Fire Chief Pretz reported that the goal of the paramedic program is to enhance the delivery of emergency medical services to the City of Lodi. Records from the California Department of Finance indicate that since 1995 to present the population in Lodi has increased from 53,100 to 59,400. The response times from San Joaquin County Emergency Medical Services (EMS) Agency have increased 35%, from 3.94 minutes in 1996 to 5.31 minutes. The number of transports has increased by 72% since 1996. In 1995 American Medical Response (AMR) had three ambulances in Lodi. In 2000 the ambulances were decreased to two and they were also used to do inter-facility transports in and out of the City. During a six-week period between February and March 2002 there were 20 incidences where only one ambulance was in Lodi; between May 1 through 20, 2002 there were six such incidences; and eight incidences have occurred where there were no ambulances available.

Chief Pretz recalled that when this topic was discussed in January, Council directed staff to refine the cost and revenue estimates, investigate public/private partnerships, develop options, and report back to Council. Chief Pretz reviewed the following options:

Ø Make no changes.

Ø Support additional private providers to enhance the number of ambulances on the street. Chief Pretz stated that competition may lead to lower prices and better service delivery for citizens. Lodi’s zone is in a nonexclusive jurisdiction, which means that other ambulance companies who meet requirements can provide services to the community. Chief Pretz reported that three other providers have expressed an interest in providing ambulance services to Lodi.

Ø Provide a fire-based EMS system. Chief Pretz believed that this option would enhance the local emergency medical delivery system. He explained that it is effective because multi-role firefighters provide a stable, dependable workforce. He noted that cost can be offset by revenues.

Ø Partner with private providers, i.e. the Fire Department would provide Advanced Life Support (ALS) service for a private provider who would handle transport service. Chief Pretz stated that his investigations indicate that there would be offsetting costs to provide this program.

Ø Enter into a third service partnership, i.e. with a locally-owned nonprofit organization composed of concerned citizens and local business owners. Chief Pretz explained that the nonprofit organization would be able to recoup cost, share revenue, and meet the needs of the community, because the board of directors in this scenario is the community. It could be operated with lower costs, which would be passed on to the consumer. Revenue would stay in the community and be used to enhance the system.

Council Member Nakanishi disagreed with Chief Pretz’s statement that competition leads to lower prices. He stated that medical economics show that more availability will increase costs.

Chief Pretz remarked that private providers do not want government interference in entering into the market; however, once they are established, they immediately ask for protection, which creates a monopoly.

Council Member Nakanishi stated that he is supportive of the Fire Department and is against privatization. He expressed concern about health insurance and uncompensated care issues.

Chief Pretz asked Council whether the Fire Department should be allowed to provide paramedic service to the City of Lodi and if so, whether the department should undertake transport as a way to offset costs. Chief Pretz noted that he had previously recommended seeking a consultant; however, he stated that he is capable of making a recommendation to Council on this issue.

In answer to questions posed by Council Member Land, Chief Pretz reviewed his background and experience in managing a fire department, which provided both advanced and basic life support services. In reference to response times, Chief Pretz reported that the Fire Department reaches the scene first 65% of the time and in 35% of the incidences it is either a tie or AMR reaches the scene first. He stated that if the proposed program were instituted immediately, the Fire Department would need to hire 12 new firefighters, and eventually a total of 15 new firefighters would be needed to cover for vacations, sick leave, etc. Chief Pretz reported that the County requires EMS to respond to calls within eight minutes or less. The Lodi Fire Department is successful 86% of the time in reaching the City’s goal of arriving within five minutes or less.

Council Member Land outlined his concept for a five-year business plan. In year one the Fire Department would have an ambulance and paramedics. In year two if AMR did not reach certain benchmarks (e.g. decreased response time) then a second ambulance would be added to the Fire Department. This would continue in subsequent years until benchmarks were reached.

Chief Pretz was unsure whether the City could tighten response time standards that are set by the County. He offered that perhaps the City could use call volume as a benchmark. He reported that a draft two-tiered plan has been developed, in which paramedics would first be placed at engine companies, and in the second tier the transport system would be instituted. Chief Pretz confirmed that 70% of calls received in the Fire Department are emergency medical calls, and of those, 65% of the time, the Fire Department arrives on the scene first.

City Manager Flynn believed that providing paramedic and transport service would benefit morale of the Fire Department staff. He noted that the private provider is meeting the standards set by the County; however, it may not be providing the level of service that Council desires for the citizens of Lodi. He estimated that the Fire Department’s proposed program will cost $1,500,000 annually at full operation. He noted that another option Council could consider is contracting with the private sector to provide a higher level of service and compare what that would cost to the Fire Department’s proposal.

In reply to Mayor Pro Tempore Hitchcock, Chief Pretz reported that morbidity figures go up considerably after six minutes from certain conditions, such as heart attacks.

Chief Pretz stated that National Fire Protection Association (NFPA) 1710 will soon be requiring for ALS services, that fire departments assemble a four-person team consisting of two paramedics and two emergency medical technicians. In addition, private providers will have to meet the same response time criteria as a fire department. Chief Pretz reported that Lodi is currently classified as a Class 3 city and indicated that insurance costs could be reduced if the number of fire department personnel were increased and paramedics were added to engine companies.

In response to Mayor Pro Tempore Hitchcock, Chief Pretz stated that the City of Stockton believed that additional ambulances should be available in the city and gave permission to their fire department to purchase up to ten additional ambulances. They intend initially to operate five additional ambulances in the core area of the city where they have the most demand.

PUBLIC COMMENTS:

• James Sepiol introduced himself as the Medical Director of Sierra Occupational Services at Dameron Hospital and noted that he is Board Certified in emergency medicine.

Council Member Nakanishi asked Dr. Sepiol if he believed the trend of non-emergency, uninsured patients coming to emergency rooms for treatment, is increasing.

Dr. Sepiol stated that since he began practice in Stockton in 1979 he has not seen a significant increase in the number of patients; however, there are less and less people that are insured.

Council Member Nakanishi stated that while in Los Angeles last week he read an article, which reported that many private hospitals in the area were closing their emergency rooms. Ambulances in the Los Angeles area are often stacked side by side with long waits. The article also reported that the indigent, and people from Central America, are being told to go to emergency rooms for treatment. He expressed concern about the financial condition of Lodi Memorial Hospital and potential unintended consequences of the Fire Department’s proposal. He reported that he spoke with Joe Harrington, Chief Executive Officer, yesterday who stated that the hospital cannot take more ambulances in its emergency room. Mr. Nakanishi recommended that a two by two committee of Council and Lodi Memorial Hospital representatives be created to discuss this matter before action is taken.

Dr. Sepiol acknowledged that emergency rooms in Stockton close to emergency transport at times due to the unavailability of beds in the intensive and critical care units. This creates a "round robin" situation for the ambulances. Dr. Sepiol did not believe that increased utilization of ambulances would make an impact in Lodi because there is a finite population going to one hospital.

Council Member Nakanishi stated that Lodi Memorial Hospital has seen an increase from 17% to 19% in uncompensated care. Ambulance service has increased from 12% to 13%. He believed that more ambulances would increase the problem of patients using the emergency room for non-emergency situations. He suggested that a decision be delayed to allow time to evaluate the impact and quality of care issues resulting from changes that have recently been instituted in Stockton.

In answer to Council inquiries, Dr. Sepiol expressed his opinion that response times in Lodi are adequate. As the first responder in Lodi is usually the Fire Department, care is begun at the time they arrive. He did not believe that communication between medical personnel was an issue to be concerned about because it routinely takes place once patients arrive at the hospital; however, continuity of care is optimum.

• Walter Mayer referred to a statement by AMR (filed) and noted that he was billed for 15 miles, when he was actually transported a distance of only 1 mile. He brought this error to AMR’s attention; however, for five years he alleged that he was ignored. On February 13, 2002 the billing error was corrected. He expressed appreciation to the Lodi Fire Department personnel who saved his life and commented that AMR came two minutes after firefighters arrived and transported him to the hospital for $725.
   

• Sandy Wichman, President of the Lodi Professional Firefighters Local 1225, of the International Association of Firefighters, clarified that this issue is about who will provide the best service to the citizens of Lodi. He stated that Lodi firefighters have been providing outstanding service to the community for many years and most citizens are under the impression that they provide paramedic transport. He asked Council to consider their loved ones and whether they would rather wait 20 minutes for an ambulance to respond from Stockton or have the Lodi Fire Department respond.

• Peter Iturraran, Vice President of Local 1225, challenged the Mayor to provide the best EMS program for the citizens of Lodi and urged Council to approve the Chief’s recommendations.

Mayor Pennino spoke in support of the paramedic program and stated that it should be done in the 2003-05 budget. He was opposed to hiring a consultant for $50,000. He suggested phasing in paramedics and bringing in ambulances over the next three to five years if certain standards are not met. Addressing the City Manager, he stated that the City should pursue discussions with the County on how standards can be raised in Lodi. He asked the City Attorney to look at legal issues related to this matter.

Mayor Pro Tempore Hitchcock voiced support for the Chief’s recommendation to move forward with both paramedics and ambulance transport, and emphasized the need to be fiscally responsible.

Council Member Nakanishi agreed that a consultant was not needed. He reiterated his support for paramedics and voiced opposition to transport services at this time. He again suggested that representatives from Lodi Memorial Hospital be brought into discussions on this matter.

Council Member Land stated that he met with Fire Battalion Chief Jeff Larson yesterday who wrote a position paper citing pros and cons of the issue. He expressed opposition to hiring a consultant and favored option 1 as presented by the Fire Department. He noted that there is some money in the budget that could be used for this purpose, as well as impact fees. He stated that he would like to see a business plan from the Fire Department.

Mayor Pennino believed that Council Member Howard would also be in support of option 1 and suggested that direction be given to staff to develop a business plan and report back to Council.

Mayor Pro Tempore Hitchcock expressed concern that Council is making decisions at an informational Shirtsleeve Session and believed that such direction should be given at a regular meeting.