By Aaron Hale
Naples Daily News
COLLIER COUNTY, Fla. — Collier County’s emergency medical care model could be headed for a makeover.
With budgets shrinking and public disputes occurring between officials in Collier County Emergency Medical Services and the county’s independent fire districts, there has been a widespread call for change.
“That’s everybody’s goal,” County Commissioner Tom Henning said. "(To) provide equal or better service for less money.”
So far, though, there has been little consensus on what changes are needed to the current system.
A citizen-based panel explored emergency response issues, treatment of patients in the field and transport to a hospital in Collier County. The blue ribbon panel released a report on Dec. 30 that could be a blueprint for a new model.
The report included 14 bottom-line recommendations on modifying the current system. A spokesman for the panel is scheduled to give a presentation to the Collier County Commission on Tuesday.
In its report, the panel depicted a current system “well-served” by its professional first responders, but with room to improve. The chief recommendation was moving toward a single management structure for pre-hospital emergency treatment and transport, with better communication and cooperation among the agencies.
Increased public safety and more efficient use of tax dollars are top priorities of the report. That finding received generally positive feedback from county commissioners, fire officials and hospital leadership, even if there are questions left to be answered.
However, with many of the recommendations likely to require unanimous approval from the same agencies that have been embroiled in public disputes, it’s too soon to tell what, if any, changes are likely to become reality anytime soon.
“I agree with the concept,” said East Naples Fire Chief Doug Dyer, who is expected to announce his retirement Tuesday. “The devil will be in the details for working things out.”
The blue ribbon panel was chaired by Geoffrey Moebius, ex-CEO of Physicians Regional Healthcare System, and Edward Morton, ex-CEO of NCH Healthcare System. It was organized by the Greater Naples Chamber of Commerce in 2009.
Its task was to provide recommendations to improve the current model of treating and delivering patients to hospitals. It sought the advice of local hospital leaders, physicians and first-responder agencies, analyzed the emergency response data in Collier County and reviewed some of the nation’s top emergency medical response models, including systems in the cities of Marco Island and Naples, before releasing its report.
Before it was even released, officials from Collier fire districts, EMS and county government officials expressed hope that the report could lead to improvements in services.
After reviewing the report, Henning praised the panel for the amount of time it spent on the report.
North Naples Fire Chief Orly Stolts called it a high-quality report “with a lot of good possibilities.”
Despite the praise, both Henning and Stolts said they expect the panel’s chief recommendation of moving toward a single management structure to be a difficult task.
Under the current model, EMS and ambulance service is run through Collier County government under the license of county Medical Director Dr. Robert Tober, who reports to the County Commission.
Through agreements, the Collier County Sheriff’s Office and Collier’s independent, dependent and municipal fire districts assist with on-scene medical care.
Although the Sheriff’s Office and fire departments follow Tober’s protocol for pre-hospital care, the agencies are technically independent government bodies with their own elected officials, who don’t answer to county staff.
The panel blamed a “lack of consistent, centralized, positive management” for parochial disputes that have spilled out to the public.
The panel called for the creation of a new Public Safety Authority that would oversee pre-hospital emergency care, and appoint Tober to head it. The panel also recommended the county establish a council, with representation from hospital administrators, fire districts and the public to provide input to the Public Safety Authority.
Tober declined to comment on the report until after Tuesday’s presentation, but at least one county commissioner supported the idea of a new body to act as an intermediary among agencies.
Commissioner Donna Fiala said she would like to see new leadership brought in to provide “a fresh approach” and to “create a sense of harmony” among the various agencies.
But creating a new authority to oversee all operations wouldn’t be as simple as a majority vote from the County Commission. Many of the fire districts were created by the Legislature and are independent of county government.
“Unless the (state) Legislature is willing to impose a countywide fire-based EMS system by a special act, this will only move forward with the voluntary cooperation of the fire districts, the county and municipalities,” wrote Commissioner Georgia Hiller in an e-mail to the Daily News.
At this point, North Naples and East Naples fire chiefs Stolts and Dyer say they are willing to cooperate with the county on proposed changes.
“We’re ready to move on and put the attacks behind us,” Stolts said. “We all need to sit down and take a serious look at this.”
Even the private hospital leadership is showing initial interest in more cooperation with first-responder agencies.
One of the 14 recommendations was getting more involvement from the directors of emergency departments at NCH and Physicians Regional hospitals and the Lee Memorial Hospital Trauma Center.
Phil Dutcher, chief operating officer for NCH Healthcare System, said he supports the concept of a council that would allow greater communication among EMS, fire districts and the hospitals.
Dutcher praised Collier County EMS for being “a leader in the introduction of new equipment” in field-based treatment, but said there wasn’t always communication with the hospitals about the use and purpose of new equipment.
Despite the enthusiasm for the report, Jorge Aguilera, deputy chief of medical operations for the North Naples fire district, said the hard work now is shifting to public safety agencies, hospital leaders and physicians to hammer out the details for improving Collier’s system.
The blue ribbon panel “left a lot of room open for us to fill in the pieces,” he said.
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