We pay the City’s Health director 6-figures to transcribe radio talk show interviews with County Commissioners?

Trust me, the following email back-and-forth between Sioux Falls City Health Director Jill Franken and Minnehaha County Commissioner Jeff Barth is intriguing enough, but what really stuck in my craw is that this seems like a very petty use of Franken’s time. And our mayor worries about subsidies to poor kids for swimming?!

To clarify, the Black NON-BOLD Lettering is the initial email sent to Jeff Barth and the BLACK/ITALIC Lettering is Barth’s response to Franken, dispersed in her original email;

Director Franken,

Sorry to make you go through all that work. I actually don’t think our views are that far apart although that may not be your impression. It may be that we just have different perspectives on the same issue.

Paramedics Plus and Metro communications are doing their work. I appreciate the competence and professionalism that they display every day. In no way do I want to disparage their efforts.

The people of Sioux Falls have demonstrated over and over a willingness to spend the money needed to improve our community. Hundreds of millions have been spent on our first class Events Center, swimming pool and now on our Administration building. People are willing to spend the money to make us a better city. I suspect our neighbors would pay more for this vital service.

I would be happy to meet you on the Belfrage show to debate these points. There is a good chance we will not agree on things!

Jeff Barth

From: Franken, Jill

Commissioner Barth,

Over the past several months you have made statements to the media expressing concerns about our EMS system, the REMSA board, the performance of Paramedics Plus, as well as the Health Department’s contract oversight.  Most recently, on July 7th, you were on the Greg Belfrage show and made a number of statements regarding our EMS system.  As I listened to you I became so concerned about the inaccuracies of your statements and the misperceptions you conveyed that I documented them and provided the accurate information regarding each, which I have shared with Mr. Belfrage.

I feel compelled to share this with you as well.  Along with reading this, I would highly encourage you to contact me at your earliest convenience and I will assist in setting up a meeting with the EMS leadership team.  At this meeting we can thoroughly discuss this high-performing system by sharing with you accurate, data-driven information about the performance of these agencies that comprise our EMS system and answer all your questions.

I urge you to reply to me with dates that work for you in the near future.  Thank you.

Barth: We are not spending tax money on ambulances, we are spending tax money on REMSA. 

Accurate: REMSA is a volunteer citizen board appointed by the Mayor and City Council. The REMSA board has no budget, and they receive no money from the EMS system, the

City, or through other tax dollars. A budget to regulate/oversee the EMS system is part of the Sioux Falls Health Department’s budget.

The City has spent millions paying Julie Charbonneau, Dr. Luther and others in support of REMSA. Are those funds not tax dollars?  

Barth: We’ve given a monopoly in our city to Paramedics Plus-god bless them- it’s a good deal for them so they extract the money from us and send it back to headquarters.

Accurate: This is a highly regulated exclusive surface ambulance service franchise. The city does NOT subsidize Paramedics Plus. Paramedics Plus generates revenues through patient fees, and those fees are used to pay the Sioux Falls operations expenses, to ensure future wage increases, hire additional staff, and make sure capital equipment needs are met for the Sioux Falls operations. A responsible profit margin should be maintained by Paramedics Plus, just like any other non-governmental community program or service.

We could have a long discussion about the difference between a “Monopoly” and an “Exclusive Franchise” but…

Paramedics Plus is making a profit. They don’t work this hard to break even or lose money. Those profits go elsewhere. 

Please let me know if someone locally is getting those profits.

Barth: Unclear how good our ambulance service is- concern about the delay in dispatching people.

Accurate: Paramedics Plus applied for CAAS accreditation within the first year of performance and received a perfect score.  This is a national accreditation, and it is very rare to achieve a perfect score.  As for “how good” their response times are, here is some real data showing their response times far exceed their contract requirements. It should be very clear, based on fact, that our ambulance service is meeting the needs of our community.

Also, dispatch is performed by Metro 911 based on specific procedures and guidelines, and the time of dispatch is based on those guidelines. There is no delay in dispatch. When calls are received, services are dispatched and the response clock starts.

When no ambulance is available, what ambulance is sent? When you say “services are sent” do you mean ambulance or fire or police?

Perhaps we could send a copy of your chart. 

Ambulance , fire and police are the three legs of Public Safety involving actual people not printouts.

Barth: They keep fudging with the numbers and the way they calculate things, used to call it zero status and now its phantom ambulance dispatch, some deal where they delay dispatch for 10 minutes I assume that’s to allow the paramedics to get the call.

Accurate: Ambulance contract compliance quality assurance was developed based on contract requirements and in consultation with Rich Oksol, the City Council’s internal auditor at that time. A recent internal audit validated the accuracy of contract response time compliance monitoring.

In an effort to consider what Barth is talking about, there was an operational policy and procedure change to Priority 3, non-emergency transport, calls to 911. Before the pilot project P-3 calls received both ambulance and Sioux Falls Fire Rescue response.  As a result of the pilot, P-3 calls still require an ambulance response time of 15:59 minutes 90% of the time per contract.  However, based on the changes from the pilot, a revised protocol now requires that if an ambulance isn’t available for dispatch within 10 minutes for these non-emergency calls, Sioux Falls Fire Rescue is dispatched as well. In most situations, Paramedics Plus has a unit freed up to respond in less than this 10-minute window, and they meet the 15:59 response time target. If they can’t, Sioux Falls Fire Rescue is dispatched to provide initial care and updates to Metro. This procedure change was an attempt to balance the need to keep critical Sioux Falls Fire Rescue resources available for emergencies in their area with the aim of having a responder on scene in about 15 minutes for non-emergency calls.

This new procedure has greatly reduced the unnecessary response by Sioux Falls Fire Rescue to P-3 calls and balances customer service with the need to keep fire resources available for higher priority EMS calls, extrications, or structure fires.

Blah, blah, blah. Bureaucratic obfuscation.

Barth: Why should Humboldt, SD get better ambulance service than SF- I don’t know

Response: There is no comparable evidence to support this claim.

People in Humboldt might have to wait but they do not wait for a “phantom” ambulance.

Barth: When they first changed away from zero status and they had some plan going on we asked them to explain it to us and they said it was too complicated- it’s too complicated because they’re blowing smoke

Accurate: Within the first year of the new ambulance agreement, the EMS system identified there was confusion regarding when and how to call for a mutual aid ambulance.  To streamline the process to activate mutual aid in life-threatening situations, the EMS system utilized improved procedures, technology, and resource polling, making the process more defined.

The EMS Leadership Team tested these news processes through a performance improvement pilot project regarding resource allocation. The team identified three system improvement goals for this pilot: 1) Keep Sioux Falls Fire Rescue resources available for emergencies, 2) Refine best practices for appropriate resource allocation, 3) Improve the mutual aid process.

The results of this performance improvement pilot project were reported to the City Council and the REMSA board.  Information is publicly available.  Anyone wishing to know more about this pilot has been encouraged to call anyone on the EMS leadership team.  I have not received any inquiries from Commissioner Barth.

Greg- Zero status…basically it means they don’t have an ambulance at that time.

Barth: I’ve heard they’ve changed it to something else, the phantom ambulance…if they don’t have one they dispatch the phantom 980 and then the 981.  Now I understand that they dispatch the fire department preposition an ambulance nearby so when the call does go for an ambulance they will be there within a minute.

Response: This claim simply has no basis in fact.

Good to hear. 

That is not what I have heard from members of the fire department.

Greg- Is this a case there just aren’t enough ambulances

Barth: Partially true but there are more ambulances outside of town that could come in and get somebody.  If it is a question of paying people…it ought to be worked out.

Accurate: System design improvements were implemented this past year with an important goal being to minimize any dependence on mutual aid from outlying communities who need and depend on those scarce EMS resources. Paramedics Plus is exceeding their response time requirements, and the City does not require a specific number of ambulances in circulation. We do require Paramedics Plus to have one or more mutual aid agreements by contract. Paramedics Plus has two mutual aid agreements in place.

We could have more ambulances and we could have a quicker response but the City has chosen not to do so.

Barth: Them (SFFR) being on the scene means we don’t need an immediate dispatch of an ambulance why don’t we use ambulances out of Omaha, so what if it takes 3 hours why should we worry because fire and police is already there…clearly that is ridiculous. Also clear that waiting 20 minutes is not better than waiting ten minutes and 10 minutes is ridiculous.

Accurate: A 10-minute response time is not ridiculous and is well within the required response time for P-2 and P-3 calls, which made up 13,355 of the ambulance calls from May 2016- April 2017.  P-1 calls, which are life-threatening emergencies, require an ambulance on scene 90% of the time in less than 8:59 and in May 2016-April 2017, Paramedics Plus did so 536 times out of 544 P-1 calls. Response times required in the contract are based on national industry best practice.

No comment on 20 minutes? 

If 20 minutes, or 60 minutes was within the “required response time” you would be OK with that? 

I’ll reiterate, ridiculous!

What about 5 minutes?

Jill Franken

Public Health Director

Sioux Falls Health Department

*This email was CC’d to many other individuals in government, public boards and individual citizens.


#1 Larry on 07.26.17 at 7:54 pm

Barth = Aother tired politician struggling for relevancy. Yawn.

#2 MK on 07.26.17 at 7:55 pm

Accurate: REMSA had a full-time executive director who also performs the Q/A (Julie S.). The IRS decided that person’s job couldn’t be contracted, they had to be an employee.

So now Julie’s salary is hidden in the health department’s budget, but that is still an $80,000+ cost per year of maintaining REMSA.

Also paramedics (ambulance) require to work under a doctor’s license, EMT’s (fire department) do not.
The City pays over $100k per year for Dr. Luther’s medical oversight.

If Dr. Luther was only reviewing fire department EMS calls, there wouldn’t be a need for a full-time medical director, and it could be done part-time for maybe $30,000 per year like Minnehaha county pays him.

So REMSA is costing taxpayers at least $140,000 per year.

Franken’s misdirection and minimization of this fact was intentionally misleading.

#3 l3wis on 07.26.17 at 9:34 pm

Larry, OK, but what do you think about Barth’s reaction? I consider Jeff a friend, but I hardly agree with him on everything, and he loves to debate his point. So, please, tell us what you have a problem with.

#4 Emoluments Clause on 07.26.17 at 10:16 pm

“You call it monopoly, I call it enterprise.”

John D. Rockefeller

It seems to me there is a really easy way to resolve this controversy. First, how big is the PP fleet? Second, how big was the prior provider’s fleet? Third, how many calls does the PP average per hour? Fourth, how many calls did the prior provider average per hour? Then let us do the math based on those facts to find out if PP is meeting the challenges based on past performances from the prior provider plus the new challenges from continual population growth in this town under PP’s involvement.

Now, the City’s response to my inquisitiveness of these past and current facts concerning this issue will most likely be that PP meets the contractual requirements and that is that. But what are the contractual requirements? Are they factoring in population growth? Does the contract require a particular fleet to population ratio?…..

…..Because what some would call meeting contractual requirements, I call legal obfuscation…

Also, the real telling thing about this whole controversy is the fact that when PP first came to town, they proactively let it be known through the local press that they did not garage their fleet while waiting for calls. Oh no, they supposedly prepositioned their vehicles throughout the city to reduce the response time. But is this policy to really reduce respond time, which it must not be doing, else we would not have this controversy, or merely a policy to hopefully keep the fleet size down and save money for PP, even if saving lives would then be put in jeopardy?

#5 Larry on 07.26.17 at 10:20 pm

Well I don’t have a dog in this hunt or care what Sioux Falls does but there seems to be a whole lot of yapping about the current ambulance contract and how the compliance with it is a huge problem for some. I guess my thought is if you have a problem with the contract, work with the council to change the dang contract. Don’t just regurgitate the party line; make your own path and advocate for real change. There’s been way too much grandstanding and not near enough leadership.

#6 The D@ily Spin on 07.26.17 at 11:58 pm

I can’t understand why everyone at Director level makes 6 figures. These jobs are political appointments for those who can’t make it in the private sector. If you suck in business, you get a welfare job at the city.

#7 ol'bubbleguts jenkins on 07.27.17 at 5:33 am

that barth said

call ambulances from omaha?
good lord
well you know,you never get what you pay for now

too much skim embezzlement by those in control of
funds grift and outright felony frauds
no one goes to pyita prison

iaal obg

#8 Judy Judy Judy on 07.27.17 at 8:40 am

Larry, beware of dogs who yap too much. You yap too quickly, too loudly and too anonymously not to have a dog in the fight. Come clean. Yesterday you were Martin, today you are Larry. Stop trolling and add something besides cynicism and obfuscation to the discussion.

#9 Bruce on 07.27.17 at 9:50 am

Larry, we are highlighting the ambulance issue in Sioux Falls because we as citizens have a dog in this fight. Our fight is for the chosen monopoly and the city health department to have patient care as the primary mission. The contract was written by a group of interested parties without bringing independent citizens into the process.

Some of us have watched the workers do their jobs and are in awe of their dedication. At no time have we criticized the boots on the street. Go sit in the meetings where the decisions are made or rationalized to see the smug looks. You know the look on a person’s face when they think they got you? We see it constantly. This contract was written for one purpose, to screw everyone they can with contract compliance.

No where in the 711 page contract is patient care a top priority. The metric is based in a timing scheme. Every time we publicize the latest version of the scheme they work to change it again. When did the City Council, the policy making body of Sioux Falls approve all these different schemes or policy changes appearing to be outside the contract?

We have a suspiciously written contract our health department has told us is too complicated for mere mortals to understand. We have to trust staff (as a city council member continuously tells us) to keep it all straight.


#10 The D@ily Spin on 07.27.17 at 4:34 pm

Anything city is not for the health and welfare of the citizens. There’s something wrong when it takes a 711 page contract to write yourself out of ambulance responsibility. I fear it’s more to protect the kickbacks paid to top city officials. It’s what Paramedics Plus is nationally known for.

It’s time to bring Uber into this city so we have some way to get ourselves to the hospital. Perhaps the state will recognize Uber not paying sales tax is minor compared to Sioux Falls citizens crawling to a hospital.