Present: Council Members – Hitchcock (arrived at 7:04 a.m.), Howard, Land, Nakanishi (arrived at 7:08 a.m.), and Mayor Pennino

Absent: Council Members – None

Also Present: City Manager Flynn, City Attorney Hays, and City Clerk Blackston

City Clerk Blackston reviewed the weekly calendar (filed).

C-1 "Paramedic Study"

City Manager Flynn stated that it is important to determine whether or not paramedics are a core service. He explained that insurance companies provide reimbursement for transporting patients and consequently this element is critical in paying for the service. He noted that American Medical Response (AMR) has nearly a monopoly on ambulance service in the area.

Fire Chief Pretz reported that he and other members of the Fire Department have spent several months developing a paramedic program study. He stated that fire based Emergency Medical System (EMS) is an extension of public health. In 2001 the Lodi Fire Department responded to 4,240 calls for assistance, which represents an increase of 13.1% over the previous year. Of these calls, 70% were medical emergencies. The Fire Department arrived first on the scene of these medical emergencies 66.4% of the time. The City’s General Plan provides for response to emergencies within three minutes driving time and one minute reaction time. San Joaquin County’s response time criteria for Advanced Life Support (ALS) services is eight minutes, 59 seconds. Chief Pretz stated that a fire based paramedic program can be implemented without additional cost to the taxpayers. He noted that the Manteca Ambulance District is a not-for-profit agency that has been operating successfully for a number of years.

Chief Pretz reviewed the following three options:

Option #1
Places two Fire Department ambulances into service and requires hiring 12 new firefighter paramedics and an administrator. A third ambulance would be purchased and used as a reserve as necessary. He believed that this option would produce a revenue stream that covers the cost of providing the service, and qualified this statement by providing the following cost breakdown:

Based on the 2001 Census population of 57,000; 9.3% of the population uses emergency services, 75% of which require transport

5% of the transports are canceled in route

52% are categorized as ALS and 48% are basic life support

Annual gross billing is estimated at $1.4 million

7.5% on the gross would be paid to a billing agency

Personnel costs are estimated at $844,000

Vehicle operation and maintenance (for two vehicles) is $56,000

A lease purchase (for three vehicles fully equipped) carried out over a seven year period would cost $54,000

Net recovery cost is estimated at $103,000

Option #2
Places one Fire Department ambulance into service for an annual cost of $97,000 to the City.

Option #3
Requires hiring 12 new firefighter paramedics and one administrator. Firefighter paramedics would be placed on current fire apparatus. No revenue stream would be generated. For Option #3, AMR has offered training, access to their supply networks, and payment of the differential between firefighter and paramedic salaries. Chief Pretz noted that he had spoken with several fire departments about this type of agreement and they advised him to be cautious.

Mike McGrane, Budget and Policy Review Manager for the City of Sacramento, reported that in 1994 the Sacramento City Council authorized the Fire Department to implement paramedic and transport service, and since that time, they have operated it without tax subsidies. They have increased rates twice, at an average of less than 1% and have accumulated resources in excess of $4 million, which can be put back into the program or offset the cost of the dispatch center.

Council Member Land asked whether there was a private company providing the ambulance service at the time the Sacramento Fire Department implemented their new services.

Sacramento Deputy Fire Chief Rod Chong reported that there were four private companies providing ambulance service for Sacramento County. The Fire Department started with a trial run on one third of the city. He noted that AMR put an injunction on the Fire Department in 1995; however, the City won the suit. He stated that they have a "seamless system" with over 40 ambulances in operation.

In response to Mayor Pennino, Deputy Chief Chong stated that it took 1.5 years to implement the service.

In answer to questions posed by Council Member Nakanishi, Deputy Fire Chief Chong reported that their population is 420,000, they have over 500 firefighters, a $60 million budget, and over $8 million in gross annual revenue. They used Long Beach as a model when developing their firefighter paramedic transport service. Mr. McGrane replied that the City Council has chosen to keep the $4 million in reserves. Sacramento initially implemented the service in two phases and began with four ambulances at a cost of $70,000 each.

In reply to Mayor Pennino, City Manager Flynn stated that this service could be set up as an enterprise fund.

At the request of City Manager Flynn, Deputy Chief Chong explained that Sacramento has a dual role system. Firefighter paramedics work four shifts on the ambulance and then rotate to an engine and truck. He indicated that this boosts morale in the department, as the firefighter paramedics are able to explore other avenues in fire service. He described a problem they encountered initially when private ambulance companies were providing transport, and firefighter paramedics accompanied the ambulance to the hospital. This resulted in the firefighter paramedic needing transportation back to the fire station, which was less efficient than their current system.

In response to Mayor Pro Tempore Hitchcock, Deputy Fire Chief Chong reported that they have 20 paramedics in their system and average a four to five minute response time from the fire station to the scene. Essentially, the Sacramento Fire Department operates using Option #1 as defined by Chief Pretz. He noted that they previously used Option #3. They use a fee for service program, which is presented to the City Council for approval. In Sacramento County, Folsom, Elk Grove, Galt, Sacramento, and Metro use dual role firefighter paramedics and provide transport.

City Manager Flynn asked why they discontinued using Option #3. Deputy Fire Chief Chong explained that the Sacramento City Council wanted the transporting fees and felt that Option #1 provided more local control over the service.

In reply to questions by Council Member Land, Chief Pretz reported that the service area would have to be expanded if paramedics and transport service was implemented. The City would essentially become part of the County’s overall program. This would result in the City responding to approximately 1,000 medical emergencies a year originating outside of the city limits. He stated that there are eight ambulance districts in San Joaquin County, of which three have exclusive jurisdiction. If AMR remained in the Lodi area, the Lodi Fire Department would respond on a rotation basis to calls from Lockeford and surrounding areas.

In response to Council Member Howard, Lou Meyer, Chief Executive Officer for AMR Northern Pacific Region, reported that AMR has entered into public/private partnerships through many of its operations in California. Mr. Meyer stated that he has extended an offer to Chief Pretz for scholarships to the Northern California Training Institute for paramedics, clinical education services, group purchasing capabilities, and augmentation of the differential between paramedic and firefighter wages. He stated that Options #1 and #2 do not enhance the level of service to the community, as they merely displace a private entity. He believed only Option #3 provided an enhanced level of care by allowing the private transport system to stay in place, and adding paramedics to fire engines for first response.

In reply to Council Member Land, Mr. Meyer reported that AMR’s statistics show that 57% of the time they arrive simultaneously, or before, the Fire Department. He stated that there are two ambulance units within the Lodi city limits. One ambulance is stationed at the Woodbridge Fire Department 24 hours a day, seven days a week. Occasionally, AMR calls for mutual aid from the City of Stockton to support Lodi. He explained that a percentage of transports require ambulances to go outside the Lodi city limits. When that occurs, they backfill the units with ambulances from other San Joaquin County operations.

Addressing Mr. Meyer, Council Member Howard commented that it must be expensive to provide all the services that AMR offers, and stated that it appears they are willing to spend a lot of money in an attempt to eliminate competition.

Mr. Meyer acknowledged that the cost for services is significant; however AMR is able to compete by spreading costs over a larger segment of the population because of the size of the organization. A zip code by zip code analysis of the usage of the service by payer source showed that while 17% of Lodi’s population has Medicare, only 33% of the Medicare population used the ambulance service. Of Lodi’s 14% Medi-Cal population, 11.4% use the service. Those that have contracts or private insurance equal 43%. He stated that section 1797 of the Health and Safety Code prohibits creating an exclusive operating area. He believed that the estimated net revenue numbers presented in Option #1 are flawed, because Lodi would be dealing with only half of the revenue. He advised against setting up a rotation system for ambulance service.

In answer to Council Member Nakanishi, Mr. Meyer reported that AMR funds the additional expense between firefighter and paramedic wages through a joint powers agreement in San Mateo County, which has 17 fire districts. The rates there are significantly higher, however, with the average patient charge in San Joaquin County being $539 and in San Mateo it is $1,075.

PUBLIC COMMENTS:

Walter Mayer introduced himself as a disabled American veteran of World War II. He stated that he had great respect for the Lodi Fire Department and relayed a personal medical emergency experience in which the Department provided assistance to him. He distributed copies of an AMR invoice (filed) for transporting him to Lodi Memorial Hospital. He stated that it was a distance of one-mile and he was charged for 15 miles. He was unsuccessful in his attempt to have the error corrected. He encouraged Council to support Fire Department paramedics and transport.

Eileen St. Yves recalled that when Seattle changed from private ambulance service to firefighter paramedics, it was due to a monopoly situation with the private company. Ambulances would arrive at emergency scenes and individuals were charged for services regardless of whether they used it. She stated that it has been her experience that Lodi Fire Department is the first to arrive on the scene. The cost for AMR to transport an individual one-mile to the hospital is a minimum of $50. She believed that the Fire Department could provide far better service than AMR.

Mayor Pennino noted that Council received a letter from Sharon Gardner in support of Lodi Fire Department providing paramedics and transport service (filed).

Sandy Wichman, President of Local 1225 United Firefighters of Lodi, stated that Lodi firefighters are in support of the endeavor to provide paramedic ambulance service through the Fire Department and feel that they could greatly enhance the service. Currently they have to wait for AMR paramedics to arrive before any lifesaving drugs or procedures can be administered. Ambulance transport would allow the City to recoup the cost of providing this service and keep any profit within the City. He believed that Option #3 would result in AMR requesting that run times be extended, they would cut their staff, and the number of ambulances in the City would be decreased due to firefighter paramedics being on the engines.

Margaret Talbot pointed out that the badges worn by AMR representatives are deceptively similar to firefighter badges and intimated that it is done to confuse the citizenry of who is providing the service.

Council Member Nakanishi believed that the City should move slowly and cautiously in this endeavor and conduct further studies. He noted that it is very difficult to run a health care business at this time, with cuts being made and profit margins decreasing.

Council Member Howard believed that this topic has been worthy of discussion for many years and was pleased that it has been brought before Council. She looked forward to additional information from an in-depth study.

Council Member Land felt that having paramedics in the Fire Department was a quality of life issue that needs to be addressed and provided for the citizens of Lodi. He supported a phased in process; however, he also felt it was important to be in a position to come on line quickly and take over services if needed. He expressed interest in reviewing the offer that AMR made to the Fire Department. He suggested conducting further analysis of the numbers related to Option #1, assuming that the Fire Department would have half of the transport and AMR would have half.

Mayor Pro Tempore Hitchcock expressed support for firefighter paramedics and transport. She noted that it is important to ensure that the City can fund up-front costs that will be necessary for the purchase of equipment, added personnel, and training.

Mayor Pennino agreed that the process should be phased in over a period of time and stated that he is 100% supportive of paramedics on Fire Department vehicles. He suggested that benchmarks be determined, as well as further study on training levels and options. He requested that a plan of action for emergency transport be brought to Council at its next meeting on this subject, noting that he felt non-emergency transport was not an appropriate role for the City. To gain a better understanding of issues related to this subject, he stated that he will visit two cities that provide transport services and two cities that have firefighter paramedics without transport services. He expressed concern about the Lodi Fire Department responding to emergencies outside the city limits. He asked that staff confirm the legality of setting up the service as an enterprise fund, and find out whether the City could have sole jurisdiction.

Frank Alegre commended the Council for hiring Police Chief Adams, Fire Chief Pretz, Electric Utility Director Vallow, and City Clerk Blackston, as he felt they were doing a good job for the City. He urged Council to award the Shanghai building lease to Lodi Adopt-A-Child, noting that it is a local organization, which that has greatly benefited the children of Lodi. He believed that Community Partnership for Families is in less need for financial assistance. He stated that the 2% for public art should have gone to Parks and Recreation programs or Lodi Adopt-A-Child. Mr. Alegre pledged a donation of $10,000 toward renovation of the Shanghai building if it is awarded to Lodi Adopt-A-Child.

E. ADJOURNMENT

No action was taken by the City Council. The meeting was adjourned at 8:30 a.m.

ATTEST:

Susan J. Blackston
City Clerk