HomeMy WebLinkAboutMinutes - 06-05-13 Special MeetingMINUTES OF THE
CITY COUNCIL OF THE CITY OF DOWNEY
SPECIAL MEETING
JUNE 5, 2013
The City Council of the City of Downey held a Special Meeting at 4:19 p.m., June 5, 2013, in
the Cormack Room of the Downey City Library, 11211 Brookshire Way, Downey, California, Mayor
Mario A. Guerra presiding.
PRESENT: Council Members:
Mario A. Guerra
Fernando Vasquez
Roger C. Brossmer
Luis H. Marquez
Alex Saab
Mayor
Mayor Pro Tern
(arr. 4:21 p.m.)
(arr. 4:24 p.m.)
ALSO PRESENT: Gilbert Livas, City Manager
Yvette Abich Garcia, City Attorney
Lonnie Croom, Fire Chief
Shannon DeLong, Assistant to the City Manager
---_ Mayor Guerra welcomed Council and Staff to the workshop and invited City Manager Livas
to introduce the workshop. Mr. Livas stated the City has been undergoing significant changes and
reorganizations to make service more efficient and relevant. He indicated that some improvements
have been the subject of ongoing discussions with Chief Croom but could not be implemented until
the engine was placed back into service. Now, thanks to the efforts of Chief Croom, we can begin
discussing this new service model. Mr. Livas stated that if Council approves of this service model
concept, staff would return early in the new fiscal year for additional approvals.
Fire Chief Croom began the presentation, greeted Council and the audience, and
encouraged questions.
At 4:21 p.m., Council Member Brossmer arrived.
City Attorney Abich Garcia clarified that public comments allowed at the meeting must
pertain specifically to the agendized matter; there would not be an opportunity for non - agenda public
comment at this workshop.
At 4:24 p.m., Council Member Marquez arrived.
Chief Croom previewed a series of PowerPoint slides regarding fire and emergency medical
service (EMS) delivery. He stated he would cover the City's current operations, current revenue
projections and three major factors indicating significant revenue increases in the near future. He
stated that he would be presenting the factors influencing his recommendation to add a second
Basic Life Support (BLS) ambulance to the City's operations and to transfer to a paramedic fire
engine service delivery model.
City Council Minutes
Special Meeting — June 5, 2013
Currently, Downey Fire is operating "at capacity" for both fire and EMS, based upon an
examination of Downey's data and a comparison to other agencies. From both a service and an
employee safety standpoint, this needs to be addressed.
Chief Croom explained "201 Rights" which give the City the right to transport medical
patients. If the City does not choose to transport medical patients, the only other option would be to
use private industry, which many other cities do. However, this also means forgoing the revenue
associated with billing for emergency medical transport costs. Chief Croom pointed out that while the
City has not historically managed their 201 rights as a private business would, there are many
private ambulance companies in service today, which do exactly that.
This year the City has contracted with a company called Whitman to more efficiently and
promptly handle its medical transport billing. With the outsourcing of billing and collection, the City
experienced a significant increase in its transport cost recovery, helping to recapture the costs of
providing emergency medical transport service.
Three other factors are expected to increase the City's opportunity to manage their 201 rights
effectively, further recover costs due to emergency transport and provide better service to residents.
Those factors are the: State's Ground Emergency Medical Transport law (GEMT), federally -
mandated electronic patient care records (ePCR) and the federal Affordable Care Act (ACA).
The Ground Emergency Medical Transport law (GEMT) declared that California emergency
medical transporters are allowed to request reimbursement from the federal government for
MediCal /MediCare patients who are transported in emergency medical vehicles. That
reimbursement is for up to 50% of the cost of transport. The City of Downey is expected to see 2 -3
years worth of refunds for prior years' transportation and will receive a steady funding stream in the
future.
Electronic patient care (ePCR) reporting will increase revenue through more efficient,
accurate record keeping and prompter billing, which has been shown to increase the likelihood of
payment. As a case study, Chief Croom presented data from the City of Monterey Park, which had
implemented ePCR partway through the fiscal year and was already showing a 15% increase in
revenue. Using that data as a baseline, conservative estimates show that when Downey transitions
to ePCR reporting, revenue could increase another $277,500 per fiscal year.
Lastly, the full implementation of the Affordable Care Act (ACA) in 2014 is expected to result
in currently uninsured patients becoming insured and beginning to use their insurance for medical
services. This increase in use of medical transport services would be reimbursed by the federal
government. In the County's Local Planning Area 7, which includes Downey, approximately 38% of
adults are currently uninsured and many of those are expected to become eligible for insurance in
2014.
Council asked how much revenue might increase and when will hard data be available?
Chief Croom stated revenues may increase $100 -$200 per patient and indicated that January 1,
2014 is the first year the law will affect uninsured adults. A full year's worth of data will be available
January 1, 2015.
Chief Croom stated that even if Council makes no changes, the annual increase in call
volume will generate approximately $100,000 in revenue.
Council Member Vasquez inquired as to the varying reimbursement rates from different
public and private insurers. Chief Croom verified that the reimbursement does depend upon the
insurer.
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Special Meeting — June 5, 2013 2
Chief Croom presented a proposal for adding a second Basic Life Support (BLS) ambulance,
stating that the City currently misses approximately $509,000 in transport revenue because outside
vendors must be utilized to transport the additional call volume the City has been experiencing. He
stated that in addition to loss of revenue, service to the community is diminished because there are
often communication issues with the private companies' radios, and they are not generally within the
City limits so their response time is significantly longer, sometimes leading to a 15 -20 minute wait to
transport a patient to the hospital. Adding a second BLS is uniquely beneficial to Downey in that
there are two hospitals within the City limits, and the majority of patients (89.34 %) are transported to
those two hospitals (with a few exceptions for trauma, children's and stroke patients). Therefore,
even with the gross increase in the number of transports, the units will remain in the City.
A chart of estimated revenue increases was presented, indicating that there had been a
$1.175 million increase this last fiscal year, without GEMT and a second BLS.
The chart showed that the City is currently losing out on the previously- mentioned $509,000
due to calling in private contractors to handle the additional medical transport load. Adding a second
BLS would add another $300,000 in personnel expenses (but not in equipment expenses, as the
City already has the necessary equipment given the proposed FY 13 -14 budget request for two
replacement ambulances), resulting in a net $209,000 increase to the City.
The chart also showed that EPCR reporting with a second BLS ambulance would generate
another $277,500 (based upon the Monterey Park case study).
Therefore, given GEMT, ePCR, a second BLS ambulance and billing handled by Whitman,
the City should see $3,761,500 in revenue.
It was noted that ePCR would require ipads and a few other pieces of equipment, which had
already been included in this year's budget requests. Also, the cost for Whitman billing was just
$7,800, due to the sharing of costs with the City's Joint Powers Communication Facility. Other costs
would be the storage of data in the "cloud" which would be added as a fee in the City's updated fee
resolution.
Council Member Saab clarified that if a patient is transported, they cannot decline ePCR.
Chief Croom confirmed that it is a federal mandate and cannot be declined. Mayor Pro Tern
Vasquez asked whether the ePCR was HIPPA compliant; Chief Croom confirmed that it is. Mayor
Guerra asked whether the ePCR system is affected depending upon which hospital a patient is
transported to; Chief Croom stated that it is not an issue with the two main hospitals in Downey, but
that some smaller hospitals are delaying implementation of ePCR until the federal requirement goes
into effect January 1. However, the ambulances are equipped with printers to print out the medical
record for hospital staff that have not yet implemented ePCR.
It was stated that with a second BLS ambulance, the City expects to capture virtually 100%
of the emergency private transports now occurring in the City, along with 50% of the non - transport
calls and 50% of the private vehicle transports.
Chief Croom then presented a new proposed model for fire /emergency medical service,
which would rely upon paramedic engines. He presented data on Downey's historical call volume
and type, showing that the last service change was in 1986 when the City's one EMS squad was
handling 4,200 calls each year. Since then, responses on each of the two squads have doubled,
again putting both engines at 4,200 calls and leading to a necessary change in service.
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Special Meeting - June 5, 2013 3
A comparison of Area E paramedic units was made. At the lower end, Vernon experiences
500 -600 runs per year while Compton and Downey are the two highest, with 3,200 -3,700 runs for
each of Compton's three squads and 3,818 -4,240 for each of Downey's two squads. If Downey had "-
four units in service, they would each only go on 2,013 calls — a much more sustainable call volume
and a much more efficient level of service to the community.
In the Los Angeles Area, only Compton and Glendale have call volumes similar to Downey.
Glendale has already transitioned to paramedic engines. No city's average response times are near
to Downey's, and in total, they respond to about 2,688 calls on average — significantly lower than
Downey's average call volume. Moreover, Downey has the fewest number of firefighters per 1,000
residents in the County of Los Angeles.
Transferring to a paramedic fire engine service delivery model would mean:
- Every district would have a paramedic engine
- All paramedics would also serve for fire suppression calls
- There would be 8 paramedics on duty at all times (compared to 4 now)
- There would be a 100% increase in the number of paramedic units
- There would be more limited flexibility in call response during peak call volumes (if 4
EMS calls were received at the same time, they would tie up all 4 engines, too), but
since most of Downey's calls are medical, not fire, it is a calculated risk that is not
significant
Because 84% of calls are medical calls, a paramedic engine service model would mean that
the engines would need to go to the hospital on 84% of the calls. It also means that those crews
would be tied up at the hospital until the patient they transported was given a bed.
However, the service model would not change minimum daily staffing. Three BLS
ambulances would be required to transport all patients (currently there are 2 paramedics and 1 BLS
ambulance). While the City would need to maintain 3 staffed vehicles for patient transport, it is likely
that four would be needed in a short period of time.
Mayor Guerra asked about the timeframe for implementing a fourth paramedic engine model.
Chief Croom stated that it could take 3 -5 years for call volumes to reach the call volume necessary,
depending upon the effects of ACA. Going to a third paramedic engine is currently an issue because
the fire houses were built in the 1950s and are not intended for that many people or apparatus.
However, while it is difficult and costly to repair a fire station, the upcoming new station with the
Tierra Luna development will result in one new up -to -date station.
Mayor Guerra asked whether remodeling fire stations is a viable option, and that he had
been advocating for this for years. City Manager Livas noted that a master plan to fund these
infrastructure improvements is important and referred to the Tierra Luna agreement as one example
for accomplishing the improvements; the City will need to pay for the station but the Tierra Luna
developer will build it.
It was noted that the staffing cost for the additional paramedics would be $778,000. The
equipment cost was already in this year's budget and not included in the cost calculations. Net
revenue is projected at $300,000, but could be significantly higher due to GEMT. Statistics show that
the medical call volume growth must be addressed and the city's current service delivery model
must be adapted for these changes.
Council Member Brossmer asked what the ongoing revenue is expected to be after initial
investment; Chief Croom clarified that $300,000 in revenue each year does not take into account the
initial investment, as that is a necessary expenditure that is already included in this year's budget.
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Special Meeting — June 5, 2013 4
Chief Croom noted that the Fire Department administration had already mapped out and
budgeted for a replacement equipment schedule through the year 2061.
Summarizing, Chief Croom stated that the current model is 4 engines, 2 paramedic squads,
1 truck, 1 Battalion Chief and 1 BLS ambulance, totaling 21 minimum staff, 4 paramedics, and 8
apparatus (9 if you include the BLS ambulance).
The proposed model is 4 engines with paramedics, 0 separate paramedic squads, 1 truck, 1
Battalion Chief and 3 BLS ambulances, totaling 21 minimum staff, 8 paramedics and 6 engines (9
apparatus including the BLS ambulances). It is expected to pay for itself and to increase revenue by
a net of $300,000. It also provides a paramedic on every medical call, and meets the NFPA standard
of 4- person engine companies, compared with the 3- person engine company that Downey has been
operating with since 1973.
Other benefits include reduction in paramedic burnout rates and result in better support,
teamwork, training and feedback especially given the significant number of new firefighters being
brought on board at the same time this year (12 new firefighters at one time makes it difficult to
closely supervise; putting the newhires on an engine with a supervisor results in better oversight,
accountability and training).
In terms of service to the City, the model is an improvement because currently if a medical
call does not require advanced life support (ALS), the engine will stay on -scene but often ALS
ambulance will leave the scene to take another call, and the patient must wait for a BLS ambulance
to transport to the hospital. In the new service model the ambulance will respond at the same time
as the engine, resulting in no wait time for transport to the hospital — this is significant considering
the speed of pre - hospital care and speed of transport to the hospital directly impact survival rate. It is
estimated that the paramedic engine service model will result in 40% faster hospital transport times.
Council Member Saab asked about response times. Chief Croom answered that they should
not change the time for a unit to arrive on scene, but the decrease in time would be the time it takes
from the assessment (decision) that the patient needs hospital care until the arrival at the hospital,
since the transport vehicle would already be on -site. Moreover, there would now be 6 staff on site (4
sworn and 2 non - sworn) to aid a patient.
The new model's reduced number of apparatus was discussed; having 6 apparatus available
instead of the current 8 (9 either way, if you count the BLS ambulances) is a factor. However, there
is data available regarding multiple calls and the risk appears to be nominal.
Mayor Guerra asked how often multiple calls happen currently. Chief Croom stated that it is
difficult to provide that information because it would require a staff person to look at every single call
time for every day, to review and categorize it. Chief Croom indicated that the proposed budget
includes a proposed consultant contract to create web -based queries and tracking in order to
analyze that data and provide detailed information. Specifically, the consultant would allow the
number of simultaneous calls to be tracked and calculated for any time of day, providing information
on the number of units available at any one time and tracking graphing changes so the department
can make adjustments.
Chief Croom noted that another other factor influencing the proposal of a paramedic engine
_ model is the 12 new firefighters hired are all certified paramedics already, meaning the City would
not need to incur schooling costs to train current firefighters as paramedics, and would not incur
overtime costs due to backfilling those firefighters' spots while they were in class. This resulted in a
savings of $720,000 that would otherwise have needed to be invested in order to deliver a
paramedic engine service model.
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Special Meeting — June 5, 2013 5
The $1.88 million FEMA grant putting the engine back into service was mentioned
Chief Croom clarified that the $1.16 million in emergency transport revenue is a business model that —
would help to sustain fire and emergency service – helping them to stop being the "drain" that
fire /emergency services traditionally are on the General Fund.
Mayor Guerra asked what happens after the two year grant expires. Chief Croom clarified
that we have two years to spend the grant, but it will likely be spent in fewer than two years. Mayor
Guerra asked how the City would keep the engine after the grant was spent. City Manager Livas
responded that the City is operating under the assumption that the engine will remain in place; that
the City is looking at expected new revenues (including the Tierra Luna site now under construction)
and has data to show what revenue from new projects will bring in, so staff expects to be able to
fund the engine even without other potential revenue upticks in the rest of the City.
Mayor Guerra clarified that the City does not expect to ever put the engine out of service
again. City Manager Livas stated that revenue projections are very conservative; even more revenue
might be brought in, and therefore better support the Fire Department. He stated that the staff is
taking a holistic approach, and believe that enough revenue will be available to support the
proposed model.
Chief Croom stated that the ACA would affect the number of patients transported so call
volumes will rise. In Los Angeles County, more patients are transported and treated than any where
in the world, and there is expected to be an even greater number transported and treated when ACA
goes into effect due to the increased number of currently- uninsured people who will now be insured.
Specifically, 38% of adults are uninsured in the County Health Department's planning area that
includes Downey. A conservative estimate is a 3 -6% uptick in use of Downey's system. That, on top
of the annual 1 -3% run production increases, means there could be a nearly 10% increase in
emergency responses. January 1, 2015 will provide an entire year's worth of data on the ACA
impact.
Currently, Los Angeles County hospitals are planning for additional changes required by the
ACA, including Community Para - Medicine. There are developing plans to open urgent cares
ancillary to hospitals so that patients can be taken to urgent care, not emergency rooms, in order to
avoid readmission penalties for hospitals whose patients return for treatment within 30 days. The
Cities of Pasadena, Burbank and Downey are requesting a federal grant to perform a pilot study and
transport certain emergency medical patients to urgent care units to help with triage of emergency
care. Currently, the law does not allow transport to anything but an emergency room, but transport to
urgent care units may become necessary with the full implementation of Community Para - Medicine,
and it is likely that the law will change soon specifically because of the situation in Los Angeles
County. Also, it is likely that BLS ambulance transports will experience an increase in scheduled
transports to provide follow -up care for patients at Community Medicine clinics; currently Downey's
201 rights pertain to 911 calls only; the pilot study would allow Downey to participate in scheduled
(non- emergency) BLS transports.
Mayor Pro Tern Vasquez asked how cost - effective Downey's BLS transports to Community
Medicine units would be in comparison to its reimbursements from healthcare plans for emergency
calls. Chief Croom responded that it would be the same cost, since the rates are mandated by Los
Angeles County. When the County updates the rates twice a year, the City's medical billing service
(Whitman) immediately implements the changes.
Mayor Guerra asked where the City stands on LA -RICS, the proposed radio inter - operability
system for police and fire emergency responders. Chief Croom suggested that it will probably not
become a reality, as it has become a political issue. The Los Angeles Area Chiefs doubt it will
City Council Minutes
Special Meeting — June 5, 2013 6
happen but still send representatives to the periodic project meetings. Council Member Marquez
questioned whether it had been a federal mandate. Chief Croom sated that a $6 million federal grant
had been awarded and was currently unspent. Mayor Guerra asked what happens when the City
sends strike teams to work with other departments on a wild fire. Chief Croom responded that
specific frequencies are set for certain fires and the radios are programmed for those incidents. Area
E radios are all on the same platform. He clarified that because fire agencies frequently cross -
jurisdictional boundaries due to mutual aid agreements, they have sorted out the radio issues. It is
different with most police departments, as they do not normally cross jurisdictions and do not have a
routine for dealing with inter - department emergency communications.
City Manager Livas stated that staff is seeking direction from Council to proceed down a
specific service model path. He stated that certain logistical details would need to be ironed out, but
they would like Council's permission to move forward and devote staff time to continue working on
this service model.
PUBLIC COMMENT ON SPECIAL MEETING AGENDA ITEMS
Mayor Guerra invited public comment.
Dan Rasmussen, Downey Fire Association, discussed the proposed model, the Councils
decision not to move forward on the County survey, and the Association's no confidence vote in the
Fire Chief.
Mayor Guerra, Council Member Saab and Council Member Brossmer expressed their
dismay at the speaker's bringing up of that topic, stating it was inappropriate for the topic at hand
and expressing their appreciation and confidence in the Fire Chief.
Mr. Livas thanked the Fire Chief for a fantastic presentation that would improve service and
increase revenues and stated that in any city the Chief would be lauded for his efforts.
Mayor Guerra stated that 81 % of Downey residents want a local fire department, it is a huge
benefit to the community and the Fire Chief's proposal is exactly what the community needs. He
stated that the numbers showed the County's proposal was not going to benefit us; it was going to
cost money and decrease service. The Fire Chief's model is exactly what the City should be looking
at. He stated he fully supports staff moving forward on this, thanked the Fire Chief and his staff for
presentation and said that staff has his complete support. He commended the Chief for obtaining the
FEMA grant, for maintaining response times, that it says a lot about the Fire Chief's leadership.
Council Member Saab also thanked staff, especially the Fire Chief, and stated he was
appalled by the Association making such an announcement at this time, when we are here to
discuss moving forward and coming up with a solution. He stated the Fire Chief handled the entire
matter professionally and had his utmost confidence. He stated the presentation was excellent and
he looks forward to continuing to provide exceptional service with commitment to the residents of
Downey.
A speaker (name not given) said the model sounded like a great idea; that it holds water and
she was appreciative of the politeness of the Council in how they have conducted themselves.
Mayor Guerra called for Council comments.
Mayor Pro Tern Vasquez stated the Chief did a good job on the presentation, that we had
discussed the impacts of the Affordable Care Act on healthcare, and he appreciated staff finding
ways to be more efficient, to not pass on costs to the taxpayers and especially staff investigating
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Special Meeting — June 5, 2013 7
options internally before suggesting going to the outside. He commended that this is not the proper
environment to politicize the issue, and that discussion should happen in the proper arena but this is
not it. He stated he was looking forward to discussing this model in the future.
Council Member Marquez stated that Council had discussed quite a bit how to move the
department forward in terms of finances, revenue, size, numbers, to provide service, capacity and
the best service to our residents. He stated the Chief has touched on both revenue generation and
improvements to public safety and that Council is constantly addressing the budget to provide the
best equipment and resources to run the best department to keep safety first. Residents come first
in safety and response times, and he appreciated the Chief's presentation.
Council Member Brossmer thanked the Chief for providing the information. He stated that as
previously discussed, when a layperson hears that 84% of calls are EMS - related and you only have
two rigs, it does not make sense. Obviously, finances have to be balanced with safety and he
appreciated the Chief's creativity and willingness to move the Fire Department forward. He stated
his absolute confidence in the Fire Chief and his leadership, and clearly the Council made the right
choice for Fire Chief for the City of Downey.
It was motioned by Mayor Guerra, seconded by Council Member Saab, and unanimously
carried, to direct staff to more forward on the second BLS ambulance and paramedic engine service
model.
ADJOURNMENT: The meeting adjourned at 5:44 p.m.
G.
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F 1 r
SHANNON DELO
NG, � MARIO A. GUERRA, Mayor
Assistant to the City Manager
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Special Meeting — June 5, 2013 8