HomeMy WebLinkAboutIR 7270 INFORMAL REPORT TQVOITY COUNCIL MEMBERS A0k No. 7270 -
To the Mayor and Members of the City Council Apri 1 5, 1988
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Subject: EXPANSION OF WDSTAR SYSTEM
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On April 1 , 1986, the City began operating ambulance service under a system
called the Failsafe Franchise Model (FFM). Although the system was implemented
in a very short period of time, the impetus was to assure that the citizens
of Fort Worth would have an ambulance service that would not be interrupted
in the event of a contractor default.
Prior to implementation of the FFM, the City had been actively engaged in
a planning process with several other Tarrant County cities in an effort to
establish a county-wide ambulance system. After several months of negotiations
and a series of problems with the company that was providing service at that
time, the City Council decided it was in the City's best interest to terminate
its existing contract on the expiration date and begin the process of procuring
a new service. That decision effectively put plans for a county-wide system
on hold.
Since the new system has been in place, the City has been approached by several
cities about the possibility of MedStar providing service to their
jurisdictions. At the current time, the cities of Westworth Village, Westover
Hills and Burleson have been approved for service by the City Council . In
August of 1987, the City's current contractor acquired the Meissner-Brown
Ambulance company and began providing service to approximately nine (9) Tarrant
County cities, using the same standards as those established for Fort Worth.
Since the FFM was designed to serve- only Fort Worth, the net effect since
August, 1987, has been the operation of dual systems with basically the same
standards. Over the past year, the Fort Worth Ambulance Authority has received
several requests from other cities to join the MedStar system. However, rather
than continue to expand a system that was established for a single Jurisdiction,
they recommended to the City Council that consideration be given to modifying
the existing system to allow others to join. An ambulance consultant, The
Fourth Party, Inc. , was hired to develop a system structure to accomplish
this objective.
During the past several months, the Fort Worth Ambulance Authority has been
meeting with and reviewing recommendations from The Fourth Party, Inc. ,
regarding conversion of the current ambulance system to a multi-jurisdictional
system. The current proposal recommends transitioning to a new ambulance
system effective August 1 , 1988. Attached for City Council review are the
following documents:
1 . Executive summary for expansion of the MedStar system;
2. Report to the Tarrant County Mayor's EMS Committee from Mike Groomer,
City Manager of Haltom City and Chair of the EMS Staff Committee;
3. Report from the Fourth Party, Inc. ; and,
001" 4. Timetable for restructuring the MedStar EMS system.
-ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
INFORMAL REPORT Tr-,ITY COUNCIL MEMBERS No. 7270
Da -P 2 nf 2
To the Mayor and Members of the City Council April 5, 1988
Subject: EXPANSION OF NEDSTAR SYSTEM
This proposal will be discussed during the City Council worksession on April
5, 1988. In the meantime, please feel free to contact me if you have any
questions.
DOUGLAS HARMAN
CITY MANAGER
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
Timetable For Restructuring of MedStar EMS System
0"" December 17 , 1985 - City Council awards contract to Texas Life-
line Corp. , dba MedStar.
April 1, 1986 - MedStar Begins Service.
February 24 , 1987 - City Council authorizes MedStar to provide
service to Westworth Village.
October 6, 1987 - City Council authorizes MedStar to provide
service to Westover Hills .
December 8 , 1987 - City Council authorizes MedStar to provide
service to Burleson.
August 27 , 1987 - Texas Lifeline Corporation assumes operation
of Meissner-Brown Ambulance Service.
September 30, 1987 Fort Worth Ambulance Authority recommends
hiring of the Fourth Party to analyze and
provide recommendations for options regard-
ing expansion of the MedStar system.
October 10, 1987 City Council approves contract with Fourth
Party per Ambulance Authority recommend-
ation.
November 24, 1987 Fourth Party's recommendations for expansion
of the MedStar to multijurisdictional status
presented and approved by Fort Worth Ambu-
lance Authority.
December 8, 1987 Consultant's recommendations presented to
City Council.
January 27, 1988 Fort Worth Ambulance Authority recommends
hiring of the Fourth Party to complete the
various tasks required for restructuring of
the MedStar system.
February 2, 1988 City Council approves contract with the
Fourth Party per recommendation of Fort
Worth Ambulance Authority.
February 18, 1988 - Consultant meeting with ad hoc committee of
staff representatives of Jurisdictions
-interested in participating in the multiju-
risdictional system.
February 19, 1988 - Consultant meeting with Fort Worth Ambulance
Authority to develop tentative work plan and
Owl implementation schedule.
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March 1, 1988 - Tentative work plan and implementation
schedule presented to City Council.
March 8, 1988 - Consultant 's and staff 's first meeting with
Tarrant County Mayors ' Council EMS Committee
staff members to begin development of Inter-
local Cooperation Agreement and Uniform
Ambulance Ordinance.
March 23 , 1988 First draft of Interlocal Cooperation Agree-
ment and Uniform EMS Ordinance presented to
EMS Committee and Fort Worth Ambulance
Authority; recommendations for revisions
made.
March 28 , 1988 Final draft of Interlocal Cooperation Agree-
ment and Uniform EMS Ordinance presented to
EMS Committee and Fort Worth Ambulance
Authority; approval of documents by EMS
staff committee. Fort Worth Ambulance
Authority approves documents and recommends
approval by Fort Worth City Council .
April 4 , 1988 - Presentation of Agreement and Ordinance to
Mayors ' Council.
April 5, 1988 - Fort Worth City Council briefing on Interlo-
cal Cooperation Agreement and Uniform EMS
Ordinance.
April 11, 1988 - Public meeting sponsored by Mayors ' Council
for discussion of Agreement and Ordinance
with all Tarrant County cities.
April 12 , 1988 - Consideration of approval of Interlocal
Cooperation Agreement and Uniform EMS Ordi-
nance by Fort Worth City Council.
May 31 , 1988 - Deadline for committment of cities inter-
ested in participating in first round mem-
bership in Authority; completion of Texas
Lifeline Corp. contract renegotiations.
June - July, 1988 Subscription Campaign; completion of neces-
sary business transactions to effect conver-
sion; legal instruments transferring title
of EMS assets to new Authority finalized and
presented to Fort Worth City Council.
July 15, 1988 Deadline for second round membership in
Authority.
August 1 , 1988 New system begins operations.
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EXECUTIVE SUMMARY
EXPANSION OF THE MEDSTAR SYSTEM
Prepared For the Fort Worth City Council
By
Richard Neuhaus
Emergency Medical Services Coordinator
City of Fort Worth, Texas
April 5, 1988
AV*, 'A
Executive Summary
Expansion of the MedStar Ambulance System
INTRODUCTION
Under separate cover is transmitted a report from The Fourth
Party that outlines the basic recommendations for expanding
the MedStar ambulance system. The major components of the pro-
posed new system, the Interlocal Cooperation Agreement and Uni-
form EMS Ordinance, have been discussed on several occasions
with a working group and the Fort Worth Ambulance Authority.
The content of the attached documents represents a consensus
on the part of everyone involved on the planning process to
this point.
BACKGROUND
The City of Fort Worth' s MedStar ambulance system, based on
the newly designed failsafe franchise model (FFM) for emergency
medical services, became operational on April 1, 1986. Under
the FFM, a competitively selected firm is authorized to do busi-
ness under a business trade name (MedStar) owned by the City
of Fort Worth, and is allowed to use certain city-owned facili-
ties and communications infrastructure. These provisions were
designed to preserve business continuity across procurement
cycles, and to ensure an orderly takeover of operations in the
event of default by a contractor. On December 17 , 1985, Texas
Lifeline Corporation (TLC ) was awarded the contract to provide
emergency medical services to Fort Worth under the new model.
The original failsafe franchise model was created to serve the
City of Fort Worth. However, recognizing that certain economies
of scale could be achieved by expansion of the system, special
provisions were built into Fort Worth's current EMS ordinance
and the MedStar business structure to allow for multijurisdic-
tional coverage.
These provisions were specifically intended to allow neighboring
communities to take advantage of MedStar's economies of scale
resulting from serving Fort Worth and to provide for a fair
sharing of Fort Worth's system startup and ongoing infrastructure
costs. These provisions have been adequate to manage small
scale expansion, and have been utilized in providing service
to the cities of Westover Hills, Westworth Village, and Burleson.
On August 28, 1987, TLC purchased the Meissner-Brown ambulance
operation and began service to nine communities in Tarrant County
under that trade name. With the addition of the Meissner-Brown
service to TLC, the potential for expansion of the MedStar ser-
vice area greatly increased. The magnitude and timetable of
such an expansion raised questions and issues that were not
anticipated in the original EMS ordinance and MedStar contract.
Based on the assumption that certain of these cities, and perhaps
other cities in Tarrant may wish to join the MedStar system,
the Fort Worth Ambulance Authority recommended, and City Council
approved the hiring of Jack Stout, The Fourth Party, (M&C G-7283;
October 6, 1987) to review the current system structure and
provide recommendations for an expansion and restructuring of
the system that would be an orderly process and that would pro-
tect the interests of the City of Fort Worth.
Among the recommendations made by The Fourth Party were the
conversion of the Ambulance Authority to an enterprise fund
structure, with the Authority assuming the responsibility for
all ambulance service billings and collections along with market-
ing and sales of the ambulance service subscription program,
and a conversion to a multijurisdictional ambulance authority
structured so that participating jurisdictions achieve some
type of representation on the authority board.
The legal basis for the establishment of the regional authority
is the Texas Interlocal Cooperation Act . Each jurisdiction
wishing to participate in the new authority would adopt an Inter-
local Cooperation Agreement along with a Uniform Ambulance Ordi-
nance.
The consultant 's recommendations were reviewed and approved
in concept by the Ambulance Authority at its meeting of Novem-
ber 24, 1987, and by City Council at the December 8, 1987, pre-
opm► council meeting. On February 2, 1988, City Council approved
a contract (M&C C-10770 ) with The Fourth Party, Inc. , to begin
implementation of the proposed multijurisdictional authority.
The first phase in implementation of the new sytem is the devel-
opment of an Interlocal Cooperation Agreement and Uniform Ambu-
lance Ordinance. The Agreement defines the powers and role
of the Authority while the Ordinance provides the legal basis
for jurisdictions to regulate the ambulance service provided
by the Authority.
The Ambulance Authority directed Mr. Stout to work with a commit-
tee composed of staff members assisting a special Mayor's Council
EMS Committee in developing an Agreement and Ordinance that
would be acceptable to other jurisdictions while protecting
the interests of Fort Worth during and after the restructuring.
Mr. Mike Groomer, City Manager of Haltom City, chaired this
staff committee.
Below is a summary of the Interlocal Cooperation Agreement and
Uniform EMS Ordinance that were approved by the Fort Worth Ambu-
lance Authority at its meeting of March 28, 1988.
INTERLOCAL COOPERATION AGREEMENT
Adoption of the Agreement by cities wishing to join the multijur-
isdictional authority creates an administrative agency referred
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to as the Area Metropolitan Ambulance Authority (AMAA) .
Board Membership - The Ambulance Authority's Board of Directors A%
will be composed of nine members, two of whom are knowledgeable
in health care administration, two of whom are knowledeable
in finance or accounting, two of whom are licensed attorneys
in private practice, two of whom are experienced in business
administration, and the medical director of the Emergency Physi-
cians Advisory Board. Until such time as the total population
of all member cities of the Authority exceeds 880,000 persons,
the Board will be composed of four members appointed by Fort
Worth, two members appointed by the City of Arlington, if it
chooses to participate, and one member representing each 110,000
persons residing within all other member jurisdictions combined.
The present board members of the Fort Worth Ambulance Authority
will be appointed to the initial board of the multijurisdictional
Authority.
Financial Investment and Rate/Subsidy Ratios - Initial membership
in the Authority requires no financial investment on the part
of jurisdictions not currently subsidizing ambulance operations, '
and allows for a gradual reduction in subsidy levels of those
with current subsidies. The power to set the annual rate/subsidy
ratio is retained by each member city. Later entry into the
system will require a one-time payment by the new member in
order to purchase the new jurisdiction's pro rata share of the
Authority' s accumulated net worth at the time of entry.
Transfer of Assets and Liabilities - The current EMS assets
and liabilities of Fort Worth, such as the medical communications
system, facility, and telephone lines will be transferred to
the new Authority. The new Authority will be responsible for
servicing the debt on those items which have been financed.
The transfer will be structured so that the City of Fort Worth
is adequately protected in the event of default by the new
Authority; the current financial liability of the City of Fort
Worth will not be increased, and will decrease over time; and
the City of Fort Worth and other member jurisdictions have the
option of recovering expenditures previously made in establishing
the MedStar system. Each legal instrument used to transfer
the various assets from Fort Worth to the Authority will require
prior approval of the Fort Worth City Council.
Initial Membership - The conditions of membership of some juris-
dictions are affected by the membership decisions of other Tar-
rant County jurisdictions. A city may be offered one level
of response time reliability it it becomes a member alone, but
receive an upgraded level of reliability if cities which are
operationally contiguous to it also join. For first round mem-
bership, jurisdictions listed in the Exhibit B to the Agreement
may secure initial membership by approving the Interlocal Agree-
ment and Uniform Ordinance no later than May 31, 1988, assuming A4%
Fort Worth approves the documents.
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Knowing the decisions of first round jurisdictions , the effects
of those decisions upon other jurisdictions can then be deter-
mined, and specific offers made to second round jurisdictions
not later than June 15, 1988. All second round jurisdictions
may then secure initial membership by approving the Agreement
and Ordinance no later than July 15, 1988. Once the system
becomes operational, jurisdictions not initially participating
will have an opportunity each year to join. Jurisdictions join-
ing in later years are required to make a one-time payment to
the Authority in order to purchase the new jurisdiction' s pro
rata share of the Authority' s net worth at the time of entry.
Regardless of decisions made by other jurisdictions, every juris-
diction in Tarrant County which joins the Authority is guaranteed
a level of service and price/subsidy ratio which is equal or
better than that which was enjoyed by that jurisdiction immedi-
ately prior to consideration of membership (not including those
jurisdictions currently receiving temporary interim MedStar
coverage ) .
Subscription Program A full-service subscription membership
program -will be available to residents throughout the MedStar
service area. Opportunity for enrollment will be available
during the months of June and July. The program allows a resi-
dent and members of the resident 's household of any member juris-
diction to annually purchase and prepay all uninsured portions
of medically necessary ambulance service.
Volume Discounts - As the system expands, member jurisdictions
will become eligible to receive discounts in the cost of system
operations ranging from two to fourteen percent , depending upon
the collective population of all member jurisdictions. Such
volume discounts are possible because the larger system will
enjoy better economies of scale. These discounts may be used
by each member jurisdiction in any of the following ways:
To reduce the price or subsidy level applicable in that jur-
isdiction;
To reduce the cost of subscription membership for residents
of that jurisdiction;
To recover costs of developing and implementing the MedStar
system; or,
Any combination of the above.
If the system reached the maximum discount rate of fourteen
percent, approximately $1,000,000 would be available to member
jurisdictions for the above uses. If the City of Fort Worth
constituted one-half of the total population of member jurisdic-
tions, approximately $500, 000 would be available to the City
each year to use in the above ways.
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For example, the David M. Griffith Ambulance Service Cost Analy-
sis conducted in December 1986, established the City' s total
development cost of the MedStar system as of that date to be
$357 , 754 . Since that date, additional costs of approximately
$140,000 have been incurred, including the costs of the current
conversion to multijurisdictional status. During the first
year of discounts, the Fort Worth City Council could elect to
apply all of its $500,000 available discount to this development
cost , effectively repaying itself for all EMS system development
costs incurred from July 1985 through August 1, 1988. Durin
the second year of discounts, Council could apply its entire
share to a rate reduction, additional subsidy reduction, reduc-
tion of the price of subscriptions to its residents, or a combi-
nation of those options. Council would decide annually there-
after the option or comination of options to which its share
of discounts would apply.
First Year Subsidy - The Agreement specifies that any member
jurisdiction which subsidizes ambulance services during fiscal
year 1987-88 will agree to subsidize the Authority in an amount
not less than 90t of that member's 1987-1988 subsidy during
the Authority' s first year of operation, beginning August 1,
1988. The subsidy can then be reduced each following year by
no more than 10t of the 1987-1988 amount . The annual 10% maximum
reduction will be waived at such time as the net worth of the
Authority reaches $5, 000, 000, or 50t of its operating budget ,
whichever is greater. At that point , member jurisdictions may
accelerate its annual reduction beyond the 10% maximum.
The 1987-1988 Fort Worth Ambulance Account adopted budget was
$1,186,761, with an additional $247,548 carried over from the
previous fiscal year, for a total revised 1987-1988 budget of
$1,434 , 309. Of this amount , the cost approved for the EMT-D
program ( $37 ,032 ) and the temporary subsidy increase approved
for the contractor in April 1987 which applies to this fiscal
year ( $116,962 ) will be deducted. This amount is reduced by
10% to arrive at the first year Fort Worth cash subsidy for
the Authority.
1987-88 Adopted Budget: $1,186, 761
Carryover from 1986-87: $ 247,548
Total Revised Budget: $1,434 ,309
Fire Dept . Admin. Cost: $ 40,000
Total Spent 1987-1988: $1,474 ,309
EMT-D: $ 37,032
Temporary Subsidy Increase: $ 116 ,958
Total: $1,320,319
10% Reduction: $ 132 ,032
Total 1988-1989 Cash Subsidy: $1,188,287 A1%
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Second Year 10% Reduction; $ 132, 032
Total 1989-1990 Subsidy: $1,056,255
Third Year 10% Reduction: $ 132,032
Total 1990-1991 Subsidy: $ 924,223
Fourth Year 10% Reduction: $ 132,032
Total 1991-1992 Subsidy: $ 792,191
Fifth Year 10% Reduction: $ 132,032
Total 1992-1993 Subsidy: $ 660,159
UNIFORM EMS ORDINANCE
The Uniform EMS Ordinance does not differ significantly from
the current Fort Worth ambulance ordinance. Adoption of the
ordinance creates the Emergency Physicians Advisory Board (EPAB )
in the same manner as the current ordinance. The EPAB is em-
powered to establish medical standards for patient care within
the system, including standards for vehicles, equipment , sup-
plies, personnel, and medical and control center protocols.
It is also charged with the duty of monitoring system performance
so as to assure that the medical standards it establishes are
maintained. The EPAB is funded by a $3 per transport fee paid
it by the Authority. The paid medical director of the EPAB
serves as a member of the Authority Board of Directors.
op" Adoption of the Ordinance also establishes the Area Metropolitan
Ambulance Authority as the sole provider of all ambulance ser-
vices within the jurisdiction. The use of the city-owned MedStar
trade name will be assigned to the Authority. The Authority
is required to comply with all terms of the Interlocal Coopera-
tion Agreement , and carry out all powers, duties and responsibil-
ities assigned to it by the Agreement.
Similar to the current Fort Worth ordinance, the Uniform Ordi-
nance provides certain exceptions to the licensing requirements
of ambulance services. The following are excepted from the
single provider licensing requirement:
1) . A privately owned vehicle not ordinarily used in the business
of transporting persons who are sick, injured, wounded, inca-
pacitated, or helpless.
2 ) . A vehicle rendering service as an ambulance in the event
of a major catastrophe or extreme system overload when such
condition is declared by the Medical Director, the Executive
Director of the Ambulance Authority, or by an authorized
representative of the Ambulance Authority's contracted ambu-
lance service provider, and such assistance has been request-
ed by the Control Center.
3) . Any ambulance owned or operated by the federal or state gov-
ernment .
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4 ) . Any transport to a location within the Service Area which
transport originated from a point outside the Service Area. *104
5) . Mutual aid calls when rendered pursuant to a mutual aid agree-
ment by the Ambulance Authority.
6 ) . Special events coverage, so long as such service is provided
without charge by an emergency medical services volunteer
provider, as defined in Sec. 1.03(18) , Art. 44470, Texas
Civil Statutes.
7) . Wheelchair transport services which are not provided on a
point-to-point basis, but which provides pickup and delivery
by way of regularly scheduled routes.
8) . Medical transports by helicopter where such transports origi-
nate outside the Service Area or at a hospital location with-
in the Service Area.
9 ) . Point-to-point wheelchair transport services rendered by
not-for-profit organizations.
SUMMARY
The Fort Worth Ambulance Authority has met with the consultant
on a regular basis and in its meeting on March 28, 1988, approved
the documents in the attached report. It was the consensus
fo the Authority that the interests of Fort Worth are sufficient-
ly protected by these documents during and after the transition
from a monojurisdictional to a multijurisdictional MedStar sys-
tem.
The members of the Mayor's Council EMS staff committee unanimous-
ly approved the documents at its meeting of March 28, 1988.
It was the consensus of that group that the interests of juris-
dictions wishing to join the multijurisdictional system are
protected and the proposed system is structured in a manner
that can be acceptable to jurisdictions interested in participat-
ing in the regional system.
Based on the timetable recommended by the Fort Worth Ambulance
Authority, an M&C will be brought to Council on April 12 recom-
mending approval of the Interlocal Cooperation Agreement and
Uniform EMS Ordinance as presented. Upon approval of those
instruments by City Council, negotiations will begin on conver-
sion of the current Texas Lifeline Corporation contract, transfer
of the current MedStar system infrastructure, financing of re-
quired infrastructure improvements, conversion of the accounts
receivable management responsibility, transfer of the three-way
leasing program, conversion of the lock box banking arrangement,
transfer of the MedStar trade name and provider license, devel-
opment of a detailed long range financial plan, and other business
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transactions. In any event , City Council and Ambulance Authority
001` approval will be required on all of these documents before they
are implemented. The schedule projects an August 1, 1988, start-
up date for the new system.
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EXPANDING THE MEPSTAR SYSTEM
A SPECIAL REPORT OF THE MAYOR'S COUNCIL
EMS STAFF COMMITTEE
o,,. MARCH 28, 1988
MEMORANDUM
To: Tarrant County Mayors' Council, EMS Committee
From: Mike Groomer, Chairman EMS Staff Committee
Subject: Status report and final draft documents for the expansion of the
MedStar system
Date: March 28, 1988
The attached Interlocal Cooperative Agreement and its four exhibits were
developed by The Fourth Party, Inc. pursuant to design specifications
approved by the Fort Worth Ambulance Authority, as further refined under
the direction of the "MedStar Expansion Workgroup".
The MedStar Expansion Workgroup was created as a staff committee to
the special subcommittee of the Tarrant County Mayors' Council
appointed to oversee this work. Subcommittee chairman Mayor James
Herring of White Settlement appointed Haltom City Manager Mike
Groomer to chair the MedStar Expansion Workgroup. The Tarrant
County Mayors' Council staff committee has completed its work as ,1
reflected in the attached documents which will permit the expansion of the
Fort Worth Ambulance Authority to a multi-jurisdictional Authority. The
various cities represented in the workgroup unanimously endorsed the
attached documents at their final meeting March 28, 1988.
The system proposed in these documents, in the opinion of the staff
committee, is equitable for each participating jurisdiction. The staff
committee's work also has provided for reasonable growth of the EMS
system as other jurisdictions in the area may opt to participate in the
future. The legal documents developed by this process include:
• the "Interlocal Cooperation Agreement";
• the "Uniform EMS Ordinance" (Exhibit A);
• "Jurisdictions Eligible for 1st-Round Membership" (Exhibit 13), i.e., a listing of
those jurisdictions whose membership decision will not be affected by decisions
of other 'urisdictions;
• the "Memorandum of Understanding" (Exhibit C), i.e., the basic elements of a
restructured contract for services to operate between the new Ambulance
Authority and Texas Lifeline Corporation; and,
• Uniform Schedule of Price/Subsidy Options (Exhibit D)
{Memo explaining MedStar legal documents,coat.....} 2
PURPOSE OF DOCUMENTS
The basic purposes of the above-listed documents are to convert the Fort
Worth Ambulance Authority and the MedStar system into multi-
jurisdiction prehospital care system, and to convert the system's current
business structure from the "Failsafe Franchise Model" to the "Public
Utility Model". More specifically, adoption of the above-listed instru-
ments by member jurisdictions will accomplish the following objectives:
1. Create New Authority. The Area Metropolitan Ambulance
Authority is created when the above listed documents are approved
by the City of Fort Worth and at least one other jurisdiction.
2. Appointment of Fort Worth Board Members. The present board
members of the Fort Worth Ambulance Authority are appointed to
the initial Board of Directors of the multi-jurisdictional Authority.
3. Appointment of Additional Board Members. Other member
jurisdictions may appoint additional directors to the multi-
op"', jurisdictional Authority, with representation determined entirely on
the basis of prorata population. Appointments by Fort Worth and
Arlington (if a member) are made individually by those jurisdictions.
Appointments by other jurisdictions, including Rural Fire Prevention
District #1 (representing unincorporated areas, if a member), are
made jointly by way of a cumulative voting method.
4. Board Expertise. Board membership requirements are specially
structured to ensure that maximum board size does not exceed nine
persons (including the Medical Director), and to ensure a defined
range of expertise in business, law, finance, and health care
administration. The job of the Authority is to provide financial
management of the prehospital care system.
5. Financial Investment & Pricing Controls. Initial membership
requires no financial investment on the part of jurisdictions not
currently subsidizing EMS operations, and allows for gradual
reductions in subsidy levels of those with current EMS subsidies. The
power to set price/subsidy ratios is retained by the elected officials of
each member jurisdiction. Later entry into the system will require a
(Memo explaining MedStar legal documents,coat.....} 3
one-time payment to purchase the new jurisdiction's pro-rata share
of the Authority's accumulated net worth at the time of entry.
Al
6. Transfer of Assets and Liabilities. The complex process of
triinsferring EMS assets and related liabilities from the City of Fort
Worth to the new Ambulance Authority, and provisions for
upgrading system infrastructure components, are so structured that:
(a) The City of Fort Worth is adequately protected in the event
of default by the new Ambulance Authority;
(b) The current financial liability of the City of Fort Worth will
not be increased, and will decrease over time; and,
(c) The City of Fort Worth and other member jurisdictions
have the option of recovering expenditures previously made in
establishing the MedStar system.
7. Financial Controls. Business controls and financial management
practices (already proven successful in other public utility model
systems) are instituted to ensure long range financial stability and
cost containment incentives.
8. Competition Required. The Authority is prohibited from
operating the ambulance system as an "in-house" operation, and is
required to contract with qualified firms selected by bid competition.
9. Decisions on Membership. Because the conditions of
membership of some jurisdictions will be unavoidably affected by the
membership decisions of other jurisdictions, a two-stage process for
joining the system has been developed as follows:
• First Round Membership: Jurisdictions listed in Exhibit B
may secure initial membership by approving the Interlocal
Cooperative Agreement and Uniform EMS Ordinance no later
than May 31, 1988. (This, of course, assumes that these
documents are approved by the City of Fort Worth.)
Second Round Membership: Knowing the decisions of
"first-round" jurisdictions, the effects of those decisions upon
other jurisdictions can then be determined, and specific offers
made to "second round" jurisdictions not later than June 15,
(Memo explaining MedStar legal documents,coat,....) 4
1988. All "second round" jurisdictions may then secure initial
membership by approving the Interlocal Cooperative Agree-
ment and Uniform EMS Ordinance no later than July 15, 1988.
• Guarantee of Service: Regardless of decisions made by
other jurisdictions, every jurisdiction in Tarrant County which
joins the Authority is guaranteed a level of service and
price/subsidy balance which is equal to or better than that
which was enjoyed by that same jurisdiction immediately prior
to consideration of membership (not counting temporary,
interim MedStar coverage).
10. Subscription Program. A full-service subscription membership
program will be available to residents throughout the MedStar
service area. Opportunity for enrollment will be available during the
months of July and August of this year.
11. Volume Discounts Available. As the system expands, member
jurisdictions will become eligible to receive discounts in the cost of
system operations ranging from two to fourteen percent, depending
upon the collective population of all member jurisdictions. Such
volume discounts" are possible because the larger system will enjoy
better economies of scale. These discounts may be used by each
member jurisdiction in any of the following ways:
• To reduce the price or subsidy level applicable in that
jurisdiction;
• To reduce the cost of subscription membership for residents
of that jurisdiction;
* To recover costs of developing and implementing the
MedStar system; or,
• Any combination of the above.
13. EPAB Expanded. The Emergency Physicians Advisory Board
(EPAB) is expanded to provide representation by hospitals
throughout the expanded service area, thus creating a uniform
standard of prehospital care applicable in all member jurisdictions.
OF*
('Memo explaining MedStar legal documents, cont.....) 5
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14. Implementation and Startup. Upon approval of the Interlocal
Cooperative Agreement and Uniform EMS Ordinance by the City of
Fort Worth, negotiations shall begin on: conversion of the current
TLC contract; transfer of the current MedStar system
infrastructure; financing of required infrastructure improvements;
conversion of the accounts receivable management responsibility;
transfer of the "three-way leasing program"; conversion of the
"lock-box" banking arrangement; transfer of the "MedStar" trade
name and provider license; development of a detailed long-range
financial plan; and, the numerous other business transactions which
must be completed prior to projected startup on August 1, 1988.
The staff committee recommends that the Mayors' Council sponsor
and conduct an informational public meeting to provide opportunity
to distribute and explain the work product of the staff committee,
and to answer such questions regarding these materials as may be
asked. The staff committee also recommends that all jurisdictions
within Tarrant County be specifically invited to attend this
informational meeting. Requests may be made for more information
to either Mike Groomer (834-7341) or Richard Neuhaus (870-6170).
EMS INTERLOCAL COOPERATIVE AGREEMENT
WHEREAS, the State of Texas, in the Interlocal Cooperation
Act, has provided in Art. 4413(32c), Texas Civil Statutes, et seq., that
this City (hereinafter called "this jurisdiction") may jointly exercise
with other local governments the power to provide governmental
services for the public health and welfare, and such services include
ambulance services; and
WHEREAS, it is in the best interests of the public health and
welfare of the people of this jurisdiction to have available to them a
state-of-the-art, high performance, high quality, prehospital emer-
gency medical system, with stringent medical controls and
accountability, and adequate response times; and
WHEREAS, due to the relatively low population and low
population density of some portions of the geographic area in
Tarrant County, Texas, and the extremely high start-up and fixed
0P*I operating costs of a state-of-the-art emergency medical system, it is
necessary to award a single provider the right to engage in
ambulance operations within this jurisdiction, in order to maximize
economies of scale for providing such emergency medical services.
THEREFORE, be it resolved that this jurisdiction hereby agrees
to join with all other jurisdictions which adopt this Interlocal
Cooperative Agreement, and this jurisdiction agrees as follows;
1. There is hereby created an administrative agency, pursuant
to Art. 4413(32c) Sec. 4(d), Texas Civil Statutes, called the Area
Metropolitan Ambulance Authority, (hereinafter called the
"Authority"). The Authority shall have all of the powers and
duties set forth and described in Paragraph 8, below. This
jurisdiction elects to become a member of the Authority, by the
adoption of this Agreement, and by the adoption concurrently
of the Uniform EMS Ordinance (Exhibit A), and by the
selection of a price/subsidy option from the Uniform Schedule
of Price/Subsidy Options Effective August 1, 1988 -- December
31, 1989 (Exhibit D).
UnterloW Cooperative Agmrr"'t, cunt....) 2
2. The Authority's term of existence and provisions for
withdrawal from membership in the Authority shall be as
follows:
(a) The existence of the Authority shall be perpetual. This
Jurisdiction may not withdraw until July 31, 1993.
Thereafter, this Jurisdiction may withdraw on July 31,
1996 and July 31, 1999.
(b) Thereafter, the dates of this Jurisdiction's right to
withdraw shall coincide with the termination dates of the
competitively awarded contracts for ambulance services
with the contractor, and the expiration dates of all
options for extension thereof. This Jurisdiction's right to
withdraw'shall occur on the last day of each contract, or
the last date of any option for extension thereof. Notice
of such intention to withdraw shall be given in writing to
the Authority, and to each member jurisdiction thereof
not less than twelve (12) months before the proposed
effective date of withdrawal.
I The Authority's Board of Directors shall be composed of no
more than nine members, constituted as follows:
(a) Two members who are knowledgeable in health care
administration, and who have resided for at least three
years in a jurisdiction which is a member of the Authority;
(b) Two members who are knowledgeable in finance, or
accounting, and who have resided for at least three years
in a jurisdiction which is a member of the Authority;
(c) Two licensed attorneys in private practice, whose
principal place of practice is a jurisdiction which is a
member of the Authority, and who have resided for at
least three years in a jurisdiction which is a member of
the Authority;
-------------------------
(Interlocal CooperOP -. Agreement, cunt....} 3
(d) Two members who are experienced in business
administration, and who have resided for at least three
years in a jurisdiction which is a member of the Authority;
(e) The Medical Director of the Emergency Physicians
Advisory Board, who shall serve ex officio, but with
voting rights.
(f) The fir-st Board of Directors shall have four members
appointed for a term of two years, and the balance of the
members of the Board shall be appointed for a term of
three years.
(g) Thereafter, the terms of office of all members of the
Board of Directors shall be for a period of three years.
No member of the Board shall be appointed for more
than two consecutive terms in office.
(h) No member of the Board of Directors shall have any
interest, financial or otherwise, either directly or
indirectly, in any firm or organization which is a bidder
for the competitively awarded contract, or in any firm or
organization which contracts to provide ambulance
service to the Authority;
(i) The membership of the Board shall be chosen as set
forth below in Paragraphs 12 and 13.
(j) Any member of the Board who fails to attend any
three (3) consecutive, regularly scheduled Board meetings
or who fails to attend at least six (6) regularly scheduled
meetings in any twelve (12) month period, without a
reasonable and valid reason for such absence shall be
removed from the Board, and his position filled as
provided in Paragraph 11, below. Removal of a member
pursuant to this provision must be approved by a
majority of the members of the board, excluding the
member in question.
(Interlocal Cooperative AgreeO*"It, cant....} 4
4. Requirements for membership in the Authority shall be as
follows:
(a) Membership in the Authority shall be open to any City
in Tarrant County, Texas which executes and approves
the Uniform Ordinance for Ambulance Services and this
Interlocal Cooperative Agreement no later than June 15,
1988, and which selects a price/subsidy option from
Exhibit D, Uniform Schedule of Price/Subsidy Options
Effective August 1, 1988 — December 31, 1989. Rural Fire
Prevention District Number One of Tarrant County may
become a member of the Authority by adopting and
executing this Interlocal Cooperative Agreement, and by
selecting a price/subsidy option from the Uniform
Schedule of Price/Subsidy Options. However, the
Authority shall provide ambulance services only in those
portions of the unincorporated areas of Tarrant County
which are operationally contiguous to member
jurisdictions of the Authority, as determined by the
Authority.
(b) Thereafter, membership shall be open, on an annual
basis, to any city which is in Tarrant County, Texas or to
any jurisdiction which is contiguous to the geographic
area served by the Authority, if such City is not located in
Tarrant County, Texas, subject to approval by the
Authority.
(c) Any jurisdiction which becomes a member after June
15, 1988 shall be required to pay a one-time initial capital
assessment which is equal to that jurisdiction's per-capita
share of the Capital Account of the Authority. Such
payment of the pro-rata share of the Capital Account
may be paid:
0) By a one-time payment at time of joining; or
(2) In monthly payments over a two-year period
which payments shall also carry interest at the
A%
(Interlocal Cooperative Agreement, cont....) 5
OpIk
statutory rate for judgments, pursuant to Texas
law.
5. This Jurisdiction accepts no financial responsibility or
commitment for its membership in the Authority except for
costs of furnishing a mechanism for transferring 911 callers
requesting medical assistance from this jurisdiction's 911 center
to Authority's designated EMS control center, and that
referred to in Paragraph 11(b), below. The sole requirements
for membership in the Authority are:
(a) Except for the Tarrant County Fire District, this
Jurisdiction agrees to adopt and enforce the Uniform
EMS Ordinance, which is attached hereto, and
incorporated by reference herein (and marked Exhibit A);
(b) This Jurisdiction agrees to establish and participate in
the Authority's first responder program no later than
August 1, 1989, as provided for in the Uniform Ordinance
and regulated by EPAB, and to fund first responder
operations within this Jurisdiction; provided, however,
op" that the Authority's ambulance service contractor shall
provide initial and continuing first responder training
without charge to this Jurisdiction, and provided further
that, at this Jurisdiction's option, required first responder
medical and communications equipment may be financed
and purchased by the Authority and paid for by way of an
increase in the subsidy or price level applicable in this
Jurisdiction.
(c) Approval of the Uniform Schedule of Price/Subsidy
Options Effective August 1, 1988 — December 31,, 1989;
(d) Selection by this Jurisdiction of one option from the
Uniform Schedule of Price/Subsidy Options Effective
August 1, 1988 — December 31, 1989;
(e) Thereafter, this Jurisdiction agrees that, no later than
July 31 of each year, it will annually select, approve and
op", adopt from the Authority's annually revised Uniform
(Interlocal Cooperative Agreerpow4t, cont....) I%k 6
Schedule of Price/Subsidy Options a �r�*ce/subsidy
formula to be effective in this jurisdiction. aces selected
on July 31 shall then become effective on the following
January 1, and the selected subsidy level shall become
effective on the following August 1.
(f) Any member jurisdiction which subsidized ambulance
services during fiscal year 1987-1988, shall agree to
subsidize the Authority in an amount not less than 90% of
that member jurisdiction's EMS subsidy in fiscal year
1987-1988 during the Authority's first year of operations,
beginning Aug. 1, 1988. Until such time as the Authority
has accumulated a prudent net worth as defined in
Paragraph 10(b), below, such annual level of subsidy shall
not be decreased by more than 10% of the fiscal year
1987-1988 amount during any single year. Such subsidy
contributions shall be made, quarterly, in advance,, to the
Authority beginning with the quarter starting August 1,
1988. For purposes of this provision, subsidies paid for
first responder services shall not be counted as subsidy.
The first year subsidy to the Authority by the City of Fort
Worth shall, pursuant to this provision, be $1,359,269, of
which $170,982 shall be paid in the form of accumulated
equity in the Fort Worth ambulance facility, ownership of
which facility shall be transferred and conveyed to the
Authority effective August 1, 1988, subject to a mutually
acceptable installment note at eight (8) percent interest
for the unpaid balance of $510,376, financed over a
twelve year period. Thus, Fort Worth's first quarter
subsidy payment shall be one-fourth of $1,188,,287,, or
$297,071.75, due August 1, 1988. At such time as the
Authority's prudent net worth level has been achieved as
defined in Paragraph 10(b), hereof, no restrictions
regarding subsidy reductions shall apply.
(g) The above restriction on subsidy reduction not
withstanding, if the subsidy/price structure effective in
any member jurisdiction during fiscal year 1987-1988 was
in excess of an applicable combination shown on the
Uniform Schedule of Price/Subsidy Options Effective
---------------------
(Interlocal Coopera#w Agreement, cont.... 7
August 1, 1988 -- December 31, 1989, that jurisdiction may
OP'' upon becoming a member of the Authority reduce its
initial subsidy/price balance to any level shown on the
Uniform Schedule. Thereafter, the restriction on rate of
subsidy reduction specified in Paragraph (f), immediately
above, shall apply.
N Should any member jurisdiction fail to maintain
substantial compliance with any membership require-
ment specified herein, the Authority's Board of Directors
may, at its option and after written notice to that
jurisdiction and reasonable opportunity to correct the
deficiency, disqualify that jurisdiction from membership
in the Authority and revoke its membership status. In
such event, the removed jurisdiction shall not be eligible
for distribution of any share of the Authority's then-
current Capital Account.
6. The Authority shall have all of the powers allowed or
provided by Art. 4413(32c), Texas Civil Statutes, the "Interlocal
Op", Cooperation Act."
7. The Authority shall not itself operate the ambulance
service, except in the event of default by the Authority's
competitively selected provider ("Contractor"). In the event of
such a default by the Contractor, the Authority may operate
the ambulance system for a period not to exceed 18 months,
during which time the Authority shall again conduct a
competitive Request for Proposal process for the award of a
contract to another provider.
8. The business structure of the emergency medical system to
be created by this Agreement, shall be what is known as the
"Public Utility Model," enhanced by the addition of the "Three-
Way Leasing Program." In this regard, items to be transferred
from the City of Fort Worth to the Authority, effective not later
than August 1, 1988, and subject to mutually acceptable transfer
agreements, shall include:
(a) The Medstar trade name and provider license;
(Interlocal Cooperative Agreero"t, cont....) '\ 8
(b) The EMS communications system, related Motorola A%
lease, communications system maintenance agreement,
and tower rental agreements;
(c) The Medstar telephone numbers and lines;
(d) The Texas Lifeline Corporation contract for ambu-
lance services, renegotiated and extended in accordance
with the terms and conditions set forth in Exhibit C,
"Memorandum of Understanding";
(e) The Medstar post office box and "lock box" banking
arrangements, restructured to accommodate the public
utility model business structure established hereby;
(f) Fort Worth's rights and obligations pursuant to the
"three-way leasing program" currently in effect,
renegotiated as appropriate to effect improvements in
EMS facilities and infrastructure necessary to safe
regional expansion of the Medstar service area;
(g) Medstar's third party payor agreements, including
any existing Medstar contracts for interfacility
transports; and,
(h) Such miscellaneous items used in the Medstar
operation as may be mutually agreed to by the parties.
(i) After said transfer, the Authority shall be solely
responsible for related costs, debts, improvements, and
other expenses associated with these items. All
agreements affecting transfer of said items shall be so
structured as to:
(1) Cause no increase in the financial liability of the
City of Fort Worth as a consequence of these
transactions;
(Interlmal Cooper oke Agreement, cont....) A**, 9
(2) Provide reasonable protection to the City of
Fort Worth in the event of default by the Authority
on obligations affecting the contingent liability of
the City of Fort Worth or the operation of the
Medstar system within the City of Fort Worth;
and,
(3) Provide for release of the City of Fort Worth
from contingent liability for the Authority's
financial obligations as soon as the Authority has
established sufficient financial stability to effect
such release.
9. The Authority shall have the following duties and powers:
(a) To set response time standards for all areas of each
member jurisdiction.
(b) To provide each member jurisdiction with advanced
life support ambulance service, such service to comply
0101, with all applicable state laws and rules, as well as all
rules, regulations, and clinical standards as the Medical
Control Board may from time to time promulgate.
(c) After expiration of the contract for ambulance
services transferred to the Authority by the City of Fort
Worth as provided for in Paragraph 8, above, to provide
such ambulance service by the competitive award of a
contract by way of a Request for Proposal process. Such
competitive Request for Proposals shall be conducted for
the selection of a Contractor no less frequently than
every 11 years. The contract awarded to the contractor
shall require the contractor to provide all ambulance
services in each member jurisdiction, except for those
exempted in Section 6F of the Uniform EMS Ordinance
(Exhibit A) adopted concurrently herewith.
(d) To prepare and distribute, not later than June 30 of
each year to each member jurisdiction a schedule of
price/subsidy options, called the Uniform Schedule of
(Interlocal Cooperative Agreerom"t, cunt....) "ON 10
Price/Subsidy Options, which shall range from zero-level
subsidy with full cost user-fees, to zero-level user fees 1
with full-cost annual per capita subsidies. (The Uniform
Schedule of Price/Subsidy Options Effective August 1,
1988 -- December 31, 1989 is attached hereto as
Exhibit D.) Future Price/Subsidy Option Schedules shall
be prepared in the same general format as Exhibit D to
this Agreement.
(e) Each member jurisdiction shall, no later than July 31
of each year notify the Authority of that member's
selection of a price/subsidy formula from the Uniform
Schedule of Price/Subsidy Options received by the
jurisdiction from the Authority. The Authority shall set
the rate schedule for each member jurisdiction according
to that member's decision, effective the following
January 1, and the newly selected level of subsidy shall be
effective the following August 1. (These effective dates
are offset by seven months to allow adequate time to
compensate for the substantial fee-for-service collection
lag which prevails in the prehospital care industry.) 7%
(f) The Authority shall implement an ambulance service
subscription program unless otherwise prohibited by law.
That program shall be a contract which allows a resident,
and members of the resident's household of any member
jurisdiction to annually purchase and prepay all
uninsured portions of medically necessary ambulance
service.
(g) To purchase, lease, acquire, accept, own or hold real
or personal property, to operate or maintain same, to
borrow or incur debt in its own name, to accept gifts,
grants or bequests, to insure itself and its members for
any liabilities which might be incurred through
performance of this Agreement, to contract in its own
name, and to sue or be sued in its own name.
10. To fund the Authority's required operations, and to insure
use of sound business controls and financial management AN
Unterlocal Coo peralW* e Agreement, cont....
practices in the Authority's day-to-day operations, the
op", following financial requirements shall be met and maintained.
(a) The Authority shall adopt sound business practices
and accounting methods, appropriate to a governmental
Enterprise Fund operation.
(b) The Authority shall establish and maintain a prudent
net worth, which shall mean an amount of money not less
than $5,000,000, or 50% of the Authority's annual budget,
whichever is greater. Such net worth shall be recorded
on the books of the Authority in an account called the
Capital Account, and each member jurisdiction's pro-rata
share of the Capital Account shall be calculated at least
once every fiscal year. Each members' pro-rata share of
the Capital Account shall be based upon the population of
each member city as reported by the United States
Census Bureau, compared to the total population of all
member jurisdictions, as reported by the United States
Census Bureau.
oph" W The Authority shall operate on a fiscal year, which
shall begin on October 1 and end on September 30 of each
year.
(d) The Authority shall cause to be developed and
implemented a long range financial management plan
designed to ensure long-range financial stability.
(e) Until such time as the Authority has established a
prudent net worth, the Authority's Uniform Schedule of
Price/Subsidy Options shall automatically be adjusted in
conformance with the Medical Consumer Price Index for
the most recent twelve month period for which such data
are then available, not to exceed a 12 percent increase in
any single year. After that prudent net worth level has
been achieved, all future Uniform Schedules of
Price/Subsidy Options shall be revised as necessary to
maintain but not exceed a prudent net worth as defined
(Interlocal Cooperative Agreerpgt, rant....) AN% 12
herein, not to exceed a 12 percent increase in ambulance
service fees in any single year.
(f) At such time as the Authority's prudent net worth
level has been achieved, member jurisdictions may apply
such population-based discounts as may then be available
as described in Exhibit C, "Memorandum of Under-
standing", hereof, in any of the following ways:
(1) To reduce rates or subsidies in that jurisdiction;
or,
(2) To reduce the subscription program fee charged
in that jurisdiction, or
(3) To recover costs incurred prior to August 1, 1988
in the development and implementation of this
EMS system; or
(4) A combination of(1), (2), or (3), above.
(g) The Authority shall make provision for an annual
audit of the Authority by an independent certified public
accountant.
(h) Any decision by the Authority affecting the financial
obligations, contingent or other, of a member jurisdiction
shall be subject to prior-approval by the affected member
jurisdiction.
11. Subject to the provisions of Paragraph 2, above, this
Jurisdiction may withdraw from membership in the Authority.
Should this Jurisdiction withdraw as a member, for any reason
except that listed below in Subparagraph (c) of this Section,
this Jurisdiction:
(a) Forfeits all rights, title, interest or claim to any asset,
or combination of assets of the Capital Account of the
Authority;
(Interlocal Cooper jke Agreement, cont.... 13
(b) Commits itself to pay to the Authority any unamortiz
ed infrastructure costs attributable to this Jurisdiction or
unpaid costs of first responder equipment financed by the
Authority which are carried on the books of the Authority,
and which were originally approved by this Jurisdiction.
Q In the event any member jurisdiction experiences
repeated and chronic failure of the Authority, or the
Authority's Contractor, to comply with the response time
standards established for that member jurisdiction, and
after written notice to the Authority and reasonable
opportunity to correct such deficiencies, that member
jurisdiction may withdraw subject to the following terms:
(1) The member jurisdiction must give written
notice to the Authority that the member intends to
invoke this section of this Agreement;
(2) Upon a continued failure for the following three
full months after receipt by the Authority of the
written notice described in Q (1) above, the member
jurisdiction may withdraw as a member, by giving
written notice to the Authority, to be effective ten
(10) days after receipt of such notice by the
Authority.
(3) Upon the effective date of the withdrawal, the
Authority shall cease ambulance service to the
former . member jurisdiction, and within one
hundred eight (180) days the Authority shall remit in
full to the former member its per capita share of the
Authority's Capital Account, as defined in
Paragraph 10(b) above, as of the last fiscal year,
less any unamortized capital costs and unpaid first
responder equipment owed by the former member
jurisdiction, as defined in Paragraph 11(b) above.
12. Until such time as the total population of all member
jurisdictions of the Authority exceeds 880,000 persons, the
(Interlocal Cooperative Agreement, cant....} 14
membership of the Board of Directors shall be appointed in the
following manner: AM%
(a) The Medical Director of the Emergency Physicians
Advisory Board shall be a member of the Board of
Directors, ex officio, but with full, voting rights;
(b) The City of Fort Worth shall appoint four (4)
directors, whose collective expertise shall fulfill at least
three of the criteria described in Paragraph 3, (a)-(d),
above, and each of whom meet at least one of those listed
criteria. Immediately upon adoption of the Uniform
EMS Ordinance and this Interlocal Cooperative Agree-
ment by the City of Fort Worth, and upon appointment by
Fort Worth of its Directors to the Authority, the Board of
Directors of the Authority shall proceed with the process
of imple m* enting ambulance services, with a target
startup date of August 1, 1988.
(c) Should the City of Arlington choose to join, Arlington
may appoint two (2) members qualified to be members,
each of whom meet at least one of the criteria described
in Paragraph 3, (a)-(d), above, provided, however, that
not more than two members meeting each of those listed
criteria may simultaneously sit on the Authority's Board.
(d) All other member jurisdictions of the Authority
combined shall be entitled to one (1) seat on the Board of
Directors for each 110,000 persons residing within all
other member jurisdictions combined, but no less than
one (1) member in any event. All members of the Board
selected by jurisdictions other than Fort Worth and
Arlington shall be chosen as follows:
(1) Each member jurisdiction shall be entitled to
appoint one (1) member to a selection Committee,
Voting on the Selection Committee shall be on a
one vote per jurisdiction basis.
(Interlocal CooperrO"k! Agreement, coat....} look IS
(2) No later than July 21, 1988, the Selection
Committee shall, for each position for which an
appointment shall be made, compile a list of not
more than three (3) persons, each of which is
eligible and possesses an area of expertise which
has not been filled by two prior appointments by
Fort Worth and, if a member, Arlington. Each list
of nominees for each available position shall be
called the "Candidates List," and all nominees on
each such Candidates List shall possess the same
area of expertise.
(3) The Candidates' Lists shall be submitted no
later than July 22, 1988 to the City Council of each
member of the Authority, with the exception of Fort
Worth and Arlington. If Rural Fire Protection
District Number One of Tarrant County is also a
member of the Authority, the Candidates Lists shall
also be presented to the Board of that District.
(4) Each member jurisdiction shall cast all of its
votes for one (1) of the eligible candidates on the
candidates' list. Each member jurisdiction shall be
entitled to the number of votes which corresponds
to the number of residents residing in that member
jurisdiction, as announced by the most recent
United States Census Bureau Statistics. For
purposes of this provision, the population of Rural
Fire District Number One shall include the
estimated population of the unincorporated areas
of Tarrant County.
(5) The candidate for each available position
receiving the most votes shall be certified as the
winner of the election to that seat. The Selection
Committee shall forward the certified results of the
first election to the existing Board Members
appointed by Fort Worth (and Arlington, if a
member). Those Board members shall receive and
certify the results causing the elected persons to
anterlocal Cooperative Agreement, +cant....? 16
Aft •.
become members of the Board. Thereafter, the
Selection Committee shall forward the results of all
elections of the Board to the other Board members
of the Authority. Those Board members shall
receive and certify the results causing the elected
persons to become members of the Board.
13. At such time as the total population of all member
jurisdictions exceeds 880,000 residents, as reported by the U.S.
Census Bureau, the following methods shall apply to select
members of the Board.
(a) The total population of all member jurisdictions shall
be divided by eight (8), the number of appointed seats on
the Board;
(b) Fort Worth and Arlington may each appoint one (1)
member for each 1/8th of the total population which the
respective population of those two cities represents,
provided such appointees meet the eligibility require-
ments for residency and type of expertise as set forth in
Paragraph 12, above, and provided that no more than
two members possessing the same expertise may sit on
the Board simultaneously. There shall be no represen-
tation for fractional population; that is, for a Board
membership a full 1/8 of the total is required.
(c) All other member jurisdictions shall elect Board
members in the manner described in Paragraph 12(c),
above, except that instead of one Board member for each
110,000 population the other member jurisdictions may
appoint one Board member for each 1/8 of the then-
current population of all member jurisdictions, and
provided that no more than two members possessing the
same expertise may sit on the Board simultaneously.
14. Because the Authority's ability to deliver services to certain
jurisdictions will depend, in part, upon whether certain other
jurisdictions elect to become members of the Authority, the
following sequence of decision-making shall apply:
Unterlocal CooperatIO"'kgrement, cont....) 10% 17
(a) First-Round Membership: The jurisdictions listed in
Exhibit B, "Jurisdictions Eligible for First-Round
Membership" shall be eligible to receive the respective
levels of response time performance shown in Exhibit B,
regardless of decisions on membership made by other
jurisdictions. Thus, the jurisdictions listed in Exhibit B
are eligible for "first-round" membership until May 31 ,
1988.
(b) Second-Round Membership: All other jurisdictions
(i.e., those not listed in Exhibit B) shall be eligible for
"second round" membership. No later than June 15, 1988,
all other interested jurisdictions which request such
information shall be informed of the level of service
which will be offered by the Authority to each respective
"second-round" jurisdiction, and those jurisdictions shall
be eligible for "second-round" membership until July 15,
1988.
OPOII Q The provisions of Paragraphs (a) and (b) immediately
above notwithstanding, each jurisdiction in Tarrant
County shall be offered a combined level of service and a
subsidy/price balance which is equal to or better than that
which was enjoyed by that same jurisdiction immediately
prior to consideration of membership. For purposes of
this provision, temporary interim Medstar coverage
agreements shall not apply.
(d) After the closing of these "first-round" and "second-
round" opportunities opportunities for membership, opportunity for
membership in the Authority shall be annually available,
subject to applicable provisions of this Agreement and
approval by the Authority.
15. The Authority is expressly prohibited from furnishing
service to any area which is not a member of the Authority,
except for service pursuant to a mutual aid agreement
approved by the Authority, or emergency coverage of non-
member jurisdictions not to exceed sixty (60) days in duration.
(Interlocal Cooperative AgreeqWt, cont....3 18
16, Texas Lifeline Corporation shall not be prohibited from
completing already-existing contracts for service with
jurisdictions which are not members of the Authority.
However, effective August 1, 1988, only member jurisdictions
shall be rendered service under the Medstar trade name,
except for authorized mutual aid service. Infrastructure and
support services used by Texas Lifeline Corporation in
performance of Authority's ambulance service contract shall
not be employed in the rendering of services to nonmember
jurisdictions without the expressed written permission of the
Authority, and subject to a payment acceptable to the Authority
for such use of such facilities in rendering such outside services.
17. All temporary Medstar contracts for ambulance services
currently in existence shall be automatically extended through
July 31, 1988, and then shall automatically terminate.
LIST OF EXHIBITS
Exhibit A. Uniform EMS Ordinance
Exhibit B. Jurisdictions Eligible for First-Round Membership
Exhibit C. Memorandum of Understanding
Exhibit D. Uniform Schedule of Price/Subsidy Options
Effective August 1, 1988 — December 31, 1989
APPROVAL
Approved by the City Council of Texas,
this day of 1988.
,pr. A%
EXHIBIT A. UNIFORM EMS ORDINANCE
Be it ordained by the City Council of
Texas:
SEC. 1 STATUTORY AUTHORITY.
This Ordinance is enacted by the City Council of
Texas, pursuant to Sec. 3.10, Art. 4447o Texas Civil Statutes, which
provides that local governmental units may establish standards for
ambulances, and to Sec. 4(a), Art. 4413(32c) Texas Civil Statutes
which provides that combinations of local governmental units may
contract for the provision of governmental services.
SEC. 2 GENERAL PURPOSES AND INTENT OF ORDINANCE.
It is the purpose of this Ordinance:
A To establish a regulated ambulance service system which
can provide state-of-the-art clinical quality of care, with
reasonable, reliable response time standards, and with the,goal
of furnishing the best possible chance of survival, without
disability or preventable complication, to each ambulance
patient.
B. To establish a sole-provider ambulance system,because it is
unreasonable to have unnecessarily high rates and/or public
subsidy to make needed improvements to ambulance service in
the Service Area, when a more efficiently designed system can
achieve the same results at lower cost. The most efficient
design to achieve the goals of high-quality service, at the
lowest cost, consistent with the quality of care required, is the
implementation of the system described herein.
(Exhibit AL Uniform EMPOrdinance,coast....) AM*► 2
C. To provide more effective system performance through the
provision of services by a competitively selected qualified
private operator, rather than direct governmental operation of
ambulance services.
D. To provide more effective medical control by establishing a
multi-jurisdictional Emergency Physicians Advisory Board
(EPAB) and by empowering that Board to oversee and regulate
all clinical aspects of the emergency medical system which
affect patient care.
SEC. 3 DEFINITIONS.
For the purposes of this chapter, the* following words and
phrases shall have the meanings respectively ascribed to them by this
section:
A. Advanced We Support Ambulance. Any vehicle which is
equipped to provide treatment of life-threatening emergencies A*N
through the use of advanced airway management, intravenous
therapy, and other advanced prehospital care procedures, and
which is equipped to transport sick or injured persons to or
from health care facilities.
B. Approved Rate Schedule. Those fees for ambulance
services rendered which have been established for this
Jurisdiction by the Ambulance Authority from the Uniform
Schedule of Price/Subsidy Options.
C. Area Metropolitan Ambulance Authority ("Ambulance
Authority"). That public administrative agency established to
oversee the operation. of the ambulance system established by
this Ordinance.
D. Base Station Physician. A physician licensed to practice
medicine in the State of Texas, knowledgeable in the A%k
(Exhibit A. Uniform EMS dinance,cant....)
A Am► 3
prehospital emergency medical protocols, EMS radio
procedure and the general operating policies of the ambulance
system, and a person from whom ambulance personnel may
take medical direction by radio or other remote com-
munications device.
E. Contractor. That person selected by the Ambulance
Authority, pursuant to the Request for Proposal process, which
is awarded the right to provide all ambulance services in this
Jurisdiction, except those specifically exempted by Section 6F of
this Ordinance.
F. Emergency Medical Technician (EMT). An individual who
is a "specially skilled emergency medical technician" under Sec.
1.03 (10) of Art. 4447o, Texas Civil Statutes.
G. EMS Control Center or Control Center. The single
facility designated by the Ambulance Authority as the central
communications center from which all ambulances operating in
the Service Area shall be dispatched and controlled.
H. Emergency Physicians Advisory Board (IIEPABII). The
medical board created by this Ordinance and empowered to
promulgate the various standards, rules and regulations
related to clinical aspects of ambulance service and first
responder services within the Service Area, and to perform
medical audits and otherwise monitor system performance.
I. First Responder. Any person, fire department vehicle,
police vehicle, or other vehicle not normally used for purposes
Of patient transport, but which vehicle and on-board personnel
are capable of providing first responder services in medical
emergencies. -
J. Helicopter Rescue Unit. Any rotary wing aircraft
providing basic or advanced life support services and patient
(Exhibit A. Uniform EMS Ordinance,cons....} 4
Oft An►
transportation originating from the scene of emergency
incidents which occur within the Service Area.
K Interlocal Cooperative Agreement ("Agreement"). That
contract adopted by this jurisdiction concurrently with the
passage of this Ordinance, which contract is entered into by
this Jurisdiction pursuant to Art. 4413(32c) Texas Civil Statutes
more commonly known as the "Interlocal Cooperation Act."
L. Medical Audit. An official inquiry into the circumstances
involving an ambulance run or request for ambulance service,
conducted by the Medical Director or a licensed physician
designated by the Medical Director.
M. Medical Control. Direction given ambulance personnel by
a base station physician through direct voice contact, with or
without vital sign telemetry, as required by applicable medical
protocols promulgated by the EPAB, and by Sec. 10.3(19), Art.
4447o, Texas Civil Statutes.
N. Medical Director. The licensed physician appointed by the
EPAB serving as administrative officer in carrying out the
duties and powers of the EPAB.
0. Medical Protocol. Any diagnosis-specific or problem-
oriented written statement of standard procedure, or
algorithm, promulgated by the EPAB as the normal standard of
prehospital care for a given clinical condition.
P. Mutual Aid Agreement. A written agreement between the
Ambulance Authority and one or more entities whereby the
signing parties agree to provide backup ambulance service to
one another under conditions and pursuant to terms specified
in the agreement as approved by the Ambulance Authority.
1
(ExWbit A. Uniform EMSAkdinance,coast....} AN 5
Q. Paramedic. A person qualified as a certified "paramedic
emergency medical technician" as defined by Sec. 1.03(11) of
Art. 4447o, Texas Civil Statutes.
R. Patient. An individual who is W, sick,injured, wounded or
otherwise incapacitated and is in need of or is at risk of needing
medical care during trapsport to or from a health care facility.
S. Person. Any individual, firm, association, partnership,
corporation, governmental entity, or other group or
combination acting as a unit.
T. Response Time. The actual elapsed time between receipt
of notification at the EMS Control Center that an ambulance is
needed at a location within the Service Area and the actual
arrival of an ambulance at that location.
U. Senior Paramedic in Charge. That person among the
ONO", certified personnel assigned to an ambulance, not the driver,
who is a certified paramedic designated as the individual in
command of the ambulance.
V. Service Area. That geographic area which is contained
within the boundaries of all of the jurisdictions which adopt
this Uniform EMS Ordinance, and which adopt and execute
the Interlocal Cooperation Agreement implementing the
Ordinance, thereby becoming members of the Ambulance
Authority.
W. Special Event. Any public event located within the Service
Area, for which standby ambulance service is arranged in
advance, and for which an ambulance (or ambulances) are
hired by the sponsor of the event or other interested party.
X. Specialized Mobile Intensive Care Unit. A vehicle which is
specially constructed, equipped, staffed, and employed in the
(Exhibit A. Uniform EMWdinance,cant....) IOWA 6
interfacility transport of patients whose requirements for
enroute medical support are likely to exceed the clinical
capabilities of an advanced life support ambulance.
SEC 4 EMERGENCY PHYSICIANS ADVISORY BOARD (EPAB).
There is hereby created an Emergency Physicians Advisory Board
which shall oversee and regulate on behalf of this city all medical
aspects of the ambulance system which affect patient care.
A The EPAB shall consist of a board whose membership shall
be composed as follows:
(1) The medical director, or his designee, of each
hospital emergency department which is located within
the Service Area and which maintains an emergency
medical services department staffed twenty-four (24)
hours per day, seven (7) days per week by in-house
physicians; all EPAB members shall be licensed
physicians, preferably engaged in the full-time practice of
emergency medicine; and,
(2) Five (5) additional licensed physicians with active
specialties or sub-specialties of benefit in developing
standards for emergency prehospital care, and who are
appointed by and serve at the pleasure of the Tarrant
County Medical Society.
(3) The EPAB may, at its option, elect from among its
members an Executive Board consisting of not less than
seven nor more than nine physicians, which Executive
Board shall exercise such powers and duties of EPAB as
are set forth in written by-laws, approved by a two-thirds
majority vote of the entire EPAB membership.
AN
(Exhibit A. Uniform EM?"b•dinance,cont....) AN 7
B. The EPAB shall appoint a Medical Director whQ shall be
responsible for the day-to-day affairs of the EPAB in carrying
out its duties under this Ordinance. The Medical Director shall
be a licensed physician who is board-certified in emergency
medicine. The Medical Director shall serve at the pleasure of
EPAB.
C. The EPAB shall have the following powers and duties:
(1) To recommend to the Ambulance Authority medically
appropriate response time standards for this Jurisdiction;
(2) To establish standards for patient care, including
standards*for ambulance and first responder vehicles and
on-board equipment;
(3) To develop medical protocols for ambulance and first
responder services and periodically revise same;
(4) To develop control center protocols and periodically
revise same;
(5) To conduct medical audits and develop standards
and procedures for the conduct of such audits;
(6) To develop and periodically revise and administer
both written and practical tests for the certification and
licensing of emergency medical services personnel,
including ambulance personnel, first responders, and
EMS control center personnel;
(7) To develop and periodically revise and administer
educational material, programs and/or tests to insure
that base station physicians are knowledgeable of the
local ambulance system, its medical protocols, radio
(Exhibit A. Uniform EWoOrdinance,cont....) 14N 8
procedures, and transport protocols; and to certify
qualified physicians as base station physicians;
(8) To conduct inspections of vehicles, equipment and
supplies on both an announced and unannounced basis;
(9) To monitor response time performance; in this
regard, the Ambulance Authority shall furnish such
statistical information regarding response time
performance as may be requested by EPAB;
(10) To develop standards and procedures for the
resolution of disputes regarding the application of
exemptions from late run penalties assessed against the
ambulance service contractor for failure to meet response
time standards;
(11) To periodically conduct intensive reviews of the
system's performance relative to specific clinical types
and to revise medical protocols and such other standards
of the system as may be appropriate in light of the
findings;
(12) To conduct medical audits of individual cases as
requested by the Ambulance Authority, by any elected
official of a member jurisdiction, by any licensed
physician regarding a patient of such physician, or by any
paramedic involved in the case which is the subject of the
audit request;
(13) To annually present a written and oral report to the
Ambulance Authority concerning the state of clinical
performance of the ambulance system; each member
jurisdiction shall be informed of the time and place of
such oral report at least 30 days in advance of that
(Exhibit A. Uniform EMS
,Qdinance,coast....) 9
meeting and shall be invited to send representatives,, and
shall be furnished a copy of the written report;
(14) To establish such committees as may be necessary
to aid in the performance of its powers and duties;
(15) To approve standards governing the operation of
specialized mobile intensive care units, including
standards limiting the types of patients which may be
transported thereby, and to issue, suspend, revoke, and
renew permits for the operation of such units as required
by this Ordinance;
(16) To approve standards governing the operation of
helicopter rescue units, including standards defining the
circumstances under which such units may be deployed to
emergency scenes, and to issue, suspend, revoke, and
renew permits for the operation of such units as required
by this Ordinance; and,
(17) To approve standards governing the operation of
point-to-point wheelchair transport units, including
standards limiting the types of patients which may be
transported thereby, and to issue, suspend, revoke, and
renew permits for the operation of such units as required
by this Ordinance.
D. For each patient transported by the Ambulance Authority or
its contractor., and for each patient transported by other
providers issued permits pursuant to this Ordinance, the
transporting provider shall pay to EPAB a fee of three dollars
($3.00), which sum shall be used to defray the costs of medical
regulation of the EMS system. Such payments shall be made
monthly by the fifteenth (15th) day of each month for services
rendered during the previous calendar month. Such funds
shall, be maintained in a separate account administered by the
(Exhibit A. Unifonn EM Ordinance,cant....) „r,� 10
Ambulance Authority on EPAB's behalf, and shall be expended
solely for the purposes set forth in this Sec. 4 as approved by JON
EPAB or its Executive Board. Effective August 1, 1990, this
per-transport fee shall be automatically increased to four
dollars ($4.00) per patient transported, and may thereafter be
periodically increased at the discretion of EPAB, subject to
approval by the Ambulance Authority,but not more often than
annually, and no single increase may exceed five percent (5%).
E. Effective August 1, 1988, funds then rem4ining in the
account of the Emergency Physicians Advisory Board of the
City of Fort Worth shall be automatically transferred to the
EPAB account established and maintained by the Ambulance
Authority.
F. This jurisdiction shall indemnify and hold harmless EPAB,
its members, its Medical Director, and EPAB staff members
from liability for actual damage, including costs and attorney's
fees, arising from any claim, lawsuit, or judgement resulting .•,
from an act or omission of said EPAB member, the Medical
Director, or EPAB staff member while acting in the scope and
course of his office, provided that such liability arises out of or
in connection with the provision of ambulance services or first
responder services originating within the corporate limits of
this Jurisdiction.
SEC. 5 AREA METROPOLITAN AMBULANCE AUTHORITY.
By adopting this Ordinance, and concurrently therewith
executing and approving the Interlocal Cooperative Agreement,
there is hereby established an Area Metropolitan Ambulance
Authority, which is herein called the "Ambulance Authority;' and in
regard to that Ambulance Authority the following shall apply:
A The Ambulance Authority is hereby designated as the sole
provider of all ambulance services within this Jurisdiction, ON
(Exhibit A. Uniform EM*dinance,cant....} 10% 11
pursuant to the terms, conditions and provisions of the
Interlocal Cooperative Agreement, except for those services
exempted by Sec. 6F, below.
B. The Ambulance Authority shall comply with all terms of the
Interlocal Cooperative Agreement, and have all of the duties,
powers and responsibilities enumerated therein.
C. The Ambulance Authority is required to provide this
Jurisdiction with advanced life support ambulance service.
Such service shall comply with all applicable state laws and
rules, as well as all rules, regulations, standards and response
times as the Ambulance Authority or EPAB may from time to
time promulgate.
D. After termination of the current competitively-awarded
contract between the City of Fort Worth and Texas Lifeline
Corporation, which amended contract shall be assigned to the
owoo. Ambulance Authority effective August 1, 1988, and any
extensions thereof, the Ambulance Authority shall provide such
ambulance service by the award of a contract to a qualified
provider after a competitive bid process. However,
compliance with response time and quality of care standards
are the non-delegable duty of the Ambulance Authority.
SEC. 6 VIOLATIONS.
It shall be unlawful:
A. To perform duties as an ambulance driver, attendant
(EMT or paramedic), or EMS dispatcher without a current
certification issued by the EPAB;
B. To permit a person to work as an ambulance driver,
attendant or EMS dispatcher without a current license issued
by the EPAB;
{Exhibit A. Uniform EMJ_Ordirance,cunt....) 12
C. To use,, or cause to be used any ambulance service other 10% AV
than that of the contractor authorized to operate in this
Jurisdiction by virtue of its contract with the Ambulance
Authority, except those services described in Paragraph F of
this Section 6.
D. For any person, firm or organization to provide ambulance
service within this jurisdiction, other than the contractor which
contracts with the Ambulance Authority; or to provide point-
to-point wheelchair transport services to or from health care
facilities, helicopter rescue services, or specialized mobile
intensive care services except in accordance with EPAB
regulationp governing the delivery of such services, and then
only pursuant to a permit issued by EPAB for the operation of
such units; or after August 1, 1989 to provide first responder
services without a first responder permit issued by EPAB. All
such special permits when issued by EPAB shall be valid for a
period of two (2) years, and then shall be subject to provisions
governing renewal, such provisions to be developed by EPAB.
Holders of such permits shall comply with requirements for
payment of permit fees as set forth in Section 4D, hereof.
E. To knowingly give false information to induce the dispatch
of an ambulance or helicopter rescue unit.
F. It shall be a defense to any alleged violation of this Section 6
that the vehicle is being used solely in any of the following
manners:
(1) A privately owned vehicle not ordinarily used in the
business of transporting persons who are sick, injured,
wounded, incapacitated or helpless.
(2) A vehicle rendering service as an ambulance in the
event of a major catastrophe or extreme system overload
(Exhibit A. Uniform EM90"*dinance,cunt....) A** 13
when such condition is declared by the Medical Director,
the Executive Director of the Ambulance Authority, or by
an authorized representative of the Ambulance
Authority's contracted ambulance service provider, and
such assistance has been requested by the Control Center.
(3) Any ambulance owned or operated by the federal or
state government.
(4) Any transport to a location within the Service Area,
which transport originated from a point outside the
Service Area.
(5) Mutual aid calls when rendered pursuant to a
mutual aid agreement approved by the Ambulance
Authority.
(6) Special events coverage, so long as such service is
provided without charge by an emergency medical
services volunteer provider, as defined in Sec. 1.03(18),
Art. 4447o, Texas Civil Statutes.
(7) Wheelchair transport services which are not
provided on a point-to-point basis, but which provide
pickup and delivery by way of regularly scheduled routes.
(8) Medical transports by helicopter where such
transports originate outside the Service Area or at a
hospital location within the Service Area.
(9) Point-to-point wheelchair transport services
rendered by not-for-profit organizations.
(Exhibit A. Uniform EMS Ordinance,coat....) 14
OW AWN
SEC. 7 PENALTIES.
The following provisions for application of penalties for
violation of this Ordinance shall apply:
A. Any person convicted of violating the provisions of this
Ordinance shall be fined no more than five hundred dollars
($500.00). This does not serve to limit any other remedies
available to this jurisdiction in law or equity.
B. Each day that any violation of this article is committed or
permitted to continue shall constitute a separate offense.
SEC. 8 TRAFFIC LAWS; EXEMPTION.
When the driver of an ambulance has reasonable grounds to
believe that an emergency exists, as determined by the EMS control
center, the driver of the ambulance may:
A. Park or stand, irrespective of the otherwise applicable
provisions of law, ordinance or regulations;
B. Proceed past a red or stop signal or stop sign, but ,only
after slowing down as may be necessary for safe operation;
C- Exceed the maximum speed limits permitted by law,
ordinance or regulation; provided, however, that life and
property are not endangered thereby;
D. Disregard laws, ordinances and regulations governing
directions or movements or turning in specified directions.
E. Provided, however, that any exemption herein granted
shall, apply only when such ambulance is operating with siren
and emergency lights in operation,, and when such audible and
visual signals meet the requirements of law, ordinance or
regulation; and provided further, that the foregoing provisions
(Exhibit A. Uniform EMV"dinance,cont....) AO%
shall not operate to relieve the driver of any ambulance from
the duty to drive with due regard for the safety of all persons,
nor shall such provisions protect the driver from the
consequences of his reckless disregard for the safety of,others.
00�
r
(Exhibit A. Uniform EMS Ordinance,coat....} 16
Oak -ON
FORM ORDINANCE FOR ADOPTION OF THE UNIFORM EMS
ORDINANCE
Ordinance No.
[INSERT CAPTION HERE]
I-
That Chapter _ of the Code of the City of
(date), as amended, is hereby repealed and there is hereby enacted in
lieu thereof a new Chapter r, entitled "Ambulance/Emergency
Medical Services", the text of which shall read as set forth in Exhibit
"A", attached hereto and incorporated herein.
Ii.
Repealer. Ordinances and any resolutions in conflict herewith
are hereby repealed effective August 1, 1988.
III.
Severability. It is the intention of this Jurisdiction that the
separate provisions of this Ordinance and applicable Rules and
Regulations shall be deemed independent of all other provisions
contained herein and it is further intended that if any of the
provisions of this Ordinance and/or Rules be declared invalid, all
other provisions hereof and thereof shall remain valid and
enforceable.
IV.
Publication. That the City Secretary of
Texas is hereby directed to publish the caption summarizing the
purpose of this Ordinance and the penalty clause prescribing the
penalties for violation of this Ordinance in the manner provided by
applicable state law.
(Exhibit A. Uniform EMSQrdinance,cont....) 40% 17
V.
The City Secretary of the City of Texas
is hereby directed to engross and enroll this Ordinance by copying
the caption and penalty clause in the minutes of the City Council and
by filing the Ordinance in the Ordinance records of the City.
VI.
Effective Date. This Ordinance shall be effective August 1,
1988.
APPROVED AS TO FORM AND LEGALITY:
City Attorney
ADOPTED:
000pl
Exhibit 11 ON
Jurisdictions Eligible For First Round Membership
Urban Sub-Urban Urban Sub-Urban
Contiguous Contiguous Non-Contiguous Non-Contiguous
Standard Staoda Stallda s Standard
Priority 1 (8 min, 90% (10 min, 90% (10 min, 8010 (12 min, 80%
Priority 2 10 min, 90%) 12 min, 90%) 12 min, 8070) 14 min, 80%)
Fort Worth
Arlington
Westworth Village
Westover Hills
River Oaks t__ ,.
White Settlement
Sansom Park
Lake Worth
Saginaw
Blue Mound
Watauga
Keller
Haltom City
Richland Hills
North Richland Hills_*
Hurst * -4
Bedford
Euless *
*wow Colleyville
GraRgvine
Grand Prairie
Pantego
Dalworthington Gardens
Mansfield
Forest Hill
Kennedale
Everman
Crowley
Edgecliff Village
Burleson
Benbrook
The standards listed are reflective of the current response time standards existing in or
available to these communities. Should participation be such that any of these cities become
operationally non-contiguous, the response time standard would change accordingly (see
pages 2 and 3).
t River Oaks'contract expiring June 30, 1988 provides for a 6 minute response time with
90% reliability. An extension from July I through July 31 will be offered at the Urban,
Contiguous standard which would, therefore, also be the offer under the new system.
Note: Unincorporated areas surrounding member jurisdictions will be covered at the rural
standard of 15 minutes, with 70%reliability.
Exhibit B, Page I
Factors NO""t Could Cause Cities To Have Reduct'Nandard
The chart on the preceding page listed the proposed standard for member jurisdictions. It was
assumed that all cities presently under contract (excluding temporary, interim contracts) would be
participating. It is possible that some cities could have different response time commitments,for
the standard price/ subsidy combination,if no neighboring jurisdictions participate making that city
operationally non-contiguous.
Following is a list of potentially affected cities:
1.) Blue Mound would go from a Suburban, Contiguous standard to a Suburban,
Non-Contiguous standard if none of the following jurisdictions participated:
Saginaw
2.) North Richland Hills would go from an Urban, Contiguous standard to an Urban,
Non-Contiguous standard if none of the following jurisdictions participated:
Haltom City
Hurst
Richland Hills
Watauga
3.) Hurst would go from an Urban,Contiguous standard to an Urban,
Non-Contiguous standard if none of the following jurisdictions participated:
Euliss
Bedford
North Richland Hills
Richland Hills
Colleyville
4.) Bedford would go from an Urban, Contiguous standard to an Urban,
Non-Contiguous standard if none of the following jurisdictions participated:
Euless
Hurst
Colleyville
5.) Euless would go from an Urban,Contiguous standard to an Urban,
Non-Contiguous standard if none of the following jurisdictions participated:
Hurst
Bedford
Colleyville
Grapevine
6.) Colleyville would go from a Suburban, Contiguous standard to a Suburban,
Non-Contiguous standard if none of the following jurisdictions participated:
Hurst
Euless
Bedford
Grapevine
Generally the population density standards are(total population is also considered):
Urban Greater than 1500 people per square mile
Suburban Between 800 and 1500 people per square mile
RurW Less than 800 people per square mile
Exhibit B, Page 2 AWN
A044
contiellous Non-Contiguous
Priority Tj
Im
S Reliability Ni Time Reli ability
I min 907c 1" 10 min 107o
2* 10 min 90% 2* 12 min 80%
3*,4*,50 60 min 90% 3*,4*,5' 90 min 8010
Prioril.y Time Reliability Priorily TLimc Reliabilily
10 10 min 90% 10 12 min 80%
2* 12 min 90% 2* 14 min 80%
3*,4*,5' 60 min 90% 3*,4*,5* 90 min 80%
Priorily Jim BeiiabililN
10 15 min 70%
2* 15 min 70%
3*,4*,5' 90 min 7010
Exbibit B,Page 3
Aawk
EX11fRIT
MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding is to confirm the discussion of the tentative
agreements reached with respect to some of the issues involved in the conversion of the
paramedic service arrangement to a countywide "Enterprise Fund Model." This
understanding is based on previous discussions between representatives of Texas Lifeline
Corporation (herein "TLC"), Richard Neuhaus, members of the Fort Worth Ambulance
Authority, its consultant, Jack Stout, and the November 1987 report to the Fort Worth
Ambulance Authority from the Fourth Party, Inc. by Jack Stout entitled "Expanding the
MedStar System; Issues, Options, and Recommendations". The parties acknowledge that
this Memorandum of Understanding does not constitute a contract but will be attached to
and incorporated in the Interlocal Cooperative Agreement and serve as a guide for the new
contract to be executed between TLC and the Multi-Jurisdictional Ambulance Authority.
These understandings are summarized as follows:
1. Ambulance Authority
The Fort Worth Ambulance Authority would be converted to a multi-jurisdictional
agency (herein the "Multi-Jurisdictional Ambulance Authority") pursuant to the
Interlocal Cooperative Agreement. The Multi-Jurisdictional Ambulance Authority
would be a legal entity separate from its city members and would own, control,
manage, and administer the accounts receivable and the billing system. Title to
infrastructure property and equipment would be transferred to the Multi-Jurisdictional
Ambulance Authority by the City of Fort Worth on some basis to be negotiated
between the two of them.
Awk '�
The contract between the City of Fort Worth and TLC would be renegotiated and ►
replaced with a new contract between TLC and the Multi-Jurisdictional Ambulance
Authority on the basis of terms and conditions set forth in this Memorandum of
Understanding and as negotiated to the extent not agreed to herein. The term of the
Z
contract would be extended by thirty-nine (39) months with the same provisions for
earned renewals as are included in the current contract.
2. Per Capita Management Fee
The contract between TLC and the Multi-Jurisdictional Ambulance Authority will
provide for compensation to the contractor on the basis of a per capita rate multiplied
by the population in the service area under agreement with the Multi-Jurisdictional
Ambulance Authority each time a city is added. The per capita fee will be arrived at
using the following methodology:
1.) Using Fort Worth historical demand,determine the annual gross
volume of intra-jurisdictional transports and multiply times$230.00
per emergency transport and$153.33 per non-emergency transport
to arrive at a projected gross revenue figure;
2.) Multiply the projected gross revenue figure by 63% to arrive at a
projected net revenue(under the Failsafe Franchise Model)figure;
3.) Subtract the actual cost of billing and collection;
4.) Subtract$3.00 per transport,for payment of the EPAB fee which
will no longer be the responsibility of the contractor;
5.) Add the annual amount of first year subsidy from Fort Worth,
$875,000.00;
6.) Divide the total amount by the population covered(using COG
official figures),to arrive at a per capita figure;
AM%
7.) Adjust the per capita figure by the CPI;
8.) Adjust the per capita figure to account for the changes in the
definition of the expanded Service Area. Both parties agree that an
adjustment needs to be negotiated to reflect the differences in the
extended Service Area;and then
9.) Multiply the per capita fee,thus calculated,times the population in
the newly contracted Service Area (again using the COG figures),
and dividing by 12 to determine a Base Monthly Fee for intra-
jurisdictional work(excluding"extra-work" items).
In no event will the total monthly payment be reduced (because of a reduction in
Service Area size or population) without at least 365 days prior notice unless a
member city withdraws for due cause, based on contractor's default as defined in the
Interlocal Cooperative Agreement. In addition, the contractor will be paid for"extra
work", for long distance transfers, special events coverage, DRG transports, and
transports in excess of the current per capita transport rate in the City of Fort Worth.
The fees for various categories of "extra work" have not yet been negotiated but
would be similar to such terms as they appear in the Pinellas County RFP. The per
capita rate would be discounted by two percent (2%) after total population in the
service area exceeds 700,000 and by one percent (1%) additional for each
incremental population increase of 42,000 up to a maximum discount of fourteen
percent(14%).
3. Existing Accounts Receivable
The parties have agreed to conduct an independent appraisal of the net value of
outstanding accounts receivable based on current collection practices less the
reasonable costs of collection and will not be reduced by a present cash value
discount. All outstanding accounts receivable would then be assigned by TLC to the
Ook 40%,
new Multi-Jurisdictional Ambulance Authority. The Multi-Jurisdictional Ambulance
Authority would give TLC a negotiable promissory note for the agreed upon net
value of transferred accounts receivable. The note would bear no interest for the first
year,interest at the rate of nine (9%)thereafter or the rate charged by Texas American
Bank on the existing operating capital loans, whichever is less, and will be payable
in twenty-four(24)equal payments beginning twenty-four(24) months after the date
on which the accounts receivable are transferred. That note and/or the accounts
receivable would continue to collateralize the existing operating capital loans from
Texas American Bank. TLC would continue to be responsible for interest on the
operating capital loan for twelve (12) months after the date the accounts receivable are
transferred. This arrangement will be subject to the approval of Texas American
Bank.
4. Billing System Hardware,Software and Management
Consultine/Maintenance
TLC proposes to lease its billing system hardware, software and software support
(including upgrades) to the new Multi-Jurisdictional Ambulance Authority for a
monthly fee equal to its actual cost, beginning August 1, 1988. In addition, TLC
will provide management consulting and system maintenance services for$2,500 per
month. Both arrangements will be for an initial term of six (6) months. Thereafter
the Multi-Jurisdictional Ambulance Authority will have the option to continue all or a
portion of the arrangement to purchase either the computer hardware (for its fair
market value, but for not less than the amount of any unamortized debt on said
hardware) or the software package or to terminate the use of the hardware and
software without penalty. In the event it is the Multi-Jurisdictional Ambulance
Authority's decision to terminate said use,TLC shall cooperate fully in effecting the
conversion of the data to the Authority's new system.
5. Three-Way Lease Aers:cmen
The existing three-way lease agreement covering ambulances and medical equipment
between TLC and the Fort Worth Ambulance Authority would be assigned by the
Fort Worth Ambulance Authority to the Multi-Jurisdictional Ambulance Authority.
The Fort Worth Ambulance Authority would not be released under the current lease
without the prior consent of Texas American Bank, however, under no
circumstances would the dollar amount if its liability be increased above the then
current level. All new equipment purchased by TLC to be used under the contract
would be leased directly to the Multi-Jurisdictional Ambulance Authority and
subleased to TLC. The Fort Worth Ambulance Authority would not be involved as a
master lessee and there would be no actual or implied guaranty of the lease
arrangement by the City of Fort Worth or the Fort Worth Ambulance Authority. All
ambulance and medical equipment currently owned by Meissner-Brown which
would be used under the contract would be leased by Meissner-Brown to the Multi-
Jurisdictional Ambulance Authority which would sublease to TLC. The lease
payments to Meissner-Brown will be set at a monthly rate necessary to amortize the
current value of the leased equipment over its remaining useful life,but not more than
the amount of the sub-lease payments related to the same equipment paid to the Multi-
Jurisdictional Ambulance Authority by TLC.
6. Subscription REOgrgm.
TLC will send a letter to all current subscribers soliciting renewals for a sixteen (16)
month term beginning April 1, 1988. TLC's direct costs will be reimbursed from the
renewal proceeds and the balance shall be divided pro rata as of the conversion date
the Multi-Jurisdictional Ambulance Authority assumes control over the system. As
A"% AWN
consideration for the transfer of the subscription rights, the Multi-Jurisdictional
Ambulance Authority will pay $58,500.
7. Meissner-Brown
The parties acknowledge that TLC has purchased the assets and goodwill of
Meissner-Brown on an installment contract amortized over seven (7) years. The
parties further acknowledge that the contemplated system conversion will result in a
partial or total merger of the Meissner-Brown operation into the Medstar operation.
In the event the TLC contract should be terminated prior to the full amortization of the
purchase price for Meissner-Brown, the Multi-Jurisdictional Ambulance Authority
will continue to make payments to Meissner-Brown for the amortized cost of the
goodwill portion of the Meissner-Brown purchase. In return, TLC and Meissner-
Brown will waive any and all claim they may otherwise have to the assets and
goodwill value in the Meissner-Brown operations being contributed to the converted
ambulance system.
8. Scrvice to Non-Contiguous Urban Areas and Suburban Areas
The parties acknowledge that service to non-contiguous urban areas and to suburban
areas is more expensive for the same level of service because of greater distances and
time between revenue producing transports. Additionally,on a per capita contract,
the population base is too small to justify the same level of response time
commitment. Therefore, it is understood that the contract between TLC and the
Multi-Jurisdictional Ambulance Authority will provide for a higher per capita fee in
such areas or, in the alternative, a lower level of response time commitment
commensurate with the greater expense attributable in those areas; provided,
however, that in no event shall the City of Fort Worth receive a lower level of service
or a higher price/subsidy combination than that already established under its current
#011. 10%
contract with TLC (except for ordinary inflation of the Uniform Schedule of Price/
l Options as approved by the Multi-Jurisdictional Ambulance Authority).
Attached is a proposed table of response time commitments for the per capita fee
described in paragraph#2 above.
C�
9. Termination Qf Intedm Agreemenj
Although no formal, written interim agreement was executed in the spring of 1987,
the major elements of the recommendations included in the Fourth Party's "Twelve
Thousand Mile Tune-Up" report have been implemented. It is agreed that the new
contract contemplated in this Memorandum of Understanding would supersede and
terminate such interim understandings, that the increase in subsidy payments will
terminate with the March 10, 1988 payment and that the increased fee for service will
remain in effect until the new contract becomes effective August 1, 1988.
This letter sets forth all of the issues the resolution of which the parties considered critical
to a determination to move forward with the contemplated EMS system conversion and
expansion to a multi-jurisdictional service. However, the parties acknowledge that there
are many other issues which have been discussed and will be addressed in greater detail
during negotiation of the new contract. Those additional issues include but are not
necessarily limited to assignment of existing Meissner-Brown contracts to the Multi-
Jurisdictional Ambulance Authority, drafting and executing an Interlocal Cooperative
Agreement which includes provisions for first responders and agreement to appoint EPAB
as the medical control authority, upgrading and/or relocating the dispatch center,
establishing facilities for a training center,refinancing and remodeling the existing building,
drafting and adopting a model ordinance including provisions regarding wheelchair service,
and financing the acquisition of ETAK.
AM%
Contiguous Non- Con tigti ous
NoTity Time Reliabilily hjoTjt i:me Reliability
10 8 min 90% 1* 10 min 80%
2* 10 min 90% 2* 12 min 80%
3*,4*,5* 60 min 90% 3*,4*,5* 90 min 80%
Ptigjjt Time y S Reliability Notity _T_img Religbility
10 10 min 90% 10 12 min 80%
2* 12 min 90% 2* 14 min 80%
3*,4*,5* 60 min 90% 3*,4*,5* 90 min 80%
Pdotjiy Time Beliabilily
10 15 min 70%
2* 15 min 70%
3*,4*,5* 90 min 70%
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