MARTIN COUNTY — Negotiations between Martin County Fire Rescue and the Stuart Fire Department may soon begin after Fire Rescue Chief Chad Cianciulli asked county commissioners to help move forward discussions to update their interlocal agreement.
Cianciulli opened the discussion by outlining the origins of the agreement and the conditions that led to its creation.
“In 2020, fire rescue administration changed and we started looking at many different areas that needed to be addressed with our services and with fire rescue in general. This was the biggest area that needed to be addressed was the imbalance that we had with their mutual aid with the city of Stuart. So let me take you to a neighboring jurisdiction for us. North of us, St. Lucie County. South of us, Palm Beach County. Our mutual aid with them, less than one percent. City of Stuart was 21 percent. And the problem wasn't getting better, it was getting worse. That's why we had to do this agreement,” Cianciulli said.
Officials said conditions have shifted since the agreement was put in place. At the time, Stuart operated a single fire station, but the city has since expanded to three stations, reducing response times.
Stuart Mayor Christopher Collins said those changes have altered how the agreement functions today.
“That previous ILA is outdated. If there was a case in the past for the county picking up the slack for the city, that does not exist anymore. If anything, the agreement that we have is now net positive for the city. Rarely will you see somebody advocating for a new deal when we are at the beneficiary of that deal, but for the sake of the public and making sure that people are not dying, this ILA needs to be updated,” Collins said.
Collins also emphasized the importance of ensuring timely emergency response.
“I know that we all want to make sure that the closest to the call gets to that call, so that residents are receiving the highest level of service,” he said.
Currently, the agreement does not include a “closest unit” response model for all calls. Instead, Cianciulli said the Stuart Fire Department agreed only to “closest echo calls,” which typically involve life-threatening emergencies such as cardiac arrest.
Cianciulli said that limitation, combined with dispatch inconsistencies, can complicate response efforts.
“An echo call, what we agreed on is if that call does happen, no matter what, it would look for the closest unit response, city or county, doesn't matter, and then they would respond and address it, and there would be no fee associated with that call. On many, many calls that were not labeled echo calls, and I arrive on scene, and it's a full-blown cardiac arrest. You do not know what the emergency is until you get on scene. So yes, I agree, all calls should be treated like echo calls, but they have refused to do it,” Cianciulli said.
Beyond response protocols, officials also raised concerns about how the agreement handles labor and delivery calls following the closure of Martin North Hospital’s delivery unit.
Under the current agreement, county units can transport labor patients to facilities with dedicated delivery units, while Stuart units transport patients to the nearest hospital regardless of available services.
Dr. Peter Dayton, a Cleveland Clinic provider who has delivered thousands of babies locally, urged officials to address that issue.
“A 28-week infant in an emergency department is a medical nightmare for Dr. Wood, because it's a very difficult intensive care situation, and those babies need the neonatal support that is not provided and is not available at Martin North. You do have a logistical problem. I ask the commission to please get these people together and let's get something done,” Dayton said.
Cianciulli said the current agreement can create barriers when trying to route patients to appropriate care.
“If you have any needs of a transport that postal care cannot handle, you call 9-1-1 and you request a county unit, and we will take that patient, no questions asked, because you cannot have that delay of care. Problem is, we are in direct violation of this interlocal agreement by doing that,” he said.
Other medical officials cautioned against changes that could introduce additional risks during transport.
Dr. Kenneth Scheppke, deputy secretary for health with the Florida Department of Health, said moving patients from hospitals to ambulances in certain cases could be dangerous.
“Taking a patient out of a hospital where there are physicians, nurses, blood products, anesthesia, operating room, into much more limited resources of the back of an ambulance may actually increase risk rather than reduce it. There are plenty of precedents where well-meaning health care teams transfer a patient in active labor only for disaster to strike before reaching the destination, leading to traumatic events for both patients and their pre-hospital providers. My team will never endorse limiting or delaying care, but we do try to protect patients from unnecessary risk,” he said.
Commissioner Edward Ciampi proposed holding separate negotiations to address labor and delivery concerns while also organizing broader discussions on the interlocal agreement with representatives from both agencies, legal counsel and Cleveland Clinic.
Collins asked that city officials be included and that the discussions be open to the public.
“What we have asked is that there is a public meeting, which I hope is not untenable to you all. I hope transparency seems like the most reasonable thing when we're discussing the health and safety of the public and pulling it out of the political gaming realm,” he said.
Commissioner Eileen Vargas supported including additional county leadership in the talks, but that proposal did not advance. Officials instead agreed to move forward with negotiations under the structure outlined by Ciampi.