Selectboard Meeting Notes – Brattleboro Fire Department Gets Their EMS Service

selectboard sept 19 2023

The Brattleboro Selectboard will be using $1.3+ million of ARPA funds to set up a municipal EMS system. The vote was unanimous to give the emergency medical services ‘contract’ to the Brattleboro Fire Department.

The Town Manager told the board why municipal EMS would be best, the board told the public their decisions as to why they would vote in favor, and then the public was allowed to weigh in with comments.

Comments | 5

  • Preliminaries

    Pre-meeting talk about adjourning by 11 pm. Daniel is willing to bet it won’t go that late.

    Starts on time!

    Chair Ian Goodnow – no remarks tonight.

    Town Manager John Potter – no remarks.

    Daniel Quipp wishes folks happy New Year.

    Ian – this is for public t speak about items not on the agenda, or to request consent items be pulled at put at the end. I see Dale’s hand. When you speak, the microphone doesn’t project – speak so people online can hear you. State your name and where you are from and try to keep it to 3 minutes. I try to go back and forth between the room and zoom.

    Dale Joy – I want to speak to a certain set of words, assault and battery – it refers to the wrong act of someone feeling imminent harm. Something a reasonable person would see as harm. Battery is physically harming someone. if you are charged with either , this means there was the real presence of harm, forced or violent, or threatened. Battery means there was real harm. Assault is a threat of harm. John Potter sent me a letter into his inquiry about the assault by the police chief…

    Ian – we’ve talked about this…

    Dale – you cut me off on this

    Ian – we’ve already gone through this.

    Dale – why are you trying to hide this…

    Ian – I ask the conversation be kept civil as we discuss these issues.

    Viv Woodland – I work downtown. Today was exciting because the new bike lanes were there for me to use on Western Ave. Thanks to all who are improving bike safety and visibility.

    Mr. Wilson – I was appointed to be rep to Senior Solutions, the council on aging for SE VT. Serves as umbrella funding for Meals on Wheels, and providing case management for seniors as they age. The advisory council gives input on these issues. Reminder that Brattleboro is entitled to two reps and the other position is vacant. So, go to the town web site and submit your application.

    Dick Degray – first request is to take EMS out of consent agenda. At last meeting I asked for people tp be invited to a meeting in October. They are more than happy to attend. Downton… the abundance of Post Oil stickers all over town have been plastered. I’ve asked for two years to get cameras. What if I did this to your property. I know where each of you live. You sit on your hands. I’m sick of property being desecrated by organizations that think they are the end all be all. I’m at my wits end. You have done squat. Why? I can’t wait until the police dept put it into a budget for the next FY then waiting for cameras again. I’m tired of waiting and having things vandalized. The EMS issue has sucked the energy about of the town. I would hope you could multitask. It is really frustrating as someone who cares about downtown. It’s not like I’m not asking for help. You do nothing.

    Peter Case – I reached out to the legislators to address issues. I walk downtown and see some of the problems. I agree, EMS has been pulling bandwidth, but I am working on this. Let’s talk later.

    Bob Oeser – remove EMS update from the consent agenda, re: billing and collection. Attempted answers are in there to questions we had.

    Carol McMannis – I want to recognize the work the Bratt Police Dept continues to do. WE’ve seen a slight shift on Canal St regarding drug dealers and addicts. I also want to bring to your attention again, what can we do about the property on Canal Street. There are people inside and outside of it. It breeds dangerous activity. Parts may fall apart on someone. If someone lights a fire… gone! It needs to be addressed. Don’t know why it is still standing.

    Ian – we can look into that. Private property?

    Carol – I need a better answer than that. Two years ago behind the train station housed homeless people, Maybe before your time. many were town about it being torn down. It was a danger. This is another situation. That’s my concern.

    Landry – Thanks to Moreland and others who worked behind the scenes to provide info for the EMS project and a shout out to AP Triton. My comment is about Sept 12, the public forum…

    Ian – this is for non-agenda items.. I don’t know what you will say.

    Landry – it’s about the forum. I was encouraged by people there and the info delivered. I was concerned about the limited time. We had to listen to town Dept heads read scripted talking points and all but three don’t live in Brattleboro. I don’t feel it was appropriate that non-residents could voice opinions. A board member accused Rescue of being unprofessional at the prior meeting, it was great to see the HR director clarify some instances. Comment by Rescue against Bratt Fire for gender discrimination, etc. It was investigated. Unfounded. New form developed, then only three complaints, so where’s all the unprofessional behavior? The letter was discussed at the town forum, and it stated that Rescue couldn’t provide services for free and an offer for meetings. Town didn’t meet with them. This leads to my question: from all the emails sent to the page, and from town residents, what did the board hear from the town residents?

    Ian – we’ll move on, since that is the agenda item.

  • Consent agenda and EMS

    A. LED Lighting Conversion – Award $49,904.05 Bid

    B. Brattleboro Co-op First Class Commercial Catering License & Third Class Commercial Kitchen License – Approve License

    C. Winston Prouty Center for Children and Family Development – Approve Limited Event Permit

    D. Avenu Insights & Analytics to Digitize Brattleboro Land Records – Approve $51,108.48 Contract

    E. Town of Brattleboro Halloween Parade – Approve Parade Permit

    F. Prayerful Procession St. Michael’s Church Approve Parade Permit

    G. EMS Update – Approve

    John Potter reads an overview of the consent items.

    Franz Reichsman – I am willing to pull the EMS item, but that moves it to the end of the agenda, and the remarks people might make are germane to the bigger discussion we’ll get to first… pulling it delays the item rather than making it more accessible.

    Ian – let’s pull it.

    Dick Degray – point of order – you can move it up in the agenda if the board so chooses.

    Ian – don’t want to do that. happy to let EMS update items can come up under the EMS discussion item A. Unless it is point of order I won’t take comment.

    Bob Oeser – not sure if this is point of order – it is from John Potter – I got an answer by email that is different… what’s the orderliness to the proceeding? Most if not all can be discussed under 8A 1 but a hard meter can discuss it after if they want to pull it. You can decide based on what I was told.

    Ian – you reiterated what I was saying.

    Franz – it would make some difference in how the discussion proceeds if we pull it and put it up next on the agenda… I don’t think…I’m not sure your objection.

    Ian – I feel the questions people will have will be relevant and answered during item A.

    Franz – when will that happen – at the beginning?

    Ian – when we hear from the public.

    Franz – so well into the discussion. I want to pull it, then move it to the top of the agenda. (makes motion)

    Daniel – help me, what in the EMS update needs to be talked about everything else?

    Franz – I don’t know. My concern is that if it wasn’t on consent it would have come first, so I’d like to restore that.

    2-3 – it fails ((Franz and Daniel in favor)

    Ian – happy to hear about it during item A. It is warm in here, the problem is the AC is very loud in the back room, so we’ll go back and forth with turning it on and off. I apologize for the back and forth. can you turn it on now? Thanks.

    Daniel – maybe the board can make an effort to speak loud.

    Ian – and the public should speak loud. Ok. New business item 8A – EMS discussion and decision. There are three subitems and we’ll tackle them one at a time. We’ll hear from staff first, then from the board, then the public, then the board, then the voting on motions. It will take a while.

    Bob Fisher – don’t forget to move the consent agenda…

    Ian – oh my – a motion… (approved). Thanks Bob. Now the new business item A. To set us up. In March we set a schedule to make a decision, either municipal or a third party. Goal was to decide by September. We maintained the schedule. The board and public and staff have used one meeting a month to discuss progress of each model, reviewing costs and RFPs, then we have analyzed the responses assessing both and made comparative documents, and now we are at the final step, for us to make a decision. The Town has a recommendation, and I pass it to John to give a presentation on that memo.

    John Potter – I was a volunteer EMT in the 90s. I express gratitude for all the people who do this work. I know they will see things that will stick with them the rest of their lives. I know how much work goes into it, and how dedication EMTs are to serve the public. Bottom line we share a collective thank you to all of these people. We started our process in March of this year , and here we are tonight. A decision means we can but it into the FY25 budget and give time for providers to get ready in 2024. Ins bring and summer, staff looked at municipal model and formulation for RFI and RFP, and everything was reviewed in public. There were 8 major opportunities for public input and good feedback came in which was incorporated. Project web site has been set up. More engagement than any we’ve seen in some time or ever. We got two RFP responses. AMR and Rescue Inc. AMR would do it all for 24/7 transport services, costing 1.66 million in FY25 and would go up 4% each year for five years. Payments would go to Brattleboro. AMR proposes a single ambulance, or more for more $. Today, the town knows it needs more than 1 ambulance in 16% of the time. Sometimes a third can be expected. Because of this, we need three ambulances. AMR offers one ambulance. For this reason, staff recommend AMR doesn’t warrant further review. The second proposal was Rescue and relies on shared ambulances in the region, and municipal personnel to be first responders. Town had this service with Rescue for a long time. This assured EMS could respond quickly for all calls. The new approach proposes using another place for dispatch, without help from municipal services. Brattleboro sends out 100 priority calls a year. Rescue estimates 100 calls a year which raised serious concern. Timely response to calls, duplication of dispatching services when taxpayers already fund a dispatch service. The cost to the Town is $454k, and that would go up 5% a year for five years. The total cost would be $2.5 million. It has some obvious drawbacks, including diminished role for Brattleboro and using the outside dispatch service. If the board wanted this, a second RFP is recommended by the Town Attorney. The delay would detrimentally impact the implementation of a municipal EMS. So do it if municipal EMS is ruled out. But, staff recommend municipal EMS. This was not a foregone conclusion. It will be a deep disappointment for some. Quality patient care, sound finances, unified approach, and importance of public oversight. BFD can provide quality care. Reduced complexity will improve patient care, too. Town has control over finances; Rescue doesn’t allow us any say in rates. The five year cost analysis – the low revenue estimate over full five years and we find 4.4 million in reimbursement. It saves $1.2 million and nearly pays back the start up costs we take from ARPA. A tremendous return on investment! Town’s hard mitigation plan shows more extreme events, and climate change will continue, and EMS and disaster assistance is an increasing community need. Town must plan for this adaptation to climate change. Municipal EMS is best poised to have staff and equipment to serve the community in difficult times. Brattleboro deserves right to determine its best interests, not those of the region. Reduced complexity in Brattleboro means we can help neighbors even better. Public oversight of essential services is what the public expects, done with transparency and accountability. The fair selectboard meetings don’t compare to the private meetings of a corporation. Town finances are reviewed at any time. Policy is set by listening to all Brattleboro residents, which is not the case with Rescue. Many people like Rescue. I like Rescue. I want to see them succeed. I don’t like their proposal and how it compares to the municipal approach. This recommendation is not about the pat, it is about the future. Staff recommends the municipal model. It is significant that it is the least cost approach, but it needs an integrated system to withstand the challenges of the years ahead. This investment is the difficult but responsible decision.

    (Heh… listening to all Brattleboro residents.. CG)

    Liz makes motion to accept this recommendation.

    Liz – we’ve had 14 months of BFD working with Golden Cross to see if BFD could be the sole provider. We perfected the model. They are will ready and able. Additional staff is not a concern. We have a waiting list of new hires. Moral is not a problem Union supports this. Ambulances can be rented. Saving lives is our concern. Competency is key and governed by standards of all state EMS professionals. The BFD is not too busy. Only 8% of call are fire-related. Also, BFD response times are favorable. A nurse says BFD is done a good job. WE can add the billing with modest fiscal expense. We’ll keep the insurance fees thus the revenues will pay for majority of staff and expenses. As for ARPA spending, adding this to ur services is a valid and valuable use of ARPA funds and will improve town services. It will prepare us or climate change. A town-wide response of climate change deeply resonated with me, as what climate change will bring to our town. We constantly ask ho to prepare for emergencies and how to work together and become resilient – we will now have unified municipal care. Bottom line – this is an exciting opportunity. The best thing g for Brattleboro now and in the future. Under our total control, for all future emergencies. Climate change is real. This is a huge win for Brattleboro.

    Franz – So, in case people haven’t noticed, the topic is important and serious. I’ve devoted many hours to understanding facts and opinions, and same is tru of my fellow board members. A serous undertaking. Things didn’t have to go this way, with disruption and ill feeling. It could have been a more cordial process. A year ago I was coming saying we should learn the lessons and I think we have – more thoughtful, less reactive, be honest with each other about what we know and don’t know, and when to take responsibility, but all these things are in the background. We’re here to decide about the future – the job is to look ahead and make good decisions. Decided in the last week, I was looking for a way to move back into a 3rd party – but the town needs to be involved so AMT doesn’t work. Rescue demanded attention and consideration – a premier provider in VT. Their excellence is recognized, but that’s not a zero sum game. The protocols at every level are determined by the system. There is no reason others can[t provide e care at the level of Rescue. BFD has been integral [art of EMS for many years. The decision comes down to BFD and Rescue’s working relationship, which deteriorated. Repairing it can’t be done at this time. Finger pointing and innuendo doesn’t work. mediation has its place. The Town is a customer. mediation won’t work without mutual respect. It isn’t present. The Town has a viable alternative, which sit to build an excellent medical system within town government. The staff shows a viable path forward, even with significant startup costs. Cheap than Rescue over next 5 years. Guaranteed? No. We have to make it a reality. We will gratefully accept help. We need participation of people of Brattleboro to reach our goal. I will vote for the municipal EMS system. Many will think this a mistake, but hope you wish this venture well. In closing, thanks and I look forward to hearing from you gaian.

    Peter Case – what has unfolded over the last 6 months. A narrative snatching event – arctics that should have been on opinion pages. People have accused me and the board of dividing the town. We band together on big and small issues. I have a unique perspective, I met with Yoshi for coffee. He was agitated. He said he came from a meeting with Rescue and was confused by answers. He gave me an overview of services. I warned if he picked a fight with Rescue he’d die on that hill. Later, he was gone. I had no idea I’d be sitting here. Much has come to light in recent weeks. I was on the fence for this issue. I did independent research – someone will show up tomorrow for 911, they will get there quickly, you won’t care what it costs, you won’t care who it is. Some will be mad, but once it is done it is done. We were elected to make decisions, You always have the next election if you don’t like it. This is a town we all love. I will work on downtown issues tomorrow. I’ll work to remove the narrative. I resent the prior knowledge prior town managers had and didn’t act. Tomorrow I will never discuss it again. I will get on to other work. You will have EMS service.

    Daniel – thanks to town staff for clear and well articulated memo that gives a great summary of what has happened and why town staff are recommending what they say. It is interesting. Recently, members of the public have said we already know what you think. Last Tuesday I met with John and I was trying to figure out that people want Rescue Inc and I was wrestling with how I could do it given the proposal I received. I was wrestling with it until yesterday. Today I think I have heard clearly from many folks that BFD and Rescue are well liked and respected. I expect that to be continued. I was happy to meet all the staff at the public forum. I know both are well liked. Rescue is experienced. That’s a fact. Both have been around a long time. Other things – there is more accountability to taxpayers with a municipal EMS system, it is more efficient use of the BFD. I spent 5 hrs with them and never spent that much time in a firehouse. We don’t have a lot of fires. We’ve done good fire prevention. They are well placed to take on this work. The partnership with Golden Cross taught us we could. BFD can do the work. Policy setting – our revenue model for the municipal model is $1400 per call, which seems extremely high. That’s too much for me to want to pay for that service. I worked with our revenue model and put in various numbers… working with low numbers. The revenues that Patrick showed us can work with a few different rates. I put in Rescue’s rates and it comes out… we’ll get the chance to set a rate appropriate for patients and taxpayers. I look forward to intervening to make it a little better for people. We’ll also set policy around collections. The revenue model we use assumes no further collections beyond insurance and reimbursements. Also, revenue changes to Medicare and Medicaid will likely go up, so we’ll get the increases. When you have it all under one roof, there is a level of teamwork that is beneficial to patient care. I road withe BFD staff on Sunday and we rode in the truck and another ladder truck showed up and all teams worked well together. There was a calm atmosphere. If they all have the same goal, it is good for patient care. There are downsides… the startup costs are high, but one-time costs. I’ve heard criticism about suing ARPA funds, I hear you. Yes. That’s not the most desirable way to use them, and the way the ARPA process has played out is patchy. We haven’t had a discussion of ARPA funds… if we use the funds for this purpose, what remains can have a great process. The community can have that for projects they feel are important. There are uncertainties. I’ve tried to make the revenue model not work. I can drive revenue down, but the floor never gets low enough to be more expensive than Rescue. The proposal from Rescue – no one said anything that they liked about the proposal. I heard less first response from Brattleboro. The dispatch issue doesn’t work for me… my concern is we’d only hear about a call if we are getting a call. Not enough in current proposal for me to want to choose it. there is plenty to say yes to in the Municipal model.

    (So, the municipal model had the votes ay 7:38 pm… CG

    Ian – I want to express a feeling of regret about how this whole process began. I standby my rationale and vote but they way it occurred should have been better for the public and the BFD. I wanted to improve the process going forward 15 months ago. We started months EMS updates and the last 6 month process. While i had regret, I don’t regret we undertook this investigation. Our duty is to ensure the best possible EMS service for the town. Town has evolved, and this has shown us that. Best EMS service means quality of care, fiscal responsibility, and transparency and accountability. After reviewing everything, the municipal model is bets. There are risk, but there are risks to any model, so we need to balance risks and benefits. I’m content the best direction is the municipal model. In considering intangibles – being owned by the town and people is critical.

    Liz – I want to mention a couple of things as an urban planner regarding regionalism. Founders did a great thing 60 years ago by establishing a regional service. Sometimes it is the best solution. Evidence we reviewed shows we have outgrown it and we need our own municipal EMS. It is the future. We’re one of the last to do it. We’re not that same as we use to be. Back then, regional made sense. It worked and everyone loved it. We’re now in a post COVD world with rapidly aging population plus homelessness and drugs and climate crisis. We get 3k EMS calls in the last year. We have a model that better meets our needs.

    Ian – more from board members? If not, the public… I see a few.

  • The public

    Dale – I have questions for Lenny – do you have a full staff? I heard you were 9 people short. I want to know if the team is full staffed. We’re going to need the full staff to pull this off. You know it and I know it. It’s a wonderful thing, but you need to be fully staffed. Is the BFD fully staffed to handle both situations.

    Ian – part of the municipal EMS will involve staffing up…

    Chief Howard – we are currently fully staff – 3 shifts of 8 people and 4 administrative staff and 5 people for potential hires and another coming in for an exam.

    John Potter – we will move to 3 shifts of 10 plus a supervisor. That’s in our cost estimates. We bargained it last spring with unions.

    John Kennedy – I support the municipal model. Don’t want to look to past. Need to go forward. let’s go forward. thanks to town staff for great memo. It’s very clear and thorough. Just ready the 9 pages.

    David levanback – two comments – one, at 2023 meeting RYM approved a motion for the selectboard to come up with a process for any ARPA fund spending. The public has begged you not to set aside money until a public process on ARPA funds… you plan to use 51% of the ARPA funds without public deliberation. 2. At RTM, the budget was approved to pay Rescue – which provided quality care – and the town would collect dispatch calls. The proposed town model is more expensive than what we had been paying. Rescue wants more now that the selectboard made this mess. The outcomes and consequences of your decisions tonight will reflect on this selectboard.

    Tom Frank – thanks to the board and town staff and BFD and Rescue. I’ve been clear to the board with letters, but Daniel said a majority would like a contract with Rescue. It was a majority of people commenting. 75 in favor of recuse, not a majority of the community. I’m a town rep and was a lister, etc. I have no expertise, but patient care seemed the same with both options. So I looked at cost, accountability, level of service… in every instance, the clear choice for me is the municipal model.

    Franz – Tom, I’m a data guy, too. I have a masters in epidemiology and statistics. Material collected was anecdotal and self-selected. A large majority of people have good feelings toward Rescue and are strongly predisposed to have them as the provider. I share the conclusion that we don’t know the numbers, but my impression is people in town favor Rescue and I’m against that current… what if I’m wrong. It’s possible.

    Tom -I don’t doubt… I thank Rescue. Many other people do. Mr. Fish said, Mr. Case… as Pete said, you don’t care what’s on the box. They do their job so well, regardless of what is on the box.

    Franz – welcome to the minority

    Ian – let’s not have too much back and forth.

    Millicent – that was excellent. Thanks for the town. One thing Franz said – the way this happened, it has been confused about this and confused about the ethics of this. Quipp’s statement is balanced and I’m behind your decision.

    Bob Oeser – don’t want to be negative, but some information for you that you need to consider. Someone mentioned an Op-Ed in the parer, but it wasn’t an op-ed – 16 people left the fire department. That comes from he Town website, not an op-ed. There has to be more detail. I asked for exit interviews and was told that would not be good to disclose because you could identify who they are. On 13th Sept, there was a letter… can I verify the veracity of this. I asked other people, workers, and people who knew… the letter says that since July 1 of 2022, the EMS transition has completely enco[passed the BFD, fire based training is out the window. EMS transition is all they talk about. That resonated with other workers. The system, the letter says, before July 2021, worked well. Less than a handful refused to play nice with Rescue. BFD can’t match Rescue’s service, says the letter. BFD staff don’t want to work on an ambulance. They want an ambulance to get better pay, but the assigns,ent is something employees dread, says the letter. I used to do hiring. New York state pay was pretty good, but I said don’t take the right job for the wrong reason.

    Ian – finish your point…wrap up you comment

    Bob – I’m over the three minute time limit, and you will spot me more?

    Ian – I already have. Conclude now..

    Bob – how much time do I have?

    Ian – I have a watch…

    Bob – I can’t see it… trying to speak to you and you are telling me I’m limited in tike.

    Ian – I’m just trying to be polite…

    Bob – I want to share one more thing from the letter, as a former employee of the BFD I know all of these things to be true….. the abrupt course correction damaged town credibility with the public. How will you restore that credibility for future decisions. I have the answer. There was a motion by Liz to have a discussion of transition of care and interagency operations – it would not be against the law to have that discussion in executive session with a mediator to work out the details. That’s my plea to you.

    ?? – I have sent an email but got no answer. You take off accountability. Golden Cross came in front of our house… They left medical hard trash in our yard. That’s unacceptable. Someone else I know broke a hip, Golden Cross came, and BFD’s trainee refused to lift her. Where is the accountability? Was it reported? When fire chiefs came and spoke, one should have been against. All research pushes toward having a BFD EMS and not showing reasons why we shouldn’t. I wasn’t able to see Golden Cross financials. There expenses would be similar to ours. Table this for another week or two. Maybe Rescue want’s to use Keene because it is free. This is a personality thing and you put lives at risk over personality.

    Will C – I want to make reference to open meeting law… at an open meeting the public should be given a reasonable opportunity to offer opinions. Public comments should be subject to reasonable rules. You imposed a 3 minute time limit. Given the magnitude of the decision and the importance, that is an unreasonably short time limit. I know my comments will exceed 3 minutes. Can I proceed. I might take 6-7 minutes.

    Ian – can you break it in 2?

    Will – I want to say what I want to say, and will exceed your time limit that I think is unreasonable. As I suspected, the Fire EMS model was predetermined – it was the oil from the very beginning, and I don’t think the town had intention to seriously consider Rescue. The Town stacked the process… the name is Fire EMS Transition Projects… the goal all along was to transition the fire department and the die was already cast a long time ago. I was profoundly disappointed with the public forum. It was advertised as a public forum on EMS alternatives. There was no discussion of alternatives. It started by choosing the fire department and all dept heads spent an hour reading prepared statements. People attending were upset. The town had hijacked the meeting. There is a movement to cooperate on regional EMS models, because this concerns health care. Pre-hospital care. Days of load and go are gone. It’s a critical service for residents. prior to my comments, I didn’t hear anything about patient care – it just appeared when recommending the municipal model. We have one of the best EMS in the area… and we’re going backward by closing ranks and we don’t care about others and we don’t need anyone else’s help. We are dealing with straining issues – homelessness, drugs… we’ll have floods, fires, heat, drought, pandemics… these issues don’t respect town binderies. They are regional and national and global issues. Town should be working with Rescue. I’m totally confused what the Town wants to contract and say we’ll do it all ourselves. Town has already rejected Rescue and you’ve already decided 5-0 and you can rubber stamp what the town says… but you work for the people, not the Town. You took and oath of office. We have a charter in town since 1753. Brattleboro was first to be granted a charter in the state. This is from our Charter – the preamble -” a legal document to serve the needs of the residents by addressing common good, respecting the will of the people” Do people want Rescue? Do the people want you to spend the ARPA funds for ambulances. This is our money, not your money. Over the past 10 days, a simple petition has been circulated. We the undersigned ask you to choose Rescue Inc as our EMS provider. I want to deliver the petitions. Over 400 people. Not online. Actual people engaging with us and expressing their frustration. At the public forum…

    Ian – you are at 8 minutes..

    Will – does the town have the courage to admit the mistake of a year and a half ago? Do you have the courage to respect the will of the people. (delivers potions to the board)

    Ian – let’s take a break now for 5 minutes. Until 8:25.

  • Public II - and the Vote

    Daniel – use the gavel – that’s what it is for.

    Ian – OK everyone. Make you way back to your seats. That includes the hallway. OK, so. We had a couple of hands up.

    Michael Bosworth – the EMS decision is not an emotional one for me. We’ve never needed to use emergency services yet but I respect both organizations. I haven’t compared all the fine details, but have looked to others and have learned from Tom Franks, and also from Kate O’Connor and her close monitoring of expenses, so I now don’t firmly know what is the best option financially. neither is definitely less costly. Not knowing is one of the unsettling feelings. Franz said the results were not guaranteed. I know we’ve been lucky having Rescue for years. I’m biased toward regional solutions. I’d rather use ARPA funds go to energy efficiency and the pool. I have many unsettled feeling about the BFD plan – we heard the dept is fully staffed, then learned many don’t want to go out on ambulances. This can’t be an easy decision. I hope the board chooses the Rescue inc solution for less unknowns.

    Carolyn – yes, I want to say my comments feel al little anecdotal, clearly the board has made up their mind and they had made up their mind when they decided to end the contract with Rescue. I believe they are being shortsighted. It won’t make a difference, but some points. The criticism of the Rescue bid is like closing the barn door after the horses are out. Brattleboro broke up with Rescue and Rescue modeled a response to deal with the challenges – to minimize problems they minimized the fire dept. The bidding process wasn’t fair. Also, the board acts like Rescue’s regionalism is a detriment. Rescue administered 61k of COVOD vaccines, leading to one of the best rates in the nation, shows their regional nature doesn’t impact service to Brattleboro. Never left short, and never a need for mutual aid during that. The service Rescue provides is the best in the state and regionally, and to look to recreate that… it’s like starting a new university next to Harvard. Not sure we need another. Last point is ARPA funds – you have to buy ambulances and equipment that Rescue already has. We need that investment in the police department instead. We have issues that need to be addressed and we’ll spend ARPA funds on something not critical? My comments tonight and in previous meetings have made no difference. I want to voice that frustration. I do not feel represented by this board.

    Dick Degray – thanks to all. This reminds me of the old light beer commercial – less filling tastes great. Both BFD and Rescue are quality organizations. Since the board has made up their minds, which you do differently – we heard from the public first then made a decision… tonight, everyone who speaks it isn’t relevant. I never heard complaints about transparency or opening up their books at Rescue. No one accused them of not being transparent. For me, I like BFD and Rescue. After the forum last week I had an issue at my building and BFD responded. Outstanding job. I had Rescue had to transport me years ago and they did a great job. My question, Mr. Chairman, is why I asked to pull the EMS discussion and taking about revenues. On page 51. Invoiced vs collected – that’s 14 months and we haven’t hit the revenue projections you have for a year. You are estimating collecting over $800k. But here you are at 60% at 14 months. In the first year you have revenue to stick in if there is a shortfall… (150K?) punched in for the first year because we won’t collect money the first three months. But I looked up here for July of 2023-Aug 23 – 149,245 collected – how do we write off anything? Elsewhere is says we wait a year to write things off…

    AC Kier – what you see in the EMS report is from Golden Cross. We asked him these questions and these are his answers – write-offs, contractural allowances, … write offs is the amount we believe we won’t receive. Can’t answer why he already has write-offs.

    J. Potter – the amount collected is 92% of the estimate so it is close to what we predict for a year. This doesn’t concern me. It look promising and may come in higher that what we estimate.

    Ian – table 1 is the first table in the memo about the 5 year projection

    Potter – yes, the low revenue estimate

    Daniel – this comes up once a month and we have this question every month. WE’ve been grappling with this. I understand the numbers – the credits aren’t payments in those dates, it is when payments come in. I have my revenue model here and spoke with Golden Cross and they told me how they bill. It’s a low number. They don’t charge a lot for their services. Close to medicare reimbursement rates. That would be $770k for a year here. Is our revenue estimate way off? It is based on Golden Cross numbers then projected a bit. But our revenue model is sound, and I can send you one to play with, it is hard for it not to be about $800k. How does that impact the bottom line? We have a choice between two proposals. I still would choose municipal.

    Alex Richardson – I was a BFD and was one of the 16 in the article. As 1 of the 16, no one approached me. I left for a personal reason. Loved my job. Not a career to get into to make money, it is because you care. if anyone is worried someone won’t help because of who they are. If you have doubts talk to them.

    Heidi F – I had written to each of you early on in the process, and I still feel strongly. Sorry I’m not there. I’m an ER nurse and have received patients from Rescue and BFD/Golden Cross. I know many of the people. I was on Rescue’s board 10 yrs ago. I know both are high quality organizations. I agree about use of ARPA funds, but there is an elephant in the room, and at risk of trouble. There is no question that the quality of care Rescue provides is far superior to anyone else coming into our ER. Bratt Fire has a few EMTs and some paramedics and a few just finishing the program is considered quality care for the town of Brattleboro. Who would you want at the most critical moments? Someone with little experience who is still learning. Some of the mistakes I see bringing patients to ER… it is frightening. It is very very scary. I can’t believe Franz say people want Rescue… you are our selectboard and we elected you to represent us. You are not listening. You want transparency and you have been far from transparent in the process and far from accountable to the people in town. I find it hard to accept given the bylaws of what you are elected to do. I agree about ARPA funds not being spent on EMS. It really matters whose name is on the box.

    Carol – A couple of comments and questions. It’s been a long journey for all of you. I wasn’t happy with the way this was done. I’ll let that go. I’ve heard a few of you acknowledge that the handling of it wasn’t the best way. I’m not here to sling mud. I was not happy with the wording “we will make that decision” but that it is a collective decision. You are elected by us, and to my neighbors, other selectboard members wore things on their sleeve before elected this year. More than the majority were not saying they’d get Rescue back. Don’t tell me the majority voting didn’t do your research. I have a hard time with myself. I voted for who I voted for. I did the research. I heard Fish mentioning Rescue. You know who you voted in. Now we’re back. People were on the fence. We don’t know the thinking process. To even imply… it isn’t fair to imply or believe that there is a conspiracy going on here? There is some bias but most people have thought this through. Questions: The BFD is municipal and we have that building already, it would be nice to have positive stuff. We won’t have to pay for the Rescue Inc building anymore… what do you think.. a huge difference in cost? I was just curious. Franz brought it up. Is that one less bill we have? Trying to look at positive aspects. This isn’t over. people will be scrutinizing. We need to come together and make this work as we look to the future. It’s going to happen. What can we do to help you make it successful?

    Ian – to address your questions – yes, the town has infrastructure for firefighters. As for building maintenance and heat, I’m not sure if we have that as an element.

    John Potter – table one fully outlines all thew additional costs to do EMS services. One benefit is we already are heating the fire department. This model builds on top of it, at the end of the day, it is 1.2 million cheaper to go with the municipal model rather that Rescue’s proposal.

    Ian – Golden Cross operates out of BFD right now, so we see what that’s like.

    Will – I want to speak to the potions I delivered to the selectboard. if you have any doubt that they represent the will of the pope. Lay it on the table. Have a referendum. A simple vote up or down. I’m not optimistic. I’ve heard members here say they’ll do whatever they want, and that is disheartening.

    Sandy – AP Triton said Rescue is the best option. Golden Cross is professional. Will the new employees – is 9 months enough time hire/train to be our professional EMS? You wanted 5 year contracts from the 3rd party, will you give BFD 5 years to see if it works?

    ian – big task

    Chief Howard – we’ll be ready. BFD is ready to do this.

    Ian – The other question, actually, I believe that the municipal option presents an opportunity – out is not permanent. A future board could move to a 3rd party. It’s part of the model that is powerful – our control. based on everything it is financially viable and it will prove itself. It’s part of the control we have!

    Liz – about AP Triton – it was not my understanding that they recommended Rescue. They said BFD can do this. They told me personally. maybe the chief will speak of AP Triton.

    Chief – both are capable to provide the service.

    Daniel – the people that will be hired and the new people are not necessarily new to EMS work. We’ll try to hire someone with experience. Skilled providers. Then build on that. I’d imagine that happens in all organizations.

    Sandy – hiring EMS or firefighters?

    Chief – minimum will be paramedic, and firefighters must have EMT and firefighter 1 to be hired.

    Daniel – if it doesn’t work… the good things is every year we can see if it is working and make changes and course corrections. I’d imagine future boards will continue to monitor this as all other town operations. It will get extra scrutiny as a new operation.

    Ian – we’ve gotten the public, so back to selectboard. John – explain the different revenue from table 1 chart one more time? How it will make up the ARPA costs that we would spend? Under Table 1 the municipal option is still in the red. It’s a confusing statement to make.

    J. Potter – this table shows… the expenses offset by revenues, so if you subtract the costs from revenues you get a cost to taxpayers… it is less than Rescue’s cost to the town by $1.2 million. If you think of ARPA as an investment, you pay it back as a return on investment. You make it up a bit every year. The bonus is that goes on fore… additional years after that were the town will continue to see savings over the Rescue proposal.

    Ian – quality of care matters the most to me. Any doubts, Chief?

    Chief – as I said, I feel confident we’ll be ready to do this. We’ve been under scrutiny for 14 months. It is news me to learn our services were as bad as someone said tonight.

    Ian – there’s been a motion…

    Passes 5-0.

    Ian – thanks to the board and public for all the participation. 8A2 is next. Now that we chose our model…

    Potter – staff recommend we reject the proposals, in the best interests of the town.

    Franz- I didn’t like the word “reject” but I was told it is a standard legal wording. You have to officially reject it. You have to say you reject it.

    Approved 5-0

    Ian – 8A3 – to direct staff to implement the plan. Now that the board decided on a model, we need to decide about next steps.

    J. Potter – staff request that plan allows staff to use up to $1.37 million in ARPA funding, as shown in Table 2of you materials. It will be to hire a supervisor for 8 months, it would hire firefighter EMTs for 21 months, start up consulting, other staff, mobile radios, potable radios, turnout gear, 3 ambulances (we have quite a bit of detail) (666k for 3) plus contingency. $1.375 million for start up costs. This allows previously set aside ARPA funding to be used for other purposes (ie, less than we originally thought). Come to the budget open house to make suggestions. WE want to accept the quote for the ambulances and HR dept create job descriptions immediately. Firefighters hired in 2024. Staff will come back with regular updates of how this is is going and recommendations for billing and collections, and a mutual aid policy for EMS, and will come up with a budget.

    Ian – thanks. Board members? I want to hear about ambulances with more detail. These are… Type 1 is what most have. The truck is new but the box and power load are refurbished?

    Chief – we propose getting two type 1 ambulances (on pickup chassis) – and one type 3 ( a van type). Allows to carry fire equipment. We chose these because the other chiefs said it takes three years for a new one. So we look at new chassis and a refurbished box. 5 year warranty on lights. We got bids – 280- days for delivery or so. Moreland made a capital plan to replace these. Type 3 will last along time, the other two will have continuous use.

    Ian – a motion?

    Daniel moves to implement the municipal plan.

    Daniel – thanks. I knew going in to today that if I chose the municipal approach I’d also choose the implementation plan, and the refurbished box was talked about a little. The original start up cost presentation had three types and we set aside $600k at the time with it keyed to three van type ambulances, which isn’t preferred. The union likes Type 1. Having more room is better for patient care. Van is a little tight. This is a reasonable option for us – refurbishing is extensive. I had misgivings hearing about this. Typically we get new vehicles. I want the public to feel confident that the equipment will do the job well. Does the union like it?

    Jamall – as far as refurbishment, the Chief let me sit through the process of choosing, weighing the pros and cons. Availability is important. Need to be familiar with equipment. The van will be gently used. The The 1 will provide us with a good truck for inclement weather and Vermont winters. We’ve been consulted on the process and feel good about it.

    Franz – if there were new ambulances available I’d still advocate for this – they meet the need and the savings is considerable. It’s my preferred approach. I support going forward with this.

    Ian – the other thing is I’d like to modify the EMS update moving forward to update us on the implementation process, so it isn’t clear how often.. let’s do it every month. We can hear about golden cross and our implementation – hiring, equipment, and so on. That’s the best way to all be on the same page.

    Franz – I’ll tell my Joni Mitchell story – in the 80’s or 90’s she did a Mingus album and it was considered a radical step and one that had little commercial potential. The record company wanted to promote it with a contest. First prize is you can keep your job. We need to make this work. No substitute for success in this endeavor. We need to keep close tabs and need to be accountable for the success of this program.

    Liz – glad you didn’t bring up “Both Sides Now”

    Peter Case – I agree with monthly, but I have a Mickey Mantle story…

    Silvia – thanks – something I wanted to get in. Maybe an endpoint to the whole discussion and decision. One thing I would hope in the future is you would set up some system for performance evaluations and reviews. It frustrates me the most that if something is going wrong, and if you aren’;t auditing but taking anecdotal info. You need to really know what’s going on. I sent you a memo last year. I had a traumatic experience, EMS, with current EMS provider. If there had been.. when I reported it there was someone else…we wondered how many others had these experiences. Check with people that use the services to make sure you are getting what you pay for and residents get what they deserve. because of your decision, I no longer can call Rescue and they are the only ones I want to come to my home. It is very sad for me. I implore you – no one got back to me about a system in place for reporting something wrong. You have no idea how traumatic. There could have been a lawsuit. I wasn’t handled correctly. Keep things safe and secure with your powers.

    Ian – speak to quality control

    AC Kier – we take complaints seriously, internally or externally. Staff have concerns about other staff. When we get a complaint we review the incident. Any breach of protocol? That involves Dr Stron, myself, Golden Cross. If error are found they are reviewed and corrections are issued if needed. Disciplinary action involves Sally Nix.

    Liz – that’s complaints that come in. You have your own review process?

    Kier – firefighters have to meet standards, reviewed regularly with shift officer, they may flag things that need more follow up, they interrogate, or question how a call goes. What went wrong, what went good. For all our calls, fire and EMS.

    Daniel – that’s helpful to hear. Complaint to any department get handled with seriousness. Sylvia wants a system that is complaint driven. Storn reviews things… we should have a customer feedback on how people felt. Sylvia didn’t feel as good as she would have liked to. Maybe a QR code or smiley faces to see how happy people are. Police and public works should do it, too.

    Ian – can we hear what we are exploring as other quality assurance mechanisms. Talk to other providers. It may be similar to others. Worth exploring.

    Liz – I’d call it patient feedback.

    Daniel – we should make it easy for people to give feedback. Maybe when bills are sent.

    Bob – since you are on the topic. Some of the EMS feedback. I read a letter implying there was a medical situation not to their satisfaction. I met with a selectboard member and said I really think this person had a more substantive response than the auto-reply. It’s a small town so I reached out. The person said “never heard back from any other them. Really insulting.” Fine ideas to have a good website but getting the response, after reading the memo… I don’t know about the smiley face.

    Sylvia – Dan- you are right. What is needed is customer feedback. The hospital does that now. It gives you some confidence you know what is going on. Otherwise you are going by anecdotal evidence.

    Daniel – so this is $1.35 million of ARPA money. Town Mtg did make that motion. I spoke with the finance committee – Paula Melton – she wrote us a memo about public process and ARPA – are we committed to doing the ARPA process from here on out is astoundingly good. We have a little bit of time. I want to make sure we don’t miss the opportunity to good a job with that ARPA money.

    Franz – since we’re talking about ARPA and RTM – if RTM thinks it is inappropriate the money could be restored and ambulances could be bonded. That’s on the table of people in town … I’m not advocating we do that but it is reasonable to talk about. I put it on the table as a possibility.

    Liz – while we put it on the table, there is no way to borrow and pay back the money in 5 years.

    Ian – we did the set aside prior to RTM. We have been clear and talked about ARPA all the way through the discussion, and part of the discussion has included the ARPA part of EMS.

    Dr. Tortolani – thanks… for all the work. It’s been difficult. I want to speak to Heidi’s testimony and quality issues. If there are any concerns on any emergency dept staff about the way a patient was handled, it should go back and be reported so we can learn from mistakes. It is an important situation and I’m concerned by Heidi’s testimony – info needs to get back tot he medical director to improve training.

    Ian – yup. That’s what we’re talking about. We have a motion to direct staff to proceed…

    5-0 approved.

    Ian – that completes the first agenda item and we’ll move on to the EMS update.

  • AC Kier reads the memo...

    368 calls in June….

    Ian – any comments? Any info we should ask Golden Cross now that we chose a model.


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