My patience is running a little thin with the Contra Costa Times Editorial Board as they put out an editorial on Sunday, February 17 regarding the Board of Supervisors running out of patience with Chief Daryl Louder. The editorial was misleading, full of distortions of reality, and flat out funny when compared to watching the actual meeting.
To be perfectly honest, I read the editorial, I watched the meeting, I re-read the editorial and I still have no idea what the Times Editorial Board was writing about because it must be some other meeting under another title. The bottom line, accuracy is out the door and the Times is writing to be read, not reporting what transpired!
For instance, the Times states the following:
“The frustration led to a public dressing down Tuesday the likes of which we haven’t seen in decades”
Say what? No such thing occurred on February 12. There was a few discussions that were touchy, but there have been much worse debates prior to Measure Q. Heck, just go watch Candace Andersens first and second meeting for good debates.
Even more disturbing, the editorial board claims the Board of Supervisors told Chief Louder “no” to potentially billing folks for firefighters showing up on medical calls. As you will see in the summary, that is not true. The Board requested more information and look into it. They did not reject it as the Times claims.
The Editorial Board then claims:
Supervisors were annoyed, and let the chief know in no uncertain terms. They hadn’t been given advance warning this was coming. Louder was pressuring them that MOFD needed an immediate decision. And he didn’t tell them that MOFD intended to own and operate the station. They gave Louder permission to talk to the district but wisely made no commitments.
Again, not entirely true. Mitchoff and Gioia were annoyed. Candace Andersen urged this item (SD-5) to be put on the agenda while Supervisor Piepho explained how the Board had known about this for years and it finally came up on an agenda. Ultimately, with some ridiculous wording tweaks by Gioia, it was approved 5-0.
So looking at the February 12 meeting, here is the leadership and communication problem the Times is suggesting.
- Public Comments
- Consent Calendar
- SD-3: Approved 5-0
- SD-4: Approved 5-0
- SD-5: Approved 5-0
- SD-6: Approved 5-0
- SD-7: Approved 5-0
- SD-8: Approved 5-0
- SD-9: Approved 5-0
As you can see, it appears the Chief and the BOS are on the same page. If the Board of Supervisors were that annoyed with the Chief and there was a “leadership crisis” as the Times claims, I doubt the Board actions would be 5-0 votes down the line.
It’s just another example of changing facts and lazy writing. Shame on them!
If there is a leadership problem then its coming from the Board of Supervisors who are Chief Louders boss. He can’t act unless they give approval. If Louder is confused or isn’t communicating well (not true), it’s because he has a lack of direction from the Board of Supervisors.
The truth is, this is nothing more than a newspaper Editorial Board trying to pit a fire Chief against the Board of Supervisors. You can’t blame Louder for offering suggestions to raise revenue and tweak services models, t least he is proposing something, all the Times Editorial Board does is complain while failing to offer any suggestions at all besides talking points.
One wonders when the Contra Costa Time’s will finally do what’s needed: Find another Editorial Board!
Here is the meeting overview with staff reports.
SD3: CONSIDER authorizing the Fire Chief, or designee, to pursue implementation of a self-inspection program for lower-hazard commercial occupancies to increase awareness of fire safety and increase compliance with state laws, regulations, and local ordinances related to fire and life safety. (100% Fee Revenue) (Lewis Broschard, Fire Marshal)
SD 4: CONSIDER approving and authorizing the Fire Chief to organize a joint County-City strategic workshop to discuss service delivery expectations and a collaborative approach to providing services. (Daryl Louder, Fire Chief)
SD 5: CONSIDER approving and authorizing the Fire Chief, or designee, to conduct formal discussions with the Moraga-Orinda Fire Protection District to enter into a partnership to jointly build and operate a single fire station to replace Fire Station-16 (West Lafayette) and Fire Station-43 (East Orinda). (Daryl Louder, Fire Chief)
Supervisors Gioia and Mitchoff wanted a more thoughtful process and what a plan looks like while not hearing about it from the papers first—they would like to here it from the Chief first.
Louder: It’s a request to start discussions, stated discussions have been informal and nothing serious from an authorized standpoint.
Piepho supported the discussion to begin and start with the community. This is simply discussion and planning to go along with this. The information will come back to the board. I believe we need to move forward and be responsible to the community.
Anderson: Admitted when the Chief went to her, she wanted to get it on the next agenda because it has to be a joint decision to continue the discussion. It’s very important because Moraga-Orinda is ready to do something. It gives the Chief authorization to have discussions
Ultimately, after some wording ridiculous tweaks, it was approved 5-0. Federal Glover stated in the future, he is looking for clearer communication.
SD6: CONSIDER approving and authorizing the Fire Chief, or designee, to conduct a feasibility study to relocate Fire Station 86 (Bay Point) from its current location to property owned by the Fire District located at Willow Pass Road and Highway 4. (Daryl Louder, Fire Chief)
SD7: CONSIDER approving and authorizing the Fire Chief to develop an Ordinance that would provide cost recovery for Emergency Medical Services (EMS) responses. (Daryl Louder, Fire Chief)
“The only reimbursement is transportation which is AMR transporting patient to hospital. Louder looking at cost recovery—a cost recovery fee. Treat and no transport fee. Fees would range $275 to $400 for cost recovery. There would also be some sort of “compassionate billing” built in.
Mitchoff – concern is people are already paying taxes for fire and emergency services…concerns about moving from a no fee to all fee when already paying taxes. When you need it, you are paying money.
Gioia – When we went through ambulance RFP, one of the major issues was where do we stand on EMS fees that we bill patients and insurance companies… we wanted to keep fees as reasonable as possible and ambulance company agreed. We are going into this not understanding of what it means to our total fee. Sounds like patients and insurance companies will get two bills. AMR currently doesn’t bill if they don’t transport (Confirmed by AMR’s Pat Frost—she also said reimbursements are getting more difficult. Certain hospitals and insurances won’t pay it and in future rates for ambulances will actually be reimbursed at lower rates). Gioa stated the issue is what recourse if the rate is capitated.
Andersen: Asked pat frost if she was talking about medical. Confirmed she was only referring to medical.
Gioia: What other fire districts do this. Louder replied Novato and Sacramento do similar as the chiefs potential proposal. Gioia wants more information prior to making a decision.
Pipeho: wants more information before they can make a decision. We don’t want to be competitive, we want to be one structure.
Andersen: She stated she was in favor of something similar and has been in favor of this since day 1. Wants to pursue it with an update with more information.
Continue to pursue: 5-0.
Staff report on this item:
Nominal fiscal impact for staff time to develop ordinance. Possible new revenue generation of $3-5 million annually if EMS cost recovery ordinance is adopted.
The Contra Costa County Fire Protection District is an “all-hazards” organization that responds to fires (e.g. structural and vegetation), rescues (e.g. vehicle extrication, swift water, industrial accidents), emergency medical services (EMS), hazardous materials incidents, utility emergencies, etc. Functioning as an all-hazards organization provides the highest level of protection, service, and value to the community.
Medical emergencies account for approximately 80% of the District’s annual responses. This includes potentially life threatening emergencies (e.g. heart attack, respiratory difficulties, allergic reactions, trauma) that require advanced life support (ALS) and non-life threatening incidents (e.g. fractures, illness, soft tissue injuries) that require a basic life support (BLS) response.
All of the District firefighters are required to maintain either paramedic or emergency medical technician certifications in order to provide these services. Each response unit is staffed with a minimum of one paramedic and two EMTs and properly equipped for EMS response. The closest available resource (fire or ambulance) is dispatched to the incident in order to facilitate a timely response to the emergency.
Under the current system, only American Medical Response (AMR), the contract company that provides patient transport, is eligible for cost reimbursement. The Fire District does not receive any reimbursement for the medical response services that are provided. Property taxes provide the funding to build the response system and capacity. However, additional support and funding is necessary to maintain and sustain the system. These proposed user fees will help to cover the direct costs of delivering these vital services to the customers. A number of other jurisdictions across the State have implemented similar cost recovery user fees in order to maintain service levels.
The majority of the cost recovery fees would be covered by health and automobile insurance policies. The District would recommend a “compassionate billing” policy for those residents that are not insured and financially unable to pay for the services.
It is estimated that the cost recovery fees for EMS services would generate $3-5 million to offset the cost of providing the services. Revenue from the EMS cost recovery fees will be reinvested in the District in order to maintain critical response services and prevent further erosion of service levels in the community.
SD 8: CONSIDER accepting a report from the Fire Chief on the EMS-only pilot program proposal. (Daryl Louder, Fire Chief)
The Contra Costa County Fire Protection District (CCCFPD) is proposing an innovative alternative service delivery solution that will provide residents in areas that are affected by fire station closures with emergency medical response and care. This is an opportunity to develop partnership with other stakeholders (e.g., County Emergency Medical Services Agency, affected cities) to collaboratively protect the community.
The residents of our communities have expressed high expectations for levels of service. At the same time, a number of residents have expressed concerns regarding the cost of delivering essential services. CCCFPD has identified a means to provide a first response capability for medical emergencies that will not only provide rapid response and treatment, but will also demonstrate our ability to offer alternative service delivery and staffing configurations at a reduced cost.
Approximately 80% of the District’s responses are related to emergency medical services (EMS). However, it is important to note that the EMS-only pilot program provides a very targeted response capability and will not provide fire and rescue capabilities. This proposed pilot program is designed to provide a targeted response capability during peak service demand time periods.
The Fire District plans to achieve the following objectives if the pilot proposal comes to fruition:
• Provide essential emergency medical assessment and treatment • Reduce response times to medical incidents that occur in areas affected by station closures • Demonstrate innovation and flexibility by addressing concerns from the community regarding alternative service delivery models • Assist in meeting state/county requirements for indigent care as outlined in the California Welfare and Institution Code • Meet performance standards that are defined in CCCFPD’s interagency agreement with Contra Costa County EMS • Evaluate initial steps toward alternative community-based health care systems that are being mandated by health care reform • Evaluate the effectiveness of smaller, less expensive response vehicles for emergency medical incidents • Enhance the recruitment and diversity of applicants to the District and provide a potential career path
Civilian EMS-Only Concept of Operations Proposal:
The Fire District proposes to hire civilian EMS-only (non-firefighter) personnel and manage the deployment of two non-transport medical response units. Each unit will be staffed by one (1) certified paramedic and one (1) certified emergency medical technician (EMT). The units would operate Monday through Saturday from 8:00 A.M. to 8:00 P.M. during peak call volume hours. The units will provide timely delivery of advanced life support services.
The pilot program units will provide coverage at Station 11 in the City of Clayton and in the area of Station 16 in the City of Lafayette. Both units will fill a void in service and response time coverage due to recent fire station closures in the communities.
For standard medical emergencies, the units will be dispatched singularly, or in conjunction with a transport unit operated by American Medical Response (AMR). Upon arrival, the crew will assess the situation and determine if other resources are necessary. If not, the transport unit will be placed in service thus reducing the demand on the response system. The crew will then begin emergency care and management of patient(s) until the arrival of the transport unit. Units will be committed to their respective first-due areas but will be subject to being accessed for other areas in the event of multiple incidents or a large scale event. These units will respond to other emergency incidents (e.g. fire, rescue) in their respective first-due areas to assess the situation and provide a size-up report. However, they will only participate in activities to provide medical care or standby at such events.
The time frame for the proposed pilot program will be two (2) years with ongoing evaluation of performance measures and outcomes. At three (3) month intervals, Fire District staff will meet with representatives from County EMS, AMR, and other partners to discuss the efficacy of the program and determine if any adjustments need to be made. At the conclusion of one year, a stakeholders group will convene to perform further analysis of data that will include, but not be limited to, response times, call volume, adherence to protocol and procedure, patient outcomes, and other measures. At that time, it will be determined if significant programmatic changes are necessary for the second year of the pilot program.
It is anticipated that there will be minimal need for capital expenditures. • 2 – CPR-assist devices @ $20,000 each = $40,000 • 2 – small SUV response vehicles with emergency warning device package @ $40,000 each = $80,000 • 2 – mobile radios @ $6,000 each = $12,000 • The Fire District will provide all of the necessary EMS-related equipment (e.g., 12-lead heart monitors/defibrillators and portable radios to outfit these units)
To staff these new positions the Fire District will hire four (4) personnel with paramedic qualifications and four (4) personnel with EMT qualifications, creating eight (8) new full-time equivalent (FTE) positions within the Fire District.
This pilot program is predicated on the use of civilian EMS providers and not firefighter paramedics. As such, the District will need to establish new job classifications and specifications within the merit system. However, there are a number of existing examples from different jurisdictions to expedite the process. The District would explore alternative hiring processes (e.g., temporary, project, or contractual) on an interim basis to facilitate implementation of the pilot program. Once hired, the new personnel will only need to be trained on local medical protocols and policies since they are required to be certified as a paramedic or EMT to apply.
Personnel Costs: See Attachment B
Annual Operating Costs:
• Supplies – $6,700 • Fuel – $36,200 • Maintenance – $12,400 • Continued Education Training – $7,500 • Total = $62,800
Total Pilot Program Costs:
Based upon staffing, operating expenses, and one-time start-up costs, the District estimates the total programmatic costs below:
Total Operating Cost for First Year per Unit (including startup capital costs) = $409,400
Total Operating Cost for Second Year per Unit = $343,400
Cost Share and Scalable Options:
In order to implement this innovative EMS response concept, it may be possible to share the cost between the various stakeholders. In spite of our challenging fiscal situation, the District may be able to contribute partial funding if other stakeholders (e.g., County EMS, cities that will benefit from the service, or health care organizations) are interested in contributing to the initiative. It is also possible to scale the number of units or hours of coverage to match available funding.
The Fire District has been severely impacted by the ongoing recession and has closed four (4) fire stations in addition to the two (2) companies that were de-staffed previously. In order to maintain acceptable response times and provide critical medical care to residents in our communities, it is imperative that alternative service models be implemented. The proposed EMS-only concept has the potential to leverage partnerships and accomplish the goal of providing critical service to our residents in a cost-effective manner.
SD 9: CONSIDER accepting a report from the Fire Chief on the EMS-only pilot program proposal. (Daryl Louder, Fire Chief)
Fire Stations 4 (Walnut Creek), 11 (Clayton), 12 (Martinez), and 16 (Lafayette) were closed on January 15th as approved by the Board of Directors at the last meeting on December 11th.
Community Meetings – Respective members of our Board of Directors, District staff, County staff, and partner agencies conducted community meetings in each of the affected areas. The goal was to explain why the individual fire stations were impacted and to discuss the specific mitigation strategies that have been implemented in each community in an effort to reduce the adverse impact.
Response Times – Only two weeks of data is available since the closure of the fire stations. This is not statistically significant for an accurate analysis. See Attachment A.
An analysis of the first month of data will be provided verbally at the Board of Directors meeting. To date, the District is not aware of a significant delayed response time or serious impact in the affected areas.
Mitigation Strategies – District staff is working closely with our response partners (County EMS, AMR, Moraga-Orinda Fire, San Ramon Valley Fire, and East Contra Costa Fire) to provide service to the affected communities.
- Closest resource from any agency will respond to the incident
- AMR is reviewing and adjusting their posting locations to provide the best coverage
- County EMS is reviewing and adjusting the response to incidents in medical facilities
- Engine Company 22 (Concord) is operating out of the Clayton fire station from 2 P.M. to 8 P.M. daily on Monday through Saturday
- Reengineering routine business flow and processes to keep units available for response
- Continue to explore the civilian EMS-only pilot program
- Continue to hire and train additional reserve personnel for limited duties
Staffing Levels – The minimum staffing for field operations for 24 fire stations is 219 personnel. The District currently has 216 personnel assigned to field operations. As such, no reductions in force or layoffs are necessary as a result of the recent fire station closures. The District will continue to monitor staffing levels as we prepare the FY-2013-2014 preliminary budget, evaluate attrition rates, and evaluate the potential impacts of AB-197 litigation.
Facilities and Apparatus – Security systems have been installed in the four fire stations and valuable equipment has been removed from the facilities. Each station is being periodically monitored by local police departments as well as staff from adjoining fire stations. Fire apparatus from the respective fire stations has been redistributed to augment the operation capabilities and enhance the reserve fleet.