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WVN #282: Improving emergency care, school technology

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  • waylandvoters1
    Dear Wayland Voter, In today s newsletter: the selectmen grapple with improving emergency care and the School Committeee advocates better technoogy. ASSESSMENT
    Message 1 of 1 , Jan 26, 2009
      Dear Wayland Voter,

      In today's newsletter: the selectmen grapple with improving emergency care and the School Committeee advocates better technoogy.


      The second of four public forums on assessment practices, scheduled for Monday Jan. 26 has been postponed, the Board of Assessors announced.  A new date hasn't yet been set.

      Other scheduled forum dates: Feb. 9, Feb. 23.


      Wayland is not a good place to be if you suffer a life-threatening event, particularly south of Route 20.
      That area accounts for 84 percent of emergency calls and includes four of the town's five schools. 

      The accepted standard of care calls for Advanced Life Support service, and most of the time Wayland can't provide  it. The situation has worsened in recent years because Wayland relies on outside providers. 

      Nobody knows this better than the Wayland Fire Department and two Wayland residents who are emergency  care physicians.

       In  presentations before the Board of Selectmen Dr. Mark Neuman and Dr. Beth Zeeman spoke in clinical terms but made it clear that ALS can be the difference between  life and death, or at least greatly diminished life.

       Neuman, a physician at Children's Hospital emergency room, said he has seen children "neurologically devastated without pre-hospital care."

      He gave a  hypothetical example: A child is in an accident  and has difficulty breathing. Without ALS, basic care by  Fire Department crews provides a backboard and an air bag, but for 25 minutes the brain gets too little oxygen and may be
      permanently damaged. With ALS, paramedics use  a needle to decompress the chest, then insert a tube, and sufficient oxygen is restored in as little as 5 minutes.

      Without ALS, Neuman said, a heart attack victim might be delayed two hours before undergoing  catheterization that could save him from "a significantly altered life."

      Fire Capt. Vinnie Smith led a committee that included the two doctors and Selectman Doug Leard, a former fireman. The committee produced a detailed study and a "flexible, scalable"  plan to start doing something about the situation immediately at
      modest cost: about $28,000 for equipment and $57,000 in operating costs for the first year. 

      Smith described the estimate as a worst-case scenario and predicted that there would be more emergency calls than in the estimate and thus more revenue to offset the cost.

      The plan calls for hiring two part-time (no benefits) paramedics to cover the eight busiest hours of the day. In addition to a faster response time, the paramedics would be able to provide vital pre-hospital care en route. By cutting the average
      response time by 50 percent, to 6-7 minutes, Wayland would be well within accepted standards of care.

      Those who believe that the first obligation of town government is to protect health and safety are likely to find merit in the plan.

      You can read it at  citizen websites:



      The selectmen and Cherry Karlson of the Finance Committee endorsed the idea in theory at a Jan. 22 meeting but raised many questions about costs and long-term planning.  

      Karlson said her committee plans to vote on a proposed  a Fiscal 2010 budget by Jan. 29. She and the selectmen asked for a five- or seven-year plan, which the committee said it could produce quickly. 

      After Karlson raised the question whether providing enhanced service would increase the town's liability, Dr. Zeeman pointed out that the town already faces liability.

      "I've been on the other side," Zeeman said, indicating that Wayland could face legal action from "a bad case." In other words, imagine a lawsuit by the parents of a child who couldn't be saved after a schoolyard accident or the widow of a heart attack
      victim who couldn't receive life-saving care in time.

      As the discussion of finances wore on, a woman  in the audience who described herself as a former nurse called out loudly to the Board, in violation of protocol: "Every one of you guys is subject to a heart attack. I went through that and ALS came for
      my husband. ALS happened to be in town." (She lives north of Route 20.)

      Selectman Chairman Michael Tichnor let her finish before replying that the Board has a fiduciary responsibility. The case is persuasive, he said, and  the town needs to "find a way to make it work."

      The ALS committee suggested tapping the $3 million "gift" from the Town  Center  to get the system started. Selectmen expressed reservations. Some  indicated that expenses must be considered thoroughly because the town couldn't back off
      once a higher level of service is established.

      There were concerns that start-up ALS costs could mean a staff layoff somewhere. The non-school part of Wayland's budget is less than a third of total spending, and  town departments have relatively small staffs.

      The estimated start-up costs are a small fraction of one percent of Wayland's budget.

      Wayland finds itself in this position because it depends on Emerson Hospital to provide ALS service as far south as Route 20 and on a private, Natick-based  ambulance service, AMR,  for all other calls requiring high-level care. AMR responds when it
      can but has no obligation to do so.

      Contracting with AMR to guarantee service would cost "huge money," said Selectman Leard.

      Though the first responsibility would be to Wayland residents, under the proposal the paramedics could serve an area of about 70,000 population. Wayland Fire Chief Robert Loomer had consulted his counterparts in neighboring towns and said they
      all agreed that  if Wayland were the closest source they would use it. 

      In time, the committee said, the system could grow to the point where Wayland hired and trained its own paramedics. (In some communities up to half of calls merit ALS response.) The committee named other Massachusetts communities that
      provide ALS successfully. 
      Someday there could be a regional solution, Loomer said, but it's unlikely in the near future. 

      "Is this the perfect solution?" Loomer said. "No. But we have an immediate problem, worse than four years ago."

      Wayland can't control costs of outside ALS providers and has no assurance that service will continue over the long haul. 

      When Capt. Smith was asked whether private donations could support ALS service if the town can't find the money, he said the committee could seek donors. But, he said, he believes ALS  is "life or death service" and taxpayers should pay for it.

      The selectmen next meet at 7 p.m. on Monday Jan. 26.

      -- Michael Short


      At the School Committee's meeting with the Finance Committee on Jan. 20 to discuss its Fiscal 2010 budget proposal, when it came to the proposed $750,000 for technology, the two committees seemed to be on different planets. The FinCom from
      Mars and the SchoolCom from Venus, perhaps.

      The School Committee argued passionately for technology as a necessary new element in 21st century education. FinCom members coolly responded with understanding and sympathy, but stated definitively that no money was available for new or
      expanded services.

      However, they said, if the proposal could be economically justified as an investment that saved money then it would be another matter. FinCom chair Sam Peper asked "does this imply a fundamental change in how education is delivered?" as he
      pushed the School Committee to lay out a vision of  new technology-enabled teaching  which would include a lower personnel count.

      FinCom member Bob Lentz said they were being asked to buy into a $6 million program (spread over ten years), and that if it wouldn't save operating money then it would just add $1.2 million to the operating budget for debt service. How do we
      convince voters that this is a good investment? asked FinCom member Richard Stack.

      But School Committee members refused to discuss any possible operating savings. The closest any member would come was Barb Fletcher's comment that over ten years teaching will evolve. Member Heather Pineault argued that technology is only a
      tool for the teacher (albeit, now, a necessary one) and the teacher would always be central to the teaching process. Pineault is a former teacher.

      Superintendent Gary Burton added that all other professionals are provided with a computer to do their work and teachers needed them too. The new passionate enthusiasm for technology is in marked contrast to the committee's attitude over the
      last ten years, when technology was chronically underfunded.

      Many if not most of the FinCom members have backgrounds in senior management in business environments, where technology is ubiquitous and used to enhance productivity. In contrast, none of the School Committee members have management
      experience, and they adamantly resisted the concept of using capital investment to improve teaching productivity.

      You can't look at this in terms of return on investment, said SchoolCom chair Louis Jurist vehemently, expressing what appeared to be a unanimous opinion.

      But at some points FinCom's Peper seemed to be almost pleading with them to do exactly that. Mars vs Venus.

      As a stalemate was reached, the SchoolCom was charged with separating the budget request into maintenance spending to support technology at the same level as in previous years and new spending, aimed at creating the "21st century classroom"
      and "one to one initiative" ( a laptop per teacher and ultimately per child). It was also asked to prioritize all capital spending, which includes some modular classrooms at the high school, solar panels at the middle school, and a new truck.

      After the FinCom left, Burton reported that the high school administrators had already considered the question of priorities, and preferred to spend $450,000 on technology first, then buy the modulars, then fund the rest of the $750,000 technology
      proposal if enough money is available.

      The long range plan calls for networking to be upgraded first, then the server infrastructure, then for teachers to be provided with laptops and training, and finally laptops provided to all students.


      The other major discussion with the FinCom was over the $900,000 warrant article for the annual Town Meeting and debt exclusion ballot question for a new high school feasibility study.

      Underlying the calculations for this request is what is probably of most interest to voters: the likely total cost of a new high school project. Starting with a population projection of 1000 and using the state's standard allowance for square feet per
      student and dollars per square feet, the High School Building Committee (HSBC) projects a maximum cost of $80 million.

      The actual population to be used has been the subject of negotiation for some time. Burton reported that it is close to resolution, with the town now asking for 930 and the state projecting 875. A compromise at 900 would presumably result in a
      $72 million project.

      But the HSBC took the $80 million number and multiplied that by 1.5 percent, which is the standard cost of a feasibility study, resulting in a $1.2 million need. $300,000 has already been appropriated. Hence, a $900,000 article and ballot question.

      However, the state has already committed to pay for 40 percent of the study. So using the 60 percent town's share, and assuming a 900 student population, the town's total cost should be about $650,000. Subtract from that whatever portion of the
      previous studies can be reused (currently unknown), and the already appropriated $300,000 and it's very likely that the amount of new money the HSBC actually needs in this next phase will be under $300,000.

      It is possible, however, that Town Meeting will have to appropriate the entire $900,000 to become eligible for reimbursement.

      FinCom's Lentz said whatever amount this is would be a debt exclusion vote. HSBC chair Lea Anderson said  a population number should be established in two or three weeks. The feasibility study will present a schematic design and resolve basic
      issues like renovation vs. new construction, and should be ready for a vote on the full project in November.

      Burton estimates that the project would be completed no earlier than 2013, but more likely in 2014.


      On Wednesday, Jan. 28, the Governor is expected to announce his Fiscal 2010 budget plan. The School Committee again decided not to discuss Burton's $350,000 list of potential cuts in anticipation of the state cuts. Instead, they have scheduled a
      meeting the following night to respond to the actual announcement.

      Thursday is also when the Finance Committee plans to finalize and vote on the town's 2010 draft budget, after having held budget hearings throughout January with various town boards.

      - Tom Sciacca
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      Wayland Voters Network
      Michael Short, Editor
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