Board of Directors - Regular Meeting

Good afternoon. Welcome, everyone, to our Board of Directors agenda meeting setting the agenda for September the 1st. We're first going to start with a brief presentation from Mr. Greg Thompson, who is our CEO of the MEMS organization.

Thank you, Mayor. Before he starts. Yes, we need to honor Mr. Thompson. He has just published his first book about all of the things he's learned for being a paramedic and probably about helping rebuild the first boardroom over there. But it just got published. And I think we need to be pleased with that.

Thank you so much for that acknowledgment, Mr. Carpenter and Mr. Thompson. We look forward to reading your book.

Thank you, sir. Thank you, sir. Council, I appreciate you letting me be here tonight. Just to remind you that MEMS is a public utility of the city of Little Rock. I find that when I tell people that many times that a lot of folks don't know that about us, assume we're private and so forth, but non-tax supported partnership between Little Rock and North Rock in the county that happened back in 1984. What I'm here tonight to talk to you about is something that's going on around the country and its effect on us here in Little Rock. This has been going on for a while. It's been happening in the country since prior to 2000. We started seeing it happen here during COVID, and over the last several months, it's gotten worse. Specifically, I'll tell you what I'm talking about here. So this is what normally should happen is that an ambulance will go to the hospital and within 30 minutes is the standard that will drop off our patient and then we will go back in service. That's the typical way that it's worked and it's worked that way for years. Every once in a while you'll have it go a little bit longer like you'll have a trauma. There's lots of things that could cause it to take a little bit more time but on the average that's the way the system works. But started happening in 2000 and again it's gotten much worse and I'll show you some statistics over the last few months is that whenever we get to the hospital and the patient stays on the stretcher and then the crew stays with the patient and the ambulance stays at the hospital. So what happens then is that the truck is physically at the hospital, but operationally it's out of service. It's not available for anything else. And so when those trucks get tied up like that, it can be a real significant problem for us. And so why is it that a patient can't be taken off at a hospital? What are the reasons that would keep you from being able to carry a patient in and drop them off? And here's a few things. One is boarding. So boarding is patients that have a bed upstairs, but for whatever reason, that bed upstairs is not ready. And so the patient is boarded or cared for in the ED. We'll show up here in a minute, but I'll tell you here that many times an ED may have, and I'm speaking generally because not about one specific hospital, but I'm thinking of a hospital when I say that may have 40 ED beds, but on a given morning there may only be 10 of those available to regular ED patients. The rest of those are taken up with patients boarded that are waiting to go upstairs, so there's not the available bed. Regional demand is a big thing. With all of the, in the news we're seeing all of the The rural hospitals shutting down and so and seeing some of the major hospitals here in the city buying up those hospitals. There's specialties that are not out in the state anymore that are now here. So what's happening is Little Rock is receiving those patients from all around the state. So that's that's become a big issue. Surge is a big thing. You'll have those days for whatever reason, big surge happens. And then, of course, staffing. high acuity patients that take a lot of time. Behavioral health. This is a big one for behavioral patients. We've changed this. I'll show you this in a second. But behavioral patients take a lot of time because they have to be monitored. Somebody has to look at them. They have to be evaluated. Then there has to be a bed found for them somewhere in the state. And so that's a big one. Hospital flows and the bedroom availability. So those are some of the reasons that we can't get those patients off the cot. And so, again, they're not available to us. So wall time, whenever we talk about that or hospital delays, two buzzwords that you hear us talking about is wall time is the time from minute 31 forward. So we give the hospital 30 minutes to get the patient off the cot. At minute 31, we go one minute. Minute 32, that's two minutes. That's important when you look at the amount of time that we're talking about. And this is the slide we had our board meeting today at MEMS. We show this every month and this was our latest. And so if you look in July, the orange line is the lost unit hours and the blue line is the number of calls. So what happened in the month of July, a record was broken at 853 hours accumulated one minute at a time of extra time that that ambulances were stuck at hospitals and not able to get out. And so I'll show you some of that here in a second. So 850 hours and that affected what 2481 actual calls that we that we couldn't get out. So 850 hours is equivalent of 71 12-hour shifts. So the problem is it doesn't happen. If you saw it that way, you're like, it's just 12-hour shifts. I mean, 71, a couple of them a month. But that's not the way it happens. When it happens, it happens with a surge. So I'll give you this quick example here. So things are maybe going through the day, but let's say at 2 o'clock, three trucks transport to hospitals, and they're going to get stuck. And so at 2.30, the next people show up with three more trucks, but those first ones haven't got out. That's six trucks tied up. And then at 3 o'clock, if we're still holding for an hour like it's been happening to us lately, up to four hours in some cases, then now you've got nine trucks out. So nine trucks out of a system in Little Rock that typically runs Little Rock, North Rock, 25 trucks. So now you pull nine out that you don't have access to anymore. And then you'll see at 3, so you kind of see what begins to happen. So whenever it does hit, it seems to hit hard all at once. And then for us to try to find our way out. This is a quick picture of that. There's not picking on this particular hospital. I could do it at other hospitals. I just happen to have a picture of that. But you can see how far they're lined up if you recognize that hospital all the way back to the street. And then if you look right in there, there's even some on that picture on the right to the left that you can't see that. So you can imagine what's happening there. Some of those crews in the very back have not even gotten out yet. They're having to wait to be able to get out of the truck. So that's that's what we're talking about here. So what are we doing? And that's where I'll get close to finishing up with you now. is there's a few things that I was going to come speak to you guys a month or so ago, and we were not able to make it all work. But we're working not only with the hospitals, but we're trying to find a way to better manage health care, especially post-COVID. One of the things we've done is hired a social worker. I don't know of another U.S. service that's done that. We're working hard with the city of Little Rock, specifically the police department, and then also with the social workers and all the hospitals. And so we're working on what we call our high acuity patients, hug patients. And remember you got a letter from the Public Safety Commission who set through that presentation that if you remember that sent a letter saying they really supported what we were doing there. So we're trying to deal with those folks who have no other option but go to the E. D. Of connecting them to services that take them out of that mix. So that frees up a bit. We're doing direct admit for behavioral patients, something new we're doing, the first in the state to do that. So we've got the hospitals, and it was a big thing to work on. But the behavioral hospitals have agreed to let us vet the patient. And then we're using an app that we communicate with the behavioral hospitals. They'll accept the patient. We go directly to the behavioral hospitals. That saves the ED and the second transfer that would go with that. This is one that kind of bother some people, but it's the right thing to do, and that is to direct a triage protocol. Meaning, if we pick up somebody who's low acuity, and there's not a bed for them, but they're low acuity, and they meet the protocol, we will carry them from the cot to the waiting room of the ED, and that's where they will wait. And so, you can imagine we pick them nameless, but go to the waiting room, but if it's low acuity, that's where they're going now. Extra cots. This has been a big A-bomb, and this is something we just started. And that is because the numbers have gotten so bad. If we need that ambulance back and it's reasonable, meaning that patient doesn't have to have treatment right now, that we will tell the hospital after 30 minutes, here's a patient report. We will lower the cot to a safe height and we leave. We'll get an extra cot, put the truck back in service and keep going because we cannot leave those trucks tied up like that. We've added additional staffing to manage transfers. We have our own school. You may not know that MIMS is the satellite campus of Pulaski Tech. So we have an EMT school and paramedic school that are constantly going to keep that. We work with the hospitals as partners. I'm not here to talk bad about hospitals. We work really hard to stay in the system to try to find solutions. I'm not laying all the blame. I'm saying that we have a health care issue that's going to take all of us to work through this. We've expanded the basic life support. It's a statewide issue. And I'll tell you one other thing, and I think my last slide is imagine a rural ambulance service coming into the city and they have two trucks in their county and they get a truck into Little Rock and they lose it for an additional two hours. Can you imagine what's happening in that community back that only has those two trucks? And so I'm on the board for the Ambulance Association. I will tell you, it is a huge issue for the rural providers right now. So the bottom line is that when an ambulance at the hospital is just not available. And so I wanted to make you aware of what's happening with that. But also I was very, I thought a lot about this part here. How do I leave you? I don't want to leave you with a sense of, oh, no, I want to tell you this is something we've been living with. since COVID, but it has progressively gotten worse. We've pulled some things out, again, lowering the cotton, those kind of things that we are pushing hard right now that we've drawn a line in the sand that can't get any worse from here. We've got to stop this. But I wanted you to be aware of it, so if you hear about it, you'll know what's going on and know how we're addressing it. Mayor, that concludes my report. Any questions?

Thank you, Mr. Thompson. Director Hines. Greg, thanks for doing this and just everybody on the board. I serve as the liaison to MEMS and this has been a growing issue. We talked a lot about it this morning at the MEMS meeting, why the big spike up, trying to kind of find root causes and And as we talk about Greg Stubblefield, who's the president of Baptist Little Rock campus, sits on the board. We have always have a rolling member on the MEMS board that's from one of the local hospitals. It was previously St. Vincent's. Now it's Baptist. I'm sure the next go round will probably be UAMS. So we do work hand in hand with them and they're having some of the same struggles we are with staffing. Our issue is not as much staffing, but getting our trucks out on the unit. And sometimes we get to the ER and they can't open any more ER beds because they don't have enough ER docs or nurses working at some of the hospitals. So it's kind of something we're seeing a lot more utilization. And you can see from the graphs a big spike up from I think it was March to, I mean, April to May or May to June when we started seeing it. And there's not been a real good reason why, but we're working to do it. And we want to make sure that we let everybody know we do partner really well with our hospital partners. And we're going to have to, as they say, teamwork makes the dream work. So we're going to work with them and continue to do it. But Greg's had to kind of pull out the I guess he'd call it the A-bomb or the nuclear option with lowering the cots and leaving because we don't want to put somebody else's life in jeopardy because we can't respond to a call. Thank you.

Director Miller. Thank you, Director Hines.

Thanks, Mayor. Thanks, Rick, for the presentation. I had no idea this was going on. Let me ask you, Make sure I understand you have twenty five total trucks.

Now I have sixty two. But at a particular time of day, I'm glad you asked that question. A great question, by the way, during the peak of the day. So ambulance is kind of they ramp up as the day goes on. And historically, when we have the most call volume, And they go out at night when we have a lower call volume. So right now in Little Rock, North Rock, 25 is the is the the peak average right now. But sixty two total trucks that we can put in into the system and we have added trucks to this, but it's just one more truck that gets stuck.

OK, so make sure I understand that any one time, depending on the time of day, you'd have twenty five trucks at your peak. Is that what

In Little Rock, North Rock. So a peak for us, system-wide, because MEMS has a public utility. We do cover the bedroom communities in Little Rock. So system-wide, 36 trucks is probably the peak of the day.

Okay. Thank you. And are you going around to North Little Rock City Council, the Pulaski County Quorum Court? some other entities sharing the same presentation with them.

So you're my first stop. Little Rock Ambulance Authority, you're my first stop. I do attend the mayor staff meeting in North Little Rock every month. And so I have presented to that group, but I've not presented to the Pulaski County yet.

Is that you plan on making this presentation?

I'd love to. And with the thing about part of it for us, like having Lance here. So whenever I present to our board, Our board has representatives from those boards. So that's how I'm here. Lance has a connection to this board, brings me here. Then we have a connection to the Pulaski County Board. So those are the ones that open the doors for me to go in. So as soon as they open those doors, I'm there.

Okay. Because everybody needs to know about this. The communities that you serve, from Sherwood to Maumelle to all, I'm not trying to create more work for you.

That's all right, though.

But I think the more people understand what this issue is, maybe the more minds can think maybe what we can do about it. So thank you for that. Appreciate it. Thank you, Director.

Thank you, Director Miller. Thank you, Mr. Thompson. We appreciate you.

No problem. Thank you.

All right. Members of the board, as we look through the agenda, any questions?

Mayor, there's one issue as I go into the agenda that we need to bring to the board's attention. There was a decision last week not to allow a particular development, and it was a short-term rental. It was zoning issue 10303. The applicant was not here. It turns out that There was some miscommunication on both parts. And the applicant had let it be known that they could not be here this week and was asking for another date. I'm going to ask one of the members of the board to announce that they would do a motion to expunge the vote on Tuesday. If you do that, it will take a simple majority. And then we need to expunge that vote and let that matter be heard again. I'm not telling you that anybody needs to change a vote because that's really your issue. The question, though, is, is if somebody has gotten caught in a process, do we want to spend two or three years wondering if we had to give the hearing or do we want to just give the hearing and take care of it now? And that's what I'm recommending. And hopefully one of you all will say, I'm going to move to expunge the vote on Tuesday, in which case we can get the thing back in order. Also, the mayor and city manager have agreed that we're going to have IT, and I don't know what this means because after email I'm kind of gone, but we're going to have a site on the website for changes in the agenda that would notify the mayor, the manager, the city clerk, and then the department heads so that if something comes up, then those that have an interest in it will know about it immediately. And it will not just be one lost email. It would have to be 12 lost emails before I ever have to say this again.

Thank you, Mr. Carpenter. Board members, any questions on the consent agenda? Any questions on the set? Director Hines and then we'll come to Director Pitt.

So I don't know if this is being done through Kevin with our CDBG. So I see we got resolution three, four, five and six to purchase lots. So we're using. Can you give us a little roll down on what and how we're doing that and we'll be able to get clear, just the tidal process, because I'm assuming that these are some lots that have not been. We've got a lot of building going on in Walnut Valley and Colony West from the tornado. But I would imagine that these are Or is this these ALLR, one company that's bought up all these lots? So just give us a little explanation.

Yes. So we're using CDBG-DR funding. That's the disaster recovery funding that we receive for the tornado in that area. Those lots that we are purchasing is two lots that we offered to purchase. The two lots appraised out at $60,000 apiece. and those are vacant lots and then we are purchasing two properties for rehab, one at 17 Buttermilk and the other one is at 1509 Breckenridge. Both of them appraised out. So whatever they appraised out for is what we actually offered them. It was a little bit more because we felt like the appraised value was higher, but they both appraised out. One was at 160 and the other one was at 225.

And these are, I take it that this property owner wasn't moving to fix or build on them?

No, they're actually going to lose on them. Yeah. All right.

I was just curious. I know I knew after the tornado, we had some speculators go in there and buy up some lots from some folks that couldn't afford to rebuild. So I guess this is some of the remnants of that. Yeah. I appreciate that. Yes, they'll come before you based on what the amount is and they'll come before you all to vote on. I just want to let Director Peck know that one of these lots of like

two lots down from the new fire station. And I know we have been having discussion on that because that area is kind of bad. So we want to kind of spur development to allow other people. I know it's been some development going on, but those lots have been vacant for quite some time and we want to make some have some improvements.

Thank you. All right. No problem. Director Pegg, then Director Miller.

Hold on, Kevin. But thank you. And I am aware and I'm delighted this is finally happening. Nothing happens quickly. So my question is, here are the first four projects, basically, and it's almost $21 million. I mean, I know there's some administrative fees. Can you give us any insight on what might be on the horizon for the rest of the money?

Yes. So we do have some other projects that we're using for housing assistance. So we have had some people apply. I can pull up the list for you shortly. But we have had some people apply for housing assistance. They're receiving down payment assistance. Also, we have some people that have submitted rehab projects, people that have some shortfalls dealing with insurance that they didn't not cover all the rehab of their structures. So there are some things going in the background. This is just some of the bigger projects that we're looking at. And we are working on implementing and open up application for infrastructure projects and improvements right now. So currently right now what's in progress, we have 17, 7 applications for preeligibility in progress. And then we have four that's under review. We have 16 that are in the application progress because we do have the application process open for housing assistance. And then we have 17 that's under review. We have 33 that have been denied because we did have some people that just submitted projects and they didn't meet the criteria of the CDBG requirements. And then we have two on the wait list. But we do have projects in place that are going right now for housing assistance. These are just projects that are currently in place for construction.

I would love to have that list because I do get questions periodically from those neighborhoods most impacted. Well, especially Walnut Valley, but Colony West and the Turbridge as well. Yes, the status and just so I can speak intelligently about it. And I know it's a big heavy lift and I'm excited to see some concrete things happening. So thank thank you all.

Yes, and they always can go to our website and go to CDBG-DR. We provide updates each and every.

There are updates there? Okay, well then I can do that as well. Okay, thank you.

But we'll be happy to sit down with you to get you a little bit more detail.

I think I can manage to navigate that. All right. If I have any questions, I'll let you know.

All right, thank you. Thank you.

Director Miller?

Yes, sir. Before you leave. Let me ask you, since you're using community development block grant funds, you're saying these are going to be affordable houses. So what's affordable?

So we so we did apply for a waiver and I know everybody was was understanding that we did apply for a waiver for housing assistance. We can go up to 150 AMI of the area median income for that area. And then we do have some some things that we have to spend a certain percentage 80 of the area median income but as far as housing assistance we can go up to 150 and then it's basically with cdbg dr it's a little bit different from cdbg so we it's a it's kind of a numbers game when you're dealing with uh what you can do in that area everybody knows that that area is well above 80 of the area median income so The actual focus is those ones that was affected by the tornado, but we did apply for that waiver and we did receive up to $150,000 for the housing assistance. Now, construction is a little bit different cost. We may have to subsidize a little bit more to get to that median income, a median sales price in that area.

So, again, it fits in the box for using community development block grant funds?

Yes.

This has got a waiver. Yes. Okay.

Yeah.

Thank you.

All right.

Thank you, Director Howard. Yes. Board members, any more questions? Any more questions? Any more? Director Adcock? No, you got one. Just one. Yes, ma'am.

Okay. I have a question on 15.

We don't have item 15.

Well, there's one laying here.

There may be an O on the direct ad code.

Okay. For some reason, I have an old one laying at my desk. Thank you.

We'll get that corrected.

I would like to have a current one, please. Thank you.

Thank you. Board members, any more questions?

Yes. Is somebody going to make the motion on Tuesday so the vote will be six votes instead of eight? Yes. Thank you.

What's the item number, Tom? Mayor, I plan on asking for an expungement of our vote on item Z10303. Oakwood.

We'll do. We'll do. Thank you. Director Webb. Got you. Thank you. All right. Meeting adjourned.