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correct correct correct pardon five-year contract excuse me yep excuse me yep so next up is what has happened to the overall call volume since the days of Union Hill and the West Webster Fire Department covering calls in Webster the 525 presentation indicates that wems compared to surrounding similar agencies has the highest Mutual Aid into Webster where an outside agency provides the call response because wems can't why is that and does any queue have a clear plan to reduce the need for outside Mutual Aid coverage into Webster I'll go with Ahmed to start sure so uh if I remember that chart let me see if I can reference it really quickly that was not mutual Aid given into Webster let me see if I can get it that was Mutual Aid out and the reason that Webster gives much less Mutual Aid out is it's a decision we made there is something that we've called Reserve capacity many EMS agencies in Monroe County chose to do this some did not the idea was we wanted to always make sure there was an ambulance in town as many of you heard uh in the during the covet period the city was a tremendous black hole for EMS calls they were short staffed call volume was up and those agencies most close to the city irondequate Brighton Penfield Pittsford we're doing a lot of mutual Aid calls over time some of them said we have responsibilities to our town and so we developed a thing called a matrix which basically said when there are limited resources we are going to refuse Mutual Aid Webster we have adhered to that very strenuously to make sure that we had resources in town other agencies didn't and that's why you see the disparity that chart was not reflecting calls into Webster that was reflecting the amount of mutual Aid out that they accepted elsewhere we chose to not give a lot of mutual Aid out of Webster yeah but the top says Mutual Aid out the 1000 calls is mutual laid out the mutual Aid out we gave was 148.

we chose not to give Mutual yep so so what's the cause of the 275 coming in to cover calls in Webster we tend to get calls in what we call waves we get them two three four at a time we staff two sometimes three ambulances depending on the day you will never cover 100 of your calls and so we took nutellate in also in the fourth quarter of last year we had a terrible time with Staffing our crews were burned out and we had very low numbers and so we again chose to make sure that whatever we had we kept in town so the second part of that is is there a plan to try and reduce what what efforts are you making now to reduce outside Mutual Aid coverage into Webster yep so when we look at quarter one which the town has seen the numbers for for quarter one and through May of this year our call coverage has gone from as low as the low 70 percent in December because we had a tough December we're not running in the mid to Upper 90s consistently it's a matter of Staffing if there are not people we cannot staff ambulances and the people are just not there they were we have had a very long two years and we just don't have the numbers like some other agencies so we did the best we could so we'll get to the questions as we go before we get to comments from the crowd if we could do that I'd appreciate it so next question up is that we received several calls or excuse me several questions regarding paid staff versus volunteers it's a little bit of a misnomer sometimes when an agency is called a volunteer ambulance and so um models that use paid and volunteer staff such as multiple fire departments use how is neq wems Staffing their operations and how do other agencies staff regarding paid and volunteers so I'm at I'll start with you where are we with neq and whims so wems has always been a fully paid Ambulance Service we didn't have the benefit of starting with volunteers we always have paid all of our staff and that is the model we continue to use um Russ you want to feel that I want to see what about your agency are you all volunteer all volunteer all paid or both so our agency started off all volunteer when we founded it back in 1994 and we are down to to literally zero ALS providers that volunteer which is very common throughout the state and we have very few basic EMTs that volunteer so volunteerism is just significantly down everywhere okay um according to the 525 presentation similar EMS agencies with higher call volume have received fewer tax dollars over the past six years than anyq has received why is there a discrepancy in call volume and tax dollars between the 525 presentation and the neq presentation in 2022 and how is it that these agencies have well-maintained ambulances on the road staffed with experienced ALS Crews yet Webster strives to to get there just looking for the chart so as Russ said many agencies in Monroe County in fact almost all of them started with volunteers and started billing in advance they were able to save money and build what I call War chests up wem started paying staff from the beginning and we did not have the opportunity to raise you know a war chest like that so we have been trying to balance our budget and continue to operate as we have gone forward and we've done a good job for the last six years I think a lot of the probability depends on the mix too the the volume of calls and the types of those calls if you're doing Medicare Medicaid that's a much lower payment into an equals and I think I could add a little to that which is one of the things that I think folks need to understand is there's this thing called payer mix right you have commercial pairs like Blue Cross Blue Shield and you have Medicare and Medicaid for instance at our agency we have about 75 percent of our uh the people we transport our Medicare Medicaid patients and only 17 percent are commercial payers even though it's only 17 commercial payers they they represent more than 50 percent of our net income and so the payer mix is a very fragile thing and that is town to town you can't look at one agency and say like Nova where we do six 6768 calls last year and look at another town that does the exact same number and say oh you should be about the same if we went from our 17 payer mix to 15 if we lost two percent of that commercial payer mix we would be going to our town asking for money so it's a very fragile thing and I'll give you an example of of cost if you were to say the cost of an ambulance the cost of running an ambulance call is say somewhere between five and seven hundred dollars depending on your call volume and economies of scale I just talked to my billing company just before this meeting to make sure I have this number right the average Medicaid reimbursement we get is 236 dollars where's the rest of the money coming from again the commercial site so payer mix is hugely important and that is something that we need to evaluate in our community in order to have a proper way of managing the money side of this it doesn't matter whether it's equals or anybody else our payer mix won't change right the people that live in our community will not change depending on who's coming you so pretty important as part of this process to look into that well you two segued right into the next question which is that we know that Medicaid and Medicare reimbursements as Paul indicated have an impact on Revenue um do either of you Russ or Ahmed want to talk about what efforts are being done now to Lobby politicians for increases in Medicaid and Medicare reimbursement for ambulance services sure so some of you may or may not know I sit on a state's New York State Senate rural EMS task force we have had lobbying days recently in Albany you know the challenge is that while we consider ems's payer mix in the Medicare Medicaid issues to be significant we've met with Congressman Morelli we have met with our local state officials the challenge is we are a small percentage of a very large problem in health care the nursing homes the hospitals they're losing millions of dollars a day so while we worry about losing a few hundred dollars on a few thousand calls in aggregate that percentage is far smaller they are focused on keeping hospitals and nursing homes alive we hope at some point that EMS will swept into some of those discussions but right now there is such an underfunding for Medicare and Medicaid at both the state and federal levels they've got to make sure that people that need hospitals and places to live are funded and right now that is not uh that is priority number one and we've been told that for years yeah and on top of that we have there's there's some laws that are specific to New York state that are certainly problematic for instance um we can't ambulances can't balance bills so that means that if you get a bill and you don't and your insurance company pays a piece of it and we can't bill you the rest the other thing that says is we are not allowed to do anything to affect your credit so we don't have a way to even ask you for that money right and the state and the government gets to determine how much we're supposed to charge we don't get to say here's what you know our business costs are and what it costs to to to provide this service so they say we're going to give you 236 dollars for Medicaid they get to determine what's called unusual and customary uh fees there's there is legislation pending as of right now is introduced in April that talks about excluding ambulances as part of a greater exclusion for health care when it comes to this thing called balance billing but it doesn't take into account folks now listen to this it doesn't take this into account we Bill let's say we bill you 800 and the insurance company pays 80 for you so you get you get a check for six hundred and forty dollars in your name and you deposit it in your bank account and you go spend that on a stereo we don't have there's no way for us to ask you for that money we can't collect it you get you keep it and we don't get it we had like almost seven million dollars in write-offs last year because we can't of money we're not allowed to collect because of regulations and laws and that again is not going to change no matter who answers the calls hear it thanks Russ um so the next question up is that Webster is the only town in Monroe County that owns their own con and that's a certificate of need I'm pretty sure most everybody in this room knows what that is but most other agencies use a model Staffing their ambulances with an ALS paramedic but any Q uses BLS ambulances with a separate ALS paramedic fly car model if any queue has financial difficulties using this model and other agencies are seemingly financially stable why doesn't neq use the more successful model does the county have any requirements regarding the model that an agency uses so we'll start with Ahmed and then maybe I'll have Tim chime in so I don't think we should confuse the response model with the financial situation last year in Monroe County we heard during EMS week Monroe County graduated 20 paramedics in the entire year 20 paramedics that is to cover 18 EMS agencies throughout the county and all the towns that we have there is a shortage of paramedics and a majority of the calls that we take are basic life support calls they do not warrant a paramedic and so we have very successfully for many years operated a model that we send the paramedic in some cases separately if they are not needed they can return to service which will either allow them to respond with another ambulance or in some cases first respond until a mutual Aid ambulance can come right many days we do run the paramedic on the ambulance but we leave ourselves the option so that uh like yesterday when we had multiple calls that are dispatched the priorities determined by the 911 Center not by us but are dispatched ALS and we get there and there's no need for it that paramedic can free up and be used somewhere else Tim follow up the county doesn't have any requirements or regulations regarding Staffing or whether the use of fly a tiered response into a system with BLS ambulance or ALS fly car what we do have is a remac regional medical advisory Council which are there 18 regions in the state our remake is Monroe and Livingston County so a cln holder can make an application to remac to become an ALS provider and so they're the ones that look at regulating the advanced life support portion in our community do you have any indication or any thought on how many agencies work with which model in the county so of the 17 transport agencies the majority of them put ALS on the ambulances so Pittsburgh ambulance acquired seq years ago and they pretty much retired that model it works for them each jurisdiction is a little bit different I like to say EMS is local because it is different throughout the county okay next up neq has recently been cited for violations by the state are there regular inspections of equipment and supplies mandatory training and documentation to show that the violations have been resolved including actions to take taken to prevent future violations and are there written reports supplied to the town when this happens I'll go I'll go with Ahmed you sure so no one else wants this one so yes we did have a bad week A couple of weeks ago right there's no fact no denying it it was a factor Crews had come off a cardiac arrest call the ambulances were not properly secured the ambulances were not properly gone through before the shift and we came back you know there's two things you can do you can sit and say oh you know we didn't do the right thing and complain about it and point fingers instead we rallied we got two of our backup ambulances in service within a few hours and and patient care continued so you know we have worked with our operations staff our new operations Chief Lloyd our Lieutenant to make and arts Crews to remind them that ambulances should be locked at all times that equipment should be checked you know the some of the things that were cited were alcohol swab jet were expired I'm not sure that's going to impact patient care there was a sharp that was left out that impacts patient safety right so we have Revisited our policies and procedures we've become more rigorous in our rig checks and it's important to know neq is not the only agency that was cited that day there was two other agencies that were also cited you know for many years and I hate to say this you know during covet things got a little bit lacks right now the Department of Health is coming back and checking and they're going to get us back up to the level we should be so we learned from it we won't do it again Ahmed are there written reports applied to the town when something like that happens yep so the county sent a report to us and the town supervisor the date that we were notified apparently they didn't have the right email for the supervisor and then we subsequently sent a corrective action plan so with the exception of the physical uh maintenance of the ambulances which are waiting for shop time uh all the other issues have been fixed based on the liability that comes with the con the town may actually consider requiring some reporting requirements as part of future metrics something we're thinking about thanks Paul um in the 525 presentation it indicated that anyq has Staffing contracts with other towns do these contracts reduce the ability of wems to answer calls in Webster and why should Webster taxpayer money be used to staff ambulances in other towns so let's be very very clear because this has become a very confusing point the Staffing contracts in no way impact wem's operation those are employees that are hired for those locations many of them live geographically close to those locations and those contracts generate a profit not a loss so if anything they're helping web State and neq stay operational as opposed to you know losing that revenue and that profit but just to be very clear again those Personnel don't work at headquarters they stay at their locations they live geographically close and the last one that we have is in Livingston County at the moment Russ do you use do you have Staffing contracts for your people who go out into other ambulance course uh no but it is very common in our County to do that okay I think there were there were actually two active contracts in 2022 and only one in 2023 I think at 22 about a third of the man hours were devoted to that but as Ahmed said you're not thinking that it had any impact no and retracted in the town we track the incoming expenses for them as line items in our budget which the town has had full access to and they were they were in no way costing us money to operate those we were making a small profit on each thank you can the town decide to fund a specific purchase such as equipment or an ambulance rather than just providing a lump sum I guess let's start with councilman Cahill well I know that the town can uh utilize that option and I believe that Irondequoit recently did that purchased an ambulance for their aim a new ambulance for the ambulance provider and uh and Irondequoit so the answer is yes okay and Mr Howard I would also like to say that you know last year the town gave us 204 thousands of dollars of federal money the article money that was that they were responsible for disbursing to the community and as we committed all of that money was used 100 for payroll we told them what we're going to use it for we've tracked it and that is all it has been used for and they have seen the books to show that okay um so other agencies such as Gates around okoy Brighton Henrietta and Penfield have received grants some for new equipment including recent grants from Monroe County and why have they received grants and neq has not does any qwe Ms apply for Grants and have they received any grants and do they have any fundraising programs similar to other agencies like the fire departments so we did apply for Grants we've applied for Grants to Congressman morelli's office to Senator Brooke's office and to Monroe County and here's what I will tell you that I've been told twice now that the confusion and concerns of what's going on in Webster has dissuaded them from giving us any money because they're not sure how what the outcome of our organization will be so we were qualified for Grants we were on the grant lists and two of the three people have said we did not give you grants because we were not sure what your future was going to be so all of the confusion and discussions we're having are now having a negative impact on our ability to secure grants the county has 10 million dollars I think they allocated for fire and EMS from the airport money EMS I think the total grant were I think 5.4 million 5.4 million for EMS ambulances were awarded some for as much as 360 thousand dollars our application was reviewed and I was told very directly that is why we did not get money so um next question is that any qwems has asked for additional funding in the from the town in the form of immediate funding and long-term funding using a taxing district town of Webster has provided six hundred and five thousand dollars to neq over the last six years so how can they say that the town doesn't support them why is additional funding needed when neq has received more Public Funding than other similar agencies in our area and has seen an increase in revenue from taking over the West Webster calls has neq provided details for how they used the funds that were already provided including the 205 000 in arpa funds and do they Supply a line item budget of their income and spending cash flow protection how they will spend the money for any additional funding received from the taxpayers yeah so we do provide line item data the town has had full access to our books all the way through the end of 2022 so earlier it was said I heard somewhere that the town has not seen our books or anything Mr Adams is sitting right here our office managers sitting here our accountant sat for days and had full access to all of our QuickBooks files through the end of December 2022 we do provide accountability for the 204 thousand dollars that the town awarded us that was as I said used 100 for payroll because that was our first priority and remains our first priority and is about 74 percent of our expense of our operating expense is part of the arpa grant agreement the town does have the right to audit we have not done so at this point I think there's an assumption that most of the money was needed for Staffing um some equipment and supplies but we have not asked for specifics and we have not seen a detailed budget not sure that we really ask for a budget but so at that point so the data you have is covers what period Paul uh the Dan I reviewed went through November the end of November 2022 but the arpa funds could be spent over a multi-year period but okay all right I've gone through a bunch of these I'm going to hold off on any more off the off the portal and let you people have a chance to come up and ask some questions again we'll remind you to come up you're going to be timed for two minutes if you can please ask your question and then we'll ask have you asked your question and then take your seat and then the panelists will answer your question so the first person that signed up on this list is Jim Redman is Jim still here you want to step up to the microphone please thank you for the opportunity to speak tonight I've reviewed both presentations and neither presentation that are on the town website show any actual financials um you know basically Nick walls is asking the taxpayer to subsidize what is essentially a private company a 501c3 but still a private company and I don't see any evidence of financial need and I don't see any evidence of a business plan for how any tax dollars will be spent and since the town has set a deadline of June 30th for coming up with a short-term solution and hopes to get to a longer term solution later on my question is you know when will the taxpayers be able to see audited Financial figures for 2022 and when will we see a business plan for where and how and and just what this money will be used for thank you thank you you want to go first Ahmed and then maybe we'll have Paul chime in yeah no thank you Mr Redding so just to be clear one two three four five six seven eight nine ten EMS agencies at cover Monroe County are 501c3s of those they get 3.7 almost 4 million dollars in tax money this is not an unusual model um the county operates with private entities that is how EMS is provided in Monroe County for the majority of the time our 990s are available publicly we provide them to the town every year you can get them on a website called guidestar.net.org.org guidestar.org you can look us up they're out there they're out there our audited financials have not been made public we are a private business and putting some of that information out in the public will give some of our competing agencies a competitive damage on how we do how we run our operations that is why the information that we have shared with the town has been done in a way that only the town can see it because we are competing interests in some ways and it's not uh not in our best interest to share that in a way that our competitor can see that I'm sure you understand that Paul as uh part of the due diligence process I did a statement of cash flow for 2022 and projected it for 2023 and based on uh the expenditure is projecting that net income or loss and need for Need for for cash I had the burning between fifteen and twenty thousand dollars per month in and from what I've heard thus far that's seems to be on track there things are getting Tighter and Tighter they finish the year with with some cash in the bank leftover arpa money but they're burning through that quickly and dipping into their credit line and Mr Redding you know one other thing that we'd like to say just coming back to the ambulance disaster we had a few weeks ago you know we cannot in good faith go to a bank and ask for a loan to take out and buy an ambulance it costs 250 000 if I'm not sure I can pay my people and keep the lights on the building I'm not going to do that my board won't do that right that's irresponsible and so that is why we're asking for help there's something called the cost of Readiness Russ can can fill in the Gap if I don't say it correctly but EMS only gets paid when we transport a patient so right now I've got my staff sitting here we're not on a call we are not generating any Revenue however we are generating expense and so the help that we need is filling in this cost of renting is to help us pay for some of the downtime when we are not generating Revenue as Russ shared earlier some of the revenue we generate is at a loss right it doesn't cover the cost of our calls Additionally you know we would like to be in a situation where we could save some money last year we were up for a grant with Congressman Morelli or sorry Senator gillibrand where I was terrified that we would win it we asked for six new ambulances to the tune of 1.2 million dollars the problem is it was a 75 Grant which means we would have to come up with 300 000 which I didn't have so actually would have won that Grant and not been able to accept it so this is the kind of things we're trying to work it's not a complicated business plan 74 of our expenses people we have lights electricity utilities and then we try and save some and at the end of the month we can't save any we don't get the equipment and supplies we'd like to upgrade oh what's the last year that you have a uh last 990s for 2021.

that is typical uh takes a few months to wrap up the financial statement then the 990 follows so I think they're close for 2022. yep our Auditors um sent us a letter the other day saying that we expect to have our audit hopefully done by the end of June please realize this is something beyond our control Sue our office manager sits with them gives them all the data you need that it's up to them to go do all the work that they do to generate an audit it is not something we have any influence on the timing or the results of so when it's done it will be done and we will share it with the town as we have in the past and as Paul said I'm not the financial expert in the room supervisor Flaherty and Paul are but we understand that they like to finish the audit first and then uh complete the 990 so the numbers are aligned I think that's correct statement that's correct I think you're better off reviewing the audit report anyway explains into more detail than a 990 what okay uh next speaker that asks to ask a question is Richard Jones Houston sorry gonna pay us next up is Ron Nesbitt would you like to pass Ron are you going to come up my question is why should Webster taxpayers give neko's wings one red penny more when the CEO signed a five-year legal binding contract in November 2020.

that doesn't include them getting any money from the Webster community on top of that the CEO signed a confidentiality agreement in 2021 or two that doesn't allow for the Webster taxpayers to look at any financial statements and the CEO continues to Stonewall the Webster Town board to obtain these documents and I continue to file foil after foil after foil and I get denied as a taxpayer in this town so why should I want to give n equals any more of my taxpayer dollars if I can't look at the financials thank you thank you Brian you want to start with Paul or you want to go with Ahmed to start family Ahmed okay yeah I'm not going to answer the foil question you're not foiling me I don't know the foil rules I'm not a foilable organization so that is something you're going to have to ask the town attorney I'm not familiar enough for that as far as the contract Ron you were right you and I started this handling service right let's just say it very openly and publicly we walked hand in hand and we started whims right why you have taken such a turn is completely Beyond me but the reality is this the reality is the situation has changed the economics of providing EMS in the last three years have changed dramatically dramatically right and so if you cannot acknowledge that times change then I'm sorry I can't help you but the reality is all of our costs have gone up our reimbursements have gone down as Russ said we cannot Chase patients for collections for a minimum of a year right and we have no opportunity to deny service right so if you if if the taxpayer doesn't understand that costs are going up that income is going down and we need help then I can't do anything else for you but that is a reality and 14 other 10 other towns in Monroe County have understood the model we're the last one to do it and I hope we'll uh through this session in this process the town will understand that we are a valuable service we do what we say we're going to do we've done it for the last six years in the last 35 years and we need help okay go ahead Paul there was an increase in 2022 for the wems portion uh actually when I was Revenue went from an average of about a million to about a million five so that was a result of the West Webster Fire District contract ending on them picking up more calls so they did have a positive impact um overall but you know that's the revenue shine of it or expenses to go along with that that's right let me let me let me let me add to something here let me add something to this um am I getting interrupted okay can you hang on one second Russ I don't want you to speak from the crowd so I'm going to restate your question because you feel that it hasn't been answered but I don't want you to try and interrupt run so the question is why are we not adhering to a legally binding contract so I guess that either goes to Paul or to John we are we are adhering to the current contract at the same time we're doing a due diligence to see where the town goes next with respect to EMS yeah I think if we choose to to provide additional funding then I think the contract is open for renegotiation because it's a different contract in my book correct so it would be renegotiated the contract that there would be renegotiated if additional funding were to be supplied correct in my view so I think that would include additional money and additional uh metrics okay so I'm going to just grab a question off the sheet because it was I'm sorry with respect to the metrics that that is a discussion that the town board will have and the conclusion that we will come to as a as an entire town board what that new contract if we get to that point we'll include okay Russ did you want to touch on this yeah I did I you know I um trying to take a little of the the emotion out of this particular question is you know why why things changed the last couple years anybody in the room know about covid raise your hand right businesses have changed I'm a business owner several of you in this room probably are as well didn't some of us get PPP money what did we deserve that ERC money I mean my call volume at Nova in 2020 was way down we're doing 6 700 calls this year in 2020 but nobody wanted to get an ambulance to go to the hospital they were all scared we were down to 5 000 calls attrition rate in the United States for EMS providers is about five percent a year which we refill with about five percent a year but during since covet we've had some states not necessarily New York have attrition rates at 30 percent right still only filling and now filling them with less than five percent like a man said 18 paramedics for the whole County of Monroe that's crazy so there have not just been some small changes that you could attribute to a single business we have gone through catastrophic changes that demand that we have to re-look at things like contracts like how any business operates but in in particular EMS and Medical Services has just been through the ringer nothing is the same thanks Russ I'm going to grab one of the questions off the portal which is when will the towns NDA with neq end can you address that John or Paul and all the exact date of the NDA you know I'm not I'm not certain that there's an end date on it uh but it was the intention uh was for it to cover during the period of the due diligence process which in my mind is still going on right uh until we at least get to a short term possibly a long-term solution I think that period is still open okay I would agree with that a non-disclosure agreement um Rod reasonberger did I say that right I hope Rod come on up to the microphone if you want thanks for your time I appreciate your uh sorry thank you for your time and I appreciate your service all of you and I'm sorry for your loss this week um my primary concern is a long-term goal I've been an EMS myself for my whole career and I realize EMS is in trouble right now so adding funds taxpayer funds to your current budget I think is a Band-Aid and I'm more concerned about perhaps making this more of a civil service position giving these folks proper benefits retirement and so on and so forth where are you with that is that is that I'm assuming we're not going to see the rest of the slides behind this one but I was able to see them earlier on the on the website and I appreciate that I think that seems to be a more viable plan to give our folks a little bit of maybe competition to come to Webster instead of begging people to come to Webster before the rest of Monroe County gets on board with this I think maybe this is a good time for Webster to perhaps look at that long-term solution Ron I think that's a great question and as I've told this town board many a time you will see the taillights of my boat when my people can work 40 hours a week and earn a decent living that has been a statement of fact I've said it a dozen times in town meetings the reality is the current income model does not allow that to happen and sure we'd be awesome to go civil service we wouldn't be asking for 400 000 a year we've asked me for 2 million right this is all about what you want to pay for you pay for what you get right we have never denied an employee a raise at any Q they're sitting right here you can ask them right we offer them benefits if they want them which by the way we pay 100 percent not many other EMS agencies do that right we have built a base to make a comfortable environment for them right we're working on getting good equipment we have done everything we can to make any cue the place it can and as a result ride we have no EMT openings in our schedule at the moment one of the only EMS agencies around paramedics are hard to find but even then we're doing a pretty good good job of Staffing so money is one part right part of it is culture and we focus on culture you know that right we do things to make sure that our employees feel valued where they're having bad days we make sure we're with them when the ambulance debacle happened a few weekends ago there was no finger pointing there was no yelling there's no screaming we all got in there we did our jobs right and that is what we're trying to do and that is why I think neq has maintained when covet came when covet came before we had our base we lived in four Bays of a garage our Medics left on roll-up cots in between ambulances and we still kept all our staff we have never been the highest paying agency we've never had the best equipment but we keep our rigs on the road part of that is because of culture and part of is because of leadership and the difficult thing with long-term planning with respect to EMS is that they are not considered an essential business which I for the life of me can't understand that's kind of my my point right so that's why a lot of communities have essential right right so a lot of I think there's like 10 municipalities that have uh ambulance districts there is a nine or ten okay right so is that something that the town board is looking to consider absolutely there are short-term goals and that is one of the long-term goals that we are considering and will be considering thank you so that grabs one of the questions that came in from the portal is why would the town tax residence for a service and then Outsource it why don't we don't do that for other departments in the town that residents are taxed for such as the police or the highway or the water treatment is so is there anybody else in the county that any other towns that have their own um Ambulance Service yeah the village of Honea Falls the village of Honeoye Falls does it covers Honea Falls and Mendes and those are civil servants they're employees of the village so they're Village employees that were in the ambulances are owned by The Village so that that model is the one that does exist yes okay that grabs that question um and their cost is a whole lot more than what we're asking them I I don't know I'm gonna tell your word for it I I'm guessing that Civil Service always costs a lot more um Brian Gutman would you still like to ask a question you're going to pass okay uh Kevin ramp I hope I said that right as I'm I'm trying to read handwriting is that right Kevin okay if the town collects some money for any coup to operate limes why hasn't this contract gone out to bid New York State Municipal bidding process says that municipalities will put contracts out to big this contract has never ever gone out to bed and there are other agencies within Monroe County and Beyond they can handle this thank you you want to know what Paul I'll start with you well I think this would be considered Professional Service which uh is not required to be put out the bid although it's uh always a good best practice to test the water occasionally but in this case it's very specialized and it's a professional service so I think that's the reason I believe that that is one of the options that's listed that we will be discussing as the town board so they're not required but they could if they wanted to correct okay good good um next up is Ed Wilkowski pass on Dan Cody you're next hi I've lived here for 33 years I've been a member of West Webster for that time was an EMS so I understand that and I also understand contracts I was purchasing manager for 20 years contract is a contract if one party fails to uphold their side of it the other side needs to do something if they can't it has to go into deep default it looks like this situation that we're in is a result of inadequate planning on both sides it looks like any Cube it off more than they could chew it looks like the town tried to do One-Stop shopping for their EMS situation it doesn't look like there is a viable business plan going forward of what we're going to do do with this money I think the taxpayers of Webster are entitled to negotiations that are in the open with contracts that are precise and detailed and that have the contingencies of doing business going for forward and oh still a little in the gray area about that end D.A if the if any cue comes and asks for money there should not be an NDA still in effect we should be able to look at all of their finances wherever they're coming from wherever they're going they're going to I'm wondering what that NDA is actually Sheltering and I'm wondering what it'll show if it is and when it should be opened open to the public I also from a financial point of view I'm wondering if neq is a top heavy organization the paramedics the Medics on on the road make 17 an hour I'm wondering if management um is a little bit over over the top so I was just wondering that dollars and cents are dollars and cents a contract is a contract thank you okay I pulled a question out of that with regard to the NBA I think but I don't know if that we could give it an answer I think we've already addressed the NDA issue we've already addressed the NDA and I think beyond that what the legal requirements might be right we would have to get from the town attorney um next up is I think it's Anastasia nadelkels did I get close I apologize so why don't you go ahead and state your name so that we get it right yes it's anastasios and adelcos and it's uh well it's two thousand well before 2009 in this building it's been butchered worse I promise you um I speak I guess on the behalf of being a patient of various ambulance services over the year or years um I have a genetic heart defect unfortunately and um so I've written with everybody I've written with Wes Webster and with Ontario Williamson not by choice um and um the Webster ambulance as well um unfortunately the last time I had to ride with anybody it was with wems and um the service was not good it was very poor and so coming from the side of being a patient [Music] I don't know that I don't know where I'm sorry I'm unprepared um but um I'm concerned that the money wouldn't fix anything potentially potentially there's a deeper problem somewhere within wems that's unknown or unfound of yet I don't think anybody should have to be told um you know oh just go to urgent care we're not going to take you even though you called 9-1-1 and requested an ambulance and the ambulance didn't take you my mom fell in the front yard and uh broke our nose open and the service pulled up and they're like just go to you know just go to urgent care you're good and with me I had a heart issue and they came in with no equipment they didn't monitor me nothing walk me out the door and took you know half an hour sitting in the driveway before we even got to the hospital so my concern is will the service actually improve I don't think it's I mean I've had better service all these years from every other agency so far so it's kind of unfortunate thank you I'm at I'll let you have that will the service improve if you're given additional funds I think first of all I'm sorry that you had a bad experience with us right I cannot discuss the call I don't know enough about it but here are the people right there why don't you ask me if the service is going to prove we put out pretty good service day in and day out you had a bad day and I'm sorry for that but I would be willing to say that 95 of our patients don't have a similar experience we have done patient surveys for years with scores well over 4.7 out of 5 consistently so I'm very sorry that you had a terrible experience with us we can talk about it afterwards so I won't discuss any patient specific issues openly but the men and women are right here we do not provide bad service in this in Webster so next up is Susie nudelkos you're going to pass okay next up is Lori Reynolds good job thank you for letting me speak I'm Lori Reynolds I'm the chair of Webster citizen action League wecal we've been an advocate for the town of resident or the town of Webster residence for this is going on 10 years and uh I'm representing wecal right now and I'd just like to make a statement that we feel uh an ambulance district is not the answer we feel the answer is to make it a town Department like the police department and that way there'd be transparency and more control and personally myself I also am a patient of EMS in April twice he had good care the second time first time uh what happened was I was hemorrhaging from my nose both times it was bad very bad I had em EMT came to my home the first time they weren't prepared they couldn't even get a blood pressure cuff on me they took me to hospital my husband my husband and my family could have taken me to the hospital I wanted to be helped just at least on my way and route to the hospital to stop the bleeding or do something I bled the whole time no siren as slow as you could go to the general second time was Within a short time after that within the next week I had paramedics it was the same situation I was bleeding I was losing blood major majorly I had a lady that was very helpful put two IVs in me and comforted me I didn't have that with the first ones they put the siren in and sped me there as fast as possible so I don't know where I stand with this personally but I'm not happy that um of what happened with their first time uh the second time I was much happier with them but but anyways uh I told you how weak healthy uh stands thank you Miss Reynolds you know as I as we spoke to uh Mr natalco you know I'm sorry you had a bad experience I'm glad your second was better but as we've said earlier if the town wants to fund a civil service ambulance we will gladly support that as long as this town has the stomach for the expense that it will generate Jerry ippolito you're going to pay us all right um it looks like is it very Pew p-u-g-h did I say it right thank you what's your question Barry I'm just going to be very brief since my retirement from the service I have had service with Webster EMS multiple times over the last two and a half years I probably had to be taken to the hospital over 16 times heart conditions bug conditions and I've never had any problems with Webster EMS I I praise every one of them very professional with me I'm sorry about anybody else that didn't have those situations but that's my stand on Webster EMS thank you thank you thank you for your service too sir thank you um Karen Mustafa but I just have a couple questions if you guys could clarify a couple things for people that might not understand before you were talking about ALS and BLS can you explain the difference between ALS and BLS and why you might have an ALS rig versus a BLS rig um also just at the beginning um supervisor Flaherty had mentioned that eight hundred thousand dollars that kept going around and around wanted to know if that was an actual number or just an idea of a number that might come up if that was just a fabricated number that was thrown out to be used as an example and lastly not that I've lived this the past bazillion years in my house where my husband does this every day on vacation we have the phone ringing all the time about ALS BLS EMS stuff if you go to a patient's house you assess a patient but you don't transport are you paid for that service that you've provided in the house without transporting okay just to clarify some things you got three in there so I'll let you sneak in with three that's all right so let's start with the one what's the difference but I'll let Russ handle this one um because he's just been sitting there doing nothing no I'm just kidding so ALS versus BLS Ross want to talk to that sure ALS stands for advanced life support bls's basic life support if you have a call can be considered ALS or BLS for instance a uh a sprained ankle at a baseball game would be BLS it doesn't require any advanced things BLS calls only require the level of a basic EMT an ALS is more advanced call such as heart heart attacks Strokes uh hemorrhaging trauma and requires Advanced care of a paramedic the difference between a basic EMT in a paramedic is some significant education at basic EMT you can get in uh but you know somewhere around six months of education and then on top of that you'd have to add another year or two years to become a paramedic and so when it comes the other differences in how those things are classified by the insurance companies ALS is classified differently than BLS and the reimbursement rates are different they reimburse sometimes slightly more sometimes quite a bit more for ALS depending like I said the Medicaid I told you before there's not much to add to that but in commercial your ALS and BLS will be reimbursed differently is that answer if you want to talk about the pain for no transfers oh the pay for no transports there are yeah that that's a tough one in EMS we don't get paid uh for no transports and if we do it's it's insignificant it's certainly not paid by the insurance companies that is a self-pay uh thing so if you are an unconscious diabetic in our in our paramedics from any ambulance respond to your home and they uh it's one of the the times that we actually can significantly impact a life is by giving an IV and and giving you some sugar um and we so we've treated you and you wake up and you say I'm a diabetic you've I've had to be treated many times this way I'm not going to the hospital so we've had that we've had some significant expense and sometimes reimbursement will be somewhere between zero and fifty dollars so that goes to one of the questions we got at the portal which is that when I call oh I'm sorry Tim go ahead I just wanted to clarify something on insurance so different insurance companies pay differently so there are codes that you can use for treatment no transport and the insurance companies will reimburse you use it at a fraction of the transport cost the other thing with um the patients getting the check instead of it being sent to the provider service provider that's that's an option so EMS like blood Labs or like uh x-ray Labs can be what's called a participating provider with the insurance companies if you're a power provider with insurance companies they'll deposit the check into your account not send it to the patient so there is agency in Monroe County that is a power provider that doesn't have these issues because they have an agreement with the insurance companies but when the insurance companies want you to be a part provider they expect you to reduce your cost to give them a discount so a lot of agencies can't financially support being a par provider because the revenue gets so low it's a spreadsheet issue right you have to figure out if how many patients are going to keep the checks and what is that going to equal and is my total revenue or my Billings minus the checks the patients keep going to actually be less than the billing everybody getting 100 but billing them less and you know for most agencies it's don't participate you don't participate but I mean there's certainly going to be payer mixes in the minority where you can actually participate and and still maximize the the revenue that you can have Russ is your organization of participating provider with any of the insurance companies well we're mandate we're mandatory participants with the government yeah other than the government no no no we are mandated to accept the the rates that they tell us to anyway but right we don't participate no you're not a participating provider right we are also a Medicare Medicaid but not with so I want to just grab one of the questions that came off of our um the portal when I call for a lift assist and wem's response I get billed but when Penfield responds as Mutual Aid it is free how do other agencies handle lift assist and or calls for vitals but no transport I think you've touched on that a little bit but do you want to maybe elaborate on why there might be a difference in Billing between agencies yeah so I can't address penfield's billing process I don't know the answer to that and I don't know if the lift assist was a lift assist with any medical treatment or care so that question is a little too vague to address if treatment is given and the patient still signs off there is a bill generated okay thanks next up on our list is Don White uh so I've I have one comment and and then a question the comment um is uh and I'm actually surprised I'm saying this because I'm the last person that would uh ever consider expanding government making government bigger but um when it comes to providing Ambulance Service EMS care I think the town of Webster should seriously look at long term having it be a department of the town I just did a brief research and while the model in Western New York is not municipally owned ambulance services downstate the Capital Area it is so you got to look Beyond Western New York for comparisons quickly I looked at the town of colony which is the largest suburb of Albany eight uh 80 000 residents if you look at their last last year their expenses were roughly five million dollars for their ambulance department service and their revenues were 5.7 million they made money so Ahmed I would question your your off the cuff conclusion that it's more expensive for government to do it it may not be the case um it may not be the case uh my question is in the short term and and because that because there's this contract that goes the end of 2025 the town is a bit handcuffed in what short-term solutions they could consider unless whims is willing to seriously renegotiate what's left of that contract and in the that renegotiation would and and I'm confused it's unclear Ahmed said that audited financial statements weren't provided to the town the 990s that's a tax return that you can't tell anything from a tax return and I'm unclear as to what exactly Paul Adams looked at it doesn't sound like he looked at audited financial statements from whims in any renegotiation short terms is wem's willing to provide its audited financial statements to the town of Webster Beyond an NDA so that it's available for the public to look at okay thanks I done I did see the audit of financial statement for 2021 and for the years prior to that 2022 is not available yet I believe the date for the 2022 will be the end of June you said that's what they're fighting so sure yeah so the second part of that question on that is will you in the part of that renegotiation of the contract if that were to come would you be willing to make your financial statements public well as I said earlier we have to be careful right our financial statements give our competitors an advantage so we will probably we will have to do so carefully and with proper legal counsel okay and until you're to your first point Don though one of the one of the things as I said earlier is this pair mix stuff it's very the the the the levers are actually pretty pretty huge you chain you know you move this one stick a millimeter like I said that pair mix go from 17 to 15 and my organization would go from having some Surplus cash at the end of the year of about a quarter of a million dollars to about a loss of a quarter million two percent will do that so you can't compare what you know a suburb of Albany and at 80 000 my town I come from sixty thousand so it's similar you can't compare that you can't compare any two zip codes any two geographies without a serious investigation into how that paramix has looked over time and over the years right it's just that makes sense you know it's it's a it's not worth even bantering about because you have to have that information that data to make a predictive model and one other thing that I'll tell you Don I pulled up Colony ems's payroll their starting paramedics start at 22 30.

every one of mine makes more than that they're paramedics at the end of 10 years make 26.96 half of mine started at more than that so yeah you will make more if you pay less you're in a more competitive environment I'm paying I'm fighting here with eight eight districts I get over four million dollars to keep their staff and Wayne County EMS has just gone to a civil service so yes our expenses are different than Colony EMS okay next up is is it David ogee ogi close enough OG Maybe I have a background running Ms I was at EMT a volunteer organization and parents and and I was the director of operations when we went through the process where we had to convert from volunteer to paid people so I fully understand what you're going through in Webster EMS with the insurance companies and uh with your Medicare and Medicaid my question to you is how are the two commercial lamboses AMR and Monroe still turning a profit with all of the problems that they're having and you're having with the reimbursements from the government you know what Mr Ogie how do you say it is it OG okay you'll have to ask them well I mean no you'll have to ask them we don't do Monroe and emr's finances that's fair enough I guess you want to make any comment Tim commercial versus no I mean one of them is a family-owned business Monroe ambulance the others held by a private Equity Firm so I we don't look at their books okay Sue Casey are you here Sue here she comes thanks for the opportunity you can pull that down just grab the handle there you go and it'll move down there we go there you go so if the special tax district is approved who will approve any rate increase increases going forward and will they be subject to the tax cap [Music] as far as it being subject to the tax cap I can't answer that question right now Paul do you know what that would that tax District be subject to the tax cap it will be part of the tax cap calculation which is they say two percent is two to three percent a year Max so just to clarify a little bit this this District if it were to be formed would be like a a Park District or a water district or a sewer district rather than like a fire district that has its own separate board and its own separate entity this would be a district that falls under the town board um you know I think it would be Shepherd like the fire district no it would not so if I could without giving a legal opinion Mr Genesee if I'm wrong correct me but anytime a special use districts is formed the town board becomes the the board for that special use District now it is not our full budget right but certainly if that was to happen there would be a much different level of cooperation and collaboration with the town and I want to be very clear right we have worked very closely to this town board for 35 years we started the ambulance service together right some of the challenges that we're facing in the discussions that we're happening are are normal and quite honestly you know last July supervisor Flaherty and councilman Cahill said we'd have this meeting and we're having it right we have been very transparent with the town they had had full access to our QuickBooks they have had the available audited financial statements there's no smoke and mirrors here and if the town says Hey to ensure that wems will survive we would like to do things as long as those things are negotiated fairly and to the benefit of both organizations and the community there's no reason not to do it we're not holding out for anything we're not training I think you're right it would be would be a special district within the town's tax cap it might correct in this understanding that the town would set the rate Tom Borden Tom Borden yeah the town board the the rate would be set based on the budget which approved by the town board right right okay next up is Ken Corpus Ken good evening hi Barry how are you I'm good thanks Ken um thanks to the town board and supervisor Flaherty for this opportunity I think it's great um I had a bunch of questions that have been answered but then after listening to everything that went on I got a lot more questions so I'm going to go with Miss mustafa's theory of three questions [Music] as long as they're brief Kathy we've got another dozen people so given um that there's 17 agencies in Monroe county is that correct Tim 17 transport agents 17 transport agencies of those 17 agencies how many have metrics at performance metrics yes um I'd have to leave that up to those different agencies on what they measure so there are standard performance metrics that were dropped at by Monroe County Office of BMS and the EMS Advisory Board those can be found on the Mel Rems website and those before performance standards are everything from response time reliability to accidents to vehicle breakdowns and it's very very detailed so while those are performance metrics are there we want people to strive for them but some of them are going to be almost impossible to meet like you can't have an ambulance never break down and be up 100 of the time but their goals and everyone should be working collectively collaboratively towards those goals and each of those agencies usually has their own quality assurance system which looks at their own internal metrics we don't look at them as a whole from the county other than through Dr Cushman who is the County medical director okay um there was mention of the 990 I have it right here if anybody wants to see it there's 2.9 Million in revenue and over 528 000 left at the end of the in what they call balance funds so year over year there's been a balance fund I don't get to see the financials I'm just looking at what's provided to me publicly can you tell me what is different than this than what's actually in the financials what year are you looking at I have 21 right here yep so 21 we had a hell of a reserve fund because we're building a building and that was all consumed by the down payment of construction it all disappeared in 2022.

okay so we'll be able to see that when the 2022 comes out and last one Ken pardon last one thank you brief um get given the uh the numbers identified in the slides that were up there um in order to continue to fund your organization it's it was mentioned that you didn't ask for any changes organizationally or operationally why would we as taxpayers want to fund this operation if we're not going to have any organizational and operational changes to make it better and provide accountability well I think you guys two three things there Ken so organizational operationally I want you ask all these people right here are we a poorly run or poorly operated organization right ask them because they work for us and I'm sure they wouldn't if it was as far as your last question which now I just completely forgot sorry Ken what was the last one that would be fun Dexter why would we continue to fund this give you more money if there's not any organizational operational or accountability included yeah sorry thank you all right so organizationally operationally you can go ahead and ask our staff you can ask any of our line officers if we are poorly run or poorly operated organization accountability we have we have traditionally always given reports to the town usually in January of our prior year right the last few years we haven't been as rigorous about that there are no secrets if the town would like to set metrics and their logical metrics that are achievable then we would we're 100 for that right we have a qaqi process we do all the things that other agencies do or we strive to right within our means okay next up is Charlie conros Charlie what's your question okay [Music] simple question what year did you actually start this ambulance Squad you came 35 years it hasn't been 35 years I just started seeing Webster ambulance a few years ago when everybody else was put out of business that's my first question my second question is really simple how much of your money did you put in this thing to get it started how did you ever get it started I'm a businessman okay 54 years a businessman you don't start a business and just borrow and borrow and borrow I started with money ahead of time because I knew I wasn't going to make money in the first two or three years how did you get I just can't understand how you're doing it other than borrowing from me a taxpayer everybody else here a taxpayer and you got the town board on your pocket it's just ludicrous to me I know you're going to give me all the smooth answers that you're going to give me everybody's going to help you but as a businessman I don't like what you're doing here I I just don't like it I just female [Applause] thank you Charlie two questions in there the start date for when EMS yeah has been around for 35 years this June we just celebrated our 35th Anniversary we started whims in 2016.

and capital in we didn't say 35 years ago an EQ was founded 35 years ago difference between neq and webs right and capital in yeah so all the capital came from any Q's budget we had allocated for it and we have operated this with 100 anyq funds you can ask those that have looked at our books we have very little debt for our organization we do not run on debt and that's why we don't take loans that we aren't sure we can pay off Scott seidman did I say that right Scott what's your question my only real interest here making sure that on what may be the worst day of my life someday if I call 9-1-1 a viable ambulance service is going to show up that's capable of transporting me where I need to go and that my tax money is spent responsibly right so that's really all my interest now when you start talking about your reimbursement my like I 100 appreciate the covid thing it's really changed the employment model and the employment of employee availability it hasn't substantially changed your reimbursement model too much and we're really looking for an organization that understands their reimbursement model sufficiently to not have to come back for a 30 bump in their contract right and uh it just seems irresponsible that given that's where we ended up that we're we're not really demanding to bid out our our next step and then the other thing that kind of gets to me if I'm going to hire a contractor to do something the contractor is going to give me a price I'm going to determine if it's the right price and if I can meet that price and if I can I'll hire them but it's not really the contractor that's going to come to me and say oh you don't have enough money to do this maybe you should go to Louis down the street and Louis will fix you up and that's how I really look at the request for a tax District why is it your business how we pay for our service set a fair question well I think we can work a question out of there can you get that one um no I don't know why so I'm not going to address it well why is it fair that the that the taxpayers should fund uh an EMS well I guess looking at nine other towns and many other in the in the state when the cost of Readiness exceeds the income available income we need support from the community you pay 100 for fire police where did you why do you care where that support comes from from the community as long as he's giving it to you I don't care I don't care what the mechanism I would really encourage the town board moving forward to treat all of these as separate issues we shouldn't be wrapping up the tax district with who's going to be providing our service there's no reason for that anybody could provide our service and we can make a tax District if we need to make a tax District okay and and the short term and the long-term question about who are also different questions so I try not to conflate these it makes for three months simpler problems thank you thank you Scott thank you Emily bit good did I say that right is it bit good Emily what's your question uh good evening and thank you to the EMS who are here tonight for all your service to this community [Music] um I wanted to just touch off what the previous gentleman said and I think that that's an important thing to discuss about conflating these issues my primary concern is that I believe the town should be putting the funding behind this service I'm happy to pay as a taxpayer tax an extra tax to support this very critical service so but I really think that the town should be funding this um that this support should be coming from the town board so my question is to Ahmed and to Russ um I'm wondering if you could paint a picture provide a hypothetical if this agency does not get the funding it needs right you guys are operating on razor thin margins what is that going to mean for every person in this room here if we do not have Ambulance Service coming from this community what would that look like if I were to God forbid or anybody in here God forbid to have an incident where they needed service and it was outsourced or put out to bid like these other people are suggesting um and you know it's no longer in-house that is a very scary issue to me and I'm wondering if you could speak to what would that look like if we didn't have it in this community anymore because that is a very um difficult situation and so what would that mean for us sure sure thanks Emily so one of the things that I I would tell you from my experience watching agencies go out of business over the years as uh you know to wrap in a little bit of what somebody else said uh you know how we how you manage money and why is reimbursement their Pro our problem I mean I told you the average reimbursement of Medicaid we get is 236 dollars that's up from 227 20 years ago so you know I we do see ambulances go out of business um and one of the problems that you see when an ambulance goes out of business I talked about the attrition rates we see about half the people who who leave EMS because their agency their full-time agency has gone out of business do not re-enter the EMS world so the number of calls in Webster however many thousands it is that won't change but and the number and if another agency doesn't matter who we're talking about we're to be doing the calls where they still need this that where are they going to get the people right so what's going to happen is we're going to have a reduced EMS step I mean we're seeing this I'm not making this up these are stories you can see throughout the state and throughout the country so what that's going to translate to quite frankly is enhanced response times now I live up on across from Hedges which is already a long haul so I think you know what I'm going to tell you from my professional experience of 30 years is the minimum thing you're going to see is increased response times and you're you know uh that that is going to have a negative impact now that doesn't mean I mean I'm I'm certainly not not saying that I'm you know anything against all the options were talked about but however we do it we have to figure out a way to do it so that we can have those the same number of people are providing our services or more coming from a similar or closer location and that's a that's a question if somebody asks right now how you would do that I don't know if anybody at this table would be able to answer that so that go ahead Tim yeah I'd like to comment so in Monroe County we have had agencies close and Mer so in my Village in my town Scottsville the ambulance merged with Henrietta so it's Henrietta Caledonia in Scottsville Rockport and Spencerport merch so in those communities when they talked about going out of business they were proactive enough to say how do we do this so we do not impact the response time reliability we do not negatively impact our residents and our patients and the EMS agencies that have closed in Monroe County have been very good at doing that um they they do patient care for one reason because they love people and so they're not going to let their communities down if they have to transition out into something they're usually very good at doing it so that grabs one of the questions that came into the portal that neq has indicated on multiple occasions that they're in financial difficulty and the continued operations are in jeopardy has the town prepared an immediate contingency plan to provide Ambulance Service to the Webster residents that may include options such as a neighboring agency or agencies maybe Penfield taking back the West Webster Fire District and or Commercial Services such as Monroe and AMR I'll let you field that one John sure well that's why we're going through this due diligence at this point right now so that we can come up with a viable short-term resolution and I know that Penfield is one of the options that we will be talking about and looking at so with that process is ongoing okay next up on our list is Ja is it Jas Jones Jonas passing Anthony sutera basically one question like clarification and a question that was raised before and I I didn't quite understand uh Paul's response uh I guess my question is everything we've seen so far nothing goes back to the quality of service that's being provided your prior presentation talks about calls for service well it doesn't Define response times for example people here said they paid bad experiences if you're gonna you need to have a baseline in which to measure to say if you're going to use tax dollars to get to a company we should see improvements not just to keep them afloat now I'm another person who didn't particularly like their service because it took 20 minutes for an ambulance to show up and you know my grandson correct his head open was bleeding in 20 minutes is unacceptable so where's the comparisons of Baseline to other towns Baseline to West Webster Fire Department did prior to them taking over we don't have any of that information yeah you want us to give more money to the company and and if I'm not mistaken one of the short-term uh things on your last presentation unfortunately I didn't make that meeting was if we wanted metrics we have to pay for the metrics the metrics exist why can't they provide those metrics I know all first responding agencies have response time metrics I worked for Public Safety agencies for 15 years it's one of the key things that they use to manage their their environments so I I think we're missing a big piece we keep talking about adding money to something and yet we don't understand where we are at a baseline other than the fact that they're losing money and they need money okay thank you just to clarify uh one of the gentlemen mentioned the bid process and I thought you said that didn't apply but what does apply is a request for proposal I mean I've written many of them when I worked in the public sector right that's the where the place where you define requirements and also it didn't get mentioned we asked for metrics we have to pay for it are we going to hold them accountable financially if they don't make those metrics and I mean I think we need a baseline of Public Safety to measure events if we're going to give anyone any more money all right thank you thank you so um the contract that we currently have um does it call for metrics does it call for response times does it call for any kind of measurements no it does not okay do you have metrics I think that in the past you've supplied the town with metrics Ahmed I mean we measure a lot of things and we have provided the data to the town I will caution you against response time metrics because more and more often we are not running red to calls it is proven that a have very little positive impact on the patient's outcome and B greatly increases risk of accidents in route to calls so we're actually reducing the number of calls that we run red lights and Sirens two and the number of calls that we actually transport a patient to the hospital is even fewer so response metrics is not really a great one as director sopranski said there are metrics that we do hold ourselves against you know that the county has set up and we have reported on those we do measure those internally we've not done that with the town in 2021 I think the supervisor asked us to look at the existing contract some metrics were proposed was it 2021 time yes right and you know we gave some suggestions back and in that process stalled correct okay just to be clear though when you say we don't we have don't necessarily go lights and Sirens that's not a that's not an any Q whims thing no that's a either industry right that's a count that's a county decision well yeah actually the response time configuration has been in flux for for many years uh when I was at uh rural metro we started going nine lights and Sirens to non-critical calls that's at reducing the number of accidents and injuries to our personnel and no patient detriment as a consequence of it so really when the call comes into 9-1-1 the call taker grades it through a series of questions that drives additional questions that drives the response time metric which is defined by Dr Cushman as the oversight position for 911.

so I was just wondering make sure everybody understood that it's not coming from from the CEO of equals or even you it's it's a systemic decision we don't have a choice we have to we have to play by those rules so one of the other things that's worth mentioning is we do not dispatch ourselves we do not take the calls the patient's call is sent 911 Center in the county and depending on what you tell them is how we get dispatched and the priority of our response somebody falling down and bleeding is not necessarily A life-threatening emergency we may take that call in service that means we stop at the red lights we stop at stop signs we obey the speed limits so it's based on the information provided to the telecommunicator that is then related to the dispatcher than is relayed to us that is what determines our response we respond based on the priority of the call that we are given not on what we feel now that may change over time so if the person that fell the bleeding is significant and bleeding you know from their head wound and it's a major event and they call back or upgrade it then we'll upgrade our response but as we have all said we're trying to minimize our red lights and Sirens response because it provides very little positive Improvement to the patient it greatly increases the risk of the responders and the citizens that we're responding through so while we're on the topic of response times the question from the portal is is that what's this what is the differential in response time from Webster EMS handling the call versus an outside agency handling the call basically a mutually that's impossible to answer yeah that's impossible to answer it depends where you're coming from time of day nature of the call response category that is that is too vague to answer that question okay next up is Garrett Wagner are you still here Garrett it's going to be a pierce and James James cometh James what's your question 's actually got answered in the portal earlier so I'll just kind of keep my comment brief I just kind of want to touch on a question that was asked earlier on the uh if it goes to another agency then it's not an in-house or in this Community Ambulance how does that affect response times and there's a comment that it could increase response time so I just kind of want to make it more of a point I guess or my question is how do we know that that's true because an example I have is if you stand at the corner of gravel road and Ridge Road right now and call for an ambulance you're waiting for it to come from Jackson Road you know depending on time of day to their point it could be 10 15 minutes however there's an another agency's Ambulance with an eyesight of that intersection that won't respond because it's not in their jurisdiction so you know if if the agents if that agency was to be giving that portion of the uh the town and I'll say it's Penfield ambulance so Penfield ambulance keeps an ambulance uh at West roster's Firehouse to cover calls in the town of Penfield portion uh of the West Jefferson fire district so if you live in the town of Webster portion of the West Webster Fire District you're actually waiting for an ambulance to come from further away not an ambulance that's closer so if you live in that any of that region you're waiting for an ambulance to come from Jackson Road even though there's one sitting on gravel road right now okay I'll answer that question if you don't mind so the Penfield ambulance is only stationed in Gravel Road for 12 hours a day at five days a week I believe not seven days a week so for the other 12 hours a day and 24 hours of the two days of the weekend you are getting an ambulance from further and Penfield is very clear that if they get busy in Penfield that ambulance gets pulled up and they go down south whereas Webster able to stay in town that's my understanding so I'll say to that is I mean and you can look at the the fire districts contract and I won't belabor it because I'm not I'm here personally I'm not here as a representative of the fire department so I want to make that clear too but uh Penfield had and you can ask their do they had agreed if if they had the entire District they would have put two ambulances 24 71 being ALS uh and one being BLS currently they have the one 12 hours a day uh and it's not often that I've personally noticed I can't speak to their data but uh it doesn't get pulled out that often other than when it is running on calls so so though we have different patches on our sleeves our Collective interest is always in patient care just the other day there wasn't to Jimmy's point or sorry Mr cometh's point a high priority call that Penfield ambulance was closer to and wem's staff did dispatch Penfield to go first respond because geographically they were closer and they were available and we were coming from a distance it was a very sick patient so when the need arises we do ask for help and we do use our brother and sister EMTs and paramedics to lend assistance because it's not about the turf it's not about the patch on their shoulder it's about patient care okay Bob Bob Anderson gonna pass does that include Debbie passing I got Bobby and Debbie on here okay next up is Colleen kepelgreco [Music] Kathleen no how about Steve hurleth is there Steve here he wants to speak and the last one I don't it looks like it's Kathy and I can't get any more than that it says it's from West Webster Kathy or Kitty or Katie starts with a K and ends with a Y that's all I got is there anybody there that wants to speak all right we did a pretty good job so we've gone through the list that we've got is there anybody else we've got a few minutes a very few minutes before we'd like to finish up I want to just quickly I want to just quickly make sure that I've covered everything that's on the portal because those people are not here and I want to make sure that there's two questions that are left on the portal questions the first one I think we've answered and that is that are the financial conditions impacting neq um and its repeated requests for additional funding particular to neq or are they industry-wide conditions perhaps driven by covet I really think that question maybe has been answered earlier with the shortage of paramedics and with the changes it do you anybody want to elaborate on that one and then the last one that's on here was if the town chooses to do an RFQ or a request for proposal how long would that process take John do you know I've heard any worse from three to six months that that process could take does that sound about right Paul I don't know yeah it does I think uh probably take about three months to locate a new provider and probably another three months for them to get up to speed and ready to go okay is there anybody else in the audience yes sir you want to come up to the microphone please well with it well here let me just so let me just tell you what the issue is this is being recorded and you there with the back your head doesn't help the recording I need you to come up to the microphone please and okay anybody else that would like to speak yeah Don go ahead with question number two for you number four I should say yeah yeah that's not a question um as most of you know will up here you know I'm the attorney for the village of Webster if you're considering an ambulance District it the town cannot establish one that includes the village without the village first passing a local law subject to permissive referendum agreeing to join that District correct so I would hope that if you're thinking of an ambulance District route you include The Village Board of Trustees in those discussions good point thanks Don the gentleman in the in the back with the glasses on I don't know name so please come on up to the microphone please oh you did come up once before I apologize you were the first guy on the list um my question goes to governance he just brought up a very important Point somebody had discussed earlier who would be the commissioners of this District that you're talking about my question is if any cure budget is about three million dollars 2.9 I think was what it was at on the 2021 um i-90.

my question is you're basically looking for the taxpayers to fund a third of your budget what will the town get and and the village as well in terms of governance sport when the government the federal government invested in GM they became one of the major stockholders um you know is you know are a third of the board seats going to go to town Representatives there's a whole bunch of questions around governance that we really haven't gotten into you know in addition to the questions about financial need so I'm not sure that that could be answered tonight but I think it's a good point to make no it's a very good point and Don you made a very good point also and those are things that as we look deeper into what's involved in a tax District those those issues will be addressed and we'll be speaking with other towns and municipalities that currently have Amos districts in them okay yeah there was yes that young lady right there in the third row Mr Mr Redmond while we're waiting for Jan if I could too if I couldn't just make what's your question Janet you know we have had a very collaborative and collegial relationship with this town board for some reason it's being perceived as a very adversarial one right if governance and whatever has to happen it will not be done with resistance right as long as the metrics and and measures make sense and can be measured and are achievable there's no reason not to do it we're not trying to have a bad agency right we have not survived for 35 years because we don't do a good job we have not been an ambulance service for six years because we don't do a good job right so please don't perceive I don't know why there's this perception but I want to put it to bed from any queue site at least this is not an adversarial relationship we have a Tom board member that sits in our town in our board meetings every single month we are the only EMS agency in the county that I that I know of that does that and we do it with open arms and we welcome councilman Cahill when he comes thank you Ahmed go ahead with your question thank you for letting me speak my name is Jan Thompson and in transparency I am on the board of nickels and I have been for five years I am a West Webster resident and I think I spoke not too long ago uh between my children and grandchildren we own 21 residences in Webster so I certainly understand the tax District issue one of the things that I really wanted to address and there may not be an answer perhaps Mr Adams can answer this I listened to Bob lonsmary this morning and our supervisor Flaherty gave an interview with Bob and he made two points the first I will address in Karen Mustafa did on several of the meetings and in these slides it was stated by Mr Flaherty that nickels wanted and requested eight thousand eight hundred thousand dollars we don't know where that number came from we sat on the board and we prepared that number with the exception of the time that Mr Flaherty and Ahmed began the negotiations this morning on Bob's Lansbury he clearly stated that we asked for between 400 and 450 000 annually so that's the first question I would like to have clarified what is the actual number that the town is looking at or is being shared by the emails from the town supervisor the second that I'd like to ask is Mr Flaherty also stated that he had not received any financial data or financial information from equals for 17 months Mr Adams perhaps you can address that is that true okay thank you Janet Paul you want to go with the what you've got financial data for and whatnot sure I uh I think I can I can say that as I stated earlier that it looks like the uh the organization is going through about twenty thousand dollars a month so we originally thought that the short-term solution would be about twenty thousand dollars a month uh take a step back and try to come up with a long-term solution I don't know if I answered all of her points I John do you want to address where the 800 000 came from versus the four in presentations a meds presentation um back in July was it 25th one of those slides did address the eight hundred thousand dollars and I think that that was utilizing 25 cents per thousand would generate eight hundred thousand dollars it was used as an example um and to your question with respect to the 17 months I could be wrong but I listened to the interview after the interview was over and and you know the supervisor would clarify this later um I think he may have been referring to the audited financials he hasn't seen in 17 months but clearly decals has gone been going through a a great deal of financial disclosure to the town of Webster since September and and you know they call it a deep dive this is the deepest dive I've ever seen into any type of business whatsoever and it's taken a long time because more questions are generated as more information is provided to the town so that's the 17 months I believe that the supervisor was referring to was the audited Financial but I can clearly understand why it may have been misinterpreted by a lot of the people that were listening to the uh the interview today so I'm just trying to add Clarity to that thanks John is there anybody else in the audience that would like to can you want another question do you get just one no please make it short because we only got seven minutes left one question five parts no one quick question Ken well I have one statement Charlie you asked about the history of the ambulance in neq I put together a two-page history that I published on Facebook I'll give you this when I walk by starting in 1985 and you guys can review it if you want to I think it's pretty accurate I pulled yeah from your website because I got a lot of people asking questions so I answered it now my other question is it was stated that of the 17 agencies a majority put BLS in an ambulance or Als in an ambulance um does that mean that Webster residents are paying more for an ambulance trip to the hospital if it includes ALS and BLS so if a deal I think if I understand your question correctly so there's an ALS call that a fly car responds to a residence right and it's determined that that patient needs to get transported to the hospital so they're going to get a bill for ALS and they're going to get a bill for BLS so what happens is the BLS ambulance bills in an ALICE rate and then the Delta is paid to anyq okay is that does that answer your question I didn't hear that can you say that again can you pull your mic in front of you a little bit please yeah so what happens is when the paramedic gets on the ambulance if it's an ALS level call then the BLS ambulance bills at an ALS rate and they pay the difference from the blsd ls rate to the neq so basic two separate bills one for ALS and one for BLM and negative correct go ahead right right no I'm asking you the patient that's my understanding yes yes we don't do the billing Ken but my understanding is the patient gets one bill I mean and that's standard I'm very involved with mine there's no the patient's gonna get one bill whether there's you know how it gets broken down and reimbursed on the back end we're not allowed to we can't do that in EMS all right okay thanks Ken thank you there's a there's a young man in the back that's had his hand up come on up to the microphone if you have a question I'm pointing to you yep yes sir you're being nice and you're here [Music] I'm Robert Schroeder and I was a patient and thankfully EMS came through perfect within a couple minutes my thought is from afar top of the way back if you didn't pay the fire company and they came to your house they didn't fight the fire Fusion pale is that what we want for Animal Service if you can't pay them they'll pull you we're looking at taxes like Insurance we're spreading it across the town so that all of us pay less totally it's the same with floods whatever I don't think the expense individually is expensive when you think of it from an insurance standpoint unless you want to buy your own insurance which is another option thank you thank you thank you thank you Jerry I just wanted to quickly say this was great to see everybody come here tonight because this is not happening in the world today that this community could get together it was calm it was polite we followed the instructions and so go Webster nice job thanks well apparently Jerry took my closer so I do I just want to make the comment that it is now the bewitching hour of 8 57 and so we've had everybody as best as we're able to listen to their questions and get their answers and I do appreciate the fact that everybody was polite and attentive and that I want to thank our panelists for coming out I appreciate you taking time out of your evenings um those of you that are in service thank you very much it's greatly appreciated and I think with that we're going to close and everybody have a good evening and drive safely thank you very much everybody