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Ambulance Committee Meeting Minutes – October 6, 2022

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6 OCTOBER 2022


The Chair, Commissioner David Wamble, opened the meeting asking Commissioner Matt Rubelsky to offer a prayer and lead the pledge.  The Minutes of 13 May 2022 were moved for approval by Commissioner Caleb Savage, seconded by Commissioner Annelle Guthrie, and were approved.  The Chair gave general information from a handout which showed the audited 2021-2022 final budget and expenditures. He specifically mentioned the total cost of $3.1M to operate the ambulance service, the collected billings of $2.3M, showing the net of $0.8M being required from the county.  Ms. Nancy Griffin of the Financial Management Office stated that from the 2020-2021 budget that additional cost was $1.2M, showing the 2021-2022 being a reduced amount.  County Executive Graham Stowe asked about the reason(s) for the reduction, e.g., better billing due to a newer contractor for that service.


Next Agenda Item – Maintaining coverage for the county with at least two Advanced Life Support (ALS) units.  Emergency Medical Service (EMS) Director Roy Griggs discussed the two biggest challenges, salaries and insurance, affecting the shortfall in staffing.  The ALS units have a paramedic on board, along with an Emergency Medical Technician (EMT).  Per Director Griggs, the staffing for the ALS ambulances have a higher level of training than those who operate the basic life support ambulances.  He mentioned the newer staffing hours of 24/72 helping and allowing some to provide an extra shift as overtime, alleviating the staffing shortage.  He also mentioned surrounding counties have used Giles’ model to change their shift hours.  Commissioner Matt Rubelsky noted that ¼ of the Ambulance Service payroll cost is on overtime.  He suggested it might be better to raise the salaries rather than paying the overtime, helping to both recruit and retain employees.  Commissioner Dr. James Lathrop said the problem goes to supply and demand – how many students graduating with the necessary skills/certifications.  Director Griggs mentioned the current number to graduate, i.e., estimated 50 students, and those students are loyal, typically, to their own counties, with those counties paying most of the cost.  A following discussion on starting and experienced salary per hour for the various skill sets, i.e., EMTs, Advanced EMTs, Paramedics, and Paramedics for Critical Care, was given by Director Griggs.  Some other examples were given with similar situations, e.g., firemen in another county, the statistics that one half of our population in this field work in surrounding counties, and a comment to Commissioner Savage from a fellow employee that the family insurance cost is a barrier.  Ms. Griffin said it’s good insurance, and county pays $697 toward coverage where premium is probably around $2K.   She further suggested to the Chair that perhaps the Insurance Committee could meet and have the insurance broker available for questions.  The Chair said he would make that happen, noting to the County Executive that he would like to have a meeting (Chair Wamble is also Chair of the Insurance Committee.)


Next Agenda Item – Options for Benefit Pay.  Director Griggs said the 2021-2022 bonus amounting to $6K was much appreciated and helped with retention.  The total amount of bonuses was pulled from the General Fund balance.  County Executive mentioned that perhaps there would be another way, since the employees did not receive a total of $6K due to how the bonuses were paid and with taxes deducted.  He mentioned the Health Insurance cost and the Chair said, if did, would have to apply to all employees.  It was noted by the Chair that the Giles County Schools are on a different system and individual cost is considerably less. Commissioner Reedy noted that if placed in pay, that amount stays the same forever only being increased in time.  Several Commissioners noted this problem is only going to get worse, so forever may be the status quo.  Questions then arose on when you might give bonuses, and how responsible is the employee in staying after receiving the bonus.  A motion by Commissioner Savage and seconded by Commissioner Lathrop to approve retention pay of $6K to maintain current staff and fill the current open positions (5 Paramedics/3 AEMTS) for this budget year, to come out of the fund balance, send to the budget committee for recommendation to send to full commission.  Motion approved.


Next Agenda Item – Paramedic Tuition Increase and Advanced EMT Reinbursement Tuition.  Dr. Lathrop noted the previous discussion focused on the short term, and where are students being trained and how to get more bodies.  Giles County’s Office of Emergency Management (OEM), Interim Director Josh Young spoke on the internal efforts to train students within an emergency medical response program.  This effort came about because the Giles County School Board wanted to start such a program.  Josh said he started with 11 at Richland and 14 at Giles County High Schools.  Most of those students went into military service and were pushed toward becoming medics.  The program has been so successful that Richland had to split into two semesters given number of interested students.  Josh, Dustin Blade and Dr. Fite are the primary instructors for this program.  Discussions with Columbia State have resulted in their doing a mobile laboratory which is now in Wayne County and will be put in Giles next year.  The local CTE at Giles County is currently paying for the testing which also encourages more interest.  There is an age of 19 required to do riding along (for real world experience).  A motion by the Chair, David Wamble, seconded by Commissioner Caleb Savage, to approve the $8781 for the tuition and that an additional $1K for those students who graduate within the year be approved, forwarded to Budget Committee, and to the full Commission.  Another motion by Commissioner Brad Butler, seconded by Commissioner Caleb Savage to amend the policy for the Ambulance Service to note that anyone receiving this assistance, payable 1/3 of the tuition for a period of three years, and failing to stay for any part of the three years must pay back the last payment received.   Motion approved.


Next Agenda Item – Update on property for building.  For the Chair, this has been going on for four years, and that now is the time to pin point the problem and move ahead.  County Executive Stowe said put a deadline on the property commission with the Chair noting move to property and get us a location nailed down.  A motion by Commissioner Brad Butler seconded by Commissioner Caleb Savage to ask the Property Committee by 1 February 2023 to provide 3 viable options to this committee.  Motion approved.  Some of the areas as possible location sites were mentioned:  end of airport, Minor Hill side (may have some restrictions on what can be done); property near Lewters; Baptist Association property (would deal directly with county so no realty charges); and property on Highway 11.  Some general comments:  Commissioner Rubelsky had pulled all information on county owner property; Chair liked being by bypass giving easy access to various locations within Giles County; per Commissioner Gayle Jones, if discuss airport need to have Randy Jones attend, i.e. property meeting; Commissioner Savage said some of his colleagues  want a new building not a makeover; visit the current Ambulance Department to see what should be considered; Per Commissioner Joyce Woodard consider possibility of combining with E911 function and having a suitable location for both; per Director Griggs some differences between E911 and ambulance service, e.g. morgue, and perhaps consider a helicopter pad.


Old Business – none.  New Business – Commissioner Roger Reedy spoke about a coalition of several of the smaller surrounding counties, e.g., Maury, Marshall.  The centralized functions could be maintenance, shared inventories, buying power to name a few and each would stand alone on other functions.  E911 service at one time considered consolidation but may have restrictions in doing so.  Chair Wamble asked Director Roy Griggs to be prepared to present this issue at the next meeting.  Commissioner Savage asked was the Ambulance all full time or did it include part time employees, and Director Griggs answered both.  Commissioner Rubelsky asked if the grant for the Shelter could be combined with other county functions, e.g., E911, and Josh Young answered that was considered and tried but was kicked back.  The shelter is for citizens and during a disaster too much confusion with people coming in and others such as E911 functioning.


Under new business – Director Griggs said they had a Medicare audit, round 1 of 3 phases, and had zero denials.  He thanked all involved for contributing to such an excellent audit and said phase 2 and phase 3 not necessary given the zero denials.  A description of the Giles County morgue was given, a freezer and a carport as is currently configured, and is traumatic for loved ones visiting the deceased was also mentioned by Director Griggs.


County Executive mentioned the name of this committee, the Ambulance Committee, and a possible name change should be considered, perhaps including the OEM and also the Fire and Rescue function.  The Chair did say he had spoken to the Fire and Rescue Director and to do that would require paid administration.  The County Executive recommended taking to the Legislative Committee.


Commissioner Guthrie moved for adjournment and with Commission Savage providing the second, the meeting was adjourned.


ATTENDEES:  Members of the Committee – Chair Commissioner Davis Wamble, Other members Commissioners: Dr. James Lathrop, Annelle Guthrie, Caleb Savage, Brad Butler, Rose Brown for Joseph Sutton (absent) and Judy Pruett for Shelly Goolsby (absent);   Other Commissioners Attending;  David Adams, Gayle Jones, Roger Reedy, Tim Risner, Matt Rubelsky, Joyce Woodard  Other:  County Executive Graham Stowe, EMS Director Roy Griggs, OEM Interim Director Josh Young, Financial Management Nancy Griffin and a member of the public