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HomeMy WebLinkAbout27- Council CITY OF SAN BERT IRDINO - REQUEST 311 COUNCIL ACTION From: Peggy Ducey, Assistant to the Subject: Proposed City Fire Department City Adminstrator Emergency Transport Services Oept: Adminstration Date: July 23 , 1993 Synopsis of Previous Council action: July 19 , 1993 - Mayor and Common Council continued the item until August 2 , 1993 to allow the City Adminstrator to prepare a written rebuttal; and direct staff to meet with Courtesy Ambulance to develop a solution. Recommended motion: 1 . Receive and file report from City Administrator; - and - 2 . Approve the operations plan as presented July 19 , 1993 ; - or - 3 . Continue item to first Council meeting in October to allow staff to pursue discussions with Courtesy Ambulance . zig 4��e�- nature Contact person: Peggy Ducey Phone: 5122 Supporting data attached: yes Ward: FUNDING REQUIREMENTS: Amount: Source: (Acct. No.) (Acct. Description) Finance: auncil Notes: �� 7-5 �� Anonrin Item Aln ..27 CITY OF SAN BERIt ,,.RDINO - REQUEST OR COUNCIL ACTION STAFF REPORT On July 19, 1993 , the Common Council held a hearing on the proposed City Fire Department emergency transport services. After hearing testimony from Mr. Steve Rice, Courtesy Ambulance, Council directed City staff to respond to the statements made by Mr. Rice. CITY OVERPROJECTED REVENUES FOR THE PARAMEDIC MEMBERSHIP PROGRAM. Mr. Rice stated that the projected revenue for the paramedic membership program was $610,000 annually. Actual revenue for FY 91/92 was only $178,000, and actuals for FY 92/93 were only $310,500. Initial revenue projections were based on current and projected medical aid call loads, collection rates as provided by Courtesy Ambulance, and performance figures from other cities with paramedic membership programs. These initial projections were realistic, however, a number of unanticipated events have affected actual collections, including the County EMS lawsuit, paramedic double- billing, and a change in billing companies from Courtesy Ambulance to Advanced Billing Concepts (ABC) . When the Paramedic Membership Program began in July, 1991, the City contracted with Courtesy for billing services because of their fee collection experience as well as the established working relationship between the Fire Department and Courtesy. In August, 1991 after investigating complaints regarding field medical aid charges, City staff discovered that Courtesy was charging for paramedic services even in cases where only City paramedics provided medical care. Over the next few months, staff attempted to negotiate a resolution to the billing issue. During the negotiations, Courtesy expressed strong concerns about the legality of the membership program and ability of the City to charge for Fire Department services. Because of this, City staff felt that Courtesy had a conflict of interest regarding City paramedic billing and was granted approval by the Common Council to contract with an independent billing firm. This change was a sound administrative decision but hurt program revenues in the short term. Any fee-for-service program takes 4-6 months for revenues to reach projected levels. Courtesy handled billings for the first six months of the program but just as fee collection was increasing, it became necessary to change billing companies. Records turned over by Courtesy to ABC, the new billing company, were incomplete and collection rates dropped for six months. However, collections have increased in the last fiscal year. While its true revenues for FY 91/92 were only $178, 000, revenues almost doubled for FY 92/93 , to $340, 000. Another reason projected revenues have not been realized is that the City cannot collect fees from Medi-Care and Medi-Cal. Initial information given to City staff indicated that the City could collect from these providers and these revenues were incorporated 75-0264 into the projections. However, once the program was implemented it was confirmed that program regulations require an ambulance transport identification number for reimbursement. This decreased the original projections by 33-40%. If the City could have collected these, revenues would have increased last year to almost half a million dollars. If the City does begin to provide transport services, these revenues would become collectable. REVENUE PROJECTIONS FOR CITY AMBULANCE SERVICE ARE OVER-ESTIMATED. Mr. Rice states that the revenue estimates for City ambulance transport services are too high. When developing an implementation plan, staff acknowledged that ambulance collections were a specialized field and revenue estimates needed to be done by someone knowledgeable in the field. Wittman Enterprises, an ambulance billing and consulting service, was hired to perform the initial projections. Wittman currently bills for the following clients: Ace Medical Transport Waterford Ambulance Elk Ambulance Paradise Ambulance Monterey Park Fire Dept. Ramona Muni Water Dist Indio Ambulance Sanger Fire Dept Mono County Emergency Med Svs. Special Services Amb. West Side Ambulance Marin County Patterson Ambulance Basis Life Support Selma Fire Dept. Bridgeport Fire Dept. Tri-County Ambulance Huntington Beach Fire Wittman estimated user fee gross revenues would be $4 , 180, 564 , with net revenues reflecting a 62% collection rate. Staff was concerned that these projections did not reflect the socio-economic conditions of San Bernardino, and requested that Advanced Billing Concepts (ABC) , the City's current billing company, review the projections. ABC confirmed that the gross projections were accurate, but that the collection rate should be dropped to 55%. At one time, Courtesy Ambulance cited a 55% collection rate to administration staff, so ABC's review was reasonable. However, to be conservative, administration staff dropped the rate to 52% of gross billings when completing its cost/benefit analysis. CITY'S TRANSPORT CHARGES ARE VIRTUALLY THE SAME AS COURTESY. Courtesy argues that City transport rates are the same as Courtesy ambulance. City transport rates will be lower than Courtesy because itemized fees such as unscheduled emergencies, night and weekend charges, etc. , will not be charged. Courtesy also has had a rate increase pending since September, 1991 that was deferred until the City resolved the paramedic double billing issue. For comparison purposes, Courtesy rates and City proposed rates are as follows: 1991 COURTESY COURTESY CITY CURRENT PROPOSED PROPOSED Basic Life Support (BLS) * $ 178 .84 $ 214 . 60 $ 238. 00 Advanced Life Support (ALS) 272 . 00 315.93 351. 00 All-Inclusive ALS 403 .75 468.84 0 Unscheduled Emergency 81.24 85. 50 0 Night Charge (7 am -7 pm) 52 . 18 60. 60 0 Weekend Charge 52 . 18 60. 60 0 Mileage 8.94 8.98 8.98 Oxygen 22 . 37 50.98 23 .00 EKG Monitoring 37 .25 43 . 25 0 * NOTE: Courtesy does not charge Basic Life Support fees on 9-1-1 calls. All 9-1-1 calls are charged the paramedic ALS rate. Based on these rates, an average ambulance bill would be as follows: Courtesy Ambulance: All 9-1-1 calls (Note: Courtesy charges ALS rates for all 9- 1-1 calls). Current Proposed All-Inclusive ALS $403 . 75 $ 468.84 Night Charge 52 . 18 60. 60 Mileage 27 . 00 27. 00 Oxygen 22 . 37 50.98 TOTAL $505. 30 $ 607.42 Proposed City Rate: Heart Attack Victim - ALS Proposed Advanced Life Support $ 351. 00 Mileage 27. 00 Oxygen 23 . 00 TOTAL $ 401. 00 Proposed City Rate: Broken Arm - BLS Basic Life Support $ 238.00 Mileage 27. 00 TOTAL $ 265. 00 Based on the current and proposed rate schedules, City transport services would be $100 - 250 less than Courtesy. Furthermore, residents would not be responsible for paramedic charges for both Courtesy Ambulance and the Fire Department. This would decrease bills by another $100 - 200, making a total reduction in fees of $200 - 450 per medical incident. THE CITY WOULD PUT COURTESY AMBULANCE OUT OF BUSINESS. Courtesy argues that eliminating emergency paramedic ambulance transport would close their business. By eliminating Courtesy's emergency transport, there is no doubt Courtesy would change the way it operates its business. However, Courtesy would still keep all routine transport, which is the more lucrative service, as well as emergency transport for unincorporated county areas and surrounding cities. Another issue that must be addressed is that the San Bernardino City Council never formally authorized Courtesy to begin providing paramedic services but Courtesy, on its own initiative, chose to expand its services when the City did not need them. In 1975, the San Bernardino Common Council considered the provision of paramedic services in the City. A motion to designate Courtesy as the primary provider failed by a vote of five to two. A motion to designate the Fire Department as the primary provider then passed by a vote of six to one. Since the City does not have a written operating agreement with Courtesy, it is unclear when paramedics were actually put on Courtesy ambulances. When questioned by Jim Page, the City's EMS consultant, Mr. Rice stated that he first employed paramedics in the mid-1970's but did not become an all-ALS paramedic provider until October, 1990. We can infer that Courtesy did not staff and bill for paramedic services until late 1990. This was the same time that the County adopted an EMS plan that identifies private paramedics as a major component of this County wide plan. When interviewed by Jim Page, the former County Health Officer stated that the County considers it important for private paramedics to exist in the City to serve residents of the unincorporated areas. In essence, city residents pay for the duplication of paramedic services to subsidize service in the unincorporated areas. Courtesy has provided ambulance transport services for the Fire Department for over forty years. However, they did not begin charging paramedic fees on 9-1-1 calls until October, 1987. Prior to that time, Courtesy charged a differential between non-emergency calls vs. emergency calls, but this equates to the "unscheduled emergency" charge they have now. Courtesy has argued that the City approved its ambulance rate schedule, including the ALS paramedic charge and by doing that approved the staffing of private paramedics. However, there is some confusion regarding the fees approved by Council and the application of those fees by Courtesy. It is unlikely that the Council knowingly approved the imposition of a fee for paramedic services when that service was not actually provided by Courtesy. It is also unlikely that Council would have approved the operation of private paramedics when the Fire Department had already been designated as the paramedic provider for the City. Because the City does not and has not have the authority to audit Courtesy's billings or accounting books, Courtesy's billing or staffing practices did not come to light until 1991. THE CITY'S NUMBER OF PROPOSED AMBULANCES IS TOO LOW. Mr. Rice argues that six ambulances and two reserves is not enough to cover the number of calls the City has. Courtesy states they responded to 19,000 medical calls last year. According to Fire Department dispatch records, City Fire only responded to 14,500 medical aid calls last year. The remaining 4, 500 calls Courtesy responded to must be for service calls other than 9-1-1 emergency calls, such as routine inter-facility transport, non-emergency transport, and emergency transport in unincorporated areas. Some may also be emergency calls where the patient has called Courtesy directly rather than 9-1-1. In these cases, Courtesy is supposed to call the Fire Department to respond, but has not done so in all emergency cases. Staff based its recommendation of number and location of City ambulances on an analysis of the total number of 9-1-1 calls and their distribution throughout the City. The City's EMS consultant reviewed the number of calls, peak times, and average time needed for an entire medical aid call, and documented that six ambulances would be more than sufficient to staff the City. This number is reasonable since the City currently has five paramedic teams that provide services on all medical aid calls. Adding one more paramedic team would add a more comfortable service level for peak times. Two reserve ambulances would allow for coverage when vehicles are being serviced as well as major medical emergencies. For comparison purposes, Courtesy reports that they operate 12 ambulances at peak periods, with ten designated for San Bernardino. Staff reviewed Fire dispatch log books which reflect daily reports given by Courtesy regarding the number of ambulances available. For the month of June, 1993, statistics were as follows: Range - # Average # Ambulances Available Available 11:00 p.m. - 7:00 a.m. 2 - 5 3.46 7:00 a.m. - 12:00 p.m. . 7 - 10 7 .91 12: 00 p.m. - 5: 00 p.m. 5 - 7 6.00 5:00 p.m. - 11: 00 p.m. 5 - 6 5. 66 During peak morning hours, it seems that more than six ambulances may be needed, however, further analysis of these statistics revealed that Courtesy covers the Cities of Highland and Colton with only one ambulance during these same peak periods. It is likely that some ambulances "officially" designated for San Bernardino are actually providing service to Colton and Highland. Also, morning hours are peak times for routine transport and San Bernardino are ambulances providing routine and inter-facility transport as well as emergency response. The San Bernardino ambulances are also serving the unincorporated areas of the City as well. So the 7-10 ambulances operating during peak hours are actually fulfilling a number of different duties besides 9-1-1 service to San Bernardino. Mr. Rice questions whether minimum ambulance coverage will lead to call screening, and the poor will be selectively served. As shown above, six ambulances are more than adequate to cover medical aid calls. However, dispatch policies of the San Bernardino Fire Department requires that staff respond to all 9-1-1 calls no matter what the situation. Fire stations are strategically located throughout the City to equally serve the entire community and in fact, if approved, 4 out of the 6 ambulances would be stationed in areas considered low income. CITY FIRE DEPARTMENT PARAMEDICS ARE MUCH MORE EXPENSIVE THAN COURTESY PRIVATE PARAMEDICS. Mr. Rice cited that City paramedics are paid $69, 000. Actually, City medic pay and benefits ranges from $56, 000 - $64 , 000, $5, 000 - 13 , 000 less than cited by Courtesy. Also, city paramedics are multi-function staff, trained not only for medical aid, but fire suppression, hazardous materials response, search and rescue, and heavy rescue. By comparison, Courtesy paramedics salary and benefits are $39,000 - 45, 000, but Courtesy staff provides only medical aid response. NECESSITY OF TWO PARAMEDICS VS. ONE PARAMEDIC AND AN EMT. Mr. Rice argues that it is not necessary to have two paramedics to provide good medical care. Courtesy Services staffs its ALS units with one paramedic and one EMT, while the Fire Department staffs with two paramedics. Eighty percent of all Fire Departments and sixty-seven percent of primary paramedic providers for the nation's most populous 200 cities staff ALS units with two paramedics, and there is sound medical reasons for doing so. Two-person medic teams specifically divide responsibilities to allow for optimum patient care. On medic, called the "patientman" takes and monitors vital signs and administers treatment to the patient, while the other "radioman" interfaces by radio with the hospital doctor to exchange information regarding the patient's condition and medical treatment per the doctor's orders. The "radioman" also prepares any drugs necessary to stabilize the patient's condition and directs the "patientman" to administer the drugs and other treatments. More importantly, two paramedics act as a check and balance system for each other to ensure that no fatal mistakes are made in the field. A 1980 study performed by the Philadelphia Department of Public Health reviewed 200 consecutive prehospital heart attack incidents where half were handled by two paramedics and half were handled by an EMT and one paramedic. Researchers found that there were no survivors among patients treated by only one paramedics, while 16% of patients treated by two paramedics survived. Furthermore, the American Heart Association took a formal position in October, 1992 advocating for the staffing of two-paramedic teams. PATIENT DIED OF HEART FAILURE AND COURTESY TOOK 18 MINUTES TO ARRIVE ON-SCENE BECAUSE THEY WERE DISPATCHED "CODE 211. Mr. Rice stated that a good friend recently had a heart attack. The Fire Department dispatched Courtesy I'Code 211, without red lights and sirens, and it took them 18 minutes to arrive on-scene. Administration staff has reviewed both the Medical Aid report as well as the dispatch tapes to determine specifics of the incident. Events happened as follows: 6:47 9-1-1 call from patient's wife reporting that her husband is having convulsions. First-responder engine company and paramedic engine are immediately dispatched. 6: 48 Courtesy ambulance is dispatched by phone, "Code 2" (no lights and siren) . Courtesy reports their location at the Crosstown (30) Freeway and Del Rosa. 6: 51 First-responder engine arrives on-scene. Takes vital signs, which are strong. Patient is able to converse with Firefighters. 6:54 Paramedic engine arrives on scene. 6:55 Vital signs taken again. Patient's condition is deteriorating. 6:56 Paramedics hook patient up to heart monitor. Indicates third-degree heart blockage. Paramedics ask dispatch to upgrade Courtesy to "Code 311. 6:59 Courtesy is upgraded by dispatch to "Code 311, red lights and siren. 7:01 Dispatch calls Courtesy with directions to incident. 7:03 Dispatch calls Courtesy requesting an estimated time of arrival and again gives directions to the scene. Courtesy reports location and dispatch realizes Courtesy has headed in the wrong direction to get to this address. Dispatch again gives directions to Courtesy. 7:06 Courtesy arrives on scene. Initially Courtesy was dispatched Code 2, but was upgraded to Code 3 within minutes after paramedics arrived on-scene. Courtesy reported that they were at the 30 Freeway and Del Rosa. The incident was located less than four miles away. Traveling within the posted speed limit, it should have taken Courtesy less than six minutes. When Courtesy did not arrive within ten minutes, Fire dispatch called to determine the problem. When Courtesy reported its location, dispatch realized that they were traveling on a street that dead-ended and they would not be able to reach the incident location. Dispatch radio'd directions three times to Courtesy. Courtesy arrived on-scene 18 minutes after being dispatched because they were lost, not because they were dispatched Code 2 . The controversy regarding "Code 3" dispatch began in August, 1991 when Fire Department began dispatching Courtesy "Code 211 , rather than Courtesy automatically responding "Code 3" on every incident. The reasoning behind this is that emergency vehicles responding through the City with red lights and sirens pose a safety hazard to pedestrians and vehicles on the street. Since Fire Department emergency medical personnel arrive on scene in four minutes or less on average, there is no need to jeopardize the safety of City streets. This dispatch policy is actually routine for most Fire Departments, including those cities in the Inland Empire. Courtesy objected and in fact, until the lawsuit judgement came out, ignored Fire Department orders and continued to respond "Code 311 . Numerous studies and reports, including those done by the U.S. Department of Transportation and the National Association of Emergency Medical Services Physicians, indicate that routine use of red lights and sirens represent an unacceptable and preventable safety hazard. .rr Wl*:H TO SPEAK? Yes No DATE: PLEA LIMIT YOUR COMMENTS TO AINUTES x,27 "AML- ADDRESS: o 4., e TELEPHONE: WRITTE COMMENTS: rz PLEASE RETURN COMPLETED FORM TO MODERATOR WISH TO SPEAK? 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Yes o DATE: [ PSE LIMIT YOUR COMMENTS 3 MINUTES NAME: = LJ ELL(-f_ ADDRESS: Pc ) _7/t/ TELEPHONE: TELEPHONE: 1,1 WRITTEN COMMENTS: - J 7z A4 2-7 E7i--7 i PLEASE RETURN COMPLETED FORM TO MODERATOR WISH TO SPEAK? Yes No DATE: PL_ASE LIM T YQUR COMMENTS 3 MINUTES �S/ NAbtE: tL ADDRESS: L/0 , TELEPHONE: WRITTEN COMMENTS: _ PLEASE RETURN COMPLETED FORM TO MODERATOR Wf3H TO SPEAKS Kro-8)N o DATE: PLEASE LIMIT YOUR COMMENTS TO 3 MINUTES NAME: ADDRESS: — TELEPHONE: WRITTEN COMMENTS: PLEASE RETURN COMPLETED FORM TO MODERATOR V V i i i Moo Ambulance Service of San Bernardino Since 1948 PROPOSED FIRE DEPARTMENT EMERGENCY MEDICAL TRANSPORT PLAN f RESPONSE BY COURTESY SERVICES OF SAN BERNARDINO , INC . DECEMBER 20, 1993 Paramedic, Van and Wheelchair Services qqP ` ac! gaimn4) gfroof q n pn—nrAinn o wi ('71 MQQ I CITY OF SAN BERFARDENO - REQUEST GOR COUNCIL ACTION From: Councilman Ralph Hernandez Subject: proposed Fire Department dt: Council Emergency Medical Transport Date: lylay 19 , 1993 Synopsis of Previous Council action: Recommended motion: That the ?,fayor and Common Council direct the City Administrator and rjae Chief to finalize and implement a plan for the City of San Bernardino Fire Department to provide emergency medical transport . Signature Contact person: Councilman Hernandez Phone: 5188 Supporting data attached: Yes Ward: FUNDING REQUIREMENTS: Amount: Source: Acct. No. Acct. Description) Finance: Co—cil Notes: 75-0262 Agenda Item No. MY' OF SAN BERNARDINO - REQUEST FOR COUNCIL ACTION s' From: Peggy Ducey, Assistant to the City Subject: Public Hearing for Proposed City of Administrator San Bernardino Fire Department Emergency dt; Administration Transport Services Date: July 7, 1993 Synopsis of Previous Council action: May 24, 1993 - Mayor and Common Council directed the City Administrator and Fire Chief to develop a plan for the provision of City Fire Department emergency transport services and present the plan in a public hearing scheduled for July 19, 1993. Recommended motion: That the Mayor and Common Council: 1. Close the public hearing; 2. Approve the operating plan for City Fire Department emergency transport services as submitted by the City Administrator's office; 3. Set a public hearing for August 16, 1993 to establish a rate schedule for City Fire Department emergency medical transport. Signature Peggy Ducey 5122 I Contact person: Phone: Supporting data attached: yes Ward: FUNDING REQUIREMENTS: Amount: Source: (Acct No.) (Acct. Description) Finance: <Avw`ncil Notes: 75.0262 Agenda Item No. 1Y .OF SAN BERG'4RDINO - REQUEST rOR COUNCIL ACTION -om: Peggy Ducey, Assistant to the Subject: Proposed City Fire Department City Adminstrator Emergency Transport Services f Dept: Adminstration Date: July 23 , 1993 Synopsis of Previous Council action: July 19 , 1993 - Mayor and Common Council continued the item until August 2 , 1993 to allow the City Adminstrator to prepare a written rebuttal; and direct staff to meet with Courtesy Ambulance to develop a solution. Recommended motion: ( 1,! Receive and file report from City Administrator; I �// - and - 2 . 2.pprove the operations plan as presented July 19 , 1993 ; \ - or - 3 . Continue item to first Council meeting in October to allow staff to pursue discussions with Courtesy Ambulance . $i nature i Contact person: Peggy Ducey Phone: 5122 Supporting data attached: yes Ward: FUNDING REQUIREMENTS: Amount: Source: (Acct. No.) (Acct Description) — Finance: uncil Notes: 7%.n262 Agenda Item No. i CITY OF SAN BERNARDINO FIRE DEPARTMENT EMERGENCY MEDICAL TRANSPORT After reviewing a number of operational modes, staff of the Fire Department have recommended a service delivery model that increases and upgrades the City's medical aid and fire response coverage, uses state-of-the-art equipment, and generates enough revenue to fully support the emergency medical response program. CURRENT FIELD MEDICAL AID RESPONSE Currently, when a 9-1-1 medical aid call comes in, the Fire Department will respond with a paramedic engine or an engine company and paramedic engine, depending upon the location of the call. Firefighter/EMTs act as first responders to begin stabilization of the patient. A two-person paramedic team then takes over to further treat and stabilize the patient, under the radio supervision of a base station hospital. Once the patient is stabilized, he is loaded into a private ambulance and one or two paramedics accompany the patient to the hospital and continue treatment. Once the patient is handed off to hospital staff, the engine company will pick up the paramedics at the hospital and transport them back to the station. Because of this operational mode, the engine company is out of service for the entire medical aid call . PROPOSED CITY EMERGENCY TRANSPORT OPERATIONAL PROFILE The proposed plan would remove paramedics from the engine company, place them in a separate vehicle, and backfill the two vacant paramedic positions on the engine with one Firefighter/EMT. To keep staff increases at a minimum, one of the Department's two truck companies would operate as an either/or vehicle with staff manning either an ambulance or a truck company, depending on the type of call . A total of six ambulances would be staffed with two paramedics, and two ambulances would be held in reserve for major medical emergencies . This system would increase Fire safety coverage because the paramedic team would be able to operate independently of the engine companies. Currently, the engine company crew is tied up for the entire medical aid call because paramedics act as dual Firefighter/Paramedics on the engine companies. In this profile, the engine company will act as first responders and assist the paramedic team in the field, but when the patient is transported by the medic ambulance, the engine company is free to respond to other safety response calls. IPROPOSED FIELD MEDICAL AID RESPONSE CONFIGURATION In the proposed configuration, a typical medical aid call would be as follows: When a citizen needs emergency medical assistance and calls 9-1-1, CALL DEMAND BY HOUR SAN BERNARDINO JAN-JUN 1993 12 10 0 I ---------- As Many As $ 1 � i Cars May Be � Required During 4 } A Single Hour 2 f i 0 JAN FEB MAR APR MAY JUN AVERAGE PEAK 9 10 7 10 10 7 MAXIMUM 10 11 8 11 11 8 EM AVERAGE PEAK MAXIMUM Source: Gow tesy Ambulance EXISTING CITY FIRE DEPARTMENT STATIONS FIRE STATIONS - PARAMEDIC FIRE STATIONS 5 Engines x 4 Positions x 3 Shifts = 60 Personrn 6 Engines x 3 Positions x 3 Shifts = 54 Total Personnel = 114 E = Engineer ® C = Captain P = Paramedic F = Firefighter 40TH ST FM 30 HIGHLAND AVE I- w ¢ U) M0 BASELINE ST. w FOOTHILL BLV - 5TH ST MILL ST w z Z 10 ^I > Uj fV w z CITY OF SAN BERNARDINO w MAY 19. 1993 STAFF REPORT: PROPOSED FIRE DEPARTMENT EMERGENCY MEDICAL TRANSPORT A cost benefit analysis performed by the City Administrator projected net revenues at $4-6 million over a five year period, depending on the service delivery model used. This does not exceed the actual costs associated with the delivery of emergency medical services, but does defray total costs by a substantial amount". Q JULY 71P 1993 STAFF REPORT: SUBJECT: PUBLIC HEARING FOR PROPOSED FIRE DEPARTMENT EMERGENCY TRANSPORT SERVICE After reviewing a number of operational modes, staff of the Fire Department have recommended a service delivery model that increases and upgrades the City's medical aid and fire response coverage, uses state—of—the—art equipment, and generates enough revenue to fully support the emergency medical response program'. 1 � . OPTION 4 ... . . TOT `# Y-033:: :.:::::.::::.:.:..::::.::... x �;;;;;:::.,:;;;:>.;:.;;>;::;'.::.:;;::;:;;:;:.;>:<•::.:.;:;.;:.::;: i:>:.:::::::::isv:;:::::.:r::i::: :;::::::i::;::::.::.�:. �SIC�C'#�tY ��AT}Of�IBLt:Y..:. >::;>:.;;:..:.. >> ..3. Qf)}A1YIf{aiTCflSTS hf, 7ER{AfSLIPiLIS GL7STS *S OR V1NG + <::» <? .... ::;: ::;;is}i:;i i:-;:x:;i:;:>::r:rGi<•,•:::;::-::i::i:i,::;+:.:;;:>a;.y:;;;:;;_ : :TAA}}1f1{�G<CQS. �.;aR::SA.V{N. . -�::>:::>::<:::::::>:>:;:>:>�;.>::>:;::>:>:>:............................................................ .�::::::::.;:.i:_::.;;:;:.;;;;i;;; .iii:.;::.;;:.::.i:;.:.ii::.:.;:.::.::::.:::::::::::::.:.::-:::.:::::.;'.::.;•;.;:;.;..,.:::;.';::::.:.�:.:;..;:.:::... . :::r`:::::::::i::::::::Y:::::iiii:ii:::k:S::i 25 4. �. .;: .:?:6:E.is::;:;;:iii:::isisi?:;:i`:$iE: ::is ii:;:;;i?;i:.i;;;;;:-•:::•;x:GS•'i••i:xn:n::.+.:::�.�:i�:.�.ii: ::t3R; FiDFfT. :::..::::::<:::.:::::::::::. ;:;.::•>:.;;;:.;:.;:.i:.i:.:;.;:::::.::;.:::::::::::.:::<::.:::::::::.::::::.:: :� �:.;�.;;:;ii:.i:.i::.i:.iii:;;:.i::.::::.::._::::::::.�::::::::::.:::.:..:;;;:.;>:.;:.i;;:.i:.;:.i:.:::.:;;.:.: :::::.:;.,....;-..:.., ii:.;:.>:::.i:.:;;<.;>:i::<::i<;:::.::., i;>::iii>:<::;:i>::i::ii::i::i>i>::>i>::i::ii::i:::<:i::::»> YEAR 2 TOTAL LAY-OFFS/ADDITIONS 0 PERSONNEL COSTS(-)OR SAVINGS(+) -717,370 SICK LEAVEIVACAT70N BUY-OUT 0 EQUIPMENT COSTS(-)OR SA VINGS(+) -192,450 MA TERIALSISUPPLIES COSTS(-)OR SAVINGS(+) �-42 TRAINING COSTS(-) OR SAVINGS(+) INCOME LOSS(-) OR PROFIT(+) 2,6 6 0,0 31 NET OUTCOME FOR YEAR 1 ,25 2,12 9 �OTR't'.f;�:Y OFFSIA£�Dl A VI S ::::::::::.::::::. .:.).i'::.i:.ii:.;:.ii:.i:.:.iii>;;;:.i:.i;:;i:.i:.;:;:.; U -0tJT 'SICK' CAT LE.4YFJVAI*`?NE Y. ........ 2i{?73 COSTS flR SAVINGS+ 1L+(ATERIAL:SISURPLIES COSTS(}DR SAVINGS{+) ri:<.i:.i:.>::. 478,284 :>-7 eosTS-;<oR: a vlNC f RATNI NGi;:::;::;::'.;::.::. :).;;:::::.::::::::.:.:::::::..�..�:::;;: ii:: :.:::- is:::,.i:,:.::;;:::.i:::,,::<:.:. ::033 :::.:i:.::'.:.;:.i::':..::;.i >:2 X93. ............ .. ................:.............:.......:........ ::.....f:..:.......a......... ;... Q,.. .•�' `i'E: 1NG�MF:� ..SS:.-;flR: :i:.i�:}:.ii:.i:.iii:.;:;.;:>;:::::::.ii ;i i:::i::;::::::i i::iiii:«:»i::>::<>::>:'>:>:::>•«:i:>«:i>:>:>::i::i:«::<:>i>:::<:::i:<:<::i ii:�iii> YEAR 4 TOTAL LAY-OFFS/ADDITIONS 0 PERSONNEL COSTS(-) OR SAVINGS(+) -722,558 SICK LEA VEIVACATION BUY-OUT 0 EQUIPMENT COSTS(-)OR SAVINGS(+) —212,176 MATERIALS/S UPPLIES COSTS(-)OR SAVINGS(+) -5021190, TRAINING COSTS(-) OR SAVINGS(+) -46,937 INCOME LOSS(-) OR PROFIT(+) 2,932,684 NET OUTCOME FOR YEAR 1 ,448,.81..4 is ;.,.< A PERSONNEL COSTS(J'OR SIC KLEAYE/YACAZIOIYBUYO , r 22 ... EQUIP,MENT..CQSTS MA:TEAIALSZSUPPLIES:COSTS:,. DR SAV1NGSj+) - 49, 34 -;:OR.:SA.VING rrRAIN1NC:�OSTS�); : �:1.::::.;:.i:.i:.ii;::.i:<.i::.:::.;i:.i:.;:.:;.:,::::.:,..�::,:::.i::;.:.;:::;.::::::::::::...,:::::::.:.i•.;...:.,. <::.. . . _-<>2'i�>:4»:>;>�`:::::;::>:>::::'>::»':<:<::::ii::ii;iii:;�:_�;i:•;;..;::<i::.;>:::ii+:;:;Qp:: - ;$' ::i:<:;>:<::ii;;:;:::>::::>:::>;:i::>:<;::;>>«<: ::<:>: ,D7 ,3 .;..: INCOME.::::::i::::::.(; ...ii.:..:.:isiii;ii::.i:.ii;:.:::::::::::::::::.,;.::: ::::.: .:ii:<:.;...:...:i::::;< ... NET OUTCOME FOR YEAR TOTAL NET OUTCOME OVER 5 YEARS 1 X6.016.979 LU N ° 0 Z h- (D. aD N �t c�D N � N� (� m :) r - 0° 0 O(D LL N N O � T � a LL ¢ O 0 0 o rC° CD It � cco. 0 cD w U � ° ° °(D o r- � LO r° C\l T LO w LU LL 0 o 0 0 0 0 0 0 0 LU Ct) U) LOL U Z LLIa w 0 00 ° O co (1) (n qt o Cl) LU F- (D q In (D rn m N m LU Co C/) a: C\j cr) _ 6 0 T O a: U CL r w It It It co rl_ O In LO W Z gH N O N T M O N N LUx � GL O OD tN N � C� 00 U ° o 0 S ° 0 W O w 0 0 CO o o O O 6 O 0 U U U O N N LO CL O M � Q CL O O cq M Q j 0 0 rn U Q� O CO O tLO N h ° 6°9 LO � C9 N O � d LLJ 0 Z LL w 0 = w ui CO T- .. Z ¢ ui U w w U w �w Z w �] J w Q U D Z C/) m w z O w ¢ o E-MiS INCOIr'` I • Revenue Billed Acct E NA,S INCOt•t ' I Calls 15.2-.b5 _ EMS Tc't-= 11147.40 Fossible TransrOrL LS Transpor�s 3901 .59 Teal ALS TranspGljts O.oS ELS Trar�spGrls 7245.51 Total ELS I ransper,s ci — - Gr'iS 0. 5� ,D Noy,- i r2n_c p 4777.,5 To',---I Non-Trensporis source: 5/19/93 City staff report (backup material) . . . Pr000sed City Rate: Heart Attack Victi-m - ALS Proposed 'kdvanced Life Support $ 351 . 00 Mileage 27 . 00 Oxygen 23 . 00 w TOTAL $ 401 . 00 Pr000sed Citv Rate: Broken Ar-m. - BLS Basic Life Support $ 233 . 00 Mileage 27 . 00 TOTAL $ 265 . 00 source: 7/23/93 City staff rebuttal report REVISED CITY RATE/INCOME PROJECTION BASED ON 7/23/93 STAFF REBUTTAL REPORT CALL TYPE TRANSPORTS PROPOSED CHARGE PROJECTED SALES A LS 3901 $401 .00 $1 ,564,301 BLS 7245 $265.00 $1 ,919,925 NET SALES $3,484,226 NET INCOME @ 52% $1,811 ,798 ORIGINAL INCOME PROJECTION _ $2,534,614 NET DIFFERENCE $ 7221816) c��rx c�?s �Hr=zvc� Ia April !993 F3rY �LBU�-G�I'i �iaZtn A?:1x11�nc�e Cats , According to chief Foyle of the Rialto Fire �nepprt ent, the of their a„�pular,cR acrvica { as judge;. `or 92/93 8485,591 �: L•�1 Revenue X550 Q00 CelLnquency,Rita 32� delinque.^,cy rata rice' to Lein cent Additienail it i i �� p �, t to col?ecLzcna Yr nc_�.�a= ccst� �';a.. rsa t recovQrable au6c t-o ?Iedicuzs and ::ed.6 4. ccgt�, re indicated t„tt g-:cup r.�g visited :roe chino (Chief shackalfcrd t;�.3 or.�d7 , �,rd t�;ey ?y xera ss;�i:,g ai�il�{ gLectio7s . C • o $ 722 , 816 0 CITY OF SAN BERNARDINO FIRE DEPARTMENT EMERGENCY MEDICAL TRANSPORT After reviewing a number of operational modes, staff of the Fire Department have recommended a service delivery model that increases and upgrades the City's medical aid and fire response coverage, uses state-of-the-art equipment, and generates enough revenue to fully support the emergency medical response program. CURRENT FIELD MEDICAL AID RESPONSE Currently, when a 9-1-1 medical aid call comes in, the Fire Department will respond with a paramedic engine or an engine company and paramedic engine, depending upon the location of the call . Firefighter/EMTs act as first responders to begin stabilization of the patient. A two-person paramedic team then takes 'over to further treat and stabilize the patient, under the radio supervision of a base station hospital . Once the patient is stabilized, he is loaded into a private ambulance and one or two paramedics accompany the patient to the hospital and continue treatment. Once the patient is handed off to hospital staff, the engine company will pick up the paramedics at the hospital and transport them back to the station. Because of this operational mode, the engine company is out of service for the entire medical aid call. PROPOSED CITY EMERGENCY TRANSPORT OPERATIONAL PROFILE The proposed plan would remove paramedics from the engine company, place them in a separate vehicle, and backfill the two vacant paramedic positions on the engine with one Firefighter/EMT. To keep staff increases at a minimum, one of the Department's two truck companies would operate as an either/or vehicle with staff manning either an ambulance or a truck company, depending on the type of call . A total of six ambulances would be staffed with two paramedics, and two ambulances would be held in reserve for major medical emergencies. This system would increase Fire safety coverage because the paramedic team would be able to operate independently of the engine companies. Currently, the engine company crew is tied up for the entire medical aid call because paramedics act as dual Firefighter/Paramedics on the engine companies. In this profile, the engine company will act as first responders and assist the paramedic team in the field, but when the patient is transported by the medic ambulance, the engine company is free to respond to other safety response calls. PROPOSED FIELD MEDICAL AID RESPONSE CONFIGURATION In the proposed configuration, a typical medical aid call would be as follows: When a citizen needs emergency medical assistance and calls 9-1-1, STAFF SHIFT FOR CITY AMBULANCE CURRENT E C i P P CHANGE 1 E C P P i Move 2 Paramedics From Engine To Ambulance CHANGE 2 E C P P F Replace 2 Paramedics With 1 Firefighter On Engine OPTION j 4 R ::•:::r:•::::>:o::;::i:;ii;:::::;:o::;: ::::;:::::: :�7!1'r�:'is:C/t:C•:.�J;:Y.fi�!!r!f;fltJl F:.f7;4i:.:;;.:.:iii.;.::•.::.�:.:.�::::::::::::::::::.�::.:::::::::::.:::::::::.::.::::.:�:::::::.ss•:.;y•::�:::::<:::::::.:;::::: , f��1P,M�NTOOSTS.-;flR:S.4Y �+ Nr mew{feQS..T..s.�:�:�� :�.:::s{.:�.:::.:::::::::::::::::::. ::> =129 2 ............ .;:<.;:.:.:::::.:: .... ...3 9.95 YEAR 2 TOTAL LAY-OFFS/ADDITIONS 0 PERSONNEL COSTS(-)OR SAVINGS(+) -717,370 SICK LEA VEIVACAT7ON BUY-OUT 0 EQUIPMENT COSTS(-)OR SAVINGS(+) -192,450 MATERIALS/SUPPLIES COSTS(-)OR SAVINGS(+) -455,509 TRAINING COSTS(-) OR SAVINGS(+) -42,573 INCOME LOSS(-) OR PROFIT(+) 2,660,031 NET OUTCOME FOR YEAR 1 ,252,129 Y . TOTAL LAY OFFS/Af3 TfO Pf!?SONNFL L'aSTS{r.OR SiWIN GSj'+) 74 0 SiK LYE/ AAT/Of�[BUY::;:;;;::::: :::::::.::.>:;:>:::. 284 MATERIAf a', 944)COSTS :.... ���70. >:::<::><>:.':<:<::::>::;;: ,,..,...: NGOM�:LOSS OF/T NET OL1TG'DMF FOA YEAR YEAR 4 TOTAL LAY-OFFS/ADDITIONS 0 PERSONNEL COSTS(-)OR SAVINGS(+) -722,558 SICK LEAVEJVACATION BUY-OUT 0 EQUIPMENT COSTS(-)OR SAVINGS(+) -212,176 MATERIALS/SUPPLIES COSTS(-)OR SAVINGS(+) -502,199 TRAINING COSTS(-) OR SAVINGS(+) -46,937 INCOME LOSS(-) OR PROFIT(+) 2,932,684 NET OUTCOME FOR YEAR 1 ,448,814 A D DI IONS;;.;:.::.;:::>::::>::>:<::>;;:<::>;:::>:.;:::;::>::»::.:.;.;;;.>•<�:;<::.>:::.>•.;..::::.::::::.�::;;:;::::::::.:::::.;::::::;.::::.:. PERSONNEL;C OSTS:{)<�R•:.:.::.�.::::.:::.::::�..)..:::::<::.;;::.;:::.;:;.;;>::<;:.;:;<.;;:;;.;;•:::.;:;.;:::::;.:.;>;:::.::;:�:;.;;>::::::<::;<;:;:;:..; SICKLEAVEIYACATI N fQUIPMENT:COSTS , QRSAVINGS f.>`.»>` .....::;.:::><:<<» :< '><..::::: :::.:>: 222,78.5 :::::;:.:;.;:.>:.>:.;:.;:....... MATERIA4§lS: PLfES COSTS(}OR SAVINGS{+J ";: :.< :: 527,30'9 NG' + 4g 28.4. TRAINING;.C..4ST5:.........;.:::.:.: .:).:::::: ::: :;:;;:';;:':':;;::;;;;::`;;::::; :,:.:.;::.;.:. AVON O :PROFIT+;: 7 9. 31. $. 6 . NET OUTCOME FOR YEAR TOTAL NET OUTCOME OVER 5 YEARS 016.979 i j . s � RIVERSIDE T.1 OPTION j PLAN r:: ::::::::.:.�Qf�#PA�fN1;'Ot1.STS:. :fl)!3.:�fi:�l}NCB:�.:::::::: $����' ...:::::::,: :<.:.: f z.......... ' >:=`x: .::: :,...::::::::. >23` " .... .,. 5 .. :::::::::::.�.�.5## 3.0#�.....:...::....:.:...::.::::.:::::.:::::3::::::::::: :. :;:»»::::>:;:>::«::<::>::>::>:::<:: ::>::>>:::;:::>:: <::::;a>>::>::>::>::>>::::::::>................ . ....:....:..:. YEAR 2 TOTAL LAY-OFFS/ADDITIONS 0 0 PERSONNEL COSTS(.)OR SAVINGS(+) 1 ,340,688 1 -717,370 SICK LEAVEIVACATION BUY-OUT 0 0 EQUIPMENT COSTS(-)OR SAVINGS(+) 50,183 -19 2,4 5 0 MATERIALSISUPPLIES COSTS(-)OR SAVINGS(+) 41 ,935 -455,509 TRAINING COSTS(.) OR SAVINGS(+) -1 ,257 -42,573 INCOME LOSS(-) OR PROFIT(+) -395,83911 2,660,031 NET OUTCOME FOR YEAR 1 ,035,71011 1 ,2 5 2,12 9 >'s£l _ ' DD1TfONS?<>�>: >> AdpftL 8: EL<:COS::S. -;:ORS:4V{NGS-t:;•.:;:;;::;;;:::>;;:::>;;;::>;>:;::.;::.:�;;>.::;;::;;;>:::::::.�:.1.:.4.#37:��3:<::�:?:>'>:>;:>::::>::<;:..::;:..::.....::>::::::::::: 3 78 28:4' 33! .::.:.:........................ YEAR 4 I TOTAL LAY-OFFS/ADDITIONS 0 0 PERSONNEL COSTS(-) OR SAVINGS(+) 1 ,4 7 8,1 0 9 -722,558 SICK LEAVE/VACATION BUY-OUT 0 I 0 EQUIPMENT COSTS(-)OR SAVINGS(+) 54,273 -21 2,1 7 6 MATERIALS/SUPPLIES COSTS(-) OR SAVINGS(+) 45,357 -502,199 TRAINING COSTS(-) OR SAVINGS(+) -11307 -46,937 INCOME LOSS(-) OR PROFIT(+) -505,447 2,932,684 NET OUTCOME FOR YEAR...........................................................................................1 ,07.0,990 { ................. 1 ,448,814 ;:::....:.::. YEAR-5: TOTAL iA Y..OFFS/ADOI T{ONS:::::::::::.::::::::::::::::.:::.::::::::::::::.::.:::::.::.::::::.::::::::::.:::::....::::.:; P,ERSQNNEL:COS.TS -;.ORSAVINGS .... >o EQUIPMEN3-COSTS OR::SA.VlNGS .............:..... ..:>.::::;:<::<:>:<:;>:.::;::...:.:..::.:,..:::::: :O VI GS 4.7.:x.71 527,3x . MATERI LSISUPPLTES COST s: (.I.:::::::.::::::::.::::.::::::. TRA.{NING..COS:TS .::OR SAVIiYG. . 31°8, ":_>;:>:::; ;.;;:.';>:::::;: : 3.0:79 INCOME: DR PROFIT t. ..<,....;..;:...,.,,...:.::..>.; ;;::,:::::.:::. �7.�.�.;..:;.:>;:;:.::.> < > >' ::. :::::::::. . ........ ..... . . NETOUTCDMEFORYEAR.:;;:.;>:,.::..:;:.:;:;,;:::;: ::�07r. : TOTAL NET OUTCOME OVER 5 YEARS $5.140.857 _ I $6.016.979 i 0 0 ADDITIONAL LABOR COSTS NOT CALCULATED IN PROPOSAL i I I f $ 1 ) 276 ) 846 i 0 O COSTS NOT ADDRESSED 0 MEDICAL MALPRACTICE 0 GENERAL LIABILITY 0 VEHICLE INSURANCE 0 WORKERS COMPENSATION INSURANCE 0 EARLY MEDICAL RETIREMENT CITY BUSINESS PLAN SUMMARY INCOME PROJECTIONS ORIGINAL INCOME PROJECTIONS (5/19/93) $2,534,614 REVISED INCOME PROJECTIONS (7/23/93) (722,8161 REVISED NET INCOME $1 ,811,798 OPERATING COSTS ORIGINAL OPERATING COSTS YEAR 1 (5/19/93) $2,020,619 ADDED UNACCOUNTED LABOR COSTS (5/19/93) 1 ,276,846 REVISED OPERATING COSTS $3,297,465 NET LOSS FROM OPERATION ($1 ,485,667) O p NET OPERATING LOSS $ 1 , 485 , 667 0 Imp- qw 0 w DC z W W � � z m Q � F- U) m � li � w ClIft• Q o rr L) 0. w 0 o 0 � w fr LL HCPCS CODES HCFA has developed procedural terminology and a coding system designed to provide all thirdparty payers with a common language that describes the service provided. For ambulance senices, most procedure codes start with the Ietter "A' and are followed by four (4) numbers. Additionally, Carriers use "local" codes for services not listed in the HCPCS system or due to Carrier variations or as a result of historical practices. Thus, for example, extra attendant and night charges are billed under local codes. It is important to note that Carriers do not necessarily use all of the codes listed below, as they have some discretion. Additionally, Carriers do not always use the official description. The more common HCPCS codes for ambulance services and their descriptions are as follows: A0010 - Ambulance service, basic life support (BLS) base rate, emergency transport. NOTE: Many Carriers use this code for the emergency, as well as for nonemergency BLS base rate. A0020 - Ambulance service, (BLS) per mile, transport. A0030 - Ambulance service, conventional air sen'ice, transport. A0040 - Ambulance service, air, helicopter service, transport. A0050 - Ambulance service, emergency, `Water, special transportation. A0060 - Ambulance service, waiting time, one half (112) hour increments. A0070 - Ambulance service, oxygen, administration and supplies, life sustaining situation. A0150 - Non-emergency transportation, ambulance, base rate. A0215 - Ambulance service, miscellaneous disposable supplies not itemized (if itemized use appropriate CPT4 or alpha-numeric supply code). A0220 - Ambulance ser-,Ice, advanced life support (ALS) base rate, all inclusive services, emergency transport. A0221 - Ambulance service, (ALS) per mile, transport. A0222 - Ambulancd service, return trip, transport. A0223 - Ambulance service, advanced life support (ALS) base rate, where . nonreusable ALS supplies are billed separately, emergency transport. A0999 - Unlisted ambulance sen•ices covered by Medicare. 93041 - EKG tracing, one (1) to three (3) leads, w ithout interpretation, no report (NOTE: some Carriers use 93005 or other codes). All base rates listed above are one-way transports. {ambulance Reference Manual for Medicare 37 0. s Y� - --s'". .. .... - INITIAL ST,aTEH..ENT 2%Z5/9Z ?IcASE I':CLUOE CG:APLETcO `:R °BILLING Ih�UT.F.I_S LSURANCE FCP:•1 aITH T-P CFFIC_ HP S/ �T.41F/1.30� l-Y.3CP't Ll P-IRT,ICN DF THIS STATEFctiT CLCScO TNURS`?AYS 714/33'7-2737 31 0/5'34-6759 • r. 054'-92001706 10 CITY CF SAN 3E:%NARDINC ; PARAF,EDICS i P.C. BOX 5150 FOUTAIti VALLEY CA 927)3 --------------------- �� pf-EASE RETURN TOP P:CRTION.WITH PAYMENT DST= OF A`!CUt�T VICE Rys ?TICt1 Sc DE SC RI =2/15/92'`'A.022o..- !, ALS FARA _DIC TIANSPORTATT_0`� 200.CG ' --------------------- ------------------------------------------------�_- --- ---- LAST CVER GVE C,VER CURREN T 0 .YS 6G DAYS 90 DAYS • ?ALAVCE P AYME'-; z _ ----------- ----- ---- ---------- 200.00 ;ITY GF SAS; BERNARDINO TOTAL DUE. ZOO.GO 0548-920-1705-10 TT• ACCORDING T01 OUR RE CGR)3 TYCUTHAVEY A SS U'•''E'7TF I\A,":C I ALT TT T PESPOt:SI3ILITY FOp S=PViCES PPOVIDFD. PLEASE ?.E4IT PAYMENT IN T - FULL I:'"EDIATELY OR C014TACT THIS CFFICE, i PATIENT NAME CITY OF SAN BERNARDINr v pF RAMEDICS P.O. BOX 9150 ACCOUNT NUMBER t STATEMENT DATE FOUNTAIN VALLEY CA 92708 714/839-2787 800/339-8443 0270380 11/16/93 Place of Service: LOKA LINDA UNIVERSITY FOR'-BILLING INQUIRIES OFFICE HRS 1MTWF 11:30PM-4:30PM CLOSED THURSDAYS CITY OF SAN BERNARDINO PARAMEDICS P.O. BOX 9150 FOUNTAIN VALLEY CA 92708 P A LE-ASE INCLUDE YOUR CLAIM(S)NUMBER ON YOUR CHECK FOR PROPER CREDIT. PLEASE DETACH AND RETURN TOP PORTION WITH PAYMENT 270380 11/04/93 A0220 ADVANCED LIFE SUPPORT 200. 00 CLAIM TOTAL 200. 00 THIS STATEMENT IS FOR SERVICES RENDERED BY THE CITY OF SAN BERNARDINO PARAMEDICS. IF YOU ARE A MEMBER OF THE PARAMEDIC PROGRAM YOUR INSURANCE WILL BE BILLED. PLEASE SEND THIS OFFICE YOUR INSURANCE INFORMATION. THANK YOU ACCOUNT NUMBER = DATE OF STATEMENT':` AMOUNT PAID 0270380 11/16/93 DATE SWILL APPEAR ON 2W OO YOUR NEXT STATEMENT PATIENT NAME' MAKEICHECKS PAYABLE TO: CITY OF SAN BERNARDINO SEE REVERSE FOR IMPORTANT BILLING INFORMATION N 1 ti O � w N N v CM 1Q r r Q c h. r 0 r r r O W 1 L c co 1 Q ' A W r W r i co ' co h � ' m o to OD 0 to to d' co N STAFF SHIFT FOR CITY AMBULANCE CURRENT E C P P CHANGE 1 E C P P Move 2 Paramedics From Engine To Ambulance CHANGE 2 E C P P F Replace 2 Paramedics With 1 Firefighter On Engine SAN BERNARDINO CITY FIRE STATIONS STATION NO. LOCATION 1 NON—MEDIC 2nd Street between Sierra Way and Allen 2 9th Street and Gardner Street 3 Medical Center Dr. and 21st street 4 27th Street and E Street 5 NON—MEDIC Kendall Drive and University Pkwy 6 Del Rosa Avenue (1900 block) 7 NON—MEDIC 40th Street and Electric Avenue 8 NON—MEDIC Highland Avenue and Orange Street 9 N0°`I 2nd Street and Meridian 10 Mill Street and Arrowhead Avenue 11 NON—MEDIC Vanderbilt Way and Hospitality Lane r.�rrrrrr �► + 11W + f E EXISTING CITY FIRE DEPARTMENT STATIONS . FIRE STATIONS - PARAMEDIC FIRE STATIONS 5 Engines x 4 Positions x 3 Shifts = 60 Personrn 6 Engines x 3 Positions x 3 Shifts = 54 Total Personnel = 114 E = Engineer C = Captain P = Paramedic F = Firefighter qL� 40TH ST FWY 30 HIGHLAND AVE w U) Cl) 0 F- BASELINE ST. w FOOTHILL BL`1 5TH ST MILL ST w z O z w 10 N W W z CC i CITY OF SAN BERNARDINO LLI SAN BERNARDINO CITY FIRE STATIONS STATION NO. LOCATION 1 MEDIC 2nd Street between Sierra Way and Allen 2 MEDIC 9th Street and Gardner Street 3 MEDIC Medical Center Dr. and 21st Street 4 MEDIC 27th Street and E Street 5 MEDIC Kendall Drive and University Pkwy 6 MEDIC Del Rosa Avenue (1900 block) 7 MEDIC 40th Street and Electric Avenue 8 MEDIC Highland Avenue and Orange Street 9 MEDIC 2nd Street and Meridian 10 MEDIC Mill Street and Arrowhead Avenue 11 NON—MEDIC Vanderbilt Way and Hospitality Lane C PROPOSED CITY FIRE DEPARTMENT STATION. FIRE STATIONS ® PARAMEDIC FIRE STATIONS 10 Engines x 3 Positions x 3 Shifts = 90 Personnf 1 Engine x 3 Positions x 3 Shifts = 9 Total Personnel = 99 E = Engineer - C = Captain P = Paramedic \'�Ftioq F = Firefighter � F - 40TH ST .\ I FWY 30 HIGHLAND AVE I > - co ®co BASELINE ST. w °- FOOTHILL BLV 5TH ST t MILL ST w a z O z N w FWY 10 w z CITY OF SAN BERNARDINO W ADVANTAGES 1 . Doubles the number of Fire paramedic units on the street from 5 to 10 2. Substantial improvement of Fire paramedic response times 3. Keeps Engine Companies in their districts for better EMS/Fire response 4. Significantly increases the life of engines due to less wear and tear 5. Will have no impact on Rescue or Fire protection services `r' 6. Saves the City $ 975,000.00 7. Can be implemented through attrition. No existing-Firefighters will loose their jobs. eprinted with permission of JEM''�► Fire vs. Private EMS It Doesn't Have To Be This Way High noon in Centerville.You can 3.Compared with transport cable res- other methods that resist duplication in slice slabs off the tension with your cue rigs,ALS engines decrease the the public sector),nothing delivers ALS Buck knife.Their jobs at stake,fire- average time spent per call— especially first response less expensively than an fighter paramedics and private when backed up by a reliable ALS ALS ante Paramedics watch their leaders square transport system. Just as a reliable private ALS tans- off down on main street for the final 4.When a private ALS ambulance and port system is no substitute for a showdown.The fire chief speaks,or an ALS engine are simultaneously dis- reliable first resoonder program,a reli- maybe it's the private owner,'This here able first responder program is no paramedic industry ain t big enough for substitute for a reliable ALS transport both of us.' service.A first-class prehospital care 'Oh yeahT says the other. system must have both.The best of "Yeah,'says the first.The caliber of ",�meday our industry's both worlds is a prehospital care system their debate hasn t changed in a decade. combining the performance and effi- The truth is that this industry is big leaders may Face the fact dency of a privately operated ail ALS, enough for both of them,and if the leaders on both sides can just get their that there is work a fire egos under control,everyone,including the patients,will come out a winner. department can do best, This month's guest'Interface-article and work that a lifted was written by Jerry Carter,chief of the 4 Largo Fire Department,Largo,Florida. private ambulance `►i�` The article is about one of the best � —` public service bargains in all of local company can do best." government—the ALS engine.In ser. vice per dollar,ALS engines rival the efficiency of privately operated all- ALS,full service transport systems.The _ advantages are obvious: L Generating the ALS service at low patched to a critical call,the patient gets _ marginal costs,ALS engines are our a second chance if either unit's response industry's least expensive means of is delayed for any reason. �2 rapidly delivering paramedic ng pamedic capability to the scene. 5.Crews working ALS engines are not - S 2.Use of ALS engines improves the just cross-trained,they are also cross- productivity of the entire fire depart- used'every day. - ment—not just crews assigned to the 6.Properly organized,the marginal cost rescue units. per response of an ALS engine is far less than that of an ALS rescue unit,and only slightly higher than that of a BLS Jack Stout has been at the forefront of innova- engine lions in the design and implementation of EMS 7 While the private sector can deliver ' systems for the past dozen years.Ifyou have a p ' ALS transport service far more efE- '< question,a problem,or a solution related to �P . _ the publiclprivate interface in prehospital care, gently than can a government agency address your letter to'Interface"jems,P.O. (i.e.,by peak load staffing,aggressive Box 1026,Solana Beach,CA 92075. system status management,and many ' 84 JUNE 1987 jems _ the major fires and not use fire suppres- sion resources for other emergencies, which might reduce the likelihood of having fire suppression readily avail- _ " 1 able for the two to three percent of time ® we use it. Our city strongly believes that a fire department can safely provide fire pro- } , , tection and play an important role in our community's prehospital care sys- ` �• term using the same resources.Our � " belief in that concept is so strong that �- today the Largo Fire Department runs An ALS engine can make an important contribution to an exist fng prehospital care system in advanced life support(ALS)engines helping to save lives. exclusively. full service system with the equally a qualified private ambulance company In 1983,ego was running both an impressive performance and efficiency can do best.While some shoot it out in engine and a rescue company out of Of an ALS engine fast responder Centerville,others cooperate to produce each of our fire stations.This system. system• a better result together than either could proved inadequate since all of Largo's Oh,of course there are problems produce alone.God bless those others. engine and truck companies were with working together.But there are chronically undermanned.When an also solutions.Who's in charge at the engine company arrived on a fire scene, scene?The senior paramedic of the first their capabilities were often so severely crew to arrive —who else?When ALS Engines Work limited that they were sometimes forced should a fire paramedic ride in with T_, T to wait for additional resources before the patient?Whenever the paramedic in 111 Largos Florida Proper firefighting could be charge makes that decision.Continuity implemented. At the same time,our rescue units of care?Joint in-service training,uni by ferry Carter were intended to be manned by two form medical control,uniform on board paramedics,but not infrequently the equipment,standard medical protocols. rescue units were forced to go on the Where cooperation is valued,solutions Among are chiefs there exist wide Apwk are found.Elsewhere,solutions are differences of opinion regarding the road with one paramedic and one EMT. AF I impossible. type of coverage and amount of com- One of the biggest problems associ- Someday our industry's leaders may mitment a fire department should give ated with the engine and rescue concept face the fact that there is work afire to emergency medical services.Some was the fact that the majority of the department can do best,and work that believe fire departments should staff for workload was being carried by the res- cue crews since over 80 percent of total One of Largo Fire Department's ALS engines which provides both fire protection and prehospital calls were EMS-related.Given the care to the community. unequal workload and the low produc- °'°`' - 1 tivity of engine company crews, animosity developed between rescue crews and engine companies Realizing ' RE ' that a way must be found to equalize 0:` ,�.�; workloads and unite our personnel,we ''" — A�-:-_r •r began a program to give the citizens of Largo excellent,yet cost-effective EMS and fire services using the same - resources -! -s The solution to the problem was ALS engine companies In 1985,all of our engine companies became ALS capable. Today,every engine carries a four-man crew,at least two of which are fire- fighter/paramedics with the remaining crew trained to the EMT level.By staff- ing in this manner,and by furnishing _ - each unit with two complete sets of ALS equipment,each ALS engine is capable of responding to and handling two ALS calls and one fire suppression call liter- ally back-to-back. The Largo Fire Department,while in command at all medical emergencies, works closely with the private ambulance companies who transport for us As ALS first responders,we stabilize the patient,sometimes with the assistance of private ambulance crews, and then the patient is transported by ` Of cours--there is still the possibility r 3 0 that a fire with property loss may some- day occur due to insufficient firefighting capability at the same time an engine is providing medical services in another private ambulance to the hospital with location,just as it is possible that we our paramedics on board,when may experience a delayed EMS necessary. response because our engines are tied In 1986,the Largo Fire Department up at a fire To minimize these pos- responded to over 10,000 calls for ser- abilities and their consequences,we are vice:Almost 95 percent of those calls now in the process of upgrading our were medical requests.The nature of private transport service to the Para- our population plays a vital role in medic level—an improvement that will determining these statistics,as many also help us rest easier when we elect senior citizens have chosen our Florida not to accompany our BLS'patients to climate for their retirement years. the hospital.But even accepting this As the figures illustrate,ALS engines possibility of conflicting demands on have proven extremely cost-effective for our resources,we believe the lifesaving our community,saving us about a mil- advantages of our system far outweigh lion dollars each year in manpower the property loss that could occur. costs alone.Costs of fuel,maintenance A Word Of Warning-A reliable ALS and depredation are about the same for trznsport service run by a qualified both our rescue units and engines,but fu-m is essential to the safe utilization of because we no longer need to purchase ALS engines.Transport unit response and replace rescue units,our overall times must be extremely reliable(Le., savings are substantial Perhaps more not more than 10 minutes maximum importantly,our capacity for handling with not less than 90 percent reliability), demand fluctuations is greater than clinical standards and quality control before,our personnel workloads are must be uniform,and the contract or more fairly distributed,and our man- franchise must incorporate adequate power productivity is something we safeguards against service interruption I don't mind discussing with our elected as well as effective takeover provisions. officials. p f- lJ F `r Q> > E � cd N � O 0 a Z cr} W F- m Z Z- QO t7 O d 7O,y--°d.+C O 7 W r N-= Ow O;"u°DD W v v G O d. 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CL c < < ° 3 F m w ° 3 0 0— c � p f n�T a 32 0jp la n+l,y ZO!h`O yCn 0 ti o< 3 mI o o ° a n ° � °o 3y � dS tr N aC 3 K -W 3 9. 0 m r 3 3 7 A s a � 3 or C � 3>w R S7 N c 0 0 o a 3 CL 0 A P a cr ° C o ° 3 <7 < O ° L° O c c 1 O o o o ° n 1?' ' a < w S O < m _ O m � z Ito A3 --A- n ­7 CURRENT COUNTY PERCENTAGE RA TES RA TES INCREASE BASIC LIFE SUPPORT 178.84 285.62 59.71 % ILEAGE 8.94 11 .80 31 .99% UNSCHEDULED EMERGENCY 81 .24 112.29 38.22% /GHT/WEEKEND CHARGE 52.18 80.40 54.08% OXYGEN 22.37 69.64 211 .31 % WAIT TIME 16.38 25.23 54.03% ADVANCED LIFE SUPPORT 277.00 419.21 51 .34% KG 37.25 57.40 54.09% LL-INCLUSIVE ALS 403.75 622.10 64.90% `OUNTy 1Sdq R¢tglRUENO >> ' San Bernardino County Fire Chief's Association December 20, 1993 Dear Mayor and City Council Members: Over one year ago, the Chino Valley Independent Fire District, along with a number of other fire agencies, here in the County of San Bernardino, was requested by the City of San Bernardino to enter into the lawsuit between the County/City of San Bernardino. At the time, we were assured by a member of the San Bernardino County Board of Supervisors that we, meaning the Chino Valley Independent Fire District, would not be affected by the outcome of this court decision. Our legal counsel indicated we would be subject to the ruling. The outcome of the decision would have been to take away all control of the emergency medical services we provide to our citizens. As a result, we joined in your efforts. Therefore, we entered into a partnership with your City to maintain local control over the level of emergency medical service. We have spent a considerable amount of time, effort and funds to obtain an affirmative ruling by the court. Courtesy Ambulance Company and the San Bernardino County Board of Supervisors have chosen to appeal the decision of the lower court. Six other State court cases, started by the California Ambulance Association, have all resulted in rulings in favor of fire departments. The Appeals Court will soon hear this case and we are hoping they will i reaffirm the policy that public safety is the number one responsibility of local government. Mayor and City Council Members December 20, 1993 Page 2 Today, we urge you to continue our partnership and support all of our efforts in the appeals process and support us on the local level. Also, today we urge you to support the policy that public safety is the number one responsibility of local government and your fire department can provide this service in the best interest of your citizens. We request you reaffirm your support today of fire departments and vote to provide ambulance transportation for your citizens here in the City of San Bernardino. Thanking you for your consideration. Sincerely, y . Shackelford, Pre ent COUNTY FIRE CHIEF ASSOCIATION r an Bernardino County Fire Services Coalition 15091 La Palma Drive; Chino, CA 91710-9615 (714) 597-9686 ext. 231 FOR IMMEDIATE RELEASE: December 13, 1993 CONTACT: Mike Dickinson, San Bernardino City Fire Department, EMS Coordinator (619) 261-4342 Dan Coffman, Coalition Chairman (909) 597-7775 Office; (909) 482-4104 Pager COURTESY AMBULANCE PROPOSAL JEOPARDIZES PUBLIC SAFETY. WILL BE CONSIDERED BY SAN BERNARDINO COUNCIL DECEMBER 20th The Courtesy Ambulance Company and the City of San Bernardino have been at odds for nearly two years over the issue of who has authority to control the delivery of emergency medical and ambulance services in the City, the City or the County. In fact, Courtesy and the County of San Bernardino brought a lawsuit against the City of San Bernardino on the issue last year, they lost and have recently appealed the ruling. In the wake of this appeal and in response to a proposal by the fire department to provide ambulance service. They have presented a proposal to the City Council that would reduce the number of firefighters and essentially allow them to take over paramedic service in the City of San Bernardino. It will be considered on December 20th. The plan, which has been sharply criticized by firefighters and the public alike, would eliminate at least fifteen firefighters positions, reduce engine company strength from four firefighters to three, by eliminating one of the firefighter/paramedics currently assigned, would raise ambulance rates more than fifty percent, calls for a ten year exclusive contract, allow them to take over paramedic service in the City of San Bernardino and, if they had their way, would have private ambulances responding from fire stations. -more- (1 of 2) Representing Fire Departments, Labor & Management Organizations & the Members of the San Bernardino County Fire Service. �f-; - San Bernardino City Firefighters think the proposal is nonsense! Reducing the number of firefighters and firefighter/paramedics puts the public at risk by reducing their response capability and jeopardizes firefighters who are often find themselves in very dangerous situations. The Fire Department is an all risk, emergency service, strategically placed throughout the community to meet the emergent needs of the public. No matter what the emergency, all you must do is dial 9-1-1 and the fire department will respond quickly and with enough personnel, equipment and knowledge to take care of the problem. While staffing, distribution of personnel, equipment and response are based principally on the potential risk for fires, as determined by the Insurance Service Office, these multi-functional firefighter/paramedics and EMTs respond to all types of emergencies and provide a much needed emergency medical service without significant additional fiscal impact to the taxpayer. Proposals, such as that presented by Courtesy Ambulance, fail to consider the need, the total cost of providing fire and emergency medical services or the economic cost associated with a reduction in firefighting personnel. Firefighters, which are required to meet ISO standards, are also needed to provide a quick response with enough manpower to manage medical emergencies. They can not be replaced without significant detriment to emergency medical services and public safety in general, without increased risk to firefighters, without an increase in fire risk, property loss, economic hardship and increased insurance premiums. The San Bernardino City Fire Department feels that it can provide emergency medical ambulance service better and more cost effectively than the private, for-profit, ambulance company can. They presented an Emergency Medical Transport Operations Plan that was approved by the City Council August 2, 1993 , that they would like to see implemented. Firefighters from the City of San Bernardino and throughout the County will have an informational picket in front of City Hall Monday, December 13th 7: 30 AM till noon, are meeting with Council Members, community leaders and are urging the public to call on their Council Members to reject this nonsensical plan by Courtesy Ambulance and will make a presentation before the City Council on Monday, November 20th (2 of 2) San Bernardino County Fire Services Coalition Representing Fire Departments, Labor & Management Organizations & the Members of the San Bernardino County Fire Service. \rr� X FOR COURTESY AMBULANCE DEC. 20, 1993 JOHN SENTO - 4325 NORTH "E" STREET, 886-2541 For City Paramedics. r r T C l I C &I 1A W 2565 F Pc M9l�-TrzT-A-T--�yi ,i c i RUTH ORR - 2736 GENEVIEVE , 883-9405 X For private enterprise - Courtesy or another company. HARVEY & JENNY GRADILLA - 25645 - 27th STREET, 883-1257 For City Paramedics. X MILDRED DAVISSON - 721 EAST 9th STREET, SPACE 139, 889-1393 For Courtesy Ambulance. X RAY KEELING - 264 East 42nd STREET, 882-8407 For Courtesy Ambulance. KARP STOCKTON - 847 WEST 18th STREET, 882-1678 X For private enterprise. JOANNE SITTS - 5405 PRADO COURT, 883-5750 For City Paramedics. MRS. M. K. SICKLER - 1329 POPLAR, 889-6660 For City Paramedics. JENNY ANDRADE - 1457 WEST 5th STREET, 808-2780 For City Paramedics. ED POFFEK - 5465 NORTH "E" STREET, 882-8855 For City Paramedics. LILLIAN JEAN - 701 EAST 21STREET, 882-3069 For City Paramedics. a.-7 •Rosemary Alonzo 3� William Krips and Betty 8 58 W. 25th 63 Bussy q, 82-2478 886-9035 For Paramedics For Courtesy /3 Robert Davie 889-4859 For Courtesy John Walters 1936 Eagle 888-7415 For Paramedics # Mrs. Beals 3280 C Little Mountain For Courtesy William Harrison 4675 Woodbend Ln. 886-8932 For Courtesy 3f Bill Jarvis 3144 Genevieve 883-7906 For Paramedics 36, Mrs . Kenny 2048 E. 18th For Paramedics 37 Maxine Kraft 2830 N. Mt. View 886-5753 For Paramedics 3F Lisa Haiston 1460 Kendall #23 887-7061 For Paramedics CONSTITUENTS FOR COURTES" Mrs . Mascari & Bruce 862-1009 /d Yvonne Knight 1235 Cedar 888-3360 Eric Romovnov 227 E. 44th 882-6001 ,2D Rodney Coe 1703 Fremontia 883-1737 .21 James Ross 3850 Atlantic 862-8110 ,�-2 Pauline Berberich 3850 E. Atlantic 862-7893 ,23 Shirley Walters 359 E. Ralston 883-2735 ,24/ ::amison Matthias 3041 Pinon 862-8097 .=' Esther Cobos 837 W. 24th 882-2157 Marilyn Leidner 874-2268 z/2 093 CONSTITUENTS FOR FIRE PARAMEPTCS PG Bruce Belkemeier Arthur Tempia 5764 N. Louise 272 E. 4th 889-8990 Loralee Newby Kevin Valentin 5565 N. Thistle 359-5855 David Agundez yr1 Harold Wear 4459 N. Vermont 1683 Lugo 880-6095 Shirley Bogh !� Duncan McEwan 3114 Belvedere 338-7558 862-1906 SrtV Sherri & Fred Janssen Al Cindy Piepmeier 4495 N. Vermont 3373 887-7087 (qJ Len Borowski y5" Fernando Garcia 1304 E. Deaville Ct. 3995 N. Golden 886-3383 �✓ Lucion Gordon Betty Schmidlhuber 4040 Piedmont 385 W. 49th 864-3712 886-5903 G� Willard Plummer 1761 Kenwood 1/j Nancy Hultgren 886-3187 550 W. 5th #709 885-8227 Lester Melzer 711 E. 21st yP Patricia Lay 882-7453 2841 N. Mayfield &f/ Andy Wallenberg 882-6753 2931 Sepulveda 883-7594 Irma Frater 550 W. 5th Street #1112 _ William McKinnon 1775 E. 20th $�Sl James & Faye Lawson 889-8916 1033 W. 26th 882-7973 Ronald Lawson 3945 Ferndale 5-2 Tint Wessel 883-1956 4422 N. Vermont Mrs. . Gallegos 887-0221 2562 N. "I" 883-1419 S3 Kevin O'Kamura 3358 Mirada Terry Tomboc 425-1765 4431 N. "F" 886-9585 /a �.toA3 r X FOR COURTESY AMBULANCE PARAMEDICS/COURTESY AMBULANCE ISSUE DEC. 13, 1993 DANA HUNTER - 1153 EAST ECHO DRIVE, 387-6762 Do not change mind re. emergency services. Keep City Paramedics. DIANA DOGERO - 2295 CINCINNATI COURT, 880-3183 Thank you for supporting Fire Department. DEC. 14, 1993 LAWRENCE HUGHES - 1428 N. WALL, 888-5394 In favor of keeping Paramedics, not Courtesy. PATRICIA CADE - 2361 NEWPORT AVENUE, 882-5886 Supports the Paramedics - Courtesy is a joke. DEC. 15, 1993 WALTER & PAULINE WYLDER - 279 EAST 46th STREET, 883-1539 Wants to keep City Paramedics. Do not want Courtesy Ambulance. KAREN MILLER - 2844 N. ARROWHEAD, 883-2516 Want Paramedics to have their jobs. Forget Courtesy Ambulance. DEC. 16, 1993 MICHAEL HARRIS - 591 E. 19th STREET, 883-7759 For City Paramedics. They are professionals - know what they are doing. LINDA HILL - 4394 N. DON DIEGO, 887-2021 Need to keep services they have been receiving. CHARLES SCAGGS - 4458 CHRISTY AVENUE, 887-8186 Opposed to private ambulance service. Supports paramedics. TONY & DOREEN FROSSARD - 4623 SAN BENITO, 887-1029 Against cutting Fire Fighters. REMELLE LUMPKINS - 4395 VERMONT STREET, 880-4394 For the City Paramedics DEC. 17 , 1993 ATHLINE BLISS - 1308 N. CEDAR STREET, 888-0631 Support City Paramedics X MARY HILL - 1747 FREMONTIA, 883-9344 For Courtesy Ambulance EDWARD DE FRATIS - 254 E. ALEXANDER, 882-6713 In favor of City Paramedics. ROBERT HUNTLEY - 3887 PARKSIDE DRIVE, 882-4865 In favor of City Paramedics ��A o f3 7 BRIAN DEMULLIN - 1108 E. DEVONSHIRE , 886-8201 In favor of City Paramedics. . Courtesy not telling true story. X = LOYA NOLAN - 1331 VALENCIA, 889-1301 For Courtesy Ambulance. 'r SUSIE CORDERO - 352 E. WABASH, 885-5108 For City Paramedics. X RON HAZARD - 3063 N. BELLE, 423-4774 For Courtesy Ambulance. DEC. 20, 1993 ' DUN DERRY - 3148 ARDEN, 864-0289 City should NOT go into ambulance business. Doesn' t care which ambulance company serves City. DUN WEIDEL - 1023 W. 9th STREET, 884-2258 Opposed to Courtesy - they are crooked. f'iR. u MRS. LOUIS UNRUH - 48G1 SEPULVEDA, 886-2738 In favor of City Paramedics .� BARBARA_ BOGGS - 1183 E. ALEXANDER, 886-3522 For City Paramedics. X y TOM BARTLETT - 921 E. CENTRAL, 889-3450 For Courtesy Ambulance. f PATRICK CARROLL - 4894 MARIPOSA DRIVE , 886-5726 For Fire Dept. Paramedics. X LUIS SCHEURER -1177 CONGRESS, SPACE 3 8, 889-3765 For Courtesy Ambulance. 26—RiCARDO TOhiBOC -4431 NORTH "F" STREET, 886-95,05 For Fire Dept. Paramedics. X THERESA SHAW - 743 E. SONORA, 8812-8391 For Courtesy Ambulance. �G JOSEPH PAGLIA - 2185 W. COLLEGE AVENUE, #3146, ,0 87-6111 For City Paramedics. X DON QUIEL - 3226 NORTH "F" STREET, 886-2255 For Courtesy Ambulance. A Eleven, $65,000 l I Fmploye�es\ ..i 9 UNIONS PICKETS DEMAND CITY TAKE OVER OF COURTESY AMBULANCE If city unions have their way, on Monday, Courtesy Ambulance will be put out of business, to be replaced by a new city bureaucracy. City staff and union membership will grow by 14 people, eleven making $65,000 a year, with guaranteed annual raises. City Hall is leaning this way. That is nutty. Does anyone realty believe the city can be more efficient than a private firm? No. Across America, cities are contracting with private firms to provide public services. Why? Private firms are cheaper. They must be to stay in business. Even San Bern--dino C:vy Fall agrees. Recently they announced they would star`s contracting Out services to save money. First to go: tree trimming. They found it could be done faster and cheaper if a private firm replaced high cost city workers. Going into the ambulance business violates City Hall's own best judgement! So what makes City Hall think they can run an ambulance business? The city budget is tight. The unions have convinced the staff they can make money in the ambulance business. They can't. City bureaucrats are paid for having large growing staffs, not smaller efficient ones. The city is self insured and would have to absorb workmen's compensation and liability costs now paid by Courtesy Ambulance. Ambulance costs are mostly for employees. City ambulance workers, though no better trained, would make more money, have better benefits, can't be fired and would get guaranteed raises. Who made Courtesy Ambulance a target? Bob Holcomb. As Mayor, he was desperate for money. He started a weird scheme whereby the public is charged for paramedic service unless they pay the city in advance for protection. Few people signed up, so most patients are getting billed $100 when paramedics come to their home, $200 if they ride to the hospital with them. The ambulance take over was started by Holcomb when patients justifiably complained. He figured that if the whole bill was from the city, people would not notice the new charge. What could force City Hall to make this mistake? Union picketing and pressure. What can you do? Call your City Council Member to protest this mistake: Edward Negrete 384-5268 Jerry Devlin 384-5278 Dr. Freddie Curlin 384-5222 Valerie Pope-Ludlam 384-5378 Ralph Hernandez 384-5333 Norine Miller 384-5068 David Oberhelman 384-5178 i lssauisng as tkaquiV aqZ ul ssauisng oN seH ileH ,�jta XqA, I0bZ6 V3 `ou'pJnulag unS jaa4E gluanas tsahl EEC ajpuaS aaunpnquiV �saunoo Adding Eleven, $65,000 City Employees... UNIONS PICKETS DEMAND CITY TAKE OVER OF COURTESY AMBULANCE If city unions have their way, on Monday, Courtesy Ambulance will be put out of business, to be replaced by a new city bureaucracy. City staff and union membership will grow by 14 people, eleven making $65,000 a year, with guaranteed annual raises. This is nutty. ]Does Anyone Believe City Hall Can Run An Efficient Operation? No. City Hall has begun contracting out its services to save money. 'Will The Public Get Better Service, Or Save Money? ]Vo. City ambulance workers, though no better trained, would make more money, have better benefits, can't be fired and would get guaranteed raises! Then What Is Really Going On? Adding Eleven, $65,000 t...ty Employees... UNIONS PICKETS DEMAND CITY TAKE OVER OF COURTESY AMBULANCE If city unions have their way, on Monday, Courtesy Ambulance will be put out of business, to be replaced by a new city bureaucracy. City staff and union membership will grow by 14 people, eleven making $65,000 a year, with guaranteed annual raises- City Hall is leaning this way. That is nutty. Does anyone really believe the city can be more efficient than a private firm? No. 6­ U Across America, cities are contracting with private firms to provide public services. Why? Private firms are cheaper. They must be to stay in business Even San Bernardino City Hall agrees. Recently they announced they would start contracting out services to save money. First to go: tree trimming. They found it could be done faster and cheaper if a private firm replaced high cost city workers. Going into the ambulance business violates City Hall's own best judgement! So what makes City Hall think they can run an ambulance business? The city budget is tight. The unions have convinced the staff they can make money in the ambulance business. They can't. City bureaucrats are paid for having large growing staffs, not smaller efficient ons. The city is self insured and would have to absorb workmen's compensation and liability costs now paid by Courtesy Ambulance. Ambulance costs are mostly for employees. City ambulance workers, though no better trained, would make more money, have better benefits, can't be fired and would get guaranteed raises. Who made Courtesy Ambulance a target? Bob Holcomb. As Mayor, he was desperate for money. He started a weird scheme whereby the public is charged for paramedic service unless they pay the city in advance for protection. Few people signed up, so most patients are getting billed $100 when paramedics come to their home, $200 if they ride to the hospital with them. The ambulance take over was started by Holcomb when patients justifiably complained. He figured that if the whole bill was from the city, pecple would not notice the ne,!;, What could force City Hall to make this mistake? Union picketing and pressure. What can you do? Call your City Council Member to protest this mistake: Edward Negrete 384-5268 Jerry Devlin 384-5278 Dr. Freddie Curl in 384-5222 Valerie Pope-Ludlam 384-5378 Ralph Hernandez 384-5333 Norine Miller 384-5068 David Oberhelman 384-5178 issauisng ajunpiquiV aqjL ul ssauisna oN suB, IfuH X113 CqAj TTtZ6 VD 'OUTPJPUJ99 UPS qE)@-Tqs qquE)AGS *M tSOT Pza-edsE[ oxeuae -aW OEM- ]JOW P -o IOP'Z6 V3 '0M1PJMUd9 UPS IddJJE YlUdAdE MIJA RCj' daieuaE diuvjnqwV i(salinoo Adding Eleven, $65,000 City-Employees... UNIONS PICKETS DEMAJ M CITY TAKE OVER OF COURTESY AMBULANCE If city unions have their way, on Monday, Courtesy Ambulance will be put out of business, to be replaced by a new city bureaucracy. City staff and union membership will grow by 14 people, eleven making $65,000 a year, with guaranteed annual raises. This is nutty. Does Anyone Believe City Hall Can Run An Efficient Operation? No. City Hall has begun contracting out its services to save money. Will The Public Get Better Service, Or Save Money? No. City ambulance workers, though no better trained, would make more money, have better benefits, can't be fired and would get guaranteed raises! Then What Is Really Going On? PAGE 02 To: The Mayor and Common Council of the City of San Bernardino FROM: Ronald G. Skipper, Attorney at Law DATE: December 2, 1993 SUBJECT: Emergency medical services negotiations between the City of San Bernardino and Courtesy Ambulance For the past two and one-half (2h) years, an ongoing area of dispute has existed between the City of San Bernardino, which offers emergency paramedic services, and Courtesy Ambulance, which also provides paramedic services within the City limits of San Bernardino. History: In July, 1991, the Fire Department implemented a Paramedic Membership Program that established a fee of $100 - $200 for every medical aid call that the Fire Department responds to within the City. The City contracted with Courtesy Ambulance to provide billing services for us. In August, the Fire Department began to receive complaints from citizens that their insurance companies were not covering the cost of two paramedics on one medical aid call. As staff investigated the complaints, it became apparent that Courtesy Ambulance was charging for paramedic level services, even though the City was the actual provider of those services. Over the next few months, Fire and Administrative staff held a number of meetings with Courtesy Ambulance, the County Health Case Agency, and ICEMA to work out a solution to this "double billing" issue. The position of both the County and Courtesy was that the County controlled all pre-hospital care and Courtesy was authorized under County regulations to staff and bill for paramedic level services on all medical aid calls within San Bernardino. The last meeting was held on November 25, 1993 . On December 10, 1993, the County and ICEMA filed suit against the City for declaratory relief regarding authority over pre-hospital care. Soon afterward, Courtesy joined the lawsuit against the City. Once the lawsuit was filed, the City stopped all negotiations so as not to affect the progress of the suit. On March 29, 1993 , Superior Court Judge E. Michael Kaiser issued a judgment in favor of the City of San Bernardino in County of Sad} Bernardino, et al. , vs. City of San Bernardino, et al. The judgment is on appeal. In essence, the judgment provides that the City of San Bernardino retains control over the administration of all pre-hospital emergency medical services and the County only has authority over medical control. In specifically addressing the issue of ambulance transport, the judgment cited Government Code Sections 38794 and 54980, which expressly authorize cities to 7 • SF-100 SERIES FAX PAGE 03 The Mayor and Common Council of the City of San Bernardino Page Two December 3 , 1993 provide ambulance transport and the Emergency Medical Services Act does not expressly or impliedly repeal those government code sections. The final judgment did not specifically authorize the City to provide emergency medical transport, however, a strong inference can be drawn that the City has not been limited by the judgment. The problem issue, that there are two distinct providers of paramedic services, has yet to be resolved. Citizens in many instances are being charged two separate paramedic charges which can substantially increase ambulance billings. On May 24 , 1993 , the Mayor and Common Council directed the City Administrator and Fire Chief to develop a plan for the provision of City Fire Department emergency transport services and present the plan in a public hearing scheduled for July 19, 1993 . Negotiations between the City of San Bernardino and Courtesy Ambulance failed to arrive at a resolution of the problem. In an effort to resolve the pending dispute between the City and Courtesy Ambulance, both of those entities agreed to have me, Ronald G. Skipper, attorney at law, review all of the pertinent data and meet with representatives of each entity. Several meetings were held and discussions took place to determine if an acceptable middle ground could be arrived at to resolve the matter and/or reach an acceptable proposal which could be submitted to the Mayor and Common Council. It has become evident to me that the positions of the City and Courtesy are so far apart that a meaningful settlement proposal cannot be achieved. Good faith efforts on both sides have not resulted in a resolution of the many issues that are involved in the delivery of and billing for emergency medical services and the development of a written protocol. it was my pleasure to have attempted to be of assistance to the parties in this matter. I am sorry that a resolution of the matter was not achieved. STATE OF CALIFORNIA—HEALTH AND WELFARE A( _'y PETE WILSON, Goromor EMERGENCY MEDICAL SERVICES AUTHORITY 1930 9TH STREET, SUITE 100 SACRAMENTO, CA 95814-7043 (916) 322.4336 FAX (916) 324-2875 November 22, 1993 Mayor Tom Minor 300 North D Street San Bernardino, CA 92418 Dear Mayor Minor: This is in regards to the current conflict between the City and County of San Bernardino over provision of emergency ambulance services with the City. The dispute between the City and County is now at the appeal stage, but in the meanwhile, an agreement is needed between the parties to ensure the uninterrupted provision of , paramedic services within the City of San Bernardino. The County Emergency Medical Services agency has developed an agreement which it has offered to the City to serve as an interim measure pending resolution of the court process. I understand that, despite the short time frame involved, there has been little or no direct negotiation between the parties. The County has contacted lne, as director of the state agency which has responsibility for oversight of emergency medical services and certification of paramedics, to see whether we can provide some assistance. Without discussing the merits of the original dispute, I think it is important now that an agreement be signed by the parties. II' there is no agreement, for one thing, individual paramedic certification will be in jeopardy. There may be no way to ensure that paramedics are performing under medical control. Without this assurance, we would have to look closely at whether paramedics working for a provider within the City without a contract with the local EMS agency are in violation of the terms of their certification. 1 would appreciate an opportunity to meet with you and perhaps be of some assistance in getting this matter resolved. I will call you within the next week or ten clays to set Lip an appointment. In the meantime, if you have any questions, please call me at the above number, extension 332. Sincerely, . Joseph E. Morales, MD, MPA Director / irl Z 's c c 0 0 a a 0 O d' U to LO C t t C !n co O M c7 x x a IW 0 0 w 0 a 0 U t- asyw z "' �. Cl) � E V ,u Z x x I z W N N p o v� � C C < �� ZO H p IL W W I c ;�' F W J d y V LO to Vf :y N z O a. z < v O �•, F w 4 V Z �� y H F W y Q , z O U P F W y Q LV = = Q J QZ D 0) to J co _Q 0 m u it n ii L'1 U a tz. m c c O N m a cn C) 00 II II II C a U W O Ch C'9 C CO >- X N O O O d o (L R LU a d O U d U) M M a X X z O, O O C U a C W O 0. o y W Z a LU r x a Q U F Ci �- ZO a U vFi W d 0 U F w y d w y F v N ZO a OIa F U r U OI ° IE W H F W V7 a Z o F to W W co CO 0 Z F =- O J_ QZ ZI 0) LO E-- J LU Q 0 m � u u li ii