I'm gonna ask uh a celebrity in the audience to lead us in the Pledge of Allegiance, Sparks Mayor Ed Lawson.

What a privilege.

Hello, Mr.

Mayor.

For which it stands.

One nation underducible with liberty and justice for all.

Mayor Lawson, thank you so much for being here.

Always a privilege.

Madam Clerk, we'll move to item three, which is public comment.

I'll note for the audience the public comment today is going to be a little different than we normally do at uh the chair's direction.

We're going to allow public comment at the beginning of the meeting and the end as we always do, but also public comment specifically on item eight on the agenda.

And so if you're here to talk about eight, you would want to do that under agenda item eight.

You're free to do so also in one or two at the beginning or end.

But that's where we'll hear it most likely.

Um, Madam Clerk, I'll let you read what you need to read.

Uh for the record, my name is April Miller.

Comments heard under this item will be limited to three minutes per person and may pertain to matters both on and off the board agenda.

Unused time may not be allocated to other speakers.

Comments are to be made to the board as a whole, and virtual public comment may be taken when facilities are available.

A speaker's viewpoint will not be restricted.

However, reasonable restrictions may be imposed upon the time, place, and matter of speech.

Irrelevant statements, and duly repetitious statements and personal attacks would be a that would be objectively antagonized or incite others are examples of speech that may be reasonably limited.

This board carries out the business of Northern Nevada Public Health and its citizens during its meetings.

The presiding officer may or uh may order a person removed at the person's conduct or statements disrupt the order or safety of the meeting.

Warnings about disruptor of conduct or comments may or may not be given prior to removal.

Furthermore, certain disruptions of a public meeting are criminal acts as defined under NRS, which may result in prosecution inappropriate cases.

And we also have received 37 public comments via email and e-comment.

These have been forwarded to the board members and entered for the record, but will not be read aloud.

Mr.

Daly, thank you.

Welcome and afternoon.

Followed by Ed Lawson.

Okay, and if you're speaking, you're coming down, and if you're on deck, you're getting closer.

If you're in the hole, that'll be the third person will announce that.

Thank you so much.

Mr.

Daly, welcome.

Thank you, Mr.

Chairman and members.

For the record, I am Thomas Daly, a resident of Washington County.

I would ask my comments today to be entered into the record of this meeting.

Are a detriment to public safety and lack of transparency.

When those response times are inadequate or far beyond the national standard of eight minutes.

The result was a reduction in response times to the eight minute mark in Damonty Ranch, Geiger Grade, Blugson Valley, and the Mountain Rose Highway communities.

Despite that success, Remsa withdrew the ambulance with no notice to those communities.

Why you might ask?

Because the ambulance failed to produce sufficient transport revenue to meet REMS's financial model.

So the needs of citizens for prompt emergency medical services were sacrificed on the altar of financial expediency.

REMSA services are revenue driven first and public safety driven distance second.

Only the Northern Nevada Health District can impose conditions in the pending franchise agreement renewal to compel REMSA to improve response times.

Other anomalies in this renewal allow REMSA to stop reporting the number of staffed ambulances on duty each day and allows REMSA for priority one calls to dispatch its available ambulance, even if arena or trucking meadows medic unit is the closer unit.

And given the pending area wide study of possible fire EMS consolidation, why extend this agreement now?

It has to 2020 30 to run.

If this consolidation study makes recommendations, they certainly will affect REMSA.

I urge you to continue this matter until next year.

Thank you.

Mayor Law said welcome.

But can we let me know who's on deck and who's in the hole?

Um yes, before we proceed, um, uh Dr.

Danko has joined out 104.

Thank you so much.

Dr.

Danko, can you hear us?

Yes, I can.

Can you hear me?

So much.

Okay.

And uh next up is Ed Lawson, and then on deck will be Monica Miles, followed by Grant Denton.

Thank you so much.

Mayor Lawson.

Thank you, Mr.

Chair.

And uh it's odd for me to be on this side of the dais, but I'm gonna do my best.

Um I got this contract yesterday to read, and uh in my past life, I had to read contracts before our company signed them.

And my job was to find adverse conditions to my company.

Um, I found 13 in this contract, and I want to just stress two of them.

One is the termination of the contract under 17.4.

There's five years' notice, but only you can only give this five years' notice if you have secured funding to purchase more efficient and cost effective, and it's been publicly vetted and approved by Reno Sparks in Washoe County.

It's what it says in the contract.

That's a pretty high bar, number one, considering that the last uh filings for uh 490 for RemSA report about 78 million dollars in revenue with the buyout that's required in this contract, and and I'm gonna be very low end on this.

25 million dollars more.

That would mean that anyone who wanted to take this contract over would have to have secured financing five years in advance after approval and before you you even know what's gonna happen in five years.

So many things can happen in five years.

We've seen that happen for us so far uh this year.

So the cancellation part of it, this is a contract, and it says it right in here.

It is under 2.5.

Remsa Health shall retain the exclusive right to operate good ambulance services within the franchise service area on a perpetual basis, unless otherwise terminated in accordance with 17, which I just recited to you earlier.

So this contract is meant to be perpetual.

Now, you're encumbering the next decades and decades of future board health members, of future council people, of future people that are making decisions for our community with this contract.

So with that, there's a lot to be learned.

There's a lot to be said.

Uh my understanding is some of the things that Sparks asked for were either ignored or eliminated from the contract.

Uh, this cannot be done in a vacuum.

So I was gonna suggest we postpone this.

Let's have some more public meetings about it.

Let's talk about it more.

There is no hurry.

This contract doesn't expire until 2030.

We're in no big hurry to get this thing done.

We also have the consolidation of fire going up.

How does this uh contract roll into possible consolidation of fire for the entire area, which could provide better service and safer service for our citizens?

So I'm urge you to postpone this.

Thank you.

Good afternoon to the board.

For the record, my name is Monica Miles.

I'm the director of operations for Nevada Donor Network, a local nonprofit responsible for facilitating Oregon Eye and Tissue Donation for transplant.

Our organization has been partnered with REMSA Health for many years, and I'm here to just share our collaboration and our perspective on that partnership.

Remsa Health has supported our life-saving work in a multitude of ways over the last decade of partnership.

As a trusted organization within our community, their regular involvement in our public outreach efforts and events has helped expand the reach of our messaging, encouraging more Nevadans to register as Oregon I and Tissue donors.

They have assisted with critical and time sensitive transport of transplant surgeons and precious donated organs from local hospitals to the airport, ensuring that waiting recipients can receive life-saving transplants so graciously given by heroic donors.

Additionally, they have worked with our team collaboratively collaboratively to develop a process that helps ensure that the wishes of registered donors and families are honored in situations where all life-saving measures have been unsuccessful in the field.

This not only has assisted with making tissue and ocular donation possible in more situations, but it has provided their team members with another way of serving the community in tragic end of life scenarios.

It's important to note that these collaborations are entirely voluntary and they reflect REMSA's commitment service.

We are grateful to our partnership with RemSA Health and their dedicated team, and we share our support.

Thank you.

For the record, the next step is Grant Denton.

For the record, Grant Denton.

Um I had a really extensive, profound statement prepared.

Uh that's in the truck.

So it's gonna freestyle.

Um I don't know much about uh contracts or finances things.

I didn't unpack that, but I'm here to speak about my relationship with Remza Health.

Um in the beginning of Karma Box when we started, we had a lot of uh engagements with them.

I called us the presponders because we were the ones that were calling the first responders.

And uh, and we spent a lot of time with them, of course, out on the street when we're calling for us, but it but it really got we really got engaged when we when the CARES campus opened.

To say the least, it was a little bit messy.

Just like when you start anything, things are messy.

What makes it uh what where the value comes from is when people uh when you start being able to perform well with people when you start collaborating and communicating well.

And uh with Remsa from the beginning, I mean, when it was uh when Dean was there and then Barry, they were always uh quick to answer our calls when there were any issues that came up.

They were very responsive.

They always engaged uh with us directly when there's any training that we needed, they leaned in.

And then um, and also the uh and also they were like really sensitive to our needs as well.

And when we had any issues, we would throw back and forth.

Um their most recent, I want to speak to their most recent uh program, the mobile integrated care program, uh led by Laura Lingman, who we've spend a lot of times with over the course of years just in um learning the population and how to how to best serve the population, how to best work together with this uh population to minimize emergency room calls to minimize calls and uh to the to the uh safe camp and to the CARES campus.

And so I'm I'm speaking behalf of the contract uh or whatever.

Whatever this thing is.

Uh I'm speaking of that uh in a positive way because I've worked with Remsa and I can't speak enough because we do have agencies that I mean that's one of the biggest issues you'll ever have when you're doing this is how do you collaborate?

So uh so yeah, I'm speaking in favor of it and thank you.

Mr.

Denton, thank you so much.

That is all the public comment for um this item.

Okay.

If there's no other public comment in the general public comment period, I'll close it, but I'll look to the room to see if there is.

Is there any no one's online?

Yeah.

Okay, we'll close out this item and move on to item four on the agenda.

That is the approval of our agenda.

Mr.

Chair uh Dr.

Kingsley, are there any changes to the agenda as written and posted?

None at this time.

Thank you.

Okay, I'll seek a motion.

I'll move to approve.

Okay, I have a motion by Mr.

Brown, a second by Miss Andreola.

Any other questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Auditing.

Motion carries unanimously.

Item five are recognitions.

Dr.

Kingsley.

Recognize Deputy District Health Officer Aaron Dixon.

Ms.

Dixon, welcome.

Good afternoon.

For the record, uh, Ms.

Aaron Dixon, Deputy District Health Officer.

I have the honor of recognizing two staff members.

One is recently retired, Mr.

James English.

He was with us for over 25 years as a supervisor in our environmental health division.

He retired very recently, January 8th.

We appreciate his commitment to public health and all that he has done to improve our community.

Many of you may remember his strong leadership role during our COVID response, and we wish him the best in his well-deserved retirement.

So definitely congratulations to Mr.

English.

And then for years of service, we only have one today.

He is with Air Quality.

He's an air quality special specialist, and he has reached his five-year milestone.

He is part of our planning and monitoring team, and he is often the one that sends the much appreciated weekend air quality preview so that we know what's going to happen as we head into the weekend.

So that is it.

Thank you.

Thank you, Ms.

Dixon.

And I want to just say thank you to both our award years of service recipients, but also specifically Mr.

English for the time that he gave.

He was a great employee.

Next recognizing French Rubio for Health Heroes.

Good afternoon.

For the record, French Rubio, an EHS office specialist.

For the month of December 2025, the Health Hero Committee has recognized Deborah Nord for the values of compassion, inclusivity, and trustworthiness.

She is also from CCHS.

So Debbie truly went above and beyond her job responsibilities to support one of our clients in a moment of crisis.

Her compassion initiative and genuine care for the client were truly above and beyond the call of duty.

We are incredibly lucky to have Debbie on our team.

And that is all.

Thank you.

Ms.

Rubio, thank you so much.

That'll close out item five.

We'll move now to the consent items.

I'll look to my colleagues to see if anyone has any items they wish pulled from the consent agenda.

If not, I'll seek a motion.

I'll move to approve.

Okay, I have a motion by Mr.

Anderson, a second by Miss Andreola.

They're trying to run neck and neck.

Any additional questions or comments at this time?

Hearing none, I'll call for the question.

All those in favor, please signify by saying aye.

Aye.

Aye.

Any opposed?

Motion carries unanimously.

Item seven is a monthly report, and I'll welcome Mr.

DuPlantis for that report.

Good afternoon, Chairman Reese, members of the board.

I'm Barry Duplantis, President and CEO of Remsa Health for the record.

I understand you've been provided with a copy of Remsa Health's November and December 2025 franchise reports.

For November and December, and for the fiscal year to date, REMSA Health exceeded franchise response compliance and priority with priority one calls in all franchise zones.

Specifically, uh in November, zone A was 90%, zones B C D, 95%.

December, zone A, 90%, and zone B C D, 9 90%.

Year to date averages, 91% in zone A, 94% in zones B C D.

In December 2025, we had an especially busy month with 8,790 responses and 5,000 789 transports to area hospitals, particularly as we experienced a strong spike in influenza.

Remsa is very dynamic and was able to readily address this spike in call volume.

Our customer survey reports for the months of November and December respectively.

Uh reduced scores of 93.77 in November and 94.98 in the month of December.

Our highest scores were cleanliness of the ambulance, care provided by the emergency medical transportation service, and care shown by the medics who arrived with the ambulance.

These ratings were higher than national averages for the data base that we are a part of.

Our goal is to provide our community with timely, compassionate, high quality emergency pre-hospital care on a 24-7 basis, 365 days a year.

That said, I'm happy to address any questions you may have on these items at this particular time.

Thank you so much, Mr.

Duplantis.

I'll look to my colleagues.

Any questions for Mr.

DuPlanus at this time for this month?

Mr.

DePlanus, I have a couple of questions.

I wanted to ask.

I wanted to ask specifically one of the public commenters, Mr.

Daly, who is a very knowledgeable advocate in this space, uh, had spoken about a specific region.

I'm not familiar with the regions, um, and so would you just tell me about the south region of Reno, what region is that?

I to answer that question specifically, it's a little difficult for me because I don't have a map in front of me showing me all the particular areas.

Why I'm confused too, so because I don't have a map.

But but our um zones are defined by by the county uh based on population density and where people live.

Um the higher density areas constitute zone A.

Uh and then as you move out from the core, uh it becomes B, C, and D, uh, where the response times requirements are not as uh strenuous because it recognizes that you can't be everywhere all at once.

Um so to really address uh Mr.

Daly's question very specifically, I'd have to look into the details of where things are on the map.

Let's put a pin in it.

And what I'd like to do is find out from you when we come back next month for your report if you can just educate us a bit more as a board about the zones and then tell me where you are in meeting the targeted goals.

Because I think you're meeting them.

Your report suggests that you have met them significantly and consistently over the last I'll just say four years that I've been on the board.

And so I just want to make sure that when um citizens inquire of a thing that they know we're listening to them, and I want to know the answer to it.

So we'll put the pin in that for next month.

Be happy to do that.

Yeah, fantastic.

Thank you, Mr.

DuPlanus.

Um, is there any other questions from the board?

Okay, hearing none, I'll just ask for uh acceptance of the report.

Okay, Mr.

Brown on the first.

Thank you so much.

Uh we've got a second and a first.

Any other questions at this time?

Hearing none to call for the question, all those in favor, please signify by saying aye.

Aye.

Aye.

Motion carries unanimously.

Okay.

Item eight.

I don't know that anyone's here for this item, but we'll see.

Item eight.

Um Dr.

Kingsley, I know you're going to lead us in a presentation.

Um, I want to make sure that we, because we don't always have uh public comment on individual items, and so I'll just sort of see what the uh flavor of the body is.

Um we might all have questions, um, but I want to make sure we uh have our public comment uh appropriately uh put there.

So we can do that in one of two ways.

We can have Dr.

Kingsley tee up the issue, speak to what he wants to speak to, and then allow public comment, bring Dr.

Kingsley back, and then you would have the opportunity to question, or we can have public comment go before the item.

What is the body's inclination?

Presentation.

Presentation first.

Okay.

The vice chair rules, and so we'll do a presentation.

Dr.

Kingsley, you'll get us teed off.

And if you could just hold your questions at this time for Dr.

Kingsley, uh, and he'll be prepared to answer them when he comes back, but after public comment.

Thank you.

Good morning or good afternoon.

Dr.

Chad Kingsley, District Health Officer, Northern Navida Public Health, for the record.

I want to thank everyone in attendance as well as the board for this opportunity to present.

This is Phil Sunvat, like the Super Bowl for Northern Nevada Public Health and uh a 40-year process and we're at on this point.

So, first, as we begin, and this is a very important topic, but I always believe a good point is to start with what's good, but overall gratitude.

And I want to state those in the room, those not in the room, that the District Board of Health as well as Northern Ad Public Health and our community are grateful for public safety and public health systems that protect, preserve, and prevent to make our community resilient and healthy.

So thank you for the EMTs and paramedics and our fire agencies and the good work that so many do.

And thank you for the district board of health for your focus and your attention to these to these matters and uh for our constituents and for our community.

So thank you across the board.

Um I'd like to set a north star for our conversation.

And these are points that I always adhere to when we go in through these and always go back to least cost to the community with focus on positive patient outcomes.

This was established in 1980 when uh when the public model was established and for REMSA, that was a priority and it continues to be a priority for our for our constituents as well as our community members.

Operational criteria to ensure EMS stability, efficiency, and regional uniformity.

That was the reason that one of the reasons that this was included, I believe, in NRS to provide a uniformity to allow us to be able to meet the needs and not have a diversity through division of different companies.

So this regional uniformity has always been important for us, and second that North Star, but the stability and efficiency equally is important.

Next, the right resource to the right place at the right time.

And lastly, for the board and for our community, informed decisions.

We need access to data, sharing, and transparency for our community, for the board, so that we know we are making informed decisions.

There are always sentinel events, there's always outliers and understanding where those come from and what they are, and understanding so we can have the correct data to so that I can provide Northern Meta Health can provide you as the board and our community with that data to make the informed decisions.

So some of the summarized purpose.

Again, this is a 40-year process that has delivered us to here today.

And so there's there's so many points we could go through, but I wanted to summarize where we are here about a year and a half, and uh what I was directed to and what to bring to this board for this franchise agreement, and what uh since May 2024 has been worked on and brought to, but the why's the what's the who's and the wins.

So purpose, the who.

The district board of health is the authority over EMS for granting a franchise agreement.

And Remsa Health, it currently is our provider.

These are the who's of it.

The stakeholders, we have our fire agencies, and currently uh two of them are subcontractors that they are contracted and have contractors with REMSA to deliver EMS services.

We also have our health care system, and this is partly how REMSA was designed.

The REMSA board is staffed with individuals that live within our community.

It's not a corporation that is run in another state, another city.

They represent our hospitals and our three largest hospitals.

So the hospitals are at the board or are at the table in discussion.

So in recognizing this, when we bring everyone to the table, REMSA also represents that portion of our community, which is the hospitals, and these are part of the stakeholders.

And then there's the public, and this is part of the reason why the ILA was had EMS authority put into it, because there is three elective represent representatives for our community that sits on this board to represent our public and their interest.

So the what?

This is a negotiated contract with two parties, the District Board of Health, and through that Northern Northern Nevada Public Health acting on their behalf and REMSA Health.

Understanding that's a contract.

This is not regulations, ordinances, fees that have a very precise and community and defined how we bring those forward to the board.

We have open meeting law, and we are lawful and the the district board health is lawful agenda and for transparency and representation.

It's not poor performance when we are dictated to post to the public and the district board of health the final document before anything else.

We legally have three days, we provide seven.

And so there are challenges to that, but please recognize and grace on that point, and for that we do follow and meet the meeting law and how we meet with our members to be able to continue to uh negotiate through these processes.

Now, overall in DHO analysis coming into is looking at that.

What's not representative, I can just say and see what I can see, there's room for improvement.

We have a veteran hospital.

They're not on the REMSA board.

They receive EMS services.

When we began, our population was significantly less.

Now we're at 500,000.

We have numerous skilled facilities in rehab that also deal with EMS.

And we also have tribal partners.

They're not at the table.

These are things in the future to address that it would be important for us to be able to hear their perspective and bring them into the conversation.

Secondary Who.

This is where Nevada, and especially where we are, we get a little, we get a little muddy.

While we have the right to grantize a franchise agreement, and we do much of our authority through that, we are still not certain EMS authorities.

That is the state.

So when sentinel events, which is an event such as severe injury up to death occurs, that actually lies with the state.

It is their process and due process to review that and correct that.

They also set our protocols.

Now we've gone through several iterations in this community of trying to develop a committee to have that locally, and they've never lasted.

And so we need to understand that we are pulled in different directions and we have different challenges.

Now, recently, last legislation, AB 102 was one passed where Northern Northern Nevada Public Health could adopt that authority, which would allow us to be able to address those sentinel events and issues that occur within our EMS system and be able to address them locally as we know them.

And so this is a one thing that we are moving towards and will be bringing to the board eventually, but we're working with our partners on that, and we've had our first meeting.

The who and when there's formal and informal.

At that, it was to be brought forward in July and June 30th of 2024 was supposed to be the six year renewal.

That was not taken in September, it was not brought forward to the board, and direction given that to continue meeting with our stakeholders to inquire and provide and find what amendments, what needs to be made.

So work through that.

And thankfully, in January to May 2024, and recognize JD JW Hodge, uh deputy manager for City of Reno, who's very well respected and uh within our community for EMS, uh, took the challenge to prove to coordinate again discussions on the franchise and as well as dispatch, which was which was identified as one of those items that was not low-hanging fruit, but one of those heavy lifts challenge.

And so we started to address it there.

In that meeting, where the fire chiefs, EMS fire chiefs, Ramsa Health, in that Northern Nevada Public Health was not invited, which I was good with.

Sometimes the conversation say, maybe it's us, we won't be in the room.

We'll wait for those amended to come back, and then we'll go back into negotiations with uh with REMSA Health.

That occurred, we received those changes, then we began to meet and negotiate again based on those recommendations given to us.

What amendments do you want?

That led us to October 2025.

And so we had developed the amended contract to that point, was brought to the board.

Again, it was brought that.

Can we postpone and have more meetings to discuss the the options on the on the franchise agreement?

So following that meeting in November 2025, I organized a discussion for negotiations.

I clearly sent an email that this will be one of those meetings that let's get everyone in the room, lock the door and come to a consensus or come to what changes do you want.

Please submit to me beforehand your required changes that you would like.

In that meeting, I received comments from City of Reno that said that due to all the changes previously, they were comfortable with those changes, which had been submitted, and they were comfortable with that.

Due to the time and turnaround, I did provide more grace and did receive comments following that from Trekie Meadows Fire as well as uh Sparks Fire from those comments again.

Then we go into negotiation.

But that was that event that we had gone through already over a year.

We're now over a year and a half of not renewing a contract.

And that meeting was clearly stated.

This is the process we will meet.

Bring those things you want addressed and advised.

And we had that meeting and to change with the understanding that in January we would be here.

So that was clearly stated.

Where we start to begin in that meeting, is that the opportunity for input from the district board of health.

This is ultimately what we're missing.

You are the authority, you are the signer of the franchise agreement.

This has to be brought to you to be able to negotiate, to be able to uh to do.

We did all the work we can, what I was directed to do, and bringing what I was directed to to you.

So December 25 to June 5, we entered in Northern Public Health with RAMSA.

And we we took those recommendations and developed a path forward that we felt was what we heard from the community, what they want and the challenges.

Informally, public and stakeholders, the district health officer, I know as well as myself as Devin Reese, Clara Andrew, Paul Anderson, any time.

And Michael Brown, Steve Driscoll, any time anyone from the board was contacted from any partner in the community, you met with them.

We were accessible, we were contacted, we offered meetings.

I've gone out of my way to continue to have meetings with everybody.

As well, I would like to recognize Northern Nevada public health staff as well as REMSA Health, that in good faith, they also mirrored that.

We've been accessible, we've we've met numerous times with as many stockholders as we can to collect this information to so that we have informed decisions or formed information to where we needed to make amendments.

So where we are today is a living, flexible and adaptive contract that is able to continue to address the interventions of the past or those that are needed, improve decision making through informed data, and provide a path forward for future growth.

What this is not today, it is not perfect.

It is not final, it is not static, it is not done behind closed doors, it is not uninformed, and it's not uncollaborative.

So amendments where we are today.

Key structural and governance updates.

So we redefined parties, they're always defined, but uh further clarification, as well as defining the parties, put in a clause that we will interact with all our stakeholders for collecting information.

That's not in the original contract.

Contracts between two people.

This we we allowed that in to put in that yes, we will always go out to our stakeholders to get information correctly from them and collaborate with them.

The franchise term.

So here is you can work on something sometimes.

If you've worked on contracts, you can spend a whole year.

You sign off, you put it forward, and then you've why didn't I see that one word on the sense?

And so looking at that, a five-year cycle whose tomb is defined by termination rights and responsibilities.

And I'll go into why we went towards that direction.

But if adopted, I would recommend a change to Article 2.5 removing perpetual basis.

It exists nowhere else in the document, but in 2.5, remove that to a five-year cycle.

And to replace that with a five-year cycle to remove the term perpetual.

What this does is sets the five-year cycle would begin in year one.

Year two would be fiscal year 27, fiscal year 28, 3.

You're looking at 28-29, these years 29 and 30.

In those five-year cycles, then it would continue to repeat from there.

There's an annual review every year to come forward and identify issues that exist instead of a 10-year process to come to a final review or a 10-year process to come to a market study.

Market study is done in the third year, now every five years.

That is a third-party entity.

And then in the fourth year is open negotiation for the contract.

So every five years, there's an opportunity to take a whole year that is defined, and how do we approach it?

We have a systematic process with our stakeholders with the district board of health to address those areas in the contract and allow us to make changes.

Now, saying that, there is also conditions that on an annual basis, if we identify an issue that needs to be resolved, we can enter into negotiations.

It's just a guardrails placed there for the district board of health as well as RAMSA and our community that allows us to do it better and more concisely and uniformly.

So if we have an issue, we can now address it every year.

We're no longer be waiting 10 years or more.

This is what how the flexibility, these are the lot of the issues that presented before.

The last time 2014, the market study, we didn't get really until 2023-2022.

That was a 10-year process.

I heard repeatedly that is just too long.

So five-year process to come here to find also how do we continue?

We know we are going to continue to grow.

We are now 500,000.

How do we become flexible?

We know a fire study is coming.

We know a CAD system's coming.

How do we adapt this to be flexible so that we can make changes and adapt with RAMSA as a partner and grow towards that?

That's where the key structural and government updates come into.

And I'll speak about termination, those termination clauses on those points.

Overall, these are the amendments that you have read through operational enhancements, performance oversight, and accountability, financial provisions, technology and communications, compliance and enforcements, quality assurance and reporting, financial provisions.

All these points were what were identified by our partners that we sat and negotiated with REMSA to address that these had been historical issues.

We wanted these identified.

We wanted more control over these issues and be able to address them.

It's definitely in the correct path, those things that we heard and what is there.

And this was through GAC and our partners identifying what do we need.

That's what was put into it.

Outside of the outside, this the this I would say was Northern Public Health and myself trying to define with REMSA how do we provide this governance to provide a better flexible, adaptable document that will allow us to be able to grow and change as we need to with our community.

Interfacility transfer.

I received a lot of antidotal information on this.

40 years never collected, and the information that is there.

Are they sentinel events?

Were these one-offs?

How much is it being charged in price?

So we went out and looked.

We need to collect data.

And I need to be able to verify and provide that data to you.

We went and looked.

Most systems do that we could not identify, but Clark County did have it.

And this is Clark Counties.

Yes, it is set at 80%.

This is the one other similar thing that is similar to Nevada that was set at 80%, which is different from our priority ones.

And but we don't have a beginning point.

And this was the best research beginning point that we had to collect data.

And so in 2029, be able to come back informed that did the district board of health.

This is what occurred over the last three years with interfacility transfers.

This is our recommendation.

As part of this, we I did discuss and put on the table free market, we remove it and provide a free market.

The district board of health is an is it right now.

So there's two sides of this.

There's benefits to a free market and what we get on pricing.

But in a free market, the district board of health has no guarantee to say you will go transport that patient.

So we are able to obligate REMSA as a partner to provide any interfacility transfer.

And if they're not doing it correctly, then we have those methods in there to address it and compliance and compliance to the board to be able to do that on a yearly basis, but also on these metrics.

So I wanted this faith, I wanted to favor the side of our community saying that the district boardhouse ultimately has a guarantee through REMSA to have to provide inner facility transfer in a free market.

I would we would not be able to do that.

Now there's benefits of both sides, and I feel we need the data to make that that decision.

Much was discussed to acknowledge it for the emergency medical uh medical treatment and labor act, uh, Mtala, and then the Federal Deregulation Act of 1978 for air uh carriers and transport service price and route.

Uh, this was many points addressed on these points, was reviewed by our attorneys, and found that uh we found we were not in a sense breaking laws.

Now, if this is contested, it's if it doesn't stand up, it doesn't stand up.

But as well, our attorneys have looked over this and they feel comfortable that yes, on this points we can we can guarantee ground contact.

So, what was postponed?

Not everything made it into this iteration.

This is a challenge on many points, but we wanted to address those things that we collected from our stakeholders.

REMSA health board governance and model, and uh as well as the fire study.

There is pros and cons of of reviewing of this.

This is a heavy lift.

It's community-driven nonprofit.

We receive immense benefits from them within our community.

It's community investment, but there's potential for conflicts of interest, but also that has never, while that has been brought up, it's never been a legal issue for 40 years.

Federal government and insurance uncertainty are approaching, we have fiscal cliffs approaching.

We need a stable EMS system that if any number of our insurance providers lose their coverage, we need to be prepared for that.

And so existing contracts, they have two existing contracts that we wanted to be able to, we need to approach appropriately and have the time to really understand board governance and the model.

While it started out as a public public service model, it has definitely adapted to a very specific model that is just for our community.

RASIDAS originally, as I said, there's so much historical points on this, but there is discussion of RASI dissolution that would then shift them.

They would be the vendor.

They are the vendor on that point instead of being an intermediary intermittent between the district board of health and that contracted party.

That model was shifted, not shying away from it.

Let's understand it.

Let's analyze it and how do we move forward?

We also in 2014 established the EMS interlocal agreement between the three jurisdictions, which is called the MS Advisory Board.

And so that too plays a part in this.

And that would require a superboard of the three jurisdictions getting together to make decisions.

So this was this is definitely a heavy list, but something that we need to address and will continue to address the reason it wasn't just arbitrarily put in there and left as is on this point.

And also the fire studies in 2020 is ending to end in 2027.

We want to see what comes out of the fire study and what best fits our community.

REMSA penalty fees for community investment are partially addressed.

There are points that refinement on those uh for the for those fees.

The district health officer has always decided where those fees go.

Now, historically, that might have just been a signature.

My eyes are on it.

And I would prefer a board decision with those with those with that community investment dollars to bring it to the board on an annual basis.

And prefer that.

Emergency medical dispatch.

Um, so currently, right now, a CAD system is in process of being developed.

It has been delayed.

Next possible date is June 15th.

Um, that is being addressed.

We want that to be able to put forward before we uh address emergency medical dispatch.

So it was addressed in the sense of we will address it and putting language in that allows us to be able to address it.

And those would be one of those events that it's out of the fourth year, but it falls on a year, that is a very specific item.

We're going to address dispatch this year.

We exactly know how to do it.

We're negotiating on this one point, we're gonna open it, settle it, and move forward.

That's where the benefit of a living document comes in.

Special recommendations.

So these are the ones that necessarily didn't make it in that I received.

Postpone until further considerations and fire study dispatch are resolved.

This is a contract.

No action is action.

So the challenge that we have in this uh contractual obligation.

Yes, it is four years away, June 30th, 2030.

We have no secured EMS provider for this community.

You have two sides of the coin to say that well, it's four years.

Fire study, CAD.

When have we ever operated correctly in four years?

How long will that take?

And so it's my obligation to help the board that we are not in a situation a year out with no provider on our community has no provider.

Taking no action at this point is not my recommendation.

We need to first think of our community and secure those providers for our community.

Recommended amendments that we received.

Establish clinical quality metrics and tie them to incentives.

On this one, data is not yet available due to regional constraints.

It goes a lot larger, it's very expensive.

They're working, we have been working to resolve this on a basis.

This isn't just us.

Um, this was worked through JEC and discussed and known by all parties.

Um, so there was nothing in put in there just because it hasn't been developed yet and may it also deals with the state authority on addressing it.

It's it becomes a larger, a larger project with it.

Require a midterm independent performance review and corrective action plan.

They recommended a proposal for every eight years, which was unclear.

Draft amendments uh provide currently draft amendments provide an annual review every year with an additional during the fourth year, and then they also an independent market study every five years.

So eight years seems too long for us to review and wait every eight years to do a midterm independent performance review.

We prefer it be done every five years.

Corrective action plan is again was unclear, has been in place since the early 2000s, the recommendation to adopt one.

And actually in 2023, following REMSA, the district board held took corrective action plans against REMSA, which was corrected and cleared up.

So not only has it been in the document, it has been enacted before.

And strengthening the penalty structure and introduced outlier penalties.

Last year we collected 170171,000.

So we looked at tiered penalties, which would have collected 528,000, sliding penalty, which would have collected 367.

We came to to remove the cap, and that will collect about 200,000.

We want to be mindful of our constituents again here.

We can start raising penalties, but will those fees be passed on to our constituents?

So we want to be mindful and have the correct penalty where it's at.

So by removing the cap allows that again, this can be addressed overlays as uh as we see that where that is at.

Last one was a recommendation for exemptions that REMSA can't exceed 2% on a monthly call volumes for priority one that is published in quarterly, and that it should be published in quarterly ports.

It already is currently published.

It's reported monthly, but to the district board of health.

We could add it to the MSAP quarterly, but doing due diligence, we went back two years.

This is a snapshot.

The closest they even got to 1% was 0.9.

So perhaps this metric is from another community that doesn't correctly dress our community, but this is why this wasn't incorporated because it didn't have weight for us.

And so we did consider everything that was brought to us.

And but these are the spec recommendations, and these are not off the table.

We can continue to discuss these points.

So the franchise agreement, bringing before you today a five-year cycle with termination rights and responsibilities as terms.

There is termination for cause and uh for to address those things if they are out of compliance.

Termination with intent to establish other provider.

Yes, there is a five year.

What if something doesn't go right?

And then what happens?

So five years is a good pace.

It's not 10 like that, but we have the right to study and explore other providers to determine if the grass is greener on the other side.

And so we can do that before we say our intent is to terminate this contract for these reasons.

We'll be moving towards another provider.

We've done the study, but also ensures that we have time to purchase if we need to purchase equipment, set up any transfer of that secure funding government improvement district, allows us to do that.

To have no barrier there is dangerous, I would say.

So that's why I put in the five year there for that termination to uh provider.

And then amendment options, which I've already reviewed.

I think that's the biggest thing is that what we're hearing is it's not a perfect document.

REMSA, we don't want to go away, but we want to address these issues and providing you with the possibility to address it on a yearly basis, but on a more method and appropriate manner with informed decisions on a five-year annual basis.

There's a saying grass is greener on the other side, the grass is greener where you water it.

This is us trying to water our local system so we can make it grow in appropriate.

So at this time, uh, I'd like to provide a few minutes to the REMSA Health CNO president Barry DePlantis, and then at the district boards of dis uh at the District Board of Health discretion, uh, the North Northern Nevada Public Health Preparedness and EMS provider manager, uh, EMS Health Board Representative and EMS Health General Counsel are also sitting behind me.

Once again, I'm Barry Duplanta, CEO and president of REMSA for the record.

It's my sincere honor and pleasure to proudly represent over 600 members of the REMSA Health team who serve our community with pride and confidence.

I'd like to highlight a few points that differentiate REMSA Health from every other EMS organization I've ever seen.

With regard to governance, um, it's very unique that we have a board leadership that is defined and centric on the clinical health of our citizens.

All three of our hot major hospital systems are represented on the REMSA board, and then they select a consumer advocate, and then you as a body appoint uh a legal representative, an accountant, and another uh consumer advocate for a total of seven members.

That was defined back when the charter uh was um was structured to uh to create REMSA.

The organization, as I said, is very community and nevada-centric.

We have no private stakeholders, and all of our resources are reinvested right here in this community year after year.

Oversight is let me say is complete.

Um there's really not a whole lot that goes on that we don't consult with all of you from time to time uh in and out of this room, uh, where we're communicating on how fares are going, how's the system performing, um, some of the issues that we might discover, et cetera.

Voice of the community is well heard within REMSA and the organization, and will be even more so because one of the articles in the uh document that you have in front of you is Article 10.3, which proposes that REMSA establishes and maintains a phone number, kind of like a whistleblower number, so that anybody can call and and report any kind of an issue, complaint, et cetera.

And RIMSA would be obligated under the proposed franchise that you have to report back to you of what those issues were and how do we address them.

So that is in 10.3.

If you wanted to go back and take a look at that.

RIMSA Health exists to provide emergency and non-emergency clinical care and transportation when appropriate.

A third at the time, just to be clear, we respond, and there's no transportation required.

We don't transport people just because that is the mechanism that our industry has always used for compensation.

Uh, our focus is on clinical care of our population.

In our December district board of health meeting, you might even remember, the big item that was discussed right here in front of this body was culture.

And one of the things I'm especially um maybe even humbled uh to share with you is that REMSA's got a culture that goes back 40 years.

I mean, we talk about a community that has grown from a couple hundred thousand people to now a half a million people, but look at the work that goes into maintaining a caring culture to when when people say, I need an ambulance, they say call REMSA.

I mean, it's synonymous, much like the Kleenex Tissue uh type debate.

Um, so I certainly want that to resonate with you that the culture of REMSA is solid, it's strong, it's been earned over and over and over throughout the many years of the many professionals that have worked through the organization.

We've been able to earn trust, reputation, a reputation of being always ready.

We're innovative, we lean forward with technology, and probably one of the things that excites me the most as the leader of the organization is that we're known around the nation as being the best of the best.

And there are not too many communities that can tout that.

Um I also want to hearken on just a couple of things.

We've talked about emergency medical dispatch.

That is very near and dear to me and the success of EMS in this community.

Emergency medical dispatch is really key, and it's important to navigate patients to the closest appropriate care that they need.

Why is that important?

Because more and more people call 911 because they're seeking health care.

They are not in a situation of high priority life and death uh questions all of the time.

And EMD is really the I'm gonna say it's the traffic uh guiding system that enables us to judiciously use the right resources.

I really, you know, when I look at our our community and the scarce resources we have from police, fire, EMS, we don't want to roll wheels uh fire resources when it's a low priority call and resources are not needed.

EMD is the key to make that happen efficiently.

REMSA was early at the table on EMD.

We are a 25% partner along with the City of Reno, the City of Sparks, and Washoe County, as stakeholders in the new hexagon system.

And let me just say, just for sake of clarity, even if hexagon were not part of what we're discussing, I'd still be here today advocating for a smarter EMD process so that we can judiciously assign the right resources to a call.

I also want to comment on the fire regionalization.

Again, REMSA is an example of regionalization working.

It does work.

And I advocate for it.

Um, in fact, that's why we also have, as Article 17.4 in the document, a pathway to get us there.

Um, if regionalization study comes back and says, here's how to get it done, I don't want REMSA to be excluded.

I want RIMSA to be at the table so that we can help to navigate the future.

And then I would just like to just comment on a couple of things that are kind of looming in front of us.

As I told you, a third of our responses uh are just to provide care in the field without transport.

A couple of interesting points to keep in mind.

The baby jummer uh baby boomer generation, which you know, I'm on the tail end of.

We're 78 million people in the community.

We're living longer, and as we live longer, we have more comorbidities, more demand on health care.

As people start falling off of public uh programs, you know, as a result of things like the HR 1, the so-called big beaver bill.

Again, I anticipate that we're going to see a greater demand on our 911 services.

Specifically, as I look at the estimate of what I think, I think for REMSA, it means about 8,400 more calls a year, based on the studies that I've been able to do.

Because we need to prepare in advance.

So you might ask yourself, well, 2030 is four years away.

Why bother?

Because we need to prepare now.

We can't get to that point and say, oh my God, we should have.

We can't be a should have community.

We have to be proactive.

We have to deal with the here and now, and and and deal with the community that we we want to see for ourselves.

I also want to comment just in terms of the collaborative work that we do in the community.

Um Truckee Meadows Fire Protection District.

Um, the Board of Commissioners met on May 14th, for example, um, accepted a proposal for RIMSA to provide its dispatch.

We did so and continue to do so.

That in itself saves Trucking Meadows Fire over $600,000 a year.

And let me just kind of simply say, because I feel that spirit of working together, it's actually costing us a little more than we even charge.

But but that's okay because we're community.

We want it to work for all of us.

Likewise, um we have a postgraduate um paramedic school, very, very successful.

But I wish we could produce all of the graduates we need.

We can't produce enough.

So we met with Truckie Meadows Community College, who has likewise a uh a um paramedic school and uh trains EMTs.

We've committed to hire all of their graduates that are qualified and interested in working for REMSA.

So as we look through and we talk about the things that we can do together.

I certainly can stand here and tell you that each year, last year in particular, 2025, we reinvested $7.6 million into equipment in right here in this community.

We don't pay a shareholder dividend to anyone.

All of the money is invested right here in Washoe County, uh, the community that we all live and work in.

And I've got a number of points that we can talk through, because as in in grand scheme, there are really two parts of our business.

There's the care flight division of REMSA, and there's the ground division of REMSA.

Here today, we're specifically talking about the ground division of REMSA because it's the part that is under the scope of the franchise.

The reason the the the care flight piece is not under the scope of the franchise is because of the airline deregulation act that that really says the skies, the skies cannot be regulated.

So, as you know, just closing out my comments today and just following on uh you know the the franchise agreement that you have in front of you, I'd like to ask for your consideration.

Is it perfect?

We never know what's in front of us.

We never know that what we don't know.

Um, but as Dr.

Kingsley pointed out, we've tried to provide those pathways and exit ramps, even um, should those be needed to get us where we need to be as community.

Uh, because it is really key that we not work in silos, it's really key that we collaborate collaboratively work together to get to achieve the vision that we all want for the community that we live in and love.

So those are my comments, but I would also say um that there's one additional point I'd like to make, and then I'd like to ask, because this agreement actually is between uh this board and the RIMSA board, and so I'd like to ask Mike Pawnee to make a couple of comments.

He's our vice chair, but let me say that you might ask yourself so what's the future look like?

Because if reimbursement is limited, um, where are you going and how are you going to fund yourself since you don't get anti-tax dollars?

And we've initiated a philanthropy philanthropy program, uh, which has actually been very, very successful.

Um, the Pennington Foundation has been very generous to us, and I will also say that the community as a whole has been really excited to step up and support uh RIMSA as a 501c3 not for profit.

Um, the number of our donors has grown and the amount of their donations has grown.

Um, and that's actually very exciting to see because as we get the word out that we are a not for profit, people are very passionate and want to support the organization as its local uh EMS provider as a not for profit organization.

So that said, and uh not taking up any more of uh of your time.

I hope I've addressed some of the key components that might have been on your mind.

And I'd like to ask uh my uh vice chair of the board uh just to say a few words on behalf of the board with regard to the franchise agreement.

Mr.

Pawnee, welcome.

Thank you.

Uh good afternoon.

Michael Ponti, I'm the vice chairman of the Remsa Board of Directors.

I'm also your consumer representative, and I've said this before.

As a consumer representative, it's my job to advocate for the best interests of patients to ensure that they receive the most responsive, most reliable, highest quality of emergency care.

This agreement does exactly that.

I've been involved with REMSA a long time, both as a board member and previously as their legal counsel.

I've been through franchise renewals.

They always generate a lot of input, both from people directly involved in the EMS system as well as those indirectly or aspiring to be involved.

RemSA welcomes all of that input.

This renewal has been unique, both in terms of the large number of stakeholders who participated in the negotiations, and the fact that it took over 18 months to complete it.

Well, it certainly wasn't the most efficient process, it definitely was the most thorough.

With the exception probably of TROA, which took 27 years to negotiate.

I don't know that I've ever been involved in a contract that was more thoroughly vetted, scrutinized, or wordsmithed than this agreement.

What you have before you today, as I said, is the culmination of 18 months of collaboration.

And it's good.

It provides more accountability, more transparency, more resiliency, more flexibility to respond to changes in community EMS, more ability to respond if there's fire consolidation, more collaboration with regional EMS partners, enhanced performance standards, and stronger enforcement mechanisms, all to the benefit of this board.

This agreement is widely supported and reflects the input from all stakeholders.

And while the perspective of some voices may differ, in fact, some may have at times been incongruent.

What nobody disputes and what everybody agrees upon is that REMSA is an exceptional 40-year partner that has and continues to provide the highest quality, highest value emergency medical care.

And at the end of the day, that's all that really matters.

Ensuring that this community continues to receive unwavering reliability, professionalism, and exceptional medical care that REMSA has delivered for over 40 years.

When you put the interests of patients first, which frankly should be the most important factor driving your decision today, the outcome is clear.

This agreement should be approved because it's in the best interest of the community.

We appreciate all of the efforts our partners have provided collaborating to get us to this point.

And we ask you to approve the agreement today.

Thank you.

Okay, Ms.

S.

Are you up next?

No, okay.

Thank you so much.

Dr.

Kingsley, is that all for the presentation then?

It is.

Okay.

Thank you so much.

We're going to go now to public comment, Madam Clerk.

Again, for those in the audience, it'll be the person up on deck and in the hole.

Uh first up is Colleen Morissett.

Um after her will be Jim Bingby and Joseph Ryan.

Colleen, welcome.

Thank you.

Uh good morning.

And for the record, my name is Colleen Morissett.

I am a part-time consultant for Remsa Health.

Um, what I'm going to say today, you're going to probably hear a similar theme over and over, and some of the comments that I would make would also be have been echoed what Barry DePlantis said and uh Mike Pawnee.

Um I've been a registered nurse for 35 years.

Um, during my career, I have worked for large teaching hospitals, uh, transport programs, both here in Nevada and nationwide.

So my perspective on the program is not just from as a Nevada health care provider, but nationally, I've worked all over the country.

Um it has been a privilege to work for REMSA, and I proudly wear my badge.

It is such an honor to wear it in the community.

When I'm out in the community and I say I work for REMSA, immediately someone will tell me a story of how wonderful the REMSA medics have to them and to their family.

Um the REMSA team is professional and committed.

I hear this over and over when I work with the hospitals.

When I ask them how are the REMSA teams doing, they say they are fabulous.

We trust them.

We know they're going to take really good care of our patients.

Remsa's commun contribution to the community extends far beyond ambulance services with their public safety programs, medical education, and as citizens, making a difference in our community and making it safer.

Thank you.

Up next is Jim Bigby, followed by Joseph Ryan and Tom Dunn.

Mr.

Chairman and members of the board, my name is Jim Bakebe.

I was a district health officer.

I retired in 2000.

I'm the 40-year person who can tell you all about the process as we began.

I am here to support the extension of the Fremsa franchise, and I hope that you decide to make that decision today.

I want to tell you a little bit about how we got into emergency medical services at the District Board of Health.

First of all, I was in the Army for three years, one year in Vietnam, and my job there was public health.

So I came to work for the health department in 1976.

Since that day forward, I've been involved with emergency medical services.

In the early years, what really prompted the creation of REMSA was we had three private ambulance services, all of which were having severe financial problems.

It was so bad that we never knew who was going to be available and who wasn't.

At that time, Washoe Medical Center, which is now renowned, and St.

Mary's Hospital approached us and asked us if we'd be interested in putting together a emergency franchise agreement similar to what you have now, much less uh smaller numbers than you have now.

And um so we did that.

We worked with all of the elected officials in the city of Reno, City of Sparks, Washoe County, and with all of our partners in EMS, and it was approved in 1986.

So 40 years ago, gosh, where did that go?

There was a lot of issues that I was involved with.

First of all, as the chairman, I'm as the board of district health officer.

I was very involved with how that was going to get going.

The health department's responsibility was to make sure that REMSA was complying with the requirements of the franchise agreement.

That was critical because there was a lot of concern in the community what was going to happen with the money that was collected that has worked out really good.

In addition to that, the REMSA board has a non-voting member who is from the District Board of Health.

I served in that position.

My job was to make sure that they were meeting the requirements of the franchise and reporting back to you as the REMSA board of director.

At that time, I decided, geez, I better know a little bit more about emergency medical services.

So I became a uh EMT.

But I want to make a point that I really support what REMSA has done for the past 40 years.

I support where they're going now.

It's really interesting to hear all of these wonderful things that's happening.

Unfortunately, I now live in a 55 community.

We have a lot of EMS business, a lot.

And if we have people who are transported by REMSA Health, I reach out, I contact them, and I want to find out how they believe their service was they were all extremely happy, especially with the um way that the ambulance members service them, how they were very kind and very, very nice.

One more thing to say to you is that in all my years as the health officer, Remsa is the one that I am the most proud of, and the one that I respect, and I think that's the one thing that I have done that has made this community successful.

Thank you very much.

Mr.

Bigby, thank you so much for your years of service and for your historical perspective.

Next up is Joseph Ryan, followed by Tom Dunn and Joey Lerner.

Mr.

Chairman and members of the board.

My name is Joseph Ryan.

I am an EMS physician.

And uh next month I will embark on my 51st year in this practice of medicine.

I am actually one of the team uh in the 1980s that created REMSA.

Uh that was a consulting group called the Fourth Party.

Some of you may know some of its members, Patrick Smith, who was a longtime president of REMSA and CarePlight, and Jack Stout, who of any single person in EMS transport transformed what we provided over this 50 years into what is the modern EMS system.

I um I'm one of the founders of the National Association of EMS physicians.

And in June, I completed 25 years professor of emergency medicine and EMS at Stanford.

I don't say any of this.

But I want you to recognize that I have an informed perspective about what EMS is.

But I've consulted nationally, I've been involved in the growth and ultimately subspecialty status of EMS as part of the practice of medicine.

And I have consulted internationally and seen EMS systems throughout the world.

Let me state as simply as possible.

REMSA is a world class organization.

And REMSA is a world class organization by design.

And over the years, I think some essential aspects of that may not be uh remembered by all of us.

But REMSA is a public utility model.

And the public utility model system is one of the few state and federally permitted monopolies that exist all across the board.

And it is over 40 years the only health care monopoly that exists.

And that's fundamentally important to what we do.

REMSA will continue to thrive within this community with your support and with your sincere insight into what it is we do and how we do it.

It's complicated, but fundamentally it's health care.

Thank you.

Dr.

Ryan, thank you so much.

Up next is Tom Dunn, followed by Joey Lerner and Belinda Norman.

Good afternoon, members of the board.

For the record, my name's Tom Dunn.

I'm the vice president of the Reno Firefighters Association.

Local 731 is a stakeholder in this community as we provide fire and EMS delivery to the Reno Tahoe International Airport, the cities of Reno, and City of Sparks.

But we have only seen this document once it was posted to the Board of Health website.

We appreciate the work that's been done on the REMSA franchise amendment draft, but we respectfully request any vote today to be tabled until further discussion and amendment to the draft document.

The three uh four major points I'd like to make are uh in Article III, Article III does not provide for another hospital system to join the REMSA board if they enter Washoe County.

Article 5 should have a date of when REMSA enters the 800 megahertz system.

Also in Article 5, there should also be a date when the local Peace apps can begin 911 EMD.

We don't want to wait another mythical two months to 20 years, waiting for the hexagon or any other cadden dispatch system to come online.

And the final point I like to make is in Article 7, it removes priority twos for compliance in zones B, C, and D.

With that, we're here to answer any other questions you may have as the discussion progresses today.

Thank you.

Thanks, Mr.

Dunn.

Up next is Joey Lerner, followed by Belinda Norman, followed by Linda Denniston.

Hi, my name is Joey Lerner for the record.

Um I am a resident of the North Valleys and CEO of Battleborne Medivac.

We provide rotor wing air ambulance services in the northern Nevada area.

We do not operate ground ambulances, have no vested stake in that side of it.

Um first thing I want to say is I wore that blue uniform many years ago, and I'm very proud of it, and I'm very proud to see people that I used to work with here, and I believe that REMSA does provide a high quality service to the community.

I don't want to take away from that.

I am in opposition to the proposed amended agreement, though, primarily because of the interfacility air transport portion of the agreement.

So airport transfers are something we deal with on a regular basis.

It is not uncommon to have to land at the airport and take an ambulance from the airport to a receiving hospital that does not have a helipad.

Uh, over my almost 10 years of flying in this area, there's been numerous times we've had to wait a very long time for an ambulance to pick us up from the airport.

I appreciate the compliance metrics that are put onto uh the proposed amendment.

However, there has been a solution for the last year and a half, which has been other other agencies have been able to provide that service.

Having the access to other agencies and it not being directly only Rimza has increased our response time significantly and the level of service we provided.

I don't think that the right move at this point is to reduce the level of service in the community.

So I have a few comments.

I don't want to get too sidetracked here.

Um from the data perspective uh that was brought up by uh Dr.

Kingsley.

Um I don't know, I can't speak for the other air ambulance providers, but we were never approached to provide any data for the airport transfer side of the agreement.

Um we'd be happy to if necessary.

Um there's a 30-minute limit once you count the margin for the airport transfers.

It's not unusual for us to have 14 for 15 minute flight time.

So if this happens, it's already guaranteed with no fine structure that we could be waiting 15 minutes on the ground at the airport.

Uh so that brings some concern to my attention.

Um the free market point was brought up by Dr.

Kingsley as well.

Um, I've worked in other systems where there's multiple ambulance providers, and they're all held to the same standards by the district or by the county to have a free market and also have standards is nowhere near out of the realm of possibility.

You can hold those providers to the same level of compliance that you hold REMSA to while also allowing the air providers to have access to other options in the event of delays.

Um, for system stability, I think I just can't imagine with the access to health care we have in Nevada, especially in the rural communities, why we're advocating for something that will restrict the ability of other providers to provide services within the county.

I think that the ability to have more ambulances, more resources, more options is only going to increase the level of service that the community has.

Um I also don't think that the bureaucratic restraints of the board, while I understand them, this is a big process, is a fair reason to try to push this through in a manner in which several stakeholders, myself included, uh didn't even get access to this contract until a few days ago.

I understand it meets the minimum requirement, but it's it's a pretty big undertaking.

Thank you.

Up next is Belinda Norman, followed by Linda Denniston, followed by Tom Potts.

Hi, I'm Belinda Norman, a Sparks resident and family member of a couple of RemSA patients.

My 84-year-old mother survived breast cancer twice and lung cancer, but her next challenge ended up being a perforated colon.

This lady never in my memory complained about having any pain or even as much as a headache.

But that evening it was more than she could deal with.

I was not there at the time, but once I arrived at the hospital, she had nothing but praise for her responders.

A few months later, she called me and she'd fallen getting off of the toilet.

When I arrived, I knew I couldn't help her, so I made the call, and the medics that came were very respectful of her dignity in that situation.

And by the time they came out of the bathroom, they were chatting like old friends.

The last time that they transported, she was talking gibberish and was frustrated because she knew what she wanted to be saying, but it was coming out as craziness.

She also seemed to think that she should be going out for a drive when she couldn't even walk across the room.

They got her to slow down, to relax a little bit as they assessed her and then transported her for a possible stroke.

In each instance, they were patient and understanding of her needs, not only medically but personally as well.

Fast forward a couple of years, and my husband was undergoing chemo for lung cancer.

One evening he had become dehydrated and was feeling pretty downed.

He wouldn't drink and was getting agitated.

I called, and when the crew arrived, they assessed him to see if there was anything else going on besides the dehydration, which there wasn't.

Then they spent time just talking to him to get him to relax.

And eventually he was engaging in the conversation, and the compassion shown helped him feel better.

About a week and a half later, we were involved in an accident where my car was totaled by being hit broadside on the passenger side where my husband was sitting.

One of the medics responding remembered us from that previous visit.

After assessing Charlie to make sure he was okay and checking on me, he continued on to the grandsons in the back seat to see how they were.

They were not only frightened, but they were also upset that their ice cream was now dipping from the dripping from the dashboard.

The guys stayed with us until family was able to come and get Charlie and the boys and take them home.

But just having a friendly face there was very helpful in lifting some of the stress in the situation.

I know that none of these examples really touch on their expertise medically, but they do show the professionalism and compassion demonstrated across the board for their patients.

Friends of mine have also expressed similar sentiments.

Thank you very much.

Ms.

Norman, you've gone through a lot.

Thank you for being here to share your story.

Next up is Linda Denniston, followed by Tom Potts, followed by Steph Cruz.

Linda, that mic moves all the way around.

You can do a lot with that.

See anywhere you needed to.

There you go.

That's okay.

And I was a patient for RemSA this past December.

But before I get into that, I'd like to give you some background information.

My late husband, Bill was a dispatcher for RemSA in CareFlight for over 25 years.

I came to know the REMSA organization very well.

They were like a big family.

The employees loved their jobs and were extremely proficient at what they did.

There was continuous training so that the employees can always be at the top of their game.

There was no such thing as hiring a warm body.

They hired the best.

I believe this is still the case.

Unfortunately, I had a serious medical emergency this past December.

My daughter called 911.

The dispatcher took the information and instructed her as to what to do before they arrived.

Although there was nothing in the call that would require them running lights and sirens, they were there.

Response time was only a few minutes.

There were three medics on board.

One took vitals and started an IV.

One hooked me up to a heart monitor, and one spoke to my daughter, obtaining any information she might have.

Going back to that IV.

Unfortunately, I've always had a problem of people not being able to find a vein.

More likely than not, they have to use Doppler in order to find one.

This medic found one on the first try.

I was impressed.

He asked the hospital, asked which hospital I wanted to go to, and I asked him to help me decide.

He told me that renowned downtown was currently very busy, and I'd likely be seen sooner at Renowned South.

So we arrived at Renowned South, and the crew made sure I was comfortable and even escorted my daughter in.

The wait was minimal.

Thank goodness it was, because my blood pressure tanked.

There were no warning signs, nothing.

I just became unconscious.

I found out later that my liver and gallbladder were blocked by a large stone, and I was suffering septic shock, which can result in death.

And I started thinking if that medic hadn't recommended renowned South, I might have still been in that crowded waiting area downtown when I keeled over.

And that IV, it was used to quickly give me the drugs I needed.

If it hadn't been there, valuable time would have been wasted searching for a vein.

These awesome REMSA medics in conjunction with Reno's renowned staff, absolutely saved my life.

And I will be forever grateful.

Thank you for allowing me to tell my story.

Linda, thanks so much for your story.

We're glad you're here today, too.

Next up is Tom Potts, followed by Steph Cruz, followed by Alyona Gorbanova.

My name is Tom Potts.

I've been asked to uh speak on behalf of Remsa.

And uh as you'll find out later, I'm not a public speaker.

So what I want to talk about is the the rat the wreck at the airport at Steadfield uh 12 years ago.

I was there.

I was behind the grandstand working for a hot August nights when I heard an unusual sound from an airplane and I looked up and he was coming right for us.

Luckily he just missed us.

My volunteers were okay.

I went out and checked it to see what happened.

I came back to check my volunteers to see if they had been hurt and they were okay.

So I decided, since I'm a member of the uh sheriff's department volunteers, I'd go out and see if I could help.

They'd already just set up a perimeter for security.

So I I was able to use my badge and to get through.

So the first thing I saw was a young lady with a scratch on her arm.

And I talked to her and she seemed to be okay.

And it was a huge mess because people were told by the announcer to leave immediately, so it was hard to get medical people in.

But Remsa was doing the best they could.

So I decided to move a little bit closer to the what I would call the ground zero.

And I came across a uh REMSA medic.

And he he was on his knees working on somebody, and I bent down to ask him and see if I could help.

And he said, yes, hold uh direct pressure, because I gotta go work on somebody else.

So I was there for quite a while holding direct pressure on this gentleman's legs.

So I had an opportunity to look around and see just how things were working.

And in the first few minutes, it was a madhouse.

People coming out of the audience, giving directions, telling people to do this and that.

But slowly the Remsa crew came in and they started working and became very peaceful and very organized.

And they knew exactly what they were doing.

They started out with the TARPS to see who was the most injured and the least injured.

They did their very best.

And there was uh as as the time went on, it got very calm as they were very business like.

I think that they were just out of this world as far as being cool and collected.

You don't want to know what was out there, but they did a great job.

And I think that uh all of these people behind me in blue, they're they're heroes.

That's all I have to say.

And next up is Steph Cruz, followed by Aliona Gorbanova, followed by Julie Ardito.

Good afternoon for the record, Stephanie Cruz.

Many probably know that I've been affiliated with RemSA since 1991 when I created my communications and marketing firm, but you probably don't know that I was associated with REMSA before that.

I was in administration at St.

Mary's in the 80s, and I saw the state of the ambulance system, and I use that word lightly, that was happening at the time.

There were multiple providers, um, not very good coordination.

One was on the verge of bankruptcy.

You never knew when they were going to respond if they responded at all, and there was no guarantees on quality or patient satisfaction or anything.

So, as Mr.

Bagby said, a group of individuals, including the healthcare leadership and elected and appointed officials from the city of Reno, City of Sparks, and Washoe County, as well as other community leaders got together and said, we need a better system.

They looked nationally across all kinds of models, and they chose the model that is the foundation of the franchise agreement that you're going to be looking at today and hopefully approving.

There are guarantees for response time.

There are accountabilities for quality of care and patient satisfaction.

There are qualifications for equipment that has to be renewed, and they do that.

And there's also requirements for community outreach and community education, as well as this board sets the top rates that they can charge their patients.

So that's a great accountability model, and that's with no tax dollars from the citizens of Reno Sparks supporting this model.

That is highly unusual.

You may not also be aware that I have one more affiliation with RemSA, and that is the fact that I'm a philanthropic donor.

Because I not only believe in their mission and how well they do their job, but I can because they are a not-for-profit organization.

It is truly a remarkable model with all of the accountabilities built in, and even more with this version of the franchise agreement, and no local tax dollars to support them with a not-for-profit model.

As Dr.

Ryan said, it is it is a high performance system that is unparalleled in most cities and communities across the nation.

Thank you very much.

Thank you.

Next up is Aliona Gorbanova, followed by Julie Ardito, followed by Aaron Abbott.

Hi, my name is Alona Gorbanova, and I'm an upcoming graduate of Remsa's paramedic program.

I'm here to share my experience from the perspective of someone being educated and trained by RemSA.

I initially completed my EMT basic elsewhere, was disappointed by the quality of education I received and started looking for a better alternative.

And that's how I came across RemSA.

Through my research, I found that RemSA has a strong reputation, high standards and expect uh sorry, strong reputation, high standards and expectations, provides a guaranteed internship and has a 100% NREMT first pass rate, which is about 30% higher than the national average.

All of these demonstrate a wholesome, safe, and competent approach in serving the community.

During my time here, the program not only lived up to my expectations, but also exceeded them.

My classroom educators have uh extensive and continuous experience in the field and are uh excited to share their knowledge.

My preceptor showed unmatched compassion and enthusiasm in caring for patients, as well as pride in his job, quality of care, and commitment for his students to do the same.

My internship exposed me to high acuity emergencies and diverse patient populations, all under the careful guidance of experienced providers who always encourage students to provide patient safety.

The clinical rotation showed me how RemSA fits into a larger healthcare system.

By allowing students to spend time in all of the area hospitals, I got to see how pre-hospital care connects to the emergency department, ICU, and inpatient care.

These continuous rotations for all REMSA students help reinforce professional partnerships with hospital nurses, physicians, and staff, and allow us to take a look into patient care beyond the call.

Overall, RemSA taught me to think, act, and care like a professional, and showed me what kind of medic I want to be.

Based on my education, training, and experience, I believe Remsa provides a high quality, compassionate emergency care and prepares medics to serve this community well.

So I respectfully encourage the board to provide the franchise agreement renewal.

Thank you.

Next up is Julie Ardito, followed by Aaron Abbott, followed by Matt Brown.

Julie, welcome.

Chair Reese, members of the district board of health.

Good afternoon.

For the record, I'm Julie Ardito, Reno resident and owner and principal of Julie Ardito Public Relations.

I'm here to voice my support for approval of a franchise extension for Remsa Health to continue serving as the exclusive EMS provider in Washoe County.

As long as I've lived in Reno, 40 years, Remsa Health has been providing consistent, high-quality care and service for patients and residents at no cost to the taxpayer.

I go farther though and say Remsa Health provides our community, our family, our friends with peace of mind.

It's knowing that we will receive high-quality clinical care when it matters most.

As former vice president at KPS3, a local marketing PR firm that supports RemSA Health, I witnessed firsthand the high performance, high-value, highly compassionate EMS system that it provides to Washoe County citizens.

The organization represents a model of excellence for EMS that ensures equal and standardized care for all Washoe County residents.

The Remsa Health EMS model is lauded by national EMS agencies, and in my opinion, it remains the right and the best choice for Washoe County.

Why?

Well, RemSA Health is the only regional 911 provider that is held to response standards.

It's required to maintain accreditations and have a third-party performance oversight, all of which it is consistently in compliance.

And for more than four decades, the organization has not only proven it can meet the franchise agreement requirements, it has sustained excellence and delivered exceptional results through strong quality outcomes, through innovation, strategic partnerships, and a commitment to investing in our community.

Remsa Health responds to more than 92,000 calls for service every year.

As a citizen whose family has had to call 911, I will say that Remsa Health Paramedics and EMTs, the folks that are here today, made our family member feel care for, prioritized, and safe, and not just a number.

And that has made all the difference.

How fortunate we all are to have Remsa Health as our EMS community partner and looking out for our health and safety of us all.

And I want to thank you.

Thank you.

Next up is Aaron Abbott, followed by Matt Brown, followed by Mark Reese with JQZEC.

Good afternoon, uh, Mr.

Chair and members of the board.

Uh for the record, my name is Aaron Abbott.

I'm the founder and CEO of Technical Medical.

I've heard a lot of uh public comment today in support of a contract extension for uh REMSA, which I think is great.

Uh, what is before you on this agenda, item eight is not a contract extension.

Material changes to this agreement have been negotiated behind closed doors, resulting in a perpetual term agreement that lacks an appropriate evaluation period and end date.

This franchise agreement has been renegotiated and extended for 40 years without public process and without a competitive bid.

Exclusive ambulance service franchise is perhaps the most important and highly consequential agreement in this county.

The rapid speed at which these changes were developed and now presented to this board with three business days for the community to react has left little room for community involvement.

Many of our customers and other interested parties were not only caught off guard by these proposed changes.

Unfortunately, they were unable to attend this meeting to provide further comment to this board and to conduct an appropriate and comprehensive review of this document.

The hurried nature and material changes of this agreement have produced a document that decreases service levels, decreases supply of ambulances, decreases performance expectations, and somehow an agreement produced an agreement that includes a perpetual term.

And language that attempts to restrict specific areas of the market that are unenforceable by this board.

The lack of public process and attempt to further restrict competition conflicts with state and federal appropriation clauses is anti-competitive and directly intends to disrupt my business, which I have evidence of.

Specifically, granting exclusive rights to air medical transports conflicts with the airline deregulation act and decreases the availability of ambulances and places patient safety at risk.

Other attempts in this agreement to restrict providers from servicing federal contracts uh contracts also conflicts with federal supremacy clauses and is also unenforceable.

Further, proposed changes to measurement strategies for response time compliance to priority one, life-threatening emergencies allows REMSA to meet response times at only 89% in zone A, as long as they're above 90% in zones B, C and D.

Please look at that carefully and do the math.

If this board simply wishes to provide an extension to the term of the current franchise agreement with REMSA, then that is what should have been presented to this board today.

If the board wishes to make material changes to performance and service levels, I implore you to please slow down.

Do this right with the appropriate time that allows community members, stakeholders, subject matters, and yourselves the appropriate time to properly evaluate, digest, and opine on the proposed changes and ensure these changes are patient community oriented, improve service levels, and increase the number of available resources in the community.

Thank you very much.

Up next is Matt Brown, followed by Mark Reese with Jake Ezik, followed by Brian Taylor.

Good afternoon, Chairman Reese and members of the board.

For the record, my name is Matt Brown, director for Tech Med EMS Henry.

I'm here to express my concern over the newest version of the amended and restated franchise ambulance agreement.

One of the most obvious and glaring changes, this new version is the language to reduce the number of ambulances available in Washoe County to transport air crews and patients to local area hospitals.

Aside from this being violation of the airline deregulation act or ADA, it also sends sick patients and air crews backwards to a place where they will have to wait for unreasonable and unsafe amounts of time for ambulance transport.

Case law under the ADA preempts state and local laws that try to regulate air ambulance prices, routes, or services, including who they can contract with for ground transport if it restricts air carriers' operations and are pricing.

The ADA preempts any interference with service terms, including regulations that effectively force air carriers to use specific ground services or limit their choice or impacting their ability to provide integrated services.

In essence, if a state or local law or regulation even indirectly dictates the economic aspects, such as who an air ambulance contracts with for ground support and or the operational scope of an air carrier, courts have and will find it is preempted by the ADA.

As a previous air provider myself, I've had to sit at airports and wait with critically ill patients for ground transport.

And it should not be an acceptable practice as proposed in this document.

Rena would be one of the only metro areas where air providers would not have to not have multiple options for ground transportation.

Again, sending us backwards.

The purpose of this document should be enhance and update EMS care in Washoe County, not to regress and take away vital resources from an already over-taxed and stretched DMS system.

Is a moral from a patient care and well-being standpoint, and I also have some ethical concerns as to why this language is even being included in the first place.

It also opens discussions around possible violations of the Sherman Antitrust Act, Nevada revised statute 5988, unfair trade practices, which prohibit anti-competitive business practices, monopolistic business practices, and conspiracy behavior conspiratorial behavior that eliminates free trade and free market competition.

I don't know of anyone here, including myself who is trying to advocate for or prevent REMSA from continuing to provide and operate service here in Washoe County moving forward.

However, this version of the agreement lowers the standards of EMS in Washoe County.

It eliminates badly needed EMS resources within the communities and has some serious potential legal and ethical ethical issues that need to be addressed, vetted and corrected before being accepted as is.

I've been in this business for over 35 years in my travels and work around the United States, including work as an EMS consultant.

I'll know any city, town, or county where the goal is to eliminate and decrease the number of EMS and health resources rather than just the opposite.

I think the residents and what residents and visitors to Washoe County deserve the best.

And as long as Washoe County resident and as a longtime Washoe County resident and EMS provider myself, I know we can do much better.

I understand you as a board as board members have been placed in a precarious and uncomfortable position to have to make the right decision on this, especially given the timeline and circumstances.

However, I also believe you're all here because you want to do the best for our communities and residents, and I urge you to do just that.

Thank you very much for your time.

Mr.

Brown, I missed who you were with.

Check me at emails.

Okay, thank you so much.

Gotcha.

Thank you.

Next up is Mark Reese with JQ Zeke, followed by Brian Taylor, followed by Amy McCombs.

Mr.

Chairman and members of the District Board of Health, good afternoon.

My name is Mark Reese for the record, and I'm here on behalf of St.

Mary's Regional Medical Center, where I have served as a member of the hospital executive leadership team since 2020.

Before that, I worked in EMS in both clinical and administrative capacities.

Beside me, and also for the record, is Jake Uzike, a registered nurse and director of the emergency department at St.

Mary's Regional Medical Center, who is a former paramedic for 10 years.

We thank you for the opportunity to speak today in support of REMSA Health being awarded a renewed franchise agreement as Washoe County's exclusive 911 ambulance transport provider, among other provisions.

At St.

Mary's, we view pre-hospital care as an extension of the services we provide inside our walls.

As it is a common entrance point into the acute care setting.

Just through our ongoing direct collaboration with REMSA Health that allows us to stay closely aligned on quality, performance, and patient outcomes, ensuring continuity of care from the field to the bedside.

Both organizations share a deep commitment to safety and exceptional patient care delivery, and that alignment has translated into reliable coordinated services.

Importantly, St.

Mary's has had a consistently positive operational experience with REMSA Health, reinforcing our confidence in a single EMS partner supporting our patients and our community.

This includes areas outside of just the 911 response duties.

As REMSA Health routinely completes timely transport of patients already within the hospital with steady efficiency and punctuality.

We value partners like REMSA Health that place an emphasis on quality and excellence, associations that are earned beyond just our hospitals' experience.

Remsa Health has been recognized nationally through the American Ambulance Association Stars of Life program, along with an EMS Gold Plus Award from the American Heart Association, a distinction given for high adherence to quality measures and treating heart attack patients, which is an area our hospital excels in as one of the highest and most frequently awarded hospitals in the cardiac and cardiology space.

These impressive feats are only possible with a culture of high standards, constructive coaching, and patient-centered professionalism.

Characteristics that precisely embody the healthcare professionals we want alongside our emergency department and hospital teams.

In closing, having one primary pre-hospital provider is a feature, not a limitation, because it creates unified responsibility, reduces duplication, and improves coordination in an effort to maximize quality patient care.

Hospitals are able to build one integrated relationship, one cadence of medical direction, dialogue, and one shared improvement process.

A renewed franchise agreement with Remsa Health supports this focused accountable system, one that can be measured, advanced, and synchronized with hospitals and first responders without fragmentation.

We appreciate the board's role and Remsa Health partnership, and we are supportive of preserving the benefits of REMSA Health emergency care and transport system for our community.

Thank you for your time.

Up next is Brian Taylor, followed by Amy McCombs, followed by Michael Peckney.

Gotta move it up here.

You have to.

Good afternoon, uh board members.

Thank you for the opportunity to speak with you today.

My name is Brian Taylor, and I am a resident of Washoe County.

I have served this community as a first responder EMT and paramedic for over 42 years.

And I recently retired from REMSA in June of 2025.

I have a unique perspective on the franchise having worked as an EMT and paramedic before the franchise existed.

Before REMSA, our EMS system was very chaotic.

There was little to no control or regulation over quality of care or the consistency of care you would receive when you called 911.

Since the franchise was developed and REMSA was created, patient care and service to our community has always been at the forefront of what REMSA has provided to this community.

This is not just what they say they will do.

It has been proven to this board time and time again through reports and the regulations that the franchise provides.

I have presented to this board many times in the past as the chair of the Interhospital Coordinating Council, which you all know is a nationally renowned health care coalition organization that does so much for our healthcare community.

RemSA has contributed countless hours in support of this coalition.

This is only one example of many examples of how REMSA goes about, goes above and beyond what is required of them to serve our community.

I ask you to vote to accept this franchise for the betterment of the community that we all live in and for the continued support that REMSA provides, not receiving any monetary rewards for this community and in our collaborative efforts.

Thank you very much.

Next up is Amy McCombs, followed by Michael Pagney, followed by Dr.

Jenny Wilson.

Good afternoon, everyone.

I'm Amy McCombs.

I'm the chief operating officer at Renowned Health, Renowned Regional Medical Center, representing Renowned Health today.

I'm here in support of REMSA's renewed agreement.

We strongly support RemSA Health's continued role as Washoe County's exclusive provider of emergency medical transport, recognizing its essential contribution to regional access, safety, and reliability.

As Northern Nevada's largest health care system, renowned health partners with Remsa Health every day, relying on their highly skilled teams to deliver timely life-saving care across our community.

Remsa Health plays a vital role in the stability of our regional health care system, providing consistent emergency response, operational reliability, and clinical excellence.

We have a strong collaboration through our ongoing partnership over the years.

We work together.

If you were to watch the RemSA field medics and EMTs work with the emergency room staff across the region, you would just be extremely impressed.

It's exemplary.

That ongoing partnership has allowed us to work together to improve quality outcomes and really we've even worked with REMSA on how to ensure that those those ambulances are offloaded promptly so that they can be back on the street for our community, for our loved ones and our families.

But really, um, it's a huge coordinated effort, and I couldn't be more supportive of continuing that relationship.

There's also strong medical oversight and coordination between REMSA's medical directors and the hospital physicians across our community, which ensures ensures optimal outcomes across the continuum.

They deliver high quality, compassionate care as was stated earlier.

And in closing, I would just say REMSA is not just an emergency transport provider, but their critical lifeline for our community.

Renowned Health stands with REMSA and strongly supports their continued role as Washoe County's exclusive emergency medical transport provider.

Together, we are delivering timely, coordinated, and compassionate care when it matters most.

Thank you.

Up next is Dr.

Jenny Wilson, followed by Kitty Graham, followed by Lewis Test.

Good afternoon, Chair Reese and members of the District Board of Health.

My name is Dr.

Jenny Wilson.

I'm the Remsa Health Ground Medical Director.

Have been for eight years.

We are grateful for the trust that's board placed in REMSA 40 years ago.

That decision created a system that since that time has evolved to provide prompt, high-quality emergency medical care to every corner of our community to every patient who calls for it.

Emergency medical services is the largest delegated practice of medicine in existence.

REMSA Paramedics and EMTs, my peeps back here, operate under my medical license.

For me, and therefore for them, that carries an ethical and professional obligation.

Care must be current, rigorously reviewed, transparent, and responsive to feedback.

RemSA takes that responsibility seriously.

Our dedicated clinical division conducts comprehensive reviews, and this is not episodic oversight.

It is daily, deliberate, and systematic.

Self-examination, reporting, and continuous improvement is built into the culture of our organization.

I've worked full-time as an emergency physician in Reno for 24 years, under five CEOs, and in conjunction with nine nursing directors, Stacy, JQ, two of whom are here.

During that time, I have had thousands of direct interactions with REMSA crews and leadership.

My partners and I trust REMSA's entire operation.

Their dispatch, their collaboration with FIRE, their clinical care, and importantly, their responsiveness should things go wrong.

The long-standing collaborative relationship between REMSA and our receiving hospitals directly influences the quality of patient care across this community.

Mtala, which was passed in 1986, as you all probably know, requires that hospital emergency departments that accept payments from Medicare, which is all emergency departments, have to care for all patients, get to care for all patients.

This federal law ensures safety of the people who cannot afford care.

Nearly a quarter of the patients we care for in the emergency department are uninsured or underinsured, without primary care, often without shelter or support.

Ask any emergency physician and ask the internal medicine doctors that we admit these patients to.

Caring for everyone indiscriminately is our job.

A responsibility to respond to all calls at all times in all neighborhoods, not just the profitable ones.

RemSA has accepted that responsibility for four decades, continually updating protocols, equipment, staffing, and changing dispatch and response models to meet the evolving needs of the nearly 100,000 people who rely on us each year.

When a critical public service becomes everybody's responsibility, it can become nobody's responsibility, especially if the work is difficult or unprofitable.

A fragmented competitive response model without board oversight risks leaving our most vulnerable citizens to suffer.

I urge you to vote in accordance with what you know to be in the best interest of continued high-quality care for all members of our community, equitably and with transparency and accountability that are written into the contract.

Thank you.

Sorry for going over.

No worries.

Thank you so much.

Next up is Katie Grimm, followed by Lewis Test.

Hello, my name is Katie Grimm.

I'm the chief nursing officer for Northern Nevada Medical Center and um Northwest Specialty Hospital.

And I'm here to give my support for RIMSA and renewing the franchise agreement.

In preparing my comments for you today, I did a couple of things.

The first thing I did was I counted how many intrafacility transfers REMSA has done for Northern Nevada Health System between our freestanding emergency departments and our three hospital campuses, Sierra, Northern Nevada Medical Center, and Northwest Specialty.

They transported over 2,000 patients for us in 2025.

Out of all those transports, I can't think of one problem that we had.

So I have confidence in their ability to take care of our patients moving forward.

The other thing I did was I went down to our emergency department and talked to our director, our nurses, our techs, and our physicians.

And I said, How is the service with REMSA?

They all said fantastic.

In fact, the director said they provide the highest quality paramedics and EMTs out of their school.

We love to recruit their people because they're that good.

They also said that their ACLS class is top.

Whenever we have, we have internal resources for that, but whenever we have somebody struggling, we send them to a REMSA class.

They provide that care.

In listening to some of the comments today.

One being, why would we restrict other people, other services from coming in?

My answer to that, being a hospital administrator and a nurse is quantity is not quality.

I feel that we have something very unique in this community in which we have high collaboration with the hospitals and our EMS service.

I'll give you an example.

We would, each individual hospital would go on divert for hours and hours and hours, backing up as soon as one hospital goes on divert, massive ambulances go to another hospital, overwhelms that ED.

RemSA got together with our hospitals and fixed that in the middle of the pandemic.

Had we not had this one resource, we would have struggled and struggled and struggled throughout those years that we were in the pandemic.

I appreciate the work that they do, and I'm here to ask you to please vote yes on the franchise agreement.

Up next is Lewis Test, followed by Adam Hines.

Members of the board, my name is Louis Test, and I've been on the REMSA board.

Well, I can't even remember how long, but I'm a baby boomer.

Okay.

And I know I was on the board when Jim back here was the head of the group of the board of the medical board, the health board here.

I've listened to everything that has been said.

And I submitted a statement for you people to read.

But I couldn't help but come up and make a couple of comments.

And one is the fact that if you look at the first page of the recitals in this, I want you to count how many amendments were made.

Over 16 amendments have been made on the old document that came forward.

Now I've heard three people get up and speak against moving on and approving this franchise agreement.

If there's a problem and they do have a problem, the legal one should be talking to the district attorney's office.

And the fire department and the other individual should probably sit down and talk with your new director, Dr.

Kingsley.

And if there is grounds on which they there is question about what our franchise agreement stands for, then if this can come back to the board and be amended.

So don't pass this opportunity for the citizens of Reno, Sparks, and Warsaw County, of passing this franchise agreement that is going to do nothing but improve what has gone on.

And I can tell you after 24 years, in fact, I was in the city attorney's office when we used to have the ambulance races.

Okay.

This is not going to hurt the community by passing it now.

If there's some flaws in it, it can come back.

Like I say, take a look at your recitals.

And there's over 16 amendments that have taken place since we originally started.

Thank you.

Please, please vote in favor of this franchise.

We've worked on it for six for 18 months, and it comes back to our board meetings, which is actually your board also, because we're appointed by you to keep an eye on what's going on down there and make sure that they're complying with the agreements.

So please vote in favor of this franchise agreement.

Up next is Adam Hines.

Good afternoon, Adam Hines, Chief Operating Officer for Remsa Health.

I'll be quick.

Um, but I thought uh it would be an obligation for me to come up and make sure that this is on the record, uh, particularly for the men and women, many of which are behind us, uh over 600 strong at Remsa Health.

Um, and it particularly uh surrounds the airport transfers.

I think we heard from the hospitals about our performance.

Um, but one of the things that I've heard is that there's some sort of pervasive uh underperformance at picking up patients from the airport.

Um the disservices is that's not something we report to this board.

Obviously, every month we come and we talk to you and we share the data points, but there are so many more that every day our staff is looking at.

And I wanted to share in the record, particularly when it comes to the service of our airport, what our performance was last year.

Last year, Remsa Health responded to 827 requests for aircrafts that landed at Reno Tahoe.

They had a medical crew on board and they were transported to a local hospital.

Of those, 96 percent, 798 of them, we were there before the aircraft landed.

On average, 16 minutes, 53 seconds before the aircraft.

That's 96 percent.

Of the remaining 4%, the 29, 44 percent of those, we were given inadequate notice.

Meaning the aircraft is on the ground, and obviously we have to respond at that time.

There are many reasons why that.

I'm not pointing any fingers.

Logistically, that can happen.

But it's important to understand that there are going to be times where the aircraft lands and we have to respond, and there is going to be a negative or a positive response time.

Of the remaining, which, if I do the math correctly, I think is 16.

The average overage was 16 minutes.

So I just thought it was important because that is something that's been brought up.

You know, when I saw that, I have not had one air carrier call me and say we have a problem.

Obviously, if we have a problem, we want to fix it.

What did you ask?

If we could have everyone retake their seat, it might take us a minute to do that.

Madam Clerk, I think as you indicated, we may have one more public commenter.

So because we're still in that space, we're going to go back to public comment before closing out and then come to the board.

So I'll turn it over to you, Madam Clerk.

Thanks so much for your patience, folks.

Madam Clerk, uh public comment.

Yes.

Next up is Christina Schoening.

Let's see what we got.

That thing moves around like gumby.

You can make it go almost anywhere you want it to.

Is that better?

Okay, yeah.

I can hear.

Um, I think your your time.

Um, and I'm going to try to make it quick because I last minute decided to do this.

Um, I am a social work student with uh the University of Nevada Reno, and I am doing my practicum through Remza, uh, Mobile Integrated Health, which is a forward thinking program that they've designed um just this last year to help relieve the sorry, super nervous.

Um help relieve some of the high usage 911 calls within our community.

Um we're a team that works together to respond to those entities, to respond to those clients and be able to provide services and care where they don't need to rely on emergency services for their calls.

So I just want to be the voice saying that they are not only an established very well recognized, very highly respected entity for emergency response, but they are also extremely forward thinking when it comes to what they're looking for towards the future.

So I thank you guys for your time.

I thank the audience for giving me this opportunity.

Thank you.

And I want to know that you I really really hope you pass this, and my support is 110% behind this.

Okay, Madam Clerk, and I'll just look at the room and say this is the time that you have for public comment on this item.

If we move past this moment, you won't have the opportunity to have public comment until the end.

So if it's sort of that speak now or forever hold your peace moment.

Okay, Madam Clerk, we'll close public comment, bring it back to the board.

Um, for my part, I'm gonna start and then turn it over to my colleagues because I'm incredibly interested to hear what uh my colleagues have to say.

I want to start by saying thank you to all the partners and stakeholders.

Certainly, all of you have worked tirelessly over the past two years to bring this agreement forward.

Uh, for my part, um, this has been one of the more challenging experiences of my life in elected office because each one of us who are elected and serve uh do some other things.

We serve on other bodies, and so we have to be able to do all the things well, and it's been a tremendous learning process for me.

But I will say this process has been highly collaborative.

It's involved input from board members today.

You've heard from 731, local governments, fire agencies, healthcare partners, and other representatives.

The region continues to experience, I think, real and uh incredible pressures of growth, including cre increased call volumes, workforce constraints, and for my uh viewpoint, operational bottlenecks across the continuum of care, uh along with rising costs, as identified by many of the folks who spoke today, and of course, we are experienced at the local government level fiscal pressures uh which are getting at some point in time uh requiring a strong regional uh alignment and clearer accountability.

Uh, the updated agreement, I think, is designed in my mind to address those pressures by creating more durable governance and performance framework while also working to keep uh the system stable and responsiveness for our residents, our visitors, and our health care emergency partners.

And it is also, I think, a desire of all of us uh in the room that we maintain an open and ongoing dialogue about the needs and changes that occur in this community rather than having an outdated franchise agreement that was nearly 40, a little actually a little more than 40 years old, uh, which has created a recurring cycle of uh problems which have required evaluation, update, and agreement to ensure that we can continue providing for our region's uh safety and well-being.

Um, a couple of things about REMSA, and I think no one can dispute uh the incredible work that they do, and and to all of those of you are here today that are employed by REMSA, thank you from all of us.

Uh, it is a tremendous thing that you do.

I know some of you personally uh have broken bread with you, know you as family, uh, and have seen the incredible uh growth that this region's stresses have placed on each of your families.

So thank you for your commitment to our well-being here.

Uh the agreement does um for my part reflect, you know, two years of this dialogue, which allows the partnerships across multiple agencies to ensure a stable EMS system.

It also strengthens accountability through the clear performance metrics and enforcement.

It improves transparency through enhanced financial visibility and formalizes collaboration across jurisdictions.

It also includes a six-month opener aligned with our regional fire study, which we're going through right now.

So this iteration of the agreement acknowledges the needs of a growing region while recognizing that no agreement will be perfect.

Uh, there may be a page or two on which you find something that you don't think is what should be in the agreement.

But at the end of the day, I'm reminded to not make perfect be the enemy of good.

What we want to do is provide the framework that allows us to have greater collaboration.

I also think it is not a static agreement.

Uh, it's designed to encourage that ongoing dialogue in a way that is incremental, but is respectful of the ecosystem that we've created here.

We need REMSA to be successful for our region to be successful.

I don't think anyone believes that REMSA should go away.

And so for my part, I have looked at the agreement.

And while I think that there are some things that I've heard today that might be changeable or uh could be amended, I want to give my colleagues the opportunity to think about uh the agreement in a broader uh brush.

Um, I do think there's opportunities here that now is really the time to engage in.

And so I'll now turn it over to my colleagues and really uh thankful for the opportunity to lead this board through this important discussion.

So, what we're gonna do is just know that we'll take whatever time we need today, and I'll start to my right.

Dr.

Edward, do you have comments that you'd like to make at this time?

Um, I I would only comment that I I was here when they had multiple agencies all competing and trying to provide the care and the fragmentation of the care.

And I agree with my medical colleagues that have spoken today about what a disaster that was and and how inconsistent the service and my experience with REMSA in in multiple uh ways, including when I was in private practice, including my experiences at the VA, including experiences at the jail and now at the tribal health center, um, have all demonstrated quality and high performance.

So uh, and I think your comments are well taken.

It's distressing to hear that there are still some problems, but I think problems uh need to be have focus and and solution.

And I think you don't want to uh discard something that's working so well just because there may be some problems or some raw spots.

So I think we should look at those.

Uh, but I I'm not in favor of uh delaying a decision.

So thank you.

Dr.

Duarte, thank you so much.

Mr.

Driscoll.

And please know that we'll we can have multiple rounds of uh opportunities to have a conversation.

Thank you, Mr.

Chair.

Um, first I want to commend the health officer on the process and the ability to have this document come in in front of us for discussion.

I think he did exactly what we asked him to do as the board, and I think he went above and beyond in the process.

And for those who um don't believe they were at the table, there may have been a reason because I think he tried to include everybody at the table, and it was open-ended.

So, with that being said, on the first side.

On the second side, I believe that the REMSA organization, the professionalism and the trained individuals that are on the ground are the best.

And I've seen other communities, I've been a customer, unfortunately, um, more than a couple times, uh, both myself and my family, and I think that um the boots on the ground are doing everything that they can to do it right.

So start with that.

For today's activity, I am not going to be able to support the agreement as it's presented, and mainly because I believe in section 2.5 and 2.6, the health officers' presentation today on those two sections were much more clear, much more definitive.

And if that the presentation language was in here, I would be voting yes.

But because words matter, and once you pass it, it takes a long time to make any changes, even by the just this definition of this year out at minimum of a year if you think something's critical, three years to four years if it's not critical.

So I'm not going to be able to support it, but what I would like to ask is that the few couple of language changes that have been talked about and we're in the presentation to get them in the agreement, get them changed, and get it back on the agenda at the next meeting.

So we're not having a delay, because I believe delaying this relationship is not a good thing.

The second thing is in Article 13, which will be something to be considered where we're doing this.

I think the language there is convoluted about what happens when there's not compliance.

Well, if I screw up the same thing over and over and over exactly, I've got I can fix it.

But if I'm just messing up this and not complying and this and this and this and this, because it's not the same thing, they're like different paths, and they can't be looked at as we've got a compliance problem.

And so I think again in the conversation in the presentation, if we were to tweak that language to match what was said in the presentation, again, quick fix doing exactly what the group wanted, but making it more definitive.

And then the last thing that I have, and this is just a personal piece because as a board member who in the bylaws establishes the governing body for REMSA Health.

It's been brought to my attention that there have been numerous times over a long period of time that the health officer as the ex officio non-voting member has been dismissed from the room, not allowed to participate in conversations or decisions are making space.

That is not what an ex-officio is.

An ex-officio participates in everything in every meeting.

The only thing they don't do is at the end of the discussion, vote.

But otherwise, they participate in the conversation, they can make suggestions, and they are there to witness everything that goes on.

And so I believe that that practice needs to stop.

It's not in here.

It'd be great if it could be in here.

I'm not suggesting that language be changed, but I'm putting it on the record that I, as one of the board members, when I read ex officio, I've just defined what that is.

And if um and we need to operate under that, under that rule.

So with that, sir, um done.

Mr.

Driscoll, thank you so much.

And and because it's so important that we um have this conversation.

Would you share with the assembled audience your background?

Because I for those who don't know you, I want them to understand that you have 30 plus years of and maybe more, and I could be wrong, of experience in local government.

So I want it to just speak to that if you wouldn't mind.

Um I actually had a working career that was just a little over 40 years.

The last 25 was with the city of Sparks.

During that time, I was the municipal court administrator for a short while.

I was the assistant city manager responsible for all the internal operations of the city for 14 years, and for the last five years, I was the city manager.

So for the the 19 years of the being the assistant and the manager, I was an advisor to the health department on all things based on the agreements and the charter of it.

And additionally, I was one of the participating members of the renegotiation in 2014, of which the reason why words matter to me on this, there were things that were agreed to by all sides, and it didn't get done, and it's 12 years later.

Now I own five years of that, and I regret that I didn't put my foot down a little harder and gather all the parties together.

So I believe um that's why I'm being really strong about the words today, because my background has taught me and all of the governmental operations, which is why I'm being a little grouchy about the ex officio because it's not right.

And we and just because we've always done it that way, doesn't mean we have to continue operating under an error.

We can correct the error today and move forward.

So that's where I see in the language a couple of things in language 2526.

We just change the language to match what we want.

We've stopped an error.

Thank you so much.

And the reason why I asked you to do that is um I know, but I want everyone else to know how much experience you have in this area because your words have weight to me, and that's why I try to listen to my colleagues.

Uh stick with me and let's see where we go to in the course of the conversation.

Um maybe there'll be something there that we can agree upon.

Um, I thought, and I could be wrong, and and uh Mr.

Dr.

Kingsley, if you wouldn't approach the uh podium for me, please.

Um, this question about your ability to participate and anyone's ability to participate.

Um, we've changed the structure of what is required to have membership on the um REMS A board, is that correct?

And no, no changes to that article has been made.

Okay, so um we'll look into that.

Okay, thank you so much.

And we're coming over here to my favorite, but don't tell anybody else, Miss Andreola.

I think you say that to everyone.

Thanks for making me feel so special.

It feels like it's a board of county commission meeting and not a board of public health.

So welcome to Washoe County Chambers.

Um, I have to share with you that I have been here for almost 40 years.

And one of the things I pride myself on is doing research.

I wish I could have done it full-time my whole time uh career.

I love it.

And Remsa should be extremely proud, and our community should be extremely proud for the folks that are in this room and aren't in this room who helped form actually what is that model of a public utility model.

If any of you want to just take a moment, not now, maybe it's up to you, and look at the definition of public utility model in Wikipedia as an example.

So kudos to all the folks who, and I don't know, I'll just add one little thing for history for trivia, maybe it'll come up in jeopardy or something.

But the reality is is that public utility model was crafted in 1983 by a gentleman in Denver.

And for at the time, Little Washo or Little Reno or our little community, think about what it was like in 1986.

And to be that forward thinking and to craft essentially a best practice and then have that carry through, I think is to be commended to all those that helped with that.

And I think some of those folks are actually in this room, so thank you.

I think that today is not about all the great work that RemSA does.

We all know that RemSA is an integral part of our community.

There's not one person that doesn't value the hard work and the sacrifice of all those who make this community as safe as possible and as efficient as possible.

So I just want to get that on the record in terms of really being proud of everything as it was created in its embryotic state.

But the reality is we have grown and things do change.

And there is, I think, some provisions that I'm not going to go through all of my notes, but some of the things were answered.

But I promise I did not speak with Mr.

Driscoll, but if you look at my notes, you'll see that 2.5 and 2.6 were two areas that I also shared as needing some additional clarity to Mr.

Driscoll's point that I'll reiterate seeing Dr.

Kingsley's presentation today helped to actually clarify some of that.

And I'm not sure because I was trying to look at did what I hear match with the language, because words do matter, and what we approve does matter.

But what I see that is missing, that I don't know why per se it's missing.

But this body, and I was not here, um, actually approved the Washoe County, um, essentially the Northern Nevada Public Health Now District, enhancing quality of life, the Washoe County EMS strategic plan that literally was put into place from to carry over from 2023 to 2028.

And going through all those provisions and looking at the document, there's no reference to this document, but I want to speak specifically to one of the provisions I think, and since being in this adventure uh since April of 2023, and and recently, I think the newest member on the board, I don't know, Mr.

Dressel Who, but certainly new in this capacity.

There's a provision that that bought that this uh plan that was approved by the board includes a provision about dispatching the close to CMS responder, and it gives a date of December 31st of 2024, at that time with the crafting of this.

Um, everyone's accessibility, but the time of us trying to get some answers, and everyone has been extremely I want to commend um Miss Reed for picking up the phone when I'm calling, and I realize that Dr.

Kinsley has made it very clear that the accessibility to all of us has been open.

But the reality is is that digesting a lot of this takes time, and um I know it's been 18 months.

I I do I mean that's a long time.

But then when things are coming up, and then seeing some of the things today and seeing, for instance, not having that provision that I can see.

So if I'm wrong and that provision is somewhere, I'd certainly welcome the correction, if in fact I am wrong.

But I think our community deserves to have the closest unit, and it's described dispatching the closest EMS responder.

I think that we all, when we pick up the phone, and I hope nobody ever has to, but the reality is we do.

You pick up the phone, you don't need to know all of the background.

You need to know that the professional response by REMSA and the training and everything you should be proud of, is you're there.

And I just feel like referencing that document, I feel having some of the provisions, if not just referencing the document are important.

The other thing that I would like to um just mention is I really appreciate um Mr.

Tess's comment, because I in looking at and listening to the presentation and reading, looked at some of the provisions that allowed for, and I can't remember how it's titled, Dr.

Kinsley, but it was uh essentially um possible amendments that could come later for I don't remember the title.

And the reality is is that yes, this is not a document that has one signature and it's put away and there's no discussion, but it appeared to me, which is what Mr.

Tess was saying, and I agree, but in looking at the language, um, and and maybe I can uh Mr.

Chair asked for clarification.

What is that?

What does that look like?

Because how I'm reading it, um, I I don't know that that uh what that time frame really means because you have like 90 days.

So what does that look like?

If this were to pass today, for instance, and and those provisions would be um considered.

What what does that look like for a time frame for coming back for review?

And that's my first question.

And if it does come back, does it come back to this board, or does it go under the the um definition of district that's been outlined as the Northern Nevada Public Health?

There really isn't a reference anywhere in here that I can see where it comes back to the board of health for anything other than an amendment, if you will, or direction.

So I'm just asking for clarity on one, what is that time frame for that possible um recommended uh list that you had, and also what does that look like with process?

Who's involved in that?

How does that work?

And then what is the time frame that and then does it come back to this board?

So I guess there's four questions.

Ms.

Esp, are you uh in a position to best answer that question?

Yes, I am.

Thank you so much for the record.

Sorry, Andrea asked preparedness EMS program manager for Northern Nevada Public Health.

Um, those are excellent questions.

And there are several items that Dr.

Keensley talked about, all of which um I don't think there's anyone in this room that would disagree.

We want to further explore.

Um, one of them being we talked about um our regional CAD system and EMD right now to put a time frame on when we could come back isn't very feasible.

Um, however, there's language in there that says we will do that.

Um and I think it's upon the board to hold us accountable that when that regional caste system comes into play that we do bring back recommendations as policies are revised at that regional level, and then we see how does that best fit in to the franchise and what kind of language needs to be revised.

Um you really asked about or one of the things you asked about was who's involved in that process.

Um I think all the partners can say that I have answered my phone at any time and have listened and wanted to know their feedback, but most importantly, I didn't want to just hear it.

I wanted to understand their perspective because I also want to be an advocate for them as well to understand how to best make recommendations to this agreement.

Um at any point, we can bring something back to you.

If you request Andrew, bring this report back or bring this franchise back, I can bring it back with recommendations.

Um being asked not to be rushed, especially when we're looking at data when we talk about patient outcome, we don't have access to all that data.

That is not a result of REMSA or fire agencies.

It's a systemic issue of things that we're trying to solve, one that costs money.

So we that's another problem on the table, but the group is actively working on.

Um I envision a tackling some of these larger items through that body that really encompassed the JEC.

Now you see that that is that language of JEC is removed from the franchise, but that does not mean that the body itself is removed.

That body does excellent work.

Um, but legally we are told we can't have it in there in that function, and then that structure that we to provide formality to it, it does need to be it needs to live somewhere else.

Um, but that body has no authority or oversight, it just informally meets and we talk about things in a non-public setting.

And Ms.

Esp, can I just point you to section 5.2 of the amended franchise agreement?

This is what you're talking about, correct?

This is the area where the hexacon discussion occurs.

Yeah, chat uh article five is about communications.

Right.

And so in Article 5.2, I think, and Miss Andreola, you'll have to correct me if I'm wrong.

You're asking that when that alternate process comes about, when the hexagon system is functional, you want to know how that will impact this franchise.

Yes, but there was just more.

I certainly appreciate the hexagon discussion.

That's been uh the goalpost keeps on moving.

So that in itself, it wasn't necessarily only talking about hexagon, but I appreciate the clarification on that.

I there were other items, and I just don't remember where on the list, there were other items on on there.

And I guess what I'm getting at, thank you also for the clarification on the JAC, because that's one of my questions, why did it get removed?

And so if it's not appropriate from a legal interpretation of not living, where does it live?

Because you said it doesn't live here, so where does it live?

Um, so on our May MSAB meeting, we're making, we want to propose the recommendation for that board to advise Dr.

Kingsley to develop a work group similar to the work group right now, working on AB 102, so they can continue in that formal fashion of discussing a variety of issues that group comes together and comes to a consensus and works on, but then reports back to MSAB.

What about the closest unit?

Closest unit.

Um, so I I would also say that there's no one in this room that disagrees that the closest appropriate unit should be dispatched.

Um part of our constraint right now is that we don't have a system that allows access and visibility to where all those units are across our entire system.

So that does not allow for us to dispatch always the closest appropriate unit.

Now we've done studies and then we have looked at it, and where we we have looked at studies that have been fragmented.

So what I mean by that is because not all of us are under one CAD system, you can't analyze the data all um respectively.

So we can look at fire and one, and then we can look at REMSA and see how we're dispatching.

Um but collectively, we're unable to do that yet, and we do look forward to that once you're in a regional CAD.

And I think once we can look at that data, it's gonna inform maybe policy change, but that is for the regional hexagon work group and that that management group to oversee and change policy and how that that plays out.

Um, although it's a re it is in the strategic plan for the EMS region, it is I don't think I'll say this.

Um we don't um have authority in the franchise to say we to say that the most the closest appropriate unit outside of RemSA can be dispatched, because they don't oversee those other entities.

So right now, policy doesn't align with what the vision and a vision of that strategic plan is that one day we will dispatch the closest appropriate unit.

But to get to that point, we re need a regional CAD system, and then from there we need policies that support that vision.

And so we're in those just that infancy stage.

Now there's been a lot of progress made.

I think everyone has Heartburn when they hear about regional CAD because it's been talked about for 10, 15, 20 years, but now we see it and there is a light at the end of the tunnel.

So I think it it it is exciting to see what the future holds, but it will take us time to get to that place.

And no, we did not meet our deadline that's outlined in the strategic plan.

However, it has not fallen off our radar and it has continued to be discussed, and what we would like to see once we get to that point time to make those decisions.

So I I guess to your point, and everyone's been waiting, and it's been a discussion for a long time, and I realize there's a lot of moving parts that aren't controllable.

So I I appreciate that.

But the reality is is that it's still in fairness, could be put in in the sense of not necessarily from an enforceable because there are constraints, but when it comes in, so then that's another provision that would end up having to come back.

That's where I'm going.

Like there's things in here that we all know and hope are going to happen.

So will it allow is as it's written, I'm not an attorney.

As it's written, are there provisions that allow those things to come back?

And then to your point on accountability, then we have a uh responsibility as well, right?

Um, that if in fact that does, and I know you're working hard, and thank you for all your hard work.

And I know that it's been not an easy thing for you and Dr.

Kinsley and a lot of staff, and for Remsa.

But the reality is is that I'm gonna go back to words matter.

And so I just am trying to figure out how what is the time frame to open these kinds of things up and how do we hold that accountability?

So if if I'm gone, which I'm sure a lot of people might be smiling, my colleague, but the reality is is that even the folks that were were before, they're not all here.

So I think that when we're looking at an agreement, and you're looking at sometimes, if you will, this five-year provision.

How you know I I I love trust, but I'm a trust but verify kind of person, and I really think that we have a responsibility to the community to hold that.

I'm not sure if REMS has even seen this agreement that um and goals that Northern Nevada Public Health has outlined and and approved.

So anyway, long story short, I don't know legally if there's a way that somehow that could be crafted.

Um I also, to be honest with you, um, seeing not having priority two calls in there.

I I wasn't sure like why we wouldn't put priority two calls in there as an example.

So priority two calls um, as mentioned earlier from public comment was removed out of Article 7.

It was about reporting on priority two calls.

There's not a metric that we currently hold in this community for priority two calls.

So the word priority two was removed in with intention because right now there wasn't a metric.

We said if we were going to have a metric on priority twos, then it would be reported to us.

But right now, there is no metric or a standard of which priority twos are responded to that is set forth in the agreement.

So we said priority two information is not being reported.

Now, with that said, there is a provision within the franchise that the district hospital officer can request any data at any point of time, and it must be provided by REMSA.

So if the board wanted specifically look at how the response time was happening or what it looked like for REMSA, we could pull that data and present it to you.

Um it could be a standing item if that's something you wanted to continually look at.

Thanks.

I I appreciate it.

I have taken um and exceeded my time.

Like I really appreciate the fact that so much has gone gone into this.

And my last question, although I actually have a lot more, but I'm going to let others talk.

Can I reserve the right to come back?

You're gonna get it.

Um I just forgot that my question just because you were so kind.

You were so kind there.

No, I will come back to you, but no, I I have it.

Oh, good.

Um, I am hopeful that the there's just some lack of clarity again on when things come back, and then how we measure that.

And because of the five-year provision, even though there's an annual review piece and then the 90 days, I understand that, but I I wish that there was a way to kind of tighten it up because there are all of these things that are happening.

And by the way, thank you, RemSA, and thank you, Dr.

Kinsley, for addressing the fire service and the regionalization.

So if a study comes, it'll open up, but does that open up automatically?

So these are kind of all the things that I think I'm just sharing with now the whole public of the hours that I've spent.

And unfortunately, I just wasn't able to get with everybody as quickly as um I would have liked to, with not only Remsa but yourself, and for full transparency, I have spoken um with um RemSA, and um I know that they want to be good partners, and everybody knows that we're just trying to actually make sure I's are dotted and T's are crossed and we understand the full process.

So for me, having the ability to open this back up with some of these things are really important.

That's why I started that out with that.

So if I can have some assurance of that, I certainly would appreciate it.

Ms.

S.

Do you feel qualified to answer the question, or do we need to bring someone else up or legal?

Can lead to the it might be a combination of legal, Dr.

Kingsley, Mr.

Pawnee.

Yeah, Mr.

Pani, I mean who wants to take a stab at it.

How about you start?

Start at it.

Um so there is a provision in there that if there's to be language to be changed in the franchise and we were going to change metrics, specifically if we were changing something that is associated with a fee attached to it.

And that's where most of our measurement comes from, is that our fee-based metrics.

Um that during that period of time in which we are changing language, that then we would there's parameters put on the board so that we move that process along and keep those guy.

I think Dr.

Kingsley called them uh guide rails earlier.

And at the same time with Remsa, so that um we address the issue, but during that period of time to help move that process forward and we don't stall in that, because that's the intent was we felt that there was we stalled and it took us a long time to get to this point, and we were kind of behind the ball on what we originally tried, our target was was to renew the contract or to make a decision on the extension one way or another.

Um and those guide rails then allow for um the board is not penalizing REMSA fee-based while they're making those changes, um, so that the agreement doesn't go for a year, two years in limbo.

Um, and those guardrails were specifically put in there so that as a board, we helpfully move forward in one direction or another, whatever you see fit, but at the same time, it keeps us with the current franchise or a franchise in place of which we can hold accountable to.

Um, but in time you could request for us to bring something back.

Um, board, I don't mean the board, sorry, the board at any time.

The board, as in the district board halls, could request for us to bring something back for discussion or amendment to the grant um the franchise.

We have done that in the past with this franchise and did it off cycle.

Um we did it twice actually, back to back.

One was content change specifically to some levels, Article 2.3, and then we came back like three months later and made some minor tweaks within the language of the franchise.

Very low-hanging fruit.

Um, if I could explain a little bit why the five year and the intent behind it, I am very open to suggestions and changes, but the logic we went with the annual review.

Right now, the annual review is nine months after the fiscal year ends.

And we felt that that right there, because we're starting another fiscal year, is too long of a period of time, that we need to be reviewing them within 90 days and coming back to the board to look at performance of where um where it is weighed the most within the franchise, and that comes back to response time.

Although we look at administrative stuff and we talk about the paperwork side of things, not response or responses included, but the administrative part is not response.

Um, then we have um that will happen every year.

In year three, we have the market study in year four.

No, sorry, in year three, we're doing I'm gonna get confused.

Yeah, we've we have yeah, we've revised this many a times.

Um we have a market study, we get to do um, and then after that market study, you're gonna have a presentation back by a third party, giving recommendations looking at how do we compare our system to the to comparable systems to compare communities throughout the region.

After that study's done and we've looked at the last three years of their performance, we start talking about formally what changes to make in the franchise.

And then we're gonna do another comprehensive review at the time at the during the fifth year, but then that the whole contract um the five-year solid starts again after that fifth year.

Um, it was done with intention so that we're doing the reviews.

You're gonna get a comprehensive review or a third party outside look on how our system is so that we can take those recommendations and then apply them to any language changes starting in that fourth year, and then we'll continue on with that final comprehensive review and any final changes.

We also felt that that timeline aligned with what was proposed for the fire study.

So opening up during that time with some wibble room to hopefully incorporate, but it also leaves there's language that if there is a major change that there's the opportunity to go through and open it up, make changes that the board wishes to do so that is found out of that fire study and revise the franchise.

It is not clear as mud, and I see why when you asked me that and why stepping away that can be a little bit more apparent.

So I appreciate you saying that.

Um, with that, the intent was never to not make it transparent and to not make it a very clear process.

We tried to look at it from multiple angles to make sure that we were serving the public, because that's my job is to help write a contract that serves the public, um, regardless who is the provider of that contract.

So I hope I answered your question.

If legal would like to chime in.

Multiple people.

Miss Esp, can I ask you a question and then we'll just make a real quick comment?

Don't think for a moment that we all don't appreciate all your hard work.

Oh, so please don't even think for a moment that you have to.

I'll use the term defend your hard work and transparency.

I know that we've done that, so I really feel it's important that we say that.

This is not to be critical of anyone at all.

This is really just trying to have someone um who is not an EMS professional.

I know how to spell fire.

I have some emergency uh management training and certification with my time at the Red Cross, but I certainly do not hold a candle to any of you, and I do appreciate Remsa's contributions and all of the hard work.

So I just don't worry, you don't need this isn't defense of any way.

This is just trying to understand having somebody like me really understand what is moving and what's before us and what the ability is to come back, because to your point, there's a lot of moving parts, and we don't know.

There's a lot of uncertainty, and we don't know.

It's not fair to REMSA as well.

It's not fair to our community be in this situation of this even hexagon moving and the goalposts moving every time you turn around.

So everyone's working hard.

So thank you for that time.

Please thank you for all your hard work.

Team Effort.

Ms.

Esp, I want to just follow up on Miss Andreola's comment.

Um so we have currently a franchise agreement that will expire in four years, correct?

Correct.

And that agreement is old and outdated and has lots of problems, correct?

Uh that would be the consensus.

Yes.

And Miss Andreola raises concerns about uh CAD and how things come back.

Will any of those things change if we keep the current franchise agreement?

Um right now, the specifically on CAD, there was language change to Article 5 to allow for the adapting of the new hexagon and then revisiting.

So sorry, I'm not talking about the revised amended updated agreement.

I'm saying under the current agreement.

So under the current agreement, is there language that would be uh would alleviate the concerns raised by Miss Andreola?

Because I'm making the point to you and through you that it's not a perfect agreement, the franchise agreement.

Many of the things that Ms.

Andreola raises are legitimate concerns, but which none of which would be addressed with the current one, but the new agreement moved us closer to being able to address them.

Correct.

Okay, and so is your professional recommendation that we accept the recommendation of the district uh health officer and yourself that this franchise agreement be approved.

It is my recommendation with the.

And why is that?

I believe that it offers a more transparent agreement.

One problem I found when I first started in this program was why don't we measure anything?

And how come we're not looking at the data?

And I kept and I kept asking questions, and I was told you can't and you won't.

And I hope you're not around when we update the franchise.

You don't want to be a part of that.

And I looked at it as an awesome opportunity and challenge that we needed to increase transparency.

I went to REMSA and I said, I'm not okay with this.

And I finally got to have the conversations of I'm not okay with how this looks.

You're gonna we're gonna have more transparency.

Um everyone I felt was accepting of that.

I would like to have more transparency.

We are just lacking the data opportunity for that.

Um so I think this is a step in the right direction, as long as this isn't, as Dr.

Kingley said, we don't keep this static, that there is accountability desk to bring this back in the future as our system evolves, and that we do make changes as appropriate, and that we keep the language in that franchise flexible to allow for adaptation as our community grows, especially if we have major changes, such as the fire study, if that may brings major changes to our region.

Okay, thank you.

So can I ask the clarification?

Of course.

So are there only conditions that have to be met?

We don't use examples.

Are there only conditions that have to be met in order for it to come back for consideration by this board?

Are there only certain conditions that have to be met in order to open this back up?

No, there are certain conditions for it to be termed.

That's where I'm really going.

And if the board for whatever reason uh wanted to open it back up for whatever reason, I'm just saying, for whatever reason.

This board has that ability to do that.

And we don't have to follow necessarily a five-year, three-year wait for the market study and all that outline.

Is that a correct statement?

I believe that to be accurate, but I'm going to ego to make sure that I'm not misspeaking.

And REMSA certainly an opportunity as well.

I don't, this dinguri, deputy district attorney, I don't have a specific provision that I can point to that says that.

I can tell you that in my discussions and what I've heard, that has been the intention, is that this is a document generally contracts can be revisited with a process.

I would also ask uh Remsa Council to weigh in on their view because we have not had those discussions.

Thank you.

Mr.

Folletta.

Uh thank you, Chair, members of the board.

Uh Lucas Folletta, legal counsel for Remsa.

Um, yes, just like any other contract, this contract can be renegotiated at any time at the will of the parties.

If there's changes that need to be made and they're mutually agreed to, that um can absolutely happen.

And it has happened over the history and course of the agreement.

I think we heard 16 times.

Um I did want to address two other things that you've been discussing kind of back and forth with um the health district staff.

One, there was a question about whether uh there's sufficient um detail around the roles of the parties in this agreement, as between this board and your staff.

Let me just tell you that um uh from our point of view, any reference to um Northern Nevada Public Health as a party to this agreement, any right, responsibility, or obligation is a right responsibility and obligation that uh must be undertaken by your staff at your direction.

Meaning if you want to be specifically involved in the execution of those uh responsibilities or duties or obligations, that's your purview, and that just simply needs to be direction you give to your staff as to how you want to see the agreement administered.

So there's no scenario where this board in my mind is um cut out of or not involved in the administration of this agreement if that's how you want it to be.

Now, yes, you would need the agreement of both parties to change one of these performance checklists.

Um, but that is a change that's there again in recognition that over time things do change.

And it's one of the many provisions of the agreement that gives, I think this board significant authority to exert its influence over what changes should be made.

Um Common CAD is a good example.

Um the current franchise, I would suggest to you is actually problematic with respect to the implementation of Common CAD because it says that RENSA is the exclusive provider of emergency medical dispatch.

Okay, that is inconsistent with a common CAD and a policy of dispatching the nearest available unit uh in connection with the implementation of that common CAD system.

That is a reason why that this agreement specifically has language recognizing that there is a um operational change on the horizon that needs to be accounted for with respect to how we dispatch these resources and leaving that agreement in place um would potentially create um an operational issue that simply has to be addressed at some point in time.

And REMS obviously has indicated its willingness to address that or has been a meaningful partner in that exercise.

Um, but just to give you a sense, you know, and to kind of endorse the idea that I think your staff indicated, which is that there is common agreement about the direction operationally that things are going in that respect, and we're trying to accommodate it.

Thank you.

Mr.

Palletta, um, the where adds clauses, I want to ask about the two of them because they relate to your last comment.

So on page three, there are two warehouse clause at the end, which essentially to me suggest a overarching framework for collaborative um endeavors and undertakings to be made.

So, and and because I am a lawyer and we can talk lawyer to one another, um, those are as binding as the other provisions of the contract, correct?

Absolutely.

Those are binding expressions of REMS's intent as a party to this agreement and as a partner.

Thank you so much.

Mr.

Anderson, I'm sorry for the delay.

I'm sorry.

I need to apologize for the delay.

No, thank you.

So uh obviously we've been at this for three hours, but I want to say um I am so impressed with those of you that are remaining, and especially those of you that uh are here in uniform.

I was thinking the last time I saw this many uniform folks in one location, it was probably a Nevada football game.

So thank you for being here.

Um and with that being said, I imagine a couple of you might be from RemSA.

Would you mind raising your hand identifying who you are?

All right.

Awesome.

Awesome.

Well, thank you.

So now I'm gonna ask the question how many of you are actually paramedic EMTs, the ones in the ambulance that are getting the job done each and every day.

Nice.

Thank you very, very much for what you do in our community because you are making a difference day in and day out.

And I truly appreciate that, as does what we've heard today.

Um I've got to ask, obviously, the other side of it are dispatchers.

Do we have any dispatchers in here?

Awesome.

Awesome.

And likewise, I thank you because you're the ones that are the first point of contact when someone is in the middle of a medical crisis, you're the one that are helping them feel more comfortable and assisting them through the process.

So thank you for what you're doing.

And then I can't leave off those behind the scene that are critical that are the support staff.

Do we have any support staff in here by chance?

Nice.

Nice.

Well, again, thank you because if you didn't do your job, they wouldn't be able to do theirs, and likewise, we wouldn't be able to take care of the community like we've we've been doing.

And in fact, what's interesting is we we got a summary of, well, not a summary.

We got all the public um uh public comments um given to us, and uh it's even graphed out um those that support, those that oppose, those that are neutral, um, and those that have no response, but they just want to comment.

Um and what is amazing is it's in the the 70 percentile of those that responded it were in a positive form.

What was even cooler is those three groups that I just mentioned are the ones that are directly related to most all of the comments that I've read through, just like the passionate, caring um comments that were made by some of the folks here today.

So thank you because it's because of you that our community is being taken care of.

I I truly appreciate what you're doing.

I I can't say that enough.

And I just want to also make it perfectly clear that as I make some comments here, in no way are they a reflection on you, your professionalism, um, how hard you work.

So please don't take it that way.

Um I am gonna make some comments here that um quite frankly, I'm I'm concerned um with the direction of the management and the governance level um folks at RemSA around the process, the responsiveness, the respect for the jurisdictions.

And again, this is not on you, the employees that are getting the job done every day.

So please understand that as I go through this.

Um I actually at one point, Mr.

Chair, had seven pages for you that I was gonna go through.

And I've already got half of the room gone by now, so I'm gonna try and make it short and simple.

Um, with that said, though, I do need to make some important comments here that I don't want to be left unsaid.

Um starting out, and I I don't want to throw anyone under the bus.

I I don't want to do that.

I know a lot of people did a lot of hard work on this um agreement, and um please understand with all due respect, I'm I'm concerned, and if you happen to be one of those ones that are targeted, um my apologies to you, but it needs to be said.

Um with that, one of the things is that I, as a member of this board and a representative of the city of Sparks, um, have some deep concerns about, and I'm gonna continue with the mantra um words matter.

Um the words that we have in this document that we're deciding today whether or not to approve are such that in no way can I, on behalf of at least the citizens of Sparks, but I believe on this board, as us as a community, that I can say this is the best thing for our community.

And it even starts with the very beginning here, and let me read the the staff report um addressing uh the right at the very beginning.

It says, quote, recommendations presented herein represent a collaborative effort between EMS oversight program, the EMS joint advisory committee, the City of Reno facilitated work group.

I would disagree with that in the sense that City of Sparks was involved with the process for for most of the way through, but just about the time that it was about to go through the finish line, two of the three jurisdictions were not included in the process.

Our comments, our concerns were not a part of what we're all looking at today.

And I I believe that that is beyond acceptable.

That because and quite frankly, Sparks was a couple days late on on our response.

TM was a couple days late as well, but to not hold on in a couple days and and get our concerns is I'm gonna say it, it's irresponsible.

I'm sorry.

I feel so passionate about this because this is the lives and and likewise death of our citizens, and we need to make sure we're doing the right thing for everybody.

And I truly believe that Remza's management team has lost sight of what is truly important for this community.

You all can be doing an awesome job on the street day in, day out, dealing with horrific things.

But if the leadership has lost sight of what's most important and they're focused on the franchise agreement and the words and all those kind of things, we're going down the wrong path.

So with that being said, I'll I'll try and move on more quickly here.

I'm I'm sorry for keeping y'all here.

Um so one of the the I'm just going to talk about three of the major concerns that I have.

And yes, uh uh Dr.

Kingsley made some comments today about changes, but based on what I have in my packet, these are my concerns, whether or not we can change them down the road.

This is what I'm supposed to be voting on today, and I cannot approve that.

So the first one is the reduced operational flexibility for local fire agencies.

The proposed agreement um expands Remsa's exclusive franchise ways that further limit local operational flexibility.

And I'm gonna give you a real world example of that.

That is as of today, this is the problem with the agreement.

The City of Sparks has a very practical impact that could be made if if we had that authority to be able to take part in uh EMS services.

Sparks currently operates an ambulance at station five with a modest operational flexibility.

Sparks could relocate that ambulance to station one and move a fire apparatus from station one to station five.

This would allow all Sparks fire stations to remain fully operational.

And let me stop there for a moment.

If you haven't heard the news, there's a financial crisis going on for all of us local jurisdictions, and we had to go to the public and say, we don't know if we can keep our some of our stations open.

If we had the the wording in a document like this in such a way that we can actually decide, we, the community representing you, could decide where best to move our resources, it would drastically improve things.

In fact, with next to no cost to the public, we'd be able to open up every one of our fire stations and have them properly staffed as a result of allowing us to shift where we have the ambulances currently.

Collectively, these changes reduce transparency, accountability, district oversight while increasing Remsa's discretion.

And I'll just name off a couple of the ones that I had as well.

A perpetual agreement, and I I'm hearing you know, we can make changes.

What I have today, if I vote on this today, what I'm saying is I'm accepting this perpetual, this language right now, and it is a per a perpetual agreement that gives us, and quite frankly, close to no out as a board as a community.

Once this is signed, we're in it for good, good, bad, or otherwise, there is no other option.

And then lastly, um what I see as a lowered um compliance standards and increased um billing disc uh discretion.

They're just so much in here that we really need to be concerned about.

So I guess, Mr.

Chair, in summary, um I I have concerns.

I named you know just three of them, but truly they're articles one, two, three, four, five, seven, eight, thirteen, and seventeen, as well as attachments A, B, C, E, F, and G.

And let me say it once again, words matter.

And it's because of the words in this agreement that in no way can I say yes to this contract.

Now let me kind of shift for just a moment, sir.

For about the past 30 years, I've been in business management.

I have worked on countless contracts as a vendor, as a supplier.

Um I've I've helped to create them, negotiate them, terminate them, amend them.

And and I've never seen one as problematic as this one.

And one of the things that concerns me is that we're talking about something that's that took place in 1986, has undergone 16 amendments, if if I'm correct, um, Mr.

Dr.

Kingsley, is that correct?

So, in my opinion, what we have here is a block of Swiss cheese.

Things have been added, they've been removed, been changed, and and now we're trying to piece together this document that's been going on for 40 years.

How much are we as a community the same way or like what we were 40 years ago?

I'm saying that competition is good.

Um, as an example, I am right in the middle of a contract negotiation with one of my larger customers.

They go out to to bid every three years.

I've had that contract for the last 25, 26 years.

Every three years, I have to compete to keep that business.

And what's interesting is that even though my legal team and I plead to keep the language in there and let's make some amendments, they the the customer, like we, the board and NMPH is the customer for RemSA, RemSA being the vendor, they make me go with a whole new contract.

We start all over again.

Yes, there's a lot that's the same, but but there are other things that are vastly different.

The nice thing about that is that it's clear, concise.

There are no, gosh, I wish we could have done this, I wish we would have said that.

It's it's complete.

And with that being said, uh, not only am I gonna vote no on this, but um, Mr.

Chair, at item um 12 agenda item 12, I'm going to request that staff begin preparing a request for proposals for emergency services.

Thank you.

Mr.

Anderson, thank you.

I'm gonna respond to just two things before we move to Mr.

Brown.

Um, one is this question about competition being good, and it sounds like you'd like to see us go out for competitive bid.

I I just want to make sure you understand first that we have an agreement in place with REMSA for the next four years.

That means you can't do any of the things you want to do anyways.

So either we under the current system or the chain system, you don't get to do what you are suggesting you want to do.

So that that's just one thing.

The second is this question about station five and station one really is um sort of disconcerting, and it it points out the concerns that are true for Sparks, but also for the other agencies.

Each one of our agencies has by agreement outside of the franchise made side agreements with REMSA to serve particular areas.

So station five is an area that's very uh removed from the city center, and REMSA, in order to help um you all with the standing up of a paramedic related program, said yes, we're gonna say that you can serve that area because you're better able to do it for those people.

And the reason why they're not willing to horse trade you for station one under your scenario is because that is in the core of their service area.

And at this body, we are tasked with not just representing our individual entities, but our region.

If you want to cut REMSA's ability to survive financially so that you can balance Sparks' book, they will not be able to survive.

You're talking about an agency that has served this community for more than 40 years and eats about nine to 10 million dollars a year in indigent care.

We cannot afford to take that on at the city of Reno.

I assume you can't do it at Sparks or Washo.

All of us are dealing with a financial crisis.

So the truth is is your request or your primary concern is about something outside of the franchise agreement, so it can't be dealt with in this, and will not be fixed by what you see, because I don't think you'll ever get them to agree that you should be able to serve the core of downtown Sparks, a budding Reno, because you'd have to have ambulances going around a service area.

So it doesn't make a lot of sense to me that you have made a passionate um defense of elements of it.

And for that, I I truly thank you for it.

But you're talking about something outside of the franchise at the district board of health level.

We have an obligation to ensure the success of the ambulance franchise for all of Washoe County, and we cannot do that if we allow you to cannibalize the parts which you think are more lucrative and therefore allow you to have ambulance service in that region.

So this is why I don't really understand.

And I get it, because it paired with your question about competition, that is one model.

That's not the model that we have designed in this region, right?

We have designed a model that says, hey, we've got a nonprofit who's gonna eat nine to ten million dollars a year in indigenous care in exchange for the other service area that they represent, and they don't come back and ask us for that nine to ten million dollars.

So in a different world, and I and certainly I think we have this idea as you know, Americans and capitalists that competition is good and monopolies are bad.

That's not the system we set up here in northern Nevada.

So and thank you for those comments, and I actually agree with some of it.

Yeah, we don't, we're not too far off.

We just we're passionate about where we live.

Yeah.

But and I I also understand we're talking about 2030, which that's why I think it's a great time to be having that discussion now to make sure that we as a community we're not bubblegum and and bailing wire an agreement together.

We're coming out with a good solid agreement of what's the best for our community.

And as far as the cannibalizing and all that, I honestly think if if it sparks Reno Washo, and we say this is what's important to us, and we include that in the RFP, that that flexibility, then if people don't want to bid on it, they don't bid on it.

I mean, I see it as that simple, but I understand the the time frame, I understand the the process, the uh the system that we have in place.

I'm saying that I think now is the right time for a change for the best outcome for our patients, our community.

Uh Dr.

Kingsley, do you want to address uh Mr.

Anderson's concern about going out for RP?

We had a conversation about this at the board, I think in November.

The cost to do that and the timing to do that is about uh a year, a dedicated staff person and somewhere in the neighborhood of 250,000 to hire a consultant, or is it did I miss any of that?

It's preliminary.

Thank you, Dr.

Kingsley, for the record.

Yes, all those concerns are there.

Do we have a price tag on it?

We do not.

Um, we do have history with going out to bid in the 1990s where RemSA went out to bid, and that was the creation of RASI.

So they went out to bid, and no one in all parties retracted.

And so then we had an emergency type, how are we going to provide emergency services?

So that would be my concern on one, going to RFP.

And I would say on the flip side, member member Emerson to go and offer an RFP to say we are gonna not, we're gonna provide these areas to you, but the most lucrative ones we're not going to.

And I think that would create a challenge for getting somebody to come in.

But this is another.

I do not know until we do it, you know, on those points and the study towards it, that would put us in a situation that we go to RFP.

Takes us two years, three years time-wise, staff-wise.

I have Andrea, and we have one vacant position we haven't filled in order to keep Andrea.

And I would need three or four more staff to do that.

And uh on that point, or we contract out to go and to do that, but then same thing, it comes out of our budget in order to do that, or it would have to be a regional thing for us to organize to find them.

You see where I'm going.

So there's complications.

I'm not going either way.

I'm just trying to provide perspective on do we if we go this route?

If you give me the if the board gives me that direction, that's the direction I go.

Um, I will I will say the complications.

Um we've already experienced it once.

We could be setting the board up in our community that we go out to RFP and we cannot fill it.

And then um it's scrambled.

Well, and Dr.

Kingsley and Miss Reed, please make sure that we're on topic.

I don't want to get into a topic that was not agendized for the purpose of our discussion today.

It was related to the conversation.

So I think it was germane, but I don't want to get too far afield into it.

And we'll address it in item 12 at some point time here in the moment.

Yes, and I will just clarify, Chair uh Daniel Reed, that the agenda item is simply discussion and approval.

So no direction today.

Okay.

Um, and so um, Mr.

Anderson, I'll uh close this and then move to Mr.

Brown or Okay, thank you, Mr.

Excuse me.

I'm really sorry to interrupt.

Can you hear me, Chair?

Dr.

Danko, do you do you need to get uh your comments?

I'm so very sorry, but um I actually have to hop off the phone and I apologize for that as well because I have been so uh grateful to be a part of this conversation and I apologize that I couldn't be there in person.

Um I actually uh am so thankful to have practiced my entire career in this healthcare community.

And uh is it okay if I if I go uh first?

Yeah, Dr.

Dango, absolutely happy to have you do it.

And I'm hopeful that maybe we'll get to a point where we will take a motion and still have you, but go ahead.

Okay.

Um yes, I will uh I'll have to uh uh get creative on that motion and hop back on the phone, but I'll take my phone uh with me to this next meeting and you can text me, and I can definitely come on board for that.

But I'll keep my comments very brief and just say that it has been an honor and a blessing of my life to to basically be in Reno my entire uh from kindergarten through medical school and residency, and have worked in every hospital uh in the community with the exception of the brand new one uh that just uh came up in 2021.

And I'm blessed for all of those experiences, and it's been the highlight of my career to be uh chief medical officer of St.

Mary's Hospital and to work with all of our healthcare partners.

We are all needed, and we do amazing work together.

And Remsa does amazing work uh for my family, for this community, for our patients, and I'd like to uh be in support of this and uh move forward with it.

Healthcare is very challenging to run.

Uh, I see it on a corporate level, I see it on a national level.

I see it at the community level.

If we think there's an easy solution, uh sometimes there's not.

And I think we have to know where strength comes from.

We have amazing strength in this community, and we stand together and I stand behind Remsa and would like to give my unwavering support uh to them and to everybody that I have the opportunity to work with.

Thank you very much.

Thank you so much, Dr.

Danko.

And we'll um let you grab your other phone as we move to Mr.

Brown, but we will come back shortly thereafter for a motion.

Mr.

Brown.

To go last.

Um best for last.

Yeah.

Again, thank you to the staff and thank you to the participating agencies.

It was nice to see everybody come together.

Um, as we can roll recall in 19 or 2014 was the last time that we did a findings of recommendations report on this.

Uh Driscoll, myself, I know Dr.

Ryan and a few others were part of that team, but we brought subject matter experts together in order to take a look and then make the changes necessary.

Out of that, we've got the EJ, you know, a lot of the committees that were formed, protocol committees, the JEC, things like that that came out of it to try to uh improve our system.

We keep saying it, 40 years it's here.

And 40 years a lot has changed.

Okay, the service delivery methods have changed, everything's changed.

In no way would I like to see Remsa go away.

RIMSA does a phenomenal job here.

They have brought us into a century now that we should be in when it comes to our EMS delivery system.

Um today we're talking about the extension of the franchise.

They're not trying to take the franchise away from anybody or anything like that.

We want to see it stay in place.

With that, we have to make changes.

And the groups have worked really hard to see if they could get the changes that are going to be acceptable to all the parties involved.

Not everybody's gonna be happy with it, that's for sure.

Um, I'm a little concerned with this because hearing today from my board member partners on here.

We've had seven days to take a look at this.

Seven days to get questions and answers from the stakeholders from the interested parties.

Um, I know everybody's phones have been lighting up.

There's been meetings taking place.

There's been a lot of questions flying my way.

I was fortunate enough to talk to one of the board members from Remsa who brought out some good things in the franchise.

I didn't have the sitting in front of me, so I couldn't answer some of the questions on that or see if they're if they're correct.

Um, you know, I'm glad to hear what we said, Andrea, transparency.

That's one thing I've said for years.

We have to have honesty and transparency in this.

And those words ought to be entered into the franchise air.

You know, when we're looking at metrics and data, you know, for the priority twos.

Let's throw them in there.

Let's get those.

This is an opportunity to make that happen.

Um, you know, some of the concerns I have, you know, um, Mr.

DePlanus, is he hiding behind the podium?

Barry's still there.

You know, um, EMD was there you are.

EMD was mentioned, and it was something that was vital to him to see this through.

Well, and what caliber of EMD.

You know, there's been a lot of discussions about the dispatch, the PSAPs actually have the ability to EMD their own calls to make those decisions on when the apparatus has to be responded, to try to reduce the amount of fire equipment that's rolling down the street.

You know, I've heard numbers up to one uh organization said it.

We reduced 10,000 calls a year.

Every time we light up with license sirens, we put our not only our employees at risk, our personnel at risk, but our community at risk as well.

And the amount of money that we're spending to go on these potentially non-necessary responses.

So I hope with Mr.

DePlantis made the comment about EMD as we can actually get a timeline.

I mean, we're talking about hexagon.

We've been talking about, you know, of AVL.

We've been talking about CAD to CAD for years.

Well, hexagon may not come by June.

May not happen by, you know, the end of this year, the middle of this year.

I think we need to actually come up with a timeline to where we start implementing EMD in our dispatch centers before the hexacon system.

If it doesn't happen in June, and that's a date they're all looking at, then we say it June, we're gonna allow our dispatch centers to get the ability to provide the EMD and provide those services and make that happen.

Um, I hope that's what Barry, you're back there.

I know you're I'm sorry, I can't see you.

But you know, that's what you were leaning towards that.

You're gonna work with those public safety agencies to come up and provide them with that ability to provide those services to their equipment, their personnel and their communities.

You know, it shouldn't be siloed and you know, with the dispatch alone.

It also should be in those other areas.

So, you know, under 5.1, I hope the EMD process is actually something that we are going to get a timeline on, and that timeline could actually be placed in here.

So we quit kicking the can down the road on a lot of these.

And I know, you know, that's we say that quite a bit, but there's changes that have to be made.

You know, we had a lot of subject matter experts that were in all those meetings.

You know, if you look at it, we had five meetings over a year and six months.

If you go off to Dr.

Kinsley's um stats up there, which is great, but did we get to hear from everybody?

You know, um, you mentioned it that some of those areas weren't, you know, the sniffs and things like that weren't involved.

I I want to make sure everybody had the opportunity.

I'm getting those calls.

I know other members are that they didn't have an opportunity to truly vet what was going on with that.

And so, you know, you know, did we do the process the correct way?

I go back to the 214 um committee that we formed, you know, the findings of recommendations.

We put a committee of subject matter experts together.

We held public meetings, they were noticed meetings, so people knew about we made sure that everybody had the input that they needed.

I'm sure we tried to do the same thing here, okay.

But again, you know, I know it's very difficult to do.

And you know, Dr.

Kinsey, I gotta say, you know, you answered a lot of questions that I had from our last meeting on this, and over the last seven days trying to digest everything on this, and I appreciate that.

But did everybody get that kind of information and are they able to disseminate it now to where they could take it back to the folks that we represent?

Um, you know, uh when I met with Dr.

Kinsey, you know, I had several, I had six pages of notes.

Um, you know, we narrowed it down.

You know, there's still some things in this document that I think need to be addressed, you know, and they're cleanup things.

You know, there's one in here on page five that actually has to do with response, what a response time means.

And they mentioned ALS ambulances.

Well, we're looking at changing the system with ILS response, BLS response.

I go, and here it says ALS ambulance.

It reports to dispatch facility that it's on scene.

You know, that needs to be changed and put into corporation that ALS, the ILS, and the BLS as well, because those are gonna be arriving on scene the same way.

So, you know, as the little things, and I'm you know, no road scholar when it comes to looking at this, but there are several holes in here that I think need to be taken a look at.

And I think it's a little premature for us to approve this today.

But what I was hoping out of this meeting is what's just happening, a lot of questions and answers.

The board gets to actually take a good look at this, and we can move on to a next meeting for potential approval after we get the questions answered that you know came out of this.

So um, I wanna say thanks to everybody who showed up, you know.

And again, I want to say in no way do we want to see our ambulance provider go away.

They're a partner in our community, and we want to keep things moving in a positive way with them, but we also got to ensure we're doing everything we can to provide the best patient care possible.

And so appreciate everybody showing up and thank you for my opportunity to say something there, Chair.

Mr.

Brown, thank you so much.

Um, Madam Clerk, is Ms.

Danko back on?

No, okay.

I want to make sure I come back to my right and see if there are any um other questions or comments from my colleagues on the board.

Okay.

Um I'm gonna hazard a motion and we'll yes, Mr.

Driscoll.

Just as an example.

Those of you can wait to see all the questions that I have to do now.

Two things are really critical in my objections.

I object to a lot of the voters.

But I'm five years until we saw these all the percent.

We've got a crazy discussion.

We're not talking about two days.

I only have two days, Mr.

Driscoll, thank you so much.

I'm gonna make a motion and we'll see where it goes.

I move to approve the amended resated franchise agreement for ambulance service authority DBA REMSA Health, including the following update to the language proposed in the draft franchise agreement.

Number one, add language in section five that clarifies a date certain for review and implementation of the working group recommendations related to call taking and the emergency medical dispatch process to be no later than September 30th, 2026.

Second, add language in section 5.2 that the working group moves forward regardless of the success or failure of hexagon.

Three, add language, which requires the DBOH and REMSA to meet in the six months following the adoption of the agreement to consider amendments suggested by the district board of health presentation.

That's my motion.

I'm looking for a second.

Oh, second, thanks for the clarification.

So for clarity, all my questions got answered with your their provision of opening that back up and looking at everything and having the board be able to do that.

And that's why I'm gonna support it because unlike Mr.

Driscoll, I wasn't so neat with color coding, but I had a lot of questions too.

And so um having us be able to do this, and that's what I'm hearing.

Your motion includes is to be able to have this open back up, right?

Within six months review.

Thank you.

Well, I tried to take the comments raised by my colleagues that I thought were appropriate given the circumstances and include them in it.

So that was my motion.

We've had a second.

Any other discussion?

Okay, hearing none, I'll call for the question, which will have to be done because we don't have tablets today.

It'll have to be done by a voice vote individually registered by Madam Clerk.

Um yes, let me just admit Dr.

Tinko really quick.

She just jumped on jumped on okay.

So for an individual vote, we have Chair Reese.

Aye.

Uh Vice Chair Andreola.

Aye.

Uh Paul Anderson.

Nay.

Michael Brown.

Aye.

With the changes.

Dr.

Tuarte.

Aye.

Steve Driscoll.

You know, just reminded him.

Dr.

Dinkel.

Could you uh repeat what the vote is for?

Because I just joined.

Yes, we're Dr.

Dr.

Danko.

I this is Chair Reese.

I've moved to approve the amended restated franchise agreement for ambulance services, including the following update to language proposed in the draft franchise agreement.

Number one, adding language in section five that clarifies a date certain for the review and implementation of the working group recommendations related to call taking and the emergency medical dispatch process to be not later than September 30th, 2026.

Two, add language to section 5.2 that the working group moves forward regardless of the success of hexagon.

And three, add language which requires the D BOH and REMSA to meet in the six months following the adoption of the agreement to consider amendments suggested by the District Board of Health presentation.

Yes, thank you very much.

Thank you.

Okay.

That is five ayes and two knees.

Hold on one second.

Um Miss Reed, we've called for discussion and the vote, and we've now taken the vote.

So I need to know.

Yes, Mr.

Warte voted aye.

Okay.

And Mr.

Driscoll, uh, do you have a point of order?

Okay.

Based on your restating of your motion, Dr.

James.

I will change, I'd like to change my vote no to yes.

Because you're opening it up no more than other things besides.

I thought we were focused only on five.

No.

And so since you your clarification was opened up, and in fairness, I read very fast.

Yeah.

And so I will cast a yes vote, knowing that we're going to be talking in less than six months.

And if for some reason that doesn't happen, then that'll be a different conversation from this board members.

Yes, understand.

And may I ask a clarifying question for the record regarding that six-month period?

I believe that you stated six months after adoption, which would be today's date versus six months after the effective date of the agreement, which is July 1st.

So I want to make sure that I am clear that the six-month trigger is today upon adoption for the well, in fairness, a contract must be signed by both parties, right?

So it wouldn't be adopted until both parties signed it.

I don't know if RemSA is inclined.

Correct.

I don't know that REMSA will be inclined to agree to my changes.

If that happens, then it's an a nullity and we'll come back to the board.

Okay.

Thank you.

I wanted to be clear on where six months.

Did we have a point of order on this side there?

Mr.

So just to clarify with your your motion, um perpetual.

Is that included?

Correct.

That's part of item three.

Okay.

Removal, point of order.

The removal of perpetual, because we heard that as a voluntary part of uh the beginning of the discussion, Dr.

Kinsley and Ms.

Epps are both uh shaking their heads.

I'm just making sure for point of order of clarification.

What we're voting on is removal of perpetual.

That it in item three.

Thank you.

Okay.

Ms.

Reed, have we completed the process on this particular agenda item?

I believe we have.

Thank you.

Okay, so I'll thank you very much to all who participated today.

Um, we're going to move on.

We still have the business of the district board of health.

Item eight is now closed.

We'll give the room a chance to adjust.

And that's not Dr.

Kingsley, as you come back up, I'll let my colleagues know all of the um items that are normally heard under 10 except for the district board of health officer presentation are being removed.

You'll accept them as presentations that were in your board packet.

Okay.

Um we'll give everyone a chance to um keep clear in the room.

Madam Clerk, I believe we're going to item nine.

Nine is a public hearing, so let the record reflect that we are opening the public hearing on item nine, and I'll ask is there any public comment on item nine A specifically.

No, Chair, there is no public comment.

Thank you so much.

And I'll make a motion without a presentation unless any of my colleagues desire to see one.

So that's a motion.

I'll take I'll be a second.

Okay, we have a motion and a second.

All those in favor, please signify by saying aye.

Aye.

Any opposed motion carries unanimously.

Item 10 are our normal staff reports and program updates.

Items 10 A, B, C, and or A, B, C and D are deferred as presented in the packet.

There will not be presentation by staff.

Thank you to uh Ms.

Vega, Ms.

Shepherd, Mr.

Fida, and uh Dr.

Dow for always being so flexible.

I appreciate that.

We'll now be on item 10E, which is uh presentation and discussion by uh Dr.

Kingsley at the district health officer report.

Thank you.

And just to be brief, my uh presentation or my board, uh, my report stands as is for your review.

I just want to notify the board of a recent development, but recent in the sense of just where we need to announce it.

We are moving towards the closure of the Moana WIC office due to budgetary constraints.

Um just intent with it, and we'll be coming back to the board to really outline why the reasons and uh to present to the board on that.

But we are working to find an affordable and sustainable solutions via satellite uh locations, and we are working with our comms team on a campaign campaign to announce the change with a goal to retain our existing clients and add new ones.

And so I just wanted uh to uh let the board know that we're in that process through with the county and the CSD on that, but just uh working with our uh local which WIC budget to maintain those services and uh develop uh satellite offices for them that are affordable.

Dr.

Kingsley, can I because I've had the opportunity to chat with you about this briefly uh for the benefit of my colleagues?

I want to just say um it is a very big decision to close a WIC office in any particular climate, especially given the current economic climate of the United States, because the people who go to that office rely so heavily upon the resources that are there, but what you've told me is that there are other adjacent properties where we might be able to still provide the same services, just not at the location which is currently costing us a large portion of uh money to uh maintain staff rent, do all the things.

Yes, but that the work will still be available and it will be done out of perhaps like a city of Reno facility or a Washoe County library or yes, correct.

Mr.

Chet, may I ask one question?

Of course, absolutely quick.

So I have um received already uh emails from constituents about this already.

What is the protocol that you set in terms of communicating that and um what can we do if you will, if we are re you know, folks reach out in terms of their concern?

I I haven't responded.

This is just happened.

Yeah, and so um, I'm just wanting to try to get clarity on how we handle that and where we point folks.

Definitely to speak with WIC staff to call the local offices on uh on and any evolution of where those services will be provided and what we're doing to move towards that.

Um that as well as they can reach out to myself or I am able to meet with those constituents and uh Christina Shepard as well as Kelly uh Kelly Sills and our staff are able to meet with them on that point on those concerns.

We are also have been working with our state officials on this on uh uh first approach them first out of out of any point to see where we were and on the availability of this, especially following the the national um during the the closure of the federal government where we did not have funds and we would have lost the program completely.

We are looking to reduce the general fund of it, but allow them to get to continue to work on their caseloads, which allows them if it many challenges with that.

So the challenges is in putting on to the community is just we don't want to overly cause concern, but we're at a good spot where we can see continuing forward to continue to provide those services at the same level.

Is it possible to uh all three jurisdictions have do a great job in terms of responding to various inquiries?

Is it possible to share with Washer 311, Reno Direct, and other people that would be really appreciated?

Yeah, thank you.

Very good point.

Dr.

Kingsley, any other updates?

No, I just need to I wanted to provide that the staff report is um as before you and no comment on it.

Okay, thank you.

Any other questions for Dr.

Kingsley?

Okay, we'll move on to item 11, which is a final period of public comment.

Madam Clerk, any public comment under item 11?

Um, we do, and so I will read this before we start.

Comments heard under this item will be limited to three minutes per person.

It may pertain to matters both on and off the board agenda.

Unused time may not be allotted or allocated to other speakers.

Comments are to be made to the board as a whole, and virtual public comment may be taken when facilities are available.

A speaker's viewpoint will not be restricted.

However, reasonable restrictions may be imposed upon the time, face, and manner of speech.

Irrelevant statements and duly repetitious statements and personal attacks that would objectively antagonize or incite others are examples of speech that may be reasonably limited.

This board carries out the business of Northern Nevada public health and its citizens during its meetings.

The presiding officer may order a person removed at the person's conduct or statements disrupt the order or safety at the meeting.

Warnings about disruptive conduct or comments may uh or may not be given prior to removal.

Furthermore, certain disruptions of a public meeting are criminal acts as defined under under NRS, which may result in a prosecution inappropriate cases.

And we do have one public comment.

Mr.

Dunn, welcome.

Yes, Mr.

Good afternoon, Mr.

Chair, members of the board for the record, Tom Dunn, Vice President of the Reno Firefighters Association.

Uh Ms.

Adriola, I really appreciate your uh Ronald Reagan reference of trust and verify today.

And I appreciate your your um you're looking into the history of how we've gotten here over the last basically four decades.

Um part of that history is also reviewing documents that have come before, and I would advise everybody that was not at these public meetings in 2011, 2012 to 2014.

I think there's like I think there's only three of us in this room right now.

There are participants that Mr.

Driscoll, Mr.

Brown, and myself, you need to go back and look at the tri data study from 2012 and look at the recommendations that were made, which was a public process, had public comment, look at the recommendations that were not adopted by whatever board, whatever entity, whatever um for whatever reason, and look at those recommendations that were not adopted and where we are at today.

And I will say this over the last 14 years now, some of the problems that we have today, or some of the issues that we have in the in the draft agreement or the existing franchise agreement could have been addressed at that time.

And I hopeful, I'm hopeful that moving forward that some of those uh recommendations that are in that can be adopted some point in the future into a franchise agreement as we move EMS and fire service delivery forward in Washa County as a whole.

Thank you.

Tom, can you make sure that I get a copy of that report if you have it by electronically?

Or I don't know if we have we can y'all can't.

Yeah, we'll send it someone will get it to Dr.

Kingsley then back to out to us.

Thank you so much.

Thank you.

Okay, Madam Clerk, we'll close out public comment then and move now last to item 12 board comments, and I'll start with my colleagues to the right.

Any questions from my colleagues or board comments?

Just uh thank you to everyone for your stamina and your input.

Um, and uh thank you, Dr.

Kingsley, for all your hard work, and uh I appreciate uh the suggestions of the other board members and their concerns or shared concerns, but I felt that we we have a mechanism in place to address them.

And and uh Chairman Reese, I really appreciate you uh amending the the motion so that we can address those concerns and get them get them uh corrected in the future.

Thank you very much.

Thank you, Dr.

Mr.

Driscoll.

Nothing more, sir.

Thank you so much.

Um I'll just offer that I want to thank um uh Dr.

Kingsley, you and your staff, Miss S, especially for all the work that's gone into today's process.

We've had two very long back-to-back meetings.

There's quite a lot going on for anyone who said that this was a sleepy board and you could just go there and quietly do your time.

Uh, they have been gravely mistaken.

So thank you for the privilege of being here with all of you.

Each one of you uh makes me a better human and a better elected official.

So thank you for that.

Ms.

Andreola.

Thank you.

Okay, Mr.

Anderson.

Yes, uh Mr.

Chairman, thank you.

I believe now is the perfect time based on the timeline of 2030 and where we are now, is the perfect time to reset the the EMS system here in this area.

I and Miss Asp, let me say I'm sorry that um this is this is where I want to go, but I I truly believe if we want to do the best thing we can for our community in emergency medical services, whether it's the dispatch, the flexibility, whatever it is, now is the time to begin the discussion.

But I I truly believe if we want to do the best thing we can for our community in emergency medical services, whether it's the dispatch, the flexibility, whatever it is, now is the time to begin the discussion.

If we come along and say, you know what, it doesn't look like it's feasible or whatever that may be, now is the time for us to begin exploring.

Talking to the the three jurisdictions, talking to all the stakeholders, at least get some ideas.

If I am a customer, I'm going to release an RFP that is in a perfect world.

It's it's all in my favor, right?

But but as the process goes on and you find out, you know what, it's looking like we might not have anyone bid on this.

Okay, then let's retool.

We have the time now to be looking at that process.

And I truly believe instead of use the Swiss cheese, I really think that's what we're putting together here.

Yes, I appreciate the fact that that we can have input and and make improvements, but I I think this is the cleanest best method to move forward with emergency medical services.

Thank you, sir.

Thank you.

I just want to piggyback on what uh Councilman Anderson said.

Um, and I didn't want to bring it up during, you know, the to change the subject and anything on our our item we just talked about with the refresh.

But I truly think agree with you because it's been 40 years, and now we're in a position where things have changed drastically.

And allowing a contractor to drive government agencies and their ability to attain costs through programs like GEMT and having them be that focal point for saying yes, you can do it or yes you can't, it is not how the system was designed.

And you know, there are there are vendor, you know.

We are the ones sitting in these positions and our local government, you know, that can apply for these programs to help offset their costs of doing services, yet they can only do it if they have the ability to contract with them in certain areas.

And you know, so it's something that we got to look at now.

You know, when we start talking about this franchise, we start talking about the future, you know.

I know that my chairman, we talked about this morning.

There's ways of allowing local government to provide the services and still gain those those funding mechanisms.

Um, it's just something that we got to look at a broader aspect on how the franchise actually operates.

Good points all.

Thank you, Mr.

Brown.

Okay, with that we're adjourned.

Thank you.