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""NOV 14 1984 Dv 841 ency service in Indian River County it could not be beyond the stated goals for them to provide emergency service. Mr. O'Grady also states that the level of service to the residents appears marginal. That is quite a serious accusation and suggests that the Commission attempt to obtain some assurance from C & J that an ap- propriate level of service will be made available. In response we found it also unuasual that the hospital failed to document the countless transfers we have made for them and the residents of the county for the last 7 years. We have enclosed our records of transfers the hospital made no mention of and also our explanation of each of their dated "refusals". It appears that the real issue is that the county is growing and as it does the need for more emergency and non -emergency services increases steadily. As a private service with the type of cert- ificate we hold are we to be responsible for every transfer? Finally, in closing we would like to continue serving Indian Riv- er county in 1985 however, the State of Florida, Department of Emergency Medical Services will not accept our application after November 22, 1984 for the upcoming year without a certificate from each county that we serve. Our local Health Department gives us an inspection which should be taking place in the next three days, and after the inspection is finished we must provide them with copies of our 1985 certificates which the Health Dept. then mails to the state with all of our paperwork. The state requires that all of these papers reach their office in Tallahassee no later that 60 days prior to the expiration of our license which will expire on January 23, 1985. If we are unable to have these papers in by Nov- ember 22, 1984 we will be forced to stop serving Indian River county when our current certificate expires on December 15, 1984. This is certainly going to be a problem not only for the hospital and the residents of Indian River county but it will be a very heavy load for the I.R.C.V.A.S. as there will be no '! non- emergency" ambulance service in the county. Lorac (Wheelchair Van Service) will not be of any assistance as they have no medical personnel on their units thus leaving all ambulance transportation to I.R.C.V.A.S. It is unfortunate that these problems have arisen but we ask that the Commission review our letter and explanations carefully, and we feel it is only fair that you realize the enormous services that we have provided consistently in the past and consequently with out the Certificate in a very short time we will not be able to service Indian River County as we have done for the last 7 years. Sincer y, Deborah A. Crouse Manager V