June 16, 2010

CALL TO ORDER 7:30 pm

ROLL CALL

x Mr. Anderson x Mr. Brotzman x Chief Lutz
x Mr. Bartlett x Mr. Takacs x Mr. Long
x Mr. Britton x Mr. Wayman x Mr. Szeman

MINUTES:

MINUTES of: 05/19/10 Regular Session
Motion by: Mr. Wayman, Seconded by: Mr. Bartlett to approve.
ROLL CALL: 5 ayes, 1 abstain

BILLS AND PAYROLL:

Bills ($108,734.22) and payroll ($128,550.30) totaling $237,284.52 are motioned for acceptance and payment.

Mr. Britton and Mr. Long reported that a final engineering bill ($15,332.46) from CT will be paid and will be reflected in the next paid bills list. Mr. Bartlett asked that, in the future, all contractor work done be tracked by itemized work orders, dates and times for validation and reporting purposes. Mr. Takacs inquired about the total completion cost of the Storage/Training building which was reported at around $200,000.

Motion to approve as presented by: Mr. Anderson, Seconded by: Mr. Wayman
ROLL CALL: All ayes

OPENING PUBLIC PORTION:

Gary Robinson of Lake Health reported on the status of the Lake Madison project. He reported that initially Lake Health announced that they were converting Lake Madison Urgent Care to an Emergency Department while keeping the Physical Therapy, Primary Care, Physicians Offices and OB/GYN. Robinson commented that after contacting focus groups, they recognized that Madison residents wanted Urgent Care walk-in service as well because the co-payment for emergency services would be higher than for urgent care services. So the plans have changed because Lake Health is trying to include walk-in services and they are looking into various “Plan B” alternatives.

Robinson explained that Lake Health needs to be sure it is legal, operational, and safe to have Emergency Care and Urgent Care in the same facility. They cannot find any other facility where both ED and walk-in care are housed in the same building. They feel it is do-able operationally and will not pose an unsafe environment (traffic) if the plans for a 2nd curb cut are approved; however, they have yet to determine whether it is legal. Robinson stated that if walk-in Urgent Care cannot co-exist with the 13-bed Emergency Department (original plan was for 4-6 emergency treatment areas), Lake Health is committing to providing a walk-in facility somewhere else IN MADISON.

With respect to the delay in starting the construction work, Robinson explained that currently Lake Health has applied to the Ohio Department of Transportation for a 2nd curb cut on Rt. 20 (west of existing cut) to accommodate emergency vehicles and emergency department patients only. Lake Health is ready to start construction of the new addition upon approval of 2nd curb cut. ODOT (District #12) wants to replace the existing curb cut with one access in the middle rather than (1) east and (1) west which will require emergency vehicles to make an immediate 90 degree right turn after entering the property. Lake Health is preparing a rebuttal with the help of Chief Lutz of the Madison Fire District and Chief McDonald with Perry Fire because, in their view, it is not safe for residents who are there for non-emergent appointments and emergency vehicles to use the same entrance. On June 15th, Lake Health received an initial rejection letter asking for additional information justifying dual curb cuts which was provided to ODOT the same day along with supportive documents from the Madison Zoning Board, letters from Chief Lutz of the Madison Fire District and Chief McDonald of Perry Fire, as well as ongoing support from Representative Snyder and Congressman LaTourette. Robinson is hopeful ODOT will send personnel to the site and approve the 2nd curb cut. If this appeal to District #12 is not granted, Lake Health will appeal to the State of Ohio. If that effort is not successful and only one curb cut is available, it will further solidify Lake Health’s rational for having the Urgent Care Center in a different, high volume location.

Mr. Britton asked if the separate facility will be owned by Lake Health. Robinson said he was not sure what specific options Lake Health is considering. Mr. Britton stated that he never heard the word “convert” when considering whether to approve the Lake Madison addition. He thought it was always going to be an Emergency Center ADDED to the existing facility. He does not feel the board would have supported the project if so. Britton stated that Madison does not need Lake Health if the Urgent Care is to be housed in WalMart. Robinson asked Britton if he would rather have the Urgent Care Center or the Emergency Center at Lake Madison. Mr. Britton replied that he thought we were getting both. Britton also stated that the plans for adding the Emergency Department at Lake Madison has become widely known for almost a year and the residents of Madison, Perry and Geneva have grown accustomed to the idea of having both services available on one campus.

Mr. Bartlett commented that over the past months, his view of the project was that it included both UC and ER. He stated that that was how the residents of the community saw it, too. Mr. Robinson asked Bartlett why he desired to have both services in the same building. An answer came from one of the Lake Madison nurses in attendance. She explained that when residents come to Lake Madison and can’t get in to see their family doctor, they go to Urgent Care in the same building. And vice versa, the physicians (one Pediatrician and three family doctors) pick up the care of the overflow patients that Urgent Care can’t see, in the same building. Robinson agreed that that was a convenient thing to have but asked if it was necessary for it to be in the same building. Another nurse in attendance stated it was certainly more economical to share the use of equipment rather than have to supply two separate facilities.

Mr. Britton interrupted the discussion instructing that participants needed to wait their turn to be recognized by the board and identified for the record.

Mr. Wayman asked Robinson why Lake Health would not want both services on the same property. Robinson replied:

1) Because they have not found an example of it. Triage becomes a questionable issue as to whether a patient is sent to Emergency Department as opposed to Urgent Care especially if co-pay is involved.

2) The certification of personnel in the ED vs. UC. Currently physicians cover for UC overflow and UC sees patients that cannot get in to see their personal physicians. This will not likely occur between ER and UC or ER and physicians because of the difference in skill set.

3) If we have a large volume of traffic into the facility and there is only one egress system, we are left with a less than desirable situation with regards to traffic safety.

Mr. Anderson asked Robinson if Lake Health absorbs the Urgent Care into the Emergency Department, will the current staff be augmented or will they be transferred to the ER. Robinson explained that it is a different level of skill mix between those who work in UC versus those who work in ED.

Mr. Takacs said that Robinson had initially been excited about being a trend setter and putting a remote ER out here when it hasn’t been done before. He said Robinson had commented then that it made sense because you had joint services (x-ray, lab, etc.) provided on both sides. He asked Robinson if he is telling us now that it will be more economical to take the Urgent Care Center out of Lake Madison and duplicate those same lab and x-ray services at another site. Robinson stated that his earlier comments are still valid since the x-ray, lab, etc. will be shared by Physical Therapy, Physicians, OB/GYN and the Emergency Department. Takacs asked again if Robinson was saying that it would make economic sense to duplicate lab and x-ray services in two facilities ¾ mile apart. Robinson said he did not have the answer to that question. Mr. Takacs stated that not having to duplicate equipment was Lake Health’s major selling point when the project was first presented. Mr. Takacs said he was not buying into the “nobody else does it” attitude and if one wants to make a difference, one must do things that nobody else does because it makes sense. He also stated that the Fire Board was sold on the idea of a supplementary emergency center at Lake Madison. Instead, Lake Health is taking it to a primary Emergency Center and moving out the Urgent Care completely.

Robinson said he didn’t think we are in agreement as to the progress of the project, but stated that the Emergency Center will a) eliminate limited hours of service; b) eliminate limited scope of service by having physicians on site 24/7 who will provide a higher level of service; and c) will eliminate the long drive to TriPoint. To address the issue of higher co-payments, Robinson commented that walk–in Urgent Care services need to be available and it makes sense to duplicate services in a separate facility if we can’t do it at Lake Madison.

Mr. Takacs agreed with Mr. Britton that there was never a discussion about converting the center to an emergency room. The idea was to put “IN ADDITION TO” services, job creation, expanding the building facility, and providing better service to the community. Takacs commented that what Lake Health is now offering is less than that and there is a real concern that Lake Health will put an Urgent Care Center somewhere else in Madison, realize the economics are not there for two of everything, and pull out which will mean Madison will have lost a service that we already have had here.

Takacs reminded Robinson that Insurance companies make the choice of where people go for medical service. They require that patients go to an urgent care at certain times of the day or they get penalized with ER service rates. Takacs stated that Lake Health is not providing the services that they alluded to and that there was no discussion about a total conversion. According to Takacs, Lake Health never said they were pulling the Urgent Care out and providing the service somewhere else.

Mr. Robinson said what is important at this point is to sit down and discuss what Madison wants and work together to make it happen.

Mr. Britton stated that he felt it might be better to build the Emergency Department offsite if Robinson felt that the two departments could not co-exist in the same building.

Mr. Bartlett stated that a year ago the Fire Board had some tough decisions to make and the community became engaged. Lake Health set an expectation and an understanding that the board minutes will certainly reflect. Now, a year later, we are getting questions from the community. Something has changed and managing expectations is a key component to keeping the residents in the process. Mr. Bartlett commented that one always needs to “follow the dollar bill”, and that he is also concerned that Lake Health will ultimately decide that a separate Urgent Care facility is not economical, will close the facility and Madison loses. The fact that the two services were tied in together gave the board comfort a year ago.

Mr. Anderson stated that even though he wasn’t yet a part of the Fire Board, he understood from the start that both services would be available. He commented again that he is concerned about having medical services for his family as well as for the jobs of people who have been around for years.

Mr. Long read from August 19, 2009 minutes that stated that Lake Health “was not closing the Urgent Care already at the facility” and that Lake Health “has hired a research company to get the community’s view on having both services available”.

Chief Lutz stated that the District needs the Emergency Room because of the extended time firefighters are away from the community when they have to go to TriPoint (90 minutes round trip). He also stated that he was sure Gary Robinson was willing to sit down to discuss the matter and fix the issue.

Mr. Bartlett commented that Madison is a growing community and that the District has a new master plan and is looking to do the right thing. Robinson said he thought the Board was doing their job and that he is committed to working it out. Robinson reported that the project is a 4 million dollar investment and Lake Health wants it to be a good thing. Mr. Bartlett asked how we should proceed to address the situation. Robinson suggested that the board identify 2 representatives from the Fire Board and from focus groups to meet with key leaders involved in the planning process.

Public comments addressed to Gary Robinson:

Valerie Sency, Urgent Care Nurse at Lake Madison, commented that at no time was the staff advised that they would be out of a job. In fact, they were assured that the Urgent Care would continue at Lake Madison and that their jobs were safe. She reported that six weeks ago Lake Health came in and said they were now putting in a 13-bed ER and that Urgent Care was out. Lake Health offered to take resumes but stated that they would be hiring ER people first.

Sency stated that it was not in the best interest of the community to eliminate the UC. She reminded everyone that many of the nurses currently at Lake Madison have been serving this close-knit community for many years and have developed a valuable rapport that would be lost if new personnel was brought in. Sency reported that they border on the poorest county in Ohio and that patients come from as far away as Roaming Shores and Conneaut because they cannot afford to go to ER. She speculated that Madison would lose income from patients who will pass by 2 or 3 ER’s to come here to Lake Madison.

Robinson stated that he did not know who told them these things but he pointed out that there are lots of opportunities in the system and he assured Sency that to say the nurses will be out of a job is inaccurate and premature at this point.

Ann Takacs commented that earlier this year (January/February) at the Fire Board meeting at the Village Hall Robinson and several colleagues gave a presentation that very clearly showed that there was an Urgent Care Center with a separate Emergency Room. She stated that Robinson explained in great detail how both services would use the lab and xray and Lake Health wouldn’t need to duplicate equipment. She further stated that Robinson had explained in the beginning that it was an ideal situation because Madison Fire would no longer be out of the area for an hour or more. Mrs. Takacs also reminded Robinson that he had stated then that ground would be broken in April, 2010. She asked Robinson if everything he reported that night was pie-in-the-sky, just a pretty picture.

Robinson responded that what he presented that night was that the ED will be attached to the current building and will be using the current location’s lab and radiology and yes, Lake Health was hopeful to break ground in April. He commented that some things are “out of our hands”. Robinson again contributed the 2nd curb cut issue and the negotiations with ODOT as the reason for the delay. He again reiterated that Lake Health is not breaking ground because they don’t have ODOT’s approval to do what is safe for this facility, a setback that no one could anticipate.

Ann Takacs asked why Lake Hospital has decided that Lake Madison doesn’t need an Urgent Care. Robinson responded that they aren’t saying that they don’t need it, they are just not certain it can be accommodated in the Lake Madison building.

Doris Cook, Lake County Tribune, asked if the existing Urgent Care Center is turning into an Emergency Care (no addition) with a heliport. Robinson stated that the Emergency Department will be housed in an addition building located on the west side of the existing building which will continue to house Physical Therapy, Primary Care Physicians and OB/GYN. He clarified that the concern revolves around whether Urgent Care services will be provided in the existing facility.

Cook commented that uninsured patients are treated at Emergency Departments in hospitals and that those who carry insurance “pay for it”. She asked Robinson if a patient without health insurance would be treated at the new ED. He stated that he is not a lawyer but assumes so because emergency rooms are required to treat anyone who needs care whether or not they carry insurance.

Cook asked why Lake Health would do away with walk-in services. Robinson again stated that Lake Health has yet to determine whether it is legal and safe to have Emergency Care and Urgent Care offered within one facility. He explained again that staff certification is different for the two services. Cook asked if Lake Health feel they cannot economically support the plan. Robinson replied no.

Veronica Cox asked Robinson if Lake Health asked the community what services they wanted. Robinson replied that they did. She commented that she was unaware of anyone who was contacted. Robinson explained that random phone calls were made and that Lake Health met with a patient advisory board of past patients and other advisor groups.

Cox asked how long the residents of Madison would be without Urgent Care. Robinson stated that the change would be simultaneous and that there would be no gap between the closing of the UC at Lake Madison and the implementation of the service in another Madison facility. Robinson told of a temporary “Quick Care Center” opened next to the subway in Painesville to service patients after the closing of Lake East. Per Robinson, the “Quick Care Center” was always meant to be temporary.

Mr. Bill Brotzman stated that the new ED addition at Lake Madison was a good thing for Madison, but as a trustee, he does not want local professional to lose their jobs. He agreed that Robinson, obviously, did not make all the decisions regarding this project, but asked that he send our concerns back to those who do make the decisions.

Robinson asked that the Fire Board meet with key Lake Health officials to discuss the project and express their concerns and goals. Chief Lutz and Mr. Bartlett requested that Cynthia More-Hardy, Lake Health CEO, be at the meeting because she is always open and committed to making sure everyone gets proper care and proper services. Mr. Britton agreed to meet with the board and contact Robinson with a possible meeting date in the next two weeks. Takacs and Anderson requested it be arranged soonest possible.

Mr. Don Bartlett asked when Lake Health expected an answer from ODOT. Robinson stated that he hoped they would schedule an on-site inspection and render a decision soon.

Britton, Wayman and Bartlett thanked Gary Robinson for coming to the meeting.

COMMITTEE REPORTS:

BUILDINGS: Per Mr. Britton, the following items have been/will be completed at the new Station #1 Building:

Interior Painting: June 17th
Kicker Board: Soon
Man Doors: Meet with Nolan Door June 17th (push bars)
Electrical: Light fixtures backordered

COMMUNICATIONS: Nothing to report.

PART TIME LABOR MANAGEMENT: Nothing to report.

FULL TIME LABOR MANAGEMENT: Nothing to report.

OLD BUSINESS:

PRIORITY LIST UPDATE: Mr. Bartlett reported that there are only 7 items out of 36 still open. He has added Item #37-Emergency Services Consulting Inc. Final Master Plan Review to the list.

Bartlett asked Chief Lutz if the 88 recommendation items listed on the last page of the new Master Plan should be added to the priority list. Chief Lutz agreed that it would be a good tracking tool since many of these items have already been started.

NEW BUSINESS:

PURCHASE ORDERS: Nothing to report.

RESOLUTION # 10-024 – 2011 TAX BUDGET: Tony Long asked the Fire Board to approve this resolution for the 2011 General Property Tax Budget (2 mil general fund/$300,000 capital fund) due 7/20/10 to the Lake County Auditor. These figures are the same as last year and will be the same next year.

Motion by: Mr. Brotzman, Seconded by: Mr. Anderson
ROLL CALL: All ayes

CHIEF’S REPORT:

SEAGRAVES: This unit was taken to the grand opening of the Perry Outdoor YMCA and to Middlefield for Chief Warne’s funeral. The Warne family sent a $100 donation to express their thanks and gratitude for our participation.

UNIT #2113 ENGINE: Unit #2113 is currently being repaired from the recent accident as well as undergoing warranty replacements. Other units will be sent for warranty replacements when #2113 returns to service.

I90 ACCIDENT: Chief Lutz reported on the 6/15/10 accident on I90 at the Geneva bridge. Mutual aid included Harpersfield, Leroy, NAD and Perry. Chief thanked everyone involved.

POD FUNDS: Lutz reported that the remaining available POD funds (Perry, Madison $8000 and Painesville Twp. $8000) will be spent on a trailer to house the supplies gathered to complete project. He reported that the new POD trailer and Perry’s Haz-mat will be stored at Station #3.

THERMAL IMAGING CAMERAS: Chief Lutz passed around the Eclipse and Bullard Thermal Imaging cameras for board review (one of each for both stations – $30,000). These smaller style units are used to look for hidden fires and to see through smoke to locate victims. Pictures are transmitted to the Chief’s staff vehicle or the command center. He reported that training is scheduled and these will be used during a scheduled burn in the near future.

CLOSING PUBLIC PORTION:

Mr. Brotzman thanked the MFD crews for their service to his family over the past two weeks.

Mr. Long reported that he met with Chief Lutz and Joe Szeman on Monday, June 15th and will be meeting with bank representatives on July 21st to discuss possible loan – USDA and Ohio CAF (Government Agencies – Learning & Research). He also reported that he has researched District records and the Ohio Revised Code and have found nothing to impede efforts in obtaining loans for master plan purposes. He expects the negotiations/processing with banks to take 2 – 4 months. Per Mr. Szeman, Bond council will be required.

Mr. Bartlett asked about the process of selecting vendors for master plan projects and spoke to Mr. Long about the difference between “Request for Proposal” (possible waste of time) vs. “Request for Qualifications”. Suggested process outline as follows:

1) Send out (publish) Request for Qualifications – A request for qualifications is a statutory process and any public authority in Ohio can go through it. It is for design professionals, architects, engineers, surveyors, etc. It is not like competitive bidding where you have to go with the least package. It is a process where design firms are evaluated according to who is best qualified in accordance with statutory qualifications and what the public authority has dictated. Mr. Long passed out a summary of the revised code. Potential companies will give proposals and be interviewed (does not include compensation issues). Many firms will just send their presentations unsolicited.

2) Select Top 3 or more choices – Board should use much discretion in selection process. Mr. Szeman stated he would like a company experienced with public contracts. The Chief and Board will have their own “wants-needs-and-desires” in regards to what qualifications are necessary. A notice of selection must be sent to all candidates.

3) Negotiate Process and Compensation – Chief Lutz and Mr. Szeman to conduct interviews with top company and work toward signing an Agreement for Professional Services Contract. State and Federal funding affect this process and needs to be finalized as soon as possible. The District can move on to next candidate if money and other terms cannot be agreed upon. This process will be more successful if the board is solid on what they want and expect.

Chief Lutz reported that he will be attending the Chief’s Conference in July and will use this opportunity to see what architect companies are available. Mr. Takacs stated that we have unique financing requirements and he is grateful that Chief Lutz has experience in dealing with architects and contractors in a project of this size.

Next meetings:

*July 21st –Regular Fire Board Meeting– Township Center at 7:30 pm

August 18th- Regular Fire Board Meeting– Township Center at 7:30 pm

*This meeting may have to be rescheduled if Chiefs Conference conflicts.

Motion to adjourn by: Mr. Takacs, Seconded by: Mr. Bartlett
ROLL CALL: All ayes @ 8:18 pm