What's going on with Collier EMS? Medical director on his way out.

• EMS medical director, Dr. Robert Tober, received notice from the county that his contract is not being renewed.

There’s been speculation Collier County may privatize emergency medical services where paramedics respond and treat patients in the field and take them by ambulance to hospitals.

Collier County Manager Amy Patterson outright dismisses the talk and says privatizing EMS is not being considered.

Still, there are headwinds of change impacting EMS and more could be on the way.

A coalition of medical directors from the fire districts, municipalities, EMS and area hospitals has been meeting to examine protocols and credentialing to see what can be improved.

In the near future, North Collier Fire Control & Rescue District will launch its first “fire-based medic transport unit” and expand from there, said Jorge Aguilera, deputy chief of North Collier.

EMS is a vital function for Collier residents in responding to 911 calls for emergencies. The department has 237 employees and an operations budget of $52 million. It responds to 48,000 calls a year through 911.

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The department has 25 stations with 26 ambulances and two MedFlight helicopters for quick transport of patients with traumatic injuries, according to the county website.

North Collier starting patient transports soon may have fueled speculation about the future of EMS but other things appear to have contributed.

The fire district is not aiming to take over EMS by getting into patient transports, Aguilera said.

“The key is we are not replacing (EMS), we are augmenting it,” Aguilera said.

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The county has notified Dr. Robert Tober, medical director of EMS since 1981, that his contract is not being renewed.

Another issue that has stirred talk is a newsletter former Collier County Commissioner Penny Taylor sent out two weeks ago. It says more could be going on behind the scenes regarding the future of EMS. Her periodic newsletter is sent to 3,000 in the community.

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Taylor met with the county manager Feb. 21. Patterson told her there is no plan to privatize EMS.

Taylor said she believes changes are coming, even if it does not entail hiring an outside company to run EMS.

“I think it is in flux,” Taylor said.

Aguilera said he has not heard any talk of outsourcing EMS.

“I have not heard the word ‘privatization’ of EMS at all,” he said.

Officials with the Greater Naples Fire Rescue District have not immediately responded to questions.

Tober, who has been medical director of EMS since its inception, declined to provide a copy of the notice of his contract not being renewed to the Naples Daily News.

As a public record, the letter dated Dec. 20 is two paragraphs and is formal notice that his contract expires April 26.

“After careful consideration, we regret to inform you that the County has decided not to renew your agreement upon expiration,” according to the procurement director. “The County intends on soliciting for these services.”

If Tober wanted further clarification, he was told to contact the procurement division.

“We are committed to ensuring a smooth transition as we approach the expiration date,” the letter said.

Tober turned in his resignation Feb. 25 to Patterson effective the end of his contract in late April.

In her newsletter, Taylor said Tober was not given the opportunity to respond to the planned solicitation for the position he has held for decades.

“He is an icon in our community for 47 years,” Taylor said.

Others declined to comment about the county's notice but lauded Tober for what he has done for the county and elsewhere in the community.

He was chairman of the department of emergency and ambulatory medicine at NCH from 1986 to 2003. He was medical director of the Neighborhood Health Clinic from 2003 to 2020 and medical director at Vi at Bentley Village from 2001 to 2020.

He is on the faculty of the University of Miami Medical School and on the university’s governing board on EMS education.

The county’s EMS was voted as the top system in the U.S. by the National Association of Emergency Medical Technicians and Paramedics in 2000, and twice Tober has been EMS medical director of the year from the state Department of Health EMS.

Mike Reagen, retired president and chief executive officer of the Greater Naples Chamber of Commerce, said in an email that Tober has expertly guided EMS since its inception.

“In my opinion, Dr. Tober is an iconic pioneer who has demanded outstanding EMS standards and deserves honor and credit for the extraordinarily positive impact he has had on the quality of health care in Collier County,” Reagen said.

 “He has demonstrated outstanding servant leadership and as he ends his public service career deserves positive public recognition and appreciation,” Reagen said.

Collier County Sheriff Kevin Rambosk similarly pointed to Tober’s achievements for EMS, from his hands-on training of deputies and others in the sheriff’s office on CPR to helping the sheriff’s office navigate the COVID-19 pandemic.

In 2011, Rambosk had employees of the 911 communications center identify ways technology could reduce response times.

Changes went into effect in 2014 that shaved more than 60 seconds from the time a 911 call is answered until a first responder arrives on scene.

“Dr. Tober worked alongside the team to make recommendations that would streamline the medical protocols used when the 911 center was speaking with callers, while still providing the high level of care the community was accustomed to,” Rambosk said. “(He) shares my commitment to utilizing innovative initiatives and emerging technologies to provide the best service to our community.”

Patterson said based on state law and a local ordinance on procurement, Tober’s contract is not being automatically renewed and is being put out as an open and competitive solicitation for service.

“Anyone, including current service providers, can submit a new proposal for evaluation and competitive selection,” she said.

In terms of the talk about privatizing EMS, Patterson said: “There have not been any discussions or comments made by (Collier commissioners) to my office or staff dealing with the privatization of EMS.”

Another issue that has contributed to questions about EMS is a recent decision that some EMS staff have been told they are being moved out of the county’s Emergency Operations Center off Lely Cultural Parkway to the main county campus on U.S. 41 East.

Patterson said only EMS staff who work in fiscal areas are moving for the purpose of improved collaboration with the county division that oversees the budget and spending.

That is part of the Collier commission’s recent “priority-based budgeting initiative” that is tied to ResourceX , a company that uses the budget method with software to help governments  direct resources to high-impact initiatives and minimize wasteful spending on low-priority programs, according to ResourceX’s website.

Besides her recent meeting with Taylor, Patterson met with two EMS leaders, Tober was not one of them, to talk about the future of EMS.

“I conveyed to them that there has been a lot of misinformation, and potentially intentional disinformation, circulating in the community on the state of EMS and the medical director contract procurement process,” Patterson said. “I requested their assistance in providing accurate statements to those who may inquire about this topic and reassuring our crews that they are baseless rumors.”

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Tober sent an email to various community leaders about the meeting between Patterson and Dr. Douglas Lee, deputy medical director of EMS, and Bruce Gastineau, EMS chief.

They were inquiring about the future of EMS since “nobody really knew the answer to that question, so it was delivered directly to her,” according to Tober's email.

They were told EMS is not going anywhere, and that the county is hiring additional paramedic trainers and moving forward, according to Tober's email.

He added that the county’s Medflight helicopter program is having a hard time finding a replacement mechanic for the chief mechanic and it may take raising the salary.

“Since Dr. Doug Lee has spent more than 12 years with me, he is the right person to carry on the medical directorship of EMS,” Tober’s email said. “Both Dr. Lee and (Gastineau) right now are struggling to reassure the field medics that they will still have a job and a future.”

In his Feb. 25 resignation sent to Patterson effective late April, Tober said there have been disheartening decisions in the last two years under her leadership that have lacked transparency.

Tober said he was not consulted with changes in a county ordinance, the Certificate of Public Convenience and Necessity, (COPCN) which provides guidelines for the care and transport of sick and injured patients within the county, according to his resignation letter.

The changes extend transport capabilities to other agencies with staff that have less training and hands-on care of patients and transport experience, he said.

“It fragments services within the community and dilutes clinical encounters which ultimately degrades our emergency medical system,” Tober said.

Aguilera, with North Collier Fire, recalls Tober was online when discussions took place about revisions to the ordinance.

Tober said the decision not to renew his contract was not discussed with him and he was not given any reason for it.

“After 47 years of successful service as the medical director in the community, I would have anticipated the courtesy of a professional conversation and not a generic letter from the director of procurement,” he said.

Aguilera said the more than 100 paramedics with North Collier have gone through the same course training and certification as EMS paramedics.

That’s in addition to being firefighters. All 240 firefighters with the fire district are trained as emergency medical technicians.

The county's EMS has faced hardships in recent years recruiting paramedics and North Collier getting into transport of patients will help relieve some of the strain on EMS, Aguilera said.

From 2019 to 2021, the turnover rate was in excess of 100 EMS personnel because the county was not competitive with other emergency service providers in the region on pay, according to John Mullins, the county's division director of communications and public affairs.

Fixes to the pay disparity began under the previous county manager and has continued under Patterson, Mullins said.

There are 31 vacancies in EMS now, yet seven recent hires will start March 10 bringing the openings down to 24, Mullins said.

North Collier has acquired seven ambulances over a number of years but the district only recently gained certification to start using them for transporting patients to hospitals.

North Collier's transports will start with one ambulance, which Aguilera calls a “fire-district based medic transport unit” in 90 to 120 days, he said. They will add more over time for patient transports.

“We will have three people on board,” he said. The goal is to not have a fire engine dispatched to a medical call to save resources, he said.

“It (the medic unit) will have enough resources not to need a fire unit,” he said.

Fire engines frequently are first to arrive at a field call and initiate medical care. An EMS ambulance typically has two paramedics, he said.

“We are doing this in lock step with the county,” Aguilera said. “We will bill the same rate as EMS. We are actually using the same billing company.”