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The lack of details regarding an interlocal agreement has prompted the Collier County Board of Commissioners to delay making a decision on the city of Marco Island's Certificate of Public Convenience and Necessity application.

In considering the merits of Marco's application, to increase ambulance service and take control of its emergency medical services, the commissioners vote 3-2 to continue its discussion until no later than the second meeting in June. 

"I'm inclined to approve the request with conditions," Commissioner William McDaniel said. "I just think there's not a rush for us to actually approve it this minute, and we can take a minute to negotiate some of the formalities regarding the (memorandum of understanding) or letter of intent for operational standards."

More: COPCN debate continues ahead of Collier County BOC action

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

Marco Island officials have tried for years to increase ambulance service in the city but have been rebuffed by the county.

Currently, the city has one full-time ambulance on the island with an additional ambulance added during season.

In June2017 the City Council approved a proposal by Chairperson Jared Grifoni to take a three-prong approach to increase those services.

The plan included:

  • Continuing negotiations with Collier County
  • Submitting a COPCN application to the county
  • Working with state legislators on a bill that would allow the city to bypass the need for a county-issued COPCN

The city's bargaining power increased after a local bill was signed by Gov. Rick Scott to hold a referendum on Aug. 28 subject to three conditions.

The conditions were to have a third-party financial analysis completed, voter approval on Aug. 28 and the county not approving the city's COPCN application.

Cost estimates completed by Fitch & Associates have determined the city will need around $2 million in additional revenue to fund its EMS services.

Ballot language approved by City Council states that it will cost Marco Island taxpayers $100 per $500,000 taxable value to finance the system.

The County Emergency Medical Authority has also recommended approval of the city's application but its decision was subject to conditions and not based on the actual merits of the city's application.

Conditions recommended by the EMA included approval by the voters, the city not seeking to recoup ad valorem taxes and no detriment to services.

Although the EMA recommended approval, county staff warned the commissioner Tuesday of their belief of the negative impacts on the county granting a COPCN.

“It is so disruptive to the integrated emergency medical system that we have today,” County Medical Director Robert Tober said. “Even with conditions, it’s just the wrong path to go.”

In addition to the lack of discussion with Marco officials about their expectations on mutual aid, Tober said that the creation of an independent EMS system would likely result in the loss of paramedics from the county. 

“If I lost 12 paramedics at a minimum, it would take me 2-3 years to train up a new group of paramedics to be at the response level that we expect in our system,” Tober said.

In comments directed toward the commission, Marco Island Chairperson Jared Grifoni asked whether Marco Island residents had the right to improve their level of service.

"Marco Islanders want to add services and are willing to pay for it," Grifoni said. "We're doing it the right way by asking citizens for their support in a referendum on Aug. 28. If they do vote yes, we will work to provide everything they need for a quality ambulance service and of course the additional costs that come with that."

Dr. Bruce Moeller, a senior consultant with Fitch & Associates, disagreed with comments that a locally controlled EMS system would fragment the system and be a detriment to service.

"We have opined, and the firms stand by this, that there will be an improvement in EMS services on Marco Island because of the addition of additional ALS transport services that serve that population," Moeller said. "There is also a strong opportunity for the county to benefit from that as well because again there are additional resources being added within Collier County."

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

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

The decision of Collier County to pull the ambulance off Marco Island during Hurricane Irma last year was also questioned by residents during Tuesday's meeting.

"Marco Island should not be left without an ambulance during a hurricane," Linda Turner said. "An ambulance should be close and immediately available just as soon as driving conditions allow."

EMS Chief Tabatha Butcher told the commissioners a decision was made to relocate the ambulance after 15-foot storm surge was predicted.

"It is our responsibility as EMS to protect the citizens of Collier County and respond to their needs," Butcher said. "However, if our first responders are injured or don't have a vehicle to help get them there, they are not going to be helping anybody."

In Everglades City, a decision was made to relocate its ambulance and validated when the station took on close to 6-feet of water, Butcher said.

Butcher also noted that Marco Island Fire-Rescue Chief Mike Murphy was made part of discussions between local fire chiefs about how resources would be relocated before the storm and told the City Council on Sept. 5 that people would be on there own for the first 72 hours during the storm.

While some of the commissioners said comments made caused them to change their minds a few times, Commissioner Penny Taylor said her greatest concern was that there was no agreement in place.

"You really don't know what the costs are going to be because we have not come to an agreement about those things: the money, the number of ambulances, whether we are going to be the backup or require the city to be a backup," Taylor said.

When queried by Commissioner Burt Saunders about the county approving a COPCN with conditions versus the state granting one, Tober said he would prefer one with conditions but questioned whether Marco Island would accept rigorous terms.

With the commissioners' decision, county staff will attempt to negotiate the terms of an agreement over the next month.

Saunders and Commisioner Donna Fiala voted against delaying the decision.

Following the meeting, Grifoni sent a one-way email to the City Council laying out his impressions of the meeting and lauding the comments made by Murphy and Moeller.

“Based on the comments from the BCC, I believe it is highly likely that if a satisfactory accord can be reached the county will vote in favor of the COPCN at that time,” Grifoni wrote in the email. “Of course, if mutually satisfactory terms cannot be reached and/or the county denies or leaves our application ‘unapproved’ we have the state path.” 

More: Marco Island Council approves COPCN ballot referendum

More: Marco City Council to aggressively pursue COPCN

 

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