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2023-28-Minutes for Meeting December 21,2022 Recorded 1/17/2023vyCES 0 BOARD OF COMMISSIONERS 1300 NW Wall Street, Bend, Oregon (541) 388-6570 Recorded in Deschutes County CJ2023-28 Steve Dennison, County Clerk Commissioners' Journal 01 /17/2023 3:46:34 PM FOR RECORDING STAMP ONLY BOCC MEETING MINUTES 9:00 AM WEDNESDAY December 21, 2022 Barnes Sawyer Rooms Live Streamed Video Present were Commissioners Patti Adair, Anthony DeBone, and Phil Chang. Also present were Nick Lelack, County Administrator; Kim Riley, Assistant County Counsel; and Brenda Fritsvold, BOCC Executive Assistant. This meeting was audio and video recorded and can be accessed at the Deschutes County Meeting Portal website www.deschutes.org/meetings CALL TO ORDER: Chair Adair called the meeting to order at 9:01 a.m. PLEDGE OF ALLEGIANCE CITIZEN INPUT: Chair Adair acknowledged the receipt of one citizen input email regarding designating a position on the Planning Commission to specifically represent the Tumalo area. CONSENT AGENDA: Before the Board was Consideration of the Consent Agenda. DEBONE: Move Board approval of Consent Agenda CHANG: Second VOTE: CHANG: Yes DEBONE: Yes ADAIR: Chair votes yes. Motion Carried BOCC MEETING DECEMBER 21, 2022 PAGE 1 OF 13 1. Consideration of Board Signature of Order No. 2022-067, Road Name Assignment of McClain Drive 2. Consideration of Board Signature on Document No. 2022-955, Improvement Agreement for Phase A of the Caldera Springs Destination Resort Expansion 3. Consideration of Board Signature on Document No. 2022-954, Improvement Agreement for Phase C-1 of the Caldera Springs Destination Resort Expansion 4. Approval of Resolution No. 2022-081, recognizing the receipt of $147,595 in grant funding from PacificSource and increasing appropriations within the Health Services Fund and the 2022-23 Deschutes County Budget 5. Consideration of Board signature on letter appointing Danielle Grimes to the Deschutes County Central Oregon Housing Authority (dba Housing Works) Board 6. Consideration of Board Signature on letter reappointing James Getchell to the Newberry Estates Special Road District 7. Approval of the minutes of the December 7 2022 BOCC meeting ACTION ITEMS: 8. Presentation from CASA of Central Oregon Heather Dixon, Executive Director of CASA of Central Oregon, shared that the organization's purpose is to match every child who has been neglected or abused with a trained volunteer who advocates for the child's best interest in court and at school. Dixon said children with CASA volunteers do better in school, are more likely to receive therapy and health care, are less likely to move from residence to residence or get stuck in long-term foster care, and are significantly more likely to find refuge in a safe, permanent home. Dixon explained that when children enter the foster care system, the State becomes their parent. Although each child's personal advocate is assigned by a judge, CASA provides them with the training and support they need to make a difference in the lives of the children they are matched with. Dixon said of the 215 children currently in foster care in Crook, Deschutes and Jefferson counties, some are not yet served by a court -appointed special advocate due to the insufficient number of volunteers. Commissioners expressed appreciation for the organization and encouraged community members to volunteer. 9. Consideration of Board signature of Document No. 2022-984, Funding BOCC MEETING DECEMBER 21, 2022 PAGE 2 OF 13 Contribution Agreement with ODOT for the US 20/Locust Project Chris Doty, Road Director, and Bob Townsend from the Oregon Department of Transportation (ODOT) shared the history of efforts by the City of Sisters and the State to construct a roundabout at the intersection of US 20 and Locust Street to better manage traffic and provide a safe connection to the highway. Deschutes County had previously indicated its support for this initiative and pledged a $1,000,000 contribution towards the project. Sisters has agreed to contribute $1,250,000 and ODOT has budgeted $5,000,000. Townsend said the State expects to go out for bids late t2023 and start construction in early 2024. The project's estimated completion date is late May of 2024. Commissioner Chang inquired about the trucking community's opinion of the plan. Townsend responded that the roundabout's lanes and turning configuration have been sized to their satisfaction. DEBONE: Move approval of Board signature of Document No. 2022-984, a Funding Contribution Agreement with ODOT for improvements to US 20 at Locust Street CHANG: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion Carried 10. Informational presentation on the Tumalo Wastewater Feasibility Study Chris Doty, Road Director, summarized that the purpose of the Tumalo Wastewater Feasibility Study was to analyze the feasibility of implementing a wastewater collection and treatment system; the analysis included various alternatives and possible rates and fees. Commissioner DeBone said the County recognized the differences of opinion in the community on this issue, and funded the study to supply needed information. Doty agreed that the study does not mandate that a wastewater system be built but rather was done to investigate the feasibility, options and anticipated costs of such a system. Commissioner DeBone asked if the existing system (TPOA) is privately owned and operated. Doty confirmed that it is; one of the factors considered in the study is an evaluation of the potential to expand this system beyond its current service area. BOCC MEETING DECEMBER 21, 2022 PAGE 3 OF 13 Doty emphasized that the feasibility study is limited in scope and does not address how Tumalo might change as the result of a sewer system. The study focused on the following items: 1. The gathering and evaluating of available existing septic system performance data; 2. The assembly of stakeholders and an advisory committee; 3. The development of wastewater collection and treatment options for consideration; 4. The estimating of capital costs, maintenance and operations costs, and a potential rate model; and 5. The evaluation of governance options. Doty shared the results of the work done on each of the scoping items, noting that many septic systems in Tumalo were installed over 50 years ago. The preferred collection option of a gravity system was deemed not viable; the next best choice is a system with septic tank effluent pumps. This system would have lower capital costs and fewer impacts on the community. It would also be scalable to accommodate project phasing and system expansion. Doty reviewed three alternatives, as follows: expand the TPOA system; install a new collection system with a new treatment and disposal site; or install a new collection system and tie into the north interceptor line proposed by the City of Bend along US 20 at Cooley. Doty summarized the benefits and challenges of each alternative and shared a table illustrating estimated monthly rates and fees according to three different grant funding models (10%, 30% and 50%). Doty concluded that the final study is available on the County's website along with supporting documentation and other information, including recordings of the various meetings held on this subject. Commissioner Adair requested that staff present this information to the Tumalo community. Commissioner Chang asked how much of this information has been shared with the advisory committee. Doty responded that it was shared in a Zoom call and has also been made available to the general public via the website. He added that staff came to understand early in the process that due to the diversity of opinions on the advisory committee, that group will not transition into a sanitary sewer district formation group. Commissioner Chang emphasized that whatever happens next will be the decision of the Tumalo community. BOCC MEETING DECEMBER 21, 2022 PAGE 4 OF 13 Commissioner Adair invited Onsite Wastewater Manager Todd Cleveland to address concerns about the soil in the Tumalo area, which has low filtration and drains very rapidly, and also explain the difference between on -site wastewater treatment and disposal systems. Chair Adair noted that several persons signed up to comment on this issue. Robert Fish considered the TPOA to be a good opportunity to see how that kind of system would function if expanded. He referenced his experience performing maintenance on many treatment systems, questioned how the source of impacts to water quality could be determined to come from treatment systems instead of fertilizer applications or farm animals, and asked to know specifics regarding a "relative high water table" as this pertains to the Tumalo area. Jeannie Fraley, who served on the advisory committee, stated her understanding that the next step would be to decide as a community whether to form a sanitation district. She said if the County were to sponsor a community meeting at the school for this purpose, the space would be provided free of charge. She referred to the likelihood of having to obtain grants to offset costs and concluded that the TPOA system is limited in terms of the volume it can handle. Jim Dunn agreed that the TPOA system is undersized. Noting that a sewer system would serve as the foundation for growth, he said Tumalo residents desire to maintain their rural community and do not want more commercial development. He believed the study should have looked at the option of a sand filter or AdvanTex system, as many who live in Tumalo could not afford a $35,000 hook-up fee and then to pay $95 per month. Commissioner Chang reiterated that the County is not doing this to or for the Tumalo community. Rather, how to proceed from this point is for the community to decide. Commissioner Adair invited other interested persons to email their comments to the Board. 11. Planning Commission Representation /Tumalo Area / Recruitment Peter Gutowsky, Community Development Director, reviewed previous discussion of and public input on the subject of designating a specific position on the Planning Commission to represent Tumalo. Gutowsky said staff seeks guidance on whether to initiate a Code amendment to establish an ex officio member until the at -large position with a term expiring June 30, 2023 could be converted to a position representing Tumalo. Alternatively, the person who lives in Bend and currently serves in one of the at -large positions could be switched to one of the two Bend positions, freeing up the at -large position. BOCC MEETING DECEMBER 21, 2022 PAGE 5 OF 13 Chair Adair noted that several persons signed up to comment on this issue. Jessica Kieras, current chair of the Planning Commission, said the Commission is supportive of waiting until the regular appointment process to address this matter rather than temporarily adding a non -voting member to its roster. She invited all interested persons to become involved and attend the Commission's meetings. Jeannie Fraley said Deschutes County Code states that the Planning Commission shall include representation from Tumalo and also from Terrebonne. Noting that both of these communities are growing, she proposed increasing the Commission's membership to nine from seven. Tammy Harty said it was critical that Tumalo have a representative on the Commission with full voting rights, and asked that the community be allowed to review candidates in the selection process before finalists are presented to the Board for consideration. Jack Farley stated he had applied for the most recent at -large opening on the Planning Commission, but although he resides in Tumalo, he was not appointed. He recounted his efforts to determine when the geographic representation for Tumalo was changed to an at -large seat. Following discussion, Gltow>k y said this matter VVi11 be brought back to the Board in early 2023 with options for proceeding. At 11:30 am, the meeting was recessed for a short break. The meeting reconvened at 11:37 am. 12. Findings of the Ambulance Service Area (ASA) Advisory Committee with respect to allegations from St. Charles Health Systems and the La Pine Community Health Clinic against the La Pine Rural Fire Protection District Chris Bell, Senior Assistant Legal Counsel, introduced Tom Kuhn, Ambulance Service Area (ASA) Administrator, who reviewed the authority of the ASA Advisory Committee and described allegations from St. Charles Health Systems and the La Pine Community Health Clinic against the La Pine Rural Fire Protection District. Kuhn stated that upon receiving the allegations, the Committee conducted an investigation into whether the available evidence supported them. The Committee ultimately substantiated two of the five allegations. Bell explained that, in accordance with Deschutes County Code Chapter 8.30 and the Deschutes County ASA Plan, the Board can direct staff to issue a written notice to BOCC MEETING DECEMBER 21, 2022 PAGE 6 OF 13 the District of the two violations that were substantiated by the ASA Advisory Committee. The District would then have the opportunity to request a hearing. Commissioner Chang stressed it is important to convey that the violations should be remedied so they are no longer issues. Commissioners Adair and DeBone concurred. Following discussion about the improper billing of St. Charles and La Pine Community Health by the District and indications that this practice is continuing, albeit under a different ordinance passed by the District, Bell said this practice could conceivably become the subject of a second investigation. Commissioner Adair was concerned that patients were discouraged from utilizing transport and asked if this has changed. Courtney lgnazzitto, Communications Manager of the La Pine Community Health Clinic, said she has not heard that this is continuing to happen. Commissioner DeBone supported substantiating the two findings. Commissioner Adair wanted to ensure that the letter is adequately firm. DEBONE: Move to accept the recommendations, support the five findings as identified, and direct staff to proceed with drafting a notice of violation for the Board's review prior to issuance CHANG: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion carried 13. Request Board signature of Document No. 2022-870, a contract with Allied Universal Security for security at the Deschutes County Stabilization Center Holly Harris, Program Manager, and Kimberly Bohme, Program Supervisor, presented a proposed contract with Allied Universal Security for the provision of private security services at the Stabilization Center. CHANG: DEBONE: VOTE: BOCC MEETING Move approval of Board signature of Document No. 2022-870, a contract with Allied Universal Security for the provision of private security services at the Deschutes County Stabilization Center Second DEBONE: Yes CHANG: Yes DECEMBER 21, 2022 PAGE 7 OF 13 ADAIR: Chair votes yes. Motion carried 14. Consideration to hear a land use matter involving commercial activity in conjunction with farm use (meadery) Nathaniel Miller, Associate Planner, said an applicant seeking approval of a meadery (honey winery) and associated uses along Highway 20 near Sisters has asked that the Board hear its appeal of a Hearings Officer decision. Miller shared the history of this matter and said the Hearings Officer denied the proposal for failure to demonstrate that the meadery use will be incidental and subordinate to the farm use on the property, and for failure to adequately address impacts to farm uses in the area. The three options before the Board are as follows: • Decline to hear the appeal; • Agree to hear the appeal with a limited de novo review; or • Agree to hear the appeal with a de novo review which would allow the Board to consider the entire record as well as new evidence and testimony. Commissioner Chang spoke to the desperate need for honeybees around the country and questioned how using land for bee hives to produce honey to make wine is different from using land to grow grapes for wine. Miller said the applicant proposes to have events such as indoor and outdoor tasting, a food cart, and wine club gatherings, in addition to other events such as concerts on a limited basis. Will Groves, Planning Manager, said the legislature adopted special winery land use provisions with the goal of preventing traffic and other activities from negatively affecting agricultural and farming uses. An essential question is whether these types of uses constitute agri-tourism, or commercial activity that happens in conjunction with a farm use. CHANG: Move to hear de novo an appeal of a Hearings Officer decision on a proposal for a commercial activity in conjunction with farm use (meadery) in the Exclusive Farm Use Zone DEBONE: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion carried 15. Request to purchase a MRL Model 1-660-ALS Paint Truck Striping Body BOCC MEETING DECEMBER 21, 2022 PAGE 8 OF 13 Randy McCulley, Road Department, referred to the Board's previous action to authorize purchasing this key piece of traffic safety equipment. The final price of $608,850.00 is $43,850.00 above the budgeted amount due to rising material costs; the total amount will be paid from the Road Department's Building/Equipment Fund. CHANG: Move approval of Document No. 2022-987 to purchase a paint truck striping body from Mark Right Lines Equipment Company, Inc. in the amount of $608,850 DEBONE: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion carried 16. Request approval to apply for OHA Workforce Incentives grant Holly Harris, Interim Deputy Director of Health Services, sought approval to apply for a non-competitive grant in the amount of $883,216 for workforce recruitment and retention efforts and to provide training and supervised clinical experience. Harris said the funds could also be used to offer paid internships, stipends for those who offer to supervise interns, and more tuition reimbursement. Other potential uses %Aunt be to exnanri Hart -time Pmnlnyment nnnorti initiPS nr nntcihly nffer hnucing stipends for rural areas. DEBONE: Move to authorize staff to apply for a OHA Workforce Incentives grant in the amount of $883,216 CHANG: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion carried At 12:54 pm, the meeting was recessed for a short break. The meeting reconvened at 1:03 pm. 17. Adult Parole & Probation Expansion Project Skanska USA Building, Inc. Change Order No. 1—Secure Parking Lot Lee Randall, Facilities Director, and Captain William Bailey explained the proposal to modify the contract with Skanska for the Adult Parole & Probation project to include expanding the secure parking area for the Sheriff's Office. The $300,243 change order would be paid from the Campus Improvements Fund, FY 2023. BOCC MEETING DECEMBER 21, 2022 PAGE 9 OF 13 DEBONE: Move approval of Chair signature of Document No. 2022-991, Change Order to the Adult Parole & Probation Expansion Project contract with Skanska USA Building, Inc. for construction of a secure parking lot expansion CHANG: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion carried 18. Adult Parole & Probation Expansion Project Skanska USA Building, Inc. Change Order No. 3—Shell Space Finish Facilities Director Lee Randall introduced Deevy Holcomb, Community Justice Director, and Tanner Wark, Deputy Director of Adult Parole & Probation. Holcomb described the proposal to modify the contract with Skanska to proceed with finishing 1,038 square feet of shell space at the Adult Parole & Probation work center now rather than later. The contractor is 80% done with the addition, and sufficient funds exist to cover this additional expense. Holcomb explained how the space will be used, emphasizing that the collaboration gained will improve timeliness of services. CHANG: Move approval of Chair signature of Document No. 2022-993, Change Order No. 3 to the Adult Parole & Probation Expansion Project contract with Skanska USA Building, Inc. for interior finish of shell space DEBONE: Second VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion carried 19. Board selection of Chair and Vice Chair for 2023 Commissioner Chang indicated his interest in serving as Chair for 2023. Commissioner Adair supported having Commissioner DeBone serve as Chair in 2023. Commissioner DeBone responded that he would accept this role. Commissioner Chang objected to the deviation from the traditional chair rotation, which he took to mean that his fellow Commissioners seek to limit his input on the Board's meeting agendas, silence his voice, and force him to pursue his agenda through outside channels. BOCC MEETING DECEMBER 21, 2022 PAGE 10 OF 13 Commissioner DeBone responded that Commissioner Chang was presuming motivations that did not exist and reaching inaccurate conclusions as a result. Commissioner Adair said the Board has many things to work on together, and hoped that next year would be more positive. After further discussion, Commissioner Adair nominated Commissioner DeBone to serve as Chair of the Board in 2023. VOTE: DEBONE: Yes CHANG: No ADAIR: Chair votes yes. Motion carried 2 - 1 Following Commissioner Chang's declination to serve as Vice Chair in 2023, Commissioner DeBone nominated Commissioner Adair to serve as Vice Chair of the Board in 2023. VOTE: DEBONE: Yes CHANG: Yes ADAIR: Chair votes yes. Motion Carried OTHER ITEMS: • Commissioner DeBone relayed a request from the Sunriver/La Pine Economic Development Program to help sponsor its annual luncheon on April 11th. He suggested sponsoring two tables for $500 each. Commissioner Adair was supportive of funding this sponsorship from video lottery funds. Commissioner Chang preferred that the Board determine its 2023 committee assignments before making this kind of investment. DEBONE: Move to sponsor the Sunriver/La Pine Economic Development Program's annual luncheon by purchasing two tables at a combined cost of $1,000, paid from video lottery funds ADAIR: Second VOTE: DEBONE: Yes CHANG: Abstain ADAIR: Chair votes yes. Motion carried 2 - 1 - 0 • Commissioner DeBone expressed his support for signing on to the amicus brief to be put forward by the Eastern Oregon Counties Association regarding the statewide ballot measure concerning firearm regulations, BOCC MEETING DECEMBER 21, 2022 PAGE 11 OF 13 which failed to pass in all eastern Oregon counties including Deschutes County. • Commissioner DeBone reported that the City of La Pine may request ARPA funding for sidewalks which would cost about $300,000. • Commissioner Chang presented a draft letter advocating for a State change to allow counties between 200,000 and 650,000 in population to pool and use tax -foreclosed property receipts to help youth and families with children attain stable housing rather than distribute those monies across various taxing districts as is currently done. He noted that this letter can be signed by the full Board of Commissioners or on an individual basis. Commissioner Adair was unsure if diverting funding from fire districts and others would be the right thing to do. Commissioner Chang provided an example of the estimated impact to a service district and reiterated the proposal would benefit youth and families with children by creating a revenue source for new low-income housing, flexible rental assistance, and housing placement and retention support services. He said the positive impacts of using pooled funds for these targeted programs would outweigh the revenue reduction to each district. Commissioner DeBone said if the proposal proceeds to assignment of a bill, the County could consider directing its lobbyist to advocate for it. He was not supportive at the present time, however, as he did not want to take funding away from local jurisdictions. EXECUTIVE SESSION: None ADJOURN: Being no further items to come before the Board, the meeting was adjourned at 1:53 p.m. DATED this ) Day of BOCC MEETING 2027 for the Deschutes County Board of Commissioners. PATTI ADAIR, CHAIR DECEMBER 21, 2022 PAGE 12 OF 13 ATTEST: RECORDING SECRETARY BOCC MEETING ANTHONY DEBONE, VICE CHAIR PHIL CHANG, COMMISSIONER DECEMBER 21, 2022 PAGE 13 OF 13 Hello Deschutes County Board of County Commissioners and thank you so much for welcoming me to your conversation today. Introduction - I am here to thank you for your consistent support for the advocacy for children in foster care. Thank you for being advocates for our community's most vulnerable members. 215 Children in foster care 104 CASA Volunteers Children waiting 18 New CASAs needed ■ In Deschutes County today there are currently 284 children in foster care. These are youth who have come into foster care because they have experienced abuse or neglect and they are no longer safe in their homes. These are the stories that we fear the most for youth, and they happen in our community every day. ■ Children who enter foster care have experienced profound abuse and neglect and are found to be in an imminent threat of harm if they stay in their homes. They are victims of physical abuse and sexual abuse, they have been exposed to illegal drugs, domestic violence, and unsafe adults. Their basic needs have often been neglected, including medical, dental, and mental health care. ® That's why we are here. it's our mission to recruit, train and support volunteers who advocate for the best interests of abused and neglected children in the court system. CASA volunteers work within the courts in collaboration with key agencies, legal counsel and community resources to ensure that every child in foster care in Central Oregon can transition into a safe and permanent home. ■ Our CASA advocates are usually assigned directly by a judge to become the primary advocate for a child who has been removed from their home and placed in foster care. ■ Our advocates become the champion, cheerleader and chief of staff for this child —ensuring that their needs are met and they have what they need to thrive in the face of the adversity they have experienced and will continue to experience as they move through the foster system. 2 Community close-up Deschutes County. 250 CASA service in Deschutes County 7/2019 - 1012019 - 1.12020 - 412020 - 712020 - 1012020- /2021 - 412021 - 712021 - 1012021 - 112022 - 4//2022 - 7/2022 - 912019 12/2019 312020 612020 9/2020 1212020 312021 612021 912021 1212021 312022 6/2022 1012022 Pi Children in foster care oo Children served with a CASA volunteer Contrary to state trends, the number of children in foster care has increased in the past few years. With the support of the Deschutes County BOCC, we have consistently served between 85% and 90% of children in foster care with personalized advocacy. We have one of the highest service percentages in the state. But it's not enough. 3 A CASA is an ordinary person who does extraordinary things for children in foster care. CENTRAL. OREGON • To serve 100% of children, we are actively seeking CASA volunteers. • CASAs come from rooms just like this one. CASAs are grandmas, they are young professionals, they are retired teachers or librarians. It's any one of you. AD you have to do is step forward and we will move forward in this work together beginning with our very next CASA training starting the last week in January. Training will be online and in -person in Bend. Sign up at our website • Session 1 (Online): 01/24/23-03/14/23 - Tuesdays 5:00-8:30pm • Session 2 (In -person, Bend): 01/26/23-03/16/23 - Thursdays 12:00-3:30pm Just to give you some context. [READ GRAPHIC ON SLIDE] Our CASAs are truly the one stable presence in the life of a child in foster care. Children with a CAA... • Move into a safe, permanent home more quickly • Are more likely to succeed in school • Are less likely to re-enter foster care • Are more likely to receive support to heal and thrive [READ BULLETS FROM SLIDE] BOARD OF COMMISSIONERS AGENDA REQUEST & STAFF REPORT MEETING DATE: December 21, 2022 SUBJECT: Planning Commission Representation / Tumalo Area / Recruitment RECOMMENDED MOTION: Board direction sought on the subject of Planning Commission representation and recruitment as described below. BACKGROUND AND POLICY IMPLICATIONS: Staff is seeking direction from the Board of County Commissioners as it pertains to the Deschutes County Planning Commission and whether: • Geographic areas representing the seven voting members of the Planning Commission should be revisited as early as next month, specifically as it pertains to Tumalo's boundaries?and • An interim ex-nffirin nncitinn chni ilrl ha ectahlicherl to allow a renrecentative of the Tumalo area to participate in Planning Commission proceedings until June 30, 2023, at which time the position could rollover to one of the seven voting members for a four year term? If the Board wishes to revisit the geographic areas next month, it will delay amendments to Deschutes County Code (DCC) Chapter 2.52, Deschutes County Planning Commission and the recruitment process for an interim ex-officio member. Alternatively, if the Board wants to prioritize an interim ex-officio member for the Tumalo area, the following expedited process and schedule could be initiated: 1. Convert the first of two forthcoming Planning Commission vacancies (Dale Crawford) from an at -large position to a Tumalo area position. 2. Amend DCC Chapter 2.52, Deschutes County Planning Commission to allow for one ex-officio member. 3. Upon adoption in January, initiate a Planning Commission recruitment for one interim ex-officio member representing the Tumalo area. The recruitment notice would acknowledge that the successful candidate serves from the appointment date to June 30, 2023 as an ex-officio member and then rolls over from July 1, 2023, to June 30, 2027, as one of the seven voting members of the Planning Commission. 4. Effective on July 1, 2023, convert an existing at -large Planning Commission position (Nathan Hovekamp) to a forthcoming vacancy in the Bend area (Maggie Kirby). The Bend area position would encompass a full term through June 30, 2027. 5. Initiate a Planning Commission recruitment notice in March for a forthcoming vacancy in the second of two at -large positions (Nathan Hovekamp) for a full term from July 1, 2023, to June 30, 2027. BUDGET IMPACTS: None ATTENDANCE: Peter Gutowsky, CDD Director COMMUNITY DEVELOPMENT MEMORANDUM TO: Deschutes County Board of Commissioners FROM: Peter Gutowsky, AICP, Director DATE: December 14, 2022 SUBJECT: Planning Commission Representation / Tumalo Area / Recruitment I. DIRECTION Staff is seeking direction from the Board of County Commissioners (Board) as it pertains to the Deschutes County Planning Commission and whether: • Geographic areas representing the seven voting members of the Planning Commission should be revisited as early as next month, specifically as it pertains to Tumalo's boundaries? 1 and • An interim ex-officio position should be established to allow a representative of the Tumalo area to participate in Planning Commission proceedings until June 30, 2023, at which time the position could rollover to one of the seven voting members for a four year term? If the Board wishes to revisit the geographic areas next month, it will delay amendments to Deschutes County Code (DCC) Chapter 2.52, Deschutes County Planning Commission and the recruitment process for an interim ex-officio member. As noted in Figure 1 below, changing a geographic boundary of one area will undoubtedly affect others. Figure 1— Planning Commission Membership Alternatively, if the Board wants to prioritize an interim ex-officio member for the Tumalo area, the following expedited process and schedule could be initiated: 1 https://deschutescounty.municipalcodeonline.com/book?type=ordinances#name=CHAPTER 2.52 DESCHUTES COUNTY PLANNING COMMISSION. DCC 2.52.040(D). The membership of the commission shall, as much as possible, be representative of the various geographic areas of the County. This should generally consist of the following: One member from the south County area of La Pine and Sunriver (Townships 19-22); two members from the Bend area (Townships 17 and 18); one member from the Tumalo area (Townships 16, Ranges 11 or 12); one member from the Sisters area (Townships 14 or 15, Ranges 9, 10 and 11); one member from the Redmond area (Townships 14 or 15, Ranges 12 or 13); and one member at large. Failure to achieve such geographic representation shall not affect the validity of any action taken by the planning commission. 1. Convert the first of two forthcoming Planning Commission vacancies (Dale Crawford) from an at -large position to a Tumalo area position. 2. Amend DCC Chapter 2.52, Deschutes County Planning Commission to allow for one ex-officio member. 3. Upon adoption in January, initiate a Planning Commission recruitment for one interim ex-officio member representing the Tumalo area. The recruitment notice would acknowledge that the successful candidate serves from the appointment date to June 30, 2023 as an ex-officio member and then rolls over from July 1, 2023, to June 30, 2027, as one of the seven voting members of the Planning Commission. 4. Effective on July 1, 2023, convert an existing at -large Planning Commission position (Nathan Hovekamp) to a forthcoming vacancy in the Bend area (Maggie Kirby). The Bend area position would encompass a full term through June 30, 2027. 5. Initiate a Planning Commission recruitment notice in March for a forthcoming vacancy in the second of two at -large positions (Nathan Hovekamp) for a full term from July 1, 2023, to June 30, 2027. I. BACKGROUND Last January, Deschutes County initiated a recruitment for a volunteer Planning Commission member. There was a vacancy on the Planning Commission for an at -large member to complete an existing term through June 30, 2024. CDD received twelve applications. In coordination with the Planning Commission Chair and the Board, five candidates were interviewed. While one of the candidates was from the Tumalo Area, the Board ultimately appointed a resident from Bend. Following the appointment, Tumalo community members expressed their displeasure to CDD and the Board, citing DCC 2.52.020(D), Membership; Qualifications, and its emphasis for one of the seven members to be from Tumalo. Many passionately advocated for representation, emphasizing that the previous at -large Planning Commissioner (Les Hudson) identified himself as living in the Tumalo area. They cited several notable projects affecting Tumalo, including but not limited to: • Comprehensive Plan Update • Tumalo Community Plan • Transportation Growth Management • Tumalo Sewer Feasibility Study (TGM) grant for bicycle, pedestrian, and • U.S. 20 Roundabout at Cook Avenue-O.B. transit facilities Riley • Transportation System Plan (TSP) Update II. PLANNING COMMISSION REPRESENTATION / TERMS As noted in DCC 2.52.020(D), there are seven Planning Commission members. They represent: At -large (2), Bend (2), Redmond, Sisters, and South County (1 each).2 Their respective terms are shown in Table 1. Commissioners Crawford and Kirby complete their second and final terms on June 30, 2023. 2 Ibid. -2- Table 1— Planning Commission Terms Commissioner Area First or Second Term Term Expiration Susan Altman Bend First June 30, 2024 Dale Crawford At -large Second June 30, 2023 Matt Cyrus Sisters First June 30, 2026 Nathan Hovekamp At -Large First June 30, 2024 Jessica Kieras Redmond Second June 30, 2026 Maggie Kirby Bend Second June 30, 2023 Toni Williams South County First June 30, 2025 III. PLANNING COMMISSION RECRUITMENTS / PROPOSED GEOGRAPHIC REPRESENTATION The Board could direct CDD to initiate two Planning Commission recruitments next year, one for the Tumalo area and the other for an at -large position. Staff offers the following approaches to maximize geographic area representation: Tumalo Area • Convert a forthcoming vacancy in the first of two at -large Planning Commission positions (Dale Crawford) to the Tumalo area. • Amend DCC Chapter 2.52, Deschutes County Planning Commission, to allow for one ex-officio member. • Upon adoption, initiate a Planning Commission recruitment for one interim ex-officio member representing the Tumalo area. The recruitment notice would acknowledge that the successful candidate serves from the appointment date to June 30, 2023 as an ex-officio member and then rolls over from July 1, 2023, to June 30, 2027 as one of the seven voting members of the Planning Commission. Bend Area • Effective on July 1, 2023, convert an existing at -large Planning Commission position (Nathan Hovekamp) to a forthcoming vacancy in the Bend area (Maggie Kirby). The Bend area position would encompass a full term through June 30, 2027. At -Large • Initiate a Planning Commission recruitment notice in March for a forthcoming vacancy in the second of two at -large positions (Nathan Hovekamp) for a full term from July 1, 2023, to June 30, 2027. Table 2 illustrates how the geographic composition of the Planning Commission could change starting on July 1, 2023. -3- Table 2 — Planning Commission / Potential Geographic Representation / July 2023 Commissioner Area Term Expiration Susan Altman Bend June 30, 2024 Board Appointment Tumalo June 30, 2027 Matt Cyrus Sisters June 30, 2026 Nathan Hovekamp Bend June 30, 2027 Jessica Kieras Redmond June 30, 2026 Board Appointment At -Large June 30, 2027 Toni Williams South County June 30, 2025 CDD believes the above process could provide a timely response to the concerns of Tumalo area residents and be consistent with the language and intent of DCC Chapter 2.52 while allowing the Planning Commission to provide uninterrupted service to the entire county. IV. TIMELINE Table 3 shows a tentative timeline for initiating the two Planning Commission recruitments: Table 3 — Planning Commission Reappointment Schedule Task Timeline Tumalo Area Recruitment 1. Draft amendments to DCC Chapter 2.52 December 22 to 28 2. Public notice December 23 3. Board hearing, deliberation and adoption by emergency January 4 4. Press release announcing Tumalo Area Planning Commissioner recruitment January 6 5. One month recruitment period January 6 to February 3 6. Board identifies candidates to interview February 6 to 17 7. Board conducts interviews Week of February 20 or 27 8. Board appointment March 1 or 8 At Large Recruitment 9. Press release announcing At -Large Planning Commissioner recruitment March 1 10. One month recruitment period March 1 to 31 11. Board identifies candidates to interview April 3 to 14 12. Board conducts interviews Week of April 17 or 24 13. Board appointment May 3 or 10 -4- Subject: l BOARD OF COMMISSIONERSMEETING Citizen Input or Testimony PC`R4ot-eSer } \4-cr Phone #s au?) .-- 3 C E-mail address (s SAS ' i , C In Favor Neutral/Undecided Date: Submitting written documents as part of testimony? Yes If so, please give a copy to the Recording Secretary for the record. (cm- C DiLk SUBMIT COMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS Opposed Q BOARD OF COMMISSIONERSMEETING REQUEST TO SPEAK Citizen Input or Testimony Subject: c5-�� Date: Name/ Address S 0 1114So �. Phone #s 5-0 5 % l ~5-7 - E-mail address (P 4,7vAAT InFavor Neutral/Undecided Opposed Submitting written documents as part of testimony? Yes L If so, please give a copy to the Recording Secretary for the record. SUBMIT CbMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS 0 ES Subject: Name Address BOARD OF COMMISSIONERS' MEETING REQUEST TO SPEAK Citizen Input or Testimony C v ry t StD'f�t �— C7#X 10441 . v S•CkLe--e- ,i1416A Oa_ 72 ct) Date: l2 2 1-2 Phone #s 64 f• "'T Z t E-mailaddress Cil..tVNlE.-2-- In Favor Td-1 [>C'r3 Neutral/Undecided Submitting written documents as part of testimony? Yes If so, please give a copy to the Recording Secretary for the record. Opposed SUBMIT COMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS Angie Powe. From: Tammy Harty <tammyharty@msn.com> Sent Tuesday, December 20, 2022 9:07 PM To: Patti Adair; Phil Chang; Tony DeBone Cc: citizeninput Subject Letter for County Commissioners Meeting 12-21-2022 Attachments: Memo to County Commissioners for meeting 12-21-2022.pdf [EXTERNAL EMAIL] Please see attached letter from the citizens of Tumalo regarding discussion about Action Item 11 for the meeting 12-21- 2022: Planning commission representation / Tumalo area / Recruitment Thanks so much !! Tammy Harty 541-815-0203 tammyharty@msn.com 12-20-2022 Dear County Commissioners, Thanks so much for addressing our concerns regarding representation on the planning commission for the Tumalo area. The citizens of the Tumalo area care deeply about what is happening in our community and want to be more involved in shaping the plans for our future. We believe it is critical for Tumalo to be represented on the planning commission at this time: Thank you again for addressing our concerns. In the process of selecting a Tumalo planning commissioner, we also ask that we have a part in the review of candidates in the selection process before finalists are submitted to the County Commissioners for consideration. The community wants and supports a fully functioning planning commissioner from Tumalo. It is important that this position be a voting position. There is much going on in Tumalo at this time that we want a voice in shaping the recommendations that will be made to the County Commissioners. We do support a look at the geographical areas that make up Tumalo, but it is not as pressing an issue as getting a voting representative on the planning commission right away. Just a few clarifications to the staff report that should be noted Deschutes County Code currently states that there shall be a representative from the Tumalo community on the Deschutes County Planning Commission (DCC 2.52.020). This seat was established in Deschutes County Board in 1994 • The rightful Tumalo seat has been exchanged for a 2nd "at large" position. This change never appears in the minutes of the DC Board of County Commissioners; The rightful Tumalo Io seat was errantly filled recently Rend City resident and not a resident of the rigrr�rurrurriarvv�u4 was errantly �nr*-•:+ ..��,:�y by a city resident unincorporated area of the county. • The Tumalo seat was reaffirmed in the Planning Commission Policy Manual updated in 2020. CHAPTER 2.52 DESCHUTES COUNTY PLANNING COMMISSION 2.52.020 Membership; Qualifications The membership of the commission shall, as much as possible, be representative of the various geographic areas of the County. This should generally consist of the following: One member from the south County area of La Pine and Sunriver (Townships 19-22); two members from the Bend area (Townships 17 and 18); one member from the Tumalo area (Townships 16, Ranges 11 or 12); one member from the Sisters area (Townships 14 or 15, Ranges 9, 10 and 11); one member from the Redmond area (Townships 14 or 15, Ranges 12 or 13); and one member at large. Failure to achieve such geographic representation shall not affect the validity of any action taken by the planning commission. CORRECTIONS TO THE STAFF REPORT: I. Background section clarification The recruitment in January included 2 applicants from the Tumalo area. II. PLANNING COMMISSION REPRESENTATION /TERMS: Clarification — The current code as noted in DCC 2.52.020 includes only 1 at large position and already includes a Tumalo area member — see above. Thank you for your consideration. Concerned citizens in the Tumalo area BOARD OF COMMISSIONERSMEETING REQUEST TO SPEAK Subject:`.., :: Date: (-d . Name Address Phone #s E-mail address In Favor Opposed Submitting written documents as part of testimony? Yes If so, please give a copy to the Recording Secretary for the record. SUBMIT COMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS VIM BOARD OF COMMISSIONERS AGENDA REQUEST AND STAFF REPORT MEETING DATE: December 21, 2022 SUBJECT: Informational presentation on the Tumalo Wastewater Feasibility Study RECOMMENDED MOTION: None at this time —information only. BACKGROUND AND POLICY IMPLICATIONS: In the spring of 2022, the BOCC was approached by a group of Tumalo business owners and commercial property owners with a request to fund a Wastewater Feasibility Study for the community of Tumalo. The County hired the engineering firm of Murraysmith (now Consor) to perform the feasibility analysis and prepare options for consideration by interested stakeholders in the community. The Feasibility Study evaluated three options and included estimates for capital construction, hookup fees, and utility rates, as well as governance and Sanitary District fnrmatinn The study and process documents have been published to the Project website: www.TumaloSewerOptions.org. With a host of other infrastructure and planning projects in the area, the Wastewater Feasibility Study has been a source of confusion in the community. It is important to note that Deschutes County is not a utility service provider and will not take any direct action to develop a community system. If the community desires a wastewater system, this study will provide stakeholders with options for consideration and a roadmap to implement - similar to how the community established and formed the Laidlaw Water District in the early 1980s. BUDGET IMPACTS: This study was funded with federal American Recovery and Reinvestment Act (ARPA) funds at a cost of approximately $150,000. ATTENDANCE: Chris Doty, Road Department Susanna Julber, Senior Associate, Consor Justin Moman, PE, Civil Engineer, Consor 0 BOARD OF COMMISSIONERSMEETING REQUEST TO SPEAK Citizen Input or Testimony Subject: `/ i .� � � l�t� J- Date: /2 Name 1)4 Pt 5/17 Address Jgc95Z) z' $- /3d770 Phone #s 48 0 406 E-mail address, 'fr.,-t-;,,,.1 a,koo In Favor Neutral/Undecided Submitting written documents as part of testimony? Yes If so, please give a copy to the Recording Secretary for the record, Opposed SUBMIT COMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS 0 BOARD OF COMMISSIONERS' MEETING REQUEST TO SPEAK Citizen Input or Testimony Subject: &. 'S I "b i I Name c_SPLU .ntL- Ffe0-2c.f Address Ca -1/1 b &t &C C Date: 1'Z 2! 22_ fib. Phone #s € • Y7t 4�0. E-mail address csQ.n n.t In Favor ?<. syvt94-a eo rh Neutral/Undecided Submitting written documents as part of testimony? Yes If so, please give a copy to the Recording Secretary for the record. SUBMIT COMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS Opposed BOARD OF COMMISSIONERSMEETING REQUEST TO SPEAK ,4.,:zoi/ Subject:. 7 � �� Date: 3 -z; Name- tip/ ,i/;' Address ct o 7 G ` vy a d Phone #s E-mail address Neutral/Undecided Submitting written documents as part of testimony? Yes If so, please give a copy to the Recording Secretary for the record. Opposed SUBMIT COMPLETED REQUEST TO RECORDING SECRETARY BEFORE MEETING BEGINS BOARD OF COMMISSIONERS AGENDA REQUEST & STAFF REPORT MEETING DATE: December 21, 2022 SUBJECT: Findings of Ambulance Service Area (ASA) Advisory Committee with Respect to Allegations from St. Charles Health Systems and the La Pine Community Health Clinic Against the La Pine Rural Fire Protection District RECOMMENDED MOTION: Review and consider the findings of the ASA Advisory Committee and direct staff on how to proceed BACKGROUND AND POLICY IMPLICATIONS: On September 28, 2022, the ASA Committee adopted findings arising from its investigation into allegations made against the La Pine Rural Fire Protection District in complaints from St. Charles Health System and La Pine Community Health Center. The Committee's findings are attached. The allegations made in these complaints were distilled into five primary allegations by the Committee, each of which alleged that the District had violated Chapter 8.30 of the Deschutes County Code and/or relevant provisions of the Deschutes County ASA Plan. After its investigation, the Committee substantiated two of these allegations. After the presentation, it is recommended the Board briefly deliberate and then direct staff on how to proceed. That decision should be guided by the terms of DCC Chapter 8.30 and the ASA Plan. BUDGET IMPACTS: None ATTENDANCE: Tom Kuhn, ASA Administrator Members of the ASA Committee Chris Bell, Legal Department Deschutes County ASA Advisory Committee Investigation of Allegations from St. Charles Health System and La Pine Community Health Center Against Deschutes County Franchisee La Pine Rural Fire Protection District Investigation Summary and Findings Prepared by: ASA Advisory Committee Authority of the ASA Advisory Committee The Deschutes County ASA Advisory Committee ("Committee") and the Deschutes County Board of Commissioners ("Board") are authorized to investigate alleged violations of the Ambulance Service Area Plan for Deschutes County ("ASA Plan") and/or Chapter 8.30 (Deschutes County Ambulance Service Areas) of the Deschutes County Code ("DCC Chapter 8.30") by County ambulance service franchisees. See ASA Plan, §8.2 and DCC 8.30.070.1 If, as here, the Committee is assigned by the Board to investigate such allegations, the Committee's task is to determine whether sufficient evidence exists to demonstrate a franchisee has violated applicable local laws or regulations, such as the ASA Plan or DCC Chapter 8.30, state or federal law or regulations, or whether the franchisee materially misrepresented facts or information given in either the application for assignment of its franchise or as part of a review of the performance of services furnished by the franchisee. Id. Upon completion of its investigation the Committee will provide its findings to the Board for its review and determination as to further action or sanctions against the franchisee. Id. If the Board determines that a franchisee has willfully violated applicable local laws or regulations, such as the ASA Plan or DCC Chapter 8.30, state or federal law or regulations, or that a franchisee has materially misrepresented facts or information given in the application for assignment of its franchise or as part of a review of the performance of services furnished by the franchisee, the Board may revoke or suspend the assignment of a franchise to a franchisee. ASA Plan, §8.4. In lieu of suspension or revocation, the Board may take other remedial measures to ensure any violations are corrected. ASA Plan, §8.4; DCC 8.30.070. Overview of Allegations The Board assigned the Committee the task of investigating two complaints received by the Board against the La Pine Rural Fire Protection District ("District"), including one from St. Charles Health System ("St. Charles"), and one that was submitted jointly by St. Charles and La 1 The ASA Plan and Chapter 8.30 of the Deschutes County Code were amended subsequent to the Committee's receipt of the complaints from St. Charles and LCHC. All citations to the ASA Plan and Chapter 8.30 of the Deschutes County Code are to the May 2018 versions of each, which were effective at the time of receipt of the complaints by the Committee. Investigation of La Pine Rural Fire Protection District - 1 1 Page Pine Community Health Center ("LCHC"). (Where appropriate, St. Charles and LCHC will be referred to collectively as "Complainants.") The first complaint was submitted by St. Charles on or about November 16, 2020. (A copy of the November 6, 2020 Complaint is attached as Attachment 1.) The second complaint was submitted by St. Charles and LCHC on or about February 3, 2021. (A copy of the February 3, 2021 Complaint is attached as Attachment 2.) Taken together, the complaints include several allegations against the District, which are summarized below: 1. The District discouraged patients from utilizing the District for emergency transports. 2. The District provided inaccurate determinations about whether emergency transportation was necessary for patients in order to support the fees it charged to St. Charles and LCHC. 3. The fees charged to St. Charles and LCHC pursuant to District Ordinance #2019-03 and District Policy #02-03 were invalid. 4. The District is currently unable to meet ASA Franchise requirements. 5. There are documentation discrepancies between St. Charles and LCHC provider chart notes and the chart notes of the District concerning the patients who were transported by the District. Summary of Investigation After being assigned the task of investigating the complaints from St. Charles and LCHC, the Committee formed a subcommittee to review the allegations contained therein and obtain information relevant to such allegations. Substantial documentation was received from Complainants in response to requests for information relevant to the complaints from the Committee. (Copies of the Committee's requests for information to Complainants are attached as Attachment 3.) The Committee also obtained information relevant to its investigation from the record of documents that are publicly available from the Deschutes County Circuit Court pertaining to pending litigation in St. Charles, Inc., and La Pine Community Health Center v. La Pine Rural Fire Protection District, Case No. 20CV39845. Requests for information were also sent to the District. The Committee sent its first request to the District on March 4, 2021. After receiving no response from the District, on April 21, 2021, the Committee sent a follow-up letter to the District renewing its requests for information. (Copies of the original requests for information from the Committee and its follow-up letter to the District are attached as Attachment 4.) Citing a pending lawsuit with St. Charles and LCHC, in a letter dated April 27, 2021, the District notified the Committee that it would not provide information responsive to the Committee's requests.2 (A copy of the District's response is 2 St. Charles Health System, Inc., and La Pine Community Health Center v, La Pine Rural Fire Protection District, Deschutes County Case No. 20CV39845. Investigation of La Pine Rural Fire Protection District - 2 ( P attached as Attachment 5.) On June 17, 2021, the Committee again requested information from the District as part of its investigation, although it significantly narrowed the scope of its requests for information. (A copy of the Committee's renewed requests for information is attached hereto as Attachment 6) To date, the Committee has received no further response from the District, nor has it received any material information in response to its requests.3 On behalf of the Board, the subcommittee hired private investigator Lori Miller to assist in the investigation by interviewing witnesses from St. Charles and LCHC, as well as relevant witnesses identified by the Committee during its investigation. The witnesses interviewed by Ms. Miller include Oliver Tatum, clinic manager at St. Charles Family Care in La Pine (hereinafter referred to as "St. Charles La Pine"), Charla DeHate, chief executive officer at LCHC, and La Pine community members Laura Beebe, Gloria Fleming, and Dennis Robinson. The subcommittee members have reviewed the information obtained during the investigation over the course of several months. Based on their review, the subcommittee submitted proposed findings, along with relevant information supporting the proposed findings, to the full Committee on September 28, 2022. After reviewing the proposed findings and relevant information from the subcommittee's investigation, the Committee adopted the proposed findings. The Committee's findings were determined using the substantial evidence standard.4 Exhibits 1. Copy of District Ordinance #2019-03 2. Copy of District Policy #02-03 3. Copy of District Ordinance #2021-01 4. Copy of Report of Interview of Oliver Tatom from Investigator Lori Miller, dated November 16, 2021 5. Copy of email from Kacie Talcott to Oliver Tatom, dated December 27, 2020 6. Copy of Report of Interview of Charla DeHate from Investigator Lori Miller, dated November 15, 2021 7. Copy of Declaration of Charla DeHate, dated September 12, 2022 8. Copy of Declaration of Oliver Tatom, dated September 9, 2022 9. Copy of Report of Interview of Dennis Robinson from Investigator Lori Miller, dated August 23, 2021 10. Copy of Report of Interview of Laura Beebe from Investigator Lori Miller, dated August 31, 2021 11. Copy of Report of Interview of Gloria Fleming from Investigator Lori Miller, dated August 23, 2021 3 The District did provide copies of District Ordinances #2021-01 and #2021-02 with its April 27, 2021 letter to the Committee, but has otherwise failed or refused to provide information requested by the Committee. ' "Substantial evidence" means more than a mere scintilla; it means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Investigation of La Pine Rural Fire Protection District - Wage 12. Copy of Emergency Medical Services Page from the District's website, https://lapinefire.org/emergency-medical-services/n taken February 23, 2021 13. Summary of Payor Information Obtained from Complainants on June 10, 2022 Copies of Materials Related to invoicing to St. Charles for "intrafacility transfer fee" pursuant to District Ordnance #2019-03 14. Call #1695 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 15. Call #1762 — 911 Call for Service Report, to appeal of fee 16. Call #1779 — 911 Call for Service Report, to appeal of fee 17. Call #1790 — 911 Call for Service Report, to appeal of fee 18. Call #1950 — 911 Call for Service Report, to appeal of fee 19. Call #1955 — 911 Call for Service Report, to appeal of fee 20. Call #2058 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 21. Call #2066 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 22. Call #2221— 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 23. Call #2300 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 24. Call #2303 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 25. Call #2357 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 26. Call #2418 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 27. Call #2441— 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 28. Call #2445 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 29. Call #2496 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 30. Call #2503 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee District invoice to St. Charles, materials related District invoice to St. Charles, materials related District invoice to St. Charles, materials related District invoice to St. Charles, materials related District invoice to St. Charles, materials related Investigation of La Pine Rural Fire Protection District - 4 1 Page 31. Call #2518 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 32. Call #2566 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 33. Call #2582 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 34. Call #8 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 35. Call #32 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 36. Call #40 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee 37. Call #116 — 911 Call for Service Report, District invoice to St. Charles, materials related to appeal of fee Copies of Materials Related to invoicing to LCHC for "intrafacility transfer fee" pursuant to District Ordnance #2019-03 38. Call #1988 — 911 Call for Service Report, District invoice to LCHC, appeal of fee 39. Call #2039 — 911 Call for Service Report, District invoice to LCHC, appeal of fee 40. Call #2062 — 911 Call for Service Report, District invoice to LCHC, appeal of fee 41. Call #1113 — 911 Call for Service Report, District invoice to LCHC, appeal of fee 42. Call #2233 — 911 Call for Service Report, District invoice to LCHC, appeal of fee 43. Call #2239 — 911 Call for Service Report, District invoice to LCHC, appeal of fee 44. Call #2285 — 911 Call for Service Report, District invoice to LCHC, appeal of fee materials related to materials related to materials related to materials related to materials related to materials related to materials related to 45. Letter Opinion of Circuit Court Judge Beth Bagley on Partial Motion for Summary Judgment, dated August 17, 2021 46. Order on Partial Motion for Summary Judgment, Circuit Court Judge Beth Bagley, dated August 31, 2021 47. Limited Judgment on Writs of Review and Claim for Declaratory Relief, Circuit Court Judge Beth Bagley, dated September 21, 2021 48. Copy of Declaration of Charla DeHate in Support of Plaintiffs'/Petitioner's motion for Partial Summary Judgment, dated March 17, 2021 Investigation of La Pine Rural Fire Protection District - 5 1 Page 49. Copy of Letter from Department of Health & Human Services, Centers for Medicare & Medicaid Services, to Rep. Cliff Bentz, dated June 21, 2021 50. Medicare Benefit Policy Manual, Chapter 10 — Ambulance Services (rev. 243, 04-16- 2018) 51. Memorandum from Mike Supkis to Board of Directors re: District Ordinance Process, prepared on November 19, 2020 52. La Pine Rural Fire Protection District Board Policy # 600.2, dated September 13, 2018 53. La Pine Rural Fire Protection District Board Meeting Minutes, dated November 12, 2020 54. La Pine Rural Fire Protection District Board Meeting Minutes, dated April 8, 2021 55. La Pine Rural Fire Protection District Board Meeting Minutes, dated January 14, 2021 56. Bend Bulletin article, "La Pine fire district now charging St. Charles for ambulance trips to Bend" dated February 3, 2020 57. Public comment received by The District in response to The District's request for such comment concerning Ordinance #2019-03 Discussion of Findings 1. The District discouraged patients from utilizing the District for emergency transports. SUBSTANTIATED. The District, like other ambulance service franchisees of the County, has an affirmative duty to respond to "emergency calls for service" when an ambulance is available for service. (See DCC 8.30.085(B)). Emergency calls for service typically arise after a patient or someone on the patient's behalf calls using 911 to request emergency medical services and County franchisees such as the District respond. Generally, Oregon law provides that when a call for emergency medical services is made and an ambulance staffed with emergency medical technicians ("EMTs") responds, competent patients — those who are not incapacitated and are otherwise able to interact with their providers and make decisions for their care — have the right to refuse ambulance transport even when such care is recommended by their medical providers, and may also choose their own means of transportation to a medical facility. See OAR 333-250- 0330.5 Therefore, if a competent patient makes an informed choice to refuse an emergency transport after interacting with EMTs, the patient is well within their rights to do so. However, if responding EMTs actively discourage patients who desire to be transported via ambulance in an emergent situation after calling 911, or if responding EMTs simply refuse to provide such transport to patients who have requested it, the EMTs violate their duty to respond to such calls under DCC Chapter 8.30 and undermine the primary purpose of their employer's franchise. The information considered by the Committee in its analysis of the above allegation includes statements from the interviews of Oliver Tatom, the clinic manager at St. Charles La Pine, Charla DeHate, the chief executive officer at LCHC, and La Pine residents Dennis Robinson and 5 See also the discussion of OAR 333-250-0330 and the rights it provides to patients with regard to ambulance transports found in the Committee's findings pertaining to Allegation #3. Investigation of La Pine Rural Fire Protection District - 6 1 Page Laura Beebe. The Committee also considered an email, dated December 27, 2020, from Kacie Talcott to Mr. Tatom, which was referenced in his interview, as well as emails from Mr. Robinson and Ms. Beebe to the District that were each sent in response to the District's request for public comment in January of 2021 concerning District Ordinance #2019-03, and the interview of La Pine resident Gloria Fleming. (Exhibits 4 — 6, 9 —12, and 57) During his interview, Mr. Tatom stated that while on duty as an RN at St. Charles La Pine, he had personally heard from patients that they had been told by the District's EMTs that they were not suffering from an emergency and did not need to go to the emergency department or be transported by ambulance. Mr. Tatom said that his understanding from these conversation is that in such instances the District's EMTs had made a "recommendation" to patients in their home and subsequently had them sign a document indicating they had refused or denied transportation by ambulance. Mr. Tatom referenced a specific encounter he had been informed about by Kelcie Talcott, a nurse he worked with at St. Charles La Pine. Ms. Talcott informed him in a December 27, 2020 email that she had a negative experience with a District EMT. She stated that this EMT had told her he would refuse to transport a patient to the emergency department at St. Charles Hospital in Bend if providers administered medications that were "outside of his practice." According to Ms. Talcott, the EMT's statement was in response to the medications the providers at St. Charles La Pine planned to administer to the patient as part of the patient's care. Because of this, after consulting with a doctor at the clinic, she and the doctor deferred treatment to the emergency department in order to expedite emergency transport for the patient. Essentially, they did not provide the treatment they believed was appropriate for the patient in order to ensure the patient was transported to the emergency room in Bend. Ms. Talcott described the EMT as brusk, dismissive, and unprofessional, and refused to provide an adequate explanation for his refusal to transport for the patient if they administered medications as planned. Just prior to being transported, the patient expressed concern over the cost of transport. After the EMT told the patient the District's services could cost between $1,000 and $4,000, the patient refused to be transported via ambulance due to the potential financial burden. Ultimately, the patient chose to have his father drive him to Bend rather than utilize a District ambulance. While the EMT's conduct toward staff in this instance are in many ways concerning, the Committee does not believe such statements support allegations that the EMT or other District staff actively tried to discourage the patient in this instance from using District resources to be transported to the emergency room in Bend. As discussed above, competent patients have the right under Oregon law to refuse ambulance transport, even when their providers recommend it, and choose their own means of transportation to a medical facility. By answering the patient's questions about the potential expense of accepting District services to transport him to Bend, the EMT's statement to the patient can reasonably be interpreted as his efforts to respond to the patient's concerns. The EMT's response, by itself, does not appear to Investigation of La Pine Rural Fire Protection District - 7 J Page demonstrate that he was actively trying to discourage the patient from utilizing the District's services. For these reasons, Mr. Tatom's reference to the above -described incident does not tend to support the above -stated allegation. For the reasons below, however, statements from Ms. DeHate, Mr. Robinson, and Ms. Beebe provide strong support for the allegation that the District discouraged patients from utilizing their services. According to Ms. DeHate, prior to 2019 the District would often decline 911 calls originating from LCHC. She stated her observations that after such calls District EMT staff would evaluate the patient after arriving at LCHC, tell the medical provider the patient did not qualify as an emergent transport, and convince the patient not to be transported using District resources. At times, District EMTs would wait to have such conversations with patients until after the doctor had left the room. As a result of this behavior, LCHC began requiring its providers to remain in the room when District EMTs evaluated their patients. Ms. DeHate further observed that after District Ordinance #2019-03 went into effect, District staff transported patients every time LCHC called to request an emergency transport, and then the District would bill LCHC, rather than the patient, for the expense of the transport. Ms. DeHate also stated the District had, at times, refused emergency transports to patients who had requested it by calling 911 from their homes. She was aware of such behavior happening during the summer of 2020, and referenced a patient who was refused treatment in that timeframe, and that she received confirmation from the doctor who spoke with the patient that this had occurred. Ms. DeHate provided a specific example as evidence of the District's behavior concerning patients who call 911 from home to request emergency medical services, referencing a patient named Dennis Robinson. According to Ms. DeHate, Mr. Robinson had suffered a stroke and had bleeding on his brain, and was refused transport by District EMTs. The investigator also interviewed Mr. Robinson. During his interview, Mr. Robinson recalled that on June 26, 2021, his wife called 911 to request an ambulance because he was slurring his words, having trouble speaking, and the side of his face was drooping. When the District's ambulance arrived he stated he was "doing a little better," but told the District's responding staff that his symptoms had lasted almost the entire 30 minutes since his wife had called. He recalled being told that he likely suffered a mini stroke and "those happen all the time." They told him that he could see his doctor the next day and that he didn't need to go to the emergency room at that time. He claimed the EMTs "very strongly suggested that everything was okay with him and that there was no reason to go to the hospital." Mr. Robinson said he followed up with his doctor at LCHC less than a week later because his symptoms got worse. Upon examining him, he recalled that his doctor immediately sent him to the emergency room at St. Charles Hospital in Bend. His daughter drove him. Medical staff at the hospital determined that he had bleeding in his brain. He was on a prescription blood thinner which may have contributed to the bleeding. According to Mr. Robinson, his emergency room doctor told him that if he had been transported to the hospital the day Investigation of La Pine Rural Fire Protection District - 8 1 Page District EMTs had responded to his 911 call, he may have suffered less damage to his brain. Mr. Robinson stated that he was not released until the first week of August. Mr. Robinson claimed that he has since spoken to other locals in La Pine and some people at the LCHC about the ambulance service provided by the District. According to him, the consensus was that the District often "strongly suggests not taking the ambulance" because they are worried about collecting payment from insurance companies and making enough profit. Mr. Robinson speculated that the District may lose money when they agree to transport patients to Bend. The investigator also interviewed Laura Beebe. Ms. Beebe submitted a public comment via email on January 11, 2021 opposing Ordinance #2019-03. Her email was submitted in response to a request for public comment from the District regarding Ordinance #2019-03. In her email, Ms. Beebe claimed that District EMTs had refused to transport her after responding to her call to 911 requesting an ambulance, despite the fact that she was suffering from appendicitis. According to Ms. Beebe, District EMTs told her she was suffering only from "a stomach bug." She also claimed the EMTs forced her to sign a document stating that she refused to be transported via ambulance. Because of these allegations, the Committee requested the investigator to interview Ms. Beebe. During her interview Ms. Beebe confirmed the details of the incident she reported in her January 11, 2021 email. She added that District EMTs told her she "just had a cold like everyone else had or possibly the flu," told her she would be fine, and told her she could transport herself to the hospital. She reiterated that the EMTs forced her to sign a form stating that she refused transport via ambulance, even though she had called 911 because she believed she needed to be transported via ambulance. Ms. Beebe added that her husband was home at the time, and he also requested that she be transported, but the District's EMTs refused his request as well. Ultimately, Ms. Beebe's husband transported her to St. Charles Hospital in Bend, where she was admitted and diagnosed with appendicitis. Her appendix was removed the next morning. Ms. Beebe also told the investigator that she had been told by District staff to sign the "refused transport" form on more than one occasion. She stated that she is diabetic, and has called 911 in the past for low blood sugar levels. While Ms. DeHate's statements summarized above are somewhat general and based to a large extent on hearsay from patients, what she described is consistent with the statements from Mr. Robinson and Ms. Beebe concerning the conduct of District EMTs. The Committee also finds the consistencies between what Ms.Beebe and Mr. Robinson each described as to their separate interactions with District EMTs to be compelling. Their descriptions demonstrate that, at least in the interactions described, District EMTs did much more than simply advise them of their rights to refuse ambulance transportation or the cost of providing it. Instead they actively discouraged Mr. Robinson from accepting transport via ambulance, to the point of convincing Investigation of La Pine Rural Fire Protection District - 9 1 Page him he did not need it. They went further with Ms. Beebe, and refused to transport her despite her desire to be transported. More disturbing to the Committee is Ms. Beebe's recollection that she was forced to sign a form indicating that she refused transport from the District, when in fact she had actually requested to be transported in an ambulance. The stories of Mr. Robinson and Ms. Beebe therefore support the broader statements from Ms. DeHate, and make them far more credible. For these reasons, the Committee finds that District staff actively discouraged Mr. Robinson from utilizing its resources to transport him to St. Charles Hospital. The Committee also finds that that District staff actively discouraged Ms. Beebe from utilizing its resources to transport her to St. Charles Hospital, and ultimate refused to provide such resources to her. Finally, the Committee finds that, at least prior to the enactment of Ordinance #2019-03, District EMTs engaged in similar conduct with the patients of LCHC. 2. The District provided inaccurate determinations about whether emergency transportation was necessary for patients in order to support the fees it charged to St. Charles and LCHC. NOT SUBSTANTIATED. While this allegation is concerning, there is no provision in the ASA Plan, DCC Chapter 8.30, or federal or state law providing the Board or the Committee with oversight authority to review the accuracy of medical determinations by District EMS staff concerning whether an emergency existed for patients at the time they were encountered by District EMS staff or the medical providers at St. Charles La Pine or LCHC. While there is a definition for "emergency care" in the ASA Plan (See ASA Plan, Section III (15)), and the District has an affirmative duty to respond to "emergency calls for service" when an ambulance is available (See DCC 8.30.085(B)), there is no indication in the information provided to the Committee demonstrating or even suggesting that providers from the District failed to respond to any emergency calls for service from St. Charles or LCHC. To the extent Complainants ask the Committee to discern whether medical emergencies actually existed and justified emergency transportation in the situations involved in each of the 31 calls referenced in the exhibits forming the basis for this investigation, such determinations are outside of the purview and expertise of the Committee. Rather, they appear to be governed by applicable professional standards outside the scope of the ASA Plan or DCC Chapter 8.30. Therefore, allegations requesting such determinations by the District are not appropriate for review by the Committee or the Board. Finally, to the extent Complainants ask the Committee to weigh-in on the ability of the District's chief to impose fees against them based on an after -the -fact determination that no emergency existed during particular calls, the Committee again believes that such allegations are beyond its purview. As discussed elsewhere in this report, the District certainly has the authority under Oregon law to impose fees for the services it provides. See ORS 478.410. However, other than Investigation of La Pine Rural Fire Protection District - 10 1 Page the basic constraints on fees placed on rural fire protections districts in ORS 478.410, neither the ASA Plan nor DCC Chapter 8.30 appear to regulate or even touch upon the types of fees charged by rural fire protection districts or the basis for such fees. 3. The fees charged to St. Charles La Pine and LCHC pursuant to District Ordinance #2019- 03 and District Policy #02-03 were invalid. SUBSTANTIATED. As an ambulance service franchisee of Deschutes County, the District has a duty to conduct its operations in compliance with all applicable state and federal laws, rules and regulations, and the terms of DCC Chapter 8.30 and the ASA Plan. See DCC 8.30.070(B), 8.30.085(A); and ASA Plan, §8.4. For the following reasons, the Committee finds the fees charged to St. Charles and LCHC under District Ordinance #2019-03 and District Policy #02-03 fail to comply with applicable state law and are therefore invalid. - The fees charged to St. Charles and LCHC by the District pursuant to Ordinance #2019- 03 and District Policy #02-03 are fail to comply with ORS 478.410(4). ORS Chapter 478 governs the formation, duties and general operations of rural fire protection districts such as the District, including the authority of such districts to raise revenue through levying taxes and imposing fees. The District has the express authority to create fees for the services it provides pursuant to ORS 478.410(4), which states in relevant part: Unless expressly prohibited by the documents creating the district, a district board may adopt an ordinance as provided under ORS 198.510 to 198.600 to create a fee for any service provided by the district. A fee created under authority of this section may not exceed the cost to the district of providing the service. The Oregon Supreme Court has weighed -in on the nature of a fee charged by a government entity for a service the entity provides. As opposed to a tax, which is "any contribution imposed by government upon individuals for the use and service of the state," a fee is "imposed on persons who apply for or receive a government service that directly benefits them." McCann v. Rosenblum, 355 Or 256 (2014) (citing Qwest Corp. v. City of Surprise, 434 F.3d 1176, 1182 (9tn Cir. 2006) (explaining the distinction between a tax and a fee is whether the "charge is expended for general public purposes, or used for the regulation or benefit of the parties upon whom the assessment is imposed.") (Emphasis added.) Therefore, ORS 478.410(4) empowers the District to impose a fee for a service it provides only upon parties who actually receive the service. The corollary to this, of course, is that the District cannot impose a fee against a party that did not directly receive that service from the District. In each of the 31 calls presented to the Committee by Complainants, the patients were transported to the emergency department at St. Charles Hospital in Bend by District EMS personnel. During each of these transports, patients received pre -hospital care from District Investigation of La Pine Rural Fire Protection District - 11 1 Page EMS staff. Therefore, during each transport it was the patients who received services from District staff. After each of these transports, however, rather than charge the patients for these services, the District charged St. Charles and LCHC a "facility transfer fee" of $2013 and mileage of $642, for a total charge of $2655. (Exhibits 14-44) These fees were charged pursuant to District Ordinance #2019-036 and District Policy #02-03, which ostensibly authorized the District to charge "the requesting medical and/or care facility for transporting a patient from one professional care facility to another using 911 emergency resources," as well as mileage fee for "all transports." (Exhibits 1 and 2) For this reason, the District failed to comply with ORS 478.410, because by their terms Ordinance #2019-03 and District Policy #02-03 authorized the District to charge fees to Complainants rather than to the patients who actually received services form the District. Indeed, it is clear from the express terms of Ordinance #2019-03 and District Policy #02-03, as well as the history behind each that the District's intent in passing each was to shift the costs of providing ambulance transport services from the patients who received such services to LCHC and St. Charles. However, in each of the situations referenced in the 31 calls at issue, it was clearly the patients who were transported to St. Charles Hospital in Bend, and it was the patients who received pre -hospital care from the District's EMS staff during these transports. This is true regardless of whether the District's services were provided as a result of an emergency or non -emergency transport. ORS 478.410(4) does not authorize the District to provide services to a patient and then charge a third -party other than the patient for such services, but that is precisely what the District attempted in charging such fees to Complainants. (Exhibits 1, 2, and 51-56) For several reasons, the Committee's findings in this regard are supported by the information it obtained in pursuing its investigation. Oliver Tatom and Charla DeHate were each interviewed regarding their understanding of relationship between the clinics and the patients concerning the provision of ambulance services, the relationship between ambulance providers and the clinics, and who benefits from ambulance transports in situations such as those presented in the 31 calls at issue. (Exhibits 4 and 6) Mr. Tatom and Ms. DeHate also provided declarations to the Committee to clarify statements made during their interviews. (Exhibits 7 and 8) Ms. DeHate also provided a declaration in support of a motion for summary judgment filed by Complainants in pending litigation with the District. With respect to transports that originate from calls to 911 requesting transports for medical emergencies, Mr. Tatom and Ms. DeHate provided the following: 6 District Ordinance #2019-03 was repealed by the District on April 8, 2021. Investigation of La Pine Rural Fire Protection District -12 1 Page • Local clinics such as St. Charles La Pine and LCHC are not transporting agencies, and therefore may not bill insurance or government programs such as Medicare or Medicaid for patient transports they do not provide • Because St. Charles La Pine and LCHC are not ambulance franchisees authorized to perform such services pursuant to the Deschutes County Ambulance Service Area Plan, neither can provide emergency transport services • Neither LCHC nor St. Charles can bill patients, their insurance, Medicare, or Medicaid for such transports because neither of the clinics provided the transports • When an ambulance service provider provides ambulance transportation services in this context, the ambulance service provider serves the patient, not the clinic who called to request the transport • The "contract" for the ambulance transportation service is between the patient and the ambulance service provider • Clinics such as LCHC and St. Charles La Pine cannot be charged for ambulance transports originating from 911 calls involving Medicare or Medicaid patients With respect to transports provided by the District as referenced in the 31 calls at issue in this investigation, each of which originated from calls to 911 by medical providers at LCHC or St. Charles La Pine to request transports for potential medical emergencies, Mr. Tatom and Ms. DeHate provided the following: • For the same reasons as stated above, neither LCHC nor St. Charles can bill patients, their insurance, Medicare, or Medicaid for transport services provided by the District • For the same reasons as stated above, neither LCHC nor St. Charles billed the patients for the transports provided by the District • Until recently, the District has always billed patients or their insurance, Medicare or Medicaid for emergency transport services it has provided Such evidence clearly supports a conclusion that when, as in the 31 calls at issue in this investigation, ambulance transportation services are requested through a 911 call and such transportation is provided, ambulance service providers such as the District provide services to the patients involved, not the medical providers or facilities that may have requested the transport. Such evidence makes equally clear that neither St. Charles La Pine nor LCHC benefitted directly from the services provided by the District in any of the calls reviewed by the Committee. It was the patients, not St. Charles, LCHC, or their medical providers, who were transported to the emergency department at St. Charles Hospital in Bend and received care from District EMS staff while being transported. The Committee also finds it significant that this conception of the relationship between the patient and the ambulance provider matches the understanding and experience of each member of the Committee who works in the EMS/ambulance services field. Investigation of La Pine Rural Fire Protection District - 13 1 Page There is additional support for the Committee's conclusions found in Oregon law. In Oregon competent patients have the right to choose to accept or refuse ambulance transportation even when recommended by their medical provider. Such patients also have the ability choose their own means of transportation when it is necessary to visit a medical facility, and can choose to be treated at a medical facility of their own choice, rather than what is recommended to them by their medical provider. See OAR 333-250-0330(3)(c),(e), and (d).' The Committee believes several conclusions can be drawn from the rights given to patients pursuant to OAR 333-250-0330. First, medical providers such as St. Charles and LCHC cannot control the decision of their patients to accept ambulance transportation; patients are not forced to accept transportation from ambulance service providers such as the District even when their providers recommended it. Rather, patients who are able to make a choice, i.e. patients who are not unconscious or otherwise incapacitated, have the ability to choose to accept or refuse ambulance transportation, to choose their own method of transportation, and to choose to be transported to a different facility than recommended by their provider. Given that that the law expressly reserves such choices for patients, it follows that the patients, not their medical providers, can choose whether to receive services provided by their ambulance service provider. This in turn supports a conclusion that patients, not their medical providers, are the beneficiaries of such services from ambulance services providers such as the District. It is also clear that under Oregon law ambulance service providers such as the District must maintain written policies and procedures regarding patient rights, and must distribute "to each employee or volunteer" and make "available in the business office and in each satellite location" a written statement of patient rights which includes the rights described above. OAR 333-250-0330(1) and (2). The Committee presumes the District complies with the above requirements, and that District staff was familiar with the patient rights described above at the time of each of the interactions referenced in the 31 calls presented to the Committee. Therefore, at the time District staff encountered each of the patients referenced in the 31 calls at issue they were aware of the patient's rights to refuse their medical provider's transportation, to choose their own mode of transportation, and to choose the facility where they were to be transported. The District's own documentation indicates the patients involved in each call were conscious and aware enough to answer questions and interact with EMS staff. (Exhibits 14-44) Yet in in each interaction, despite the observations of District staff indicating that the patients involved were aware, able to answer questions, and were not in acute distress, District staff transported these patients to the emergency department at St. Charles Hospital in Bend. Thus, in each circumstance the patient involved indisputably had the right to refuse transport from the District EMS staff and still chose to be transported. There is no indication that providers at St. Charles or LCHC somehow forced or coerced any of these patients into being transported to the 'The Committee would note that on at least one occasion the District had acknowledged the right of patients to refuse treatment. (See Exhibit 14, Call #1695, District Response to Appeal of Fees, dated September 29, 2020) Investigation of La Pine Rural Fire Protection District -14 1 Page Hospital in Bend, nor is there any indication they were forced or coerced into being transported by District staff. These facts and the inferences reasonably drawn therefrom also support a finding that the patients involved, not St. Charles La Pine or LCHC, received ambulance transportation services by the District. Finally, at least with respect to those patients who were on Medicare at the time they were transported by the District, federal Medicare reimbursement rules prohibit the District from billing St. Charles and LCHC for the services provided to their patients. The Center for Medicare and Medicaid Services ("CMS"), a division of the Department of Health & Human Services, publishes the Medicare Benefit Policy Manual, which governs billing and reimbursement for providers that provide services for patients covered by Medicare. Chapter 10 of the Manual governs billing and reimbursement for ambulance services. (Exhibit 50) On June 21, 2021, CMS sent a letter to the Office of Congressman Cliff Bentz in response to an inquiry from his Office about the District's conduct. (Exhibit 49) The Office had been informed of the District's conduct in billing St. Charles and LCHC for ambulance transports for patients to St. Charles Hospital in Bend. The premise for the inquiry from the Office of Congressman Bentz is stated in the letter: The inquiry from Congressman Bentz office states that LaPine Fire and Ambulance service is billing LaPine Community Health Center and St. Charles LaPine clinic for emergency ambulance transports of Medicare patients to St. Charles Hospital. It goes on to state that directors of medical facilities and for- profit ambulance services believe this is against Medicare rules, and they are seeking clarification. In response to this inquiry, CMS responded as follows: If the patient is seen at the clinic and then transported to the hospital, they should not bill the facilities. Either Medicare or the patient (if the patient does not meet Medicare coverage criteria) should be billed. ... The only time a facility could be billed is if it was by contract with the provider supplier and it was part of the consolidated billing (usually a non -emergent situation). (Emphasis added.) The response later continues, citing Chapter 10 of the CMS Medicare Policy Manual: IOM 100-02, Chapter 10, Section 20.1 states the following: "When an ambulance provider/supplier ... furnishes a Medicare -covered ambulance service to a Medicare beneficiary and the service is not statutorily excluded under the particular circumstances, the provider/supplier must submit a claim to Medicare and accept assignment of the beneficiary's right to payment from Medicare." Investigation of La Pine Rural Fire Protection District -15 1 Page This regulation explains that when a medically necessary transport from an eligible location such as a physician's office ... the ambulance supplier/provider must submit a claim to Medicare for adjudication. When they accept the terms of the regulations to participate within the program. (Emphasis added.) The letter from CMS clarifies that, at least with respect to Medicare patients who are transported by the District, in order to receive reimbursement for such services the District should not bill St. Charles or LCHC, but rather "Medicare or the patient should be billed." It states further that when an ambulance provider such as the District furnishes Medicare - covered ambulance services to Medicare -covered patients, the provider must submit a claim to Medicare in order to be reimbursed. This is provides a strong inference that CMS considers Medicare patients to be the beneficiaries of ambulance transportation services; that such services are provided to the patients themselves, not to medical providers. Otherwise Medicare policy would not prohibit ambulance service providers such as the District from billing clinics such as St. Charles La Pine and LCHC for their services.8 Finally, the Committee has found no evidence in the information it obtained during its investigation that contradicts or calls into question the conclusions drawn above, nor has the Committee found any relevant information that would tend to support a conclusion that the services provided by the District during the 31 calls at issue were provided to anyone other than the patients referenced in each call. For the above reasons, it is clear that the patients, not St. Charles La Pine or LCHC, received the services provided by the District, yet the District imposed fees for these services on LCHC and St. Charles. This practice clearly violates ORS 478.410(4). Therefore, the fees charged to St. Charles and LCHC by the District are invalid under Oregon law, and the District violated both the ASA Plan and DCC. Chapter 8.30. - The fees charged to St. Charles and LCHC by the District pursuant to District Ordinance #2019-03 are invalid in that the District failed to comply with ORS 198.540 prior to adopting District Ordinance #2019-03. On September 8, 2021, Deschutes County Circuit Judge Beth Bagley entered an order granting partial summary judgment in favor of St. Charles and LCHC in St. Charles Health System, Inc., and La Pine Community Health Center v, La Pine Rural Fire Protection District, Deschutes County Case No. 20CV39845. (Exhibits 45 and 46) Judge Bagley's order invalidated Ordinance #2019- 03 itself and any fees charged thereunder to St. Charles and LCHC. Judge Bagley's order was based on her ruling that the District failed to comply with the notice provisions of ORS 198.540 8 The Committee would note that of the 31 calls at issue in its investigation, 21 involved patients who had Medicare coverage. This means that for these 21 patients, the District chose not to be reimbursed for its services through Medicare as required in Chapter 10 of the Medicare Policy Manual, and instead chose to impose charges directly against St. Charles and LCHC. (Exhibit 13) Investigation of La Pine Rural Fire Protection District - 16 1 Page in adopting Ordinance 2019-03. An enforceable judgment to this effect was entered on September 21, 2021. (See Exhibit 47) Based on the above -referenced order and opinion from Judge Bagley, and the enforceable judgment entered against the District, it is clear the fees charged by the District pursuant to Ordinance #2019-03 are invalid as a matter of Oregon law. Therefore, it is again clear the District violated both the ASA Plan and DCC. Chapter 8.30. 4. The District is currently unable to meet ASA Franchise requirements. NOT SUBSTANTIATED The Committee has obtained no relevant information demonstrating that the District does not currently have the financial resources to meet its obligations as a franchisee. 5., There are documentation discrepancies between St. Charles and LCHC provider chart notes and the chart notes of the District concerning the patients referenced in the 31 calls at issue in this investigation. NOT SUBSTANTIATED. While this allegation is concerning, there does not appear to be any provision in the ASA Plan, DCC Chapter 8.30, or federal or state law providing the BOCC or the Committee with oversight authority to review or question the accuracy of medical documentation produced or submitted by the District Findings nn thic allegations would also require the Committee to make after - the -fact determinations regarding whether the observations of patients by providers at St. Charles or LCHC were accurate or not, and similar determinations regarding whether the observations of the same patients by the District's EMS providers were accurate or not. The Committee believes such determinations are outside of its purview or expertise, and therefore it would not be appropriate for the Committee to pursue findings on this allegation. Investigation of La Pine Rural Fire Protection District -17 1 Page BOARD OF. COMMISSIONERS AGENDA REQUEST & STAFF REPORT MEETING DATE: December 21, 2022 SUBJECT: Request approval to apply for OHA Workforce Incentives grant RECOMMENDED MOTION: Move approval to apply for a OHA Workforce Incentives grant in the amount of $883,216 to increase access to services, provide supervised clinical experience, and increase training for and improve recruitment and retention of behavioral health care providers BACKGROUND AND POLICY IMPLICATIONS: Oregon Health Authority (OHA) has made available grant monies through HB 2949 (2021) (as updated by HB 4071 (2022). The purpose of the funding is to a) support the recruitment and retention of behavioral health providers and b) provide supervised clinical experience necessary for behavioral health providers to obtain a license to practice. G inrlina is haing rlictrihi itari by (HA to community MPntal HPaIth Prngrams_ i icing an equitable formula, with $625,286 available to Deschutes County Health Services (DCHS) for workforce incentives and $257,930 for Clinical Supervision. Program Goals are as follows: • Increase access to services that are peer and community driven and that provide culturally specific and culturally responsive services for people of color, tribal communities, and persons with lived behavioral health experience. • Increase access to services for rural and underserved communities • Increase the number of individuals training for and entering the field of behavioral health and improve the recruitment and retention of behavioral health care providers. • Provide supervised clinical experience to associates or other individuals who have the necessary education but need supervised clinical experience to obtain a license to practice If approved, DCHS plans to use the "Incentive" funding to incentivize recruitment and retention to the south part of Deschutes County with housing stipends or other supports, expand part-time opportunities, expand tuition reimbursement options, offer stipends to licensed staff who provide internship supervision, and for program administration. "Clinical Supervision" funding would be used to cover stipends offered to licensed clinicians that provide Iicensure supervision to individuals outside of their own team. BUDGET IMPACTS: $883,216 revenue if awarded and approved. ATTENDANCE: Holly Harris, Interim Deputy Director, Health Services December 22, 2022 Dear Senator Knopp, Representative Levy, and Representative Kropf, We write to request your assistance to establish legislative authority for our taxing districts to help youth and families in our community to attain stable housing. We are elected board members from cities, school districts, park districts, Central Oregon Community College, the library district, and the county commission within Deschutes County. Our districts are the major recipients of tax revenue collected within Deschutes County and are the key stakeholders in discussing the revenues from property sale outlined below. Currently, by statute, when Deschutes County auctions tax foreclosed properties it is required to distribute the receipts from those auctions proportionately to all of the taxing districts within the County. While our districts welcome this revenue, the amounts are quite modest in relation to our total operating budgets. ORS 275.275(1)(d)(i), (ii), and (iii) authorize Counties with a population greater than 650,000 to retain and pool the receipts from tax foreclosed property auctions rather than distribute modest portions to each taxing district as Deschutes County currently does. These pooled funds are then invested to help youth and families with children attain stable housing. Specifically, ORS 275.275(1)(d)(i), (ii), and (iii) states that proceeds are to go to: (i) Funds for housing placement and retention support services for youth and families with children; (ii) Flexible rental assistance far housing placement fnr youth nnrl fnmiliac with children• nr (iii) Funds to develop new low income housing that is affordable to youth and families with children with 30 percent or lower median family income. By reducing the population criteria in ORS 275.275 from 650,000 to 200,000, the legislature could provide Deschutes County and the taxing districts within it with the option to use these funds to support our youth and families. We have reviewed the actual receipts from tax foreclosed property sales in recent years and believe that targeting pooled funds at the housing needs of youth and families may be more beneficial for our communities than receiving the proportional slices that our districts are currently receiving. Please see the attached spreadsheets detailing the proportional amounts that each taxing district would ultimately receive from tax foreclosed property sales in 2019 and 2020. An important thing we learned when we investigated the current system of distribution of tax foreclosed property sale receipts is that school districts receive the largest amount of these receipts, but ultimately do not get to use very much of them. For example, the Bend -La Pine School District might be due $235,664 of the $787,676 of sale receipts generated in 2019. But the school district would then surrender those $235,664 to the state and then get a proportion back based on how much of the total state student population BLPSD represented (approximately 3%). So the tax foreclosed property receipts received by Bend -La Pine, Redmond, and Sisters School Districts provide benefits for all students across the state of Oregon, but only a small fraction of the tax foreclosed property sale receipts sent to Salem by the districts are available to expend on students in those districts. We know that having local fund sources for innovative programs or affordable housing projects helps to leverage substantial amounts of federal, state, and private funding. So contributing our `shares' of tax foreclosed property receipts to a local pool focused on housing security for youth and families with children could have a huge impact. We would like to have the option of using receipts from tax foreclosed properties in Deschutes County in this way, but it will require legislative action for us to have that local control and flexibility. Once we receive the legislative authority to have this option the taxing districts should collectively evaluate whether we would like to exercise this option and what the governance and allocation priorities and methods would look like. We are signing this letter as individual Board members or Councilors. Our Boards and Councils may wish to take collective positions on this policy item at a later date but with the short window of time to promote legislative concepts an individual sign on letter is what was achievable right now. Thank you for considering this request for legislative action and if we can provide any further information to help you weigh your choices on this policy issue please do not hesitate to contact us. Sincerely, Phil Chang, Deschutes County Commissioner BOARD OF COMMISSIONERS BOARD OF COUNTY COMMISSIONERS MEETING 9:00 AM, WEDNESDAY, DECEMBER 21, 2022 Barnes Sawyer Rooms - Deschutes Services Building - 1300 NW Wall St - Bend (541) 388-6570 I www.deschutes.org MEETING FORMAT: In accordance with Oregon state law, this meeting is open to the public and can be accessed and attended in person or remotely, with the exception of any executive session. Members of the public may view the meeting in real time via the public meeting portal at www.deschutes.org/meetings. To view the meeting via Zoom, see below. Citizen Input: The public may comment on any meeting topic that is not on the current agenda. To provide citizen input, submit an email to citizeninput@deschutes.org or leave a voice message at 541-385-1734. Citizen input received by noon on Tuesday will be included in the meeting record for topics that are not on the Wednesday agenda. If in -person comment from the public is allowed at the meeting, public comment will also be allowed via computer, phone or other virtual means. Zoom Meeting Information: This meeting may be accessed via Zoom using a phone or computer. • To join the meeting from a computer, copy and paste this link: bit.ly/3h3ogdD. • To join by phone, call 253-215-8782 and enter webinar ID # 899 4635 9970 followed by the passcode 013510. • If joining by a browser, use the raise hand icon to indicate you would like to provide public comment, if and when allowed. If using a phone, press *6 to indicate you would like to speak and *9 to unmute yourself when you are called on. a Deschutes County encourages persons with disabilities to participate in all programs and activities. This event/location is accessible to people with disabilities. If you need accommodations to make participation possible, call (541) 388-6572 or email brenda.fritsvold@deschutes.org. CALL TO ORDER PLEDGE OF ALLEGIANCE CITIZEN INPUT —May be provided as comment on any topic that is not on the agenda. CONSENT AGENDA 1. Consideration of Board Signature of Order No. 2022-067, Road Name Assignment of McClain Drive 2. Consideration of Board Signature on Document No. 2022-955, Improvement Agreement for Phase A of the Caldera Springs Destination Resort Expansion 3. Consideration of Board Signature on Document No. 2022-954, Improvement Agreement for Phase C-1 of the Caldera Springs Destination Resort Expansion 4. Approval of Resolution No. 2022-081, recognizing the receipt of $147,595 in grant funding from PacificSource and increasing appropriations within the Health Services Fund and the 2022-23 Deschutes County Budget 5. Consideration of Board signature on letter appointing Danielle Grimes to the Deschutes County Central Oregon Housing Authority (dba Housing Works) Board 6. Consideration of Board Signature on letter reappointing James Getchell to the Newberry Estates Special Road District 7. Approval of the minutes of the December 7 2022 BOCC meeting ACTION ITEMS 8. 9:05AM Presentation from CASA of Central Oregon 9. 9:25AM Consideration of Board signature of Document No. 2022-984, Funding Contribution Agreement with ODOT for the US 20/Locust Project 10. 9:30AM Informational presentation on the Tumalo Wastewater Feasibility Study 11. 10:30AM Planning Commission Representation / Tumalo Area / Recruitment 12. 10:50AM Findings of Ambulance Service Area (ASA) Advisory Committee with Respect to Allegations from St. Charles Health Systems and the La Pine Community Health Clinic Against the La Pine Rural Fire Protection District 13. 11:20AM Request Board signature of Document No. 2022-870, a contract with Allied Universal Security for security at the Deschutes County Stabilization Center December 21, 2022 BOARD OF COUNTY COMMISSIONERS MEETING Page 2 of 3 14. 11:30AM Consideration to hear a land use matter involving commercial activity in conjunction with farm use (meadery) 15. 11:45AM Request to purchase a MRL Model 1-660-ALS Paint Truck Striping Body 16. 11:55AM Request approval to apply for OHA Workforce Incentives grant LUNCH RECESS ACTION ITEMS (continued) 17. 1:OOPM Adult Parole & Probation Expansion Project Skanska USA Building, Inc. Change Order No. 1—Secure Parking Lot 18. 1:10PM Adult Parole & Probation Expansion Project Skanska USA Building, Inc. Change Order No. 3—Shell Space Finish 19. 1:20PM Board selection of Chair and Vice Chair for 2023 OTHER ITEMS These can be any items not included on the agenda that the Commissioners wish to discuss as part of the meeting, pursuant to ORS 192.640. EXECUTIVE SESSION At any time during the meeting, an executive session could be called to address issues relating to ORS 192.660(2)(e), real property negotiations; ORS 192.660(2)(h), litigation; ORS 192.660(2)(d), labor negotiations; ORS 192.660(2)(b), personnel issues; or other executive session categories. Executive sessions are closed to the public; however, with few exceptions and under specific guidelines, are open to the media. ADJOURN December 21, 2022 BOARD OF COUNTY COMMISSIONERS MEETING Page 3 of 3