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[Music]
there you're
on hi
everyone good afternoon welcome to
today's joint work session today is
Monday March 10th
2025 it is approximately 1 pm. I am
mayor proen Beno we will start with a
moment of silence for the brave men and
women of the United States armed forces
and our uh brave men and women of the
Los cruus police department and Los cras
fire department as they keep us safe
24/7 please join me in a moment of
silence thank you
everyone uh fortunately our pets of the
week will not be available today so
we'll be skipping that but make sure to
follow them on social media um I'll also
be reading a closed meeting statement
right now bear with me it's a bit long
so uh the city council met in closed
session at 10:35 a.m. on March 10th
2025 the following were in attendance
myself mayor pend Momo councelor mlar
councelor matis councelor Corin city
manager Connie tomow City attorney uh
Brad Douglas external councel Chris def
filipo commissioner Sanchez commissioner
chaparro commissioner Shalo Hernandez
interim County attorney Carrie Neil
County Manager Scott Andrews assistant
County Manager Maas assistant County
Manager weer assistant County Manager
Steven Lopez commissioner Shannon
Reynolds city clerk Riva councelor Ivan
Flores and commissioner gametos the
meeting adjourned at 12:31 a.m. p.m.
statement this is a statement for the
record the Clos meeting discussion was
limited to the item stated in the posted
notice the purpose of this Clos session
is to discuss threaten or pending
litigation in the matter of me Memorial
Medical Center notice of breached that
August 29th
2024 okay on the agenda today is item
3.1 opioid settlement funds update um
and I just would like to hand it over to
Barbara and of course uh welcome our
County colleagues to the to City Hall
today thank you for joining us
Barbara good afternoon uh Barbara Beno
chief administrative officer for the
record and yes welcome uh to this joint
work session of the donana County
Commission and Las crusis city
council right today we are here to
discuss the opioid settlement funds and
proposed osed uses for those funds the
agenda that we will follow is to go over
the settlement agreements themselves
just an
overview uh we'll introduce the advisory
Council go through the strategies being
recommended by The Advisory Council and
then the next steps along with a
timeline so through the um litigation
process the donana county and city of
Los crus will receive approximately $24
million through
2038 uh those settlements are with
Distributors manufacturers and retailers
some are one-time payments some are
payments over a few years some are
payments over many years the county will
receive um about $14 million and has
received just over 5 million to date the
city will receive just under 10 million
and has received about 3.7 million to
date the use of the funds is government
governed excuse me by the terms of the
settlement agreement and the funds are
head held separately by each of the
entities the city and the county um as
stipulated in the settlement agreements
the funds are are to be held uh
separately within the governmental
budgets as well
so that's just the background on the
funds the amount that we expect to
receive and just a reminder that it will
be over over many
years all right um and just a visual uh
representation of the amount that has
been uh received we started receiving
funds in FY 23 even though the
settlement came about I believe at the
end of uh fy22 so you can see uh we
received a large amount of the funds in
FY 24 and now and some of those were
some of the lump suum funds that I
mentioned earlier and now we're more
into a pattern of the um the annual uh
payments that we'll be receiving over
many years from a variety of the the
entities but again 5.4 million received
from the county to date 3.7 received by
the city to date with that I'm going to
turn it over to Jamie Michael from the
uh County to continue through the
presentation just clicking yep
just thank
you good afternoon uh my name is Jamie
Michael I serve as the Director of the
County's Health and Human Services
Department pleased to be here today to
share the recommendations for the
investment um and it is members of our
advisory Council that have been working
to collect all the data analyze all the
data look at the resources and make
these recommendations I know you've met
the council members several times but
many of them are here today so I'd like
to ask all of them to to stand up so we
do have Gabriella we have Joe we have
Athena we have Tanika we have Ry we have
Ned and we have Miguel and anyone else
that walked in all right perfect thank
you all very much they give their time
uh voluntary each month they come to to
monthly meetings and in between the
meetings they yes thank you uh
commissioner
Reynolds in between meetings they have
action items so they have been working
to come together and make these
recommendations for you here on the
slide you see what sector they represent
and it's important to note that because
we are following some of the best
practice guidelines when assembling this
Advisory Group we wanted to find a nice
balance of people who are very informed
um about the topic also informed about
the community could leverage other um
activities in groups um and things that
are already happening in our community
and not be just um a a bunch of
providers because that can get
complicated then when you turn around to
provide a funding to different agencies
so again very pleased um and here's the
the list of the advisory council members
and the sector that they
represent as they were working through
this process to come up with the
recommendations at the foundation of
that are these nine core strategies this
this is referred to as exhibit e and it
is part of the settlement agreements so
these nine core strategies are basically
um the allowable activities that the
opioid funds can be invested in so if
you look across there they can be very
broad um and we can't fund all nine of
them or we wouldn't do a very good job
at anything so the group had to figure
out a process how do we go from nine to
a reasonable number of strategies to
invest in and we were looking shortterm
so we weren't looking at making a
recommendation for investing over 18
years we were looking at the initial
investment and maybe over the 18 years
we can touch all of these but initially
they went through a process um that
started off with those nine strategies
and The Guiding principles that helped
them make that decision about which re
which um strategies to recommend their
guiding principles we adopted from John
Hopkins and vital strategies again as
part of some of the best practice
guidance for local communities and we
want to use the money to save lives
that's at the core of this investment we
want to use it on things that are
evidence-based so not just a great idea
that that I had but really something
that has some evidence behind it so the
investment is going to have a proven
outcome we want to invest in youth
prevention so we can kind of stop
perpetuating some of the the impact that
opioids have in our community we want to
focus on racial equity and we also want
to be fair and transparent in the
process so there is already a website
our web page set up on both of our
websites so the public can see this
information um as The Advisory Group is
developing it again the decision making
process was well informed with data we
worked with New Mexico State
University's Crimson research and vital
strategies to help conduct A needs
assessment and that was presented to all
of you several months ago the needs
assessment also included a resource map
so we looked at the assets and resources
that already exist so we wouldn't
duplicate things we tried to look at
what the state is investing their
funding in so we can coordinate and
support uh government Investments across
all local governments again they were
very focused on only recommending things
that are going to be evidence-based and
obviously things that are allowable in
that exhibit
e the planning
process you can see we went through a
very intentional process and the first
step was the needs assessment how do we
know what the need or the problem in our
community is and this is where the
advisory members helped design that
needs assessment and helped inform US
helped answer that question what is the
problem and what do we need in our
community then we went on to the the
Second Step what do we want to focus on
so which of those core batement
strategies do we want to focus on and
that's where we are here today we're
making that Rec recommendation to you
all so then we can continue with this
process and really design some specific
um activities and continue this planning
process I think most of you have seen
the four recommended strategies So today
we're going to provide you with a little
more information about each of those and
I'm going to invite three of the um
advisory council members to join me at
the podium here and first we have uh
Athena Huckabee to give us some
information about assisted medication
assisted
treatment are you good yeah all
right hi everyone my name is Athena
Huckabee um I for my full-time job I
work for a medication assistant
treatment provider that provides low
barrier access to this care so we
thought I would be the best one to talk
to you about this Slack
um examples of activities that could be
more robust here in the city of Las
crusis are um connecting people with
transitions to care especially at Ed
discharge um only two uh I'm sorry only
one of our emergency departments
currently provides that type of service
uh the other two do not um primary care
transitions um making sure that folks
are um oh sorry sorry I think you were
on the wrong slide I was on the wrong
slide
that's okay that's still something we
need so that's great um anyway um
examples of things that we could do with
medication assisted treatment besides
the things that I just mentioned are
Specialized Care for pregnant and
postpartum Women and Infants um patient
and provider education about substance
use disorders and treatment and then 24
247 access to matap Providers through
tella Health the crisis triage Center
emergency departments as I mentioned
only one of our emergency emergency
departments is connecting people with
that care and or mobile mat units for
Rural communities so places like
chapparel for instance we ask people to
drive into that care rather than
bringing the medicine to the people so
those would all be great things I think
that's all I have
thanks can yourself yeah I'm Ray Stewart
with Amador uh Health Center I'm the
recovery director I I've been there
since since September
2018 um it's been a wonderful experience
in so many ways I'm also a certified
pure support worker so I I I think I
have the content both lived and learned
to talk a little bit about this it's one
of my favorite subjects uh recovery in
itself um is something that it doesn't
have to be abstinence only a base it's
absence oriented but it's recovery is
really about the person the individual
you're talking with uh as far as what
the person sees as the destination
Direction delays detours and the
determination of arrival in recovery is
about the person and there are multiple
ways uh multiple Pathways to Recovery so
I think these are two important points
recovery Support Services is a broad
term is anything to help someone access
treatment stay in treatment benefit from
treatment and probably the most
important concept is to return to
treatment uh addiction is a chronic
disease or
disorder um it it's not linear in how
you approach it so I think it's really
important to there's no wrong door to
treatment um the missed opportunities
are out there so the places that
transitions in care in our community are
listing listed here emergency room or uh
Department discharges Primary Care harm
reduction jail release and EMS um we
have Assets in all of these areas but
definitely not enough uh I I think
Primary Care is you know we ask the
right questions about what substances do
you use how often how much but what
happens after that so Primary Care is
still a big challenge of all of these
the one I'm particularly fond of is the
harm reduction site um Harbor induction
is a place where we don't just exchange
needles and give Naran and fenal test
strips and other things is the The
Exchange is really about offering
someone um hope and dignity to
counteract the shame the guilt and the
dis spare of what addiction is so harm
reduction is a perfect place for these
types of services again uh recovery
support is best face to face when you
look somebody in the eye you're
listening to them you're not talking to
them you're listening to them more than
anything so that's quite important uh
but it can be done video it can be done
by field visit or home visit which I
think is super important and but it's
something that remember remember about
addiction only 10% of people that need
treatment end up in treatment be that
therapy medication or both but the real
number here is only 25% nationally of
people that enter treatment stay in
treatment 6 months so it it's something
that I believe it's not just a warm
handoff it's a welcoming welcoming hand
out that's two words not one word where
you do with the person not for the
person that's what's recovery is all
about so as far as comorbidities 80% of
our people at Amador have behavioral
health conditions uh the most common
ones anxiety depression PTSD and the big
one now is a methamphetamine in induced
psychosis our people are using not just
opioids it's methampetamine it's it's
alcohol and the biggest one is is
tobacco the rates among homeless people
that use drugs it's all about tobacco so
uh chronic disease disorders conditions
is it's a team sport you know it's it's
really something you do together as a
interdisciplinary team an inter agency
team and I think that's what's been good
about our opioid settlement fund
Advisory Group it brings us together and
I hope and pray that it continues after
after today and when the funding the
rfps go out it's not the time to split
up it's the time to get together and
Contin continue all the good work so my
message is to end this is the best
health care is self-care recovery is all
about self-care
self-determination self-care self selfa
actualization or fulfillment so uh
recovery support is a the key to keeping
people in safety and making progress in
their lives so thank
you thank you Ry and next we have Ned
Reuben good afternoon thank you all for
inviting us here today uh my name is Dr
Ned Rubin I'm a retired addiction and
health
psychologist not only involved with the
opioid settlement advisory Council I'm
also chair of the unified prevention
Coalition of donana County and involv
with the resilience leaders of donana
County on their medical and dental work
group I want to talk about the third
strategy selected by The Advisory Group
which is enriching prevention
programming and I think you'll see as I
talk about this I want to talk about
things from a slightly broader
perspective um the first of the two
activities I want to mention is to
provide Universal screening in a variety
of settings Rey actually just mentioned
primary care so one of the settings we
can talk about is primary care I'll give
you a little more detail about that in a
second the second activity I want to
chat about with you is attacking stigma
and lack of
understanding Universal screening allows
us to integrate systematic substance use
disorder screening within Health and
Family
Services so we're talking here about
Primary Care as Ray just mentioned
Pediatrics family and internal Med
medicine settings OBGYN practices any
practice which generally can um
encounter people who potentially could
be having problems with substance use
disorder and if we can do it in this
sort of universal way it will allow us
to include particularly pregnant and
parenting women families Youth and to
intervene with kids to prevent or
mitigate uh opioid use disorder in the
family and subsequently trauma and Aces
so this is a much broader purview than
we've talked about previously today the
second um activity I want to mention is
to attack
stigma um this could take multiple
forms um we could talk about a community
media campaign directed at reducing
stigma associated with opioid use
disorder and the stigma people have who
are suffering in seeking treatment but
there's not only stigma there there's
stigma in the medical profession who
don't necessarily want to have those
people in their practice for a variety
of reasons
and there's also stigma within the
organizations as they decide how they
want to focus the work that the
providers are going to do so there's a
multiple levels of stigma that we could
uh take a look
at so the information that we could
provide for them in this working with
stigma includes um resources that might
be available where and how to seek
treatment what happens in treatment
which for a lot of people is a mystery
and sort of scary
and what so what to expect and what
treatment choices people might have when
they're deciding on and selecting
treatment so I think you can see that
the prevention approach is a broader
approach to the community and can
support the other strategies that you've
just heard about
thanks we have a great experts that are
working on the advisory council with us
Athena gave you a little bit of her
background but I think many of you know
she has her hands in a lot of areas
related to opioid use disorders uh
Suicide Prevention Ray Stewart was uh
really helped us become first in the
state in doing medication assisted
treatment and harm reduction other um
Public Health regions are just starting
that now and thanks to Ray this uh
public health district has been doing it
for decades and then Ned in his own ride
is fantastic ftic but we also got access
to his wife who Ren some of these
programs um as well so thank you to to
all three of them the last
recommendation that everyone really
collectively uh agreed on is to invest
some of the money to help us with data
collection and research we want to make
sure that there is some standardized
program evaluation so we can come back
and say the investment yielded this
result we want to make sure that we have
the ability to do um ongoing monitoring
and Reporting not just because because
that is the most effective way to
operate these programs but it's also
required um in any um local government
that received the funding has some
reporting requirements back to the the
public and we want to make sure again
that the um Investments are producing
the outcomes that we intended and that
we're able to share it with you and the
public in a very transparent way if you
remember that was one of the The Guiding
principles I'm going to turn it over to
um Barbara and she's going to talk a
little bit about another um
recommendation that wasn't part of
exhibit e but something that was
discussed by The Advisory
Group thank you
Jamie and thanks to all of our advisory
council members for their input and
guidance and expertise through this
process one of the things that we um
talked about uh at The Advisory Council
as a use of the funds is whether or not
there might be an appetite to establish
a trust for the opioid settlement funds
this is essentially what the state has
done with their funds where they are
setting aside a large portion of the
funds and then allocating a portion
every year to be expended as you know
the um state is receiving 45% of the
total settlement amount the local
governments are splitting 55% so
obviously the state has a much bigger
pot of money they are expected to to
receive uh around $310 million and then
the local governments will be sharing
about $325 million and the state so far
has received over $90 million of the
settlement funds um but in in setting
aside a portion of the funds W uh for a
trust uh structure what they're doing is
ensuring that there's a stream of funds
that can be spent years into the future
once the uh distributions from the
settlement
cease um they trust preserve uh some
amount of the funds 50% of the funds 80%
90% there's a lot of different scenarios
and we'll talk about those and then
typically expend a smaller proportion on
an annual basis it might be just uh
spending the um investment income from
what's uh invested in the larger trust
portion or it might be expending a
certain proportion of the fund say 5% on
an annual basis um expenditures can be
made over a long time period for these
settlement funds there's no expiration
date per se by there's no end date by
which we have to have expended all of
the funds however we we will want to
mention and and remember that the funds
do need to be spent in accordance with
the allowable criteria at any point in
time and as I mentioned there can be
many different scenarios set up for a
trust I'll go over a couple of options
here in just a sec um and one
consideration in whether to establish a
trust is to think about what you want to
address now and what is the magnitude of
the problem what are the magnitude of
the expenditures that would be necessary
to address the problem in your community
so that we could potentially hold back
some uh to be spent later um later in
time but if you were to expend funds
over a longer period of time then
periodically would need to come back
together to decide on the uses of the
funds again Under the Umbrella of the
allowable expenditures from the the
settlements just a couple of scenarios
here um for potential trust structures
uh for example in scenario one we could
allocate all of the distributed funds to
the trust and then transfer 5% a year
for expenditures in this scenario
between the city in the county we could
spend just over um half a million
dollars a year say over the first 10
years um in scenario two you could take
50% of the distribution and allocated to
the trust and 50% to
expenditures which would mean that you'd
have a larger portion available UPF
front 3.7 million in the first year and
then again somewhere around a half a
million dollars um over the next uh 16
years over time trusts tend to grow
that's that's the purpose of
establishing a trust to to have a source
of funds uh into the future under
scenario one uh the trust would grow to
about $24 million if you assumed a 5%
return on the Investments and similarly
under scenario to the trust would grow
to $21 million at the end of the time
period that we will be receiving
distributions from the settlement so
around
2039 uh in both of these scenarios the
expenditure fund would have about1 to
$1.2 million uh compared to again the
the the majority of the funds will be
held in trust and at any time of course
you could determine how you'd want to
distribute funds between the trust and
the and the
expenditures but again this is one other
thing to consider with respect to the
use of funds as as Jamie said um it's
it's not the primary discussion that
we've had and and what guided The
Advisory Council in terms of uh what's
going on on our community what actions
we might need to take to address this um
this uh opioid uh situation in our
community but it is certainly one thing
to consider if you if you would like to
establish a source of funds many years
into the future we don't know what the
um what the future will hold and what
kind of challenges we might have at that
time the funds will always be governed
by by the terms of the settlement
though so with that I'm going to turn it
back over to Jamie to just talk about um
next steps and the guidance we'd like to
get um from this joint meeting
so what we uh would like to do going
forward if we get the nod that we're on
the right track with these
recommendations is from there really
take a look at the role of each
government city government and County
government um those will need to be
discussion with staff and Leadership
with um each of the local governments
we're hoping that can take place in the
next 30 to 60 days just so we have a
clear idea of the logistics um how to
roll out the money how to monitor the
money and how we're going to make sure
that we're still coordinating the
efforts uh across governments then we
want to look at some specific activities
and programs and what Associated outcome
measures we want for the initial funding
again we're hoping that this is where
the staff and members of our advisory
Council can really come together and say
Here's the type of activity that we want
to fund here's the outcome that we're
going to measure um and thep purpose of
that that activity or that investment
then we want to move forward with logic
models or uh developing a scope of work
again that includes evaluation for each
of those suggested activities and staff
can work on that along with our
technical assistance Partners at vital
strategies they have done this in many
communities and they have a lot of the
tools already uh available for us to
develop these scopes of work to figure
out what outcomes we want to Monitor and
how we're going to look at Key
performance indicators related to a
variety of these
activities um and then obviously
determine the funding process for
Distributing the money monitoring the
investment and Reporting back again this
is where we'll bring in our finance
department and look at procurement and
all of the other um practices that each
of our governments will need to get the
money um invested we want to throughout
this process make sure that we're
seeking approv approval from both the
the council and the the commission um
obviously at the root of this is how to
allocate funding in the budget which is
where you all have to make um the
decisions about what funding how much
funding will be invested in each of the
um recommended areas and then um go out
and solicit
providers to implement these activities
hopefully working as Ray said in
Partnership we want to keep the advisory
Council together through that process so
they can continue to monitor um and
review reports and go through that in
that that process of celebrating
successes but then letting that
information again feed our decisions and
any changes that we want to to make in
the future so that U monitoring and
Reporting back will be ongoing these are
the um suggested next steps but again
before we um leave here today we want to
make sure that we're all in agreement on
the recommendations
so I think I'm going to go back to the
recommendation
slide there we go and uh we all stand
for questions we have several subject
matter experts here so thank you thank
you all so much and thanks again to the
committee for uh you know being a part
of this for such a long time we
appreciate you very much I will go to
questions now and I have um councelor
Corin I'll go to you and then I'll come
to commissioner sh Jo ad mandes we have
you have to share these little buttons
so that's why sorry I don't want to
steal your button you can the button is
yours thank
you
um uh I have a couple of sort of I guess
things that I sort of heard in this
presentation I I feel like these seem
like excellent recommended strategies I
deeply respect the work that the
committee has done and I do want to sort
of speak to I feel like I would like the
committee to really continue to play a
pretty critical role I I feel like it's
really a very powerful group of folks
who know a lot of things and I think
that um trusting that that work um I I
would like to see that really be
maintained in Into the Future um I guess
I sort of have a follow-up question
related to so I'm I I think one of the
inflection points of strategies and one
of them is related to funding my
question um is more related to funding
the two trust related strategies I'm
curious because I think I've been very
vocal in saying like I believe that we
should be maximizing our benefit as soon
as possible because literally we need to
prevent people from dying 5 years into
the past which we can't do so um but I'm
curious in the models where the two
different scenarios of funding
um we I I don't see in here anything
that looks like a big pile of money at
the front a lot of these things look
like to me small not small amounts of
money
but these seem like programs that we
would want to maintain in the community
longer than a very short initial
dispersement and and but I I say that
because I I am in favor of us maximizing
our benefits at this moment but I'm
curious programmatically if
there's if one or the other of these
approaches will maximize the number of
people affected Andor the capacity in
the community to to address these issues
in the long term and how those two
things relate to those two funding
related
strategies yeah that that is actually an
excellent question and that is actually
the balance that you would have to
perform in order to decide not only
whether you want to establish a trust
but then What proportion of the trust
you would want to expend and that's why
the two scenarios that I gave you are
really kind of on either end of that of
that Spectrum we could we could uh so
the first one as you recall was setting
aside 100% of the proceeds into the
trust and just taking a portion say 5%
for expenditures on an annual basis
that's the one that gave you about a
half a million dollars a year to spend
the second scenar scario was splitting
up the proceeds 5050 and we'd have a a
greater amount of funds to spend on the
F on the front end because we've already
received uh expenditures to date or
excuse me received funds to date and
then you would proceed with about a half
a million uh a year um and and the trust
would then grow uh as I said in both
cases of those scenarios to just over 20
million but you could structure a trust
so that you um set aside 25% and
expended 75% it all depends on you know
what time Horizon you want to go out 20
years 25 years um what is it you think
that you would need for this opioid
crisis in the future and the reason I
emphasize for this opioid crisis because
as I mentioned the use of the funds is
governed by the settlement for this
specific purpose so going out 10 20
years I'm certainly not an expert I
don't know what might come up in those
years that we might need to address that
would be different from what we're
dealing with now we would have some
limitations on those funds going out
years from now
go I just want to add a bit to that it's
probably premature for us to ask you to
make a decision about investing the
funds right now what I I foresee one of
the next steps as we put together the
proposed activities and really work
those out as a scope of work we we can
come back to you and say the investment
for this activity is approximately this
much money or approximately this much
money and that may then help you decide
how much do we need to kind of frontload
these programs versus how much do we
need to have over time to maintain these
Services thank you that that would
actually be really helpful if that could
be part of that because I I don't want
us to set up nonprofits to to especially
the nonprofits or or other organizations
to to to have this like unpredictable
pile of money and then no money or not
enough money in the future so that would
be a really helpful Dimension if you
could include that when the next part
comes forward thank
you thank you counselor and I'm going to
go to uh commissioner shjo and then come
back to
you thank you mayor proam I do have a a
few questions and I was actually really
surprised and and glad to see the trust
portion put in here as well um but I
just had a general question and maybe
this is for a member of The Advisory uh
board the so we have the recommended
strategies off of these recommended um
four
strategies how many of these are current
programs that we have in our community
versus new programs that we're going to
be introducing into our community
and with that being said also um if we
can just get a general idea of you know
if they are programs that are in our
community already then someone's
obviously monitoring these programs for
what kind of outcomes are coming from
these programs and do we have a general
idea of how successful they are
currently to date in our
community commissioner um Shel Joo
Hernandez the we did an asset map along
with this and there is something
happening there are some activities
happen happing in our community related
to to to all of
these that's why the group is really
recommending some very specific using
this money to meet some specific gaps so
for example medication assisted
treatment is available in fact we have a
lot of providers in our community that
offer medication assisted treatment and
the evidence shows us that that is
extremely effective so we know that
that's an intervention that works but
when we looked at the asset map there
were very few one provider that can work
with pregnant women or newborn babies if
they have an opioid use disorder so we
know that that's a population that's
missing um we know that people out in
the rural areas have less access so we
know that that's a population and a
service that's missing when we look at
medication assisted treatment so we took
an effective proven intervention and
we're trying to figure out how to
connect it to more people or to um more
vulnerable populations that have less
ability to access the service so that's
an example um that I hope answers your
question but I'm going to ask Athena to
also help me
respond um hi Athena hakabe again I was
just going to talk um for example the
company that I work with ideal option in
other states where we have funding
available for it we have mobile units um
a van you know with a logo right that
goes to the rural communities provides
services via a a nurse practitioner a
medical assistant you know takes the
vitals has you know in some cases can
even have the medication available on
the van um and therefore expanding that
access so we currently do have a clinic
we have a 247 referral line um we have a
peer support worker but that could all
be expanded to be more accessible to
people and then the thing that I also
would like to talk about is something
that Ned touched on which is stigma um
there still is a lot of stigma not only
around having an opioid use disorder but
around taking a medication for it um
even though these medications are proven
to be effective are FDA approved you
know are um have a broad evidence base
um people in certain you know certain
Behavioral Health Providers or certain
medical providers or certain peers will
say that people aren't really recovering
you know if they're choosing to take
these medications and so I can see ways
also that things that Ned talked about
like a media campaign could fall in also
to um reducing stigma around medication
assisted treatment and thereby
encouraging more people to get into that
if that makes sense no for sure and
thank you for addressing that and I also
love what you said about kind of meeting
people in the rural areas where they are
because expecting them to come to Lost
Cruis isn't practical that's 30 45
sometimes
an hour depending where you are in the
county so I really appreciate you saying
that and something that I would really
like to see along those lines as well is
when we start continuing these
conversations hopefully on a more
regular basis that we do look at the
successes so that way us as a board um
both boards together can make these
decisions as informed as possible um
because at the end of the day we do want
to make the right decisions not
decisions that may or may not work um so
thank you for addressing that and that
also kind of brings into my ideas of the
trust that was talked about is if we
were to allocate money for you know what
we said The Upfront cost is for a lot of
these to get them going whether it's you
know working with those one-time
payments of whatever it takes to get
those providers in house or whatever it
is but also the trust would then set up
monies
for any possible changes in 5 10 15 20
years to programming um when it comes to
these funds that way this board can meet
again to go over maybe we need to change
what money it is and it gives us more of
a longevity outlook on hey this best
practice isn't a best practice anymore
um we want to move that money here well
if we allocate all that money up front
on the front end we don't really have
that ability to then change
programmatics later on so I actually
would definitely be a fan of the trust
um I don't think 100% is needed but
definitely highlighting what needs to be
done um and then I do see him here now
and my question was on uh harm reduction
as well so I see that we went with harm
reduction
um as a recommended strategy where in
these four strategies does harm
reduction uh
fit um commissioner Shel Joo Hernandez
one thing that that is really um
beneficial working with vital strategies
is they have laid out how you can take
harm reduction treatment and prevention
and have it touch all of these
recommendations so we can do harm
reduction in all three of those those
recommendations obviously it it will
look different in in each of them but
harm reduction touches all of them okay
thank you uh Ned Rubin again I just
wanted to address
your question about what else is going
on in the community um a couple of
things I wanted to mention there are
certainly prevention programs that are
going on in the schools the kind of uh
prevention I had talked about earlier is
a broader prevention program that will
have uh touch the whole Community as
well as working with the kids in the
different um uh medical settings that I
had briefly mentioned we're also there's
a project going on right now to
increase uh Prov providers of medication
for opioid use disorder where um through
the Center for Health Innovation we're
reaching out to train medical providers
in the state certainly here as well
obviously who um to Pro on how to
provide uh buin orphan in the context of
their practice so that they'll be able
to reach more people that of course
address partly addresses the issue or
confronts the issue of stigma what
practices will allow that to happen
which is one of the things that we want
to talk about but there is some work
going on in the community to try to
expand that now we hope through some of
the work we can do down the road we can
expand interest and the availability of
um medication for opio use disorder as
well thank you thank you thank you for
the questions councelor
Flores thank you um my question is money
so you have the trust
who um takes care of it and is there um
you know you talk about money running
out when wanting to allocate money to
programs that are going to uh be
successful it sounds like the ones that
have been implemented this far have been
uh based on what people are saying um
successful so um it seems though that
how much is a trust and has it been
invested is it going to grow you know
the corpus you always have a corpus and
um is that destined to grow or are you
just going to go with this program until
the funds run out um that's the part I
and I I want to applaud everybody Athena
uh Ned Francine and everybody else who
has been involved with uh this
project so um yeah that's my question
Barbara thank you councelor FLOTUS uh
Barbara been again for the record so I I
do want to emphasize that we the city
and the county will be receiving
distributions for over a
17-year period um so if you think about
uh the receipt of the funds I mentioned
some of them are front-end loaded maybe
one-time payments but we will be
receiving funds over a long period of
time um from the various manufacturers
distribut Distributors and retailers so
there will be a source of funds for um
you know for quite some time the trust
would would protect a corpus as you
mentioned uh you could establish that as
a long-term investment similar to what
we have done for the telshore funds that
allows you to invest it in longer term
Vehicles right now the funds that the
city and the county have received are
not designated long-term Investments and
so we maintain the same kind of uh
liquidity and short-term Investments uh
for these These funds as we do with um
our other funds that we hold for our
operations uh payroll and that sort of
thing uh we are receiving Returns on
that but it's not the same kind of
investment that you would make if you
designated it a long-term investment so
so that's one thing about how the how
the uh trust would be administered and
then of course in establishing a trust
you would need to establish the
oversight um who is involved if it is
the The Joint City and County or if each
establishes their own trust there there
are many different ways uh to do that
many different options so of course that
would be at the at the uh request of the
governing bodies as to how it's how
they're
established yeah I suppose it would be
um the onus would be on the U governing
bodies but um and and 17 years sounds
like a lot of time but think about the
baby you had a few years ago who's now
20 I mean that went by really
fast so um and and I and I I really L
and applaud um the people who are you
know down in the trenches uh working uh
with people who are who have um
addiction and all that um but I don't
with all due respect I don't think it's
going to be solved in 17 years um it
took a long time to get where we are are
now we're you know we're and I know that
Athena really emphasizes that the shame
part really has to be worked on you know
there's no shame in in being uh you know
being a woman there's no shame in being
a brown woman there's no shame in being
a drug addict I'm not a drug addict but
um one of my brothers um became heavily
reliable on on drugs after Vietnam and I
think uh that happens a lot to our
veterans so uh but you know he he he he
recovered he was okay and uh he's passed
away now um and but um anyway has any of
the those thoughts or any of discussion
any of that has have you addressed that
issue of uh making sure there's funds to
perpetuate because I think we've been
very fortunate to have something that
will go 17 years and however that happen
happened maybe you can make it happen
again to make it possible to go on
beyond that time thank you yeah I I
applaud The Advisory Council for uh
bringing forward the the concern and the
interest in providing this option to you
all uh certainly it was at their behest
that we developed um the scenarios that
we presented to you we did not go as far
as you know recommending one we didn't
even know if that would be a direction
that you would want to entertain but
that's the kind of guidance that we're
that we're looking for
now but what about the money part I I
just wonder I mean because I you know
with all due respect I think that you
all have done a wonderful job in the
short amount of time uh everybody who
spoke uh spoke very highly and
positively but I'm just wondering about
how much longer this can go on you know
be beyond our our given lifetimes here
so I think um sorry Barbara Ben Como
again for the record thank you counselor
flus for the question um I think as
Jamie said if we were to uh get the
go-ahead to pursue the strategies that
the advisory Council has recommended
then we can move to the next step which
is the recommendation of certain
specific actions and programs and that
would certainly help to inform the
expenditures that would need to be made
when and how and where and by whom and
that would also help us to present some
options uh more specific options with
respect to a trust structure so we
really need to to get to that next step
where we start to quantify the actions
that can be taken under these um
strategies so that we can pursue that
the trust option
further go ahead commissioner um
Reynolds thank you madam chair uh thank
you all very much for this presentation
it's very insightful
and we appreciate your time and also the
committee very much looking at um some
of the discussion first thing I am is I
am totally in favor of the trust and
putting the money in there so that we
can M have these programs last as long
as possible part of the reason I feel
that way is because Mr Stewart pointed
out something that I think statistics
that are very important and that is he
said that only 10% of the people who
actually need the support get the
support and then the ones that do get it
uh only 25% of them last in a program
for 20 for over 6 months so what that
tells me is we've got some really good
ideas here I don't think we have
Solutions and I think the only way we're
going to get the solutions is to take
some of these ideas put them into
practice and try to determine where our
money should be spent in the future and
if we create a trust that's going to
provide us long-term money and I'm even
past 17 years I think we have a better
opportunity to actually get a good
handle on the situ ation and
appropriately address it and uh for that
reason I think it's important we
remember that these are really great
ideas we got a great committee we don't
have enough evidence-based Solutions yet
to determine exactly how to use all the
money all the funds we're going to get
and so putting it into trust gives us a
chance to try a few things change
direction and refocus thank
you thank you commissioner Reynolds and
I'll I'll just add that that fourth
strategy that you see up there for data
collection and research is really going
to play into the evaluation of the
expenditures and the programs that we
Embark upon to determine how effective
they are for our
community yes ma'am thank you thank you
madam chair I have some questions as
well and I'll ask my questions and then
I'm going to go to our folks who I
believe are online so if you all want to
get your questions ready I'll give you
that time um again thanks so much I I
just have a couple of questions in terms
of um you know
the logistics of how we hope to spend
the money um I do think it's interest I
was looking at the National League of
cities and they they talk a little bit
more about uh the principle around
spending money to save lives and I think
that has to happen now not in 20 years
right like that needs to happen
yesterday um and it's interesting
because on here it also talks about you
know given the fears of an economic down
term that many localities will be
tempted to use and even perhaps
nonprofits will be tempted to use
to fill holes in their budgets rather
than to expand needed programming and it
warns jur jurisdictions should use the
funds to supplement rather than replace
existing funding which I think is
incredibly important to keep in mind um
I I actually I also appreciate the
recommendation on the trust I think I um
I don't know it's always really tricky
for me to think about rainy day funds uh
given the
uh size of New Mexico's rainy days fund
and how we hardly tap into it when our
communities are mostly in need and I
think there's a really slippery slope in
in like trying it in this scarcity
mindset right like and it is because
let's be honest this money was never
intended to solve our problems this
money was intended to stop Gap right
they the these uh Pharmaceuticals
created a ginormous problem our
communities didn't have the resources to
care for trauma
uh and and heal people's trauma and
that's how we ended up here it's going
to take a lot more than what their the
settlement is to to reverse and to heal
the the the amount that we actually need
to so by no means am I looking at this
money thinking it is our Saving Grace
though I think uh thinking about a trust
is really Smart Balance in terms of um
you know how we leverage it and ex
extend the life of it I agree that I
don't think uh 100% right now uh I don't
think 100% of of that honors the spend
money to save lives principle I think we
need to do that now we need to invest in
programs now now getting to that part I
guess you know in in just in my
experience being on the council I guess
the only other thing I can sort of
compare this to is the arpa dollars
right arpa dollars came they gave us one
set of money and they said good luck use
it best you can and of course we try to
leverage that and many ways some of it
was to supplement budget because of the
economic downturn and a lot of the rest
of it was to provide back to communities
and here we're saying that's literally
what we want to do Barbara in your
discussions with you know uh staff and
the committee is the I guess I didn't
hear this laid out explicitly so is the
hope that we would create an RFP process
that we would uh you know put out to the
public and have organizations apply with
their ideas that fit these uh these
strategies yes I'm going to invite Jamie
to come up as well because I know we
have discussed this um mayor protm
Barbara Ben com again for the record yes
we have we have spoken a little bit of
it but we have been really focused on
the data evaluation data Gathering
evaluation uh the the uh establishment
of the recommendations to date versus
the the next step which is the
administration which does and I think
Jamie mentioned this does involve
potentially rfps and obviously uh
alignment with with PE code local and
state Etc um but we did think about that
in the beginning as Jamie mentioned the
folks that are on our advisory Council
there are there because of the groups
that they are in their expertise of
course not necessarily their um
employers who might uh respond to an RFP
but to the different collaboratives that
they represent as well as well because
we wanted to make sure that that we
maintain the Integrity of that process
when we did get to it and Jamie is that
okay just going to make sure that I I
covered everything but yes that is
certainly a next step after we uh Define
the specific actions that could take
place under any of these umbrellas then
we'd have to determine then how do we
how do we get those services in place in
our
community I mean I think that doing this
kind of RFP process that encourages
collaboration amongst organizations
right like that'll decrease less of that
somebody talked about like that's this
is the time to unify right not split
split apart when the rfps come and we're
all fighting for a little bit of the
piece of the pie no like let's honor and
you know uplift more so projects that
are uh collaborative in nature with
organizations in our community the other
thing you know I think of and I think
this will allow for some creativity to
come about I can certainly as in my
experience as a social worker as a
counselor I can certainly say I think
programs that have mobile units are
really exciting I think overdose
prevention sites are really exciting and
if but if we as a council and a
commission say do that um there's not
necessarily A co- collaboration with
Community Partners that may be saying
there is no capacity or whatever or
maybe there is right what I'm saying is
I think it's a lot better um to to
create a space where the end user the
actual organizations of in our community
are being the ones sort of co-creating
and inviting us to participate in a
partnership um instead of us sort of
mandating or dictating what we think
should be done I think it can happen in
a collaborative way that being said and
I appreciate that you're thinking about
the committee being uh sort of in place
for a while when I think it's important
I do have some concerns that some commit
that you know my hope would be that some
of the folks on the committee who work
for organizations like ideal option or
FYI would be applying for these funds
and so um have you thought about the
sort of conflict of interest that exists
there and how we plan to navigate
that and those were just organizations
off the top of my head I'm not saying
only those are represented uh Jamie
Michael County's Health and Human
Services you're bringing up some great
points and when um Barbara and I sit
down and say okay now logistically how
is this going to work we both kind of go
okay wait we need uh we need to step
back and really put together a good plan
part of that defining the
responsibilities of each government
looking at different procurement
processes RFP is one procurement process
but there are other procurement
processes um but yes at some point that
um whatever the procurement process will
override the um participation in The
Advisory Council so there may be a time
where it's you know we only few members
of The Advisory Council come together
and review proposals for for example um
we will have to balance that out um and
it is going to take uh some thought on
both parts of government Beyond just us
but with our legal departments and our
purchasing departments to figure that
out um but I also agree that the more
collaborative we can make it the better
and if we really work through
some intentional and specific
outcomes then the proposals will all be
focused on accomplishing those outcomes
and I think we'll have a better chance
of making sure that the contracts that
result from that all all work
together okay thank you those are all my
questions I um I appreciate it the
timeline that you presented on the
PowerPoint uh I think you
know I I would like to see
um some of this money start to flow out
this year um I think that you know we've
sort of done this process uh that
collection process long enough that I
think um getting some of this money out
is critical now um and or as soon as
possible I will just also um before I
hand it off to my colleagues just say
that on on the education piece you know
if there's anything we can do also to
try to prevent money being used on Bill
boards or like strategies that we know
are proven to not necessarily work right
like I think you know prevention where
is it best and where are the dollars
best spent that aren't necessarily like
commercials and billboards and those
kinds of things to me uh would be I
would be very grateful May potim um I
also wanted to mention you you
highlighted collaboration very grateful
that you did that because that's the
whole you know root of this effort
certainly want to make sure that we also
highlight the collaboration with the
state as I mentioned they are receiving
funds they are utilizing funds for this
P purpose as well and one of the things
we've been very intentional about is
keeping that um collaboration strong
with the state so that we don't
duplicate efforts that we're well aware
of the areas that they will be
contributing to of in our community as
well thank you so much thank you Barbara
I appreciate that I actually also had a
question about State funding here so
thank you for saying that
okay um do we have folks online that
have any
questions we have Commissioners chaparo
and GTO
online if you either of you have
questions go ahead and come off
mute I'm going to take your silence is
it no uh though if you were speaking in
maybe I'll give you one more shot
because maybe you were on mute or
something
okay folks
here in the flesh no more questions I
will open it up to public comment uh now
and we'll do three minutes per person uh
and if you have any public comment
questions you'd like to ask come on
up wow oh okay here we
go good afternoon Tim
Jenkins um thank you very much for the
trust fund
issues um one thing that was brought to
my attention when Karan spoke if we do a
trust
fund my concern is let's just say we do
a trust fund and something comes up in a
year like you know we've done this for a
year it looks like we could really use a
mobile unit if we have some kind of
umbrella in that trust fund that allows
us to say we need
$80,000 to do this Milestone that we
make sure that we put that in there to
where we're able to do that does that
make sense thank
you any other folks in the public that
would like to give
comment okay yes
[Music]
oh Barbara it perhaps they might not be
uh able to hear me can you ask from your
microphone if the Commissioners online
have any questions I will certainly do
that Barbara benom for the record for
the Commissioners who are online are
there any questions that you have for us
please go ahead and come off mute and
ask your questions
okay okay maybe not Barbara we'll have
them email them to you that's all right
okay if that's it I guess the final
question here is is there anything else
you needed from us today and then when
can we expect to be back here so to
thank you for the question mayor proam
Barbara Ben k for the record so today
what we were looking for was guidance on
the four recommended strategies so that
we can then take that next step to
develop the actions and come back to you
all uh with that information according
to the timeline that we have here so I I
think we have the the thumbs up I see
commissioner Reynolds thank you so much
uh but that's what we were looking for
today and then I guess individually as
bodies each of us would have would be
presented with resolutions to to vote on
correct uh yes mer protim once we
determine kind of the administrative
path
forward uh taking that through both the
city council and the County Commission
yes there would be a whole series of
actions that we would need to undertake
that would come back before the
individual bodies because as I mentioned
earlier the funds are held separately by
the city and by the county and so in
order to authorize them for certain uses
you will definitely on the city Side be
getting a budget adjustment uh
resolution for that okay thank you yes
maybe when I just have a question on
the funding
so if we decided to do a trust or
anything like that and there is monies
available um Can these monies be used as
matching funds for
Grants oh good question Chris they're
stumped I don't know if that's good or
bad though use the allowable yeah Jamie
and I were confirming right here Barbara
B coma for the record thank you uh
commissioner shelo Hernandez for the
question again Schedule E which is the
allowable use is really uh what governs
the use of the funds so if the grant
were for an allowable use then I
absolutely think that there uh it could
be used as matching funds and that way
we could leverage them so thank you for
that Barbara I think that helps but also
just kind of a final thought if we did
choose to put some money into a grant or
into a trust I would love to see a
provision in there to where if a
nonprofit organization that is following
the guidelines that we set forth for the
use of this money whether it's you
know whatever it could be I would hope
that we would be able to help out with
possible grant funding um if it falls in
line with the acceptable uses that we
put forth as a board I would love to see
there be like almost like a a process to
help shell out some of that money
especially if they're helping to bring
solutions to our community and it would
even help offset those monies so like
what Mr dunin said about you know
needing a mobile unit or something like
that I would love to say an $80,000 is a
great estimate if you can find it I'll
I'll we'll buy them um but to say like
hey we'll we'll match that $80,000 grant
for 80,000 more whatever it is I would
love to see us be able to do that as a
board and maybe that's another role that
the advisor board can kind of help stay
engaged with is a mechanism such as that
so thank you um thank you for that
commissioner uh shra Hernandez Barb been
com for the record you know we have
something similar like this set up in
the with the telshore fund for health
related public services and our own
Natalie Green administers that where
there are proposals from the community
that meet certain criteria so um I think
that that certainly is doable and if I
may I just wanted to speak to one one
last item here that's very important
especially um uh near and dear to me and
that's the transparency for the use of
these funds I know uh for those of you
in the city council you know that for
arpa funds for telshore funds uh for our
opioid funds we have set up um
transparency portals in the website that
explain where the come the funds come
from what are the allowable uses how
much of the funds we've received from
where and how are they being used and
what is the impact right now we have
that set up for the opioid settlement
funds just through the
the point in time where we're receiving
funds but once we do establish the use
of the funds I very much anticipate as
anticipate that similar to the arpa
funds we would also um continue to add
to that transparency portal to indicate
where the funds are going um who's
administering them and what the the
outcome is um and along those lines we
certainly have uh received numerous um
uh uh documents and um directives from
our state auditor with respect to the
use of funds they're certainly watching
that to make sure that they're um in
compliance with the allowable uses uh of
the funds and so that's something that
we all uh are very cognizant of and
again can be very transparent and and
how we're spending the funds in order to
show compliance uh with those allowable
uses so thank
you okay thank you Barbara um we're
actually going to take a quick recess
due to technical difficulties because
our two Commissioners online have been
trying to provide some feedback and ask
some questions and we want to allow them
to be able to do so so um we're going to
take a quick recess Adrian's going to do
his it magic and hopefully we'll be back
online
soon e
Bo like going through
what
now
for
e
e e
Adrien thank
you we'll wait for folks to get settled
in Commissioners can you hear
me I'm able to hear you madam Pro Tim
okay hi commissioner I can too okay
great hi um commissioner chaparo would
you like to go ahead and uh ask your
questions and uh provide your
feedback um Madame protm I feel as
though I missed a lot of the
presentation because of the audio is
audio issues so at this time I have no
questions well let's start over I'm just
kidding uh okay commissioner gameo are
you on and and would you like to ask
some
questions um I have the same issue isue
that uh Comm commissioner chaparo has as
well so I have no questions to ask say
that are you
sure I am because I don't know what to
ask I would say like you said let's
start all over
again mayor the Audio I wasn't able to
hear um much of
it Barbara Beno for the record would it
be possible for we for us to meet with
them separately afterwards okay yes we
will make sure that you get the
information that was presented
today okay thanks thank you I hope you
are able to hear us as we move forward
to our next item yes Madam chair sorry I
would like to make a recommendation that
this this video that we have will be
available later today and it'd be a good
idea if they would take a moment to
review that and then of course meet
separately yes thank you commissioner
Reynolds yes for both of you this this
is this will be live on the city's
YouTube page so that you can review it
uh as well and then we'll have Barbara
and Jamie reach out to you
individually and hope you can hear us
for this next item which is
3.2 overview of emergency transportation
ambulance services within the city of
Las crusis and donana County and I'm
going to hand it over to Steven Lopez
assistant County manager and Brad
Douglas city of Los cruus
attorney good afternoon uh mayor protim
and Cher Shalo Hernandez Steven Lopez
assistant County Manager going to just
give you a little bit of uh information
and then I'll be turning it over to City
attorney Brad
Douglas over the last roughly 10 months
the uh city has contracted with AMR
American Medical Response uh to provide
Ambulance Service throughout doniana
County and this was a result of a joint
agreement between the city and the
county and we have noticed on the county
side significant uh impact uh adverse
impact to our uh fire and rescue
department and so we started working
with the city of Los Cruz's
Administration over the last few months
uh the city has been noting similar
concerns and so we jointly wanted to
bring this item up to you all uh to
start having a discussion about where we
may want to go in the future for example
for the doniana county side in the last
four months of
2024 the county was averaging having to
transport
225 patients each month because AMR
could not uh that's a big impact for
County fire rescue um and again that's
averaging out over four months and this
becomes a bigger impact to the County
because we lease our license our
certificate of need to AMR as part of
the contract had we not been doing that
we would have been able to Bill an
annual average of $1.4 million or more
to
insurance so we are currently
subsidizing AMR not only in the $3
million that the county provides the
city to provide to AMR by contract but
we're also losing out on any potential
billable Revenue because of what we're
having to cover because AMR cannot so
with that I'm going to go ahead and turn
it over to Brad Douglas to talk about
the history of the contract and where
we're at now thank you
Sten all right good afternoon uh mayor
protim Mr chair uh County Commissioners
and city council my name is Brad Douglas
I'm the City attorney for Las cruus and
I would like to give you kind of a
general overview of the situation uh in
which we find ourselves and basically
how we got to where we are today and
then at the end um I'd like to not that
I can open it up for discussion but I
would hope that you would all have some
uh
discussion all right
so uh some years ago the city of Las
Cruses had requested uh that the nmprc
that's the public Regulatory Commission
issue a certificate so that the city uh
could manage and provide ambulance
Services um doniana County had filed a
formal protest or they rather they
objected to the filing with the
nmprc and subsequently negotiations
between the parties took place in July
of 2020 the city the county and AMR
negotiated a settlement agreement that
would allow the city to file a permit
with the PRC to provide those ambulence
services that same settlement uh stated
that the lasusa fire department would
trans transport all sick and injured
persons within an exclusive operating
area and so how did we end up uh where
we are the settlement stipulated that
the city would go through the formal
request for proposal or RFP process to
select a contractor for ambulance
services for a unified response system
uh throughout the
county excuse me uh on November 10th of
2022 this city issued a competitive RFP
to select the contractor and as a result
we received one proposal from American
Medical Response also known as AMR this
proposal was evaluated and scored by the
selection advisory committee who
recommended
approval a little over a year ago city
council through resolution 24- 84
authorized an annual not to exceed
amount of $3 million for ground
ambulance services payable to AMR and
then that Professional Services
agreement was ultimately signed by all
parties honor about May 24th of last
year the agreement contemplates a 5-year
time period with the option to extend
for three additional one-year
terms and as Mr Lopez stated the county
is currently leasing its ambulance
certificate to AMR with this lease set
to expire honor about February 23rd 2026
uh with regard to a list of possible
concerns it should be noted that uh the
city's agreement with AMR uh really
explicitly States the importance of
meeting response time standards
throughout the county uh there is
language in there that suggests that of
course we obviously want to be
economical about this and we want the
best rate that we can possibly get but
that economy is no substitute for
meeting response time standards it is
very well understood that that is
important to both the city and the
county uh with regard to the agreement
itself areas of coverage are broken up
into individual zones throughout the
service area uh I think of it as North
Central and South as far as the county
goes with different um response time
standards throughout of course distance
is
important um and the response times are
mandated to be met at least 85% of the
time for one zone and at least 90% of
the time for the other two zones call
that don't meet the response time
standards uh that are articulated in the
agreement are subject to liquidated
damages per violation and these damages
would be payable to the county at the
end of the current fiscal
year with regard to the liquidated
damages the city is alleging that AMR
has consistently failed to meet these
response time standards so far
throughout the entire life of the
agreement and the current I think it's
very important to say that these are
alleged liqu data damages they haven't
been proven but to the best of our
knowledge uh for quarter 1 around
$450,000 Brad Quarter Two I'm sorry I'm
so sorry to cut your to interrupt you I
just I think our folks online Lost okay
um audio and so we may have to have
Adrien uh
n come help us once
again um so just one second Brad I'm so
sorry thank you mayor proen
Adrien are you able to come out
here apologies to folks online who may
be tuning in uh we're just having some
tech issues today so uh bear with us as
we try to ensure our colleagues have all
the necessary information today
for
for for
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sing Tim I can sing
okay like I'm not yeah we're just GNA
just phone it
in like we're not even getting anything
from the speakers either yeah the just
just put it on let's just put it on the
this but we're not going to be able to
hear that yeah
yeah audio card's
done okay okay we sincerely apologize to
our presenter to our two Commissioners
to the public we
are figuring it out um next time the
county can have us there and
um maybe we'll avoid the tech issues I
don't know perhaps but Brad please go
ahead I don't even know where I cut you
off so maybe start at the top of this
page six thank you mayor protim um so as
I was discussing
the Professional Services agreement
entered into between the city and AMR
does
contemplate uh liquidated damages when
AMR does not meet their response time
standards and that's broken down in a
couple of ways uh anytime they miss a
response time standard for an emergency
call or priority call as I might refer
to it there are liquidated damages in
addition to anytime they don't meet the
overall response time standards for each
specific Zone there are also uh
enumerated liquidated damages within the
contract and so unfortunately uh we have
good reason to believe that both of
those things are occurring and so our
current alleged and I do think it's
important that that I say alleged
because it hasn't been proven yet but
administratively what we believe
liquidated damages are currently uh in
the following amounts for quarter 1
approximately
$450,000 uh for Quarter Two $973,000
and for quarter three
$867,000 in liquidated damages and
you'll notice that I put a note by
quarter 3 that says uncontested so far
uncontested by AMR is what that means
and really I should have put that note
by quarter two as well uh the quarter 2
liquidated damages have not been
contested by AMR as of today that could
change but as of today those are
uncontested
amounts uh particular ular note I I
pulled this out of our quarter 2 numbers
uh we're alleging that
2,67 calls were late from quarter 2 um
AMR has only requested an exemption of
283 of those late calls so basically the
response so far is um of those
2600 approximately 280 AMR saying well
it's possible that those were not late
and so with regard to the future of
ambulance services throughout the
entirety of doniana County we do believe
that there are some important factors to
consider uh as I mentioned earlier when
we went through the formal RFB process
AMR was the only responding
party um with regard
to the alleged failure to meet response
time standards uh the process for what
where we go next is actually laid out in
our contract so the city's contract
administrator May determine that a
material breach has occurred and if
public health and safety are endangered
AMR will be given a reasonable
opportunity to correct said breach uh
basically what would happen next is I
would work with the city's contract
administrator I believe that's our
purchasing manager Alicia if that's not
you I
apologize um and then we would
coordinate a response or or request or
demand rather to AMR to take remedial
measures um there is actually a step up
uh from that and by the way that that
kicks in if there's non-compliance for
any three months out of the preceding
12-month period which we believe we're
already
there uh possibly uh there is an
accelerated measure of relief laid out
in the contract as well if there's found
to be non-compliance for six months in
the preceding 12-month period again we
could already be there uh then the AOC
the ambulance oversight committee uh if
they concur with the city's contract
administrator there is an emergency
takeover Clause that the city uh could
take over operations uh and the way I
read that is potentially even including
equipment uh the only thing that would
be excluded and I reserve the right to
change my reading of this is Personnel
would be
excluded and if that were to occur then
that that hand offer that takeover would
have to occur very quickly within 72
hours of that finding by the ambulance
oversight
committee so next steps would be if we
do allege a material breaches occurred
regarding the response times AMR must
make reasonable goodfaith efforts to
correct the breach if that breach
endangers Public Health um and the next
note I I put in here uh the city would
have to be prepared in the event that an
emergency takeover becomes necessary
we're not making that our position as of
right now that that's what we are ready
to do but if it were to occur we would
have to be ready uh in an expedient
manner because in the last slide I
discussed that 72-hour
turnaround and lastly of importance uh
pursuant to the terms of the agreement
AMR May at their discretion terminate
this agreement without cause as soon as
July 1st of this year and so that ready
component uh is again very
important and that concludes my
presentation thank you Brad thank you
mayor protm um go ahead councilor Flores
thank you mayor protm and and thank you
uh Brad
um um attorney Douglas I um I'm not
surprised to uh I'm not surprised that
you've presented this report about them
and um our fire department had was th
this topic came up several years ago and
um I mean the same old same old same old
and the person who was heading that or
owner I don't know he came in here and
stormed and you know was yelling at us
and yada yada blah blah and there was a
lot of blah blah and they they they said
oh you know we're going to take all
these corrective measures and yada yada
and here we are and my concern I mean if
all if it all falls well first of all
you said they were the you listed one of
the fact how they came about they were
the only ones who applied yes is there
anybody else in the area that would be
able to perform that Duty or that
service because and then you know it's
like you can't take blood out of a stone
or whatever the expression is can't
bleed a rock I don't know but um I I I
think we're between a rock and a hard
because what options do we have but the
my real concern here is the people the
people who uh have not gotten the
service and you know we probably have
had some deaths or dire consequences of
no response or has our department jumped
in just for the record Steven Lopez the
assistant County Manager uh the of L
crues within the city limits has
actually been very well poised had good
over good foresight to build up that
emergency response capability within the
Los crues fire department and so they
have been handling those high priority
calls um which is fantastic and you
asked you know kind of what can be done
we're between a rock and a hard place um
at the County uh County management has
been working with our individual
Commissioners about the potential need
to move to fire-based Emergency Medical
Services uh we expect delivery of three
more some people call them ambulances in
the fire service right now they're
calling them rescues way back in the
days of Squad 51 they were called squads
um but we're we're getting three more of
those within the next week and a half
with those plus what the Sunland Park
fire department has and the msia fire
department has we will actually have
more ambulances in the outside the Los
crues area than AMR has right now so we
are not quite ready Staffing wise but we
are getting there by July 1 we are fully
prepared to take over Firebase EMS if
need
be well thank you that's really uh
reassuring because I think
um we have a saying in Spanish so if you
don't understand Spanish even better
thank
you thank you counselor is anyone
else commissioner uh Reynolds and
then Madam chair thank you very much um
I started studying the AMR service about
uh five years ago when I first came on
almost six years ago and pulled all the
mvda data for a year in order to study
whether or not they were meeting the
contracts that we have have and since
I've been on the MDA board for the last
six six years now uh I've have not found
them to be able to meet the required
times of response times in either the
city or the county consistently at any
year that I've looked part of the reason
is the way that they manage their
service and one of those is that you
you'll get a service call out to have
somebody show up here at this building
and then it's their choice to actually
move it from one Squad to another Squad
which they can do but when they do that
the there's no handoff so the one Squad
may get called 20 minutes later they'll
hand it off to another Squad who takes
10 or 20 minutes to respond but there's
no connection from the time of the first
call until the squad that actually
responded so we have a problem with
recordkeeping we have a problem with
management we have a problem with
response and also having people out and
my one of my districts
Tela uh I've actually been been there
talking to them on several occasions and
they say that their instructions to
their family members are drag my ass
excuse me drag me into the car and drive
me down to the hospital because I can't
wait 45 minutes for the ambulance to get
here and that's been the standard
practice from the time I've been in the
office for now almost over six years
thank you oh and also we are we are we
have been preparing for this moment for
like four years as well thank you
commissioner Shalo ernandes thank you so
no I appreciate yes um no I just have a
quick question sorry I'm getting
Delirious um who makes up the ambulance
oversight Committee hearing board people
group that is an excellent question
commissioner one that I do not have the
answer to the contract contemplates that
it'll be made up of both city and county
officials uh Chief Smith you're not
Chief Smith Chief Smith hasn't shown up
to work for weeks uh inter Chief heck
might have some more insight into
that mayor proam council Sean heck
interim fire chief uh the AOC is made up
of mainly the the fire department um
since we were the contract
administrators who created it so the
city fire we we lead the AOC but we also
have um the county Chiefs in there too
as well Sunland and and
msia Los crues doniana and then of
course Jimmy Michael she's also involved
with this as well and that that is our
responsibility is to look at the data
and provide the um oversight on whether
not to get an exemption on the A on the
ocu which is where the the the money
comes from and then also the other
components of the contract where they're
supposed to be providing us uh data on
their apparatus rating this uh the
service on the apparatus their response
time um I'm sorry their unit
availability times their plan for
deployment uh which we have not received
that part either yet to date and we're a
year we're past a year of this contract
already it would affect March
one awesome thank you Brad really quick
on one of your slides you had uh
actually don't even go through the
slides it's not even going to work um
but what is the trigger Andor the
mechanism that would force the
AOC um to kind of start looking at this
what was that trigger point so mayor
protim uh Mr chair that trigger would be
if the contract
administrator uh makes a finding that
for any six-month period and they don't
have to be consecutive in the way that I
read them of the preceding 12 that AMR
is non-compliant with their response
time standards meaning 85 and I'm just
making the zones up but North Central
and South 85 for one of those zones 85%
of the time and then 90% for the other
two if they're non-compliant for 6
months then the AOC uh can Implement
emergency takeover
proceedings thank you for that Brad that
is
um very definite take on that thank you
thank you thank I'm going to ask some
questions and then I'll come back to you
thank you for your questions I in terms
of the exemptions can you talk a little
bit about that how do how do they go
about Amar go about getting an exemption
for not showing up to a call Mayor
protm yes so I can talk generally about
it I'm going to defer again but with
regard to exemptions so what what you
would be looking at there is if
something is classified as a priority
call and then later on it has found and
they don't meet the response time let's
say and then later on it's found that it
was actually not a priority call let's
say it was mistakenly classified as
priority when really it was just an in
facility transport uh you know moving
from One hospital to another or one
carrier to another in a n non-emergency
status they could contest uh that
finding and request an exemption Chief
heck am I on base or totally off base
there again Sean hick andum fire chief
um no that's exactly right I mean
there's in the contract they have some
criteria that allows them to get
exemption whether they're cancelled
whether they're downgraded onto a call
and um and then of course inside of the
call itself there are certain parameters
that that they can as well uh we were
looking at the uh concept of but the
scene is not secure right and then
because it's not a secure scene you
don't want we don't want people driving
code three so response time criteria
kind of tapers off on those a little bit
um and so there are a few items within
the contract itself that allow us to to
provide them that exclusion and
basically the way the system is designed
is they're supposed to go through all
those calls and then they submit a
request through this the their program
first watch they submitted request to
get it Exempted and then we turn around
on our side between uh the chief DC and
then uh the BC CEO BC we go in and we
look at those and say yay or nay and
then we say yes they get it or no they
don't and um so that's kind of where
that's supposed to go the problem we're
running into is that um they're not
doing it I mean we're not and that's why
it's uncontested I've been trying to
make sure uh when when when Brad was
presenting that they still have that
right to do so per the contract but it's
been a very challenging process to get
that done I mean we still hav any the we
did that million-dollar request a few
yeah part of that reason we're doing
those things is because they're not
getting that part done they haven't even
looked at quarter two yet except for 239
calls of the 2000 um none in quarter
three quarter four I mean again we're a
year in and we've really not done a
whole lot for that part of it so the way
it looks in my head today and talking
with staff is that the numbers are the
numbers and we're just going to move
forward with that and just call it a
today because we've been trying to get
them to follow through on that part of
it thank you and then just a real quick
point of clarification just to make sure
the zones are laid out in the contract
and and he's kind of right there's
there's the north the Central and the
South the response time only is in the
central though the North and the South
have what we call level of effort where
they just do the best they can which is
I understand your concern in the county
is that is because realistically there
isn't a true time because one of the
things we did is we we forced AMR to
keep units in the South and in the North
in the past they would take those units
from the North and the South bring them
in to cover the city because we're the
busiest but they would also bring them
in for non-emergency transfers too but
they would bring them into the City and
then you wouldn't have that unit
available at all in that area so now
they have to keep the unit there and the
unit that's there is just doing the best
they can with what they got kind of
thing and but they're still running into
the same issues that they're having to
transport no different than us I mean we
we we're averaging somewhere in the
neighborhood of about 800 transports a
month in in the city alone for for those
calls that are not our calls because
they're right we took the emergency we
took the big ones we took the ones that
have the greatest impact on life like
CPR uh chest paint Strokes those are
fire department you're getting us um the
other ones we're still having to
transport in the neighborhood of roughly
about 800 a month of those cost that are
supposed to be done by AMR just because
of lack of availability that's a
significant number thank you thank you
enam Chief I think the other concerning
thing is that outside of the sort of
zentral Zone like you said that the bar
is
low and it's still not being met yes
ma'am um I think you know councelor
florides is right we have been here
before in terms of this conversation and
so um obviously you know I'd like to
hear from our fire department as well in
terms of Readiness and and the
challenges of of being able to meet that
whether it's July or sooner um you know
we heard a little bit from the county in
terms of the number of uh apparatuses
that you'll have that's great I am
curious if we can get an assessment from
the
city yes ma'am again in term Chief Sean
heck um for the record yeah so as it
sits today we have four rescues right uh
ambulances right that are uh 247 right
now that are operating for the
Department uh we just put our fourth one
which was doing 12 hours as right now
it's doing 24 hours so we have those
availability right now we have uh rescue
9 when N9 is built come right come
February when nine opens up we have
another rescue that's going to be there
too as well and then of course we have
our backups our Reserve we have in the
neighborhood of we have three van Styles
which aren't the best but if you need to
use them they work okay but then we also
have an additional four um apparatus too
that are in reserve and we got another
one coming um so for us we're set like
we were set last year we just have to we
we're going to have to pick up a few
people to kind of help support this
because of the numbers and the amount of
units we want to have available um to
meet the needs of the community so that
they're not waiting so we may if we set
a standard of 12 and and and and 13
minute response times uh then we need to
meet that too as well as as the
department but we're poised to do that I
think it would have been a little tight
last year but we're definitely in a
better position now because again we
already have 4 24s running right now and
we need seven total units and we're
almost there and seven drivers more than
that well it's it's it's more than
driver it's a EMT but two EMTs on it
right and so right so you you'll need
the two Personnel per that uh we would
need another 20 so we need five 24-hour
trucks and two peak time trucks to meet
the needs of the city is what we what we
would need for us okay thank you um
hoping we can I don't know if there's a
budget analysis for that in from the
city manager um that we can get and then
the last thing I'll say on this is that
um obviously the the obvious challenges
are there right like matter of life and
death in some cases and many cases I'm
sure just honoring a contract all those
kinds of things I think the additional
sort of piece that feels really
important to bring up Brad is like this
is also a consumer protection matter
right and so maybe not you're the
attorney I just feels to me like there
are um like serious issues here Beyond
just not being able to meet the terms of
the agreement mayor proam that's exactly
right I I think of it as I think that
you or or maybe councelor Flores had
mentioned negative outcomes that's
something that we want to obviously
avoid at at at all costs um I would say
at this point uh the next steps that
that I'm going to pursue and unless I
hear something different from you all is
I am going a coordinate with the
contract administrator and AMR should be
expecting uh to receive that
communication this week because we would
like to see their plan for remediation
to to address these issues hopefully
that's the end of it um hopefully it
does get addressed to both the city and
the county
satisfaction um but if it doesn't work
out uh you know the reason for some of
the slides that I put in here kind of
focus on Readiness and some of your
questions focus on that as well but I
just wanted everyone to be aware that we
need to be ready uh to take over on very
short notice if if that's what ends up
occurring thank you bradan I also just
want to thank you all for having you
know these uh conversations both city
and county that's very important thank
you mayor Pro yes commissioner Reynolds
Madam chair thank you very much uh prior
to the contract in 2024 I've been on the
board since 2019 prior to that contract
we did have a specific response time I
think if I remember correctly it was 40
or 45 minutes that we required and uh
they never met those standards either so
uh based on the numbers that I was able
to pull um then the other but I do have
a question if in fact we do uh they do
we do take over their uh contract do we
also get any of their assets like some
some other
ambulances mayor protim commissioner
Reynolds uh in my reading uh as recently
as two or three days ago of the
agreement the the emergency takeover
provision seems to anticipate that the
Takeover would involve equipment and
assets uh the only exclusion in my mind
or what wasn't clear is that it would
not include personnel and with regard to
the 45 minutes that you referenced that
language is actually uh still in the
current the current agreement um there's
a clause that states that in in no event
shall a call take longer than 45 minutes
to respond to thank you very much that's
what I thought as well and thank you for
responding about the equipment because
it was my understanding that by taking
over a utility we actually get all the
equipment as well thank you thank
you uh commissioner sh
randz thank you mayor protm um Brad
really quickly so in the contract Whoa
We you've been talking about how they're
curing the calls if there's any that you
know they're they're asking the AOC to
cure or whatever so in the contract also
there's the part about a third party uh
data review is that that AOC
board no that is not I'm not sure
honestly okay there's a lot of people
saying no okay so with that being said
in the in the contract it clearly states
that they have to be out of compliance
for 6 months in in a 12-month
period and basically they're behind how
many months on getting us that data
I'm sorry um Mr chair I don't think I
understand the very last part with
regard to let me let me answer and let
me see if it answers your question or if
I'm confused the way that I read the
data is so far and chief you correct me
on this if I'm wrong uh every single
month has been delinquent in meeting
those response times and now the
six-month
requirement uh applies to an emergency
takeover that would have to be approved
in recommended by the AOC however the
remedial measures requirement is only
that they be not meeting response times
for a three-month period I strongly
believe that we are already there
arguably for both but certainly for the
remedial measures
requirement okay no that makes sense so
thank you for that I was just
um I'm trying to understand exactly so
there's two things that play then right
there's the money aspect of getting
compensated that way and then there's
the deficiencies on their contract and
what they're actually performing so we
believe that they are in they're not in
compliance with both of those
aspects uh unless someone corrects me I
believe that's accurate okay and then
which portion of that triggers the kind
of not the money remediation but the
we're taking over Ser service portion
not meeting response times for the 3
months or the six months six months six
months and we have all that data from
the day that they started services in
Los Cruses and doniana County to now we
have all that data up to date I believe
that's accurate okay so then I think the
only thing that I just have a question
of is is that in the contract that we
kind of got a presentation on one of the
key differences was all that data needs
to go fourth through a third part party
data
review portion system so that's my only
question is what is that uh mayor proam
Mr chair uh candidly I do not know I can
look into that and and get back to you
unless Chief fek might know he's raising
his hand Sean again um yeah so that is
that First Watch program the ocu the O
the uh the oversight compliance utility
right that third party program it was in
the contract that they have to find and
it's their program I mean they they're
the ones who went out and got it they're
the ones who brought it they use it in
other locations so this is a program
that they've been using in other
locations who have the similar standards
that we that we set forward so we've
already been exercising this program
that's what we were it came online
probably about in August we spent two
months exercising it get it right so all
the data comes in what's our clock start
time what's the clock stop time I mean
for those response times so we went
through all that effort for two and a
half months to get it where it's
supposed to be and so that's the data
that's sitting there so that's that
review that you're referring to sir it's
it's through that company called First
Watch and it's it's in play the like I
said our problem is is they're not
exercising it they're not utilizing it
as the contract said and but even if
they did I I just their their average
response time percentage right now is
like 45% in the city and even at their
best trying to scrub some there's no way
they're going to get another 40% back in
my mind so that's why I'm I'm very
confident in in what Brad's bringing
forward that yeah I don't they haven't
been hitting it and at all theyve been
hit those benchmarks at
all all right thank you so much thank
you thank you thank you um I'm just
checked in with county manager and there
are no uh texted or emailed questions
from our folks watching online so if
there are no other oh my apologies
commissioner Reynolds Madam chair I'm
sorry
um talking a lot but there's one more
thing I think is relevant that this
board should know or both boards should
know and that is one of the biggest
challenges we're going to have moving
transitioning into this uh service is
actually having someone to do the
billing for the transports because it's
a medical it's insurance that gets built
and right now I don't believe that the
county is in a position to start taking
over that building and I'm not sure that
the city is
either we we have contracted with
somebody we've been using someone for
two years two years now I was looking
for Mike but he's not paying attention
to me but I think we've been using this
person uh emmc we've been using them for
the past couple years um because we we
do have since we got our Co that was one
of the benefits of getting it is we
since we've been transporting so much we
started tapping into that part so
they're they are poisoned and ready to
help you when you need it they' love to
get your business so Madam chair um
thank you DC I appreciate it and uh
that's something the county will have to
deal with thank you madam chair thank
you um will take any questions comments
from the audience at this point for
public comment for three
minutes okay uh look looks like nobody
if no one else from the Das has any
additional questions uh that is it for
joint session if I can get r a motion in
a second to adjourn so move by
florus second sh hernandes all those in
favor to end today's meeting say I pee
hi hi all those again say thank
you
e for