One of the big changes the proposed budget entails is the destruction of the state’s current 18 Regional Emergency Services Councils (REMSCOs) and reformation into 6 Regional Advisory Boards. This is a big change in how state EMS agencies are coordinated and governed in their respective regions.
There have been, not too surprisingly, two overall reactions towards the news. There are opinions for the REMSCOs and there are opinions against REMSCOs. To understand both reactions we should understand what the 18 REMSCOs are actually responsible for. From Article 30 of New York State Public Health Law:
2. Each regional council shall be comprised of at least fifteen but not more than thirty members to be initially appointed by the commissioner, with the approval of the state council, from nominations submitted by local organizations applying for establishment as the regional council. Not less than one-third of the membership of the regional councils shall be representatives of ambulance services and the remaining membership of the regional councils shall consist of, but not be limited to, representatives of existing local emergency medical care committees, physicians, nurses, hospitals, health planning agencies, fire department emergency and rescue squads, public health officers and the general public. The county EMS coordinator, established pursuant to section two hundred twenty-three-b of the county law, of any county within the region shall serve as an ex officio member of the regional council; provided, however, nothing in this subdivision shall prevent a county EMS coordinator from serving as a voting member of a regional council. Members of each regional council shall be residents living within the geographic area to be served by the regional council. The presence of a majority of members shall constitute a quorum.
3. Each regional council shall have the power to:
(a) have a seal and alter the same at pleasure;
(b) acquire, lease, hold, and dispose of real and personal property or any interest therein for its purposes;
(c) make and alter by-laws for its organization and internal management, and rules and regulations governing the exercise of its powers and the fulfillment of its purposes under this article; such rules and regulations must be filed with the secretary of state and the state EMS council;
(d) enter into contracts for employment of such officers and employees as it may require for the performance of its duties; and to fix and determine their qualifications, duties, and compensation, and to retain and employ such personnel as may be required for its purposes; and private consultants on a contract basis or otherwise, for the rendering of professional or technical services and advice;
(e) enter into contracts, leases, and subleases and to execute all instruments necessary or convenient for the conduct of its business, including contracts with the commissioner and any state agency or municipal entity; and contracts with hospitals and physicians for the purposes of carrying out its powers under this article;
(f) undertake or cause to be undertaken plans, surveys, analyses and studies necessary, convenient or desirable for the effectuation of its purposes and powers, and to prepare recommendations and reports in regard thereto;
(g) fix and collect reasonable fees, rents, and other charges for the use of its equipment and the provision of its services;
(h) contract for and to accept any gifts or grants, subsidies, or loans of funds or property, or financial or other aid in any form from the federal or state government or any agency or instrumentality thereof; or from any other source, public or private, and to comply, subject to the provisions of this article, with the terms and conditions thereof; provided, however, that the councils may contract for payment of debt evidenced by bonds or notes or other evidence of indebtedness, either directly or through a lease purchase agreement;
(i) recommend to the department approval of training course sponsors within its region, and to develop, promulgate and implement annually an EMS training plan which addresses the needs of its region;
(j) enter into contracts or memoranda of agreement with other regional councils to provide services in a joint or cooperative manner; and to enter into contracts or memoranda of agreement with an EMS program agency to carry out one or more of its responsibilities under this article;
(k) procure insurance against any loss or liability in connection with the use, management, maintenance, and operation of its equipment and facilities, in such amounts and from such insurers as it reasonably deems necessary;
(l) approve regional medical advisory committee nominees;
(m) provide focused technical assistance and support to those voluntary ambulance services operating under exemptions, to assist such services in progressing toward the uniform standards established pursuant to this section. Such assistance and support shall include, but not be limited to, volunteer recruitment and management training; and
(n) do all things necessary, convenient and desirable to carry out its purposes and for the exercise of the powers granted in this article.
4. Each regional council shall have the responsibility to coordinate emergency medical services programs within its region, including but not limited to, the establishment of emergency medical technician courses and the issuance of uniform emergency medical technician insignia and certificates.
5. The regional council shall have the responsibility to make determinations of public need for the establishment of additional emergency medical services and ambulance services and to make the determinations of public need as provided in section three thousand eight. The regional council shall make such determination by an affirmative vote of a majority of all of those members consisting of voting members.
Although not scientific in nature, I’ve had a number of conversations with people regarding the REMSCO dissolution from across the state. Here’s a summary of the arguments:
The Opinion For REMSCO
The opinions for keeping REMSCO vary from region to region, but there were common themes that emerged. Some specific arguments for keeping them include:
- the opportunity for all agency types to be represented
- the opportunity for a cost/effect analysis of proposed protocol changes prior to enacting them and adding unreimbursed operational cost to agencies
- direct support provided to volunteer agencies
- a point for regional coordination of an EMS system comprised of multiple agencies
- the means to complete projects and achieve goals too big for one agency
The Opinion Against REMSCO
The opinions against keeping REMSCO vary from region to region but some common themes emerged. Some specific arguments include:
- the beauracratic composition of the councils not accurately representing the region
- failures in successfully implementing programs that were conceived on the regional level to begin with
- failures in the effective coordination of resources
- failures to support the volunteer sector that they are directed specifically to do
- relying too heavily on one agency to define a regional system
The Public Hearing
The legislature is holding joint public hearings on the budget items. The hearing for the Department of Health is scheduled for February 8 at 10:00am in Hearing Room B of the State Capitol. You can read the official press release here. Whether you are for or against the decimation of the REMSCOs, that’s your opportunity to have your voice heard.