One Noteworthy 1 August 2011 Closed Session Agenda Item & Three Noteworthy 2 August 2011 City Council Agenda Items

ABSTRACT: One Noteworthy 1 August 2011 Closed Session Agenda Item, namely Meet and confer with the Carmel-by- the-Sea’s Meyers-Milias Brown Act representative, Interim City Administrator Goss, to give direction regarding labor negotiations with the International Association of Firefighters, Carmel-by-the-Sea Police Officers Association, and LIUNA/UPEC Local 792 and three noteworthy 2 August 2011 Agenda Items, namely Update on provision of fire services, an appeal of the Planning Commission’s decision to approve Design Study, Demolition Permit and Coastal Development Permit applications for the construction of a new residence located on Mission Street 2 NW of 11th Avenue and a Resolution to adopt a Fire Department Emergency Medical Service Fee. Excerpts from Agenda Item Summaries and Staff Reports are presented.

CITY OF CARMEL-BY-THE-SEA
CITY COUNCIL AGENDA PACKET
Regular Meeting
Tuesday, August 2, 2011
4:30 p.m., Open Session

Live & Archived Video Streaming

City Hall
East side of Monte Verde Street between Ocean and Seventh Avenues

V. Announcements from Closed Session, from City Council Members and the City Administrator.

A. Announcements from Closed Session.

Pursuant to Government Code Section 54956 et seq. of the State of California, the City Council will adjourn to Closed Session to consider the following:

1. Labor Negotiations – Gov’t. Code Section 54957.6(a) Meet and confer with the Carmel-by-the-Sea’s Meyers-Milias Brown Act representative, Interim City Administrator Goss, to give direction regarding labor negotiations with the International Association of Firefighters, Carmel-by-the-Sea Police Officers Association, and LIUNA/UPEC Local 792.

C. Announcements from City Administrator.

4. Update on provision of fire services.

VIII. Public Hearings

A. Consideration of an appeal of the Planning Commission’s decision to approve Design Study, Demolition Permit and Coastal Development Permit applications for the construction of a new residence located on Mission Street 2 NW of 11th Avenue. The property owner is Domicile Properties, LLC. The appellant is Sherrie Spendlove Gallo, joined by three other neighbors. (Continued from July.)

Description: The appellants are requesting that the Council overturn the approval of the project. The appellants are generally concerned with the location of the detached garage and the size of the proposed residence.

Staff Recommendation: Deny the appeal and uphold the Planning Commission’s unanimous approval.

Important Considerations: The applicant is unable to develop the middle portion of the lot due to the presence of two significant trees.

Decision Record: On May 11, 2011 the Planning Commission unanimously approved this project.

RECOMMENDATION
Deny the appeal and uphold the Planning Commission’s unanimous approval.

BACKGROUND
The project site is located on Mission Street two northwest of Eleventh Avenue and is developed with a small one-story residence. The property contains three significant trees, one of which is located near the center of the lot. A Determination of Ineligibility for listing on the City’s Inventory of Historic Resources was issued on November 8, 2010.

On May 11, 2011 the Planning Commission unanimously approved the construction of a new one-story residence on the subject property. The Planning Commission was presented with opposition letters from three of the appellants at the hearing. However, the Commission determined that the proposed project met the zoning requirements and was consistent with the Design Guidelines.

PROJECT DESCRIPTION
The proposed residence is 1,583 square feet in size with a 217-square-foot detached garage located in the front setback. The applicant is proposing a combination of board and batten siding with stucco. Unclad wood windows and doors are proposed throughout the residence.

EVALUATION
Basis for Appeal: This approval is being appealed by four neighbors who live within the immediate vicinity of the project. The appeal is led by Sherrie Spendlove Gallo, the neighbor who lives directly to the north of the subject property.

Summary: The proposed residence is one story, presents a simple design and
incorporates the use of wood siding. The applicant has also done a nice job of designing the residence around the three significant trees on the property and redesigned the project early in the planning process to help mitigate the impact on the northern neighbor. For these reasons the Planning Commission determined that the proposed project is consistent with the Guidelines. The Commission considered the concerns that were raised by the neighbors and determined that the project was appropriate. Staff concurs with the Commission.

RECOMMENDATION
Deny the appeal and uphold the Planning Commission’s unanimous approval.

X. Resolutions

B. Consideration of a Resolution to adopt a Fire Department Emergency Medical Service Fee.

Description: This Resolution would establish an Emergency Medical Service Fee to reimburse the City for expenses related to the Fire Department’s response to medical emergencies within the City of Carmel-by-the-Sea.

Staff Recommendation: Adopt the Resolution.

Important Considerations: This fee would allow the City to obtain reimbursement for Fire Department EMS calls from insurance companies, government health programs, and individuals. This fee would help cover the costs of Fire Department EMS calls. At a fee of $250 per call, which is the low end of the range of this fee collected in other California cities, it is estimated that the City would obtain an estimated $42,640 in annual revenue to support Fire Department emergency medical services.
Decision Record: The City Council, during its June 2011 budget workshops, indicated an interest in considering the adoption of this fee.

A potential fee for supporting emergency medical services provided by the Carmel Fire Department was suggested in the budget transmittal letter and was discussed during the budget workshops. The proposed fee is called an Emergency Medical Service (EMS) fee.

PURPOSE
The purpose of an EMS fee is to reimburse the City for the expense of its Fire Department in responding to medical emergencies within the City of Carmel-by-the-City. While general tax dollars are used to support the availability of three fire fighters and an engine 24 hours a day, seven days a week, specific service is provided for short periods of time to those who receive emergency medical service. The proposed fee will cover a portion of this expense.

Part of the rationale for such a fee is that just as general tax dollars should not be required to support ambulance transport services, the response to emergency medical calls by the Fire Department also should not be subsidized by general tax dollars. It should be noted that the City currently is unable to obtain reimbursement for Fire Department EMS calls from insurance companies, government health programs (Medi-Cal), and individuals because there is no fee structure in place. The City can recover the cost of this service by establishing a fee for service and by billing the appropriate agencies.

How Will This Fee Work? When there is a medical emergency in the City of Carmel-by-the-Sea, usually the fire engine with a three-person crew will arrive first on the scene and will begin treatment at the Basic Life Support (BLS) level. All of the City’s fire fighters are certified Emergency Medical Technicians (EMTs) and can perform service at the BLS level. This level of service can include the application of a number of emergency medical skills and services depending upon the situation found at the scene.

These include:
• Evaluate the ill and injured;
• Obtain diagnostic signs including temperature, blood pressure, pulse and respiration rates, level of consciousness and pupil status;
• Perform CPR, if needed, including the use of mechanical adjuncts to this process;
• Use of different types of adjunctive airway breathing aids, such promoting airways, basic oxygen delivery services, and manual and mechanical ventilating devices designed for pre-hospital use;
• Use of stretchers and body immobilization devices;
• Initial pre-hospital emergency care of trauma;
• Administer oral glucose or sugar solutions;
• Extricate entrapped persons;
• Perform field triage;
• Assist ALS procedures upon arrival and with the direction of a paramedic.

After the Fire Engine with its three-person crew arrives and provides emergency medical care, which can include some or all of the above described services, there may be a need for Advanced Life Support (ALS). This can be provided by the subsequently arriving ambulance which is staffed by paramedic fire fighters. If ALS service is not required, the fire engine crew will complete medical aid at the scene in a “treat and release” mode.

After the service is rendered, the insurance company and/or Medicare is billed. This billing function would be consolidated with the staff who currently files ambulance charges. It is suggested that the same debt collection agency used by CRFA also be used for these bills. This would promote the efficiency of the billing function and add only an incremental cost to bill collection, with most of that expense absorbed by existing staff.

Amount of the Fee. The cost of providing BLS service is estimated to cost $300 per call. This expense is based on the hourly salary and benefit rate of the three fire fighters plus administrative overhead. There is also included an hourly engine rate based on California Emergency Management Agency’s reimbursement rates. The expense per call is somewhat greater than the proposed $250 per incident fee for this service.

Any resolution adopted by the Council implementing this fee should make it clear that the fee is only for the cost of firefighter time and their engine in responding to and addressing a medical emergency and does not cover the cost of medical supplies, medical equipment, specialized medical radio communication equipment, and the training and certification of first responders. It also does not apply to paramedic ambulances staffed with at least one paramedic. These expenses cannot be reimbursed by this fee since they are already covered by funds collected and distributed by CSA 74 via a MOU of which Carmel is a signatory. The source of the CSA 74 funds is a $12 parcel tax; therefore a fee cannot be charged to cover these CSA 74 MOU expenses.

As pointed out earlier, this fee will allow the City to recover this expense from insurance and Medi-Cal, with its collection accomplished by the same process and personnel by which ambulance charges are collected.

Comparable Practice. While no cities in Monterey County collect this fee, many cities in the state charge an EMS fee of $250 – $350 per call. In some cities this is called an “assessment fee” but the fire department service is often substantially beyond an initial assessment.

These cities include both Charter and General Law cities. Therefore, there is no requirement that the fee can only be collected by Charter cities. General Law cities like Carmel-by-the-Sea may also can implement this fee.

Estimated Revenue. Initially, in Supplemental Budget Memo #2 a rough estimate of revenue from this fee was $92,285. It was pointed out that this was a “rough” estimate, particularly since the EMS incident data would need to be refined. There were more than 800 EMS calls reported in 2010, and a limited number were eliminated as clearly not applicable to this fee (arrival at scene with no victims, for example). But there was a need to further refine the incident calls to determine which ones were applicable to this fee. This review process has now reduced the number of EMS incident calls to 388 during 2010.

Using this number the estimated revenue from this new fee is a projected $42,640. This is based on 388 calls with a collection rate of .47 which is similar to the rate collected for the local ambulance service as well as other cities with this program. The revenue from this fee is estimated with 388 incidents x $250 x .47 = $45,590 less $2,963 for collection expense = $42,627.

Implementation. Besides the normal steps of setting up the billing process for this fee, it is suggested that, if adopted, implementation of this fee be delayed one month in order to inform the public about the fee.

RECOMMENDATION
It is recommended that the City Council adopt the Resolution implementing a fire department emergency service medical fee.