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Welcome to the regular meeting of the Multimum Accounting Board of Commissioners. Today's meeting is held virtually and due to construction at the Multumum Accounting Building. All Tuesday board briefings, Thursday regular board meetings and proclamation ceremonies will be held virtually through the end of September. So please bear with us through any technical difficulties. Members of the public can still provide testimony either from an electronic device through the WebEx platform or by calling into the meeting from a phone.

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And information on how to provide testimony electronically is shared by our board clerks when an individual signs up for public testimony.

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We're also offering a space in room 126 of the Multnomah County building where people can testify if they have technology and accessibility needs.

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And of course, people can continue to submit rest written testimony as well.

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For both members of the public and presenters, please remember to mute your mic when not speaking.

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And before you present, make sure that your mic is unmuted and that your camera is on.

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For all presenters please state your name for the record before speaking or responding to questions.

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If anybody would like to sign up for public testimony or to submit testimony, you can do that by going to

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maltcode.us and look for the about board meetings link and click on that for the public testimony form.

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Right. May I have a motion on the consent calendar?

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To move. Second, Commissioner Jones to extend moves, Commissioner Moyra seconds approval

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of the consent calendar. All those in favor, please say aye. Aye. Aye. Aye. Aye. All right. The consent calendar

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is approved. JJ, can we move on to public testimony? Opportunity for public comment on

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non-agenda matters. This is the time for the board to hear public testimony not for board deliberation.

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When it's your turn to speak, I will call your name and unmute you. I'll set a timer for three minutes

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when you begin speaking in an ounce when your time is up,

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which point, please wrap up your sentence.

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We have three people signed up for verbal testimony

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and received eight written testimonies

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which are shared with board members,

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hand staff.

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First step, we have Gus.

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Gus, you can unmute yourself and begin.

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Hey, can I kind of go wear some of the bus?

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Can I go wear some of the time?

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Oh yes, I will come back to you.

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We'll go to Ann Casper and you can unmute yourself and begin.

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Hello, I'm Ann Casper, I'm a student from University of Oregon.

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I happen to be at the beach now because I am at the peer fusion, so I'm with peers

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from across Oregon and we're connecting and making plans for what's going to work in mental

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health and addiction.

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I would like to first thank you for having the room 126 accessibility open for people

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to come and testify. Montenamo County is so good in these things. I mean, other places around

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the country don't do that. So thank you again for that. I'm here to talk about a couple

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things. We had a mental health chair campaign, a campaigner, mental health chair, candidate

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forum on TV. It's now in YouTube.

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And Julie, a commissioner from Edward sent in an introduction,

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But it didn't touch upon the nine questions that we the audience came up with from around the report in the metric for Alexandria and we're hoping that you will send in the answer to those questions

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We see those TV show in this community event as a long experience and if whoever becomes chair, it's really important that we learn to communicate and work with each other

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So it's not too late to send in information.

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There are 170,000 people signed up in mental health services to be able to have a health

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services in Montgomery, another 50,000 who are signed up in programs that touch upon mental

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health.

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So we really just want a good communication with everybody.

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And Commissioner Singleton sent in answers, which were put in the video.

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But some of the answers had more to do with homelessness and houses and addictions and didn't answer the questions from the mental health community.

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So let's all work together on that to make things better.

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We know things are not good now, but they really can get better as we plan and do things in a really comprehensive and ways of working together already three times.

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but together. So let's do that. And also here there's a woman from the Ukraine who's a peer leader,

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mental health peer leader, telling me at the conference how multicultural trainings and multicultural.

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roll program, it doesn't always work because you've got people from the state, cultures and

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languages, and war experiences, other kinds of experiences. So by putting everyone together in

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multicultural, it doesn't work for everybody. So let's think of new ways. How can we help refugees

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heal through this war trauma? And that helps all of us and also how to educate people on what

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trauma really is. We hopefully will never see it in the United States but it's really tough.

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I want to again thank you all for your hard work during this hard time. Hopefully you do get some

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respite and thank you very much. I'm going to end now so. Next, we have lightning.

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Yes, my name is lightning. I represent lightning super creativity. AI is everyone. You may have

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Now, as you all know, as a good friend, Steve Palmer, from the MBA LA Clippers, he's just

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having a bad week. He's been suspended for a year. He can't even go to any of the board of

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governors. And in my opinion, he will be selling the LA Clippers within three months and to avoid

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any devaluations of all the MBA franchises. So I see him basically selling within three months.

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I'm looking at it off for somewhere around maybe 8 billion to 10 billion. That's for the team.

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And that's also for the into it dome itself, which he just developed. So again,

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state bomber enjoy your retirement. It's been a pleasure. Now getting back to business with Tom

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done. Again, I want to see him relocate to Texas. Again, in the Texas Building AI Triangle.

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Again, that is what I call the Elon Musk Space Economy valuations that we will never see on planet Earth.

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We'll happen within that triangle. Austin is the perfect position to be right in the middle of that.

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And again, the growth will be unprecedented, then in the Texas triangle will surpass California.

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The Texas currently is about $2.7 trillion.

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I believe that California is around $4.2 billion of our trillion if I'm correct.

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So there's going to be a real gain there on what they can do in Texas.

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It's the place to be, it's the place you want your MBA franchise.

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Again, on this outdated mode of center, I want to see a seismic study done on this.

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A lot of these older buildings like that, there is a reason why they tear them down because

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they're not up to seismic standards.

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I want to see that study, then I want to see that building torn to the ground in a new

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one put in.

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But by that time, Tom Dundin will already be relocated, it will have to get approval.

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And again, when Tom Denton gets the green light for me on Vusk, Mike Dale, and various

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other University of Texas, various other people.

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When he gets the green light, he can move in there quite easy.

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His value is going to, without any doubt, value added will probably push him up to $68 billion

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automatic.

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And then with that strong economy there, similar to what California used to have until all

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the businesses started relocating to Texas, he'll be able to match those

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those numbers. So when you look at Los Angeles Lakers at 12 billion, you're going to

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be able to bring your valuation up, probably anywhere from 8 to 10 to 12. And again,

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what just happened to the LA Clippers is a devaluation. And we need to stop that in

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steep bomber. We need to move on and enjoy your retirement serve. Take care.

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All right,

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back in like 2015, 2016, I came through, I went to like one of your, I wonder, one of

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the monomakani board things like this or so, and during that time, my son or my son

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was getting the rarest attack by students and teachers, and the more I've done, the more I

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I received, I said, I was refused the opportunity to continue violence here.

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Because this was a time done. I after I got hit by a car. So my time was trying to support him.

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Now, he said, afterwards, the principal, the school, they gave my son, I mean, his mom, father's document saying that he didn't have any problems, even though there was documented proof that things were going on.

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Now today, all of that kind of got worse in schools to where the kids, you know, get attacked and everything on the sword or getting the rest family fathers mainly being pushed out of being able to volunteer even be positive towards.

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I think we lost.

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It looks like.

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He's no longer in the meeting.

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Okay, let us know if he comes back on.

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Okay, if that was our last person sent up for non agenda public testimony.

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Okay, and if you are reaches back out to you can you let him know he can also send right in testimony.

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Yes, okay. Thank you.

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All right, so let's move on to our one.

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are one. Budget modification number DCJ, DCJ,

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dash 0.001, dash 27, DCJ, ASD,

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reallocation of funding from one parole and

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permission officer to 2.5 Reconnizons,

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correction technicians.

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May I have a motion?

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So moved.

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Second.

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Thank you Mr. Chairman and Prince Moved. Commissioner John

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taken six and seconds approval of R1.

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So this next item is a DCJ bedmod to reallocate funding

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from a parole and probation officer position

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to provide six months of funding for two

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correction technicians in the recog unit.

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So I will turn it over to Tera Hubbard

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and Denise Pena to walk us to this item.

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Good morning.

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Thank you. Good morning chair and commissioners.

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My name is Denise Pena.

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I am the director here at DCJ

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and I use she and her pronouns.

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and joining me for this presentation this morning will be your Hubbard or adult services division director.

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And today has been stated, we'll be reviewing the budget modification for

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reallocation of funding from one for all probation officer to 2.5 corrections technicians

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in our custody and release service program please. Next slide please.

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For the record, my name is Tira Hubbard and I am the IUCHI her pronouns and I am the adult

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services division director. We are bringing this budget modification before you today to acknowledge

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recent revisions that occurred after the fiscal year 27 budget was finalized. Although our

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PSP, a pre trial monitoring program was removed as a pre pre trial monitoring option,

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the presiding judge's order that was most recently updated on July 13, 2026, revised the

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County's responsibility for administering the presiding release order and that included DCJ and MCSO.

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Due to guidance from the County Attorney's Office, DCJ is temporarily adding the necessary personnel resources to provide continuous coverage for this function.

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This funding supports the six-month timeframe for the added function for DCJ through December 31, 2026,

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While the idea is finalized between the county and OJD.

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Next slide, please.

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Thank you, Tira.

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This slide shows the program offer budget impact based on this budget

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modification, and as you can see, the impact is net neutral as this is a

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reallocation within personnel expenses to support this transition.

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Next slide, please.

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And that concludes our brief presentation, and we are ready for any questions

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is that the board might have?

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Hey, thank you, Denise and Tira, and did we have any public testimony on this, Tisha?

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Yes, we have one person's side, though.

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Right.

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Lightning?

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Yes.

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Yes, my name is Lightning, I'm representing Lightning, super-connected, yes.

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Again, I do approve of the modification, but again, I want to stress my position just

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on the correctional officers, as you know, we had a revealing death that happened in the jail

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of Dominic, and it showed that in their report that 12 correctional officers circled

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them in a wheelchair began to rough him up.

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Then, when he passed away, it showed that he had brain swelling from the use of cocaine.

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And you as being monomecality experts in the health department, to people normally have severe brains.

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I want to make sure that we have body-worn cameras on the correction officers. I want to be able to have the family members at the very least to be able to pull up that video to see exactly what happened to their son and their relative, and have a clear understanding of what happened to him.

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what takes place in these jails. And I don't think that's asking too much from the commissioners

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in the chair to have transparency, accountability, and for the family members when one of their

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relatives passes away in the jail, at the very least to have access to that body-worn camera video

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to where they can review that situation where he was put in the wheelchair in 12

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for action officer surrounded him and it's my understanding by the statements from the Oregonian

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rough team up and again he had severe brain swelling so again to the experts from the health

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industry does ingesting cocaine cause that that is my question because I want to have more facts

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on that situation. And again, I'm just asking for you as our representatives and to keep

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the community members safe to get the body worn cameras on the correctional officers,

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on the patrol officers, and allow the public to at least have a chance to have a clear

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understanding what happens if one of their relatives dies in the jail and things don't appear

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to be right. Again, we're just relying upon their written statements and what the correction

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officers put down on paper. But as you know, a video tells a full story and gives a much

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better story on what happens. We need that video for the safety of our community members,

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for the family members that lose one of their relatives and these jails, and as the least,

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Then mold nomic County can do for them. We have them on the Portland place. They even put them on the ice officers

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Why is there such a hold out for mold nomic County? I expect those to be put on immediately. Thank you

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That's all for public testimony

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Okay, thank you. We'll go to the board to see if there are any questions on this. We'll talk. We'll start with comissures. We'll take. Thank you chair

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excuse me. I'm not sure that the right people are in the room for these questions, so I will

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just say I don't have any problem with this budmod, but I continue to be concerned and frustrated

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by pretrial services and what the next steps of this will look like in the transition.

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So

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and particularly having a new PGO signed after our budget pass that pulls you all back

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to this just and I saw just you come on camera. Do we have an update on the IGA, at least

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as far as timeline, maybe not the specifics of the negotiations?

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Good morning, commissioners. For the record, my name is Justin Black. I can give a quick update.

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So we are in conversations with the courts. We sent them a draft IGA. They sent us back

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red line version. We actually responded back with some clarifying questions to that are

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understand where they are. I had a very good conversation with Barbara Gordon

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Australia last week. We plan to get together and talk further about these. I think the

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plan is our hope is that we come to some resolution by the middle of October. I think on both

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sides, that's the timeline that we're committed to. If we are unable to come to an agreement by

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and you will be hearing more for me.

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Thank you.

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I appreciate that, and Denise and Tara,

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thank you for the presentation today

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and the ongoing work.

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Again, Justin, I'll do some more follow-up with you

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on some of the concerns that I have

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and those next steps on the IGA negotiations,

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but I'm supportive of this budget modification today.

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Thanks, Chair.

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Thank you, Commissioner.

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Commissioner, bring my words.

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No questions.

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Thanks for bringing this forward.

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I'm supportive.

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Thank you. Commissioner John Sixon.

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Yep. No questions. Supportive. Thank you.

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Thank you. Commissioner Moira.

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Can I get kind of a timeline of when we knew that the court was...

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Not going to step in to do this and how, and when we decided we needed to make this step in adjustment, this happened, right? Like we've had meetings, like this has been happening. I don't remember when the kind of that realization that we would have to do this happened and how, how did that? How was that decision made?

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Thank you. Thank you for that question, Commissioner Moir. We received the updated PJO on July 13th.

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That still maintained DCJ doing this part of the work for pre trial and the jails and it also added

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MCSO to the PJO and that was something that was a change as well and the PJO did though

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however remove PSP as a monitoring option and so once we were made aware that we were going to

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to continue the services because DCJ during our FY27 budget process had indicated that we were going

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to be getting out of the pre-trauer.

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We did make reductions in CTs out of the recog unit.

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And so then after consulting with legal, just talking about the implications, if there was

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going to be a significant delay in a defendant potentially being denied released if they were

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going to be eligible is when we were given the guidance that we were going to need to continue

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the services as they had been, to make sure there was not any extended gaps in our services.

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So was that something that you, I don't know how information came back and forth, but like

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was that

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situation made where do you, or you made the COO and the chair available, and then

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How did we come up with this budget reallocation and timeline and duration?

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So when we were made aware that we were continuing this via the PGAO as far as still being

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included, that's when we reached out to the CEO's office and the chair, I believe the

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CEO's office had also received a copy of the PGAO as well and so that's when we coordinated

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internally consulted legal to really give a guidance on what is going to be what we need to do

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forward. The reason that for the allocation, we did have a vacancy in the PL classification,

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so that is the position that we identified to reallocate and then again the initial discussions

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have been that we would continue this work through December 31st and then at that point the

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courts would pick this up in January. There have been some changes to that timeline potentially

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But all I know is that via this flood mod, this would allow us to continue to 1231, and we would not have the funding, should we need to continue this past January 1.

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Just to add on that, you know, I think that this is a continuing conversation.

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And even if we come to some agreement in mid-October with the courts, you know, we may be coming back to the board for further conversation around this.

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not knowing specifically what the agreement is going to look like.

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Yeah, I totally understand that.

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My comments have absolutely nothing to do with DCJ.

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I think you handled this totally appropriately.

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And both above and at your level responded quickly.

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and appropriately, my concern is that this is not an allowable action under our charter, that

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the action happened before the board approval.

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That has nothing to do with you guys that

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has to deal with how decisions are made. And this was an emergency, this was totally not something

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that was for seeing in the budget process, totally acknowledge that, that it was something that

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needed to be adjusted due to unforeseen circumstances. We have a process for that in our charter,

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the budget authority of the county is lies with the Board of County Commissioners, the chief

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executive being the chair is to execute that is the act of term in our charter is to

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execute the actions of the board. The chair does not get to change or reallocate funding

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and then months later come to the board and say, FYI, I did this. We have.

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To stop this practice. I get that this has been held at Luma County has operated, but it is in violation of our

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charter and it is not acceptable. We have to go use the governing body that controls the budget. If we need to make

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budget changes, which, of course, we do. And this is a very good example of a totally appropriate

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adjustment that needed to be made, it needed to come to the board. We have processes for things that are emergencies.

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I do understand that it can take a while to get things together,

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but this is a practice that this county has had that is totally inappropriate and you

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the power of the board. This has to stop. I could list probably right now. I have the dozen things

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where I feel like the administration of the county has gotten out and implemented things that

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did not have the authority to do. And it clearly exceeds what the executive branch is ability to

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act unilaterally is. I don't know how we changed this practice. We had something I can't

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remember. It was a little over a year ago that was a similar situation where we were asked

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to vote on something that had been going on at that point for an extended period of time. That

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isn't a real process. Like what would happen if we voted no? We get that money back? No, we spent

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It's gone. That's not a real process for this board. We are not actually making this decision. It was made.

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That is not appropriate. I'm putting it out there. This practice needs to stop.

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Again, I don't think anybody has a problem with this decision.

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And I don't expect that it will fail, but it is now largely symbolic.

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And that is not the role of the county commission, we are not, you know, a validator of decisions that have already been made.

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All right.

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So, we don't have a problem with what we're doing.

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Have a huge problem with the process.

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Thank you, Commissioner.

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I just want to respond to that briefly.

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I mean, I understand what you're saying.

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And we always try to bring things to the board ahead of them actually happening.

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In fact, like, there's been vast improvements with the timing of budget medications, notice of intent for grants, all of these things over the past few years.

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Like, you know, I would say, like, point out, like, one of the ways that that has happened is the having departments do all their budget modifications before fiscal year ends.

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When I first started on this forward, we were doing budget modifications for the previous fiscal years months into the new fiscal year.

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So we're always doing that.

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We always try to do that.

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There are sometimes when that's not possible.

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And I will say, I didn't thought you were a discretion.

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You don't have the authority to do that.

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So I was like, there are sometimes when that's not possible.

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And if that happens for instance,

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like if a department has a very short timeline

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for a grant application, they will put the grant application

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and come to the board.

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But say, like in the APR, that if the board decides not

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to support this and they would recent the great application.

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And I think this was one of those situations

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where the operational realities got ahead of this.

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So I'm going to look in.

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But that's not allowable.

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So a grandian commissioner, Commissioner,

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I'm not done.

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Commissioner, I'm not done.

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I'm going to look into this because I honestly don't know

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when this was requested to be on the book.

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We know like when the APR was put in to put this before

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the board and I will look into that.

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And I'll commit to doing that for you

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because I want to understand the little bit better

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about the timing of this myself, but but I will say the intent is always to get things to the board in like ahead of when action is taking place.

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My response is that's not a power you have.

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You don't have the power to spend money and move money in budgets.

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Like I get you think that it was necessary.

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free? You don't have that power. Do you want to grant application that you can then decline

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as a totally different thing? This is about democracy and you are taking a power that

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does not belong to you and belongs to the Board of County Commissioners. We have a mechanism

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for emergency decision making. You could have motioned at any point during any meeting we

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I've had since July 13th.

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So can I finish this because that?

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No, this is mine.

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Moment.

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Please, I get, I interrupt to do. I apologize for that. You're interrupting me.

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I wouldn't make a big deal about this. If I have not been over the last several months, horrified by the number of things that are happening, that have never been approved by this board. So, if you want to state that it is your belief that you have the power to reallocate

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both position authority and budgets, then say that, and I think that's an issue that needs to be brought forward

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for a judicial review. That's not your position, and don't execute things that you don't have the authority to do

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before born approval.

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So, I would, I have said, and what I will say again is that we work to bring things to the board as quickly as possible

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when an operational change is being made,

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that doesn't match what the board is approved in the budget.

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That's why we have these budget modifications.

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This one was not as timely as it should have been,

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and I already said I commit to looking at the timing

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of this and why it's being brought forward today.

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But that's where we are.

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And I think that we can continue this.

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I also, you know, this is the first time

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that you brought this issue up recently to me.

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And so I'm very surprised to hear it today.

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since you and I just met on Monday for a check-in,

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and you didn't bring this up as a concern with this item.

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So I also, you know, if you're saying this now,

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that's your right, but also, I could have had more answers

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for you today.

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I mean, I have talked to you, and I've talked to Chris,

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and I've talked to multiple-

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Phil Dougan, the entire Interrupting Me Commissioner.

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So I just wanted to say, if you had brought this up on Monday

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in our check-in, I could have gotten more information

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to understand a little bit about the history and timeline

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of how this got there.

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And so, again, I'm committing to doing that research

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and finding it out.

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But it is not that I think that these things

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shouldn't be coming before the board for budget modifications.

354
00:32:10,340 --> 00:32:11,920
Absolutely, that's the board's right.

355
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That's why we're doing this today.

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But if the action already took place,

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you've used circular authority.

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That's the point.

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I don't, it's not about, it should have come two weeks after it happened.

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The point is, it can't happen without board action.

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I'll let it go, we can move on, but I, one, I would like to make a very clear for

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the record.

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00:32:36,540 --> 00:32:42,540
I have talked to you and many in leadership about this issue, just because it was not the topic

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of Monday's meeting.

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Does not mean we have not spoken about this.

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This board has talked about this publicly.

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And so that's not accurate, and two, my concern is not that you inform us quickly after you've made a decision.

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The point is you don't have the authority to do it.

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All right, I'll move on.

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Thank you.

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All right.

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I have my hand brace.

373
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Oh, commissioner.

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Yeah.

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I just want to sort of echo commissioner Moyer's statements.

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This is not a new issue.

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I mean, it goes back to when I first joined the commission three years ago, when at the end of the fiscal year, all of a sudden, there was a bunch of retroactive bud mods. So I think this should be framed not in sense of what happened today, but the larger issue of having the commission action not being taken before the commission has approved it, but it's it's not it's not a new issue at all and it's been.

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00:33:45,700 --> 00:33:52,100
publicly discussed. Yeah, thank you commissioner and I did in my remarks speak to the fact of those

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post-physpossible year budget modifications is something that we work to improve.

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Commissioner Jones-Dixon.

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00:33:58,040 --> 00:34:01,540
Yeah, great. Thank you. Thank you chair and thank you commissioner Moira for bringing this forward. I was just saying

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I was just going to add that we should look at this. You're not an export retreat and look at our

383
00:34:06,200 --> 00:34:10,840
board rules for how do we make it this moving forward and look forward to let's move forward with

384
00:34:10,840 --> 00:34:14,960
vote. Thank you. Thank you. I appreciate the call for the vote to you.

385
00:34:14,960 --> 00:34:16,340
Can we have a roll of comment?

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Commissioner Moere.

387
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Yes.

388
00:34:20,220 --> 00:34:21,220
Commissioner Singleton.

389
00:34:21,900 --> 00:34:21,920
Yes.

390
00:34:22,620 --> 00:34:23,840
Commissioner Brementoritz.

391
00:34:24,720 --> 00:34:24,820
Yes.

392
00:34:25,460 --> 00:34:26,520
Commissioner John Stixon.

393
00:34:27,460 --> 00:34:27,600
Yes.

394
00:34:28,340 --> 00:34:29,160
Chair, Vega Peterson.

395
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Yes.

396
00:34:30,380 --> 00:34:31,880
Budget modification is approved.

397
00:34:34,480 --> 00:34:35,640
I'm sorry excuse me.

398
00:34:40,010 --> 00:34:43,070
Our two first hearing of ordinance

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demanding county ambulance service plans and mcc-21.400 emergency medical services.

400
00:34:54,720 --> 00:34:55,360
In that motion.

401
00:34:55,700 --> 00:34:56,240
Thank you.

402
00:34:56,780 --> 00:34:57,040
Second.

403
00:34:58,100 --> 00:34:59,280
Commissioner John Sticks in move.

404
00:34:59,400 --> 00:34:59,840
Commissioner Singleton.

405
00:35:00,000 --> 00:35:27,160
Seconds approval of our two. So today we're taking up an action that has been more than two years in the making. Back in 2024, as the county and our partners felt the impact of persistently delayed ambulance response times, the board took two important actions. First, we coalesced around an ambulance staffing model change with the intent of stabilizing staffing and improving response times in short term.

406
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That move has led to improvements in response time consistency, but we always knew it wasn't

407
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a long-term solution, which is why we took a second critical step when the board of

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00:35:37,820 --> 00:35:41,840
proof funding and set the direction for updates to our ambulance service plan.

409
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That began with a comprehensive study of our EMS system by an external third-party evaluator

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who conducted extensive data and document review, stakeholder engagement with more than

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interviews and field observations, and the application of best practices and lessons from other

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00:35:58,620 --> 00:36:05,540
EMS systems. The result was an EMS system's assessment report with findings and recommendations

413
00:36:05,540 --> 00:36:10,240
that provided strong building blocks for Multnomah County's updated ambulance service plan.

414
00:36:11,060 --> 00:36:15,840
So the plan we're considering today strikes an important balance. It codifies what is working

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and promotes flexibility and innovation, all while still centering a focus on quality care

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and strong clinical oversight.

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Under this plan,

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our staffing model continues progress

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on using the right resource for the right call,

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prioritizing specialized skill sets for the emergencies

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that are most needed on.

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This model continues to

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valid value and leverage the existing skills of

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paramedics and EMTs with clear pathways

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for career development for developing enhanced skills.

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Our fire departments

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are critical partners in emergency response, and this plan affirmatively and explicitly promotes

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collaboration and partnership between an ambulance provider and our fire departments through

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00:37:00,740 --> 00:37:06,460
subcontracting. This plan also sets realistic response times standards for all areas of the county

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using objective, consistent state methodology, while still providing a pathway for jurisdiction

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that may want to build on that foundation for differential response. This plan reflects an

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00:37:17,720 --> 00:37:22,660
a enormous body of work and input to achieve an ambiance service plan for Multnomah County that

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is both durable and flexible to serve our community into the future. And we have been the consultant

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in Kenton form every step of the way. I want to thank our EMS team, Dr. Bruno and Erin Monig,

435
00:37:35,040 --> 00:37:40,440
as well as Mark Prins Medal and Charles Miller, and the small but mighty EMS program team for all

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00:37:40,440 --> 00:37:45,300
of your work. I also want to thank Renee Hezinger for leading our work in our emergency

437
00:37:46,280 --> 00:37:49,820
management systems for my office over the past few years and specifically for

438
00:37:49,820 --> 00:37:53,720
her work on this plan. I want to thank you all for the time you've spent both

439
00:37:53,720 --> 00:37:57,520
with us in this board room and outside of it with commissioners and staff and

440
00:37:57,520 --> 00:38:00,960
partners to answer questions and address concerns. With that I will hand

441
00:38:00,960 --> 00:38:05,480
things over to Bruno and Eric. Good morning. Thank you chair. Thank you

442
00:38:05,480 --> 00:38:08,900
commissioners. Nice to see you all this morning and thanks for the

443
00:38:08,900 --> 00:38:12,360
opportunity to present with you. I'm going to turn it over to Erin

444
00:38:12,360 --> 00:38:17,320
who is our EMS administrator, who's going to take us through some slides this morning.

445
00:38:19,600 --> 00:38:23,680
And there are slides. Good morning, Chair Vega Peterston and commissioner for the record.

446
00:38:23,900 --> 00:38:26,820
My name is Aaron Monning. I'm a county's EMS administrator.

447
00:38:27,440 --> 00:38:30,040
And then joined today by Dr. Bruno County Health Officer.

448
00:38:30,620 --> 00:38:35,140
Please to prevent the first reading of the ordinance to adopt the revised 2028

449
00:38:35,140 --> 00:38:40,820
Multnomah County Ambulance Service Plan and amend Multnomah County Code after 21400.

450
00:38:40,820 --> 00:38:46,200
I want to start by thanking everyone who has been involved in the development of this proposed plan.

451
00:38:46,440 --> 00:38:50,900
And all of those who are going to give verbal and written testimony is clear.

452
00:38:51,060 --> 00:38:56,000
We are all attempting to provide the community high quality care. Next slide please.

453
00:38:58,370 --> 00:39:04,710
Our primary objective today is to walk you through the key structure updates in the proposed 2028 ambulance service plan.

454
00:39:05,070 --> 00:39:11,670
I will provide a brief overview of the NS system outline the system assessment process that brought us to this milestone.

455
00:39:11,670 --> 00:39:15,350
on walk through the major operational changes in detail

456
00:39:15,350 --> 00:39:18,150
or next steps towards state approval and procurement.

457
00:39:18,990 --> 00:39:19,810
Next slide, please.

458
00:39:23,850 --> 00:39:24,770
The ground or discussion,

459
00:39:25,230 --> 00:39:27,430
Multnomacanian Emergency Medical Services

460
00:39:27,430 --> 00:39:29,930
operates at the critical intersection

461
00:39:29,930 --> 00:39:34,270
where public safety, public health, and health care overlap.

462
00:39:34,770 --> 00:39:37,150
Our core mission is ensuring the right level

463
00:39:37,150 --> 00:39:39,710
of clinical care is delivered to every person

464
00:39:39,710 --> 00:39:40,970
at the right time.

465
00:39:41,630 --> 00:39:43,230
The county achieves this by providing

466
00:39:43,230 --> 00:39:49,570
high-level medical direction, regulatory administration, and overall system coordination across

467
00:39:49,570 --> 00:39:52,070
our entire county. Next slide.

468
00:39:54,630 --> 00:39:57,710
This diagram illustrates the patient journey through a pre-health

469
00:39:57,710 --> 00:39:59,970
system. From the initial 9-1-1.

470
00:40:13,460 --> 00:40:20,240
We will now

471
00:40:22,580 --> 00:40:32,320
transition into the back-down on the emergency medical services system assessment, which provided the foundational assessment and the assessment and program recommendation, and we will now transition into the back-down on the emergency medical services system assessment.

472
00:40:32,320 --> 00:40:35,320
for the revised plan. Next slide.

473
00:40:38,060 --> 00:40:41,900
Under Oregon administrative rule, counties are required to maintain an

474
00:40:41,900 --> 00:40:49,160
ambulance service plan. Townings act as an agent of the state, following a prescribed format and

475
00:40:49,160 --> 00:40:57,380
content for each county plan. A current plan with left updated in 2016, given persistent contracts and

476
00:40:57,380 --> 00:41:01,740
science, challenges, evolving clinical best practices, and less than

477
00:41:01,740 --> 00:41:03,840
learned from recent operational pilots.

478
00:41:04,460 --> 00:41:08,320
We commissioned an independent third party assessment to inform the revision

479
00:41:08,320 --> 00:41:09,620
of our system design.

480
00:41:10,460 --> 00:41:11,260
Next slide, please.

481
00:41:13,960 --> 00:41:19,860
This assessment was designed to move our system from evaluation into action.

482
00:41:20,520 --> 00:41:22,400
A real task year, the EMF program,

483
00:41:22,660 --> 00:41:24,540
since the five consultant recommendations,

484
00:41:24,540 --> 00:41:28,500
than stakeholder feedback, clinical committee review,

485
00:41:28,940 --> 00:41:32,220
and board direction to draft an ambulance service plan

486
00:41:32,220 --> 00:41:34,300
that updates our pre-hospital framework.

487
00:41:35,220 --> 00:41:36,200
Next slide, please.

488
00:41:39,970 --> 00:41:42,270
This timeline reflects our process.

489
00:41:42,750 --> 00:41:46,330
We engage health care strategists in late 2024

490
00:41:46,330 --> 00:41:49,490
to conduct very comprehensive system review.

491
00:41:50,190 --> 00:41:51,570
Throughout early 2025,

492
00:41:51,990 --> 00:41:55,270
the consultants conducted extensive stakeholder engagement

493
00:41:55,270 --> 00:42:01,410
session with fire departments, dispatch agency, hospitals, and clinical advisory committees.

494
00:42:02,150 --> 00:42:02,890
Next slide, please.

495
00:42:06,590 --> 00:42:11,890
Following the release of the assessment report in December 2025, we opened a multi-month

496
00:42:11,890 --> 00:42:13,210
public comment window.

497
00:42:13,830 --> 00:42:20,330
We briefed the board in April of 2016, released the draft plan in June, and how they dedicated

498
00:42:20,330 --> 00:42:25,770
board work session in August to refine the final language presented to you today.

499
00:42:26,690 --> 00:42:27,190
Next slide.

500
00:42:29,360 --> 00:42:34,460
Today marks our first reading and public hearing, following a scheduled second reading

501
00:42:34,460 --> 00:42:35,700
on September 17.

502
00:42:36,620 --> 00:42:41,220
When the county has an adopted plan, it will submit it to the Oregon Health Authority

503
00:42:41,220 --> 00:42:43,200
for the state's review and approval.

504
00:42:43,940 --> 00:42:50,340
This sets the stage for our 2022 procurement process ahead of an implementation on September

505
00:42:50,340 --> 00:42:52,020
1, 20, 28.

506
00:42:52,600 --> 00:42:53,400
Next slide, please.

507
00:42:55,680 --> 00:43:02,100
Now, let us examine the core policy and operational recommendations in the 20, 20, 8, and

508
00:43:02,100 --> 00:43:03,080
do a service plan.

509
00:43:03,860 --> 00:43:04,320
Next slide.

510
00:43:08,110 --> 00:43:13,850
The plan introduces the advanced care paramedic or ACP as the highest peer-up county level

511
00:43:13,850 --> 00:43:16,130
EMF provider credentialing.

512
00:43:16,270 --> 00:43:20,810
While county credentialing has historically recognized the lead paramedic versus non-lead,

513
00:43:21,190 --> 00:43:22,810
this formalizes that structure.

514
00:43:23,310 --> 00:43:28,410
Under the new plan, all life-threatening 911 calls require the response of it leads

515
00:43:28,410 --> 00:43:32,110
of one advanced paramedic. Next slide please.

516
00:43:35,470 --> 00:43:38,130
This change directly addresses assessment findings

517
00:43:38,130 --> 00:43:43,310
regarding clinical concern of left experience provider workforce by concentrating

518
00:43:43,310 --> 00:43:49,830
phyria low frequency for teachers among season paramedics more strategically deployed

519
00:43:49,830 --> 00:43:55,810
and use for the highest of security responses. First of the way the plan confirms that holding

520
00:43:55,810 --> 00:44:03,750
or deploying ACP is a county-quitable credential and does not impose a mandatory staffing duty

521
00:44:03,750 --> 00:44:10,290
or a financial burden on non-contractive municipal fire agencies or other future sponsor agencies.

522
00:44:11,330 --> 00:44:12,530
Next slide, please.

523
00:44:16,460 --> 00:44:20,240
We are transitioning from a rigid staffing requirement to a flexible

524
00:44:20,240 --> 00:44:26,700
acuity-based deployment model, combining advanced life support and basic life support units

525
00:44:26,700 --> 00:44:32,840
and quick response vehicle. For time-critical, life-printing calls, the plan mandate

526
00:44:32,840 --> 00:44:38,180
a minimum of two paramedics on the field, at least one of whom must be in a advanced

527
00:44:38,180 --> 00:44:43,480
character or medic. However, it does not dictate which agencies those conditions belong to

528
00:44:43,480 --> 00:44:49,680
or what vehicle they arrive in, but does hold the single, franchise, ambulance provider, agency,

529
00:44:50,660 --> 00:44:55,340
responsible for meeting this staffing standard financially and operationally.

530
00:44:57,350 --> 00:44:58,230
Next slide, please.

531
00:45:00,340 --> 00:45:05,740
This model aligns with system assessment recommendations to match resources to actual patient

532
00:45:06,120 --> 00:45:13,240
acuity by enabling EMT staffed basic life support and single-paramedic advanced life support units

533
00:45:13,240 --> 00:45:19,900
to handle lower acuity calls. We preserved the high-tier paramedic resources for life-threatening emergencies,

534
00:45:20,900 --> 00:45:27,080
build system resilience during workforce shortage and reduce provider burnout. Next slide please.

535
00:45:29,920 --> 00:45:32,520
We have updated our response zones,

536
00:45:32,660 --> 00:45:35,700
no-minclature to match state regulatory definition

537
00:45:35,700 --> 00:45:39,860
under Oregon Administrative Rule 333-200.

538
00:45:40,860 --> 00:45:45,560
Defining clear, open, sub-open, rural, frontier,

539
00:45:46,080 --> 00:45:49,700
and search and rescue boundaries as required by the state statutes,

540
00:45:50,660 --> 00:45:52,720
rule, state and regional trauma requirement.

541
00:45:54,020 --> 00:45:56,940
Response time standard benchmarks are now strictly

542
00:45:56,940 --> 00:46:07,080
feared by geographic zone and patient activity measured at a 90 percent monthly compliance threshold as required by law.

543
00:46:07,880 --> 00:46:10,260
I want to pause here for one added second.

544
00:46:11,360 --> 00:46:21,180
Having appropriate achievable clinically relevant response time benchmarks that are appropriate for the response and transport volume are imperative.

545
00:46:21,180 --> 00:46:29,400
If the standards are not set up appropriately, they will lead to a failed procurement or an immediately failed contract.

546
00:46:30,100 --> 00:46:36,600
The measurement of the 90 percent is directly achievable or not achieved based on the volume being measured.

547
00:46:37,580 --> 00:46:45,080
And small numbers that 90 percent effectively becomes 100 percent because a vendor cannot miss any calls due to low numbers.

548
00:46:45,080 --> 00:46:51,260
The time and percentage both played directly into our procurement and the measure of a contractor.

549
00:46:52,040 --> 00:46:58,760
If we have a county, have a failed procurement, or the chosen vendor has immediate failure due to the benchmark,

550
00:46:59,580 --> 00:47:06,500
the county becomes the provider per section 7E until a suitable replacement can be found.

551
00:47:07,440 --> 00:47:08,280
Next slide, please.

552
00:47:10,970 --> 00:47:17,030
Replacing the land planning metro urban growth boundary with incorporated city limits and state

553
00:47:17,030 --> 00:47:24,190
size and density tier ensures legal alignment and equity performance target across the entire county

554
00:47:24,190 --> 00:47:26,810
exactly as the state is defined.

555
00:47:27,350 --> 00:47:34,530
Furthermore, Section 5CC established a supplemental performance agreement framework, allowing any

556
00:47:34,530 --> 00:48:00,650
incorporated city or fire district and contract independently for faster local response times or dedicated staging without stiff and cost the county taxes or deluding overall coverage this proposed base level service reports maintaining the explicitly non county subsidized model and maintain the fee for service model for these poor ambulance services across the entire county.

557
00:48:00,650 --> 00:48:02,770
Next slide, please.

558
00:48:06,340 --> 00:48:10,560
The plan formally recognizes active call management for ACM.

559
00:48:11,580 --> 00:48:16,840
Under this 9-1-1, under this system, 9-1-1-pthap triage low-acuity calls,

560
00:48:17,560 --> 00:48:22,480
are routed to a dedicated Q, monitored 24 hours a day, 7 days a week,

561
00:48:22,600 --> 00:48:26,680
by experienced paramedics, who actively manage patient needs.

562
00:48:27,100 --> 00:48:31,280
Provide telephonic consultation or arrange non-emergency response

563
00:48:31,280 --> 00:48:32,960
and Character Pathways.

564
00:48:33,440 --> 00:48:36,100
This is a process that the county has previously used

565
00:48:36,100 --> 00:48:37,460
during large scale events

566
00:48:37,460 --> 00:48:39,020
like extreme weather events

567
00:48:39,020 --> 00:48:41,100
that overwhelmed the normal resources.

568
00:48:42,040 --> 00:48:46,460
In 2023, this system was activated 24-7,

569
00:48:46,920 --> 00:48:48,660
commandage lower activity calls

570
00:48:48,660 --> 00:48:51,420
and favor resources for higher activity calls.

571
00:48:52,100 --> 00:48:55,320
It is clear that there will always be lower activity calls

572
00:48:55,320 --> 00:48:58,700
that the 9-0 and 1 system was not designed for.

573
00:48:59,040 --> 00:49:00,640
Many of these calls don't require

574
00:49:00,640 --> 00:49:02,040
transport to a hospital.

575
00:49:02,660 --> 00:49:05,740
Of note, the low acuity cue call currently

576
00:49:05,740 --> 00:49:08,520
have the highest response to transport rate

577
00:49:08,520 --> 00:49:10,720
of any call type in the system,

578
00:49:11,040 --> 00:49:14,500
with nearly 90% of all of the call being transported.

579
00:49:15,560 --> 00:49:17,320
Matching a lower acuity resource,

580
00:49:17,840 --> 00:49:21,420
a basic life support ambulance with lower acuity patient.

581
00:49:22,560 --> 00:49:24,300
Although this is not strictly limited

582
00:49:24,300 --> 00:49:26,020
to basic life support patients,

583
00:49:26,380 --> 00:49:29,120
the system continues to receive numerous calls

584
00:49:29,120 --> 00:49:34,620
that could be classified as interfacially transferred from one medical facility to another,

585
00:49:35,000 --> 00:49:39,440
that are also not time critical in nature and are appropriate to manage and transport

586
00:49:39,440 --> 00:49:45,280
as the system has the resources to do without impacting availability for these high

587
00:49:45,280 --> 00:49:54,820
activity calls that the 911 system was designed for. Next slide, please. ACM protects

588
00:49:54,820 --> 00:49:59,960
emergency transport capacity by preventing unnecessary ambulance dispatches.

589
00:50:00,000 --> 00:50:14,060
For non-emergent call, it addresses dispatch feedback by clarifying that the ACM clinicians actively monitor calls post EMD triage under strict protocol set by the county EMS medical director.

590
00:50:15,540 --> 00:50:16,060
Next slide.

591
00:50:18,730 --> 00:50:26,310
The county maintains unified clinical governance through the office of the medical director under a single county EMS medical director.

592
00:50:26,310 --> 00:50:31,470
This structure centralizes clinical quality assurance protocol development,

593
00:50:32,070 --> 00:50:36,230
credentialing, and dispatch standards across all system components.

594
00:50:37,210 --> 00:50:38,150
Next slide, please.

595
00:50:40,270 --> 00:50:45,410
Unified oversight eliminates fragmented care delivery across the municipal line.

596
00:50:45,750 --> 00:50:48,610
Both private transport providers and fire departments

597
00:50:48,610 --> 00:50:53,330
strongly supported standardized clinical protocols to ensure seamless patient

598
00:50:53,330 --> 00:50:59,490
hand off and consistent quality of care across the county. Next slide

599
00:51:04,160 --> 00:51:05,940
for operational agency

600
00:51:05,940 --> 00:51:11,340
is the plan establishes EMF agency medical directors. These positions report directly

601
00:51:11,340 --> 00:51:16,700
to the county EMF medical director are employed by the county and provided dedicated medical

602
00:51:16,700 --> 00:51:23,980
consultation and clinical auditing tailored specific to provider agencies. Next slide please.

603
00:51:26,000 --> 00:51:39,340
This condition responds to partner feedback requesting dedicated day-to-day physician support by employing agency medical directors through the county while having funding provided by the supported agency.

604
00:51:39,940 --> 00:51:45,020
We further observe unified medical authority while delivering tailored clinical oversight.

605
00:51:46,580 --> 00:51:47,400
Next slide please.

606
00:51:49,700 --> 00:51:56,560
The plan explicitly details the baseline capabilities of municipal fire departments and fire district.

607
00:51:57,140 --> 00:52:07,820
It clarifies that fire, of course, responder participation and clinical levels of care remain voluntary, and at the sole direction of each local jurisdiction.

608
00:52:09,080 --> 00:52:09,900
Next slide.

609
00:52:13,550 --> 00:52:19,530
This section balances operational integration with legal-safe guard if protects municipal

610
00:52:19,530 --> 00:52:25,950
fire departments from unfunded credentialing or staffing mandates. Furthermore, to satisfy

611
00:52:25,950 --> 00:52:33,670
federal anti-kip-back statute papers, any proposed vendor revenue sharing are passed through

612
00:52:33,670 --> 00:52:40,950
requires an independent bear market value study ensuring legally compliant pathways for local

613
00:52:40,950 --> 00:52:44,170
partnership. Next slide, please.

614
00:52:47,040 --> 00:52:51,160
We will wrap up by reviewing the adoption and procurement

615
00:52:51,160 --> 00:52:53,740
roadmap ahead. Next slide.

616
00:52:57,070 --> 00:53:00,690
Following today's first reading and public hearing, we look forward

617
00:53:00,690 --> 00:53:09,710
to the scheduled second reading on September 17. Upon board adoption, we will submit the completed

618
00:53:09,710 --> 00:53:15,930
the Indian Service Plan to the Oregon Health Authority, OHA approval will enable us to send

619
00:53:15,930 --> 00:53:25,090
the remainder of 2026 and beginning of 2027 developing competitive procurement ahead. This procurement

620
00:53:25,090 --> 00:53:31,470
ahead is complex and will take multiple months for partners to complete their portion related

621
00:53:31,470 --> 00:53:37,190
to legally required for our market value studies to support any requested path through payment.

622
00:53:37,190 --> 00:53:44,310
And for the county of EONF team and procurement team to design the procurement, the procurement

623
00:53:44,310 --> 00:53:53,010
that must be underway no later than March given the September 1, 2028 implementation

624
00:53:53,010 --> 00:53:53,970
date.

625
00:53:54,310 --> 00:54:00,170
And the large amount of internal infrastructure and capital expenses any vendor will

626
00:54:00,170 --> 00:54:03,190
need to have in place in this very short timeline.

627
00:54:03,190 --> 00:54:09,090
So, in summary, any day we'll compress our ability to start the procurement.

628
00:54:09,830 --> 00:54:10,550
Next slide.

629
00:54:12,940 --> 00:54:16,440
We'd like to express our gratitude to county leadership.

630
00:54:16,980 --> 00:54:21,940
And for all our public safety and health care partners who contributed to this plan,

631
00:54:22,720 --> 00:54:23,140
thank you.

632
00:54:23,280 --> 00:54:27,920
And we are now open to your question and back to you, Chair.

633
00:54:28,820 --> 00:54:33,460
Thanks so much, Bruno and Erin, and I know we have public testimony on this item, so

634
00:54:33,460 --> 00:54:35,140
Tasia can we move through this public testimony?

635
00:54:37,300 --> 00:54:48,480
Yes, first up for public testimony, we have Jeff, Teeter, Jeff, you can unmute yourself

636
00:54:48,480 --> 00:54:49,260
and begin.

637
00:54:55,720 --> 00:54:59,960
there. Can you guys hear me? Yes, we can. Okay. Good morning.

638
00:55:00,000 --> 00:55:16,560
Morning chair and county commissioners. My name is Jeff Teter. I'm the President of the Gresham Professional Firefighter Association. I represent 130 members providing fire and EMS services to the citizens of Gresham, throughout the fair view, would village and unincorporate areas of fire district 10.

639
00:55:17,460 --> 00:55:24,480
I am here today to advocate the Gresham firefighter stance on the currently proposed response times on the ambulance service plan draft.

640
00:55:26,000 --> 00:55:33,060
We're looking to make positive changes on those current numbers to increase services to the communities of East County, East Multimak County.

641
00:55:34,300 --> 00:55:40,540
Currently, as proposed in the draft, Multimak County, a lot of the longest response times in all categories except urban.

642
00:55:41,220 --> 00:55:44,780
When compared to neighboring Washington County and Cochemous County.

643
00:55:46,080 --> 00:55:50,320
When looking at the doubling of the response times in the cities of Trapale, Fairview and Wood Village,

644
00:55:51,080 --> 00:55:55,760
I can't help a ponder on what that will look like for our already overloaded emergency medical system.

645
00:55:59,490 --> 00:56:07,370
The current response times as proposed will directly impact three of six fire stations that my members operate out of.

646
00:56:07,730 --> 00:56:09,210
That would be half our fire department.

647
00:56:10,430 --> 00:56:12,510
These response times are currently drafted.

648
00:56:13,350 --> 00:56:16,130
As currently drafted, we'll cause ripple effects in Eastland on the county.

649
00:56:16,670 --> 00:56:19,970
It will first affect Gresham fire department and then further impact

650
00:56:19,970 --> 00:56:24,130
Portland fires most eastern stations fire companies that will have to

651
00:56:24,130 --> 00:56:27,230
shift their work in the Gresham area to cover while we're on seeing for longer

652
00:56:27,230 --> 00:56:28,210
periods of time.

653
00:56:29,310 --> 00:56:31,790
There are many ways to fix this current draft day SP.

654
00:56:32,670 --> 00:56:35,730
The one that Gresham firefighters would endorse is looping all the currently

655
00:56:35,730 --> 00:56:42,890
described suburban cities into the urban section for the response signs. Giving citizen giving

656
00:56:42,890 --> 00:56:46,650
every citizen in the metro area eight minute response times for emergency operation.

657
00:56:48,070 --> 00:56:53,230
All in all response times matter in the emergency medical field setting a standard that puts

658
00:56:53,230 --> 00:56:58,190
every citizen represented in this county first should be the top priority. Let's work together to

659
00:56:58,190 --> 00:57:02,910
correct these response times so the county ambulance service plan reflects this. Thank you so much for

660
00:57:05,080 --> 00:57:11,460
Next, we have Nathan George. Nathan, you can unmute yourself and begin.

661
00:57:13,420 --> 00:57:17,240
Good morning. I'm Nathan George. The city manager.

662
00:57:17,860 --> 00:57:20,240
Good. Thank you. I can see myself.

663
00:57:21,080 --> 00:57:23,000
Good morning, commissioners. Thank you for having me to testify.

664
00:57:23,320 --> 00:57:25,580
I'm Nathan George City of Magic City of Fairview.

665
00:57:25,740 --> 00:57:28,120
I'm asking you not to adopt the Island Service plans.

666
00:57:28,120 --> 00:57:32,220
currently proposed. City of Fairview, along with the cities of Troutdown, with village had

667
00:57:32,220 --> 00:57:37,460
many concerns. I will focus on three. First collaboration, Fairview, Troutdown, with village

668
00:57:37,460 --> 00:57:42,120
were not engaged in the process until very recently, after the assessment was already being written.

669
00:57:43,160 --> 00:57:46,780
Next, response and time and equity, our three cities are directly affected by the news

670
00:57:46,780 --> 00:57:51,260
suburban response standard, is extremely important to a collaborate with us as well as the

671
00:57:51,260 --> 00:57:56,080
rest of the county. Today, we are standing for life-threatening calls as eight minutes, the county

672
00:57:56,080 --> 00:58:01,120
in the PIN and Consultant to assess system, that consults a recommended 12-months, counting

673
00:58:01,120 --> 00:58:05,880
sheet of staff, chose 15 minutes. That does not show a commitment to equity, cost distribution

674
00:58:05,880 --> 00:58:11,140
finally. Last point, our communities are already paying for the system. We ask that services

675
00:58:11,140 --> 00:58:15,620
not be reduced, which would shift more of a burden on the cities. The Gresham Fire Department,

676
00:58:15,740 --> 00:58:19,780
the contractor, which is the contractor for our three cities, is the first responder on the

677
00:58:19,780 --> 00:58:23,980
scene in life, threatening priority calls, more than 80% of the time. We are already paying

678
00:58:23,980 --> 00:58:28,980
services, including all our 911 services. In the case of City of Fairview, the expense

679
00:58:28,980 --> 00:58:34,000
for public safety are so high, 6.3 million this year. There are 3.2 million dollar

680
00:58:34,000 --> 00:58:40,380
property taxes, which is all we collect. Building and cover half, we now have a $55 per household

681
00:58:40,380 --> 00:58:45,640
public safety fee this year, just to pay for our public safety costs. Our residents cannot absorb

682
00:58:45,640 --> 00:58:51,060
more increases medical emergencies for our residents or just as urgent and important inside the

683
00:58:51,060 --> 00:58:55,620
important as they are outside the City of Portland. Please do not adopt this plan as written

684
00:58:55,620 --> 00:58:59,560
and need more work for representation and involvement from all citizens of Multnomah County.

685
00:59:00,240 --> 00:59:01,020
Thank you.

686
00:59:03,680 --> 00:59:08,000
Next, we have Greg Durks. Greg, you can unmute yourself and begin.

687
00:59:10,790 --> 00:59:14,710
Thank you very much, Honorable Chair and Commissioners. This opportunity to testify. My name is

688
00:59:14,710 --> 00:59:18,770
Greg Durks, the City Manager for the City of Wood Village. I'm asked for you not to adopt

689
00:59:18,770 --> 00:59:22,750
payment service plan as apparently proposed and I want to frame our concerns around the county's

690
00:59:22,750 --> 00:59:27,030
own commitments to accountability, equity, collaboration, and data-driven decision-making.

691
00:59:27,770 --> 00:59:31,210
The County Identify stakeholder engagement for the medical service system assessment

692
00:59:31,210 --> 00:59:36,490
occurred December 2024 and February 2025, followed by the County's internal committee in April,

693
00:59:36,830 --> 00:59:40,570
with Village, Fairview, and Child Bill, and not engaged until June 25, 2025, when his

694
00:59:40,570 --> 00:59:41,650
assessment authority being written.

695
00:59:42,590 --> 00:59:46,050
These are the three seasons, directly affected by the New Superb and Response Standard and

696
00:59:46,050 --> 00:59:49,730
meaningful collaboration we use involving affected partners while decisions are being developed.

697
00:59:49,730 --> 00:59:52,550
Today, our standard for life-threatening calls is 8 minutes.

698
00:59:52,910 --> 00:59:55,230
The county-hard independent consultant to assess that system.

699
00:59:55,470 --> 00:59:57,010
That consultant recommended 12 minutes.

700
00:59:57,370 --> 00:59:58,450
County staff chose 15.

701
00:59:59,210 --> 00:59:59,970
The county's parking niche.

702
01:00:00,000 --> 01:00:06,800
Legislative emphasizes performance, data, benchmarking, and measurable results. It's strategic plan commits to county-to-transparent, data-driven decisions.

703
01:00:07,540 --> 01:00:12,940
So, show us the data, demonstrating why this disparity is necessary, consistent, which equity and performance commitments.

704
01:00:13,760 --> 01:00:16,840
We've been told that providing fast-free response for our three cities would cost more.

705
01:00:17,160 --> 01:00:22,420
But can you members of what Village Fairview and Childhood will not receive a discounted ambulance rate, an exchange for lower service standard?

706
01:00:22,900 --> 01:00:29,020
The ambulance does not cost less because it took longer to arrive, same system, same ambulance rate, different excretation for service.

707
01:00:29,020 --> 01:00:32,200
that is difficult to reconcile with the county's commitment to equity.

708
01:00:33,260 --> 01:00:35,280
And our community is already paying for this system.

709
01:00:35,660 --> 01:00:39,640
The county's assessment indicated that fire agencies respond to approximately 64% of

710
01:00:39,640 --> 01:00:41,040
medical calls counting why.

711
01:00:41,360 --> 01:00:45,200
What it didn't show is that for the four city area fires, the first responder on seeing a

712
01:00:45,200 --> 01:00:47,620
life-threatening party calls more than 80% of the time.

713
01:00:47,980 --> 01:00:52,320
The assessment calls these services force multipliers that reduces a number of ambulances needed.

714
01:00:52,820 --> 01:00:56,080
Our city tax payers fund those fire fire paramedics and the MTs.

715
01:00:56,080 --> 01:00:59,440
They respond, assess patients, begin treatment, and stabilize some emergencies

716
01:00:59,440 --> 01:01:01,440
followed by what's not signing that patient in the bill.

717
01:01:01,820 --> 01:01:05,380
The county does not subsidize Amazon's contractor, but cities and fire agencies provides

718
01:01:05,380 --> 01:01:08,880
substantial public funding for that EMS system, which makes that model possible.

719
01:01:09,700 --> 01:01:12,100
We're going to told that multiple ambulance service areas would cost more,

720
01:01:12,220 --> 01:01:15,180
again, to show us that analysis, what costs more and by how much.

721
01:01:15,920 --> 01:01:19,020
We're asking you to apply the county's own principles and gauge effective communities,

722
01:01:19,360 --> 01:01:22,480
to show us the analysis, recognize resources, our community is worried provided,

723
01:01:22,700 --> 01:01:25,900
and don't establish a lower emergency response simply because of which

724
01:01:25,900 --> 01:01:26,900
and leave some of those.

725
01:01:27,040 --> 01:01:28,900
Medical emergency doesn't become less urgent

726
01:01:28,900 --> 01:01:30,880
when a curse east of 211 for 7 in.

727
01:01:31,040 --> 01:01:33,280
Please do not adopt this plan as written.

728
01:01:33,620 --> 01:01:34,340
Thank you.

729
01:01:36,650 --> 01:01:39,970
Next we have Elizabeth Perez Elizabeth.

730
01:01:40,190 --> 01:01:41,730
You can unmute yourself and begin.

731
01:01:45,600 --> 01:01:46,100
Good morning.

732
01:01:46,880 --> 01:01:49,460
Good morning, Tara Vega Peterson and commissioners.

733
01:01:49,580 --> 01:01:50,860
I'm Elizabeth Perez and our private

734
01:01:50,860 --> 01:01:53,760
Services Director for Public Safety at the City of Portland.

735
01:01:54,660 --> 01:01:56,040
Thank you for including the City and the

736
01:01:56,040 --> 01:01:57,500
ambulance service plan process.

737
01:01:58,240 --> 01:02:00,500
We appreciate the collaborative spirit so far.

738
01:02:00,500 --> 01:02:05,900
City Administrator Lee Sherrod shared our consolidated feedback on August 5th and we were grateful

739
01:02:05,900 --> 01:02:11,000
for the opportunity to meet last week with Commissioner Jones Dixon, Dr. Bruno, Aaron,

740
01:02:11,120 --> 01:02:13,960
and the broader team to walk through our concerns and suggestions.

741
01:02:15,260 --> 01:02:18,400
The City County and our EMS partners share a core commitment

742
01:02:18,400 --> 01:02:23,560
delivering the fastest, safest, and most effective life-saving services to our community.

743
01:02:24,320 --> 01:02:27,080
That shared mission should guide how we shape the ASP.

744
01:02:27,080 --> 01:02:32,320
Because this is a system, changes in ambulance requirements directly influenced Portland

745
01:02:32,320 --> 01:02:35,240
Fire and Rescue's ability to meet community expectations.

746
01:02:36,380 --> 01:02:41,100
When response standards aren't met, or when PFNR, paramedics must provide advance care,

747
01:02:41,260 --> 01:02:46,520
or write in an AMR unit, PFNR units are taken out of service, creating coverage gaps,

748
01:02:46,680 --> 01:02:49,400
and shifting both workload and cost to the city.

749
01:02:50,160 --> 01:02:55,160
Clarifying responsibility for advance care staffing is essential to maintaining system reliability.

750
01:02:55,160 --> 01:03:00,540
There are also significant financial considerations for both PF and R&BOEC.

751
01:03:01,180 --> 01:03:05,200
While the county sets medical standards, equipment requirements, and training expectations,

752
01:03:06,420 --> 01:03:10,020
the associated funding does not currently match the operational burden.

753
01:03:10,700 --> 01:03:16,340
While MCEMS is ultimately responsible for cost sharing as a user on the BOEC user board,

754
01:03:16,780 --> 01:03:22,540
we understand MCEMS's desire to pass the cost allocation onto the contracted ambulance provider.

755
01:03:22,540 --> 01:03:32,840
We ask that the ASP incorporate those cost-sharing updates to the EMS dispatch services and mandated training and equipment are sustainably funded.

756
01:03:34,460 --> 01:03:37,040
Flexibility in the plan is critical as well.

757
01:03:37,360 --> 01:03:44,720
The ASP should allow county and its partners to introduce future innovations such as nurse triage systems, updated response models,

758
01:03:44,720 --> 01:03:51,160
and non-emergency-shuttleing solutions without requiring full renegotiation of it the ambulance contract.

759
01:03:51,820 --> 01:03:57,600
Building an adaptability now ensures that we can evolve the system as the community needs change.

760
01:03:59,000 --> 01:04:04,440
Going forward, we welcome a more structured collaborative development process for the ASP.

761
01:04:05,080 --> 01:04:12,080
One that allows city stakeholders to participate earlier in shaping the system requirements rather than reacting once the draft is completed.

762
01:04:12,080 --> 01:04:17,620
We recognize the complexity of the agreement, standards, and operational structures that support

763
01:04:17,620 --> 01:04:22,520
EMS services in Montgomery County and the city looks forward to continue partnership as we

764
01:04:22,520 --> 01:04:28,460
refine the ASP together and ensure the system remains coordinated clinically effective and ready

765
01:04:28,460 --> 01:04:31,380
for future challenges. Thank you so much.

766
01:04:35,410 --> 01:04:40,150
Next, we have Travis Stowell. Travis, you can unmute yourself

767
01:04:40,150 --> 01:04:40,570
begin.

768
01:04:44,200 --> 01:04:48,020
Good morning, Chair, and commissioners for the

769
01:04:48,020 --> 01:04:49,800
recommend name is Travis stoleball mayor of city

770
01:04:49,800 --> 01:04:52,500
aggression. And I'm here on behalf of the city and the

771
01:04:52,500 --> 01:04:55,540
diverse community that we have the privilege to serve.

772
01:04:55,800 --> 01:04:58,020
I want to begin by thinking each of you and your staffs,

773
01:04:58,040 --> 01:04:59,980
county employees, and for the thought.

774
01:05:00,000 --> 01:05:06,240
Full and collaborative engagement with Gresham over the last several days, regarding the proposed ambulance service plan.

775
01:05:06,780 --> 01:05:12,540
Gresham wants to be a partner in developing a plan that puts equity, public health, and people at the center of our decisions.

776
01:05:13,080 --> 01:05:24,480
We also recognize the difficult balance before you. Physical realities, system reliability, ambulance provider capacity, and the equitable service across a large and diverse county.

777
01:05:24,480 --> 01:05:26,180
As you weigh those considerations,

778
01:05:26,360 --> 01:05:28,540
Gresham is asking the county to maintain the

779
01:05:28,540 --> 01:05:31,480
current suburban response standard for life

780
01:05:31,480 --> 01:05:32,300
threatening calls.

781
01:05:32,440 --> 01:05:34,060
Today, the standard is eight minutes.

782
01:05:34,240 --> 01:05:35,920
The proposed plan would increase it to 15.

783
01:05:36,360 --> 01:05:39,220
Our staff has looked at an ambulance service in systems

784
01:05:39,220 --> 01:05:41,720
and contracts in our neighboring jurisdictions,

785
01:05:42,320 --> 01:05:43,860
including Washington and Clark and his counties.

786
01:05:44,680 --> 01:05:47,000
Those comparisons give us the confidence

787
01:05:47,000 --> 01:05:50,880
that we can continue working towards a model that

788
01:05:50,880 --> 01:05:53,820
that provides timely, sustainable service

789
01:05:53,820 --> 01:05:55,800
without lowering our expectations for care.

790
01:05:56,200 --> 01:05:58,880
This matters most for those with the fewest alternatives,

791
01:05:59,020 --> 01:06:00,440
our seniors, people, disabilities,

792
01:06:01,100 --> 01:06:03,940
lower income families, and historically marginalized communities.

793
01:06:04,500 --> 01:06:06,540
When someone is experiencing a lack of a redding

794
01:06:06,540 --> 01:06:09,820
emergency, every second matters, regardless of their zip code,

795
01:06:10,180 --> 01:06:12,660
our opportunity is not simply to build a system

796
01:06:12,660 --> 01:06:15,940
that works, it is to build one that can be great

797
01:06:15,940 --> 01:06:17,240
for all of Montename County.

798
01:06:17,680 --> 01:06:19,280
None of us can solve this alone,

799
01:06:19,280 --> 01:06:27,160
But working together, I believe we can build a system that is equitable, sustainable, and worthy of the communities we collectively serve.

800
01:06:27,420 --> 01:06:38,060
So today on behalf of the City of Gresham, we humbly ask you to adopt a plan that holds the line on service and maintains the current eight minute response standard for life threatening emergencies.

801
01:06:38,540 --> 01:06:41,880
Gresham stands ready to be a partner in getting there. Thank you very much.

802
01:06:43,290 --> 01:06:50,560
Next we have David RIPMA. David, you can unmute yourself and begin.

803
01:06:54,050 --> 01:06:55,090
Mayor, Mayor RIPMA.

804
01:06:57,320 --> 01:06:59,900
Can you hear me? Yes, we can.

805
01:07:00,400 --> 01:07:05,540
Yeah, okay. Yes, I'm David Carl RIPMA. I'm Mayor of Troutdale.

806
01:07:07,180 --> 01:07:13,120
And I don't know what's why I'm not seeing myself, but I'll leave that to the technical people.

807
01:07:13,120 --> 01:07:24,740
I joined the other cities, the Gresham Fairview and Wood Village in the August 10th

808
01:07:25,240 --> 01:07:28,960
letter to preceding your work session.

809
01:07:30,460 --> 01:07:35,380
The commissioners' work session, questioning basically how this new ambulance service plan

810
01:07:35,380 --> 01:07:43,100
would increase service to persons calling 911 and I endorse everything in that

811
01:07:43,100 --> 01:07:53,660
letter, but I, and I also endorse the comments of Jeff Teder, Travis Skowall, Nathan

812
01:07:53,660 --> 01:08:03,340
George, and Greg Dirk's today, question, I mean, the response time standard for

813
01:08:03,340 --> 01:08:09,460
Troutdale Wood Village and Fairview is clearly inequitable.

814
01:08:10,380 --> 01:08:13,620
You've greatly increased it for our cities.

815
01:08:14,300 --> 01:08:18,400
I can understand different response times

816
01:08:19,320 --> 01:08:22,480
for based on physical distance and so on,

817
01:08:23,160 --> 01:08:26,720
but the idea that response time standards

818
01:08:26,720 --> 01:08:29,120
for Troutdale Wood Village and Fairview

819
01:08:29,120 --> 01:08:37,780
to be practically twice what it is in Gresham and I'm talking adjacent Portland and

820
01:08:37,780 --> 01:08:44,540
Gresham neighborhoods with the same density of people based on basically city limit

821
01:08:44,540 --> 01:08:57,920
boundaries, artificial lines on maps is clearly inequitable and I'm asking you please

822
01:08:57,920 --> 01:09:07,600
to delay, pause this process, delay final adoption, and please engage with the three cities.

823
01:09:08,280 --> 01:09:16,780
If you would, it's been pointed out that our involvement has been minimal at best, and

824
01:09:16,780 --> 01:09:24,660
I think that is reflected in the fact that it response time standards for our cities has

825
01:09:24,660 --> 01:09:26,920
really degraded in this plan.

826
01:09:26,920 --> 01:09:35,920
So, please pause it. I urge you to reconsider and let's delay final adoption of this. Thank you.

827
01:09:44,870 --> 01:09:53,950
We also have, oh, Councillor Sue Piazza. You may unmute yourself from you again.

828
01:09:58,460 --> 01:09:58,800
There we go.

829
01:10:00,000 --> 01:10:05,660
Good morning, thank you, Chair Vagan Peter, sending commissioners for the opportunity to testify. For the record, my name is

830
01:10:05,660 --> 01:10:12,580
Supiasa and I serve on the Gretchen City Council. I have been involved with these conversations with many of you about ambulance services,

831
01:10:12,920 --> 01:10:21,740
paramedics and emergency response for several years now. I worked alongside many of you, and we have tried to improve a system that we all know has faced challenges.

832
01:10:22,620 --> 01:10:28,780
There is certainly no shortage of history here. You cannot Google ambulance service in Multnomah County without finding years of

833
01:10:28,780 --> 01:10:34,840
articles, reports, opinions, and debate. I'm not here to rehash all that today and I want

834
01:10:34,840 --> 01:10:38,840
to thank you for hearing our concerns and for the care I know each one of you brings

835
01:10:38,840 --> 01:10:44,580
to these decisions. These are difficult choices and I believe all of us come to this conversation

836
01:10:44,580 --> 01:10:51,100
wanting the same thing, a system that is there for the people when they need it most. As you consider

837
01:10:51,100 --> 01:10:56,920
this plan, I hope we continue to think about what these respond time standards mean in the real world.

838
01:10:56,920 --> 01:10:59,720
What does it mean for the person who called 911?

839
01:11:00,800 --> 01:11:04,380
What does it mean for the firefighter or paramedic already

840
01:11:04,380 --> 01:11:07,660
if they're side providing care while they wait for an ambulance?

841
01:11:08,220 --> 01:11:11,820
And what does it mean for the next family that means that same fire crew?

842
01:11:12,420 --> 01:11:16,580
Those questions matter because our emergency response system is interconnected.

843
01:11:17,180 --> 01:11:21,640
Our firefighters, paramedics, ambulance providers, cities,

844
01:11:22,180 --> 01:11:25,260
and the county all have a role in making it work.

845
01:11:25,260 --> 01:11:35,680
That is also why I believe the communities and first responders most affected by these changes should continue to have a meaningful role in shaping the solution.

846
01:11:36,480 --> 01:11:44,520
For me, this is deeply personal. I'm a mom, a grandmother. I have family and people I care deeply about living across this county.

847
01:11:44,520 --> 01:11:50,660
If one of them suffers a heart attack, a stroke, or another life-sentimenty threatening emergency,

848
01:11:51,320 --> 01:11:55,600
I want them to all have the same expectation that help is coming quickly,

849
01:11:56,100 --> 01:12:00,340
whether they live in Gresham, Trapdale, Northportland, or the Pearl District.

850
01:12:01,580 --> 01:12:07,280
I know all of you want this for all of our families in the county. That is why I support maintaining

851
01:12:07,280 --> 01:12:13,400
the current eight-minute response standard for life-threatening emergencies. We have spent years talking

852
01:12:13,400 --> 01:12:14,980
about how to improve the system.

853
01:12:15,520 --> 01:12:18,440
My hope is that this moment gives us the opportunity

854
01:12:18,440 --> 01:12:22,540
to bring the county, cities, first responders, providers,

855
01:12:22,880 --> 01:12:25,960
and communities together to build something better.

856
01:12:26,800 --> 01:12:30,060
So I respectfully ask that you maintain the unit standard

857
01:12:30,060 --> 01:12:32,360
and continue working with those most impacted

858
01:12:32,360 --> 01:12:35,400
to find a path forward that strengthens

859
01:12:35,400 --> 01:12:37,920
emergency, mental care, medical care

860
01:12:37,920 --> 01:12:39,560
for all of them in county.

861
01:12:40,340 --> 01:12:42,100
Thank you for listening, and thank you

862
01:12:42,100 --> 01:12:43,560
your continued partnerships.

863
01:12:47,400 --> 01:12:49,360
That's everyone signed up for public testimony.

864
01:12:51,340 --> 01:12:52,600
Okay, thank you so much.

865
01:12:52,920 --> 01:12:56,160
We'll go to questions from the board.

866
01:12:57,320 --> 01:13:02,020
I will just say there were a lot of comments about the public engagement process.

867
01:13:02,220 --> 01:13:07,240
I would like to hear from Erin and Bruno at this point a little bit more about that.

868
01:13:07,280 --> 01:13:09,260
Public process when you get to some of your responses.

869
01:13:09,860 --> 01:13:12,380
But for now, let's go to Commissioner Brimitwards.

870
01:13:16,670 --> 01:13:17,470
Thank you.

871
01:13:17,470 --> 01:13:27,310
I'd like to focus on a couple of the slides that also coincides with some of the testimony we just heard.

872
01:13:27,950 --> 01:13:31,730
On slide 17, I'm wondering if we could bring that

873
01:13:53,900 --> 01:13:55,520
up.

874
01:13:56,220 --> 01:13:57,220
That's part of the slide.

875
01:13:58,900 --> 01:14:08,620
There's the bottom of the slide, the feedback and it echoes much of what we heard in the testimony today from the.

876
01:14:08,620 --> 01:14:19,440
leaders of the cities in the county and as I was listening, it sounded like there was a response

877
01:14:19,440 --> 01:14:24,120
that was provided of like, here's the response to the feedback that local governments could

878
01:14:24,120 --> 01:14:32,060
contract separately, but I'm not seeing that on the slide as sort of the county's response to

879
01:14:34,460 --> 01:14:42,340
the feedback. So I'm wondering if you could read what you said, the sound on the slide of how the

880
01:14:42,340 --> 01:14:48,160
county is looking at that because what it seemed like it was saying is that in response to the

881
01:14:48,160 --> 01:14:57,240
feedback, you'd be telling the counties to have separate contracts to address that, so that

882
01:14:57,240 --> 01:14:59,040
wouldn't be a cost-borne by the county.

883
01:15:00,020 --> 01:15:04,660
And maybe I was mistaken that I'm pretty sure that's what I heard you say on this slide.

884
01:15:08,240 --> 01:15:16,940
Okay. I did. I referenced that part of the response to the feedback was that jurisdiction that

885
01:15:16,940 --> 01:15:25,520
desired a faster response on the floor that the county has in their plan could do supplemental

886
01:15:25,520 --> 01:15:43,580
to a performance contract with the vendor to get whatever that need is, it is a somewhat common practice in the industry, Clark County, for example, one of our neighbors.

887
01:15:43,580 --> 01:15:48,680
the county that they poor performance standard and then city of

888
01:15:48,680 --> 01:15:52,900
or fire district, they're able to contract with the vendor for

889
01:15:52,900 --> 01:16:02,320
increased unit hours or more a faster response time again with a

890
01:16:02,320 --> 01:16:09,220
volume of call, the volume of transport and a fee for service system.

891
01:16:09,320 --> 01:16:13,400
You're only getting that revenue when you're doing the transport

892
01:16:13,400 --> 01:16:20,380
And when the ambulance is first sitting, waiting ready are not generating that revenue.

893
01:16:20,940 --> 01:16:30,540
And so you have to have more units available sitting, waiting, not running call in order to drive down that time.

894
01:16:31,020 --> 01:16:40,540
And so that is something that the fee first service is not paid for letting the ambulance sit in.

895
01:16:40,540 --> 01:16:47,840
that is how that was addressed and how that came up and I'm going to make sure I answered your

896
01:16:47,840 --> 01:16:48,480
question.

897
01:16:49,000 --> 01:16:53,580
He does and when you say the vendor you're talking about in this case, I mean, assuming it's

898
01:16:53,580 --> 01:16:55,300
the current vendor AMR.

899
01:16:55,500 --> 01:17:00,800
That's whatever vendor, so that the ambient service plan and the code are vendor agnostic

900
01:17:00,800 --> 01:17:07,820
we have to go to a procurement process, but I just want to make sure that it's like whoever

901
01:17:07,820 --> 01:17:10,520
the vendor is like right now, if that were the case.

902
01:17:10,520 --> 01:17:18,000
right now, it would be the expectation that the cities would go to AMR and have a supplemental

903
01:17:18,000 --> 01:17:18,900
contract.

904
01:17:19,240 --> 01:17:19,920
Correct.

905
01:17:20,040 --> 01:17:26,160
And that would give them direct oversight of whatever that supplemental performant is and the

906
01:17:26,160 --> 01:17:31,860
ability to negotiate with the vendor or what the cost of that supplemental performant is

907
01:17:31,860 --> 01:17:32,980
going to cost.

908
01:17:36,480 --> 01:17:44,240
So, those cities would actually bear the cost of getting back to where to what they had,

909
01:17:44,300 --> 01:17:45,980
what they have in the current contract.

910
01:17:46,460 --> 01:17:54,300
So the current contract has a benchmark of eight minutes, which is not met in that current benchmark.

911
01:17:54,300 --> 01:18:11,780
We've discussed this over the last few years, a lot about the East County 50, but that geographic region is urban. It includes brush from Southdale wood village and fair view all in a single lump to increase the volume.

912
01:18:13,420 --> 01:18:17,280
The consultant will get the response time to actually occur.

913
01:18:17,860 --> 01:18:24,560
What's actually occurring, the benchmark if you're going to separate out those areas needs

914
01:18:24,560 --> 01:18:29,500
to account for the volume and what the actual performance is happening there currently.

915
01:18:29,680 --> 01:18:35,100
The numbers are being mixed with a much denser call volume area, much higher volume and much

916
01:18:35,100 --> 01:18:35,880
denser.

917
01:18:35,880 --> 01:18:49,360
But just to get the practical quality of it and the implications of this is that if they wanted something better than 15 minutes,

918
01:18:50,420 --> 01:19:02,860
the expectation from this plan would that they would need to contract with AMR or the vendor to get a faster response time.

919
01:19:02,860 --> 01:19:11,020
Correct. And the other piece of that is, if we choose to have something faster than that,

920
01:19:11,220 --> 01:19:17,040
they can at the base level. It will require the empty to subdivide that performance,

921
01:19:17,640 --> 01:19:22,640
because it does not get paid for based on people's service by itself.

922
01:19:23,180 --> 01:19:28,600
It will require a subsidy from somebody to move it.

923
01:19:28,600 --> 01:19:34,980
and then this is just this is another question because during my time on the commission

924
01:19:35,720 --> 01:19:42,200
much at the time there wasn't the ability that you know we had the whole level zeros where

925
01:19:42,200 --> 01:19:48,300
there weren't enough ambulances so would you anticipate safest a city chose to contract that there

926
01:19:48,300 --> 01:19:55,600
would actually be the ability for the vendor to provide those services because for the last

927
01:19:55,600 --> 01:19:59,980
of years, there hasn't been the capacity to even provide the base level.

928
01:20:00,000 --> 01:20:00,640
Service.

929
01:20:01,780 --> 01:20:11,140
Yeah, that's a second very question. I can't say. I suspect if you asked any for profit vendor, they usually say, yes,

930
01:20:11,340 --> 01:20:19,340
if the matter of what it cost them will import paramedics from Australia, they fill the whole, or whatever that happens to be.

931
01:20:20,100 --> 01:20:25,460
And so we get an answer of, yes, but it's not built in.

932
01:20:25,460 --> 01:20:31,800
Finally. Yep. Okay. My next question is on slide 25.

933
01:20:42,870 --> 01:20:46,650
So, and this question, it looks like

934
01:20:46,650 --> 01:20:53,610
the fire chiefs are looking at supportive of this formalized roles, but I'm concerned about

935
01:20:53,610 --> 01:20:56,630
equipment and training mandates?

936
01:20:58,650 --> 01:21:05,090
What is the county's position on the equipment and training

937
01:21:05,090 --> 01:21:07,990
mandates and funding to ensure that?

938
01:21:11,060 --> 01:21:17,760
I'll come up with a question, but I will try to take it on. So the first one is that the county,

939
01:21:17,920 --> 01:21:25,800
on the subsidized system, I don't have any county general funds for the county if they're

940
01:21:25,800 --> 01:21:32,800
And if we built in the fair market value assessment,

941
01:21:33,220 --> 01:21:35,440
so if they want to be paid for something,

942
01:21:35,620 --> 01:21:38,900
we need that to occur under federal regulation.

943
01:21:40,120 --> 01:21:44,560
So they would need their federal requirement to do a fair market value assessment

944
01:21:44,560 --> 01:21:47,520
for the cost of once they want to be paid for.

945
01:21:47,640 --> 01:21:51,360
We would build it into the procurement process and the proposal

946
01:21:51,360 --> 01:21:54,900
for the system would know what those expenses are.

947
01:21:54,900 --> 01:22:04,000
There are things that are permitted to be paid for and things that are not permitted to be paid for under CMS regulation.

948
01:22:04,800 --> 01:22:08,900
The penalties for violating those are very high, including criminal penalties.

949
01:22:09,500 --> 01:22:15,040
So again, the payment structure is built in there to be compliant with federal regulation.

950
01:22:17,500 --> 01:22:29,580
We're supportive of having a vendor pay for things that are commercially reasonable and meet the standards that just need to be built into the procurement process.

951
01:22:30,020 --> 01:22:34,840
The standards themselves related to training and equipment.

952
01:22:34,840 --> 01:22:37,440
Those have to do with clinical care.

953
01:22:37,520 --> 01:22:39,240
If you want to be part of the system,

954
01:22:39,500 --> 01:22:42,540
you have to have equipment that interoperable

955
01:22:42,540 --> 01:22:46,020
that fly back to how the system eats.

956
01:22:46,280 --> 01:22:48,860
Each one of the partners interacts with the next one.

957
01:22:49,000 --> 01:22:50,780
So you need to have medications.

958
01:22:50,880 --> 01:22:52,180
You need to have protocols.

959
01:22:52,540 --> 01:22:56,840
You need to have training where everything works interoperably.

960
01:22:57,260 --> 01:22:59,320
If you're going to have a system instead

961
01:22:59,320 --> 01:23:02,420
of a bunch of components that are not related or coordinated.

962
01:23:02,420 --> 01:23:02,520
good.

963
01:23:05,200 --> 01:23:34,060
Thank you. Um, so I'm going to want to hear the other questions that come up this morning. I'm going to say that was since I'm very, when I got on the board at the very beginning, it was in the middle of the huge ambulance to play issue, including it's like it might just start to the eastern portion of it. And as the commission discuss it, one of the issues that got raised.

964
01:23:34,080 --> 01:23:40,180
is that the actual contract, not the English service plan, but the initial contract was done

965
01:23:40,180 --> 01:23:46,860
on the consent agenda, no discussion, things got locked in, and then changes could

966
01:23:46,860 --> 01:23:57,180
be made. And then when a different approach was brought forward, there was a lot of conversation

967
01:23:57,180 --> 01:24:01,360
about how we were locked in because of the ambulance service plan and a whole host of other

968
01:24:01,360 --> 01:24:05,740
reasons of why the county couldn't

969
01:24:05,740 --> 01:24:07,720
nimbley move to address the delays.

970
01:24:08,700 --> 01:24:14,480
So I'm concerned about having a vote today on the first reading

971
01:24:14,480 --> 01:24:18,220
of the ordinance of getting ourselves locked in.

972
01:24:18,540 --> 01:24:21,840
So I may be later in the meeting,

973
01:24:22,320 --> 01:24:26,460
voting to table this to a date certain so we can

974
01:24:26,460 --> 01:24:28,380
have some of these issues addressed.

975
01:24:28,380 --> 01:24:43,520
I don't want to move ahead and say we're going to address them later and then come to the point where then the response is, well, we already did X and we're locked in.

976
01:24:43,640 --> 01:24:55,520
We can't address that. I'm concerned that we have leaders from essentially all of our partner cities this morning raising issues that are unresolved.

977
01:24:55,520 --> 01:24:59,380
I think there's also an expression of interest in partnership.

978
01:25:00,000 --> 01:25:14,420
The, you know, an anti-recognition that for this to work, we need to have close partnership and collaboration with the cities and the far departments.

979
01:25:15,100 --> 01:25:27,960
And I would hope that we get to a point when we're voting on the ambulance service plan ordinance that we have everybody who's needs to make the system successful on board with it.

980
01:25:27,960 --> 01:25:37,960
So I'm just going to put that out there, but we'll wait for all the other questions to come up to be raised by and answered by the commissioners.

981
01:25:42,840 --> 01:25:45,180
Okay. Thank you commissioner. Commissioner Jen sticks in.

982
01:25:45,840 --> 01:25:48,980
Yeah. Thank you chair. And I'll just say build off the web.

983
01:25:48,980 --> 01:25:51,040
Mr. Rimmer, just did it.

984
01:25:51,160 --> 01:25:54,060
So thank you, Dr. Bruno, for being here this morning

985
01:25:54,060 --> 01:25:56,180
in Administrator Monica, Erin.

986
01:25:56,380 --> 01:25:58,220
And thank you for just the last three weeks.

987
01:25:58,480 --> 01:26:00,260
And Renee, as well, for just your support

988
01:26:00,260 --> 01:26:02,140
and your help to look at my office and facilitating

989
01:26:02,680 --> 01:26:05,020
all of the meetings with the City of Portland,

990
01:26:05,460 --> 01:26:07,500
the City of Gwood Village, Fairview of Prouddale,

991
01:26:07,660 --> 01:26:09,620
and the City of Gresham, and the fire unions.

992
01:26:10,460 --> 01:26:12,700
So to build off of what Mr. Rimmer

993
01:26:12,700 --> 01:26:15,180
Edwards just stated, could you just share

994
01:26:15,180 --> 01:26:17,240
about this level of engagement that's been made?

995
01:26:17,240 --> 01:26:44,740
I mean, on slide eight on slide nine, as far as with the cities in East County, if you could just do just the level engagement for 20, 24 up until now. And then also if you can turn the engagement over the last week, you share the difference between the ordinance and the opportunity to the ASP to make changes in the different pockets.

996
01:26:44,740 --> 01:26:47,060
And you were going to put together a spreadsheet.

997
01:26:47,800 --> 01:26:49,960
So that would be helpful for us, the board as far as

998
01:26:49,960 --> 01:26:51,540
maybe the citizens will be bored.

999
01:26:51,900 --> 01:26:53,540
They go be helpful for all this.

1000
01:26:57,560 --> 01:27:00,880
Let's see if I can try to cover the engagement part.

1001
01:27:02,580 --> 01:27:05,460
So input for our partners is valuable partners

1002
01:27:05,460 --> 01:27:09,920
have been consulted since the outset of the EMF assessment

1003
01:27:09,920 --> 01:27:14,020
and invited to provide feedback in various means.

1004
01:27:14,420 --> 01:27:16,380
In person right along.

1005
01:27:17,780 --> 01:27:24,720
surveys, a lot of that is documented actually in the NSF assessment report about what the

1006
01:27:24,720 --> 01:27:33,400
message was between the public release of the draft ASP in June of 26, the work session

1007
01:27:33,400 --> 01:27:40,120
in August. We received a written feedback from partners both on the assessment and the

1008
01:27:40,120 --> 01:28:02,220
National draft, whatever practical, wherever we could find a way to incorporate it in the appropriate document. Again, we received feedback and sometimes our answer was that doesn't belong in an ambience service plan and to the point that doesn't belong in an ambience service plan where does it belong. So actually a couple of those other tools.

1009
01:28:03,440 --> 01:28:06,520
Our partners all have roles in the system.

1010
01:28:06,860 --> 01:28:09,740
They're here to advocate for their role, their position,

1011
01:28:10,460 --> 01:28:13,360
their component or their jurisdictional boundaries.

1012
01:28:14,240 --> 01:28:19,520
And so our goal is to balance that across looking across the entire

1013
01:28:19,520 --> 01:28:24,100
county geography and ensuring that the service is able to be provided

1014
01:28:24,100 --> 01:28:25,220
across everywhere.

1015
01:28:27,060 --> 01:28:30,280
And we sometimes don't satisfy all of our partners.

1016
01:28:30,280 --> 01:28:33,880
and I will acknowledge we do not always identify all of our partners.

1017
01:28:35,200 --> 01:28:42,540
So, going on to the tool for the ambiance service plan has very specific components and structure

1018
01:28:43,900 --> 01:28:49,800
that is dictated by the state at what has to go in there and must be addressed.

1019
01:28:50,500 --> 01:28:57,280
There are some decisions to be made and there are some descriptions that need to occur and that's a very structured piece.

1020
01:28:58,140 --> 01:29:04,040
In addition to the end-on server plan, we then have county code.

1021
01:29:04,320 --> 01:29:09,500
County code needs to support or supplement the end-on server plan.

1022
01:29:09,780 --> 01:29:11,720
It can't conflict it.

1023
01:29:12,020 --> 01:29:20,780
And that county code is basically the additional legal structure that the board is putting out.

1024
01:29:20,780 --> 01:29:23,880
for us and our partners to follow.

1025
01:29:25,680 --> 01:29:29,280
And so some items go in county code,

1026
01:29:29,840 --> 01:29:33,080
our end-to-end service plan and county code,

1027
01:29:33,320 --> 01:29:36,000
our written provider agnostic,

1028
01:29:36,700 --> 01:29:39,200
meaning we're going to have to put cure for services.

1029
01:29:39,760 --> 01:29:42,880
And there's no predetermination of who's going to do that.

1030
01:29:43,140 --> 01:29:44,580
It could be a private vendor,

1031
01:29:45,040 --> 01:29:46,740
could be a not-for-profit,

1032
01:29:46,940 --> 01:29:49,700
could be a governmental entity or a hybrid,

1033
01:29:49,700 --> 01:29:55,600
where they join a partnership or ultimately it could be the county that provides those

1034
01:29:55,600 --> 01:29:59,420
services depending on how it plays out.

1035
01:30:00,000 --> 01:30:11,960
The ambulance service plan and county code are formally put in place by the board through this ordinance process and readings and vote.

1036
01:30:12,200 --> 01:30:16,900
In addition to that, we then have a procurement that needs to occur.

1037
01:30:17,520 --> 01:30:29,380
And so the board will fit the procurement board when we come to you for our procurement piece, working with Brian Smith and the county procurement team on.

1038
01:30:29,380 --> 01:30:37,980
How we plan to purchase or contract or get agreements for the services, we have a legal obligation

1039
01:30:37,980 --> 01:30:44,280
with the state for that procurement process to be consider all offers to provide the

1040
01:30:44,280 --> 01:30:44,760
service.

1041
01:30:45,180 --> 01:30:46,800
So we can't just assign it to anybody.

1042
01:30:47,440 --> 01:30:53,000
You can't just direct negotiate it with AMR and you're not allowed to give preference

1043
01:30:53,000 --> 01:30:55,540
to existing providers of the service.

1044
01:30:55,540 --> 01:30:58,200
So, some items belong in procurement.

1045
01:30:59,140 --> 01:31:01,220
A lot of those are like the cost.

1046
01:31:02,300 --> 01:31:04,900
If we've been a pay, the fire department

1047
01:31:04,900 --> 01:31:08,920
to ride in on call, or you're going to pay them for training.

1048
01:31:10,280 --> 01:31:13,120
They're federal requirements that need to be met

1049
01:31:13,120 --> 01:31:15,620
in order for us to put that into a procurement

1050
01:31:15,620 --> 01:31:17,260
of somebody to pay.

1051
01:31:18,160 --> 01:31:20,200
So, that's where that would live.

1052
01:31:20,480 --> 01:31:24,240
We have EMS Administrative Rule, those are rules

1053
01:31:24,240 --> 01:31:32,760
that the program publishes or how we accomplished the work and we need to have rockers of every

1054
01:31:32,760 --> 01:31:39,840
enough provider in the county. And we can change the rules at any time. Right. Right. So the administrative

1055
01:31:39,840 --> 01:31:48,520
rule follow our administrative rule process. So those are run by the program and we publish the

1056
01:31:48,520 --> 01:31:56,200
out for public comment for 30 to 60 days, take comments and then the program finalizes those rules

1057
01:31:56,200 --> 01:32:03,920
at a program level. So again, it's how we enact things that are either encoded or are with

1058
01:32:03,920 --> 01:32:04,440
responsibility.

1059
01:32:06,600 --> 01:32:12,320
We have, yeah, that's clinical protocol. The MS clinical protocol or how we treat

1060
01:32:12,320 --> 01:32:19,220
patient has to do with the equipment, the medication, the state organ medical board, that's

1061
01:32:19,220 --> 01:32:26,840
the highest level, but the county medical directors actually allow EMF providers to do those

1062
01:32:26,840 --> 01:32:33,400
things, and so that is under the medical director's statutory authority, just that EMF clinical

1063
01:32:33,400 --> 01:32:40,740
protocol. Again, with those are on the clinical side, and then we have the contracts in the

1064
01:32:40,740 --> 01:32:45,240
government or agreements. And so the context in and in our government or agreement, typically

1065
01:32:45,780 --> 01:32:53,300
document commitments either from the county to an agency or from that agency to the county.

1066
01:32:54,000 --> 01:33:02,460
Those can be payment. Those can be action. I think we sometimes talk about the fire department

1067
01:33:02,460 --> 01:33:09,200
can determine what call the fire department is going to go on or what level of purpose are going

1068
01:33:09,200 --> 01:33:14,980
to run that, and that is documented within an intergovernmental agreement between the fire

1069
01:33:14,980 --> 01:33:20,200
agencies and the county that say that was going to tell you what we're going to do.

1070
01:33:20,480 --> 01:33:26,720
So those are kind of the structure of the common tool that those various things live in.

1071
01:33:26,860 --> 01:33:35,700
And again, we kind of not put payments or financial matters into county code because it doesn't

1072
01:33:35,700 --> 01:33:38,340
makes them to be in that level of document.

1073
01:33:39,180 --> 01:33:42,640
I am sure there's some other document that those are the main ones.

1074
01:33:43,180 --> 01:33:46,540
Yeah, that's, that's, that's a shame the helpful as far as the timeline is concerned

1075
01:33:46,540 --> 01:33:50,060
in a pump-able moving forward, that's, that's such a trouble.

1076
01:33:51,060 --> 01:33:57,980
So the, the questions that I have regarding the ASP, or what's before us today is one,

1077
01:33:58,260 --> 01:34:02,700
just to clarify for the suburban and rural,

1078
01:34:02,700 --> 01:34:06,640
Corvette, they're moving from rural to suburban, is that correct?

1079
01:34:07,200 --> 01:34:10,460
A portion of them does not all of them.

1080
01:34:10,880 --> 01:34:17,160
So the way the state defines the suburban and I'm going to paraphrase and not read it.

1081
01:34:17,560 --> 01:34:22,820
But it's a 10-mile radius from the center of the urban area.

1082
01:34:23,580 --> 01:34:28,360
And so if you look at that map, you'll notice that the pink area is an arch.

1083
01:34:28,360 --> 01:34:35,220
And that's because that's a 10 mile radius from the core of the Oben Center.

1084
01:34:36,240 --> 01:34:43,040
And so that currently rural is outside of the Oben Gross boundary.

1085
01:34:43,340 --> 01:34:45,340
We use the plan planning tool.

1086
01:34:46,400 --> 01:34:50,400
When we move the using the state's actual definition,

1087
01:34:50,400 --> 01:34:58,840
and now it's a radius of 10 miles from the center of the area on the left turn side of the county.

1088
01:35:00,000 --> 01:35:07,660
Because Hillboro and Beaver can open that arch actually starts in a different county.

1089
01:35:08,380 --> 01:35:24,260
To get the suburban area of the west hill, there's also just a teeny tiny river of suburban outside of Portland, because Portland is such a large geographic map that 10 mile radius doesn't go as far.

1090
01:35:24,260 --> 01:35:39,260
the map on the eastern side, where Gresham needs that urban definition to 10 miles goes out quite a bit further because Gresham has a smaller urban geographic map.

1091
01:35:40,160 --> 01:35:41,260
Got it. Got it. Got it.

1092
01:35:41,860 --> 01:35:45,260
Well, I, like I said, we've been doing a lot of conversations over the last two weeks.

1093
01:35:45,360 --> 01:35:47,180
I just wanted to just put on the record.

1094
01:35:47,880 --> 01:35:54,620
We hear just the three cities or just everyone in East County as far as the city managers have been staying over the last two years.

1095
01:35:54,800 --> 01:35:57,400
We need to engage the three cities.

1096
01:35:58,200 --> 01:36:00,780
The fire changed the fire union, so something we've made an effort.

1097
01:36:01,120 --> 01:36:16,880
We need to make a better effort to include the city administrator, the new city administrator as far as the city of Portland and our fire chiefs and things like that as we move forward in the process as far as collaborating as we're building up the system of care.

1098
01:36:16,880 --> 01:36:21,020
And I'm looking forward to hearing the responses from the rest of my colleagues.

1099
01:36:21,260 --> 01:36:25,040
I'd like to be putting forward, I will be putting forward an amendment to the ASP

1100
01:36:25,040 --> 01:36:29,560
as far as the response sounds or all of the smaller cities.

1101
01:36:30,240 --> 01:36:34,980
To eight minutes, I do agree with President Teter as far as making it universal.

1102
01:36:35,760 --> 01:36:42,360
And then we'll have to let the discussion be paid for that or just overall implications.

1103
01:36:42,360 --> 01:36:48,120
I just want to say it overall, just thank you for, I've learned a lot over the last two or three months.

1104
01:36:48,500 --> 01:36:50,580
I'm just learning from you and everyone else.

1105
01:36:50,960 --> 01:36:55,440
I'll just hand it off while you're my time to the rest of my colleagues. Thank you.

1106
01:36:56,340 --> 01:37:04,820
Thank you. Before we go to districts one in districts two, we did have somebody who had signed up for a public testimony who is having technical difficulties who are now, who's now online.

1107
01:37:04,820 --> 01:37:09,100
So, Tejik, can we have them right there testimony now?

1108
01:37:09,440 --> 01:37:14,700
Yes. Frank, Hiltabrand, you can unmute yourself and begin.

1109
01:37:17,090 --> 01:37:20,590
Hey, the morning everyone, can you can hear me all right?

1110
01:37:20,870 --> 01:37:21,370
Yes, okay.

1111
01:37:22,090 --> 01:37:29,390
Well, thank you so much, Apologies. I have not used this format before.

1112
01:37:30,150 --> 01:37:34,470
So, listen, I want to bring you back, all of you back to

1113
01:37:34,470 --> 01:37:37,650
Well, the Molda McKown code 24,

1114
01:37:39,980 --> 01:37:43,280
2140, or 21400.

1115
01:37:44,760 --> 01:37:48,500
But for again, to do that, my name is Frank Hildebrand,

1116
01:37:48,500 --> 01:37:50,220
I'm the morning commissioner, Schermoing Chair.

1117
01:37:51,420 --> 01:37:55,700
I am the union representative for local Teamsters Local 223.

1118
01:37:56,240 --> 01:38:01,140
I proudly represent the approximately 400 paramedics

1119
01:38:01,140 --> 01:38:06,820
any MTs currently working in Malima County as employees of AMR.

1120
01:38:07,280 --> 01:38:15,140
And so today what I want to bring to your attention or what I want to talk about is labor dispute and neutrality.

1121
01:38:16,260 --> 01:38:22,160
So, but before I get into that, I want to take this opportunity to reassure the board

1122
01:38:22,160 --> 01:38:27,260
that our current relationship with AMR as an employer is cooperative and productive.

1123
01:38:27,260 --> 01:38:33,900
In fact, joint letter to that effect between the teamsters and Amar was recently submitted

1124
01:38:33,900 --> 01:38:37,080
to Multnomah County MS as part of this process.

1125
01:38:38,080 --> 01:38:43,060
So we are going to talk about something that makes some people a little uneasy, but I just

1126
01:38:43,060 --> 01:38:49,820
want you to know that the current situation is very good, and we are prepared to continue

1127
01:38:49,820 --> 01:38:56,200
our support of our teamster employer in areas that provide clear benefits to our members

1128
01:38:56,200 --> 01:39:04,860
of their families. That being said, I'm obligated to bring to your attention to something we view

1129
01:39:04,860 --> 01:39:15,320
as a loss. And that is this deliberate position by Montnomic County that ensures the full

1130
01:39:15,320 --> 01:39:21,000
weight and consequences of bargaining are placed directly in the hands of the bargaining parties.

1131
01:39:21,000 --> 01:39:25,240
So, you probably think of what Lucy talked about.

1132
01:39:25,900 --> 01:39:26,800
So, I'm gonna get there.

1133
01:39:26,980 --> 01:39:29,880
So, previously, we were provided that assurance

1134
01:39:29,880 --> 01:39:33,220
under Multimak County Code 21.406,

1135
01:39:33,680 --> 01:39:36,560
subsection five, which prevented approval

1136
01:39:36,560 --> 01:39:41,360
by Multimak County MS to provide alternative staffing

1137
01:39:41,360 --> 01:39:42,920
in the event of a labor dispute.

1138
01:39:43,020 --> 01:39:44,220
And it was very specific.

1139
01:39:45,400 --> 01:39:47,360
That language, as a part of this process,

1140
01:39:47,520 --> 01:39:48,640
has been struck.

1141
01:39:48,640 --> 01:39:56,800
So we, and I would like you to do some consideration in helping us solve that problem.

1142
01:39:58,600 --> 01:39:59,960
So we're seated in the question.

1143
01:40:00,000 --> 01:40:03,760
We request the Board, please reinstate specific and deliberate position of the

1144
01:40:03,760 --> 01:40:07,820
reality. With the new language, and we'd like to see that new language

1145
01:40:07,820 --> 01:40:13,400
in the local county code 21.417, the medical direction and supervision.

1146
01:40:14,520 --> 01:40:19,540
So, copies of that proposed language have been provided to

1147
01:40:19,540 --> 01:40:26,160
Ms. Zinga, Sprazener, and Mr. Monnick. So, we have an example of what we'd like to see.

1148
01:40:27,180 --> 01:40:35,200
We hope to develop a relationship with you and work with you on the development of the language.

1149
01:40:35,900 --> 01:40:38,300
Thank you so much for this opportunity to speak. I appreciate it.

1150
01:40:40,480 --> 01:40:42,760
All right. Thank you. I'm glad we were able to get that in.

1151
01:40:43,300 --> 01:40:45,620
Okay. We'll go now to further questions from the board.

1152
01:40:45,820 --> 01:40:48,540
We'll start with her will go to Commissioner Morgana.

1153
01:40:48,660 --> 01:40:49,860
Yeah. Thank you.

1154
01:40:49,860 --> 01:40:52,920
Um, I have a question,

1155
01:40:56,050 --> 01:41:09,430
when we went into rewriting, the family service plan was the directive that it be cost neutral or would not encourage additional cost to accounting.

1156
01:41:09,430 --> 01:41:12,510
effective, efficient, sustainable.

1157
01:41:16,620 --> 01:41:17,780
Can what is that mean?

1158
01:41:18,180 --> 01:41:18,460
Yeah.

1159
01:41:18,900 --> 01:41:21,700
I don't have any money coming to me.

1160
01:41:21,980 --> 01:41:26,780
So if you, it is been an explicitly non subsidized system.

1161
01:41:27,880 --> 01:41:32,560
There's no direction to the program that there is a subsidy.

1162
01:41:33,480 --> 01:41:35,400
You'll find it maybe different.

1163
01:41:35,980 --> 01:41:38,780
It's still going to subsidize the system.

1164
01:41:38,780 --> 01:41:53,180
But as proposed with out-to-direction that there's a financial subsidy coming is written as the specific effective and sustainable with out-to-to-to-to.

1165
01:41:53,180 --> 01:41:54,100
Okay.

1166
01:41:58,560 --> 01:42:10,720
If we wanted to achieve faster response times to be on par with, say, Washington County.

1167
01:42:12,220 --> 01:42:21,640
In some of the areas, I have some concern about some unincorporated parts of my district.

1168
01:42:21,640 --> 01:42:32,500
the don't have a city that could make an alternative contract. I am concerned about a sliver

1169
01:42:32,500 --> 01:42:44,000
that is a ten minute drive from downtown Portland, but is considered frontier. I can't tell

1170
01:42:44,000 --> 01:42:49,700
how many people live there because of the map, but I am aware that there are some popular beaches

1171
01:42:49,700 --> 01:43:01,520
that fall into that frontier category, I'm nervous about 120 minute response time for a time

1172
01:43:01,520 --> 01:43:08,040
sensitive call. And so I'm trying to understand the ramifications if we were going to

1173
01:43:09,520 --> 01:43:16,800
want to engage in a conversation of what it would take to get those response times somewhat

1174
01:43:16,800 --> 01:43:24,520
in line with our neighbors, how would we go about understanding the give and take of that?

1175
01:43:24,840 --> 01:43:31,820
Like if I said, I want no where in Multimak County, it to be less than 60 minutes.

1176
01:43:32,200 --> 01:43:32,860
I'm making that up.

1177
01:43:32,860 --> 01:43:36,140
I don't have any idea what that means or doesn't mean.

1178
01:43:36,700 --> 01:43:43,380
But what would you push back or say about like the reality of what it would take to

1179
01:43:43,380 --> 01:43:43,580
you?

1180
01:43:44,780 --> 01:43:51,100
I think my first pushback is going to be we talk with our neighbors, I talk with the

1181
01:43:51,100 --> 01:43:56,920
NF administrators in our neighboring county every week and a child Miller who is actually

1182
01:43:56,920 --> 01:44:04,660
on our team helping with this is actually the NF administrator in Washington County now,

1183
01:44:04,860 --> 01:44:11,560
so I would say we have a fantastic understanding of the differences. We're comparing apples

1184
01:44:11,560 --> 01:44:17,580
an orange or apple from something else when you're kind of

1185
01:44:17,580 --> 01:44:22,980
to compare Malton on the county to our neighbors, the definition

1186
01:44:22,980 --> 01:44:29,660
that their plan have are not currently compliant with the state

1187
01:44:29,660 --> 01:44:36,580
definition of urban, urban, rural, frontier, and search and

1188
01:44:36,580 --> 01:44:44,000
you. We have collectively worked on a fry county map that actually does map out what that looks like

1189
01:44:44,000 --> 01:44:52,100
with them, but their measurement methodology is also different. Our neighboring counties are measuring

1190
01:44:52,100 --> 01:44:59,240
from the time of dispatch to the arrival of the first EMF provider, and they're not holding the

1191
01:44:59,240 --> 01:44:59,980
ambulance vendor.

1192
01:45:01,640 --> 01:45:19,660
So if a fire department shows up, that stops the clock, not the ambulance, and so it's fundamentally a different metric when we're holding the ambulance provider to be the start and stop of that clock.

1193
01:45:19,660 --> 01:45:33,700
So we can go offline or I'm happy to meet with you and talk about what the impact is of those differences, but you're not comparing the same geography,

1194
01:45:33,700 --> 01:45:41,820
be a clock in the county areas on their map that they classify as open or actually sub-open

1195
01:45:41,820 --> 01:45:47,860
and their urban areas are receiving a 10 minute response to the first EMF provider arriving

1196
01:45:47,860 --> 01:45:54,580
so they basically split it down the middle. Under the feedback we received from the state

1197
01:45:54,580 --> 01:46:00,780
the plan will be required to update the geography at the next send they go through.

1198
01:46:00,780 --> 01:46:09,040
So it would be more comparable for the county to county, but right now you're not comparing the same thing when you're comparing them.

1199
01:46:11,840 --> 01:46:12,260
Yeah.

1200
01:46:12,380 --> 01:46:13,960
And I appreciate that.

1201
01:46:14,080 --> 01:46:15,580
I'm not an expert.

1202
01:46:16,740 --> 01:46:17,380
Regardless.

1203
01:46:19,000 --> 01:46:21,780
I am uncomfortable and cannot support.

1204
01:46:23,560 --> 01:46:30,000
A response time on the South Island of 120 minutes for an emergency call,

1205
01:46:30,000 --> 01:46:36,200
especially since they don't really have the same kind of professional

1206
01:46:36,200 --> 01:46:46,150
fire department that some other locations have and so you know I'm trying

1207
01:46:46,150 --> 01:46:49,210
to be responsible knowing that I don't understand all the

1208
01:46:49,210 --> 01:46:53,910
employment implications of of these response times.

1209
01:46:55,970 --> 01:46:59,470
Why did we choose the slow

1210
01:46:59,470 --> 01:47:07,250
like these were minimums and we seem to have adopted the minimum response time in every category.

1211
01:47:08,430 --> 01:47:20,070
Why did we not look to some degree geographically and say 120 minutes for

1212
01:47:20,070 --> 01:47:30,870
And the first obvious island is too long for it to be geographically not that far from downtown Portland.

1213
01:47:31,450 --> 01:47:40,530
I guess I'm not understanding why we chose the thresholds we chose since my understanding is that they're minimums and they're not.

1214
01:47:40,590 --> 01:47:43,050
We could have a higher standard.

1215
01:47:44,780 --> 01:48:10,560
Yes, I guess I will add that those are the bench marks that we are measuring the actual performance against until the ambulance and the fire unit will be dispatched according to dispatch protocols, dispatched in the close to available appropriate resource to the call they will get there and whatever it humanly takes to respond from where they're at to that location.

1216
01:48:10,560 --> 01:48:19,780
the side of the island that you're looking at is Oregon Department of Fish and Wildlife

1217
01:48:19,780 --> 01:48:27,240
Protected land that doesn't actually have a paved road on it and so even under the

1218
01:48:27,240 --> 01:48:34,280
definition it is probably actually search and rescue but we classify it as rural. I mean

1219
01:48:34,280 --> 01:48:44,160
frontier based on the gravel load that goes out there. I actually went out and drove some

1220
01:48:44,160 --> 01:48:49,720
of these and for the lighthouse at the very end of Sobby Island. It takes almost three hours

1221
01:48:49,720 --> 01:48:56,500
to get to drive out to the end of the gravel road and then you have to get out of the vehicle

1222
01:48:56,500 --> 01:49:03,900
and do the rest of it on foot and the ambulance is actually don't get there. So we'll get a

1223
01:49:03,900 --> 01:49:10,980
detailed map to you because the road alongside the island is actually classified as world, it's

1224
01:49:10,980 --> 01:49:19,520
tank and then the Oregon Department of Brisbane Wildlife Area is frontier, which has a benchmark,

1225
01:49:20,240 --> 01:49:28,600
there were 30 fixed calls in that area over the last seven years. And so if you have one call,

1226
01:49:28,600 --> 01:49:36,460
you got zero percent. If you had two calls in a month, which never happened, you would be at 50%

1227
01:49:36,460 --> 01:49:44,520
and so some of those measurements of time and percentage need to be adjusted based on very,

1228
01:49:44,520 --> 01:49:51,120
very, very low volume. I'm not taking away from the activity or the importance of that emergency

1229
01:49:51,120 --> 01:49:58,740
for the individual there, but the benchmark is very tough to measure on exceptionally low numbers

1230
01:49:58,740 --> 01:49:59,880
in very difficult.

1231
01:50:04,620 --> 01:50:08,040
Thank you. Thank you.

1232
01:50:10,520 --> 01:50:15,820
Thank you. Thank you. Thank you, chair. Thank you, chair. And thank you.

1233
01:50:15,880 --> 01:50:31,320
Who's using the Erin and Dr. Bruno for the work in the presentation. Also, I want to thank you, commissioner Jones sticks in for really leading some of the convenings that happened over the past few weeks to get more feedback and input from our cities.

1234
01:50:31,320 --> 01:50:45,980
And, Erin, when you were responding to a question from Commissioner Remembrance, you talked about that the current eight minute benchmark is not being met for some of the areas in our East County.

1235
01:50:47,300 --> 01:50:51,860
Can you tell us what is actually occurring and what the timeline is?

1236
01:50:51,860 --> 01:51:00,080
Yeah, so there have been several different reports for that geography, and they are all pretty

1237
01:51:00,080 --> 01:51:09,340
consistent, which is the actual performance of somewhere in the 14-15-minute timeframe

1238
01:51:09,340 --> 01:51:18,760
for all responders are analysis in terms of that, so they're getting a suburb in level

1239
01:51:18,760 --> 01:51:25,640
respond today. It doesn't mean that that's what they want. It doesn't mean that that's necessarily

1240
01:51:25,640 --> 01:51:31,500
what the community forget, but they've all used and the finances, whether it's the city,

1241
01:51:31,780 --> 01:51:37,100
finances, or the Indians, and their finances. That's what it's paying for resource-wise.

1242
01:51:37,800 --> 01:51:46,520
And if we continue to apply a benchmark without restoresping it for availability, fire, police,

1243
01:51:46,520 --> 01:51:53,280
ambulance, it doesn't matter what it is, you're setting it up for a failure to meet those benchmarks.

1244
01:51:55,240 --> 01:51:58,600
So, again, there's the several studies out.

1245
01:51:59,260 --> 01:52:05,300
They have different methodology, but right now they would meet the suburb and just barely.

1246
01:52:07,730 --> 01:52:17,850
Thank you. And can you speak to the piece that came up in some of the testimony from our colleagues that

1247
01:52:17,850 --> 01:52:25,010
The consultant recommended 12 minutes, but we adopted 15 or we've drafted 15.

1248
01:52:25,170 --> 01:52:35,930
They did, so I guess the first thing is in the assessment report to put the response time benchmark in perspective.

1249
01:52:37,090 --> 01:52:43,330
There is no clinical benefit for this response time after four minutes.

1250
01:52:43,330 --> 01:52:52,350
So, and nobody can afford for a minute, so like the research out, so that the respond time

1251
01:52:52,350 --> 01:52:54,270
that matters is for a minute.

1252
01:52:54,490 --> 01:53:01,130
And the way you get good care for a minute is public access to the defibrillators, CGR program,

1253
01:53:02,210 --> 01:53:06,810
community members out providing care and help those responders get there.

1254
01:53:06,810 --> 01:53:30,030
The consultants recommendation with 12 minutes based on current industry best practices and that 12 minutes only works if you're going to do it across the entire urbanized area and so if you have to have eight minutes at one area and you make the other area 12 minutes.

1255
01:53:30,030 --> 01:53:33,110
The resources still have to be in the eight-minute area.

1256
01:53:33,330 --> 01:53:52,310
We have a legal obligation and so the difference between the consultant report and what you have is the consultant report was looking around the nation around the world about what a good number would be if we didn't have any legal obligation.

1257
01:53:53,230 --> 01:54:01,230
Once you are a related state requirement, you can't actually do 12 minutes across that whole area,

1258
01:54:01,490 --> 01:54:06,210
because you have to have resources to meet the eight minutes in the urban area.

1259
01:54:06,850 --> 01:54:13,090
It becomes absolutely financially impossible, and that's how the state set up those standards.

1260
01:54:13,090 --> 01:54:22,770
the standards are that the whole county across the state to a system that is financially viable.

1261
01:54:25,840 --> 01:54:32,120
Thank you. This is likely a question, maybe you'll know, but there's been a lot of discussion

1262
01:54:32,120 --> 01:54:41,460
around potentially changing the draft to that eight minute requirement in our East County

1263
01:54:41,460 --> 01:54:48,100
as well and additionally Commissioner Moyer wanting to look at some pieces in her jurisdiction

1264
01:54:48,100 --> 01:54:54,900
or in her district. Do you know what it will cost to do these? Like what is the actual dollar

1265
01:54:54,900 --> 01:54:58,620
amount that it would cost the county to make any of these changes?

1266
01:55:00,000 --> 01:55:22,180
We wouldn't be able to pencil it out until you told me exactly what the chain beer, they will all have a cost, the payment, the fee for service, even when our rates go up, we should all be prepared, the rates are going to go up, ambulance rates are going to go up, healthcare, medical care.

1267
01:55:22,180 --> 01:55:29,820
we're probably looking at somewhere between $6 and $10,000 per ambulance transport rate based

1268
01:55:29,820 --> 01:55:37,960
on our pair of mix in an unsubsidivated system. If you subsidize it and ambulance is going to

1269
01:55:37,960 --> 01:55:45,160
cost you about a million dollars for each additional unit and you're paying for unit to fit

1270
01:55:45,160 --> 01:55:50,920
and be available. So you're not paying for them to actually do the work like in order to get

1271
01:55:50,920 --> 01:55:54,500
that are coverage, you need those ambulances to be sitting

1272
01:55:54,500 --> 01:55:56,620
available waiting for a call.

1273
01:55:57,180 --> 01:55:59,140
And then they'll go on a call and they'll make money.

1274
01:55:59,560 --> 01:56:01,800
But the money they're making is not paying

1275
01:56:01,800 --> 01:56:03,320
for the sitting time.

1276
01:56:03,900 --> 01:56:10,280
And so big system, we run somewhere between 50 and 55.

1277
01:56:10,900 --> 01:56:12,700
Ambulins is a day.

1278
01:56:13,320 --> 01:56:17,060
And so you're talking about increasing the number of those.

1279
01:56:17,060 --> 01:56:18,680
And there's another piece to that.

1280
01:56:18,680 --> 01:56:26,420
And that's like, is it even feasible to find the additional staff to put on the units that you want to pay?

1281
01:56:27,020 --> 01:56:29,040
And that's also going to increase the cost.

1282
01:56:29,520 --> 01:56:34,680
So again, we would really want to see what the proposal you're putting forward is,

1283
01:56:35,320 --> 01:56:38,660
so we can understand what the impact is.

1284
01:56:39,820 --> 01:56:50,660
The three cities in eastern Gresham have about nine responses per day and fixed transports.

1285
01:56:51,300 --> 01:56:54,700
That amount of call volume by itself.

1286
01:56:54,780 --> 01:56:57,260
If you created an island and they ran it by itself,

1287
01:56:57,760 --> 01:57:01,540
does not generate enough revenue to have one ambulance,

1288
01:57:02,060 --> 01:57:06,840
and you certainly need more than one ambulance to cover a simultaneous call in the area.

1289
01:57:06,840 --> 01:57:11,960
So you're talking about multiple ambulances and millions of dollars for each of this.

1290
01:57:14,590 --> 01:57:19,970
Thank you. I'll definitely want that cost analysis of any of these that come up.

1291
01:57:23,110 --> 01:57:30,630
And I would say I just also want to appreciate Councillor Piazza and bringing up the impact

1292
01:57:30,630 --> 01:57:36,810
on the people, the human beings who are at the end and needing the services. And so I don't want

1293
01:57:36,810 --> 01:57:40,990
money to be the reason we don't do something, but I do think we have to make an informed decision.

1294
01:57:42,030 --> 01:57:47,790
So I'll be interested to hear folks proposed or amendments that might come up, but I think

1295
01:57:47,790 --> 01:57:53,030
then we need some further analysis on them so that I don't want to vote yes on an unfunded

1296
01:57:53,030 --> 01:57:59,030
mandate when we don't know what the funding requirements will be. So that'll be important to me.

1297
01:57:59,310 --> 01:58:05,410
I also just want to check in about the, I'm grateful that we were able to hear from the team

1298
01:58:05,410 --> 01:58:12,090
is this morning. My office had some conversations with them as well and has this language that

1299
01:58:12,090 --> 01:58:20,930
has also been shared with you all. Is this language in I know it takes some work but is this

1300
01:58:20,930 --> 01:58:28,410
language in the works is there some receptiveness to the need that has been raised by our front

1301
01:58:30,010 --> 01:58:32,790
We received the language last evening.

1302
01:58:33,090 --> 01:58:42,290
We will need to work with county legal and some other people about what the appropriate tool is that we put it in just like I discussed earlier.

1303
01:58:43,570 --> 01:58:48,610
Our code and our plan are vendor agnostic.

1304
01:58:49,770 --> 01:58:55,230
So they're written whether it's a public or not profit or a private or a hybrid.

1305
01:58:55,230 --> 01:59:00,670
And so we're just going to have to go through and figure out where we would recommend putting it.

1306
01:59:00,910 --> 01:59:10,370
I will say that we believe there is a lot of protection from maintaining the services to the community,

1307
01:59:10,870 --> 01:59:17,170
even in the event of a labor dispute or a strike within the plan already.

1308
01:59:17,170 --> 01:59:26,410
So, Section 7A of the selection process requires the vendor to maintain services throughout

1309
01:59:26,410 --> 01:59:33,330
regardless of what's going on and Section 7E have some immediate cakeover provisions.

1310
01:59:33,550 --> 01:59:39,590
Should we find that the public health or community health is at risk to do anything, including

1311
01:59:39,590 --> 01:59:41,990
a labor dispute or a strike.

1312
01:59:41,990 --> 01:59:45,770
And so we wouldn't want to get in the middle of anything.

1313
01:59:46,050 --> 01:59:48,650
We are neutral when it comes to that.

1314
01:59:48,910 --> 01:59:52,050
But we are not neutral when it comes to delivering service

1315
01:59:52,050 --> 01:59:55,750
to the community, even in the white of that strike.

1316
01:59:56,410 --> 01:59:59,970
The service, I might call it 911, we still need to have some.

1317
02:00:00,760 --> 02:00:22,820
And we need to get the right people there. So I believe that there are sufficient protections in there. And we want to ensure that if it's the team's first representing the future staff in that, that they, they also are comfortable that the county is not going to get interfere with them.

1318
02:00:22,820 --> 02:00:28,240
Yeah, I think they're shared alignment on the values that sounds like maybe there's just a miss.

1319
02:00:29,180 --> 02:00:31,020
Not quite matched up on the language yet.

1320
02:00:31,460 --> 02:00:35,640
So that will be something I'll stay in touch with you all on as this piece moves forward.

1321
02:00:36,540 --> 02:00:38,020
Those are all my questions for today.

1322
02:00:38,580 --> 02:00:40,920
I'll depending on kind of what happens from here.

1323
02:00:41,000 --> 02:00:43,420
I know there's a couple of potential motions on the floor.

1324
02:00:46,510 --> 02:00:47,890
Thank you commissioner.

1325
02:00:48,150 --> 02:00:50,410
I see some folks at their hands up.

1326
02:00:51,090 --> 02:00:53,550
You did and I see here's that commissioner for a minute or so.

1327
02:00:53,610 --> 02:00:56,370
I had I still have questions of people who have their means up to make motions.

1328
02:00:56,550 --> 02:00:58,450
I'd like to ask my questions first.

1329
02:01:00,510 --> 02:01:02,690
I added an additional question not.

1330
02:01:02,810 --> 02:01:04,090
I wasn't ready to move emotions.

1331
02:01:04,690 --> 02:01:07,430
So I can wait till when you make extra question, then I'll ask my question.

1332
02:01:07,950 --> 02:01:11,930
But I wasn't raising my hand to make the motion at this.

1333
02:01:12,130 --> 02:01:13,690
Gotcha. Okay. Great. That's that's very.

1334
02:01:14,010 --> 02:01:15,050
Okay. I'll go to you after.

1335
02:01:15,910 --> 02:01:16,410
I finished my question.

1336
02:01:17,410 --> 02:01:19,810
So Aaron, I appreciate this question.

1337
02:01:19,810 --> 02:01:25,370
And I know that, so I will say like the conversations about our EMS system, I've been having

1338
02:01:25,370 --> 02:01:26,550
them for years now.

1339
02:01:26,670 --> 02:01:30,810
I've had conversations with partners, including the chairs of Washington and Clackham as

1340
02:01:30,810 --> 02:01:36,790
County over even in Clackham as County through different administrations over there.

1341
02:01:37,150 --> 02:01:42,330
And one of the things I know is that both Clackham and Washington County have had significant

1342
02:01:42,330 --> 02:01:47,650
increases in their contract costs, even Washington County when they went to a new contract

1343
02:01:47,650 --> 02:01:49,990
and then very soon after signing that new contract,

1344
02:01:49,990 --> 02:01:54,370
they had an increased in costs that they had to deal with

1345
02:01:54,370 --> 02:01:57,470
just because of what was required in that contract.

1346
02:02:00,750 --> 02:02:04,850
And ultimately, we know that the people who end up paying the cost

1347
02:02:04,850 --> 02:02:07,030
and those contract a lot of time are the end users

1348
02:02:07,030 --> 02:02:09,830
of the system, right, of those individuals.

1349
02:02:10,110 --> 02:02:12,250
So can you talk a little bit about that?

1350
02:02:12,270 --> 02:02:15,690
Like I think the risk of having a cost increase,

1351
02:02:15,690 --> 02:02:21,970
you know, if this were to go to a private entity and you know, who we would be contracting with.

1352
02:02:22,130 --> 02:02:26,730
And then like what could potentially be the impacts to people who are the end users of the system,

1353
02:02:27,430 --> 02:02:30,330
who are receiving the ambulance services, they am at the services.

1354
02:02:31,890 --> 02:02:35,110
Medical debt is a real thing.

1355
02:02:35,930 --> 02:02:42,390
And part of the assessment looked at our payer mix of our community and our county.

1356
02:02:42,390 --> 02:02:50,290
That makes currently, when it was assessed with 77% of them are covered by Medicare and Medicaid,

1357
02:02:50,890 --> 02:02:54,110
which pays below the cost of providing the services.

1358
02:02:54,970 --> 02:02:57,630
11% are uninsured.

1359
02:02:58,310 --> 02:03:04,170
So you're getting penny from those call and the ref is private insurance.

1360
02:03:04,430 --> 02:03:12,350
And so any rate really falls on the private insurers to cover the cost of everything else.

1361
02:03:14,150 --> 02:03:25,990
And we're going to be some changes related to Medicaid, come January, a lot of people are going to lose coverage, and they go into that bucket of uninsured.

1362
02:03:27,010 --> 02:03:37,990
When we have a vendor, they're going to pencil out what they're expecting to collect when they give us what that rate is based on our paramax.

1363
02:03:37,990 --> 02:03:46,830
We can expect that rate's going to be high, because our mix is not covering the cost of providing the services.

1364
02:03:47,430 --> 02:03:54,530
I am not sure that we're not going to get a request for a rate increased from AMR in the last years of the contract.

1365
02:03:54,770 --> 02:04:00,550
The most recent financial report, they lost millions of dollars last this year.

1366
02:04:00,550 --> 02:04:11,970
the previous year, they lost $2.4 million, so the fee per service is not covering the current level of service that we are receiving.

1367
02:04:13,430 --> 02:04:23,130
Even with all of this flexibility in there, if the benchmarks and the pair mix are not good, we won't get a vendor looking at this.

1368
02:04:23,130 --> 02:04:37,130
And that will mean we either need to go back and look at our benchmarks, look at the subsidy or be doing the service ourselves. We should be very prepared based on what this procurement looks like.

1369
02:04:37,950 --> 02:04:49,270
That's what it is. If it's important to put in there for you, it should be so important that you're willing that the county would have to do that ourselves because we might.

1370
02:04:50,090 --> 02:04:53,070
And I hope that answers that question.

1371
02:04:54,050 --> 02:04:54,070
Yeah.

1372
02:04:54,270 --> 02:04:55,630
No, I really appreciate it.

1373
02:04:55,710 --> 02:04:57,270
I mean, I think this is...

1374
02:04:58,330 --> 02:04:59,970
We're trying to balance a lot of different...

1375
02:05:00,000 --> 02:05:09,880
We need desires and realities of the system and providing these really, you know, these critical services to folks. So I, I appreciate everybody's testimony today.

1376
02:05:10,740 --> 02:05:18,800
And I think I'm going conversations and thank you commissioner, John Sticks, and for convening some of the conversations around the stakeholders, especially those in East County.

1377
02:05:19,360 --> 02:05:29,800
And it is, you know, the ambulance service plan is always a really big deal. I appreciate the work that's gotten into it. And I think this board has to consider, you know, ultimately like.

1378
02:05:30,000 --> 02:05:38,200
what we as a county are able to accommodate and what we're not based on on the realities of providing EMS services.

1379
02:05:39,380 --> 02:05:39,600
All right.

1380
02:05:40,140 --> 02:05:42,020
So Commissioner.

1381
02:05:43,040 --> 02:05:43,680
Permitator.

1382
02:05:46,630 --> 02:05:47,950
Thank you.

1383
02:05:48,750 --> 02:05:53,550
So just a follow-up question on just globally.

1384
02:05:54,010 --> 02:06:01,110
I know that early on in some of the conversations there was a inquiry about.

1385
02:06:02,290 --> 02:06:11,450
Just how we structured our ambulance service plans, it's just generally since other counties, some of them have more than one ambulance service plan providing.

1386
02:06:12,890 --> 02:06:17,970
And we, you know, just again, my time so far on the commission.

1387
02:06:17,970 --> 02:06:39,270
There's really struggle just to serve sort of out of East Portland and East County and I'm curious why we haven't looked at or have we, if we have, what are the sort of benefits and the downsides of having

1388
02:06:39,270 --> 02:06:46,750
to end the service plan stage of, I provide service in a more customized way, the better

1389
02:06:46,750 --> 02:06:52,570
meets the needs of East Portland versus them being sort of treated as the carve of the

1390
02:06:52,570 --> 02:07:00,320
long top of like the Portland Urban Plan. I appreciate the question. We received it in feedback.

1391
02:07:01,240 --> 02:07:08,940
Our consultant did look at having more than one ambulance service area. I won't say that it doesn't

1392
02:07:08,940 --> 02:07:19,980
have benefits, the benefits are at ads, capacity, and redundancy and backup because you now have two instead of one.

1393
02:07:21,520 --> 02:07:37,100
The downside of it is each ambulance service area must run independently and have all of the theme administrative overhead and infrastructure.

1394
02:07:37,100 --> 02:07:50,140
And it really drives up the cost of the county system because you're duplicating infrastructure in each one of them and some of that infrastructure.

1395
02:07:52,700 --> 02:08:00,860
for no better reason, so it doesn't just it, but like we have a ambulance for communicable

1396
02:08:00,860 --> 02:08:09,440
to these transports. That's a $40,000 vehicle. It's actually more like a $250,000 vehicle

1397
02:08:09,440 --> 02:08:18,260
if it's new and fancy. Sitting waiting for that call, very after can be on to your now duplicating

1398
02:08:18,260 --> 02:08:26,960
So, and there's not a geographic split in the county that specifically, like, a mountain

1399
02:08:26,960 --> 02:08:33,560
range down the middle or something that splits it in a way that makes sense to have that

1400
02:08:33,560 --> 02:08:34,980
duplication of efforts.

1401
02:08:35,380 --> 02:08:38,080
The consultant reported a draft state in the assessment.

1402
02:08:39,300 --> 02:08:45,900
It recommended one area, again, for efficient and effective provision of services.

1403
02:08:46,560 --> 02:08:53,400
One of the things that happens in the east part of the county is a lot of those transports

1404
02:08:53,400 --> 02:08:59,500
take the ambulance from the east into the core and if those ambulances have to go back out

1405
02:08:59,500 --> 02:09:07,320
east you're adding a dead head drive back to their service area every time instead of a mixing

1406
02:09:07,320 --> 02:09:13,700
and so it also becomes less efficient and it takes more ambulance to make up that

1407
02:09:13,700 --> 02:09:20,740
efficiency, driving the coughs up even further. So what that pretty closely we looked at all

1408
02:09:20,740 --> 02:09:30,120
of the different renditions of it and it makes the system more resilient and significantly

1409
02:09:30,820 --> 02:09:38,980
more expensive without necessarily getting tailored service. Is that what other jurisdictions

1410
02:09:38,980 --> 02:09:55,100
that have more than one, like we done, the benchmarking of the cost of how much there's cost versus when they have multiple providers versus multiple plans versus our one plan.

1411
02:09:55,100 --> 02:09:59,660
a lot of the system that

1412
02:10:00,300 --> 02:10:13,600
We have multiple plans or highly subsidized systems, where the fire district or the city is heavily subsidizing those multiple pieces. They have that infrastructure.

1413
02:10:14,540 --> 02:10:20,020
So, I didn't do the comparison. We can certainly get you some comparable if you're interested.

1414
02:10:21,660 --> 02:10:30,720
Our neighboring counties are primarily one or two ambulance service areas in our local

1415
02:10:31,640 --> 02:10:42,660
of the important metro area. That's further out you go. The lower the volume gets and you start getting more

1416
02:10:42,660 --> 02:10:46,960
automatically than what we have in the Portland natural area, and becomes less comparable.

1417
02:10:52,160 --> 02:10:52,680
Thank you.

1418
02:10:52,720 --> 02:10:57,700
I would be interested in any data that you have that you could share with us.

1419
02:10:58,400 --> 02:11:07,160
So the other question I have relates to sort of just where the sort of the belly button

1420
02:11:07,160 --> 02:11:08,100
of the system is.

1421
02:11:08,100 --> 02:11:24,220
So again, looking at where you live in the county, we have different standards and while I appreciate your statement that it doesn't matter after four minutes,

1422
02:11:26,240 --> 02:11:36,300
I think we heard a lot of testimony, and we've heard a lot of people that like, you know, it's not just the four minutes standard and sort of the agonizing weight when we had really long weight times.

1423
02:11:37,620 --> 02:11:42,040
That to say to somebody, like clinically, it doesn't matter after four minutes,

1424
02:11:46,220 --> 02:11:56,520
I find that hard to square with what I've heard and what I know that may that may be true from like in an an average.

1425
02:11:57,040 --> 02:12:06,600
But I do think saying somebody coming in eight minutes is a lot different than coming in two hours or an hour or twenty twenty five minutes.

1426
02:12:06,600 --> 02:12:13,220
of the length of the time, so I don't want to just let that statement go that, like,

1427
02:12:13,260 --> 02:12:18,540
hey, it doesn't really matter after four minutes because I think we know it does. And

1428
02:12:18,540 --> 02:12:22,520
certainly if it's our loved one, if you're calling an ambulance for,

1429
02:12:24,620 --> 02:12:25,400
we're not going to just hold

1430
02:12:25,400 --> 02:12:30,000
it as standard as a matter after four minutes. If I can, if I can address that commissioner,

1431
02:12:30,340 --> 02:12:37,000
if you'd like me to, I can explain a little bit from the clinical perspective. When we're talking

1432
02:12:37,000 --> 02:12:41,800
about that four-minute benchmark really that is for life-threatening calls, you know, our tax

1433
02:12:41,800 --> 02:12:46,880
stroke seizures, the things that are going to, and when you can have an intervention in

1434
02:12:46,880 --> 02:12:51,120
less than four minutes, those are going to be the ones that have higher survivability rates,

1435
02:12:51,120 --> 02:12:54,940
and there's a lot of been done a lot of research on this. I'm happy to send you some data on this.

1436
02:12:56,580 --> 02:13:01,920
And so when we're kind of discussing the sort of eight-minute versus 12-minute versus 15-minute

1437
02:13:01,920 --> 02:13:07,600
response times, you know, those are kind of past that four minute window where you have that kind

1438
02:13:07,600 --> 02:13:15,300
of opportune intervention opportunity to do that life-saving interventions right away. And as

1439
02:13:15,300 --> 02:13:21,320
I mentioned before, in a lot of times, you know, bystanders, having AEDs nearby, those are going to

1440
02:13:21,320 --> 02:13:27,060
be like really important interventions to put into place within that kind of four minute standard.

1441
02:13:27,060 --> 02:13:51,060
I'll just add that there's clinical impact and there's customer service and perception and so the clinical impact has been well researched and I think we're hearing a lot about the level of service or the feeling of level of service and that doesn't always match that clinical outcome piece.

1442
02:13:52,960 --> 02:13:58,220
I just think we can't say it doesn't matter clinically after four minutes without adding

1443
02:13:58,220 --> 02:14:03,380
what Dr. Bruno just added because that's a very different qualifier than it doesn't matter

1444
02:14:03,380 --> 02:14:12,440
after four minutes I would say say somebody has a brain aneurysm. Every minute counts and maybe

1445
02:14:12,440 --> 02:14:17,640
it's not the first four minutes the counts but the longer it goes the longer the brain bleak goes

1446
02:14:17,640 --> 02:14:41,380
the great of the damage. So I just think we'd be very careful because our communities are listening to that and it's certainly not to hear the county say it doesn't really matter clinically after four minutes without the context that we're talking about a very specific set of responses. I think is not what we what we should be communicating with our community.

1447
02:14:42,280 --> 02:14:48,920
The last thing I want to just raise is, and this is more sort of a commission sort of just process.

1448
02:14:50,560 --> 02:14:59,520
And this may or may not be relevant once we move ahead here, but I'm concerned that on page 27 they have the next steps.

1449
02:15:00,000 --> 02:15:08,640
September 17th is right now. The schedule's second reading and I know Commissioner Moir is not going to be at that meeting.

1450
02:15:08,900 --> 02:15:22,840
And I would hope that we had the flexibility to actually have just given the importance and how it sets the table really for a lot of other decisions that we actually, you know,

1451
02:15:22,900 --> 02:15:28,800
at the meeting have everybody be able to fully participate, especially if it's impacting their district.

1452
02:15:28,800 --> 02:15:29,600
question

1453
02:15:35,940 --> 02:15:38,720
that we push the second reading to October?

1454
02:15:41,220 --> 02:15:43,020
That would be my request.

1455
02:15:45,350 --> 02:15:51,010
I'm just so that we can set the second reading date when we will.

1456
02:15:51,750 --> 02:15:57,250
I don't know what people who's been to be here or not in October if we wanted everyone here.

1457
02:15:57,450 --> 02:16:01,490
So I think we need to check out some dates to see if anybody had any.

1458
02:16:01,830 --> 02:16:03,110
Planned out since this is for October.

1459
02:16:03,770 --> 02:16:07,730
if that's the goal, but I will say I'm curious if,

1460
02:16:07,730 --> 02:16:11,670
I'd be as I know that there's questions about the back or not.

1461
02:16:11,910 --> 02:16:14,910
There's a plan from a backwards calendar of like this needs to,

1462
02:16:14,910 --> 02:16:17,550
you know, when we need to start procurement in March, we would have to,

1463
02:16:17,570 --> 02:16:20,190
you know, go to OHA with a plan that has been approved by the Board,

1464
02:16:20,350 --> 02:16:24,610
there needs to be some back and forth from with OHA on that.

1465
02:16:24,670 --> 02:16:30,330
So I'm just curious, like, does that give us enough time to do the steps

1466
02:16:30,330 --> 02:16:38,070
that we need to take place so that we can go to procurement in March and it may very well

1467
02:16:38,070 --> 02:16:41,570
and that's fine, but I just want to confirm that before we set on a date.

1468
02:16:46,300 --> 02:16:48,900
I don't know if that's a question for me, but I'm going to try.

1469
02:16:48,900 --> 02:16:50,300
That is a question for you, Erin.

1470
02:16:50,300 --> 02:16:52,640
Who ever can help us do the backwards?

1471
02:16:52,960 --> 02:16:59,980
I don't have a Brian Smith or Rob Smith with me today, but what I'm going to say is, we do

1472
02:16:59,980 --> 02:17:03,560
are going to need to be procuring stuff by March.

1473
02:17:03,880 --> 02:17:07,620
That is our notice timeframe with AMR.

1474
02:17:07,720 --> 02:17:10,340
If we need to extend our contract with them

1475
02:17:10,340 --> 02:17:14,480
for some reason, or if we lift that,

1476
02:17:14,580 --> 02:17:16,860
then we won't be doing that, and we will be locked in.

1477
02:17:17,220 --> 02:17:19,000
Again, it's a very large procurement.

1478
02:17:19,120 --> 02:17:23,020
It's going to start having a compression

1479
02:17:23,020 --> 02:17:25,060
on that procurement timeframe.

1480
02:17:25,480 --> 02:17:29,740
And if our partners want to get things paid for,

1481
02:17:29,740 --> 02:17:35,400
that pass through a pathway is going to compress the amount of time they have to do.

1482
02:17:35,780 --> 02:17:40,520
They're far market value studies and get them to us before we can get the procurement out the

1483
02:17:40,520 --> 02:17:46,800
door. So I want to acknowledge it's not just going to impact me or the procurement team.

1484
02:17:46,880 --> 02:17:52,920
It's going to impact the partners ability to get out the stuff for us to do our work.

1485
02:17:53,260 --> 02:17:58,360
It's team compressed a little bit, but for some reason, OHA does improve it the first time around

1486
02:17:58,360 --> 02:18:20,160
in 60 days. We have to come back and do additional reading. It goes back to them. We will, we will be way past a window of getting the procurement done. So a cushion that's starting to go away. I absolutely understand that we have things that you need answered are done, but this cushion is starting to do into a way for a

1487
02:18:23,200 --> 02:18:24,040
madam chair.

1488
02:18:24,040 --> 02:18:31,480
One of the things might be, say if we said date where everybody could be here, that that stills within the window, that works.

1489
02:18:32,180 --> 02:18:40,100
One of the ways that potentially we could get some issue address between.

1490
02:18:40,880 --> 02:18:53,300
Before the second reading is just to have a agenda item on the next couple weeks on our Thursday meeting that if people were going to bring amendments or had questions that we could.

1491
02:18:53,300 --> 02:19:00,720
just address it during that instead of waiting till the moment and then having a whole

1492
02:19:00,720 --> 02:19:05,560
bunch of issues and potentially some new issues coming up. But that way we could move

1493
02:19:05,560 --> 02:19:11,540
some things along that maybe everybody has a agreement upon and so when you get to

1494
02:19:11,540 --> 02:19:17,280
that final second second reading, it doesn't get alongated again because we didn't get

1495
02:19:17,280 --> 02:19:21,860
everything done. Just a suggestion of maybe a way that we could continue to move things

1496
02:19:22,600 --> 02:19:26,900
along. And still meet the window.

1497
02:19:28,640 --> 02:19:42,080
Yeah, I like that idea. I also, but we can't, I mean, we can't guarantee everybody's going to be here for every meeting and every discussion that we have for that because I, you know, so I just want to put that out there. So I am.

1498
02:19:43,260 --> 02:19:51,500
I think that we could probably move the second reading to October 1st and then look

1499
02:19:51,500 --> 02:19:54,520
at some time in September to have a work session.

1500
02:19:54,520 --> 02:19:59,960
Um, either on a Tuesday or Thursday, I think either one is fine, uh, to, to.

1501
02:20:00,000 --> 02:20:11,400
To talk about any amendments that people are going to bring forward, and so we can figure out a date for that, maybe it, it could be the time that we had originally held for the second reading. So we'll take a look at that. All right.

1502
02:20:12,120 --> 02:20:13,580
Okay, so I'm happy to do that.

1503
02:20:17,100 --> 02:20:23,160
And I think that, and that way, hopefully, we'll preclude, hopefully, having a third reading that would be necessary.

1504
02:20:24,980 --> 02:20:30,240
But depending on the amendments that come, we may need to have a third meeting if there are significant amendments that pass.

1505
02:20:31,700 --> 02:20:37,240
So just want to put that out there like that that will be that would require another meeting pass that October date.

1506
02:20:37,540 --> 02:20:46,080
So Erin and Bruno I would be looking for you to like provide some guidance on what our window is

1507
02:20:50,020 --> 02:20:52,440
based on the timelines that we're looking at.

1508
02:20:52,760 --> 02:20:52,780
Okay.

1509
02:20:53,220 --> 02:20:56,160
Are there any so at knowing that we'll have a work session.

1510
02:20:56,380 --> 02:20:59,460
Is there anything anyone wants to bring forward now or are we ready for the vote?

1511
02:21:03,100 --> 02:21:04,960
I don't see any Commissioner of a Jones section.

1512
02:21:06,440 --> 02:21:12,040
Yeah, just for the next meeting on the first, Dr. Bruno, and I'm going to share in a moment

1513
02:21:12,040 --> 02:21:18,520
if you can just bring forward on October 1st, just the numbers as far as if we switch

1514
02:21:18,520 --> 02:21:29,140
the three cities, including city name would, up to the eight minutes response time, Mr.

1515
02:21:29,140 --> 02:21:32,040
and it's just how much that cost would be.

1516
02:21:32,120 --> 02:21:33,520
That would be great.

1517
02:21:33,920 --> 02:21:34,700
And then we'll bring that.

1518
02:21:34,900 --> 02:21:36,300
And then we'll pour it.

1519
02:21:36,300 --> 02:21:38,300
First, I'm going to put you free for it.

1520
02:21:38,740 --> 02:21:38,860
Yeah.

1521
02:21:39,420 --> 02:21:39,920
And I would make.

1522
02:21:40,480 --> 02:21:43,600
It's much information as possible that we keep it ready for when we schedule the work session.

1523
02:21:43,720 --> 02:21:47,140
I think that's going to be the most helpful for our discussions that we have.

1524
02:21:48,080 --> 02:21:49,020
It's just a point of clarity.

1525
02:21:49,340 --> 02:21:52,160
Commissioner Jones six and do you mean for the.

1526
02:21:52,520 --> 02:21:55,580
But not for our October 1st, but for the.

1527
02:21:55,600 --> 02:21:59,120
Whatever the work session that we get scheduled that we have.

1528
02:21:59,120 --> 02:22:05,120
that information. Yes, for the word session, and then we'll, yes, thank you. Okay.

1529
02:22:05,120 --> 02:22:10,280
It may work to make the framework to appreciate that. And then just another point of

1530
02:22:10,280 --> 02:22:19,340
inquiry. So do you, do you envision at the, whatever the word session date that you would be

1531
02:22:19,340 --> 02:22:24,440
bringing an amendment to address the issues that were raised this morning

1532
02:22:27,290 --> 02:22:28,790
during the word session

1533
02:22:28,790 --> 02:22:30,090
or on the first?

1534
02:22:30,090 --> 02:22:32,730
Or just at the work session to put it on the table,

1535
02:22:32,830 --> 02:22:34,190
so we can discuss it.

1536
02:22:34,530 --> 02:22:34,550
Yes.

1537
02:22:35,790 --> 02:22:35,990
Okay.

1538
02:22:37,630 --> 02:22:37,930
Great.

1539
02:22:39,830 --> 02:22:43,160
So I'm going to be okay with,

1540
02:22:43,600 --> 02:22:45,800
I'm not going to move to table it,

1541
02:22:46,060 --> 02:22:50,140
knowing that I think we have a thing to have an agreement

1542
02:22:50,140 --> 02:22:55,220
that we'll have more time between now and October one

1543
02:22:57,600 --> 02:22:59,480
and that we'll have a work session

1544
02:22:59,480 --> 02:23:04,300
the ability to bring issues to the table. There are a number of things that have come up this

1545
02:23:04,300 --> 02:23:14,440
morning that I potentially will have amendments related to, and certainly be interested in

1546
02:23:14,440 --> 02:23:25,080
commissioner John Sticks and in addition, I would be interested in, even though, our language

1547
02:23:25,080 --> 02:23:34,680
with the Ambassador to respond is Vendor Neutral be interested in that labor language that we've taken out,

1548
02:23:35,500 --> 02:23:43,140
and whether even if we're Vendor Neutral that that prevents us from having that language in there.

1549
02:23:43,520 --> 02:23:50,460
So that'll be a follow-up I have. So with that, I will be putting a motion forward to table

1550
02:23:50,460 --> 02:24:04,840
Because I think we have made some adjustments which will allow us to have a consideration of what I think is the issues that were raised by pretty much all of our partners.

1551
02:24:04,840 --> 02:24:14,620
I wouldn't request, though, that in the we receive the talking point that was associated

1552
02:24:14,620 --> 02:24:24,020
with slide 17, that was actually not on the slide, which is the county's response to the

1553
02:24:24,020 --> 02:24:30,440
delayed response time, which is basically you can contract yourself, because I mean, I just

1554
02:24:30,440 --> 02:24:33,680
think that should be part of the record, and we should be talking about that, because if we say,

1555
02:24:33,680 --> 02:24:36,520
we're not going to do it because this is what you think you should do it. We should

1556
02:24:36,520 --> 02:24:40,060
that should bear the count. That should be the count. That's the county's formal response.

1557
02:24:41,300 --> 02:24:46,800
I want to see it in the materials or what we're actually presenting so the community can see what

1558
02:24:46,800 --> 02:24:49,520
the county's actual response is to the feedback.

1559
02:24:57,050 --> 02:24:59,970
I would like to have a comment. I would like to

1560
02:25:00,000 --> 02:25:09,300
We see it in written form following this meeting, but in future presentations, I think that needs to be included because it's obviously a big issue for our partners.

1561
02:25:10,520 --> 02:25:24,260
And we've said we've received the county has said they've received this being back. And here's the response, but they actually didn't provide the alternative response in materials that were presented today, other than a verbal readout.

1562
02:25:24,260 --> 02:25:48,070
I am going to motion that we postpone. I don't know why. We would vote on something that it sounds as if a significant number of commissioners are not supportive of this as written. I don't want to be on the record with the yes vote on this.

1563
02:25:49,230 --> 02:26:02,730
And it would just then require if we do amend it yet another meeting, so I don't see an advantage to proceeding with the vote today.

1564
02:26:04,730 --> 02:26:13,450
I don't want to be on the record support of this, but that's fine. I can vote no, if the majority wishes to do that.

1565
02:26:13,450 --> 02:26:18,590
Commissioner Moyer, are you, is your motion to table it to a time certain,

1566
02:26:18,630 --> 02:26:24,190
although I'm sorry, sorry, Commissioner for my words. So we have a motion to, I'm asking

1567
02:26:24,190 --> 02:26:29,350
her about her motion. I'm wondering if it's a motion. So we should have a second to a second.

1568
02:26:30,050 --> 02:26:36,110
Second, second. But I'd like to know what I'm seconding. But I'll secondary,

1569
02:26:36,110 --> 02:26:46,630
Anyway, are we, are you proposing a indefinite motion to table or to a time certain?

1570
02:26:50,040 --> 02:26:55,480
I would have a hard time not looking at our calendar to definitively say when we should

1571
02:26:55,480 --> 02:26:59,720
vote if we want to do a work session before the vote.

1572
02:27:00,720 --> 02:27:09,680
So I would say a postpone indefinitely with the intent that of course we're bringing this

1573
02:27:09,680 --> 02:27:16,040
we need to move this. But I don't know when we're going to be able to schedule that work session,

1574
02:27:17,500 --> 02:27:22,760
and then to fit to fit this in. I guess my question is I don't know why we would vote on

1575
02:27:22,760 --> 02:27:30,840
something we don't like as is to then amend it and still have to do two more votes. I guess that's my

1576
02:27:30,840 --> 02:27:38,360
two cents I prefer to postpone and fix it. So, so first reading is to move it forward for the second

1577
02:27:38,360 --> 02:27:47,440
and then we have time between now and the second reading to do any work discussions, engagement, and development of any amendments that we have.

1578
02:27:47,500 --> 02:27:53,220
This is really just moving it forward in the process. The process also is not true. That's not what a first reading is.

1579
02:27:53,220 --> 02:28:23,120
First reading is an adoption. All ordinances require two votes. It is silly vote on the substance of, so, so you don't have to vote for it, but I'm saying that this, it is not the final inaction of the ordinance, like it is, it's to move to get it's, it is approved, the, the actual image is that the first reading is approved, like we are approving the first reading of it, but we are not approving the actual ordinance.

1580
02:28:23,220 --> 02:28:25,080
That is not true.

1581
02:28:25,500 --> 02:28:30,180
All ordinance require two affirmative votes of the exact same language.

1582
02:28:30,940 --> 02:28:34,680
Yes, we are voting to approve the language as it is.

1583
02:28:34,900 --> 02:28:36,700
That's on the vote on the substance.

1584
02:28:37,420 --> 02:28:38,580
Yes, but we're not.

1585
02:28:38,840 --> 02:28:39,540
Yes, you're right.

1586
02:28:39,700 --> 02:28:42,300
It does take two votes, but we're not.

1587
02:28:42,740 --> 02:28:43,800
Okay, so you can vote.

1588
02:28:44,000 --> 02:28:45,900
If you want to update, that's fine.

1589
02:28:46,080 --> 02:28:47,360
But we are also.

1590
02:28:47,860 --> 02:28:53,000
We also have time within because it does require two votes to have.

1591
02:28:53,960 --> 02:28:58,120
to have a work session and to have the second reading at a date certain.

1592
02:29:00,360 --> 02:29:03,080
So, but it's all in fact, you're it.

1593
02:29:04,300 --> 02:29:06,020
That's what we're doing it indefinitely.

1594
02:29:06,520 --> 02:29:08,020
That makes me very nervous.

1595
02:29:08,260 --> 02:29:09,880
And that's what I was going to say in my comments.

1596
02:29:10,160 --> 02:29:13,300
It makes me nervous to have an indefinite date for something

1597
02:29:13,300 --> 02:29:16,220
that we know has a very specific timeline that the county

1598
02:29:16,220 --> 02:29:20,200
has to abide by in order to make sure that we have a new

1599
02:29:20,200 --> 02:29:31,080
the service plan that we are contracting for and not being forced to contract to under our old ambulance service plan, which is, which is what happens if we don't have a new one that's approved in the right time one.

1600
02:29:31,480 --> 02:29:34,360
Okay, so I have Commissioner Singleton and then Commissioner for memories.

1601
02:29:37,060 --> 02:29:45,140
So I had some comments before this motion was made so I'll come back to those after this piece.

1602
02:29:46,600 --> 02:29:59,960
I think one we had a time that was already on the agenda for the second reading. I'm unclear on why we're getting so squishy around timelines. Why can't we just use the existing hold that we have.

1603
02:30:00,000 --> 02:30:16,880
Added for first reading and then the second one on October 1, which was just the date that was discussed, or alternatively, if you want to use the first date for more work session, can't we just do this with one vote and an add an emergency clause, if we're worried about timeline.

1604
02:30:19,060 --> 02:30:20,860
Aaron saying no.

1605
02:30:20,860 --> 02:30:27,360
must be approved through non-emergency ordinance procedure per state. I'm not doing that.

1606
02:30:27,560 --> 02:30:29,660
That's why you can't use the emergency class.

1607
02:30:30,320 --> 02:30:32,880
Gotcha. Thank you.

1608
02:30:33,700 --> 02:30:41,080
But I did suggest using the time that we had on the 17 for the second rating for the work session that we could do.

1609
02:30:41,220 --> 02:30:42,440
So I think that would be a good solution.

1610
02:30:44,710 --> 02:31:00,250
I would just like to say that I think Commissioner Moore, very clearly stated that this isn't an indefinite postponement that is really just a matter of looking at the calendar and getting it finding where we can schedule work with a work session and

1611
02:31:00,250 --> 02:31:28,250
us, and after that, a second, well, a first reading and then the second reading. But it's not an indefinite. It's just a matter of we don't need to be spending time in a commission meeting checking everybody's calendar right now. So I don't view this as it might be supportive, but I don't view it as sort of in indefinite. It's just not definite until we have a chance to nail down the.

1612
02:31:29,590 --> 02:31:32,270
the actual dates that we can did the work.

1613
02:31:38,820 --> 02:31:41,340
Okay, so there's three hands-up setup.

1614
02:31:41,840 --> 02:31:43,440
It's focused on this topic.

1615
02:31:44,080 --> 02:31:49,620
Not on this motion, but I still haven't been able to talk about the things I wanted to before this motion was made.

1616
02:31:50,260 --> 02:31:53,300
Okay, so we have a motion on the table and he further discussion on the motion.

1617
02:31:54,460 --> 02:31:55,580
Okay, so we are now.

1618
02:31:55,680 --> 02:31:59,280
Tisha can we have a roll call vote on the motion to postpone indefinitely.

1619
02:32:00,500 --> 02:32:01,380
Commissioner Singleton?

1620
02:32:06,270 --> 02:32:15,950
Chris, you're single to me. Sorry, I'm struggling because I, yeah, the indefinitely threw me there. I think we're postponing the first reading to October 1st. Isn't that correct?

1621
02:32:16,350 --> 02:32:20,570
No, that is not correct. That's that's that's why I said I had a problem with.

1622
02:32:21,970 --> 02:32:25,870
Um, the motion was postponed indefinitely without a date certain.

1623
02:32:30,420 --> 02:32:31,780
Um, yes.

1624
02:32:33,240 --> 02:32:34,640
Commissioner Brim Edwards.

1625
02:32:35,780 --> 02:32:35,920
Yes.

1626
02:32:36,500 --> 02:32:37,960
Mr. Jones sticks in?

1627
02:32:38,860 --> 02:32:39,340
No.

1628
02:32:40,180 --> 02:32:41,100
Commissioner Moyer?

1629
02:32:42,020 --> 02:32:42,200
Yes.

1630
02:32:43,320 --> 02:32:44,120
Chair, vacate the answer.

1631
02:32:44,840 --> 02:32:45,080
No.

1632
02:32:45,720 --> 02:32:49,740
The motion to postpone indefinitely is approved.

1633
02:32:50,960 --> 02:32:53,800
So we're technically done with the discussion on the item.

1634
02:32:53,800 --> 02:32:59,000
Commissioner Singleton, but since you didn't have a chance to talk about your item before,

1635
02:32:59,240 --> 02:33:02,060
I want to give you the space to do that.

1636
02:33:02,880 --> 02:33:03,520
Thank you, Chair.

1637
02:33:03,520 --> 02:33:10,220
And I just wanted to come back to what I had said earlier around the language.

1638
02:33:10,620 --> 02:33:16,000
Commissioner Bramad word you mentioned, as well, wanting to be involved in that conversation.

1639
02:33:16,220 --> 02:33:20,560
So I'm happy to pull you and your team in, we have that language.

1640
02:33:20,720 --> 02:33:23,540
We've already shared it with, from the teamsters.

1641
02:33:23,660 --> 02:33:26,820
We've already shared it with Erin, as well as with the chair staff.

1642
02:33:27,300 --> 02:33:32,320
So I think it's just about finding the right place to put that was what the conversation was earlier.

1643
02:33:32,320 --> 02:33:35,160
so I just wanted to put a fine point on that piece of it.

1644
02:33:39,780 --> 02:33:40,100
Okay, great.

1645
02:33:40,100 --> 02:33:40,840
Thank you, Commissioner.

1646
02:33:41,540 --> 02:33:41,640
Okay.

1647
02:33:41,960 --> 02:33:49,300
So that, so we will come back, we'll find a date for that meeting to have R2 and now is when we

1648
02:33:49,300 --> 02:33:51,640
have time for board comments on non-agenda items.

1649
02:33:51,640 --> 02:33:55,400
So I want to open it up to commissioners to see who have items to discuss today.

1650
02:33:55,400 --> 02:33:59,860
We are five minutes over time, but we didn't, since we were an hour and 15 minutes over

1651
02:33:59,860 --> 02:34:01,940
time last week, we didn't have time for that.

1652
02:34:02,320 --> 02:34:04,300
So we'll, I want to make some time today.

1653
02:34:07,760 --> 02:34:14,300
Commissioner Jones section. Yeah, I just wanted to give a huge shout out to Dr. Armstrong Romero,

1654
02:34:14,420 --> 02:34:18,980
but I believe today's for last day officially, she's going back to Colorado. She was our director

1655
02:34:19,660 --> 02:34:23,400
of the juvenile division. So just want to say thank you. Thank you. Thank you. Thank you.

1656
02:34:23,460 --> 02:34:29,300
Thank you. Remember the first time I heard her speak at lipstick or I think it was a presentation

1657
02:34:29,300 --> 02:34:35,440
for the juvenile division. I was just thoroughly inspired. So just want to say shout out thank you

1658
02:34:36,240 --> 02:34:39,080
for your leadership, Dr. Armstrong,

1659
02:34:39,300 --> 02:34:42,220
Romero, and just for your advocacy for the youth

1660
02:34:42,220 --> 02:34:45,720
and the kids that are under our care and the families.

1661
02:34:46,300 --> 02:34:47,720
And that's the love to you and your family,

1662
02:34:47,740 --> 02:34:49,820
as you transition back to Colorado.

1663
02:34:53,820 --> 02:34:56,080
Thanks so much, Commissioner, for acknowledging that.

1664
02:34:56,400 --> 02:34:59,980
And she will be missed here, but I'm happy for her for her personal-

1665
02:35:05,900 --> 02:35:30,700
Thank you, Chair. I just wanted to, as always, uplift some of the mechanisms that continue to happen in our by this federal regime. Last week, they continued to show us that they do not care about voting rights of all citizens, and it is clear they're trying to set so fear and confusion just before the election.

1666
02:35:30,700 --> 02:35:37,340
I stand by my Commissioner Jones sticks and work to fund grants to organizations to do voter education.

1667
02:35:37,880 --> 02:35:45,420
And I will push back alongside our AG, Rae Field, and Secretary Reed, against Trump, and there continue to tax on voting.

1668
02:35:46,280 --> 02:35:52,900
I think it would be important share if there's particular guidance coming out of our elections division that we start sharing that here.

1669
02:35:53,200 --> 02:36:00,420
If we are like we heard out of Washington that they're encouraging folks to go to drop boxes as opposed to mailing their ballots back.

1670
02:36:00,420 --> 02:36:03,080
I don't know that we're here in that same space,

1671
02:36:03,080 --> 02:36:05,420
but it would be helpful if we can start sharing some guidance

1672
02:36:05,420 --> 02:36:09,900
from our elections division as we near the mid-terms.

1673
02:36:10,660 --> 02:36:12,740
I also want to acknowledge that there continues

1674
02:36:12,740 --> 02:36:14,940
to be an increase in immigration enforcement,

1675
02:36:15,560 --> 02:36:18,180
particularly regarding those who had previously

1676
02:36:18,180 --> 02:36:20,480
held temporary protected status.

1677
02:36:21,300 --> 02:36:23,240
During the last federal budget process,

1678
02:36:23,600 --> 02:36:27,620
those changes were getting less and less information.

1679
02:36:28,280 --> 02:36:37,480
Yes, today reports came out around Leon Youngway, who died hours after being put in the ice custody.

1680
02:36:38,340 --> 02:36:40,180
However, he died almost two weeks ago.

1681
02:36:41,860 --> 02:36:51,160
There's also been additional deaths that have not been shared broadly, or that we don't know about until far after these folks are dying.

1682
02:36:51,160 --> 02:36:56,600
There's been 84 detentions in Oregon and August, as far as recent reports show.

1683
02:36:57,100 --> 02:37:03,200
There's also an increase in detentions of immigrants who do delivery jobs, seeing more

1684
02:37:03,200 --> 02:37:06,900
activity in parking lots and at airports that are traveling domestically.

1685
02:37:07,700 --> 02:37:10,460
I want to continue to urge people to make family plans.

1686
02:37:10,780 --> 02:37:16,400
The Oregon Law Center and Latino network have templates in different languages that people can use.

1687
02:37:17,560 --> 02:37:22,100
Additionally, the Department of Justice has stated that all spades and their departments

1688
02:37:22,100 --> 02:37:25,860
must report undocumented people or they could lose funding.

1689
02:37:26,520 --> 02:37:32,140
This was a rule that came out of the DOJ yesterday, and I want to be very clear that

1690
02:37:32,140 --> 02:37:33,480
I say no to that.

1691
02:37:34,040 --> 02:37:35,120
I will not comply.

1692
02:37:35,240 --> 02:37:39,320
I will advocate for Multnomah County to not comply, and I will stand with others to make

1693
02:37:39,320 --> 02:37:41,480
sure that Oregon does not comply.

1694
02:37:42,480 --> 02:37:49,500
A couple of local issues I want to give a shout out to some of the amazing folks who are working on the Park Rose grocery store.

1695
02:37:50,520 --> 02:37:53,720
They are at 90% of the way to meeting their fundraising goal.

1696
02:37:54,120 --> 02:38:02,220
Donna in the Park Rose community have been doing really incredible work in their neighborhood to bring this sort of life and create a space that is truly centered around the needs of the neighborhood.

1697
02:38:02,220 --> 02:38:06,100
There's still time to donate and to sign on to a letter of recommendation.

1698
02:38:06,500 --> 02:38:11,220
You can find that at www.histarkparkros.com.

1699
02:38:13,160 --> 02:38:17,700
Additionally, I just want to appreciate the City of Portland and Prosper Portland in particular

1700
02:38:17,700 --> 02:38:23,300
for putting out grants for these types of local grocers and small storefronts and supporting

1701
02:38:23,860 --> 02:38:27,040
better foods here in some of our neighborhoods.

1702
02:38:28,180 --> 02:38:33,920
I just also want to highlight, I know Black Business Month has come to a close, but I want

1703
02:38:33,920 --> 02:38:38,040
to thank those who engage with me, the elected that joined me in highlighting businesses,

1704
02:38:38,780 --> 02:38:43,100
and Laquita Elliott and Brie Williams, that won the most clues figured out and visited

1705
02:38:43,100 --> 02:38:47,960
all of these different stores. And for everyone for making Black Business Month a success.

1706
02:38:48,520 --> 02:38:54,260
A couple of stats I want to share. I engage with over 120 Black businesses within Multnomah County.

1707
02:38:54,260 --> 02:38:58,100
I have a list of black owned businesses that I'll share with all departments.

1708
02:38:58,740 --> 02:39:04,420
I want folks to especially know that black owned food and beverage businesses need your help now more than ever.

1709
02:39:04,760 --> 02:39:13,820
And if you don't know where to go, you can visit my county website to get a list along with the location of these different food and beverage businesses.

1710
02:39:14,600 --> 02:39:20,820
And I look forward to working with purchasing and specifically Maggie about how Multnomah County can continue to be a good partner.

1711
02:39:22,040 --> 02:39:27,940
I think that it's been, it's going to be really important for us to look at Commissioner Moyer.

1712
02:39:28,260 --> 02:39:35,520
I know there's some work that we're looking at together, I think, around both local, but also equity in our purchasing power.

1713
02:39:35,740 --> 02:39:46,440
And so I just want to give a shout out to Commissioner Moyer for raising this issue, but also to a procurement who I know you're going to dig in with us and get us to a good place on this.

1714
02:39:47,480 --> 02:39:52,580
excuse me. I also want to just encourage people to apply for the community member

1715
02:39:52,580 --> 02:39:58,980
seed on lipstick. Applications are open until September 26th. And then lastly, I want to

1716
02:39:58,980 --> 02:39:59,980
really encourage people to look at it.

1717
02:40:00,000 --> 02:40:06,240
More and more and consider getting involved in our Multnomah County Charter Commission for the upcoming charter review.

1718
02:40:06,840 --> 02:40:12,020
And I appreciate Dr. I'm sorry, director, press for all of the work that's been happening.

1719
02:40:12,300 --> 02:40:21,380
I see you and your team out of a lot of fairs throughout the community and making sure that we're spreading the word, so that we have a broad range of representation in that next charter review.

1720
02:40:22,180 --> 02:40:22,660
Thank you chair.

1721
02:40:26,800 --> 02:40:28,600
Thank you so much commissioner. Single tank, commissioner.

1722
02:40:32,000 --> 02:40:56,720
just want to take a moment to recognize that on Monday we will be celebrating Labor Day and I want to thank all of the workers at Multnomah County who provide services every day to our community and hope that their Monday is a day of celebration and community with others in the Labor Movement.

1723
02:40:56,720 --> 02:41:02,460
So happy Labor Day and advance to everyone who celebrates.

1724
02:41:05,310 --> 02:41:07,730
Thank you so much Commissioner of Room Edwards.

1725
02:41:08,250 --> 02:41:10,130
Anyone else?

1726
02:41:10,130 --> 02:41:10,850
Okay.

1727
02:41:10,890 --> 02:41:20,690
I just wanted to just note the passing of Gloria Steinem yesterday as a leader and, you know,

1728
02:41:21,210 --> 02:41:23,450
the women's rights movements, the feminist movement.

1729
02:41:23,450 --> 02:41:35,540
I had the opportunity to meet her a couple times in my life, and even as she, you know, even in the further decades of her career and her work, she was still such a force and a power.

1730
02:41:37,070 --> 02:41:55,000
And, you know, I think her central belief that all women are deserving of all rights and privileges and our fully human is something that we need to hear.

1731
02:41:55,000 --> 02:42:03,660
now more than ever. And I think that we are seeing very in addition to all of the work by the federal

1732
02:42:03,660 --> 02:42:11,200
administration to undermine the I work and LGBTQ to IA work and so many else we're seeing

1733
02:42:12,980 --> 02:42:19,280
an intensive effort and a purposeful effort to undermine the rights that women have gained over the

1734
02:42:19,280 --> 02:42:27,160
several decades, and this is something that, you know, as somebody who has worked in so much

1735
02:42:27,160 --> 02:42:36,240
of my career to support women's ability to have economic power and to be able to have the support

1736
02:42:36,240 --> 02:42:43,380
of government and social structures that support and raise up all the work that women do. I will,

1737
02:42:43,860 --> 02:42:58,380
Her passing is a big thing that on top of Dolly part and I feel like we've got a torch that has been passed to all of us in the younger generations that continue to do the really great work that that they have led and they have modeled in their lives.

1738
02:42:59,860 --> 02:43:00,820
Thank you.

1739
02:43:00,960 --> 02:43:01,300
All right.

1740
02:43:01,300 --> 02:43:02,120
Thanks so much.

1741
02:43:02,300 --> 02:43:04,060
That concludes today's business.

1742
02:43:04,860 --> 02:43:10,720
the board will meet in executive session on Tuesday, September 8, 915, our board briefing on

1743
02:43:10,720 --> 02:43:14,540
September 8 has been canceled, and our next public meeting will be the regular meeting scheduled

1744
02:43:14,540 --> 02:43:19,760
for Thursday, September 10th at 930 AM. There being no further business, we are adjourned.