks for coming down… excellent presentation.

    Bob – We can come back before the traffic patterns change.

    Ian – we appreciate the outreach.

  • EMS Update

    Liz – you are ahead of the schedule by 2 minutes.

    Chief Howard and Assistant Chief Kier

    AC Kier – (reads monthly report) 264 calls for ambulance in April. We didn’t meet with Dr Storn. Did clinical training on airway management with VT Packing House. Will work with DH helicopter landing crew. (Reads stats.) Lastly – you asked that we supply info throughout the year – still something you want after July? For the last 10 months things have been consistent. Happy to do it. Want every other month at the meetings? We are seeing less public comment and questions.

    Liz – I move to accept the report as presented.

    Daniel – thanks for the report. I agree that the early months showed new information and now we see the picture and it is pretty clear. We are looking at the totality with Golden Cross – almost a year – the percentages about ambulance use won’t change that much. So, I wonder if the community thinks these are helpful? What would be better?

    Liz – I’d say I’m content to have this in the monthly update background materials.

    Peter – I think this is good info even if it is static. Not a big hardship to do it. I’m a fan of being updated monthly in the printed report.

    Liz – same as what is reported in the back…where the fire department has info.

    Daniel – Liz suggests they don’t come to the meeting but do supply the reports. Good info in there and it is hard to find. Our website is not that great. People plugged in know the reports exist. The police report shows every call they responded to. That is interesting data. I want to defer to the community.

    Franz – I like having them here and to hear what they say but isn’t necessary every month. I’m flexible.

    Liz – the next item is all about the new public information program for the fire department and that kind of begs the question of where this fits in. In the backup report is sufficient. There will be lots of info from our next item.

    Ian – my perspective – we had a new contractor and new system and really concerned that it was effective and meeting the needs of the community. Now we have gotten reports for a full year, feels satisfying to me. We’ll still collect the data and it will be in back up materials. I’m agnostic on it. I appreciate the work that has gone into it. It has been critical.

    Peter – just having access to it is good enough for me.

    Fire Chief – we can post it on our web page

    Dick Degray – my concern. The monthly financial report was in the consent agenda. You put it on there a while back and I asked you not to do it. There is a reason it isn’t in the consent agenda. It means the public can ask questions. I worry about the money – what is invoiced and what is collected. We’re a far cry from $975k. Having the chief here for 15 minutes is important, just like the financial report. You have a new board member, Peter, who hasn’t had questions. I found lots to ask you about. Public participation. That’s the emphasis this year, right?

    Judy Davidson – I would appreciate the monthly reports. It is a nice, neat summary. It is hard to find the backup materials. I’m interested in the billing and collections, and the trainings. This was interesting. How many BFD folks participated in advanced training – were they EMT, paramedics, non-EMT – who participated in this training? Would the Chief provide a list of current with staff listing paramedics, EMTs, regular firefighters… maybe in the next monthly report. I’d like to see the staff at this point in the next report. Not tonight. But who was in the advanced airway clearance training?

    Ian – how many participated? And can it be in the next report? If we have one…

    Chief – we had 12 staff in training plus 2 Golden Cross. We had 2 paramedics, AMT and EMTs were there. Currently 3 staff are halfway through a paramedic program and done by November. I’ll get the exact number..

    Dora Bouboulis – I agree with Dick and Judy – the EMS stuff will be one the agenda for the next few months so they’ll be here anyway. If you decide to not do it, make the info easy to find. The website is terrible, doesn’t work well on a phone.

    Ian – Great, thank you Dora.

    Peter – based on the interest in having it continue, and they will be here, let’s continue with this format.

    Ian – no modification.


    Ian – let’s take an early break and be back at 8 pm.

  • "Fire-EMS Transition"

    (i) Engagement Improvements – Project Website, Project Email, and Podcast

    (ii) Review Draft Request for Information (RFI) from Potential Third-Party EMS Contractors

    (iii) Initial Analysis of Potential Revenues with a Municipal EMS Approach

    Ian – it’s 8:02. So, this is a multipart discussion and I’d like to tackle it one piece at a time for simplicity so we can get questions on items that are relevant. Engagement improvements, draft request for information, then a presentation from Patrick of poetical revenues for municipal EMS. We are on a dual track… 3rd party contract could be different. Tonight is the first step down both tracks. We approved a calendar for the process that shows every step along the way until September and this was on the calendar. It’s on our website.

    John Potter – we want to mention to try to make enhancements to our engagement approach to this – people have responses to what staff prepares. We have made enhancements. The town communication coordinator made a deviated EMS project website to have up to date info about eh transition project and avenues for the project to give feedback to the staff. It has a FAQ that we will add to and has a catalog of background materials – the AP Triton report, all the mess and conversations we’ve had. The second enhancement is a dedicated email – emsfeedback – people can send their feedback about he [project and is a central place we can document all that coming in, and extract to present to the public and to you at the end of the project. The final engagement enhancement is the town podcast to reach people in an alternative means. We hope you look for that when it is published on Wednesdays before selectboard members.

    Liz – it comes out before the meeting – what will be discussed at the nest meeting?

    Potter – both the previous meeting and the next meeting.

    Ian – Town Matters is not just about EMS it is about all sorts of things but we bring it up here because it will be talked about there.

    Daniel – it could be a call in show. I listened and wondered about the approach. Whether there would be opinions. It’s pretty straightforward. It’s a good start. Similarly, this is about needing to do so much work to show people how they can get in touch. The communications coordinator has been getting good graphics out there and I assume there will be more to launch the project website… it looked pretty good to me. It bears repeating – you need to bash people over the head… put it before them many times before they get it.

    Ian – one thing – I’d like every graphic to have the email and website in the graphic for the EMS transition.

    Liz – we are welcoming comment and people should feel comfortable commenting.

    Peter – the podcast is just what happened and what will happen. Can’t have opinion. Must be a consumable format. We can all share it on social media to build its audience. I’ve been doing this for 30 years. It sound like you’ve been doing it for years yourself. You’ll hate it within a year, but will keep doing it. Just pop it on. It’s quick and consumable. You could do a complete EMS podcast on another subject on another day, but this shouldn’t be touched. Strictly information.

    Dick – when yo get a question in email, will they be available to see the email and response? It is public information. there were questions I was going to ask that you answered so I don’t waste time.

    Ian – that’s are we going to use the emails?

    Potter – there will be thoughts and opinions. Somehow summarizing, or make it all available. Not a big deal.

    Ian – I’d want to make sure that if we all publish it that we make it clear we could do that.

    Potter – we’ll get many repeats, so we could summarize as FAQ. Open to do it any way.

    Liz – I like FAQ

    Daniel – there will be themes and questions… questions people in the community have, like who attended the training? We’re happy to provide the information.

    Dora Bouboulis – I wonder…you are talking about logging all info and how you will use it, and how you will inform the public and those are two different things. There needs to be a place where it is all documented and collated… not lost in the netherworld. Anything sent to the selectboard it is public. It gets sent to the town manger, that’s another thing. Figuring out how to standardize responses so people know… One thought on the podcast. It could enter into dangerous territory… of spinning things in a positive light. If it is just information, it has to be positives and negatives. The concern would be to start doing groupthink from 1984

    Ian – thank you Dora…

    Potter – starting out, we are trying to keep it simple and just the facts, just like reading the agenda for the meeting. There would be some interpretation of basic simple information. Just informing in a different way.

    Peter – have you heard it? The first one I heard …it was just what happened. Another way to consume what happened in town government. The first reading of the radiance happened. If no one knew, they might come to the next meeting for the second reading. That’s the traction we want to get with this tool.

    Ian – I appreciate this. It is Town manager podcast, not the selectboard. We could spin things. John can just present the information matter of factly. That’s part of his job. It would be different if it were a selectboard thing.

    Franz – I think John should say what he wants to say and don’t want any limits, and we can say what we want to say.

    Peter – we aren’t trying to do that..

    Franz – it was Dora’s comment, and I see no need for a list.

    ian – this is just an update, nothing for us to approve.

    Daniel – when I learned about it, I listened and won’t become that. if an individual board member wants to have options they can do it, but this is very straightforarw. It’s a nice and simple idea.

    ian – It’s a trend to engage the community – a constant project of changing where information is and reaching people where they are at. We’re never done. This should stay within what it is trying to accomplish, I am excited to see it grow.

    Potter – one thing we’ll always do is to ask for feedback. if you hear an agenda, I want to hear it. That’s not our intention.

    Bob Oeser – First, I did listen and it was concise and had facts. My next question, who remembers Marshal McLuhan – the medium is the message. I sent it to EMS feedback… if someone sends it to that address, how do you make sense of it or what do you do with it? It might be some seed for an FAQ, it may be a question that hasn’t been thought about… how does the person who wrote the email know it has been read. What if you get 30 emails – do you report that 40 people said this and 20 said the other thing? It will be a lot of work, but that’s my question. What happens if I send an email.

    Ian – it is a good question – what is the process. The town could give us an update in June about what information has come from the email and other sources and if town staff feel like they’ve collated it, they could present it. If we don’t like the presentation, we can give feedback and it can be modified. if we like it we can keep getting updates on it. If there are issues…

    Liz – that will lend itself to if FAQ is the right way to go.

    Ian – is that clear enough?

    Potter – that was my question – that’s helpful to us.

    Daniel – when town staff get an email, or the board gets an email, and there is a question, somebody answers it. Usually the town manager or selectboard chair answers it. If I send a question, will it be answered? In most cases, yeah. Sometimes it is so difficult to answer in a clear way, so we explain why it can’t be answered. My experience is that people get answers. If 40 people all said a thing… I don’t see this EMS as a survey – just send us a question. Maybe we’ll find out other things show up in the email. I wouldn’t want town staff spending time answering the same question 17 times. If we see a theme, we can add it to the FAQ and can send a canned response to the people who wrote. Chief Howard and Kier resounded to every question in real time last year reassuring people. It was time consuming. Don’t wan to tie people up answering the same question over and over.

    Ian – uh, okay. The review of the RFI…

    John potter – this is the part of the meeting where we look at the contracted track and tonight we have a draft request for information. Typically procurement are very operational at the adminstration and we’d bring low bids to you. because we want to emphasize transparency and get best information, we bring this RFI to you, to bring as much to you. So, what I’m getting at, we could have put together a RFP based on what we have in hand so far – AP Triton, internal concerns, standards… and sat back and waited. But, we decided we’d like to bring this request for information to gauge the level of interest but also to inform the request for proposals to be more receptive. An RFI is a versatile solicitation method to gather information about services that may or may not be in the market. Not binding in any potential supplier. Just a way to do research. Open and transparent. many times with procurement, a buyer might call someone or have a meeting… we don’t do that in the public sector and that’s what the RFI is all about. No unfair advantages to providers and to do the best RFP. What we have given you is a draft of the RFI, and it is in your packet. Not set in stone. Here to get feedback from you and public tonight. It’ll be about criteria, information required, etc. Our plan would be to get feedback, make revisions, then make it available June 1 due back June 30 at 4pm. Potential vendors have lots of time to think it through and make something advantageous to all parties. It’s not mandatory to be in the RFP. If no one submits anything, we can still do the RFP. or we can revisit non results. It would be your option. Hopefully multiple parties would explore it. There are strong potential candidates in the region. We will reach out to other states. That’s the summary. Feedback?

    Daniel – The RFI first page (pg 155) of the men summary overview, and the second page is the questions. Number 15 – what additional criteria would you suggest the town include in a request for proposals. We’re asking people who want to bid to inform what our RFP looks like? Is that appropriate?

    Potter – yes, done frequently. It’s not binding. We can look at what they suggest or not. For example, we didn’t require the RFP that some providers might not submit a proposal… we wouldn’t have written ehRFP that way. That kind of complication in the process.

    Franz – I’ve heard this from others. You are asking those with an interest in the outcome to mold the process, so they could do something in their own self interest. Too much power to the entities that might contract with you. There a\is some theoretical truth, but not real. You are asking for info and we are asking people with lots of experience to tell us what is important about what they do. We have some experience. The questions are new to us and we could use another point of view. People said we should talk to other ambulance providers, like Middlebury. It’s similar. As soon as you go ask for info, there is some risk, but it is outweighed by the benefit. The potential for misinformation can be mitigated and we’ll have abetter product for doing this.

    Liz – it is common – a request for qualifications and why they are poised to do good work. They may have some insight that is helpful to us, and it is open and we can accept it or take it or leave it for the RFP. It’s commonly done. Very open and above board. I’m not concerned.

    Potter – our intention was to bring back all responses to the board and public.

    Franz – an example, at the Brattleboro tennis Club we want to repave the parking lot. The president knows nothing of paving. To make an RFP wasn’t possible. We had contractors come and recommend to us what we should do, then we decided what made sense to us and we wrote that up as our RFP.

    Lis – Thank god you are president.

    Daniel – #9 and #10 – revenue sharing arrangement? Help me explain this. The contractor provides ambulance services. What is revenue sharing?

    Potter – the idea there is to see if the board wants a proposal that included revenue sharing… the billings for service. That could be a potential requirement. If service providers say no, we might back off.

    Daniel – my assumption is that no contractor would be interested in starting revenue.

    Potter – for example, a provider might want to share revenue if they wanted to share risk with the town. Upsides and downsides.

    Daniel – so, I’d imagine someone would cal you and talk to you… seems like that’s a nuanced situation.

    Potter – yes – there is guidance on page 1 about contact with town personnel. All questions would be address here and shared with the world prior to the due date.

    Daniel – #10..

    Franz – the revenue sharing – some models might have workload divided up between fire department and 3rd party, so it could account for the different work being done?

    Potter – eye, more options on the table in the RFP.

    daniel – #10 – if no revenue sharing, then would you share reimbursements? If they say no…

    Potter – not dead in the water but we might not put it in the RFP.

    Peter – that would be for this body to decide if the body is dead in the water? In the rap?

    Ian – I appreciate the line of questioning, with a broad net to get as much information for the best RFP in 3 months.

    Franz – it looks from the numbered items here that were set on the 90th percentile response time. I wonder… item 15 expands it for suggestions. The way it is worded it is a little strong.. 11 and #12.. the volume of words gives emphasis to the notion. Might be better to beef up language in number 15 a bit.

    Ian – yes – if the response to other questions…

    Daniel – question #14 – how would you recommend quality of service? Response time is important but not the only issue. There’s a place to add other things they want tell us, too.

    Ian – the public…

    Judy Davidson – My question is about #11 and #12 – would you require BFD staff to meet the 90th percentile. BFD has done this for decades. Are you not expecting the BFD to be emergency first responders, or backed up by ambulance services? Is that a requirement for ambulance transport?

    ian – We want to do the RFP process to be looked at with fresh eyes. The BFD has been providing that incredible service for years and years. We are asking because we don’t want to assume. We want to hear what they are looking for.

    Potter – great answer.

    Peter – Chief Howard said he’d never not respond in a situation. Ce’s not sending vibe that will change.

    ian – we just want to hear what models are being proposed.

    Dick Degray – using the extrapolated data from this year and estimating 3k calls and 2100 will be transports, do we have any… I’m concerned about data from just this year. Can we get any from last year? From dispatch the number of calls last year? That would be important to have. What if there were 2700 calls? Would we divide the number? Can you get the number of transports… from the organization we aren’t speaking of. We’re making assumptions on a single year? I appreciate questions about the evaluation process – what will we use. If we decide to go with the system we are using this year, and the evaluation process… if we terminate that contractor it will put us in a difficult position. We need to think of that process and how we will measure who will be our partner. It would be nice to know how many calls we had last year and transports.

    Ian – in paragraph 3 of pg 155 there could be qualifier that this is one year of data. The point is well taken. We could qualify so they could know that. I’d like as much data as possible in here.

    Daniel – in the Triton report on 26-27 it speaks of multiple years of service demand, not hard numbers for a 12 month period, but I assume we have it. We had the data in the past. Due to the pandemic, we’ve had outlier years.

    Bob Oeser – 3 comments – we are talking about the RFI and that’s a commonly accepted ida? Do you have citation for that? Someone more knowledgeable than I thought it wasn’t a good idea. I understood the explanation, but do you have a citation. With respect to revenue sharing questions. I got a negative answer and it might come out of the RFP, but I’m concerned the whole money thing is part of the RFI. I gave you an email. On the 90th percentile, is there a distinction being made between priority calls or not priority or if 90th percentile is just for priority calls.

    Potter – RFI – we can , not sure exactly what you are looking for…

    Ian – an RFI is common…

    Potter – Franz describe a good example but we could look for another example, so yeah.

    Ian – I believe we’re clear on 9 and 10 and those questions will give us information to guide us in crafting the RFP. Better to keep it in.

    Liz – people are welcome to respond”hell no.” That’s information for us to have.

    ian – the 90th percentile – what type of call?

    Potter – appreciate that will consider whether to factor it in.

    Franz – it is a good point that Oeser makes – to compare comparable numbers. Anyone in the ambulance service has to say what they are reposting to… emergency calls int eh 90th percentile data. I’m sure that will happen as the prices goes forward. It would be started practice to report it.

    Dora – so, as I’ve said many times. This is ass-backwards. using the RFI to fulfill the inadequacy of the Triton report. I’m hearing good points about these questions and hear them get explained away, not offering for editing. It’s not ready for primetime. You say a good point is being made, but it drives me nuts. Any suggestions, daniel, to address your concerns?

    Daniel – stay there for a econd

    ian – no

    Daniel – this is a draft. I have raised questions and I have answers that have satisfied me. I can’t ready your mind.

    Potter – I have been taking notes and we will be redrafting this to make it better. I appreciate the feedback.

    Ian – no more public… ok. So, um. No motion on this. The schedule one more time?

    Potter – next, we will publishing an RFI on June 1, due back on June 30, compiled for you by mid July, then talk about feedback and making a draft RFP and you can give us feedback like this. Typvially it is operational but we want to do as much in public as we can.

    Ian – 9Ciii. The potential revenues in the municipal approach. We will look now at the municipal track. A discussion of revenue. There is presentation.

    Potter – Kim Frost will join us but Patrick Moreland will inform us..

    Moreland – I’ll take a stab at staff’s initial estimate of revenue if we bring EMS fully in house. This takes about 10 minutes. Want to show our math. We start with the payer mix and payer count. Medicare 41% or 871 people, Managed Medicare 10% or 212 people , Medicaid 29% or 615 people, Private Insurance 13% or 276 people , Private Pay 4% or 85 people, Veterans 3% or 64 people. 2,122 total people. That’s Brattleboro’s mix. The rate is estimated at $1400 per transport for all of the categories. $1,218,028 from Medicare… we’d bill about $2,970,800 billed out each year.

    Moreland – there are differences between ALS and BLS responses. Adduced Life Support vs Basic Life Support. We can see we have 460 ALS calls at 31% and 69% or 1033 calls are BLS. Sop we then break down those counts by ALS and BLS, so with Medicare, we expect 870 transports, so 268 will be ALS.

    Moreland – standard government programs reimburse differently. Medicare ($518) and VT Medicaid ($358).

    Moreland so the general estimate of revenue, we know we get 268 AL responses and they will get $518 per, so that’s $139k of revenue. medicaid, we will expect 426 BLS responses, so we get $301 per call and we get $128k. The column combining all revenue numbers, leas to an estimate annual revenue of $978,592.

    Moreland – there are some other insurance and user types… private pay, or coinsurance, if they get a bill we don’t know a hell of.. a heck of a lot about how well off they are. AP Triton says we expect 15% of what gets billed for uninsured customers. Private insurance has a great deal of variability. Medicare is very specific. With private insurance has numerous types of plans, so we have to be more statistical of how to estimate, thankfully it is just 13% of our customer base. We s]anticipate collecting 65% of what is billed out. Lower than what AP Triton recommended. They estimated 80%. To be conservative we dropped it down to 65% of what gets billed. That’s our revenue collection. We expect to collect about 33% total of what is billed.

    Moreland – as many might guess, this comes from an Excel spreadsheet and the data can be explored on the town website. Not static, but as an excel sheet for people to play with and maybe that will lead to interesting comments and feedback.

    Franz – good presentation and shows the reasonable collections and gets us to a solid place to start the discussion.

    Daniel – slide #1 – this is Brattleboro, you said. This is not who Brattleboro is… it is who ambulances in Brattleboro serve. #3 – billing – that $1400 as a placeholder is a policy decision. If we choose to go this route the selectboard will decide what to bill for an ambulance call. We could bill lower an that could influence what comes back.

    Patrick – there sill be a range of policy actions. Setting rates, approving billing and collections. Will we chase after customers or write off unpaid balances?

    Daniel – we expect to bill just about $3 million and Golden Cross has billed about $1 million. Just pointing it out.

    Peter – changing the rate of pay – that doesn’t necessarily change what we get paid.

    Ian – it depends

    Peter – we’d accept and increase… say we doubled that rate, could we expect private insurance to collect more?

    Patrick – we see higher collections from communities with high bill rates. There are some ceilings…

    Liz – and standards…

    Daniel – also want to point out there is a policy decision about ALS and BLS calls. We’re charging the same but calls use different services. We could charge for those calls differently. the spreadsheet to play around with, could we plug in a different BLS rate?

    Patrick – I’m sure people out there could do it. One thing to consider, if a provider sends a paramedic and an EMT for broken ankle, it costs the same. There could be an argument hat uniform billing makes some sense.

    Daniel – another policy decision about this who don’t get transport. AP Triton suggested a treatment or transport fee. It isn’t in here.

    Patrick – right. If the team heads out and someone is ok, that still consumes services. There should be some bill for that, but there doesn’t;t have to be. There are other expenses for the town to get reimbursed.

    Daniel – seems helpful and valid and I’m glad that I can see how you arrived at the numbers, and the policy decisions we’ll need to make.

    Liz – differentiation of rates based ons services? What did AP Triton recommend?

    Patrick – $1400 flat rate.

    Franz – we do need to look at the current figures in terms of collections by Golden Cross, which is lower than what you’d project for the ten months. Who has the explanation for the multiple ingredients in there? I don’t want to say that the Golden Cross is more valid, but we do need to address the difference.

    Patrick – can’t speak for them, but we know they bill much lower, and within private insurance, that will result in lower collections. Another major distinction is that what is shown here is 12 months of operation that are not start up. Golden Cross includes start up costs as you first start billing. You won’t get there until 15 months or so.

    Franz – collection delay will be a factor, but there are ways to correct for it. Worth looking at those numbers as not a start up year.

    Peter – if we did transition to another provider, will we still do startup costs again?

    Moreland – if Golden Cross went away and we went with ABC company and they provided a similar service, there would be a start up for them her their first year and there would be a delay in collections. For any providers of that type.

    Ian – great presentation. I’ve read articles that EMS doesn’t pay for itself and municipal EMS providers doesn’t pay for itself. Do yo have anything to respond to that kind of information?

    Patrick – sure – what I’d say to that. EMS does not pay for itself. Understood within the town – we are all on the same page that EMS doesn’t cover the expenses. The bigger picture to the financial decision about an in-house program – the question will we – there is additional expenses… will the additional revenue offset this expenses… positive or negative net impact to the General Fund. There will be additional fire dept costs.

    Ian – will we look at costs? We look at revenues… this is not a full picture. What will we see next?

    Patrick – In June, we’ll show startup expenses, and in July we’ll look at operating models and compare them to the revenue. Then we’ll look at models of operation.

    Ian – I’ll rehab cuz I like to talk – we’ll look at this data again in July when we can compare with expenses, maybe get additional info to answer Franz’s question – we’ll have a full 12 months of data by then. I’d like to use the 12 month number and redo the speadsheet then. n June will be start up expenses. July will be regular operating expenses.

    Daniel – looking at startup expenses, that will be capital investments?

    Patrick – we have the operating model for long term.

    Ian – okay, the public… (9:45 p.m.)

    Kate O’Connor – on pg 142 and 144 – revenue projections informed from other municipal EMS providers – whoo, what did you ask for and what did they say?

    Patrick – I may need help form the Chief on this – we spoke to Springfield, Colchester, Milton, Hartford, and others. We had multiple community rates. We mostly have seen is billing rates. Sometimes we see an explanation of revenue benefits. That sort of info.

    Gary Stroud – I’m powering in there so you can see my handsome face. Patrick – my new Medicare book for 2023, you had the numbers up.. there is medicare Advantage and medicare Traditional…each pays differently. You pay 20%, it says. The book has different numbers and codes. I’d be happy to give you a fee copy. It changes every year, medicare. Each has a different cost if you allowed to have it or if they got rid of it. It might help the numbers better. It might help out. Nice spreadsheet. if you are open to it I’ll drop a copy off.

    Patrick – Gary, yes, absolutely. I’d greatly appreciate it and see if there are ways we can further fine tenth calculations. Traditional vs Managed Medicare – there isn’t a copayment with traditional care but there are many different medicare advantage plans, so we had to make assumptions, with help from Golden Cross.

    Dick – I think we did ask Golden Cross id they’d bill the delta on insurance and they said NO. When you think about this, the taxpayers pay for this, and you are billing them so it is a double pay. I need some clarity. On pg 144 there is a segment that AP triton to use 80% estimates for for we collect, so we’d get $1100 a call, and that doesn’t add up with what you are saying. You used the rate of the BLS and ALS, not $1400, the rate you’d get from Medicare.

    Patrick – town funds we’d receive, yes.

    Dick – I must say. AP Triton was talking of $975k and we’re at $978, we don’t know what expenses will be yet. To get back to even, you have $1.7m saved toward expenses. We’re not looking for this to be a profit or an enterprise fund – we should think about that. From beginning to now, the taxpayers I’m looking out for… quality of care is fine, and then I look at the reality – it was costing $285k a year and now this worth it? All this time and effort, and the potential for collections and how we may have to go after money it all needs to be considered. A lot on the plate. Thanks,

    ian – the 80% vs 65%

    Patrick – the AP Triton recommendation was 80% collection from private insurance. Wes struggled with it. It’s the one place where a judgement comes into play. You know what Medicare will pay. In an effort to be conservative we downgraded it to 65%. We’ll continue to research and come back with new numbers and different operating models. if we can find sufficient evidence to bump that up a little bit we will, but trying to stay conservative.

    Ian – I agree that all these elements are a consideration for what model to go with. It will make the September decision difficult. We have to decide if it is worth it. Some things are just numbers, some are about if we want this responsibility, and that’s something we all need to consider.

    Dick – your largest base is fixed income elderly. If private insurance wa 25% or 30%… but it isn’t and the number could go down. I wish we could get younger. Look where that base is coming from.

    David Levanbach – I appreciate the presentation. I have one two part comment and a question. the comment, there is an assumption that the balance between ALS and BLS is the same by payer category, but it may not be. Also, when you get to the costs, you need to take into account any differentials in pairs of ALS and BLS – are there caps on individual customers for number of calls, or limits for someone who makes repeated unnecessary calls for service. That reimbursement won’t pay for.

    Patrick – ALS and BLS – good point. We had thought about that and conferred with Golden Cross. They said that split is more or less the same across payer categories. In terms of billing, we can seek reimbursement differently for ALS and BLS calls. if there are additional interventions you can submit for additional billing. Reimbursement could go up based on mileage and use of services. The last point was

    ian – Uh…

    Franz – the prudent lay person standard for emergency room visits. The prudent layperson standard in federal law, you can’t make a judgement not to pay – an insurance company must pay for something that isn’t frivolous to the emergency room. It’s a little different for the no transports… sometimes they don’t transport a patient. In general, there is presumption that if you say you are sick you are sick.

    Patrick – the non transport fee… you could charge of a 911 call to feed the cat… a non transport policy for the board. They arrive and see alarming symptoms, they will transport them and get paid.

    Ian -if someone keeps calling and there is no insurance…

    Chief – a diabetic visit to get them stable won’t got to the hospital, but a non transport fee could work for that.

    Dora – I think Rescue had the subscription for people who needed regular calls and that helped offset the calls of those not transported. You might know better. They do have that. It keeps coming up that Golden Cross bills lower at? ($525-ish). So, food for thought about billing. The states deal with wilderness rescue differently. Vermont doesn’t charge for rescues because they want he calls for help. NH is different but discretionary. people have delayed calling for rescue due to concerns about billing. That needs to be in your minds. You don’t want people to no call because they might get a bill.

    Gary – I can wait…

    – I’m going way back to when I attended an info meeting at the library and listen to the Chief’s presentation and how it would be the best for the town – $5k profit, no implications to taxpayers! The VT Digger article out today is an eye opener. 95% of the state is covered by regional services. None of the others break even or make a profit, same with ambulances run with fire departments. Ambulance costs have jumped but reimbursements haven’t kept up. We pay a lot of taxes in this town. Additional cost to take on the ambulance service in house is going to be very expensive. One ambulance jumped $60k in one year… I’d like to hear what the board thinks about this data as far as taxpayers having to come up with 40% of the operating costs?

    ian – first thing we need to continue to evaluate the data until we have a full picture. we do need to look at expenses and start up costs. Need to consider costs and towns staff. None of what you have spoken to is counter to what we have in mind. It is part of what we are considering.

    Daniel – I read the article this morning. I thought it was talking about municipal fire and EMS… a little different. It’s not apples to apples. It said 95% of towns are covered regionally. We are in the category of outliers due to our size. I look to Hartford, Springfield, Burlington, and their budget documents report revenues lower than what we are projecting, but still not apples to apples. There is a different payer mix and different policies. So, really hard to compare with any other places. I won’t say we should do this if it is too expensive to taxpayers. It’s reasonable concerns and had good information. More will be revealed and hopefully we’ll make the right call for the town.

    Peter – Golden Cross uses a different payer scale – have we plugged those numbers in here? Have we taken what Golden Cross and put it into this spreadsheet to see if it alls seems to validate… are we tracking and

    Peter – happy to do it in a more formal way. if you account for it being a startup year, it comes in about where you’d expect it.

    Liz – we asked two weeks ago about the Chief and AC getting data from towns more like ours.

    Gary – once you get the booklet you’ll get better numbers. Medicare may pay for some transportation with a written order from your doctor saying it is medically necessary. Know your insurance company. Franz – you were a doctor. Knowing the insurance you’ll get a better assessment that way. I’ll help Patrick to the best of my abilities.

    Kate – Last week I suggested EMS providers from other towns to speak with us. We’re told other towns aren’t like us… I urge us to speak with them . We’re just guessing here looking at budgets and spreadsheets.

    Ian – so, thanks…

  • Emergency Housing Response Team – Discussion (8:55 PM)

    10:21 pm

    Potter – the state program for emergency housing during COVID was expanded. 1800 households benefitting from this, and in Brattleboro we have about 180 households. Using vouchers to stay at hotels in Brattleboro, but this runs out after May 31 for 80 people, and another 34 people will return to Groundworks shelter, and 140-190 people will lose funding at June 30. State is helping work with everyone and develop plans for everyone. Town staff has communicated with state to develop a crisis response team across public and private organizations to help town and region coordinate during this reduction in scope. WE don’t know the impact, but given the numbers and uncertainty, we want to take an incident command approach. The team being established will create situational awareness, find resources, and identifying gaps. Cross sector representatives have been invited to this. – groundworks, Retreat, BMH, WRC, DBA, etc. Town staff also coordinating our response. Once concern is expanded tent encampments and sanitary public safety and health concerns. Staff will have procedures to address problems. We’ll give you the status and what’s going on.

    ian – great.

    Peter – I plan to stay involved and hope other board members stay involved.

    Franz – you said an incident command structure – then an incident commander? Who will give commands and who will respond. How will this work and what will we try to accomplish. the problem has unclear boundaries. What will we do?

    Potter – incident awareness… there is no commander. There are so many organizations involved and no authority, but we do need to be communicating and find out what’s happening and potential impacts. And who can help. No right answers here and we don’t know what to expect. Starting with communications.

    Franz – defined meeting times?

    Potter – yes, weekly meetings

    Liz – thanks to John for being proactive.

    Daniel – it’s about having a housing plan and that can be hard. We need one that will work so when they exit the motels they have housing to go to. WE need to recognize the difficulties of the moment.

    peter – mistakes will be made and we need to be patient as we correct them.

    ian – I echo this points. No policy decision beyond accepting the response plan. I’d look to the Town manager to bring a policy decision to us if necessary.

    Potter – ok!

    Oeser – it says staff will put together procedures and resources but take a non involvement approach… that’s important to not criminalize homelessness. More detail?

    Potter – yes, we are figuring it out as it develops but the general sense is that there has been guidance through courts about not criminalizing people without hinges and we need to be careful that we are legally complaint.

    ian – but this could change

    they accept the response plan!

  • Mr. Wessel

    Mr. Wessel last night: (Base on the transcript above)

    “Also, I’m relieved and surprised that people are interested in private security. I advocated it and it ended like a lead balloon with fellow board members.”

    Mr Wessel: (Viewpoint, The Commons, May 11, 2022)

    “JUST AS MANY would rightly object to hiring an outside private security firm to protect our streets, we should recognize the advantages of using our own talented employees, not contractors, to care for our residents from the moment of crisis all the way to the hospital.”

    I remain confused about his position on outside/private contractors.

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