Resolution 358-1986
James R. Paros, Director
Emergency Medical Services
RESOLUTION NO. 358-1986
A RESOLUTION AUTHORIZING THE MAYOR AND
CHAIRMAN OF THE BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA, TO EXECUTE A
CONTRACT BY AND BETWEEN THE BOARD OF COUNTY
COMMISSIONERS OF MONROE COUNTY, FLORIDA, AND
ARTHUR YOUNG AND CO. TO HAVE A STUDY
CONDUCTED CONCERNING THE COUNTY'S EMERGENCY
MEDICAL SERVICES SYSTEM.
BE IT RESOLVED BY THE BOARD OF COUNTY COMMISSIONERS OF
MONROE COUNTY, FLORIDA, as follows:
1. That the Mayor and Chairman of the Board of County
Commissioners of Monroe County, Florida, is hereby authorized to
execute a Contract by and between the Board of County
Commissioners of Monroe County, Florida, and Arthur Young & Co.,
a copy of same being attached hereto, to have a study conducted
concerning the County's Emergency Medical Services System.
PASSED AND ADOPTED by the Board of County Commissioners of
Monroe County, Florida, at a regular meeting of said Board held
on this ~,.d
day of~, A.D. 1986.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA,
(SEAL)
Attest:DANNX La KOLHAGE, Clerk
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BY
OVED AS TO FORM
GAL SUFFICIENCY.
CONTRACT
THIS CONTRACT made and entered into this day of
, 1986, by and between the BOARD OF COUNTY COMMIS-
SIONERS, Monroe County, Florida, hereinafter referred to as the
"COUNTY" and ARTHUR YOUNG & COMPANY, a certified public account-
ing and management consulting firm, with offices located in
Fort Lauderdale, Florida, hereinafter referred to as the
"CONSULTANTS".
WITNESSETH:
WHEREAS, the COUNTY desires to have a study conducted of the
County's Emergency Medical Services (EMS) system, in regard to
all agencies presently providing such services in the County, and
WHEREAS, the COUNTY desires to employ the CONSULTANTS in
connection with the study thereof upon the terms and conditions
hereinafter set forth, and the CONSULTANTS are desirous of
obtaining such employment and have represented that they are
qualified and competent to perform such services upon said terms
and conditions.
NOW, THEREFORE, in consideration of the mutual covenants and
agreements hereinafter contained, it is agreed by and between the
parties hereto as follows:
ARTICLE I: WORK PLAN OF CONSULTING SERVICES
A. The CONSULTANTS shall diligently perform in a timely manner
professional services for the COUNTY in connection with all
PHASES of the Work Plan, Attachment "A" which is herein made a
part of this Contract. The Work Plan and schedule shall clearly
define each TASK, each sub-task within each TASK, and include a
detailed budget including all fees and direct costs. Such budget
shall specify the maximum total amount to be paid to the CONSUL-
TANTS for the PHASE including maximum total amounts for fees and
direct costs. The Phases of the project shall be:
PHASE I Current Ssstem Analysis
Will involve the su -tasks associated with project ~n~-
tiation, as well as a detailed analysis of the current EMS system
in Monroe County including an identification of existing
strengths, weaknesses, problems and needs.
PHASE II Pre-Evaluation Analysis
Will involve the identification and preliminary analysis of
several alternative EMS delivery systems. The result of this
task will be to obtain agreement with appropriate representatives
of Monroe County concerning the specific alternative which will
be evaluated in detail in the subsequent tasks of this project.
PHASE III Operational Analysis
Will include evaluation of the operational issues inherent
in each alternative model being analyzed. This would include
factors such as organizational structure. training, personnel.
communications, vehicles. equipment, facilities, etc.
PHASE IV Financial Analtsis
To evaluate the financia implications of each alternative
delivery system, a computer-assisted financial model will be
developed to evaluate each model under varying assumptions.
PHASE V EMS Master Plan DeveloEment
This will involve recommending teEMS delivery system that
would effectively satisfy the EMS needs of Monroe County. In
addition, it will result in a comprehensive EMS Master Plan
including objectives, methodology for completion, time frames,
resources required, restraints to achievement. budget consid-
erations and sources of funding.
B. The CONSULTANTS shall submit up to twenty-five (25) copies of
all reports or other deliverables for all required services to
the COUNTY.
ARTICLE II: COMPENSATION
A. The COUNTY agrees to pay the CONSULTANTS a fee not exceeding
the budgeted fee specified in writing for each TASK as detailed
in the WORK PLAN. The Total amount paid to the CONSULTANTS for
all services under this Contract shall not exceed $63,216.00,
plus direct expenses as described in Paragraph C below unless
subsequently amended in writing with the mutual agreement of the
parties.
B. The CONSULTANTS fee for each TASK shall be calculated on the
basis of the CONSULTANTS hourly rates presented in Attachment "A"
for each of the CONSULTANTS' employees and subcontractors while
such employee or subcontractor is actually working on a TASK
under this Contract.
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C. I. Direct expenses shall be reimbursable to the CONSULTANT.
Direct expenses are defined as the costs incurred on or directly
for the project. Such direct expenses shall be computed on the
basis of actual purchase price for items obtained from commercial
sources and on the basis of usual commercial charges for items
provided by the CONSULTANT. Receipts will be required only for
reimbursable items exceeding $25.00. Mileage and per diem
expenses and allowances shall be reimbursed pursuant to the
provisions of Section 112.061, F.S.
2. Notwithstanding any other provision of this contract, the
following expenses shall not be reimbursed as direct expenses:
a. Travel to and from Monroe County not authorized by
the WORK PLAN;
b. Telephone costs other than long distance calls
directly related to project;
c. Computer costs, except for actual on line charges for
operations directly related to the project;
d. Document preparation other than production of the
actual copies of reports submitted to the COUNTY.
D. The CONSULTANTS may submit statements for payment on a
monthly basis to the COUNTY ADMINISTRATOR, or his designee, as
portions of the study are completed, and same shall be reviewed
and approved for payment if such deliverables meet the require-
ments of this Contract. The COUNTY will pay all non-disputed
items of a statement within thirty (30) days of receipt of said
statement.
E. Certain of the services provided for in the WORK PLAN may,
with the mutual written agreement of the parties, be paid for on
a lump sum fee basis.
ARTICLE III: COUNTY'S RESPONSIBILITY
A. The COUNTY shall furnish the CONSULTANTS with all existing
data, plans, and other information in its possession and useful
in connection with the project, all of which shall be and remain
the property of the COUNTY and shall be returned to the COUNTY
upon the completion of the services to be performed by the
CONSULTANTS. CONSULTANTS may retain copies of all project
related data, plans and information which relates to the project.
B. The COUNTY shall not be required to provide any services to
the CONSULTANTS in connection with any claims brought on behalf
of or against the CONSULTANTS.
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C. The COUNTY shall make COUNTY personnel available on a
time-permitted basis, where required and necessary to assist the
CONSULTANTS. The availability and necessity of said personnel to
assist the CONSULTANTS shall be determined solely within the
discretion of the COUNTY. The COUNTY shall provide all necessary
personnel on a timely basis to review project status, progress
payment authorization and provide project direction.
D. The COUNTY shall encourage the individual ambulance districts
and agencies to make personnel available on a time-permitting
basis, and to furnish all existing data, plans, and other
information in their possession and useful in connection with the
project in accordance with the same conditions as specified in
paragraph A. of this Article. It is, however, the CONSULTANTS
responsibility to inform the COUNTY if significant problems are
encountered which impact the satisfactory conduct and completion
of the study and to propose action to be taken or changes in the
project scope.
ARTICLE IV: CHANGES IN SCOPE
"
The COUNTY may from time to time, request changes in the
scope of the services of the CONSULTANTS to be performed hereun-
der. Such changes shall not be binding unless mutually agreed
upon by and between the COUNTY and the CONSULTANTS. Any Changes
in the WORK PLAN approved by the COUNTY shall be in accordance
with the payment provisions of this Contract.
ARTICLE V: TERMINATION OF CONTRACT
The COUNTY shall have the right at any time upon thirty (30)
days written notice to the CONSULTANTS to terminate the services
of the CONSULTANTS hereunder and, in that event, the CONSULTANTS
shall cease work and shall deliver to the COUNTY all documents
prepared or obtained by the CONSULTANTS in connection with their
service hereunder. The COUNTY shall, upon delivery of the
aforesaid documents, pay to the CONSUI.TANTS and the CONSULTANTS
shall accept as full payment for their services hereunder, a sum
of money equal to: (I) the fee for each authorized and completed
TASK issued by the COUNTY; plus (2) the percentage of the work
done in any authorized but uncompleted TASK, less (3) all
previous payments.
ARTICLE VI: INSURANCE
A. The CONSULTANTS shall indemnify and save harmless and defend
the COUNTY, its agents, servants, and employees from and against
any claim demand or cause of action of whatsoever kind of nature
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arising out of error, omission or negligent act of the CONSUL-
TANTS, or its agents, servants or employees in the performance of
services under this Contract.
B. The CONSULTANTS will secure and maintain during the period of
this Contract Worker's Compensation Coverage as well as insurance
to protect against claims for damages arising out of bodily
injury, including sickness, disease or death, and injury to or
destruction of tangible property, including loss of use resulting
therefrom caused by CONSULTANTS, or its agents, servants, or
employees in an amount not less than $1,000,000 per person and
per occurrence, with a deductible of not more than five (5%)
percent of the policy.
C. The CONSULTANTS will furnish the COUNTY Certificates of
Insurance including the amounts of coverage. CONSULTANTS shall
cause its carrier to notify COUNTY of cancellation of its policy.
ARTICLE VII: INDEPENDENT CONTRACTOR
It is hereby mutually agreed that the CONSULTANTS are and
will remain an independent contractor, and not an employee or
agent of the COUNTY.
ARTICLE VIII: NEGOTIATION DATA
The CONSULTANTS hereby certify, covenant and warrant that
the fee rates provided to the COUNTY are accurate, complete and
current as of the date of negotiations. It is further agreed
that said fees provided in Attachment "A" hereof shall be adjust-
ed to exclude any significant sums where the COUNTY shall deter-
mine the fee was increased due to inaccurate, incomplete and
non-current rates. All such Contract adjustments shall be made
within one year following the date of final billing or acceptance
of the work by the COUNTY, in writing, whichever is later.
Records of reimbursable costs incurred under terms of this
Contract shall be maintained by the CONSULTANTS and made avail-
able to the COUNTY during the period of this Contract and for one
year after final payment is made.
ARTICLE IX: OWNERSHIP OF DOCUMENTS
It is understood and agreed that copies of all documents,
including detailed reports, plans, and reproducible drawings,
prepared or obtained by the CONSULTANTS with its services hereun-
der shall be delivered to the COUNTY at its request and shall
become the property of the COUNTY, without restrictions or
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limitation on their use, upon final pa)~ent to the CONSULTANTS.
The CONSULTANTS shall not be liable for any use by the COUNTY of
said documents or data if modified in any manner without written
approval of the CONSULTANTS.
ARTICLE X: STANDARDS OF CONDUCT/CONFLICT OF INTEREST
A. The CONSULTANTS warrant that they have not employed or
retained any company or person, other than a bona fide employee
working solely for the CONSULTANTS, to solicit or secure this
Contract and that they have not paid or agreed to pay any person,
company, corporation, individual or firm other than a bona fide
employee working solely for the CONSULTANTS, any fee, commission,
percentage, gift, or any other consideration contingent upon or
resulting from the award of this Contract. Except that subcon-
tractors, who assisted in the presentation of the CONSULTANTS'
proposal without fee, will earn fees for service as part of this
project.
B. The CONSULTANTS covenant and agree that they and their
employees shall be bound by the standards of conduct provided in
Section 112.313, F.S., as it relates to work performed under this
Contract, which standards referenced will be made apart of this
Contract as though set forth in full herein. The COUNTY reserves
the right to cancel and terminate this Contract, without penalty,
in the event that the CONSULTANTS or any employee, servant, or
agent of the CONSULTANT is indicted or has a direct information
issued against them for any crime arising out of or in conjunc-
tion with any work being performed by the CONSULTANT for or on
behalf of the COUNTY. It is understood and agreed that in the
event of such termination, all tracings, plans, specifications,
maps, and data prepared or obtained under this Contract shall
immediately be turned over to the COUNTY in conformity with the
provisions of Article VII hereof. The CONSULTANTS shall be
compensated for their services rendered up to the time of any
such termination in accordance with the provisions of this
Contract. The COUNTY also reserves the right to terminate and
cancel this Contract in the event the CONSULTANTS shall be placed
in either voluntary or involuntary bankruptcy or an assignment be
made for the benefit of creditors.
ARTICLE XI: COMPLIANCE WITH FEDERAL, STATE AND LOCAL LAWS
The CONSULTANTS shall comply with all Federal, State, and
local laws and ordinances applicable to the work or payment for
work, and shall not discriminate on the grounds of race, color,
religion, sex, or national origin in the performance of work
under this Contract.
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ARTICLE XII: ASSIGNABILITY
The CONSULTANTS shall not assign any interest in this
Contract, and shall not transfer the same (whether by assignment
or novation) without the prior written approval of the COUNTY,
provided that claims for the money due or to become due the
CONSULTANTS from the COUNTY under this Contract may be assigned
to a bank, trust company, or other financial institution, or to a
Trustee in Bankruptcy, without such approval. Notice of any such
assignment or transfer shall be furnished promptly to the COUNTY.
ARTICLE XIII: ATTORNEY'S FEES
If the COUNTY is required to institute or defend any legal
proceedings against the CONSULTANTS in connection with this
Contract, the CONSULTANTS agree to pay the costs thereof, togeth-
er with reasonable attorney's fees for COUNTY'S attorneys in the
event such legal proceedings are terminated in favor of the
COUNTY.
ARTICLE XIV: MISCELLANEOUS
A. The prov~s~ons of this Contract shall be construed according
to the law of the State of Florida.
B. Should any section, clause, sentence or prov~s~on of this
Contract or the application of such section, clause, sentence or
provision be held to be inoperative, invalid or unconstitutional
under the Constitution of the laws of the State of Florida, the
invalidity of same shall not be held, deemed or taken to affect
the enforceability, application or intent of the remainder of
this Contract, which shall remain in full force and effect to the
extent reasonably possible.
C. The CONSULTANTS specifically agree that nothing contained in
this Contract shall be construed as creating any personal liabil-
ity on the part of any present or future individual member of the
Board of County Commissioners of Monroe County, Florida, or of
any officer, agent, or employee of said COUNTY.
D. This Contract constitutes the entire Contract between the
parties and may not be modified except in writing after the
approval thereof by the COUNTY at a duly convened meeting of the
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Board of County Commissioners.
E. This Contract shall be binding on the successors of the
COUNTY and the successors and assigns of the CONSULTANTS.
IN WITNESS WHEREOF the parties have herein placed their signa-
tures and seals on the date first above written.
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By: -u:.-::---' I Ch .
l'Jayor a~ltnan
(SEAL)
Attest:
Clerk
WITNESS
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/~ i4,
ARTHUR YOUNG & COMPANY
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As: P~aR
APPRovr:'D.':s TO FOf::lIl
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EXHIBIT "A"
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TASK I - CURRENT SYSTEM ANALYSIS
1.1 - Plan and Initiate Project
To assur~ the success of the project, it is important to
develop project and management plans, including controls for
the execution of tasks and adherence to delivery dates. To
complete this subtask, we will:
Establish
staff and
County;
appropriate communications between
appropriate representatives of
project
Monroe
Identify availability and sources of existing data and
information;
Revise detailed' workplan, as necessary;
Conduct a project planning and orientation meeting;
and
Agree on dates for .delivery of reports, drafts,
presentations, etc.
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1.2 - Document Current System'
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The first step in the current system analysis is to document
and understand the current EMS system in operation in Monroe
County and its history. This will not only provide a basis
for evaluating the current system, but will also provide our
pro j e c t tea m wit h an' un d e r s. tan din g 0 f the un i que nee d s ,
problems and constraints under which an EMS system must
operate in Monroe County.
1.3 - Collect Historical Data
Data will be collected relating to factors such as:
.
Points of origination
Diagnosis distribution
Response type
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Type of treatment (advanced
basic life support (BLS))
Age of patient
Destination
Time of day
life s~pport '(ALS) and
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1.4 - Process and Analyze Data
Various analyses and cross tabulations will be performed to
develop a profile of the current EMS delivery system. This
profile will provide part of a basis for identifying current
strengths, weaknesses, problems and needs.
1.5 - Interview Current Providers of EMS Services in Monroe
County
Interviews will be conducted not only wi th leaders of the
EMS seryices, but also wi th a sample of those i nd i vi duals
who provide the service on a day-to-day basis. Experience
ind i ca t es that these providers of ten have un ique 1ns1gh ts
into the current system's needs and problems.
1.6 - Interview Other Relevant Parties
Interviews will also be conducted with various other parties
who affect, or who are effected by, EMS services. The list
of parties who would be inteviewed includes:
· Area hospital administrators
· Emergency Room physici~ns and staff
· Medical directors
· County officials
· M~nicipal officials of relevant municipalities
· Others, as identified or requested by Monroe County
representatives
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1.7 - Summarize Existing Strengths, Weaknesses, Problems and
Needs
Th is summary will provide a basis for recommenda t ions to
improve the system and will be used to communicate the
results of the current system analysis to Monroe Countr
representatives.
1.8 - Recommend Short-Term Improvements to Current System
Our experience indicates that some of these recommendations
can be implemented immediately so that the ben.efits of
improvements in the current system can be r~alized while the
project is underway.
TASK II - PRE-EVALUATION ANALYSIS
11.1 - Identify Several Alternative EMS Delivery System
Models for Preliminary Consideration
These alternative models will be identified based upon:
. . The results of the Current System Analysis
. Our project team's experience
. The experience of other cities and counties within
Florida and in other parts of the Country
. Discussions with appropriate Monroe County personnel
11.2 - Develop Preliminary Evaluation Criteria
These criteria will highlight the major factors affecting an
EMS delivery system's desirability.
11.3 - Conduct Preliminary Evaluation
This subtask will involve evaluating each alternative to
reduce the number of alternatives for further analysis.
This screening mechanism will assure that significant time
and effort is devoted to only these alternatives which
warrant furtber evaluation.
11.4 Review Selected Alternatives with County
Representatives
To assure agreement on the alternative EMS delivery systems
to be evaluated in detail, we plan to review results of the
preliminary evaluation with representatives of Monroe
County. This review is especrally important since only the
selected alternatives will be subject to the more extensive
and detailed evaluation to be conducted in Task III and Task
IV.
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TASK III - OPERATIONAL ANALYSIS
111.1 - Develop Specific Operational Requirements
For each alternative selected in Task II, we will develop,
at a minimum, the following requirements:
. Manpower requirements (current and anticipated)
. Training (EMT and Paramedic)
· Vehicles
· Com~unications
· Management
· Equipment
· Facilities
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111.2 - Develop Operational Evaluation Criteria
These criteria will form the basis for evaluating the
various alternatives on an operational basis. Examples of
the types of cri teria which may be included are presented
below:
· Response time
· Political acceptability
· Ability to handle growth
· Recruitment requirements
. Training requirements
. Management capabilities
· Others
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111.3 - Apply Operational Evaluation Criteria
Results of this task will include a ranking of the various
alternatives on an operational basis.
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111.4
Review Operational E~aluation with Monroe County
Prior to finalizing the operational evaluation, the results
of the analysis will be reviewed with appropriate represen-
tatives of Monroe County to help assure that all critical
operational factors have been appropriately considered.
TASK IV - FINANCIAL ANALYSIS
IV.! - Analyze Historical Revenues and Expenses
As a basis for the financial analysiS, historical financial
information will be gathered and analyzed.
IV.2 - Develop and Analyze Historical Revenue and Cost
Relationships
Historical ratios of revenues and costs pe~ unit oj service
provided will be calculated, and historical trends will be
analyzed to provide a means for developing financial projec-
tions for various alternatives.
IV.3 - Develop Financial" Model
A computer-assisted financial model will be developed to
facilitate the financial evaluation of various alternatives
under a number of different assumptions, such as utiliza-
tion, inflation and user-charge levels.
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IV.4 - Identify Alternative Funding Mechanisms
Al terna t i ve fund i ng sources appl icable to each aft erna t i ve
will be identified. Included in these funding sources will
be alternative levels and methods of user fees.
IV.5 - Analyze Costs, Revenues and Funding Sources
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The computer-ass isted f inanci al model wi 11 be ut i 1 i zed to
analyze the costs and revenues associated with each altern-
ative. In addition, the impact of various funding sources
and the! r effect on both user fee levels and the County's
cost will be evaluated.
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IV.S - Review Financial Analysts with Monroe County
Before finalizing the financial analysis, the results of our
work will be reviewed wi th appropriate representat ives of
Monroe County to assure that all critical financial factors
and potential funding sources have been considered.
TASK V - EMS MASTER PLAN DEVELOPMENT
V.l - Recommend Best Alternative
Based upon the analyses conducted in Tasks III and IV, the
most effective EMS alternative that satisfies the County's
needs will be recommended. A ranking of all alternatives in
terms of their relative desirability will also be included.
In addition, the most desirable funding source and the
appropr ia te level of user charges under each al ternat i ve
will also be recommended.
V.2 - Review Recommendations with County
Our recommendations wil~_be reviewed with representatives of
Monroe Co~nty including, if appropriate, the Board of County
Commissioners. It is anticipated that at this time the
County will adopt our recommendations, or one of the other
favorably evaluated alternatives. The adopted alternative
will form the basis for the EMS Master Plan for Monroe
County.
V.3 - Draft Comprehensive EMS Master Plan
We will prepare a first draft of the comprehensive EMS
Master Plan whicb will reflect the recommended pre-hospital
care and transport and secondary transport systems, and will
al so add ress other components of EMS. The recommendations
resu 1 t i ng from t he Current System Anal ysis (Task I) wi 11
form part of the basis of the EMS Master Plan.
V.4 - Review Draft EMS Master Plan with County
Representatives
To obtain agreement on the elements contained in the EMS
Master Plan, we will review the plan with appropriate person-
nel which may include County Administration, the Director of
Emergency Services, bospital representatives and the Monroe
County Chiefs Association.
V.5 - Finalize the EMS Master Plan Document
As a result of the review of the EMS Master Plan, we will
prepare a final draft of the EMS Master Plan document for
Monroe County.
V.s - Present EMS Master Plan to the Board of County
Commissioners
We would formally present the results of our work on the EMS
Master Plan for Monroe County to the Board of County Commis-
sioners for review and approval.
Output
Upon completion of final reviews and approval by the County,
we would plan to present three separate reports which are de-
scribed briefly below:
· Current System Analysis - This document will contain
the results of Task I of this project and will
include specific recommendations concerning ~hort-term
improvements to the County's EMS _ system. These
recommendations would be designed to achieve improve-
ment s whi Ie the projec t is proceed i ng (these recom-
mendations will be communicated in draft form during
t he ear 1 y stages._~~ the projec t) .
· Analysis of Al ternatives - This report will present
the results of Task II, Task III and Task IV and will
i nc 1 ude a speci f ic recommendation regard i ng the best
alternative and the means by which pre-hospital EMS
services should be delivered in Monroe County.
· EMS Master Plan This comprehensive document will
address the enti re EMS system in Monroe County and
will include obj~ctives, methodology for achievement,
time frames, participants required, restraints to
ach i evemen t, bud get cons idera t ions and sou rces of
funding.
Project Schedule
We are prepared to begin this project wi thin two weeks of
receiving formal approval. The timing of each task is presented
in the project schedule on the next page. In total, we estimate
tha t the en ti re project wi 11 requ i re approx ima tel y 17 weeks of
elapsed time.
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l~. PROFESSIONAL FEES
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The costs of our professional services are determined based
upon the standard rates of the consultants to be assigned to the
project and the estimated number of hours each consul tant will
work on the project. Out-of-pocket expenses for travel, report
preparation and other items are also billed at cost.
We are very interested in conducting this project for Monroe
County. Accordingly, we would plan to discount our professional
fees by 10% to reflect our interest in working with the Monroe
County EMS system.
The details of our proposed professional fees are presented
on the next page and are summarized below:
Consultant
Hours
Hourly
Rate
Fees
G. Wexelbaum
T. Romano
.T. Weldon
T. Wolfenberger
Total
10% discount
Total professional fees
188
202
88
212
690
$155
100
105
55
$29, 140
20,200
9,240
11,660
70,240
(7 , 024)
~63.216
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In addi ti"on to the above, out-of-pocket expenses which are
estimated at 10% to 15% of the professional fees, will be billed
as incurred.
We would plan to bill monthly for fees and expenses incurred
during the previous month.
.
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