HomeMy WebLinkAboutAGENDA REPORT 1991 1002 CC REG ITEM 11I 012191 CCn'tik
° 1
MEMBERSO H BOARD
.4. O F VF MAGGIE ERICKSON KILDEE
• ' ? .:'0,1 ;=FT.',-4`A Chair
J' r `~ V "t '1:C. SUSAN K. LACEY
CO;\ .r' d� D MARIA E. VANDERKOLK
� `r` VICKY HOWARD
I1 Q� x JOHN K. FLYNN
(',�`r.FJ�NP VICKY HOWARD
SUPERVISOR, FOURTH DISTRICT
(805) 582-8010
BOARD OF SUPERVISORS FAX 1805) 582-8055
INTERNAL MAIL, L #5910
COUNTY OF VENTURA
3855-F ALAMO STREET
SIMI VALLEY, CA 93063
Agenda
Emergency Medical Services/Paramedic Meeting
September 27, 1991
3: 00 p.m.
Supervisor Howard's Office
During the last meeting we discussed several topics to be on the
agenda for this meeting. Please review this agenda and if you have •
any additions or deletions please call Linda White at 582-8010 or
fax document to 582-8055. The topics are as follows:
I. Response Times
(Please see attached documentation)
II. CAD Prioritization System
A. Emergency Medical Dispatch
III. Pilot Study
(Status)
IV. Implementation of EMT-D Program '
V. Paramedic Issue Moorpark
w
VI. Discussion of other topics, and scheduling of next meeting.
•
-- RECEIVED ..•
-. SEP Z ? 1991
City of Moorpark
•
6.-)
RucyC/erl Paper
-)
Pruner Health
Services, Inc.
September 19, 1991
72 Moody Court
Thousand Oaks
CA 91360
(805)496-4664 Supervisor Vicky Howard
County of Ventura
3855-F Alamo Street
Simi Valley, CA 93063
Dear Supervisor Howard: ,
In preparation for the upcoming EMS/Paramedic meeting
on September 27th, we have reviewed all of the
ambulance calls Pruner received in the Moorpark area
for a 3 month period ending July 31, 1991. We have
enclosed a complete recap of every call received,
including dry-runs and AMAs (patients that refused
treatment and/or transport "Against Medical Advise") .
It again becomes quickly apparent that the total
number of emergency service requests in Moorpark that
actually end up receiving paramedic (ALS) treatment is
extremely small. ALS transports averaged just less •
than 10 per month during this 3 month period.
Of the 29 total ALS transports, 13 patients (45%)
received only an IV line and/or cardiac monitoring as
ALS treatment. This would have left roughly 5 calls
each month in which all of the paramedics that would
be participating in the proposed pilot program would
have shared the possibility of providing, on an actual .
patient, one or more of the entire remaining scope of
advanced life support procedures and drug therapies
that they are required to be proficient in.
Dry-runs continue to represent a very high percentage
(47%) of all responses occurring in Moorpark. This is
approximately 17% higher than the average percentage
of dry-runs occurring in our other service areas.
,l v 10, 7() .). • .. .) i1 "l!!S'Bct,on .•
The summaries provide additional recap statistics along with
details about patient conditions and treatments rendered for every
call.
Hopefully, this information will assist the meeting's participants
in attaining an accurate perspective of the issues involved in
providing paramedic service to the Moorpark area and in reaching
effective conclusions.
Sincerely,
PRUNER HEALTH SERVICES, INC.
Steven G. Murphy, R.N.
Chief Administrative Officer
U
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•
MOORPARK PARAMEDIC STUDY
Background:
The City of Moorpark has a desire to enhance emergency medical
Services and improve response times in its City. Several options
have been explored including (1) an Emergency Medical Service (EMS)
Station in Moorpark, (2) a paramedic pilot program in the City's
two local fire stations and (3) expansion of the County' s contract
With the current ambulance company to house a paramedic unit
locally (probably in a fire station) .
The City, through its Budget and Finance Committee, has attempted
to. identify the advantages and disadvantages of each option
including the extent to which the option would improve EMS and the
related cost. A report to the Moorpark City Council, dated May 10,
1991, summarized the Committee's findings as follows:
1. EMS Station in Moorpark
This option would provide a paramedic ambulance in a central
location with a response time in the 3 to 6 minute range.
Cost for the service, as an enhancement to the County EMS
System, would be approximately $270,000 per year. The EMS
System would provide backup services when the local unit was
busy or transporting a patient out of the area. •
2. Paramedics in Fire Stations
A one-year pilot program would provide a paramedic at Stations •�
40 and 42 in Moorpark to evaluate the concept of paramedic
services in the County Fire Protection District. The ,�,•'�
Firefighter position on each engine would be reclassified to
• Firefighter/Paramedic and the engine would be equipped with' .
the necessary paramedic apparatus. Response times would also
be in the 3 to 6 minute range. Cost for the one-year program
was estimated at $70, 000 for the staffing and equipment.
3. EMS Station Co-Located at Fire Stations
An ambulance would be located at one or both of the Fire
• • Stations 40 and 42. Response times should be in the 3 to 6
minute range. No cost estimates were available. •
The Committee indicated that any of the above proposals would
improve response times in the City, which were estimated at 8 to 9
minutes.
•
...__. ...... .. •+3 .
1
OL1, Li tis
The Moorpark ,City Council took action, on May 22 , 1991, to support
the paramedic pilot program (Option 2) and to place a qualified
paramedic as one of the three persons assigned to each shift in
both Moorpark Fire Stations. The Council also took action to
finance the one-year pilot program by budgeting $75, 000 for
equipment, bonuses and salary adjustments and, tentatively, up to
$50,000 for other program costs . ' The City council requested the
Board of Supervisors to take action on the proposed pilot program.
The Fire Protection District, also conducted preliminary research
on Option 2 and, while not opposed to the proposal, believed that
the City's funding earmarked for the program was not sufficient to
cover all program costs. The District also expressed concern over
several programmatic issues. As a result, at the request of
Supervisor Vicki Howard, the County Chief Administrative Office has
Conducted further research on Option 2 .
The purpose of this report is to present an objective program
summary and cost estimate of Option 2 . The report is not intended
to evaluate whether this option is the most effective or efficient
program alternative, however, this report does address the
logistics of the pilot-program, EMS delivery network and the
programmatic concerns, some of which remain unresolved.
NOTE: While this study was in progress, the City, in its pursuit
to consider all viable options, also requested the Fire Protection
District to research the feasibility of housing a Pruner Health
Care ALS ambulance at one of the two fire stations located in the
City of Moorpark (Option 3) .
The District, in response to the request, has indicated that Option `
3 is not practical or feasible. While there is adequate garage
space at Station 40 to house an ambulance, the personnel quarters
will not accommodate additional people. There is also adequate
garage space at Station 42, however, even with relocation of
Sheriff ' s deputies and station personnel the conditions would be
unacceptably crowded.
•
2
•:t
Pilot Program- and EMS Coordination:
Representatives from the Ventura County Firefighters Association,
the Fire Protection District, Ventura County Public Health,
Emergency Medical Services and the Chief Administrative Office met
several times to discuss the composition of the proposed pilot
program. There were several outstanding issues which were
.:• addressed and, ultimately, consensus from all members of the review
committee was achieved.
•
If the City decides to proceed with the one -year pilot program for
enhanced paramedic service delivery within the City, it is
recommended that the program will consist of the following
components. The one-year pilot program should:
1. Include one Firefighter position on each shift, at each of the
two Moorpark Fire Stations, who will be a trained (certified
and accredited) paramedic. This position will be a
modification of a currently existing position allocation
(reclassified to Firefighter/Paramedic) and will not be an
additional position to the engine company. Training and
salary compensation are discussed below.
2. Supplement (not enhance) the current paramedic program
provided by a private vendor. The private vendor will
continue to provide the coverage with one EMT-D and one
paramedic on each ambulance and will provide transport.
3 . Be acceptable and compatible with the Emergency Medical
Service delivery system throughout the County.
4. Maintain current emergency response priorities. The two
engine companies will continue to respond to all emergencies
and provide back-up to other stations as required.
•
• 5. Include the provision of all required equipment necessary to
provide paramedic service. This is discussed in detail below."
6. Be financed entirely by the City of Moorpark.
7. Retain eight certified and accredited paramedic firefighters
at all times. This number should be sufficient to provide •
• coverage for two positions on three shifts and provide
coverage for sick days and vacation days.
The Ventura County Firefighter Association has indicated that there .
are a total of 13 paramedic trained firefighters currently on staff
• with the Fire Protection District. Of these, all 13 have indicated
a willingness to be assigned to one or either of the two Moorpark
•
•
* Stations.
There is some question as to the status of the paramedic
3
certification and accreditation of the 13 firefighters. In June,
1991, only 4/ firefighters were actually certified and accredited;
uaa (A .1iL-Lv.ac�1 .�vu11 liuva uk...iFurrll.�l.o.l LI . � itl>ir. b1» lo-�+�
months. The status of the 13 firefighters will be verified to
insure that there are an adequate number to commence the pilot
program (if and when that is the desire of the City) .
-The District has expressed concern that the initial assignment of
eight paramedics to the program will not be sufficient. While the
District agreed to this number, the District believes that actual
experience during the pilot program will show this number to be
insufficient.
Possible Pilot- Program Concept:
Under the pilot program, the Fire Protection District would
continue to be the first responder. Upon arrival of the engine
company on the scene, and if warranted, the firefighter/paramedic
(along with other members of the company if necessary) would
provide advanced life support (ALS) medical assistance to the ill
or injured party. Upon arrival of the private vendor (ambulance)
the paramedic assistance and responsibility would be transferred
from the engine company, as appropriate, to the private vendor.
With the transition of service from the District staff to the
private vendor, it is possible that some of the equipment in use
would remain with the ill or injured party to be utilized by the
private vendor while in transport. Also medical supplies will have
been used by both the District staff and the private vendor. The
District and the private vendor will cooperatively determine which
entity will provide and/or replace the medical supplies and how the
equipment will be returned or replaced. Any additional costs to
the District for these supplies, to support the pilot program, will •
be financed by the City.
patient Transport:
The private vendor would continue to be responsible for patient
transport to the Base Hospital . If, due to circumstances, the
firefighter paramedic must accompany the ill or injured party, the
entire engine company will be required to travel to the Base
Hospital to retrieve the firefighter paramedic, During this time,
the engine company, with only 2 staff members, will be unable to
respond to other emergencies until the firefighter paramedic
rejoins the engine company. Since the Base Hospital could be
either Simi Valley Hospital or Los Robles Regional Medical Center,
this inoperable status could exist for 30 minutes or more.
e. The transport and staffing arrangement under the pilot program, may
require further coordination between the County EMS Agency, the
4
District and the vendor. Currently, the vendor must (according to
contract) provide 2 EMT-1 ' s (BLS) in the ambulance. A current
trial study allows the vendor to staff each ambulance with 1 EMT-1
and 1 EMT-P (paramedic) . The vendor is able to cover the provision
of advanced life support by billing the ill or injured party for
all ALS services.
' if paramedic coverage is partially provided by the District, it may
change the vendor's operation and may result in a request for
contract modifications specifically addressing staffing levels . In
addition, the rate structure may be reconsidered. (Recommendations
to revise the rates must be presented to the Board of Supervisors
for approval. ) While it is not anticipated that contract
modifications would result in increased costs to the County or the
City for the pilot program, it may affect the ill or injured party
due to potentially revised rates .
Concerns have also been raised regarding the potential conflicts
between paramedics from different 'agencies working the same
patient. Dr. David Chase, Paramedic Liaison for VCMC, has strongly --4--r that the District personnel accompany all ALS patients y
to the Base Hospital and not transfer any responsibility to another
ALS provider. This arrangement would insure continuity of care to
the patient and minimize the liability potential to the District.
If this transport arrangement is included in the pilot program,
costs to the City may increase to provide mileage (to/from the
medical facility) and to reimburse the District for additional fire
suppression back-up costs, if any.
According to State Health and Safety Code, the proposed program is
• acceptable and compatible with the EMS delivery system. As a pilot
program, it is anticipated that the program will cause no or little
disruption to the EMS delivery system.
4 . Other Concerns: •`'''. N.
Another concern is the provision of ALS coverage, when the engine
company(s) are already responding to a medical or other emergency.
Back-up coverage will have to be coordinated as appropriate. •
The County EMS Agency has suggested that the pilot program may have
• some impact on the Base Hospitals, specifically, Simi Valley
Hospital and Los Robles Regional Medical Center. This impact could
include additional monitoring responsibilities for the Paramedic
Liaison Nurses, but these are not thought to be significant
increases . An orientation session for the "new" EMT-P' s would be
:, needed to familiarize them with Base Hospital (BH) operations and
expectations. The BH's have the capability to provide medical
control for multiple calls.
The intent is that at the end of the program year, the program will
5
be evaluated and the above items will be considered in determining
whether the service should be continued in the City and whether
enhanced paramedic service should be considered for other areas in
the County. There is some concern that since this pilot program is
being conducted in an area of limited medical emergencies due to
the small population, that one year may not be sufficient to fully
analyze the success or failure of the program. It has been
suggested that the City may want to consider a longer period of
time for its pilot program.
Fire Suppression Response Coverage:
As was mentioned earlier, if the engine company must accompany the
patient to the Base Hospital, arrangements for another area engine
company to cover the fire station area must be made . In most
cases, this will be accomplished by having Stations 40 and 42 cover
for each other. During this time, albeit brief, one engine company
will be providing general emergency response coverage for twice the
area it normally serves. In most cases, it will not mean that an
additional back-up engine company will relocate to Station 40 or
42. This could increase response times by 8 minutes or more. In
addition, ALS calls, on the average, take longer than Basic Life
Support (BLS) calls (which are the Fire Protection District's
current responsibility) .
As a result, the City may find that this pilot program may actually
reduce the ability of the District to provide general emergency
response in order to provide enhanced emergency medical service.
Also, there will be times, particularly during fire season, when
either the engine company from Station 40 or 42 (probably not both)
will be required to relocate to a station out of the area to
provide adequate coverage. The pilot program will have to �.
accommodate those times by accepting a reduced level of paramedic
response coverage.
ALS Designation:
The Advanced Life Support (ALS) provider for any area requires
Board of Supervisors designation and a contractual agreement.
Currently, the private vendor for Area 4 (which includes Moorpark)
has been designated as the ALS provider. If the District is to be
the ALS provider, under this pilot program, the District must apply
and be approved as an ALS provider for Ventura County. This will
require the development of a plan to the EMS Agency, Emergency
Medical Care Committee (EMCC) and the Board of Supervisors
outlining the staffing, coverage, geographic area, education,
training, record keeping , etc.
6
The Board's policy has been to have one ALS provider in an area to
avoid confusion and provide efficient effective emergency service
delivery. since the current ALS provider, a private vendor, has
already been designated for Area 4 (including Moorpark) , potential
conflict issues will have to be resolved. Also, it is still
unclear whether, according to the State Health and Safety Code, two
ALS providers can be designated for one area. This will also have
' to be determined by the EMS Agency.
Trainincu
Prior to program initiation, eight certified and accredited
Firefighter/Paramedics will be designated for the program by the
District. No training, certification or accreditation costs will
be financed by the District. As indicated by the Firefighters
Association, there are five additional staff members (total of
thirteen) who are willing to participate if necessary.
All participating Firefighter/Paramedics (thirteen) will obtain, at
their own expense, the required on-going training as required
during the course of the pilot program to maintain certification
and accreditation. If this required training must be obtained at
a time when overtime pay is earned, the City will pay the
additional half-time cost.
If during the course of the pilot program, it is apparent that
additional Firefighter/Paramedics (in addition to the current 13)
need to be made available for the program, the Fire Protection
District will:
1. Review the pilot program to determine an appropriate course of
action, including the option of terminating the program at an
earlier date than anticipated. (If termination seems
appropriate, the City of Moorpark will be contacted to
participate in the decision making process . )
2 . If the program is to be continued, the District will survey
its current staff to determine if any qualified staff are
available and willing to participate. If none are available,
a recruitment will be conducted. This may be at the City's
expense if this is a recruitment which would not otherwise
have been conducted by the District. •
Equipment:
The Ventura County Firefighters Association and the Fire Protection
District agree that the equipment listed on Attachment 1 will be
necessary to implement the pilot program.
The total cost for this equipment is $15, 200 per station or $30,400
for the program. This includes the upgraded, additional
7
,
•
defibrillators which are required to support the paramedic
operation. The EMT-D defibrillators which are currently budgeted
by the District for each of the Moorpark stations will continue to
be purchased as was originally planned.
The purchase price of the defibrillators also requires a one-year
service agreement to provide repair and a replacement within 2
hours (on loan if necessary) . Therefore, no additional contingency
funding for this potential expense has been included in the budget,
however, if the program continues beyond the pilot program, some
financial provision for these potential occurrences should be made.
Also, no contingency funding has been provided for the
communication equipment. The vendor has indicated that if a
failure occurs within the year, loaned equipment will be provided
while repairs are completed. Again, , if the program continues, a
contingency fund for the repair and replacement of this equipment
should be considered.
tf the enhanced paramedic program is terminated during or after the
pilot program, the additional program'equipment (Attachment 1) will
remain the property of the City to administer: as it deems
appropriate.
staffing Requirements:
Administrative Supervision:
The Fire Protection District has indicated that its staff person,
currently functioning as the Emergency Medical Services (EMS)
{ Coordinator, could command and supervise paramedic training,
equipment, legal issues, quality control, public relations and
hospital liaison, and/or assist with operations of assigned \�
programs and perform related work as required. The estimated
. required time for this administrative assignment would vary over
the course of the pilot program but would probably include 25 hours
initially and an average of six hours per week (52 weeks) . The
cost for this time, computed at the Board approved rate for a Fire
District Engineer, is approximately $24 , 000 .
Medical Supervision: •
The State Health and Safety Code; California Code of Regulations,
Title 22 , Division 9; and local EMS policies and procedures,
require medical direction for providers of advanced life support
services. For the purposes of the pilot program, this requirement
can be met by contracting with a medical firm or medical individual
for intermittent program monitoring for quality assurance.
Dr. David Chase has indicated that he would be able to serve in
this capacity. He suggest 15 to 20 hours to establish the program
and 5 hours per month thereafter. The estimated cost for this one-
year contract is $7, 500.
If the enhanced paramedic program is continued in the City (beyond
the pilot program) and/or it is extended to other communities, it
is reasonable to anticipate that this contractual approach will
need to be reevaluated.
Bonus Pay:
Both the Firefighter's Association and the Fire Protection District
have indicated that Firefighter/Paramedics with other Fire
departments in other jurisdictions earn a bonus pay of 10% to 20%.
It was proposed that the Firefighter/Paramedics participating in
this pilot program be paid a 10% bonus (based on salary and
benefits) to offset the training costs.
There was some question as to how' many Firefighter/Paramedics
should receive the bonus pay. The Association contends that all
thirteen should be paid the bonus to. maintain their training; the
District believes that the designated eight should receive the pay.
For the purposes of the pilot program, it does not seem reasonable
to expect the City to pay the bonus for more than eight positions
actively participating. Therefore, the recommendation is to
include the cost of the bonus pay for the eight designated
positions as long as they are directly involved in the program.
Only eight positions will receive the bonus pay at any given time.
It is anticipated that the position of Firefighter will be
designated for the Firefighter/Paramedic classification.
Therefore, the bonus has been calculated based on the top amount of
the firefighter salary range. The total annual bonus costs (based
on salary and benefits) for eight positions is $41,200.
(Attachment 2)
In addition, the County Risk Management Office has indicated that
additional liability insurance coverage will be required for the
paramedics. The estimated one-year cost for this coverage is
$3, 000.
Total Cost:
If the City determines that it wishes to initiate this one-year
pilot program for enhanced paramedic service, it is recommended
that the Fire Protection District administer the program and bill
the City for the following amount in advance of program delivery.
Upon program evaluation, the City will be notified of any
overcharges or undercharges which will be corrected.
9
-';:r
•
.7[.1 GJ J1 10./it 1L•Jt.
•
The total program costs are as follows:
Equipment $31, 400
Supervisorial Staff 24 , 000
Medical Supervision Contract 7 , 500
Insurance 3, 000
Bonus Pay 41,200
Possible training overtime 3 , 00Q
TOTAL $110, 100
The above total does not include any cost estimates for mileage,
potential firefighter/paramedic recruitment, or additional contract
costs.
Summary:
This evaluation of the potential one-year pilot program for
enhanced paramedic service in the City of Moorpark has indicated
that the program is possible and is within the cost estimate
initially developed by the City.
There are however, some unresolved concerns which the City and, in
• some cases other entities, will want to address prior to the
initiation of any pilot program and modification to the EMS
delivery system in the area.
The concerns for the City to address are:
1. Is the City willing to potentially reduce general emergency
response in order to enhance paramedic response in the area.
• 2. Can the City accept reduced paramedic response delivery during
times when either Station 40 or 42 are providing fire
suppression service or back-up out of the area.
3. Given the number of emergency medical responses, is one year
a sufficient period of time to fully analyze the success or
failure of the proposed pilot program.
The concerns for the County's EMS Agency to address are:
1. What operational and/or contractual needs will the private
vendors propose.
2 . Can emergency medical care be transitioned from one paramedic
= to another paramedic without jeopardizing the level of care.
The concerns for the Fire Protection District are:
1 . Does the District currently have sufficient firefighter/
10
paramedics who can obtain the required certification and
accreditation to support a successful pilot-program.
2. Will eight paramedic firefighters initially assigned to the
program be sufficient to provide complete coverage.
3 . How will the medical supplies and equipment, and subsequent
billing, be coordinated with the vendor.
4. How will fire suppression response back-up be coordinated when
Station 40 or 42 are providing paramedic coverage.
5. Can emergency medical care be transitioned from one paramedic
to another paramedic without increasing potential liability.
These concerns, along with any other items identified by affected
agencies, should be addressed prior to the initiation of any pilot
program by the City.
11
Attachment 1
XQUIPMENT COST ANALYSIS
The following equipment is the minimum additional equipment
required to support the expanded paramedic pilot program at each of
the two Moorpark stations. The following costs are for one
'station.
Basic Life Support (BLS)_Eclujnment Costs:
Sand bags/head restraining devices (approx. ) $ 70
Backboard with straps 130
Advanced Life Support (ALS) Equipment Costs:
Bio-Communication Equipment: .$ 3, 000
(A cellular telephone with telemetry
capability can be used in lieu of a bio-
cm radio. The telephone will cost
$2, 500 plus an estimated $500 for calls.
A medical radio would cost $7, 920. )
Cardiac Monitor/Defibrillator: 11, 150
(Life Pack 10 with service agreement
and battery support. (This is in addition
to the defibrillator previously budgeted
the District. )
Laryngoscope and Equipment 250
Misc. Equipment (i.e. drug box, etc. ) • 200
Pneumatic Anti-Shock Garment 400
TOTAL $15, 200
FOR TWO STATIONS $30, 400
Defibrillator Service Contract 1,000
TOTAL EQUIPMENT COST $ 31, 400
•
• 12
Attachment 2
STAFFING COST ANALYSIS
Annual Firefighter Salary $ 37 , 688
10% bonus pay paid to Firefighter/Paramedic $ 3 ,768
Fringe Benefit cost (37 . 68$) $ 13 , 824
10% bonus cost to Fire District $ 1, 382
Total additional cost per Firefighter/Paramedic $ 5, 150
Total additional cost for 8 Firefighter/Paramedics $41, 200
•
13
//. L -
1 s�
Pruner Health
Services, Inc.
October 2 , 1991
City Council
72 Moody Court City of Moorpark
Thousand Oaks 799 Moorpark, CA 93021
CA 91360
(805)496-4684
Dear Councilmembers:
Pruner Health Services has continued, as requested, to
work with the Ambulance Sub-Committee of the City
Council to locate appropriate housing which will allow
the stationing of a paramedic ambulance in the City of
Moorpark as soon as possible.
Much time and effort was expended by both the sub-
committee members and ourselves to attempt to arrange
for the paramedic ambulance to be stationed in one of
Moorpark's two fire stations. Unfortunately these
efforts proved unsuccessful. As soon as it became
apparent that co-location would not be possible at
this time, other options began to be explored.
We have investigated several potential locations and
the related costs. Based on available options we are
prepared to accept a maximum fixed dollar amount of
$13,800, plus any site improvements required by the
City, to meet the City's financial responsibility to
provide housing for the paramedic ambulance as
proposed in our letter to the City dated June 5, 1991.
Adding the proposed maximum housing cost to our
existing proposal would bring the total fixed cost of
immediately stationing paramedic ambulance service
within the City of Moorpark to $77,800.
If the Council should decide to accept this proposal,
Pruner continues to be prepared to finalize the
details and to relocate immediately.
We respectfully request your earliest consideration of
this matter.
Sincerely,
PRUNER HEALTH SERVICES, INC.
Don Pruner, President
"Service is our responsibility—helping people is our satisfaction."