COPCN debate continues ahead of Collier County BOC action

Devan Patel
Marco Eagle
Marco Island firefighters respond to a medical emergency in this file photo. The Marco Island City Council voted 7-0 Tuesday to apply for a Certificate of Public Convenience and Necessity (COPCN), which would put the city in charge of its own ambulance services.

For the most part, it’s been one-way traffic for information about the city of Marco Island’s Certificate of Public Convenience and Necessity application.

As it did in April, the Our City, Our Ambulance committee hosted a town hall Thursday featuring Council Chairman Jared Grifoni, Fire-Rescue Chief Mike Murphy and Dr. Jerry Swiacki, who all spoke in support of the benefits of Marco Island having local control of its emergency medical services and increasing the number of ambulances in the city.

Tabatha Butcher
Collier County Emergency Medical Services

While the Collier County Board of Commissioners will take action on Marco Island’s application Tuesday, EMS Chief Tabatha Butcher spoke out at the town hall to set some of the record straight.

“There’s no doubt that Marco has a desire to have its own ambulance, but I feel a lot of the information that has been put out there has been one-sided and some of it not very factual,” Butcher said.

More:Marco Island, Collier County continue back-and-forth on ambulance issue

More:Leaders push for increasing level of care at Marco Island ambulance town hall

For years, Marco Island has been attempting to increase its ambulance services but has made little progress outside of adding a second ambulance during season.

The city has received push back from the county on numerous occasions about the need for an additional ambulance. City leaders have also expressed a desire to implement their own medical protocols, saying those created by the county limit emergency personnel.

With additional resources, Marco leaders say they can improve the level of care and customize programs to the city's demographics, which, they noted, are different from  the county.

“We are trying to create a system that is locally controlled, where we will provide medical care based upon Marco’s demographics, Marco’s medical needs and not based on what’s good for the county,” Murphy said.

City Council approved a three-prong approach developed by Grifoni last year that included continuing negotiations with the county, submitting a COPCN application to the county and working with state legislators on a bill that would allow the city to bypass the need for county authorization.

In late March, Gov. Rick Scott signed a bill paving the way for Marco Island voters to determine whether it would like the city to have local control of its EMS. That vote will take place Aug. 28.

If approved, it will cost voters $100 per $500,000 taxable valuation. Murphy said the plan would be to hire a medical director with input from Marco’s medical community, 12 additional EMS personnel and acquire the additional ambulances through a 5-year lease-purchase plan. 

While the ballot language has been approved, the city was still required to move forward with its county COPCN application.

The Emergency Medical Authority voted 3-2 to recommend that the Board of Commissioners approve Marco’s COPCN with conditions.

Those conditions include:

  • Majority approval by voters on Aug. 28
  • The city must deliver services of equal quality or greater than what’s currently offered
  • Participation of a medical director that will be designated as “assistant medical director of Collier County” 
  • Marco Island must remain a full participant in Collier County dispatch and automatic mutual aid system
  • COPCN shall not result in financial detriment including the city not seeking reimbursement of ad valorem taxes

Edwin Fryer, the EMA chairperson, wrote in the board’s majority report that the decision to issue the recommendation was not based on the merits of necessity but more so on the need to protect the county’s interests in the event Marco’s voters opt for local control.

In addressing the medication issue, Butcher said that same protocols apply for all fire districts in Collier County so Marco Island was not being treated differently and that the majority of lives were saved with basic life support, not medication.

“For the most part, the medications that all of the fire districts in Collier County can give are the same across the board,” Butcher said.

While there are 37 medications carried by Collier County EMS in its system, Marco’s ambulance carries 23. Out of the 23 medications the Marco ambulance carries, 16 were administered last year. The average time to administer those medications was 10.6 minutes after EMS arrived at the scene.

For the 14 medications that the Marco ambulance does not carry, five were administered elsewhere last year. Those five medications were given on average of 23.6 minutes after EMS arrived.

The rest of medications not given “basically sit in the box and expire,” Butcher said,

Butcher also said that one of the seizure medications Marco Island has been clamoring to have available, Versed, has yet to be used since it was given to Tower 50 in March.

Additionally, in the 2,983 calls for service on Marco Island from April 2017-2018, Versed was administered 17 times.

“What that paints the picture of is a lot of things need to be done before anyone can go into a medication box,” Butcher said.

More:Collier County staff, EMA lay out preferred conditions for COPCN

More:EMA board recommends conditional COPCN for Marco Island

With Swiacki referencing a story about Marco paramedics transferring a patient to the hospital during Hurricane Irma, Butcher also explained that her decision to pull the Collier County ambulance off of Marco was based on the safety of personnel and the prediction of a 12-foot storm surge, which did not happen.

Butcher’s comment that she would have pulled the ambulance from the island again was not well received by Marco residents.

“That really upsets me to hear that you would do that again,” Linda Turner said.

Regardless of how the commissioners vote, Marco and Collier County will need to reach an inter-local agreement to make sure the system does not become fragmented and Marco is not cut off from the system.

Grifoni said he had reached out to the board of commissioners about negotiating the inter-local agreement and expressed confidence in the execution of one despite the difference in opinions on the need for additional services.

“I just cannot for the life of me contemplate that possibility because we all have everybody’s best interests in mind,” Grifoni said. 

More:Marco Island Council approves COPCN ballot referendum

More:Marco City Council debates COPCN referendum language

More:County to city: You don't need a second ambulance