14668ORDINANCE NO. 14,668
AN ORDINANCE ADOPTING A PROPOSAL TO PROVIDE
INTERIM AND LONG TERM AMBULANCE SERVICES
FOR THE CITY OF LITTLE ROCK.
WHEREAS, the Board of Directors of the City of Little
Rock has taken testimony and reviewed evidence concerning a
proposal prepared and approved by the Little Rock Ambulance
Authority describing a plan for maintaining a high level of
interim ambulance service; and
WHEREAS, the City supports the recommendations of the
Ambulance Authority in the implementation of a permanent
ambulance service system based upon the public utility model; and
WHEREAS, the Board of Directors of the City of Little
Rock finds that the Little Rock Ambulance Authority's interim
system must be structured and managed to operate reliability for
approximately eight (8) more months; and
WHEREAS, the Board of Directors of the City of Little
Rock hereby finds that it is in the best interest of the safety,
health and welfare of the citizens of Little Rock.
NOW, THEREFORE, BE IT ORDAINED BY THE BOARD OF DIRECTORS
OF THE CITY OF LITTLE ROCK, ARKANSAS:
SECTION 1. The Board of Directors of the City of Little
Rock, Arkansas hereby adopts the PROPOSAL TO PROVIDE INTERIM AND
LONG TERM AMBULANCE SERVICES submitted by the Little Rock
Ambulance Authority to the Board on May 30, 1984, attached and
included herein as Exhibit "A" and expressly made a part of this
Ordinance by reference.
SECTION 2. The Board of Directors of the City of Little
Rock, Arkansas approves the implementation of the proposal by the
Little Rock Ambulance Authority and specifically approves the
scope of work described in Exhibit "A" including the employment
of an interim operations manager and to pursue the interim system
financing.
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SECTION 3. The Board of Directors of the City of Little
Rock, Arkansas further adopts and ratifies the proposal to
provide interim and long term ambulance services of the Ambulance
Authority in all respects; expresses its support of the municipal
lease concept; the continuation of first responder services; and
the continued support of staff and use of City facility in
accordance with the provisions of the report attached as Exhibit
"A"
SECTION 4. The Board of Directors of City of Little Rock
finds that the capacity to provide basic life support and
advanced life support to the citizens of the City of Little Rock
is crucial and that failure to do so would result in endangerment
of the public safety, health and welfare and therefore finds that
an emergency exists and is hereby declared.
ADOPTED: May 30, 1484
ATTEST:
FI. _..i 4j:
7 C, I 'CLERK 'ta CZECH
APPROVED:
MAYOR J. W. SENAF LD j
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EMBI�T
• Ordinance #14,668
175
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PROPOSAL TO PROVIDE INTERIM AND
LONG-TERM AMBULANCE SERVICES
Prepared by: Little Rock Ambulance Authority
Presented: May 30, 1984
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ABSTRACT 176
The attached proposal, prepared and .approved by the
Little Rock Ambulance Authority describes a plan for maintaining
a high level of interim ambulance service coverage by the LRAA
until February 1, 1985, followed immediately by the full -scale
implementation of a permanent ambulance service system based upon
the Public Utility Model. Approximately $500,000.00 in short -
term interim system development costs are commercially financed,
with 'no additional financial support requested from the City of
L`.ttle Rock, by incorporating most interim system developmental
activities into commercially financed long -term system implemen-
tation plans. Both interim and permanent system costs, develop-
mental and operational, are financed entirely from user fees.
System stability, clinical sophistication, and response time per-
formance will be steadily improved throughout the interim period,
culminating in state -of- the -art stability and performance, as
well as efficiency, with full system implementation February 1,
1985.
while no subsid
proposal, four types o
include the following:
lease arranged by the
behalf of the City by
recognize the February 1 perman
the municipal leasing arrangemi
_program support, and (4) cc
cooperation, as well as use of
to by the affected departments.
y is requested from the City within this
f City support are requested. Those
(1) a $1.9 million long -term municipal
City, with all lease payments made on
LRAA; (2) two ordinance changes to
ent system start date and to allow
ant; (3) continued first responder
ntinued City staff support and
certain City facilities as agreed
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PROPOSAL TO PROVIDE INTERIM AND
LONG -TERM AMBULANCE SERVICES
Prepared by: Little Rock Ambulance Authority
Presented: May 30, 1984
This report is proposed to serve as a "scope of work" to
be incorporated within the body of an amendment to the contract
currently in effect between the City of Little Rock and the
Little Rock Ambulance Authority, if the proposal contained herein
is accepted and approved by the Board of Directors of the City of
Little Rock.
I. BACKGROUND BRIEF
During recent months, the LRAA has been in the process
of implementing the Public Utility Model in accordance with poli-
cies previously established by the City of Little Rock Board of
Directors. Those major policies included: stable and reliable
state -of- the -art ambulance services, superb response time perfor-
mance throughout all neighborhoods of the City, competitive
selection of a private operator, safeguards to prevent service
interruption or deterioration, and user financing through fees
and subscriptions of all service costs including capitalization,
implementation, regulatory, operational, uncollectibles, and all
other costs associated with the ambulance service system.
Originally, the new system's scheduled start -up date was
November 1, 1984. However, delays and complications associated
with LRAA's long -term financing arrangements made it necessary to
consider postponement of the start -up date to February 1, 1985.
The LRAA and City officials were in the process of developing
solutions to these financing problems when a crisis with the pre-
sent ambulance service system necessitated an immediate takeover
of emergency ambulance operations by the LRAA.
With the help and cooperation of many individuals and
organizations, the LRAA did succeed in restoring paramedic
emergency coverage to the City within five hours after being
directed to do so by the Board of Directors. The borrowed
resources of numerous organizations and individuals have been
organized to provide this temporary service, and $5,000.00 has
been appropriated by the City Board of Directors to partially
defray the Authority's costs of service restoration.
The actual takeover scenario was complicated further by
the fact that, approximately three hours after the City Directors
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LRAA REPORT 178
authorized the $5,000.00 funding to restore paramedic coverage,
the City's only emergency provider notified the City of its
intent to discontinue all emergency response. Two hours before
paramedic coverage was to be restored, LRAA's mission was altered
to include total restoration of emergency ambulance services.
As of this date, LRAA's temporary coverage has produced
excellent clinical and response time performance in response to
all emergency requests originating within the city limits, as
well as several mutual aid requests. At the moment, citizens in
Little Rock are protected by paramedic level emergency coverage
at least as reliable as that which existed prior to the crisis,
and by some knowledgeable reports, the temporary service may
actually be superior to previous coverage.
LRAA estimates that this temporary service system can be
maintained for another two or three days. After that, borrowed
resources will, to an increasing extent, need to be returned, and
more permanent resources will be needed to provide extended
coverage. Those resources included personnel, administrative
services, various staff and consulting assistance, vehicles, on-
board equipment expendable supplies, and numerous other factors
of production.
The LRAA has prepared a plan to provide extended ambu-
lance coverage until a permanent system can be installed on
February 1, 1984. That plan, summarized in this proposal, provi-
des for a building upon the present temporary service system,
gradually phasing in the Authority's own resources as borrowed
resources are returned to the various owners, with financing of
all interim system costs from a combination of interim revenues
generated and slight modification of permanent system financing
arrangements previously anticipated.
II. GENERAL STRATEGY
The LRAA's Public Utility Model system is now scheduled
to become fully operational February 1, 1984. Therefore, LRAA's
interim system must be structured and managed to operate reliably
for approximately eight more months, and to do so without addi-
tional injections of local tax subsidy. LRAA has determined that
we can achieve this ambitious objective by adapting the following
strategic guidelines:
(a) Long -Term Stability and Direction. A stable
interim system depends upon its integration into the long -term
future. Little Rock's previous ambulance system structure suf-
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LRAA REPORT
fered, in part, from an inherent lack of stability and long -term
perspective. LRAA cannot bring stability to the interim unless
the path to long -term system stability is clearly in sight.
(b) Retain Investment in Current Personnel. Our com-
munity's current ambulance personnel constitute LRAA's most
valuable resource for maintaining interim service capabilities.
Unless those personnel can be persuaded to remain with us
throughout the interim system's life, LRAA cannot maintain
reliable service. Similarly, the same lack of long -term stabi-
lity and direction that might inhibit our ability to retain
current personnel would also inhibit our ability to recruit
replacement personnel. We must take steps to demonstrate clearly
what the future holds for field personnel after the interim
system's life, in order to persuade field personnel to remain
through the difficult and stressful experience of interim system
employment.
(c) Interim System Financed by Permanent System
Mechanisms. Working capital, capital equipment, initial supply
inventories, and other developmental costs associated with the
interim system are estimated at approximately $500,000.00, even
assuming all interim system operating costs would be recovered
from break -even fee - for - service revenues. However, by
integrating interim system financing plans into long -term system
financing arrangements, and by accelerating and slightly
modifying LRAA's original plans for borrowing long -term working
capital, the entire developmental costs of the interim ambulance
service system can be financed without requesting any additional
subsidies from the City of Little Rock.
(d) Permanent Svstem Operations Contractor Assists with
Interim System Operations. While LRAA's long -term financing
arrangements were delayed by complications, LRAA's competitive
selection of an operations contractor remains on LRAA's original
schedule. That is, within approximately 60 days LRAA shall have
identified its operations contractor for the first several years
of Public Utility Model operations. By design, the winning com-
pany must possess strong credentials in paramedic service deli-
very, and must have considerable management "bench strength" and
successful field experience. In a variety of areas (e.g.,
vehicle maintenance, operations management, personnel recruit-
ment, etc.) the new operations contractor can assist LRAA in
maintaining and upgrading LRAA's interim service delivery, and
can also assist LRAA in effecting a smooth transition from the
interim system to the permanent system. As soon as LRAA's long-
term operations contract has been awarded, LRAA will immediately
enter into appropriate negotiations for interim system support
and transition coordination with the successful bidder.
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LRAA REPORT
III. SCOPE OF WORK - INTERIM SYSTEM
If so directed by the City of Little Rock, the Ambulance
Authority is prepared to carry out the following steps to main-
tain and improve the Authority's current ambulance coverage until
February 1, 1984, at which time the Authority's permanent Public
Utility Model ambulance system shall become fully operational.
(a) Interim Operations Manager. The Authority shall
immediately identify an interim operations manager to take charge
of the Authority's interim system operations. At such time as
the Authority's long -term operations contractor has been iden-
tified, LRAA shall negotiate to integrate interim systems opera-
tion management with long -term systems operations management.
(b) Interim System Finance. The Authority shall imme-
diately secure a revolving line of credit to finance all interim
system operating capital requirements and short -term equipment
requirements. These financing arrangements will not require City
participation, provided the Authority's long -range implementation
plans and municipal lease financing arrangements are approved by
the City. LRAA estimates that this line of credit will include a
maximum limitation of $400,000.00, made available immediately for
use by the Authority to finance interim system operations. The
Authority's accounts receivable will be pledged as security, with
the Authority's interim equipment serving as additional security
in a form compatible with LRAA's long -term municipal lease
financing plans. (Only a $400,000.00 line of credit is needed
for interim system development and working capital, rather than
the full $500,000.00 estimated costs discussed above in this
report, because it is assumed that approximately $100,000.00 in
short -term equipment financing will be either "rolled over" into
LRAA's long -term municipal lease arrangements or held out for
separate refinancing on a monthly payment basis, thus effectively
restoring an additional $100,000.00 to the LRAA line of credit in
either case.)
Present plans call for initial delay of interest
payments until permanent system start -up, with this interim
system line of credit serving as a long -term revolving line of
credit, probably declining cyclically over a five to ten year
period of permanent systems operation.
Thus it appears that LRAA can totally finance all
interim system start -up costs and operating capital requirements
without requesting additional subsidies from the City, provided,
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LRAA REPORT
LRAA's long -range financial and operational plans can be soli-
dified.
(c) Interim System Data Processing, Rate Setting,
Billings, and Collections. To stop the drain on LRAA's working
capital reserves as quickly as possible, the Authority shall
immediately establish a conservative rate structure to remain in
effect throughout the interim system's life. Effective February
1, 1985, LRAA shall establish a new rate structure based upon the
known operations contractor costs and known histories of sales
volumes and collection effectiveness. LRAA estimates that the
all- inclusive interim rates for paramedic emergency service shall
be $375.00, with a base rate for paramedic nonemergency transfer
service of $120.00. The LRAA shall periodically adjust rate
structure formats to maximize third party recovery and minimize
patients' out -of- pocket expenditures. No on -scene collections
shall be allowed in either the interim or long -term systems. It
now appears that LRAA's original estimated maximum average total
bill will still remain within our $285.00 average total bill
estimate.
To institute a manual billing system immediately, and to
convert to automated data processing, billings, and collections
within approximately 90 to 120 days, LRAA shall modify its
current billing contract with The Fourth Party, Inc. (originally
scheduled for implementation after November 1, 1984) to effect
immediate manual implementation and conversion to full automation
as soon as possible. All up -front costs of computers, software,
data entry, and related office personnel shall be furnished by
The Fourth Party, Inc.
(d) Interim On -Board Equipment and Central Supply
Inventory. As soon as possible, LRAA's current borrowed on -board
equipment shall be replaced by approximately $90,000.00 in new
on -board equipment purchased through LRAA's line -of- credit
arrangements, to be later refinanced under LRAA's long -term muni-
cipal lease. Currently, the University Hospital is furnishing
ambulance expendibles and softgood supplies, with the promise of
being reimbursed for costs at a later time. LRAA shall imme-
diately order approximately $18,000.00 in central supply inven-
tory for interim system use. Under LRAA's permanent operations
contract arrangements, as already released for bid, central
supply inventories are to be furnished by the operations contrac-
tor. Therefore, LRAA shall immediately amend its operations
contractor bid document to require the winning bidder to purchase
LRAA's remaining central supply inventory at a reasonable and
competitive cost, thereby restoring that aspect of LRAA's line of
credit.
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LRAA REPORT
(e) Temporary Vehicle Acquisition. LRAA's long -term
vehicle procurements are currently in process, and cannot be
accelerated. Therefore, LRAA shall immediately acquire six used
ambulances, or possibly lease six new ambulances for a short
term, and shall acquire at least two additional used or leased
ambulances within two or three months. Funds for purchase or
lease of these vehicles shall come from the Authority's line of
credit, which shall be restored when the temporary vehicles are
converted to longer term financing arrangements. After selection
of the operations contractor, the Authority shall negotiate with
the winning bidder to attempt to institute an accelerated main-
tenance incentive program which may allow the Authority to delay
acquisition of all twelve of LRAA's permanent system vehicles, to
the mutual financial benefit of LRAA and the operations contrac-
tor. However, the winning bidder does retain the right to
require LRAA to furnish the full complement of twelve new state -
of- the -art vehicles of identical configuration. It should also
be noted that, should LRAA's interim system marketing plans prove
exceptionally effective, especially as regards long distance
transfer services, the VA contract, and similar services, it may
be necessary for the Authority to acquire additional vehicles and
on -board equipment during the interim. In such event, however,
the increased demand for services causing the need for additional
equipment will also furnish the additional revenues to allow com-
mercial financing of that same additional equipment, at no addi-
tional cost to the City. (Remember that regionalization is
anticipated as a means of stabilizing rates, and improving econo-
mics of scale.)
(f) Franchise Fee Payments. The Authority shall pay
the $10.00 per run franchise fees, as required by current City
ordinance, until such time as the City's original $140,000.00
developmental appropriation has been repaid. At that time, the
Authority's franchise fee payments shall be made directly to AEPF
at $3.00 per transport.
(g) Interim Communications Systemi. As of this writing,
it appears that, assuming the Authority does execute a purchase
order for the Authority's permanent communications system pro-
curement, the Authority's interim system communications require-
ments can be incorporated into long -term communications system
costs, without requiring any additional. contribution from the
City or any depletion of the Authority's line of credit.
(h) Miscellaneous Interim Activities. In addition to
the above areas, the Authority shall. develop and implement
programs dealing with the following areas of responsibility:
(1) New Personnel Recruitment Program;
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IV.
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(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
(15)
(16)
(17)
LRAA REPORT 18 3
Interim Equipment Maintenance Program;
Purchase and Inventory Control of
Controlled Drugs;
Interim Facility Arrangements;
Interim System Status Management,
Dispatching, Emergency and Nonemergency;
Interim Mutual Aid Agreements;
Acquisition of State Paramedic Provider
License (current temporary approval is
for 90 days only);
Refine First Responder Program and Improve
Extrication Capability (Note: Fire Depart-
ment's Hurst tool request);
Prepare to Bid VA Contract (Probably during
July, 1984);
Arrange Nonemergency Telephone Access and
Yellow Page Ads;
Interim System Public Information and
Marketing Programs;
Institute Subscription Program (as soon as
full service capabilities are established);
Interim Payroll and Personnel Management,
Salary Structures, Personnel Transition
Arrangements (currently handled by Red
Cross);
Interim Fuel Purchasing Arrangements;
Interim In- Service Training Program;
Interim Internal Accounting and Financial
Management Services;
Interim System Insurance Coverage;
SCOPE OF WORK - PERMANENT SYSTEM IMPLEMENTATION
Permanent system implementation activities overlap
somewhat with interim system activities. As discussed above, a
key feature of this plan, and in fact its financial viability,
depends upon making many interim system developmental activities
perform the dual function of permanent system installation.
Major aspects of permanent system implementation shall include:
(a) Full implementation by February 1, 1985.
(b) Completion of municipal lease for approximately
$1.9 million in capital equipment and facilities, with such
financing arrangements to be finalized by the City within 60
days, but no later than September 1, 1984. (All such lease
payments shall be made by the Ambulance Authority, with ownership
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LRAA REPORT
of paid -off equipment reverting to LRAA.)
(c) Completion of operations contractor bid, execution
of contract, and negotiation of interim system provisions.
(d) The present Little Rock Ambulance Ordinance shall
be modified to anticipate a February 1, 1985 Public Utility Model
start date, and § 9 of Ordinance No. 14 -062 shall be amended to
allow the required municipal lease finance.
(e) Complete new vehicle procurement and permanent com-
munications system procurement, possibly with accelerated vehicle
maintenance incentive programs, as discussed above.
bidder.
(f) Effect central supply inventory buy -back by winning
(g)
Institute
long -term
marketing plan.
(h)
Continue
franchise
fee payments.
(i) Complete building of permanent ambulance facility,
including permanent dispatch center.
(j) Convert to permanent insurance coverage program.
(k) Complete transition from interim system to per-
manent system.
(1) Revise all financial projections and establish
medium range fee structures.
(m) Launch first annual major subscription drive.
(n) Continue to operate the permanent ambulance system
at increasingly higher levels of clinical sophistication, with
periodic competitive bidding for operations contractor services,
and without reliance upon local tax subsidization, throughout the
term of the amended City /LRAA contract. (Note: LRAA's permanent
system financing plans anticipate a minimum of 10 years of
planned operation for amortizing communications system and cer-
tain other equipment costs, and 20 years of operations for amor-
tizing facility costs, thus, a 20 year contract term is
recommended.)
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V. CONSIDERATION
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LRAA REPORT 18 S
Sections III, IV, above, outline LRAA's scope of work as
proposed herein, both interim and long -term. Where relevant,
City involvement is specified. The following items, however,
summarize the areas of assistance and cooperation required of the
City of Little Rock to enable LRAA to carry out its respon-
sibilities as described herein, with the first item listed below
identifying what will not be required of the City if this propo-
sal is accepted, and if the City carries out the remaining tasks
listed below.
(a) No Subsidy Required. This proposal does not
require or anticipate any requests for subsidy from the City. In
fact, this proposal incorporates franchise fee payments to help
pay back the City's previous appropriation of approximately
$140,000.00, with further franchise fee payments earmarked to
finance ongoing regulatory and medical supervision costs. All
interim system costs are commercially financed, interim system
operating costs are covered by fee - for - service revenues, per-
manent system installation costs are commercially financed, and
permanent system operating costs, including municipal lease
payments, are covered by permanent system fee - for - service reve-
nues.
(b) Municipal Lease Required. Because the LRAA is
unable to obtain its own direct long -term equipment and facility
financing, at this early stage in LRAA's business life, it is
necessary that the City authorize the creation of a municipal
lease in the amount of approximately $1.9 million, structured in
accordance with LRAA's capital requirements and lease payment
plans; provided that LRAA shall make all such municipal lease
payments on behalf of the City from its operating revenues. It
is understood that property paid off by this method shall revert
automatically to ownership by the Ambulance Authority, so that
the Authority may gradually establish its own financial strength
to avoid the need for further reliance upon City assistance for
financing purposes. It is also understood that, in order to
effect the Authority's interim system line -of- credit financing
arrangements, the municipal lease arrangements must be finalized
within 60 to 90 days from the date of this proposal.
(c) Amend Current Ordinances. Current City ordinances
must be amended to both accomodate the new February 1 permanent
system start -up date, and to allow the use of the above - discussed
municipal lease arrangement.
(d) Continued First Responder Services. It is
necessary that the City continue its commitment to a sound first
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responder program, provided that with the eventual establishment
of fully centralized paramedic dispatching and system status
management, a reduction in reliance upon first responder services
may be anticipated.
(e) Continued Staff Support and Use of Facilities.
Because of the aggressive work program outlined herein, LRAA's
small administrative staff, and the zero - subsidy mandate of the
City Directors, it is necessary that LRAA continue to receive
liberal assistance and cooperation from various City staff mem-
bers, and that LRAA be allowed the use of certain City facili-
ties, as necessary and agreed upon by the affected City
departments.
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OPTIONS AND BRIEFING ON ISSUES RELATIVE
TO AMBULANCE SYSTEM FINANCING
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Submitted by:
Little Rock Ambulance Authority
d/b/a Metropolitan Emergency
Medical Services (MEMS)
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CONTENTS
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Memorandum Discussing Options Relative
to Financing pp. 1 - 5
Briefing on Financing and Related
Issues pp. 6 - 15
System Financing Experiences/Difficulties
Communications System
Regionalization to Promote Stability
Attachments
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MEMORANDUM DISCUSSING
OPTIONS RELATIVE TO
FINANCING
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BOARD OF DIRECTORS COMMUNICATION
MEMORANDUM
February 8 , 1985
TO: Mayor & Board of Directors
FROM: Susan B. Fleming, City Manager
Subject: Ambulance Authority
Attached please find information provided by the
Ambulance Authority.
If you need additional information, please let me
know.
tat(TC S. A
Susan B. Fleming
City Manager
SBF: ji
Attachment
CITY OF LITTLE ROCK, ARKANSAS
11,
{" MEMORANDUM
TM ,
IVIS TO: Susan B. Fleming, City Manager
M°""'" ,vS FROM: Karen L. Muldrow,
Executive Director
SUBJECT: Options for Consideration Relative
Metropolitan to Municipal Lease
Emergency
Medical
ServicesI. Recommended Approach to Resolving Municipal Lease
Problem Centering on Property Restrictions:
P.O.Box 2452
Little Rock,Arkansas
72203-2452
(501)375.6090 1. Consider authorizing the execution of a triple
net municipal lease arrangement with the City serving
as primary lessee, Authority as sublessee, Management
Improvement Corporation of America (MICA) as lessor
and Stephens, Inc. as underwriter, in the amount of
$2, 016, 000 for the financing of the following equipment:
a ) One (1 ) new UHF-EMS communications system
(negotiated and ordered through Motorola, Inc. )
including, but not limited to, fixed-end equipment
consisting of radio base station equipment,
microwave, audio matrix and virgo monitors; other
equipment consisting of pagers and consoles for
dispatch and medical coordination, and additional
equipment consisting of 180 ft. tower at Ozark
Point, 120 ft. tower at 8th and Ringo and a
fail-safe generator.
b) Ten (10 ) new Type I ambulance units including
ten (10 ) chassis and ten (10 ) patient
compartments;
c) On-board medical equipment for ten (10 ) units
and back-up inventory;
d) Eight (8 ) used ambulance units purchased in
response to crisis to be rolled into the lease
to restore the working capital line extended
through First Commercial and Worthen Banks.
e) One (1 ) new 100 ft. ladder truck and one (1 )
new 1000 gallon pumper truck (replacing the central
facility to house Authority Administration,
Communication Center, Operations, Central
Maintenance and Supplies ) .
2. Consider diverting $358, 000 from purchase of
aforementioned fire equipment and reappropriate the
same for construction of a central facility to be
leased from the City by the Authority with such lease
payments to be applied toward lease payments for fire
1
equipment included under the municipal lease
arrangement.
III3 . Consider authorizing execution of a sublease with
the Ambulance Authority whereby certain responsibilities
of the City under the master lease are assigned to
Ithe Ambulance Authority.
4 . The City Board appropriated $300, 000 in the event
of default by the Authority. Clarify and define this
I appropriation as a reserve of one year of annual
payments to secure the municipal lease arrangement.
7 Background: A detailed report of financing activities
including discussions on the significance of the 8th
11 and Ringo site is attached. Originally, the central
facility proposed at 8th and Ringo was included under
the municipal lease. However, public purpose
restrictions prohibit the lessor from obtaining clear
II title to the property or as an assignable lease.
Therefore, the lessor would have no recourse relative
to the building in the event of default on lease
Ipayments.
II Other Points Relative to the Proposed Municipal Lease
Arrangement:
1 ) The proposed arrangement, modified to resolve the
public purpose property restrictions, does not increase
I the City' s financial commitment in terms of the total
amount of the lease, or reserve of one year annual
payments which were anticipated in the municipal lease
Iarrangement.
2 ) Termination values have been assigned to fire
1 equipment and in the event of default, the City can
purchase equipment from under the municipal lease.
1 3 ) Fire equipment is requested because the useful
life coincides or exceeds the term of the lease.
4 ) Furthermore, the City will hold title to the building
which is not included under or financially encumbered
by the municipal lease. However, when the municipal
lease debt is retired at the end of the ten year term,
or sooner if feasible, the Authority requests title
to the property.
1 5 ) The building is designed to meet the needs of the
Authority. However, it is not "so specialized" that
it could not accommodate other public purpose functions
1 requiring office-vehicle maintenance accommodations.
6 ) Further delays in the municipal lease arrangement
1 2
restrict the Authority from meeting the clinical
standards deemed necessary to best serve the citizenery,
as specified in Ordinance 14 ,511.
7 ) Further delays also restrict the release of working
capital tied-up in used vehicles and other equipment;
force unanticipated extensive maintenance on used
vehicles; and restrict our ability to meet payment
requirements of vendors of new equipment.
II. Alternatives to Reliance on Said Property
1. Direct the Authority to find another site.
2. Increase municipal lease financing by approximately
$300, 000 to compensate for the additional cost
associated with securing new property.
Background: Having given considerable effort in
exploring financing options,the Little Rock Ambulance
Authority continues in its belief that execution of
the proposed Municipal Lease arrangement with Stephens,
Inc./MICA is the most feasible course of action.
Execution of this arrangement is, unfortunately,
complicated by the "property" issue. The"why" and
"how" of decisions regarding the
g gproposed 8th and
Ringo property are detailed in addendum to this memo.
However, the City and/or Authority is still confronted
with a need to provide additional collateral to replace
the leased land per the Municipal Lease proposed. For
reasons outlined in Option I Little Rock Ambulance
Authority has proposed "fire trucks" to be purchased
by the City in 1985 to serve as "securable" equipment
per this lease, with funds that were to be spent on
the fire apparatus to be reallocated for construction
of the Little Rock Ambulance Authority central facility.
While this is Little Rock Ambulance Authority' s
recommended approach to the collateral issue, the
City could, obviously, provide other forms of property
instead of fire apparatus that would serve the same
purpose. We think it' s apparent that Little Rock N '
Ambulance Authority has no other forms of collateral
to assist in remedying this problem.
If acceptance of the recommended approach is untenabale
to the City, then the only other option which Little
Rock Ambulance Authority can pursue is to discontinue r�
efforts to make 8th and Ringo work, and begin a search
for new property which is securable within the
financing. However, this option has serious
disadvantages which the Little Rock Ambulance Authority
believes should be avoided if at all possible. These
disadvantages include:
1 ) Probable increase in financing requirements
3
of an estimated $60, 000 to $80 , 000 for the cost of
land. Increased capital debt will possibly have to
be reflected in ambulance charges dependent upon other
factors.
2 ) Probable increase in financing requirements
of $15,000 to $25, 000 for new architectural/engineering
work, whether new construction or renovation of an
existing facility.
3 ) Certain increase in financing requirements,
or current cash outlays, to cover cost incurred on
construction begun at 8th and Ringo. This would be
approximately $66, 000 (architectural and engineering
fees) .
4 ) Certain increase in financing requirements
to cover new engineering and specification work for
UHF communications sytem of approximately $10, 000
and possible increases in equipment and tower costs
due to site relocation. This is an unknown until
a site is selected, but if the only land available
were located in areas such as those existing facilities
11 reviewed by the Little Rock Ambulance Authority last
year, the costs could be substantial. (e.g. Safeway
at Asher and Wright, Educational Service Bldg. on
Thayer, etc. )
11
5 ) A loan from the City would be required for
temporary operating capital purposes for Little Rock
Ambulance Authority until its previously arranged
working capital line of credit with First Commercial
could be re-established through the Municipal Lease
"used" equipment provisions. With current service
expansion for Little Rock Ambulance Authority, the
amount required is estimated to range from $60, 000
to $100, 000. An alternative, if acceptable to First
Commercial, would be to have the used equipment financed
directly by First Commercial over a 24 to 36 month
period. However, if available, this would be at
interest rates far less favorable than those available
through the Municipal Lease.
6 ) Certain increase in Little Rock Ambulance
Authority operating expenses because of delays in
delivery of new ambulance units. The used ambulance
units are now experiencing increased maintenance costs
because of the increasing demand for service.
7 ) Possible legal/financial entanglements directed
primarily toward the Little Rock Ambulance Authority,
but possibly secondarily at the City, caused by delayed
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payments already committed to vendors of the
communications equipment, rolling stock, on-board
medical equipment, and
contractor/subcontractors. Purchase orders and
contracts have been executed for virtually the entire
$2 million in equipment/building needs. While it
is probable that arrangements can be made to extend
the payment commitments these arrangements will be
extremely difficult since they center on Little Rock
Ambulance Authority finding new land.
8 ) Possible interference with expansion of the
service to North Little Rock, given delays and financial
implications .
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5
BRIEFING ON FINANCING EXPERIENCES
AND RELATED ISSUES
.,. _
1
INTRODUCTION
The Public Utility Model for Advanced Life Support Ambulance
Service is a comprehensive state-of-the-art prehospital care
system. (See attached organizational structure. ) Furthermore
the implementation and ongoing operation of such a system involves
complex interrelationships among clinical, financial, operational,
managerial and legal principals.
Purusant to Ordinance No. 14 ,511, the Ambulance Authority was
charged with the responsibility of implementing a system which
would insure the following: High guality clincial performance
(reliable paramedic level ambulance service) , fast response
times ( eight (8 ) minutes ) and reasonable rates ($49 annual
subscription membership and regular rate structure) all to be
achieved without local subsidy. Note that the regular rate
structure is reasonable by national standards when levels of
care and subsidy are considered. For example, Austin, Texas
provides paramedic level ambulance service but receives a $5. 75
million dollar annual subsidy. As such, Austin's charge to
the user is $100 per emergency run. (See attached Rate Structure
Survey. )
Currently three such Public Utility Model systems are sucessfully
operating in Tulsa, OK, Kansas City, MO. and Ft. Wayne, IN.
However, Little Rock has the only such high performance system
which began without the benefit of local subsidy. Note that
the Ambulance Authority is obligated to repay the $140,000
advanced by the City to develop and install the system. However,
the Authority's ability to repay the debt in a timely fashion
has been inhibited by the absence of "exclusivity" , the premise
upon which such systems are created.
The Public Utility Model concept aims toward systematically
reducing the level of city subsidy to zero. After seven years
of operation, the Tusla system currently operates without subsidy
and subsidies are being reduced in the other systems.
On September 20, 1983, the City Board took action authorizing
implementation of the system via ordinances and resoulations.
Resolution Nos. 7060 and 7061 authorized the City Manager to
enter into contracts with the Authority for developmental
activities associated with implementation of the Public Utility
by November 1, 1984 and with the Arkansas Emergency Physicians
Foundation (AEPF) for the development of the clinical aspects &`
of the system. Note that the AEPF reviews and approves the
purchase by the Authority of all clinically related equipment
including but not limited to, UHF-EMS communications system, £`
vehicles and medical on-board equipment.
The following discussion centers on financing. However, it
also reviews the Authority ' s efforts to implement the system
6 k?
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I and explains certain decisions made by the Authority in
recognition of those previously mentioned complex
interrelationships between clinical, financial, operational,
managerial and legal prinicipals.
II
SYSTEM FINANCING EXPERIENCES
I1 .Background - In November, 1983, the beginning of the contract
period between the City and the Authority, the Authority set
II out to arrange approximately $2 million financing after completing
the appropriate financial information, including proforma
financial statements. Local banks were approached with the idea
of consortium financing. First Commerical Bank agreed to be
il the lead bank in the effort. The banks expressed discomfort
with the Authority as a new business with no "track record"
and certain assurances from the City were sought to relieve
II this discomfort. A Resolution of Assurance was adopted by the
City Board. However, the banks expressed dissatisfaction because
the reolution was not unanimously adopted by the City Board.
Therefore, the Authority sought the unanimous adoption of a
I Resolution of Assurance from the City which was accomplished.
The City' s strongest commitment of assurance was to protect
the market place and enforce exclusivity so that the Authority' s
Ifinancial projections could be met.
2.Failure of the Consortium Financing Attempt - Local banks
I were never satisfied with the City ' s level of commitment or
the Authority' s ability to satisfy the debt with no proven track
record. On Good Friday, 1984 , the Authority was informed that
the banks would not participate without a "full guaranty" from
the City. Furthermore, the banks expressed discomfort regarding
the heavily publicized anti-trust suits filed against the City
and the Authority, and defamation claims against certain Authority
members.
City legal issued the opinion that a full guaranty was legally
impossible because cities were constitutionally prohibited from
committing funds beyond one fiscal year.
3.Authority announces that it has designed a finely tuned engine
1 but asks, "Where' s the fuel" - In a Status Report dated March
27, 1984, the Authority reports completion of numerous tasks
associated with system implementation, ie. private operations
contractor pre-bid conference, medical on-board equipment list,
design of EMS-UHF communications system and purchase price
negotiations, vehicle specifications, medical protocols, rules
I and regulations, hospital assurances, and a data reporting,
billing and collections contract. However, financing commitments
had not been received.
I 4 .Municipal lease concept for system financing surfaced - The
Authority continued its effort to meet the November 1, 1984
system start up date and to finalize financing. The Authority
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11 had informed City staff of financing alternatives used in other
Public Utility systems, the most successful being the municipal
lease. However, other alternatives were explored because the
municipal lease concept would expose the City to limited subsidy
should the Authority default on lease payments. Note the City
had made it very clear that it never intended to subsidize the
11 new ambulance system.
Being unsuccessful with other alternatives, the Authority staff
began to communicate with the City via Status Report of May
4 , 1984 regarding the municipal lease concept. The Municipal
lease was not a request for a direct injection of funding. Rather,
the municipal lease concept centered on the following: Under
a municipal lease the City of Little Rock would serve as primary
lessee and the Authority as sublessee. Equipment would be owned
by the lessor. The City would annually appropriate a reserve
equal to one year of lease payments. The Authoriy, would make
lease payments on behalf of the City. If the Authority defaulted
on lease payments, the City' s exposure would be limited to the
extent of the one time annual appropriation.
5.Memorial Day weekend crisis occurred necessitating intervention
in ambulance service by the Authority - On May 25, 1984, a crisis
occurred whereby the City' s only provider of emergency ambulance
service ceased operation because of labor-management problems.
In response, the City authorized the Authority to intervene
by granting a temporary franchise and appropriating $5,000.
Note, at the time of the appropriation, the City was not certain
of the extent of the crisis. However, by four o'clock on the
afternoon of the 25th, the City' s only emergency ambulance
provider gave 30 minutes notice that it would no longer be
operating in the City.
11 In response to the crisis , the Red Cross, local hospitals , local
physicians, mutual aid providers and numerous individuals
cooperated to ensure the provision of emergency medical services
throughout the Memorial Day weekend and until the Authority
was able to acquire the necessary equipment. Note that the
State Health Department monitored Authority activities and allowed
the Authority's provision of paramedic level service under the
supervision of the Arkansas Emergency Physicians Foundation
(AEPF) during the crisis.
11 6.City Board approves the Authority' s proposal for interim and
long term ambulance services which included approval of the
municipal lease concept. - On May 30 , 1984, the City Board adopted
a resolution accepting the Authority' s proposal for interim
and long term operation and passed an ordinance authorizing
the municipal lease arrangements as previously summarized and
extending the full system start-up date from November 1, 1984
to February 1, 1985.. The City' s agreement to enter into a
municipal lease was significant because of the extension of
a $400,000 line of credit to the Authority from First Commercial
and Worthern Banks. The availability of such funding was
contingent upon the arranging of the municipal lease. The funding
8
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Vwas in the form of a line of credit for working capital purposes.
However, the banks authorized the Authority to purchase vehicles
and medical on-board equipment to be used during the interim
11 in response to the crisis which would be rolled into the municipal
lease, thus restoring working capital. The lease was to finalized
and working capitol restored by September 30, 1984 when the
II120 day note became due.
7.Proposal of Stephens, Inc./Management Improvement Corporation
# of America (MICA) for a triple net municipal lease accepted
by the City. - On September 12, 1984 the City Board accepted
the recommendation of the Authority after receiving a concurring
recommendation from Jack Murphy, Finance Director. Numerous
hours were spent by City staff, Authority staff and Authority
members reviewing the municipal lease proposals submitted in
response to the City's request for proposals for a triple net
municipal lease. The Stephens/MICA proposal was recommended
for the following reasons : 1 ) overall compliance with evaluation
criteria, 2 ) lower first years cost which would reduce the annual
contingent liability of City/Authority and 3 ) local accessiblity
and sensitivity in the event of future problems.
8 .Efforts began to finalize the municipal lease agreement to
be entered into by the City, Authority and Stephens, Inc./MICA
and a sublease agreement to be entered into by the City and
Authority - The Authority had received a strong legal opinion
that the success of the financing effort was contingent upon
a "properly drafted municipal lease agreement". Caution was
essential in order to avoid violating State constitutional
restrictions against governmental entities entering into financial
agreements other than bond issues. For example, cities cannot
commit to stipulated interest rates nor merely lend their full
faith and credit to financing deals.
1
Weeks passed and numerous draft documents flowed among parties.
City staff had a difficult time reconciling the intent of the
City Board with what legal counsel felt to be essential for
finalizing an agreement within the constraints of the
Constitution. For example, the City would need to commit to
certain responsibilities under the master lease which could
only be passed on to the Authority through the sublease agreement.
Otherwise, legal counsel warned that the agreement could be
construed merely as the lending of the City' s full faith and
lcredit.
Stephens was disgruntled because First Commercial and Worthen
would not forego the first lein on the Authority's receivables
to secure the $400, 000 line of credit.
The Authority's concerns centered primarily on completing a
Ilegally defensable agreement so that its working capital could
be restored and documents would honor the intent of the City
Board. In addition to the cost associated with the purchase
of the used vehicles (purchased to last approximately six (6 )
months until they could be replaced by new vehicles ) , new medical
i9
Ion-board equipment and normal operating expenses, the Authority
had expended approximately $25, 000 in architectual costs and
$18,000 in construction costs associated with the building
proposed at 8th and Ringo.
9.The "Public Purpose Requirement" associated with the 8th and
Ringo site posed a threat to the municipal lease
arrangement.However, the Authority continued to rely on property.
Reasons for continuing reliance upon the 8th and Ringo site
despite public purpose restrictions were as follows : 1 ) Months
of design and manufacture of UHF-EMS communication system from
the Ringo site to be installed at the same, 2 ) Monies expended
in the architectual design of a building scaled to the awkwardly
shaped piece of property at 8th and Ringo, 3 ) Monies expended
in construction begun at 8th and Ringo , 4 ) Exhaustion of other
possibilities for central facility location and 5 ) avoidance
of more lengthy delays associated with change of site which
would delay restoration of working capital.
The 8th and Ringo site was selected after weeks of work beginning
in November of 1983 with local realtors to find an appropriate
central facility location. Originally, the Authority had sought
an existing structure of approximately 8000 sq. ft. Variables
controlling selection were as follows: 1 ) $4 , 000 per month budget
figure for leasing cost, 2 ) compatibility for installation of
UHF-EMS communication system (which required the plotting of
microwave paths, etc. ) and 3 ) central location in the event
of jurisdictional relationships (central location being of lowest
priority) .
Examples of existing facilities viewed by the Authority are
the following: 1 ) Bart-Roach at 2nd and Broadway, 2 ) Selinger
Tire Co. at 9th and Broadway, 3 ) Old Continental Cars location
on New Benton Highway, 4 ) vacant Safeway store on Asher, 5 )
PeterBilt Building on New Benton Highway and 6 ) City owned
facility at 14th and Pulaski. Several of the aforementioned
facilities far exceeded the square footage needed by the Authority
or required extensive renovation, and therefore exceeded the
budget figure. The Continental Cars location best fit the
criteria, but we learned that it was in the floodway. The 14th
and Pulaski site, at 5400 sq.ft. , would not accommodate dispatch
communications, security for ambulance vehicle storage and parking
and employee parking, etc.
After consulting with architects, the Authority became convinced
that a specialty building could be constructed in a manner that
would not exceed the budget and would best suit the Authority' s
needs. This was true only if the Authority could find "dirt
cheap" property.
The Authority communicated with the City regarding problems
associated with finding a site for a central facility and
regarding available City land. At that time, the Authority
was made aware in January, 1984 of the 8th and Ringo site which
had been acquired by the Arkansas Highway and Transportation
Department (AHTD) from the City. City staff felt that fee simple
10
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title could be acquired for $1. 00 consideration. Since the
property would be offered to the City, the previous owner, and
if the AHTD declared it surplus, the City staff felt it should
handle negotiations. The site met all of the aforementioned
criteria (especially "dirt cheap" ) .
The AHTD requested a letter from the City stating the need for
the property in February, 1984. The Authority requested that
the City include in the letter that construction should begin
no later than June 1, 1984 . The architects were directed to
develop plans from that site for review by the AHTD and Federal
Highway Administration. In March, 1984 the plans were presented
by the City and Authority to the AHTD and Feds. The City and
Authority also made it clear that private financing was being
ought for the construction of the building. Representatives
of the AHTD and Feds indicated that the AHTD could give fee
simple title, or worst case a 75 year lease.
The Authority plans continued from this site in reliance upon,
minimally, a 75 year lease. In other communications with the
AHTD, the Authority learned that a 75 year lease was the only
option and that fee simple title was not available. In September,
1984, nine months later, neither title nor lease had been
acquired. Authority staff was authorized to intervene in
negotiations. At that time the Authority had received a one
year lease with a 30 day termination clause and other restrictions
which were unsatisfactory and inconsistent with previous
communications. Authority staff inquired whether the terms were
negotiable and the AHTD responded in the affirmative. The
Authority began to renegotiate. In October, 1984, a 75 year
lease was negotiated with the only restriction centering on
"public purpose" .
The Authority submitted and thought that the problemed lease
had been executed since it presented no problems to the City -`
on the surface. Construction, centering on engineering and -'
clearing of the land was begun primarily in an effort to give
the contractor a head start given that bad weather months were
approaching. Furthermore, the AHTD had cooperated in certain
City Board of Adjustment actions centering on the need for setback
variances for construction of the building. The AHTD was aware
of the City' s desire for a formal closure of Ringo Street. The
Planning Commission approved the closure; however, the AHTD
indicated that its grant of permission for Authority use was
sufficient and would not participate in actions necessary for
City Board action.
The Authority learned on Friday, January 4th, 1985 via Mark
Oswald of the Arkansas Gazette that the lease document had been
signed by the AHTD but had not been signed by the Mayor and
r#:
that construction had begun without a lease.
Prior to learning of the absence of a lease, construction had
been halted because it was clear that the public purpose
restrictions would interfere with financing and because questions
11
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regarding a December 22 Arkansas Supreme Court decision placed
clouds on the financing effort. However, questions regarding
the State Supreme Court decision were dismissed. However, it
11 was obvious that the lessor could not obtain clear title or
an assignable lease to the property at 8th and Ringo. Therefore,
the lessor would have no recourse to the building if the Authority
defaulted on payment.
10.Authority requests modifications of the original lease
arrangement as described in the Memorandum for City Board Action
,included as part of this package: On Friday, January 11, 1985,
City staff called a meeting in response to the Authority's
concerns regarding the lease and the fact that the companies
continued to operate violating "exclusivity" . Carolyn Witherspoon
recommended that an injunction be sought in State Court and
requested approval of her recommendation by the Authority.
Discussions were then focused on the public purpose problem.
The idea regarding the placement of fire equipment under the
lease was discussed. It was determined that funds had been
appropriated for the purchase of such equipment by the City
in 1985.
On January 25, 1985, at the request of the City, the Authority
discussed the prposal of including fire equipment under the
lease with Mayors Prince and Hartwick. Susan Fleming indicated
that full presentation should be made to the City Board at the
Agenda Session of February 13 , 1985, and not sooner because
of incompleted staff work and associated information. Mayor
Hartwick was concerned that rumors regarding "financial problems"
might negatively affect the effort to expand MEMS system to
North Little Rock. The Authority explained financing difficulties
as elaborated in this package.
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COMMUNICATIONS SYSTEM
Discussion of the communication system is provided because it
is the largest single dollar item proposed under the lease. A
41 state-of-the-art communications system was specified in the
September 20 , 1983 City Board actions.
11 Points Relative to the Communications System Selection and as
Outlined in the Authority' s March 27 Activity Update to the
City:
1. Sole source negotiations began with Motorola, Inc. because
of the twelve-month time constraint for design, procurement
and installation of the major equipment components.
2 . Motorola was the only company to bid UHF communications
system procurements with similar ambulance systems, involving
a "turn-key supplier/contractor" (only one manufacturer being
responsible for supplying, installing and maintaining all
communications components ) .
11 3. Prior to negotiations, the Authority was certain of a
substantial discount off of retail price.
4 . Furthermore, Motorola demonstrated its commitment to the
12-month implementation schedule by agreeing to proceed with
certain activities associated with installation in the absence
of executed purchase orders and despite the Authority' s inability
to finalize financing arrangements.
5. However, with the City Board' s approval of a municipal lease
arrangement, purchase orders were executed on June 1, 1984 and
Motorla was authorized to proceed with the new February 1, 1985
timetable.
6. Options were reviewed to cut the post of the system. However,
it was essential to provide a communications system where
dispatching and system movements could be controlled by the
Authority' s contracted private company, which would be financially
penalized for failure to meet the eight (8 ) minute response
time 90% of the time on an equalized basis throughout the
community. Also, the communications system had to meet the
clinical standards required by the AEPF for "medical control" .
That is , a system which would allow immediate field paramedic
voice and telemtry communication with medical control physicians
from any locations within Little Rock Ambulance Authority's
area of responsibility.
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7 . The Authority explored the idea of relocating dispatch with
the City' s central communications facility. A one-time capital
savings of approximately $150,000 would have been realized. And
the Authority would have assumed the cost of renovation associated
with establishing its dispatch center there. However, the
Authority later realized that such a decision would cost
approximately $30, 000 per month in on-going operational
expenditures due to increased manpower needs. The City could
not commit to cross-training central communications personnel
to relieve Little Rock Ambulance Authority dispatchers in the
event of system overload in ambulance dispatch. Therefore,
the Authority' s Operations Contractor would be required to have
additional personnel to cover in the event of overload because
of the fear that failure to perform would jeopardize performance
under his contract.
8 . The Authority had anticipated another savings of approximately
$100,000 associated with tying-on to the City' s system and placing
dispatch at 8th and Ringo. However, the Authority was informed
that central communications could not accommodate the housing
of Authority equipment, nor could its towers at Ozark Point
and Central Communications be utilized.
9. Therefore, the Authority proceeded with a modification in
the system design to provide for construction of its own towers
at Ozark Pt. and 8th and Ringo. Note, this requirement was good
in the sense that its eliminated the weakest aspect of the system,
an above ground cable linking 8th and Ringo and Central
communications.
10. The State Health Department Resource Coordination Center
(RCC) was explored as a permanent operation for Authority
dispatch. However, the same disadvantages associated with
response time requirements and system status management would
exist for the operations contractor.
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Regionalization to Promote Stability
11
Formal communications regarding expansion of the service to
North Little Rock began as early as February, 1984. The Authority
11 sought to determine the level of interest in expansion so that
the "service area" could be defined in the specifications for
the competitive bidding process where an exclusive contract
would be awarded to a private company.
The idea of "regionlization" was discussed as a means of enhancing
the financial stability of the ambulance system prior to the
onset of implementation. However, the need was reasserted with
11 the City during May discussions on the financial aspects of
the system, including financing difficulties.
Three (3 ) proposals have been submitted at the request of North
Little Rock officials and submitted to Little Rock city staff
for review and comment. The recent proposal, consistent with
the August 23rd proposal, was submitted on December 26 , 1984.
-, s An across-the-board reduction placing the emergency rate at
$320 is proposed along with other performance requirements
consistant with Little Rock. In addition, the Authority requests
that North Little Rock be given a seat on the Authority Board
which currently has one vacancy. Efforts are also being made
to amend the Health Care Board Facilities Act, under which the
Authority is created, to allow such boards to expand beyond
the five-member maximum currently available in the Act. Such
flexibility would enhance the ability to regionalize and encourage
cooperative efforts among jurisdictions in health care projects.
Further delays in finalizing system financing could affect the
Authority' s ability to regionalize, and therefore, negatively
impact another means of creating financial stability within
the system.
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ATTACIMENTS
U .
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Metropolitan
• Emergency GENERIC ORGANIZATIONAL STRUCTURE
• • Medical PUBLIC UTILITY MODEL SYSTEM
Services
Governmental
Entity( ies)
rA= NAM I .
Ambulance Medical
Authority Control
Board
I L I
Data Reporting,
Billings & Operations First Radio
Collection Contractor Response Control
Contractor Providers Physicians
* MEMS is modeled from the Public Utility for Advanced Life Support Ambulance
Service , a comprehensive approach to prehospital care and functions according to
these organizational relationships.
* The Public Utility Model organizational structure and other aspects of the Public
Utility Model Concept have been adopted by the City of Little Rock via Ordinance
No . 14 , 511 and are under consideration by the City of North Little Rock .
RATE/SUBSIDY/SERVICE COMPARISONS
Annual Provider ALS BLS Non-
City Service Description Subsidy Type Emergency Emergency Emergency Comments
Tulsa, Ok. All ALS (Emergency & - 0 - Single Public $320 $320 $110 Went to zero city
Non-Emergency) Authority All InclusiveAll Inclusive subsidy this year.
Began family sub-
scription service.
Kansas City, Mo. All ALS (Emergency & $800,000 Single Public $275 $275 $120 City has left subsidy
Non-Emergency) Authority All Inclusive All Inclusive level unchanged from
date PUM implemen-
tation
Portland, Or. Fire Dept. ALS Rescue Unknown F.D. Rescue - 0 - - 0 - - 0 - F.D. does not charge/
unknown budget.
Private Ambulance BLS Unknown Private Am- $450 $450 - ? - Average charge by
Transport bulance private companies.
Transport
Austin, Tx. Separate Municipal EMS $5,750,000 Separate $100 $60 N/A Equal volume to Ft.
ALS (Emergency Only) Municipal Wayne. Charge, if
Department unsubsidized, would
be $1,004/run, +
private ambulance
charges.
Oklahoma City, 3-tiered system provided $400,000 Single Public $253 $195 $120 Limited ALS capability
Ok. by public trust operating Trust (3 cars); membership
service "in house" program generates
most of revenue.
Palm Springs, Ca. BLS & ALS service pro- Unknown Private $295 $99 $99 No response time stan-
vided by private ambu- Ambulance dards; very limited
lance company Company regulation of service
quality
Cleveland, Oh. Separate Municipal $5,000,000 Separate $70 $70 $70 Only recovering 20%
Department for ALS & Municipal of receivables gener-
BLS Private Ambulance Department ated. If unsubsidized,
Company N/E char re would be $660.
r-euor R°rcaT p---7. r'-'a, , -^e - ---3 0---! ,---, ----, ----, ,........1 „T..r,_a