HomeMy WebLinkAbout09/10/1990 Patricia Smith, Chair
Conni Brunni
Kevin McDermott
Staff: John W. Stinson
INTERGOVERNMENTAL RELATIONS COMMITTEE
MEETING
Monday, September 10, 1990
12:00 noon
City Manager's Conference Room
1. Booking Fees (Patterson)
2. Ambulance Ordinance (Drew)
3. Bingo Ordinance (Schuett/Findley)
4. Congestion Management Plan - Kern COG (Heinrichs)
5. CSA 7g (Hawley)
6. Castro Sewers - CDBG
7. Citywide Park District (Andersen/Heinrichs)
8. Fair Housing (Wager)
9. California Clean Air Act (Abbott)
Fred A. Dre~ ~ 1400 "H" Street
Department Director Blke~fleld, C~llfoml~ ~
~ (eo~) Ul-3~
Robert Barne~, M.D.
Medical Director
EMERGENCY MEDICAL SERVICES
guly 20, ~990
Dale Hawley, City Manager
City of Bakersfield
1501Truxtun Avenue
Bakersfield, California 93301
Dear Dale:
The purpose of this letter is to initiate formal discussions
'with you on the proposed Kern County ambulance ordinance and
related issues. Attached for your review is the final version of
the proposed ordinance which will go to the Board of Supervisors
initially on August 28, 1990. This ordinance has been prepared
over the past ten months with input from the entire EMS community.
As you know, I have been keeping John Stinson apprised of the
on-going ordinance development, and particularly the dilemma of
greater Bakersfield rates. As we are all aware, the rate issue
will most likely be the most controversial, especially considering
the position of County Counsel that the county' ordinance will
supercede any city ambulance ordinance currently in the county..
I believe that the wording in the ordinance, except for the issues
mentioned above, will be acceptable to the cities in the County as
it lays out the ability for enacting policies, procedures and
regulations necessary for adequate prehospital public health and
safety services and quality control. My intent, as I have
mentioned previously, is to work closely with you and your staff
to hopefully reach agreement on the ordinance with a goal of having
the CitY Council adopt a resolution in favor of it. You will note
that much of the language in the ordinance is similar to that
contained in your current ordinance.
On the rate issue, I am very close to arriving at a common
rate for the entire metropolitan Bakersfield area, which would
alleviate the inequity of different rates charged to the citizens
in and out of the city limits within the greater Bakersfield
community. This common rate, which is tied to the currently
applied Medi-care rates for the two local providers, would in
July 20, 1990
Page 2
essence keep them "whole" so that the same level of service can be
provided.
I will call you in a few days to schedule a meeting to discuss
these issues in detail.
Respectfully,
~R~D ~. DRE~
Director
Kern County EMS Department
FAD:srs/hawleyord.90
cc: Board of Supervisors
County Administrative Office
County Counsel
John Stinson, CitY of Bakersfield
Art Saalfield, Attorney, City of Bakersfield
July 19, 1990
HEALTH AND SAFETY
QHAPTER 8. 12
The purposes of this chapter are:
A. To enact policies and regulations which are necessary for
the public health and safety regarding ambulance provider services
in the County;
B. To enact policies and regulations for issuing permits and
regulating air and ground ambulance services to ensure competent,
efficient and adequate care is provided within the County;
C. To allow for adequate ambulance services and rates in all
areas of the County, and;
D. To allow for the orderly and lawful operation of the
Emergency Medical Services (EMS) System pursuant to the provisions
of Division 2.5 of the Health and Safety Code commencing with
Section 1797 et seq.
II. INTENT AND APPLICABILITY
A. It is the Board of Supervisor's intent with this
ordinance to undertake the prescribed. functions and
responsibilities of a local government entity concerning ambulance
services as authorized by the State of California pursuant to,
among other authority, Health and Safety Code Sections 1443 and
1797, et seq., Welfare and Institutions Code Section 17000, 'and
Vehicle Code Section 2512.
B. It is the Board of Supervisor's further intent in
enacting this ordinance to exercise to the full extent allowable
under the laws of the State of California its discretion and
authority to regulate emergency and non-emergency ambulance
transportation services throughout all the unincorporated and
incorporated areas of the County of Kern. This ordinance is not
intended for "medi-vans" or "gurney-vans" and their associated non-
emergency services.
III. DEFINITIONS
For the purposes of this Chapter, the following terms shall
have the meanings set out in this section:
K. "Driver" shall mean a qualified person who operates an
~mbulance as specified by Title 13, California Code of Regulations~
and in the appropriate section of this Chapter.
L. "Emergency call" shall mean a request for the dispatch
of an ambulance to respond, transport or provide other assistance
to persons in sudden need of immediate medical attention.
M. "Emergency Medical Technician-1 Ambulance (EMT-1A)" shall
be a person trained and certified to provide basic life support
according to standards as prescribed by Division 2.5 of the
California Health and Safety Code.
N. "Emergency Medical Technician-1 Non-Ambulance (EMT-1NA)"
shall be a person trained and certified to provide basic life
support according to standards as prescribed by Division 2.5 of the
California Health and Safety Code.
O. "Emergency Medical Technician-Paramedic (EMT-P)" shall
be a person specially trained and certified to provide advanced
life support according to standards prescribed by Division 2.5 of
the California Health and Safety Code.
P. "Emergency service" shall mean any service provided
during the dispatch, response and prehospital phase of an emergency
call.
Q. "EMS Aircraft" shall mean any aircraft certified as an
air carrier by the Federal Aviation Administration and designated
in compliance with Title 22 and Department specifications designed
and equipped to provide air transport of sick, injured,
convalescent, infirm or otherwise incapacitated persons.
R. "Level of Service" is the type of emergency-medical
services that may be provided by a permit holder, and will be
specified as basic life support or EMT-1A provider, and/or advanced
life support or EMT-P provider service rendered by personnel
certified as specified in Division 2.5 of the California Health and
Safety Code and Title 22, Division 9 of the California Code of
Regulations.
S. "Non-emergency call" shall mean any request for the
dispatch of an ambulance other than to.respond to an emergency
call.
T. "Non-exclusive Operating Area or Service Area" shall be
specific geographic emergency ambulance transport service areas of
the County adopted by the Board.
U. "Operation within the County" means the receiving,
picking up, or embarking within the County of a sick or injured
person for transportation or conveyance tooany point within or
3
emergency", as defined in the California Emergency Services Act,
Chapter 7, Division I, Title 2 of the Government Code, as amended.
G. The terms and conditions of the permit may at any time
during the life of the permit be amended or modified by the Board
after notice to permittee and after completion of public hearing
and after exhausting administrative procedures, appeals and other
reasonable due process.
V. PERMIT TERM
The length of the initial permit will be ten (10) years. On
the fifth anniversary of the initial permit, and every fifth year
thereafter, permittee may request an additional five (5) year
renewal to the permit, thereby resulting in a permit that will not
be less than five (5) years, nor more than ten (10) years at any
one time. Permit extensions (renewals) shall be granted in
accordance with the appropriate application procedures section of
this Chapter.
VI. ApPLICATIQN FQR A PERMIT OR RENEWAL
A. Procedure and Information Required. Prerequisite to the
issuance of a permit or renewal of a permit, an applicant shall
file with the Department an application, in writing.
B. The application will include information, depending on
whether it is the initial application ("I") or renewal application
("R") as per Department application guidelines.
C. Department will establish and furnish application
requirements guidelines to applicant.
D. Ambulance providers in County with service areas as
designated by Department effective on the date of this Chapter,
will be issued permits for defined operating areas upon receipt and
approval of completed initial application information and payment
of established fees.
VII. ~ONTENT OF PERMIT~
A. The permit shall specify the date of issuance, date of
renewal, and date of expiration, the operating area for which the
permit is authoriZed, the permittee name, business and fictitious
business name, if applicable.
B. The permit shall contain language on the type and level
of ambulance services to be provided, within the defined operating
area and the specified term.
C. The permit shall have the signature of the Director~
5
3. The Board may in addition order the denial of a
permit if the applicant or any partner or officer
thereof:
a. Was previously the holder of a permit issued
under this Chapter and which permit had'been
revoked or not reissued;
b. In committing any act, which, if committed by
any permittee, would be grounds for the
suspension or revocation of a permit issued
pursuant to this Chapter;
c. Has committed any act involving dishonesty,
fraud, or deceit whereby another is injured or
where the applicant has benefited;
d. Has acted in the capacity of a permittee or
firm under this Chapter without having been
issued a permit therefor;
e. Has entered a plea of guilty to, or been found
guilty of, or been convicted of a felony, and
the time for appeal has elapsed or the judgment
of conviction has been affirmed on appeal,
irrespective of an order granting probation
following such conviction suspending the
imposition of sentence, or of a subsequent
order under the provisions of Section 1203.4
of the Penal Code allowing such person to
withdraw his plea of guilty and to enter a plea
of not guilty, or setting aside the plea or
verdict of guilty, or dismissing the accusation
of information..
XI. SERVICE AND PERFORMANCE REOUIREMENTS
A. Each permittee service shall provide ambulance service,
of the level specified in the permit, twenty-four (24) hours per
day, excluding acts of God or labor disputes. If for any reason
an operator ceases to provide the prescribed level or levels of
ambulance service on a twenty-four (24) hour per day basis,
permittee shall immediately terminate any advertisement of
emergency services which have been discontinued and immediately
notify the Department.
B. The Board shall, by resolution, adopt, the emergency
medical transport service areas for the purposes of issuing.permits
for the ambulance services therein. The service areas shall be for
emergency 9-1-1 calls and shall be shown on a map of the County
(hereafter referred to as "Map") kept on file with the Department
7
1. Med-Alert where one or more Permittee
¢
ambulances were deployed out of the
operating area by an authorized agency;
2. Back-up ambulance response to a call where
Permittee already has deployed one
ambulance to the same call location;
3. Two or more emergency calls occurring
within one (1) hour in the Permittee
operating area for designated single
available ambulance Permittee areas
authorized by Department;
4. Two or more emergency calls occurring
within two (2) hours in Permittees
operating area for designated single
available ambulance Permittees areas
authorized by Department.
5. Certain weather or roadway conditions
which prohibit safe Permittee ambulance
operation to meet response time standards,
as authorized by Department, or;
6. A local declared emergency, local declared
emergency in another county or state of
emergency, where Permittee units and
certified staff are sent for authorized
mutual aid response.
7. Other appropriate exceptions, such as
unavoidable vehicle breakdown, as
determined by Department.
b. The Department shall identify such Permittee
calls for authorized response time exceptions
and re-evaluate Permittee response time
standard performance for the evaluation period.
E. Department will develop policies, procedures and
regulations for EMS aircraft and ground ambulance utilization
within the Kern County area and publish said rules and regulations.
F. Each ambulance provider service operating in the County
shall establish and maintain radio contact with a base of operation
where technically feasible.
G. Each ambulance provider service will be responsible to
maintain communications means to receive emergency 9-1-1 dispatched
9
be developed by department and approved separately by Board. The
ACI formula and process included for such adjustments shall be
adopted by the Board by separate resolution. Variances necessary,
such as those caused by an act of God, labor dispute disruptions,
or other unusual conditions, a permittee, or permittees, may apply
to the Department for an adjustment in addition to any annual
adjustment. Such additional adjustments recommended by the
Department shall be computed with application of the ACI formula.
D. A rate change when approved by the Board, as applicable,
shall be effective on the date of approval.
E. Proposed special rates or proposed changes in such rates
shall be submitted to the Department.
F. Ambulance service rates and rate categories shall be
those listed by said separate resolution. The intent is to have
fewer, consolidated and uniform rate categories, so as to provide
for simplicity in ambulance billing for the citizens of the County
of Kern. Current rate categories and charges shall be posted at
each permittee's place of business.
XIII. CONTINUATION OF CALL
An ambulance based and properly licensed outside the County
shall be authorized to pick up a patient outside the county and
transport a patient to or through the County.
XIV. INTERFAGILITY TRANSFERS
A. Each ambulance provider participating in the transfer of
patients with an ambulance will conform to all laws, rules, and
regulations set forth in the California Health and Safety Code and
Department policies applicable to interfacility transfer of
patients, and pursuant to any formal transfer agreements between
transferring and receiving facilities involved.
B. Transport performed by an ALS or BLS ambulance for the
patient in transport, shall be provided with appropriate medical
care, including personnel and equipment, according to the
California Health and Safety Code and applicable Department
policies. Transport personnel shall not be authorized, and shall
not provide service beyond their scope of practice.
XV. DEPARTMENT RESPONSIBILITIES
A. The Department shall make rules and regulations deemed
necessary and reasonable, subject to the approval of the Board, and
after consultation and public meetings with EMS system
participants.
B. The Department shall review operational records,
11
XIX. PROBATION. SUSPENSION. REVOCATION OF PERMITS
A. If the Department finds, after 'conducting an
investigation, that the complaint, allegation or infraction is
valid, the Department shall be empowered to place a permittee on
probation or suspend or revoke the permit, depending on the
seriousness of the infraction. These actions are intended to be
progressive in nature unless there is a violation so serious as to
preclude the normal progressive nature of these kinds of actions
or if there is definite threat to public health and safety
determined by the Director and/or Medical Director.
B. The investigation by Department will include:
notification to all parties in a timely manner; review of all
pertinent documents and information to include personal interviews;
conferences with parties to allow for administration cross
examination; initial findings by Department communicated to
permittee allowing ten (10) days for rebuttal by provider and final
meeting with Director to resolve and conclude the issue; and
finally, if not resolved.or concluded, a decision made by Director
to place the permittee on probation; suspend an aspect of the
permit and/or revoke the permit.
C. For purposes of this section the following definitions
apply:
1. Probation shall mean a period'of time not to exceed
one hundred twenty (120) days wherein the permittee
has one or more minor violations of this Chapter.
These will normally not include violations directly
related to health and safety issues.
2. Suspension shall mean an action taken which affects
(or suspends) an aspect of the provider's permit.
Suspension would normally be for continuous and
repeated minor violations or a major violation which
can be corrected in a short period of time, but no
more than thirty (30) days. It is intended that a
suspension would be.for one or more specific items
of the provider's business, and that a suspension
notice would identify the specific area(s) of
concern and set a time not to exceed thirty (30)
days when the issue of suspension must be resolved.
A suspension puts the provider on notice that the
permit is at risk. If not resolved, the permit may
be revoked.
3. Revocation shall mean the loss of the permit. This
action will. be taken only when there is conclusive
13
insurance, or personnel to serve and such lack or failure
constitutes a substantial decrease in ability to provide the level
of ambulance service noted in permit, then the Department shall
place the permittee on probation.
XX. APPEAL PROCEDURE
A. If the Director places a permittee on probation, suspends
or revokes a permit,.the permittee shall be given written no~ice
specifying the action taken within five (5) days of the action.
Such notification shall be by certified mail, return receipt
requested.
B. The Department shall notify all public safety agencies,
County Communications Division, and all hospitals in the respective
permit area if the permit is under suspension or has been revoked.
C. The permittee shall then have the right to request a
hearing before the Board as the final step in the administrative
appeal process. A request for a hearing shall be made in writing
to the Clerk of the Board of Supervisors within twenty (20) days
following the receipt of action taken by Director. The decision
'of the Board upon any such appeal shall be final.
XXI. INSURANCE
A. As a condition of receiving a permit, applicant agrees
to protect County, its governing board, agents, officers and
employees against any and all claim(s), expenses, liabilities,
attorney's fees, damages, costs, losses, actions, damages or
destruction of property or injury or death in any way arising out
of or incident to ambulance business or applicant's performance
under this Chapter, shall secure and maintain at its sole expense
in full force during the entire term of this Chapter and covering
any such claim or liability, automobile public liability and
general liability insurance in an amount not less than one million
dollars ($1,000,000) per occurrence or claim and not less than one
million dollars ($1,000,000) aggregate.
B. Ambulance business or applicant shall also maintain at
its sole expense during the terms of this Chapter, professional
liability (malpractice) insurance in amounts of not less than one
million dollars ($1,000,000) per claim or occurrence and one
million dollars ($1,000,000) aggregate. Said insurance shall
contain coverage expressly recognizing the indemnification
obligations assumed by ambulance business or applicant in
accordance, with this Chapter, but shall not be construed to limit
in any manner the amount of ambulance business or applicant's
liability thereunder. Providing further, where permitted by the
carrier, said insurance shall expressly name County, its governing
board, agents, officers and employees as additional insureds. Said
insurance shall not be subject to cancellation or reduction without
15
CONTENTS
I. Purpose
II. Intent and Applicability
III. Definitions
IV. Permits
V. Permit Term
VI. Application for a Permit or Renewal
VII. Content of Permit
VIII. Transferability of Permit
IX. Permit Fees
X. Application Process
XI. Service and Performance Requirements
XII. Ambulance Rates
XIII. Continuation of Call
XIV. Interfacility Transfers
XV. Department Responsibilities
XVI. Temporary Variance
XVII. Violation of this Chapter
XVIII. Complaint and Investigation Procedures
XIX. Probation, Suspension, Revocation of Permits
XX. Appeal Procedure
XXI. Insurance
XXII. Emergency and Disaster Operations
XXIII. Records
XXIV. Take Effect
POINT PAPER
Summary of State Law and County Counsel Opinion
· Each county that develops an EMS program shall designate
a local EMS agency (EMS Department). The local EMS
agency shall plan, implement, and evaluate an emergency
medical services system (1797.2'04). The local EMS agency
shall establish policies and procedures to assure medical
control of the EMS system, and may require EMS
transportation services requirements including dispatch,
patient destination policies, patient care guidelines and
quality assurance guidelines (1797.220).
· "Counties" are given specific authority to adopt
ordinances, while no similar authority is conferred upon
incorporated cities within counties.
· It is the County's responsibility to de'al with such
issues as medical control, ambulance districting,
efficient use of EMS resources, and to generally ensure
that safe and efficient emergency services are available
to ~11 citizens of the county.
· All cities, including chartered cities, are subject to
and controlled by the provisions of general law, except
where there is a conflict with the city's charter. No
such conflict occurs in the City of Bakersfield Charter.
· Emergency medical services should not be handled pi'ece
meal. The system requires uniformity of standards and
practices among county and cities to ensure the best
possible patient care service to all residents.
· Two valid positions could be argued if the issue is
litigated:
u County could argue that the State has preempted the
area of emergency ambulance regulation and' has
designated counties to administer the system on a
local level, on its behalf.
As an alternative, if both the city and county are
authorized to regulate, then general law (the
county) has prominence over the city ordinance
because it affects matters which are not
exclusively of municipal concern.
FAD:srs/pointppr.90 ~
COMPARISON OF CITY AND COUNTY ORDINANCES
- City of Bakersfield County of Kern
1. I)efmitions 1. Definitions (similar)
2. Application and Receipt of License 2. Application and Receipt of Permit Is Similar - However County ordinance
includes level and type of service and defined service areas
3. Transferability - Not Transferable 3. Transferability - Not Transferable unless gaining provider approved by
Board of Supervisors
4. Ambulance Service Charges - Set from time to time by 4. Ambulance Service Charges - Authority to regulate rates by separate
separate resolution resolution; Annual review
5. Insurance 5. Insurance (similar)
6. violation - City Manager Reviews and Decides; Limited 6. Violation - EMS Department Reviews and Derides; Detailed Definition;
Definition; Lose License Probation; Suspension; Revocation of Permit (more demfl but similar)
7. Appeal - To City Council 7. Appeal - To Board of Supervisors
8. New Provider - Public Convenience and Necessity, Reviewed 8. New Provider - Need and Necessity/Health and Safety; Reviewed by EMS
and Decided by City Manager Department, Decision by Board of Supervisors (sLmilnr in process)
9. Intent - City of Bakersfield 9. Intent - County of Kern, Including IncorpOrated Areas
10. Service and Performance Requirements - None 10. Service and Performance Requirements - Time Response Standards;
(Although by agreement with ambulance companies and Communications, Personnel and Equipment Standards; Quality Assurance
EMS Department, they are performing under time response standards) System to Cheek; More Substantive in County Ordinance
11. Interfaeility Transfers - No Provisions 11. Interfaeility Transfers - Requires Same Medical Protocols and Other
Requirements
12. Temporary Licenses - No Provisions 12. Temporary Variance and Permits - Allows for Limited Authority of EMS
Department to Grant Under Certain Circumstances
13. Emeagency/Disnster Operations - No Provisions 13. Emergency/Disaster Operations - Provisions for Operating During Disasters
CITY VERSUS NON-CITY RATES
Typical Response: BLS/ALS, Night, Emergency, Oxygen, Five Miles
A. Oakhaven A. Acacia
BLS response BLS response
City $283 City $283
Non-City $618 Non-City $580
<$335> <$297>
B. E1 Dorado B. Pico
ALS/with ALS/with
City $463 City $463
Non-City $683 Non-City $680
<8220> <$217>
C. Andrea C. Baker
ALS/without ALS/without
City 8313 City $313
Non-City $618 Non-City $680
<$305> <$367>
CHART ONE
CITY RATE COMPARED TO MEDICARE RATE
BLS ALS W/O ALS WITH NIGHT EMERGENCY OXYGEN MILES
City Rate 145 175 325 35 30 23 7.50
Medicare Allowed 194 n/a 400 46 n/a 38
*Ambulance companies automatically lose revenue because City rate is below Medicare.
BLS ALS W/O ALS
City Rate $253 City Rate $283 City Rate $433
Medicare Allowable 8328 Medicare Allowable $328 Medicare Allowable $534
Company Loses <$75> ,Company Loses <$45> company Loses <$101>
Approximately 33% of business is Medicare.
CHART TWO
KERN COUNTY AMBULANCE SERVICE RATES
~ ~-573.50
?
t-504.50 ~
~,-429 %
*~,-425
5( -- *%%-350
B-325
*~e-25o
B-l?5
B-145
BLS ALS ALS
W/O WITH'
PROCEDURES PROCEDURES
B-BAKERSFIELD CITY AREA *-SHAFTER - OTHER CITY
%-KERN COUNTY AREA WITH ORDINANCE
RR/Ip/AMBRAT2 9/90 -1-
RATE COMPARISON
CITY MEDICARE COMMON HALL GEA
CATEGORY RATE RATE .RATE RATE RATE
Basic Life Support 145 194 199 381 342
Advanced Life Support
w/o procedures 175 n/a 405 381 442
AdVanced Life Support
w/procedures 325 400 405 446 442
Night 35 46 51 66 65
Emergency Response 30 n/a 35 66 65
Oxygen 23 38 43 35 38
Mileage Charge 7.50 10 I0 14 14
Waiting Charge 14 n/a 19 20 18
Common rate for entire greater Bakersfield area. Both companies would charge the same.
CHART THREE
9~T_E..EOMPARISON _ SHOWING .RECENT SURVEY AND~PREVIOUS._SURVEYS_ COHPARED._TO.. A .COMMON_RATE .........
COUNTY RATES ( 1990 } CATEGORIES
............. ALS ...... BLS ......... EMERG .......... NIGHT ..... OXYGEN ...... MILES WAIT
MONTEREY (90) 360 189 49 41 37 8
...SAN JOAQUIN (90) 420 236 46 50 33 9
FI~I~-SNO_~ 90 l .......................... ~.95 ....... _~t75 ................ _48 ................ 48 ........ 9 ........
MERCED (90) 450 241
INYO {90) 500 250 50 50 .40 14
_____ALAMEDA_(.90} ............ 403 .......... 250 ................................ ~5 ............ 40 ........ 9 .........
CONTRA COSTA (90} 429 251 45 40 9
SAN LUIS ~BISPO i9'0~ "-421 255 55 44 9
SAN__HATEO~_(90). · ........... 393 ....... ~05 ...... ~___5.9 .............. 49 ............... 49 ............... 9 ..........
SANTA CLARA (90) 362 219 38 38 8
0~-ER~L 'AVERAGEi 41'3.30 .... 22~'~1d ......... 5-~-~'0~ .......... ~6-~ .... ~i~ ......... 9:33 ......
RATES 40 COUNTIES (,88) 341.23 188.46 47.74 41.59 35.67 8.11 24.57
RATES--~-~-UN~IES' i 8'8'~ ......... 36~ ~'i ........ 21'~.-~ ....... ~%~-~ ........ ~'~i~ ........ 3~ ~'~'~ ................~ 38 20.39
EHSA ANALYSIS (DEC 89) 408.77 ._ 229..77 47.33_ .39..44 31.06 8.09 21.85
AVG KERN RATES {90! 456.83 346.74 66.33 68.94 46.76 13.92 25.02
.......... BAKERSFIELD RATE: 325 145 . 30 35 23 7.5 14
MEDI-CARE RATE: 400 194 NA 46 38 10 NA
· *~COMNON RATE*~e: 405 199 35 51 ,13 10 19
USING THE COMMON RATE COMPARED TO CURRENT CITY RATE - NET RESULT BILLED TO CITY PATIENT
PRIVATE PAY INSURANCE
BLS ALS W/O ALS WITH
Current City Rate $283 Current City Rate $313 Current City Rate $463
Insurance Pays $228 Insurance Pays $250 Insurance Pays $370
Patient Billed $57 Patient Billed $63 Patient Billed 893
Common Rate Total $378 Common Rate Total $584 Common Rate Total $584
Insurance Pays 8303 Insurance Pays $467 Insurance Pays $467
Patient Billed $75 Patient Billed $117 Patient Billed $117
Difference Billed Difference Billed Difference Billed
To Patient $18 To Patient $54 To Patient $24
CHART FOUR
USING THE COMMON P~TE COMPAI~D TO CUPd~NT CITY I~ATE - NET RESULT BILLED TO CITY PATIENT
MEDICARE INSURANCE
BLS ALS W/O ALS WITH
Current City Rate $253 Current City Rate $283 Current City Rate $433
InsUrance Pays 8202 Insurance Pays $226 Insurance Pays $346
Patient Billed $51 Patient Billed 857 Patient Billed $87
Common Rate Total $328 Common Rate Total $328 Common Rate Total $534
Insurance Pays $262 Insurance Pays $262 Insurance Pays 8427
.Patient Billed $66 Patient Billed $66 Patient Billed $107
Difference Billed Difference Billed Difference Billed
To Patient $15 To Patient $9 To Patient $20
*Medi-Cal patients - No increase/no change/no charge to patients
CHART FIVE
MAJOR POINTS
While City rates are low (relative to other rates) and this is perceived as a positive
thing for City residents; the ambulance companies report, and EMS analysis concludes
that without non-City residents being charged a higher rate and the County subsidy, the
ambulance companies could not provide ALS service at the current City rate level.
2. City rates are lower than Medicare; and generally Medicare is recognized as a very low
government "subsidy" type program and pays lower than what it would take to keep an
ambulance company in business (especially ALS service).
3. The County provides over $1,000,000 subsidy to County ambulance companies for non-paying
County and City residents throughout the County. Of that amount, the subsidy to local
ambulance companies for B~kgrsfield city residents was $318,000 last fiscal year.
4. Maintaining patient care at the current level is the overriding public health and safety
concern. It is simply unfair and inequitable that different segments of the community
are charged'different amounts for the same patient care service. The methods to resolve
the issue of uneven charges are: lower the non-City rate; raise the current City rate;
or a combination of both.' In order to maintain the current level of service in the
community the only workable solution is to have a common rate, which necessarily results
in raising the City rate.
~KERN COUNCIL OF GOVERNMENTS
INFORMATION AND DATA MANAGEMENT DIVISION
-~AUGUST 28, 1990
1990 % OF COUNTY EQUAL 30% VOTING 40% VOTING
JURISDICTION POPULATION POPULATION VOTING LIMIT~ LIMIT~
ARVIN 9,209 1.713%' 7.692% 3% 2%
BAKERSFIELD 171,601 31.914% 7.692% 30% 32%
CALIF. CITY 5,765 1.072% 7.692% 2% 1%
DELANO 22,616 4.206% 7.692% 8% 6%
MARICOPA 1,160 0.216% 7,692% 1% 1%
MCFARLAND 6,569 1.222% 7.692% 2% 2%
RIDGECREST 28,161 5.237% 7 692% !1% 7%
SHAFTER 8,397 1.562% 7 692% 3% 2%
TAFT 5,848 1,088% 7 692% 2% 2%
TEHACHAPI 5,656 1.052% 7 692% 2% 1%
WASCO 12,327 2.293% 7 692% 5% 3%
KERN COUNTY 260,388 48.427% 15 385% 30% 40%
TOTAL 537,697 100.00% 100.00% 100% 100%
SOURCE: UNITED STATES CENSUS, PRELIMINARY 1990 CENSUS ESTIMATES-AUGUST, 1990
~ ROUNDED TO NEAREST 1% WITH NO MEMBER AGENCY RECEIVING LESS THAN 1%.
DEPARTMENT OF 'PUBLIC WORKS
.": .-.'.. a:.~+ !501 T:uxmn A~enu¢ gakersfieiO. Caiiforn,a 93301 (305} 326-3721
E.W $CHULZ. gircctor
August 21, 1990
Mr. Bill Mungary, Director
COMiM~4ITY DEVELOPMENT PROGRAM DEPART?r~NT
2700 "M" Street, Suite 250
Bakersfield, CA 93201
~ RE: CASTRO LANE SE~ER IMPROVEMENTs PROJECT
I Dear Mr. >iungary:
-~ Your~u-7' ~' 26, 1990 letter to Mr. Dale Hawley, Bakersfield City Manager, has been
y referred ~o ~his office for response.
The City would prefer that properties would annex ~o receive urban services.
However, in those instances vhere seuer service is requested and annexation is
13 hoc, the following apply:
.~ Fhe City uould desire to have signatory approval of imorovemenc olans,
secondary to County approval. The City s, hail be furnished ac least two_
sets of plans and specifications prior to construction and one set or
.~ "record" drawings with ail construction corrections indicated ~hereon.
.~ Each service connection should be extended to within one foot, bu~ short of
.,z the right-of-way line unless a connection and service agreemenc has been
.,k executed for the property involved.
Prior to connection each property owner connecting to the sewer shall
execute a standard agreement wi~h ~he City providing for payment of sewer
service annual fees and hookup fees.
~ Additionally, the agreement shall stipulate the property owner will no~
~ oppose future annexation efforts.
[ Lastly, we must have assurance that no permit will be issued by Kern County
~ Public Works for work within the right-of-way for sewer hookup unless the
appiican~ can produce an executed agreement as s~iPuia~ed above.
L
Current hookup charge is $900 per residential unit. The current sewer service
~) charge is $~_1- per year billed bimonthly
Please le~ us kno~ if we can be of additional assistance.
Very truly yours,
=. W. SCHULZ
Public Works Director
FRED L. KLOEPPER
=.ss~s~an~ Public Works Director
FLK/mro xc: Mary K. Shell, KC Suoervisor
· L-i990.~6 District No. S
COMMUNITY DEVELOPMENT PROGRAM DEPARTMENT
C.D. Program Del~artment BILL MUNGARY
Pul}IIc Services Building Oll~ctor
'2700 M Street. Suite 250
Bal~emfield. California 93301
Tetel~One (805) 861-2041
ENGIN EF IN( DEPA TM N
Mr. Dale Hawley, City Manager
City of Bakersfield
1501 Tmxmn Avenue
Bakersfield, California 93301
RE: Castro Lane Sewer Improvements Project
In 1985, the Kem County Board of Supervisors authorized the allocation of $55,000 of County
Community Development Block Grant funds for design of sewer improvements within the County's Castro
Lane Community Development Program Area (map attached). The Castro Lane Program Area is an
unincorporated island within the Bakersfield Metropolitan Area.
The sewer improvements project was created in response to a public hearing request of residents. Creation
of a sanitation district with its own treaunent plant was found unfeasible. It is now expected to al/ow
residents of the Castro Lane Area to abandon their existing septic tanks and tie into the City of Bakersfield
Sewer System as had been the policy in the past. We are currently formulating recommendations
regarding whether to implement or cancel the project.
As you may recall, one of thc reasom r~hese funds have not been spent relates to the City of Bakersficld's
policy regarding permimng residents within County islands to tie into the Metropolitan Sewer System.
Please advise us, in wridng, of the City Of Bakersfield's policy regarding permit~ng residents within
County islands to tie into the Metropolitan Sewer System without annexation. If connection is permitted
without annexation, we would also like a list of specific actions which must be taken, and all associated
costs. With that information in hand, we expect to be able to make a recommendation to the Board of
Supervisors.
We appreciate your assistance in this matter and request a response by August 15, 1990. If you have any
questions, please call me.
Bill Mungary
Director
BM:ayb
xc: Mary K. Shell, Supervisor.
SPECIAL REPORT
CITY-WIDE RECREATION & PARKS SPECIAL DISTRICT
SEPTEMBER 5, 1990
Prepared By
City Manager's Office
and
Community Services Department
· METROPOL!T~ BAKERSFIELD
PARK, .RECREATION AND CULTURAL SERVICES ANALYSIS
STATEMENT OF THE PROBLEM:
Over the past twenty years the City of Bakersfield has
experienced a dramatic shift in the manner in which it provides
parks and recreation and cultural services to its citizens. This
is due to a number of dynamic changes which have occurred as a
result of political and demographic shifts.
Financing
Traditionally, the City provided parks, recreation and cultural
services through revenues generated through the City's General
Fund and financed capital improvements through general tax
dollars, grants, or via general obligation debt (Civic
auditorium).
Historically these services competed, as they do now, with the
other services funded through general tax funds (i.e. police,
fire, public works and general government).
Competition with these departments for increasingly scarce
resources over the yea~s, combined with one of the most
significant changes in the financing of local government services
in California history (Proposition 13) resulted in a major shift
in the manner in which the City provides parks, recreation and
cultural services.
Maintenance districts
The fiscal impact of Proposition 13~ on the availability of
general tax funds combined with the theory that new development
should be required to pay its way, resulted in a City Council
policy that park and landscape maintenance funds must be provided
by maintenance districts for any new parks constructed in the
city. This policy was based on the theory that existing funds
dedicated for park maintenance should not be used to pay for
maintenance of new parks. Since there were no new tax revenues
available to fund park maintenance, maintenance districts
appeared to be the best alternative. The acquisition of land and
construction of parks in the newly, developed areas has generally
been provided by the developer or through the use of grants using
state or federal funds.
While this seemed to work initially, over time this solution
created its own set of problems. First, was the problem that the
districts were often created by developers and some property
owners were not aware that they were part of a maintenance
district and therefore paying an assessment in'addition to their
property taxes. When they eventually became aware of this fact
(usually through their annual assessment hearing notice sent by
the City) some residents were very upset. An additional, and
Page I
more significant, problem was a result of PropoSition 13 itself.
Proposition 13 provides that property be assessed at the time of
sale or transfer. Because many of the areas included in
maintenance districts are newly developed, they generally have a
higher property tax base than older areas of the City not
included in maintenance districts. This resulted in the
situation where people in maintenance districts were not only
paying assessments for their neighborhood parks, but depending on
when they purchased their home they could be paying for a greater
share of property taxes to provide for pre-Proposition 13 parks
maintenance compared to other taxpayers in the City.
North Bakersfield Recreation and Park District
The tremendous growth experienced within the City during the 80's
also resulted in an additional condition impacting the delivery
of parks, recreation and cultural services. As a result of the
Laborde annexation, it was determined that parks and recreation
services should continue to be provided by the North Bakersfield
Recreation and Park District (NBRPD) for areas annexed by the
City within their district boundaries. This provided for a
continuation of the high level of parks and recreation provided
by NBRPD but also provides less property tax for other City
services.
Annexation of Unincorporated areas
Annexation of unincorporated areas which are not within existing
recreation and park districts create certain inequities. These
areas generally are deficient in park resources compared to City
and NBRPD standards and are not receiving recreation programs
from the County. Annexation of these areas adds further
inequities to the City park and recreation delivery system.
Park ordinance
The City is also grappling with the problem of providing for land
acquisition and park development in newly developed areas by
implementing a park ordinance to provide a consistent standard
for park development and possibly providing a mechanism to
address some of the more pressing park deficiencies.
Kern River Parkway
In addition to neighborhood park and recreation needs the City
has recently begun development of the Kern River Parkway. This
popular project includes further development of the bike path and
provides access points for its users. Much of the construction
of parkway facilities has been done through grants and donated
labor. The City must deal with the problem of how to fund
ongoing maintenance for the parkway. Currently, the single park
maintainer is funded by Agricultural Water Fund Revenues.
Page 2
Recreation programs
The recreation programs' offered by the City have also been
impacted by the lack of available general fund revenues.
Competing annually with public safety and public works
departments the recreation division has had to rely more and more
on user fees to support its programs. While there has been some
expansion of programs with the lease of the Bakersfield Sports
Complex (used for adult softball) the uneven distribution of
facilities (community cent'ers, swimming pools, tennis courts,
etc.) has made the equitable delivery of recreation programs very
difficult. In addition the City has had difficulty in developing
recreation programs and facility use agreements with several
school districts within City limits.
Cultural arts facilities
There is also demand for increased metropolitan cultural arts
facilities as the city continues to grow. With the remodel of
the Convention Center a greater emphasis will be placed on
convention and visitor business which potentially could displace
existing concert events such as the Bakersfield Symphony. There
have been inquiries about the possibility of renovating the Fox
Theatre for stage and musical performances and the possibility of
building a performing arts center. In addition, significant
improvements are planned for the Bakersfield Art Gallery. There
is currently no source of City revenues to support the expansion
of these facilities.
All of the circumstances noted above have resulted in a park and
recreation delivery system which provides unequal recreation
service levels and park standards while financing them through
methods only loosely related to the benefits received. A summary
of the inequities that exist within the City Park and Recreation
delivery system is listed below:
Park Maintenance Districts pay additional assessment and
some districts have higher park acreage standards.
City areas served by North Bakersfield Recreation and Park
District potentially will receive a higher standard of
service once they are developed.
Annexed unincorporated areas are generally park deficient.
Unequal facility and park standards exist within the city.
Unequal delivery of recreation programs due to uneven
distribution of facilities and lack of use agreements with
schools.
Page 3
APPROACHES TO SOLVING INEQUITIES:
How can we improve the Parks, Recreation and Cultural
Services delivery system to make it more equitable? ~
- Develop a long range park and recreation plan which
addresses the inequities in the delivery system and
provides strategies to mitigate them.
- Bring all parks within the metropolitan area up to a
reasonable standard. (Still might be less than NBRPD).
- Include unincorporated areas within the 2010 Plan to
insure future consistency of facilities and programs.
How can a system of fundinq be provided which is fair,
equitable and provides adequate resources to develop and
maintain facilities and recreation pro~rams?
- Create a special district which encompasses all of
metropolitan Bakersfield within the 2010 Plan excluding
those areas within the North Bakersfield Recreation and
Park District and the Bear Mountai~ Recreation and
Park District. (Additional tax - requires 2/3 vote)
Possibly utilize a CSA to address park or recreation
service deficiencies.
- Create a County Service Area (CSA) which encompasses
all of metropolitan Bakersfield within the 2010 Plan
exclusing those areas within the North Bakersfield
Recreation and Park District and the Bear Mountain
Recreation Mountain Recreation and Park District.
(Additional assessment - requires initial protest
hearing and annual assessment hearing)
- Create an Assessment District which encompasses all of
incorporated Bakersfield within the 2010 Plan
excluding those area within the North Bakersfield
Recreation and Park District. (Additional assessment-
requires requires initial protest hearing and annual
assessment hearing)
- Encourage annexation of City and unincorporated areas
in the metropolitan area by North Bakersfield
Recreation and Park District. Fund additional services
in the annexed areas with a County Service Area.
(Additional assessment - requires initial protest
hearing and annual assessment hearing)
- Initiate a tax override to provide additional
Page 4
recreation programs and eqUalize park maintenance costs
by replacing maintenance district assessments 'with
additional tax monies. (Additional Tax - requires 2/3
vote)
- Initiate legislation to consolidate all recreation and
park services within the 2010 Plan into a s i n g 1 e
district with its own tax base. (Additional t a x -
requires 2/3 vote)
How can we provide for-special metropolitan-wide facilities
such as the Kern River 'Parkway and possible major cultural
facilities?
- Initiate a General Obligation Bond issue to provide
additional facilities and pay for maintenance costs
with the inclusion of these facilities within a special
district or assessment district as mentioned above.
(Bond election requires 2/3 vote. Additional
assessment - requires initial protest hearing and
annual assessment hearing)
How can we reduce deficiencies in the Park,Recreation and
Cultural Services delivery system?
- Upgrade park areas that are less then the City
standard.
- Provide additional community centers and park
facilities to upgrade the quality and quantity of
recreational programs.
- Provide swimming pools in deficient areas throughout
the City.
- Fund and develop a cultural arts complex including'an
outdoor/indoor concert hall, art gallery, museum space
and a downtown parkway.
- Construct an indoor sports arena and an exhibit hall
for special events.
- Expand channels of communication between the City and
local school districts to secure facility use
agreements.
Page 5
Survey
Recreation and Parks Districts:
Before recommendations could be made, it was necessary to
talk with concerned agencies and individuals~ First,
meetings were held with Jim Spengler, Director of North
Bakersfield Recreation and Park District (NBRPD) and Allen
Abe, Director of Bear Mountain Recreation and Park District
(BMRPD). Both were· asked for their thoughts on the
advantages of special districts and whether they would be
interested in annexing/ with other agencies to form a
metropolitan district. Following is a consensus of their
responses.
- Both felt special districts had greater flexibility, a
supportive community, a single purpose or direction,
did not share funds with other departments and board
members were usually very supportive.
- NBRPD feels their current staff and program levels were
highly efficient and should not be jeopardized and that
their board would most likely be opposed to annexation.
If they did annex, additional funds would have to be
'~guaranteed to raise the City's level of service to
match theirs.
- BMRPD would also want funding guarantees. They did not
want to lose sight of why they were formed and are
afraid they would be treated as new kids on the block.
- Both felt their communities would feel threatened and
would not endorse annexation.
- NBRPD feels its board would support a Joint Powers
Agreement with the City and County to develop and
expand the Kern River Parkway.
Both districts have reservations in forming a single
metropolitan district. However, if the City chose to
pursue a single district they would certainly consider
the project and cooperate wherever and whenever
possible. If the City formed a special district
without them they would cooperate to insure levels of-
service.
Page 6
City and County:
The second series of interviews involved Frank Fabbri and
Jim Ledoux, City Parks and Recreation Superintendents, Bob
Addison County Parks Director, Joel Heinrichs, Director of
Policy Analysis and Intergovernmental Relations.
The major concern of the City Parks Superintendent involves
maintenance districts. Established to offset costs due to
new development of parks after Proposition 13, residents
within these districts are in effect paying double taxes-
once for the City's overall parks maintenance program and
again for special maintenance districts. A city-wide
district would resolve the double taxation issue by
combining both programs into one and spreading the costs, in
an equitable manner, to all residents within the district.
If a special district is found to provide local services,
existing City staff should be protected against loss of
employment. Positions should be made available within the
new district to absorb these employees and to insure similar
salaries, benefits, etc. In addition certain pieces of City
equipment may be transferred to the new district. If so,
who gets what? Since several departments use the .same
equipment, distribution would need to be carefuil~
monitored. Also, how will the staff and equipment be housed
or maintained? Facilities need to be acquired to handle
those needs.
Finally, the Kern River Parkway: This project needs to be
completed and the major concern is funding. Finances should
be set aside to insure its completion. Perhaps a separate
special district just for the Parkway would be established.
The City Recreation Superintendent felt a special district
could address the need for additional facilities.
Currently the City only has one community center. A city of
this size should have at least four. These facilities would
go a long way towards increasing its overall program.
Because of the expense and lack of availability of City
schools, securing meeting space has been difficult. Special
districts have greater flexibility and a single purpose
which helps guarantee its success.
Bob Addison, County Parks and Recreation Director, indicated
the need for a special district or County Service Area. He
feels the Counties should not duplicate services provided by
Cities or districts. He recommended the City take over
several small parks scattered throughout the area. The
County should only handle large regional parks and if at all
possible the Kern River Parkway should be expanded to
include Hart Park and Buena Vista Lake.
Page 7
Joel Heinrichs, Director of Policy Analysis, recommended the
· formation of a County-wide service Area (CSA) to facilitate
funding efforts. The CSA would create zones of benefit
(cities, special districts, etc.) who would make assessment
requests to upgrade' parks, facilities, or programs.
Subzones (in the City's case: park maintenance district,
Kern River Parkway, Recreation, etc.) can be created within
each zone if necessary and can be used to upgrade existing
facilities or for acquisition and development of new sites.
The hearing would be noticed via the newspaper and not by
individual notices. The formation of a CSA would be an
additional assessment requiring an initial protest hearing
with annual assessment hearings. Finally, the County could
create an area just for the City with a second area for the
outlying sections. These requests are filed with the County
each year during the budget process. Funds would add to
existing budgets giving cities much needed revenues to
complete or expand existing facilities or programs. In
addition, the CSA would make funds available for the County
to assist those areas who absorbed County parks into their
program.
It should be noted that on August 21, 1990, a meeting was
held to discuss the possible formation of a CSA. Attending
were administratars of City and County Park and Recreation
departments and directors of Park and Recreation Districts.
Joel Heinrichs gave his presentation and then asked for
comments and ideas. Several special districts indicated
they can do what the County is suggesting within their own
systems. Cities were concerned with the distribution of
funds and the level of monies available each year. In other
words what would happen if programs were initiated and then
funds were reduced the following year? CoUld create some
severe problems.
Overall, the feelings of both cities and special districts
were neutral. Special districts felt they could do what the
County is proposing on their own and recommended the County
form a CSA to upgrade their existing park sites and
financially assist those agencies absorbing County parks.
Resource Individuals:
The third and final meetings were held with individuals who
are familiar with special districts. Steve Ruggenberg from
GET, Darrel Hildebrand of KERNCOG (former employee of NBRPD)
and Bill Turpin of LAFCO were interviewed and their
comments are as follows:
- Special districts are very efficient and would lend
itself nicely to solving the City's parks and
recreation problems.
- There should be no elected officials serving on the
Page 8
boards. Should 'be five or seven members with City and
County appointing two or three each then those members
elect the fifth or seventh.
- If district is formed, it should include parks,
recreation and the Kern River Parkway project.
- Consolidation of services is good. You don't want to
duplicate services and facilities.
- Districts have a Single purpose and are not caught up
in municipal government.
- If NBRPD is part of the district their level of
services should be protected from being reduced or
eliminated.
- A new district would probably be in a better position
to work with schools.
- Transition would probably take five to ten years.
- District should have its own financing system intact.
It should not rely on allocations from NBRPD, City,
County, .etc. It should be based on a percentage of
taxes rather than a fixed dollar amount.
- JPA agreement for Kern River parkway is better than a
County Service Area because it eliminates power
struggles with a properly structured board.
- City-wide district can resolve the double taxation
problem with regards to parks by transferring the
taxing authority to the district from the City.
- By combining forces, acquisition of grants and funds
can be better facilitated.
Recommendations ....
As indicated earlier in this report, there are several plans that
address the complex issue of providing adequate recreation and
park services to the citizens of Bakersfield. The most cost-
efficient and effective method is to create a Special Recreation
and Park District which encompasses all of metropolitan
Bakersfield within the 2010 Plan, excluding those areas within
the North Bakersfield and Bear Mountain Recreation and Park
Districts. The new District would require an additional tax and
must be approved by a two-thirds (2/3) majority of registered
voters. By taking it to the voters, the issue of their
willingness to pay and support expanded services would be
addressed. The new tax rate would provide funds to expand,
complete and maintain the Kern River Parkway. It will also limit
the need'for park maintenance districts as costs for these areas
Page 9
can be spread out in an equitable manner throughout the District.
In addition, contributions or transfers of funds equal to current
tax supported levels of park services would be provided by the
City and County to supplement costs for park maintenance
services.
To administer the District a five (5) cr-~~~ member board
should be established. This would give both the City and County
representation by allowing each to appoint board members based on
an agreed upon formula. Finally, to upgrade park facilities and
establish recreation programs in deficient areas, a County
Service Area (CSA) would be formed. Formation of the CSA would
require an initial protest hearing with annual assessment hearing
during the budget CYcle. CSA funds would be used for special
projects and would not be relied upon to handle yearly
operational costs.
IMPLESIKNTATION
Implementation of the above would include the following steps:
1. Develop a long range Parks and Recreation plan within
the 2010 boundaries.
2. Form a Park and Recreation District for operations and
maintenance which will include the Kern River Parkway.
3. Develop a financing plan for park and recreation
deficient areas through the use of grants, assessment
districts, county semvice areas, tax overrides, 0w
General Obligation Bonds.
Page 10