For several years now, the debate of whether to move forward to seek a COPCN (Certificate of Public Convenience and Necessity) has been front and center on the minds of first responders within the Marco Island community. That debate centers around who should be responsible for providing pre-hospital emergency care and transport to the hospital.
Three major factors have contributed to those concerns. Amongst those issues lies the uncertainty surrounding the future of the delivery system that will exist within the county in the future. Previous discussions by past county boards have indicated their desires to see the county exit both the delivery of fire protection and EMS services throughout the county.
Issue Number 1
Collier County has already proceeded to exit the delivery of fire protection services in the unincorporated areas of Collier County. As part of that move they have turned that responsibility over to the Greater Naples Fire District, while the North Naples Fire District has taken over the responsibilities for the Big Corkscrew Fire District.
A consolidation of fire service has been part of the ongoing changes within Collier County and supported by commissioners. As part of that overall discussion, past boards of commissioners have discussed the option of turning over EMS to one of those consolidated fire districts.
The issue of how that would impact the cost of delivery services for EMS has also been a matter of concern to Marco residents and city staff. The issue of having no control over the level of services and lack of representation on an independent board that will set those policies in addition to the costs of those services has been another concern.
Issue Number 2
The second issue revolves around the present level of services concerning the positioning of units on Marco Island. Presently, Collier County stations one unit on the island during the year and a second unit on a part-time basis during the height of season. Former Councilor Amadeo Petricca was the moving force behind that enhancement in coverage almost four years ago. Discussions with the county to increase the presence to two fulltime EMS units has been rejected by county staff.
Issue Number 3
A third issue revolves around the level of service that the certified Marco Island Firefighter/Paramedics are able to provide to residents without being in the presence of similarly certified personnel from the county. That has become a major factor in regards to the advanced technologies and lifesaving medications which are available to be administered by first responders that have the necessary certifications. Twenty-eight of those firefighter/paramedics that are employed by Marco Island have those certifications, but are barred from using their skills unless a Collier County paramedic is in attendance.
The city did have its legislative delegation along with its Tallahassee lobbyist successfully move a “local bill” through the legislature this last session. This gives Marco the ability to apply directly to the state for its certificate should the city and the county not reach a mutually satisfactory agreement to grant the city its own COPCN.
As part of the enabling legislation the city must provide an independent financial review of their plans for providing that service and hold a referendum on the issue to get voters’ approval of their proposal to provide those services.
The county’s Emergency Medical Authority recently gave a 3-2 approval of Marco’s local request for a COPCN with conditions. However, the Collier County Emergency Management Staff recommended denial when they presented their report to the Board of County Commissioners on May 23.
Dr. Tober, the county’s medical director spoke in opposition to the granting of the petition and opposing the “fracturing” of the present system and spoke to the harm it may do.
Dr. Jerry Swiacki, a board-certified physician and Chairman of Our City Our Ambulance from Marco Island presented a detailed request for approval. Several citizens from Marco Island came forward to request that the commissioners vote to approve this application and spoke to the benefits to residents of the island.
Dr. Bruce Moeller, the representative for the city’s consultant, Fitch and Associates, which prepared a detailed review of options for city to improve delivery of services, also made a presentation at the meeting. That report, which they prepared, had a financial overview of the operational and maintenance expenses which the county staff would question.
Marco Island City Council Chairman Jared Grifoni spoke to the local control issue and why he believed it was important to approve the petition, again emphasizing the issue of home rule.
Chief Michael Murphy also addressed several questions that commissioners had, all the time highlighting the positive effects that would benefit the county, as it seeks to stretch its limited resources. While making his remarks he also called on the board to assist in the standardization of drug protocols for all ALS engines throughout the county, while allowing the administration of lifesaving medications by trained and certified firefighter/paramedics, regardless of the presence of a Collier County first responder.
When asked by Commissioner Saunders whether Dr. Tober would be utilized as the Medical Director for the Marco Fire Department if a COPCN is issued to the city, Chief Murphy responded that Dr. Tober would be welcomed to submit an application for the position of Medical Director, but a condition to have him appointed to that position without debate would not be acceptable to the city.
Removal of County Ambulance During Hurricane Irma
A contentious issue which has been widely discussed since Hurricane Irma dealt with the removal of the county ambulance during the recent hurricane, essentially leaving Marco without coverage. Marco citizen Linda Turner complained that action left city personnel and approximately 1,500 citizens in potential jeopardy during that event.
The city did in fact transport a patient to the hospital while the county unit was off the island, which they deemed necessary due to his condition. Chief Tabetha Butcher defended that decision during her testimony saying they had indeed dispatched their unit, but from its location at Physicians’ Regional Hospital on Collier Boulevard.
Chief Butcher went on to further detail her thought process in regards to repositioning that asset and its personnel and said she would do it again should a similar situation arise.
In a surprising observation, County Manager Leo Ochs and Chief Butcher both raised the possibility of the county not being able to provide backup service to the island, should Marco proceed to obtain their own license to operate an independent EMS and transport system.
Commissioner Penny Taylor was concerned that no language for an interlocal agreement had been created when she questioned Chief Butcher.
“This is supposed to be an evidence-based decision on each of the criteria for this decision,” said Commission Chairman Solis. He would suggest a hearing officer might be a better process to follow to eliminate the confusion and deal solely with the issue before them.
“It frustrates me to no end that there are egos involved here,” said Commissioner McDaniel. “I don’t think we need to vote on this today. This discussion is fraught with emotion and politics and I want these agreements to be in place before we vote,” said McDaniel, “I’d even volunteer to help mediate between the parties.”
County Manager Ochs would caution against such an arrangement as he saw it as a step over the line from policy making on the part of the commissioners.
After some additional back and forth, Commissioner McDaniel would move to continue the vote to no later than the second meeting in June so details concerning an interlocal agreement could be worked out between the parties. The vote would be 6-1 with Commissioner Saunders objecting.
For additional information on this issue and more breaking news from Marco Island visit www.coastalbreezenews.comor visit us on our Facebook page.