MOORLACH UPDATE — Privatizing Paramedics — March 28, 2013

The Voice of OC article below will provide you with a major eye-opening experience on the powerful control of public employee unions, even in reputedly conservative County of Orange.

Last year the 2011-2012 Orange County Grand Jury issued a very revealing report, titled “Emergency Medical Response in Orange County – Where did all the ‘fires’ go? Long time passing (Apologies to Pete Seeger)” (see http://www.ocgrandjury.org/pdfs/emergmedresponse/emergmedresponse.pdf). Here is the opening paragraph:

During the last forty years, the role of local fire departments has changed. The services have changed from fire prevention to medical emergency responses. In earlier days, the fire departments were predominately staffed with fire fighters with their fire trucks, but now these departments include paramedics and emergency medical technicians as part of the crews that respond to the calls. Today medical emergency calls account for at least 70 percent of fire departments emergency dispatches. The low percentage of fire emergencies, i. e., less than two percent in the Orange County Fire Authority (OCFA) alone, is attributed to improved building codes, more alarm devices, fire suppression systems, stricter code enforcement, and perhaps greater public awareness.

The term firefighters may have become a misnomer, in the sense that these individuals spend very little of their time actually fighting fires. This is simply where this industry has evolved to. Consequently, any and all paramedic services have been gobbled up by fire departments – what else is there to do? Moreover, any attempts to transfer such assignments to nonpublic fire department personnel have been bitterly fought by their union leaders. You may as well hit a hornet’s nest with a bat while wearing only a bathing suit. This might explain why even the private sector ambulance industry leaders are scared to death to broach the idea of regaining ground that they previously held. I am very impressed with Dr. Samuel J. Stratton of the County’s Health Care Agency for pursuing the pilot program described in the article. I’m sure he was extremely hesitant to do so, knowing about the certain backlash. But, he’s doing the right thing and I applaud him for it.

A couple of years ago, an elected official called me and said that he went to a nearby hospital to donate blood. He explicitly told the attending nurse that, due to his age and physical condition, he was prone to fainting spells when giving blood. Sure enough, he fainted. When he woke up, he was in the adjacent emergency room of the hospital. A few weeks later he received an invoice for more than $1,000 dollars for being transported a few feet by city fire department paramedics. The first recommendation in the Grand Jury report is that “the city fire departments and the Orange County Fire Authority should engage independent private consultants to re-evaluate their models for providing response for both fire and medical emergencies.” The second of the two recommendations stated that “alternative models should include . . . privatizing the emergency medical response.” Re-evaluating the current model should occur on several levels. The union stranglehold of these services is an outdated paradigm. It looks like Dr. Statton has the moxy to get the ball rolling. Stay tuned, this may provide an interesting lesson in union tactics, even in conservative Orange County.

County Experiments With Privatizing Ambulance Service

By REX DALTON

For the first time, private paramedics were deployed last week in Orange County to transfer patients between health facilities — a move that instantly generated ideological controversy and questions about quality.

County Health Care Agency officials designated a lone ambulance company beginning March 18 to perform 100 inter-facility transfers for “a study” to examine “the feasibility, safety and effectiveness” of having paramedics move patients previously cared for by critical-care nurses.

The new transfer method is part of an effort to ensure hospital beds are available for rescued patients by reducing overcrowding in emergency rooms.

But the HCA’s selection of Lynch Ambulance Co. — an Anaheim firm that has long championed the idea of widely fielding private paramedics instead of fire department personnel — immediately drew sharp criticism.

The Orange County Professional Firefighters Association, the union that represents firefighters for the Orange County Fire Authority in 23 jurisdictions, filed a letter that day with the county demanding the new paramedic service be halted. The letter argued its creation violated county and state policies and law.

County officials dispute that assertion and others say that using paramedics in inter-facility transfers is a widely accepted practice.

In a separate March 18 letter addressed to the Orange County Board of Supervisors Chairman Shawn Nelson, Dave Rose, president of the firefighters union, wrote the “politically driven pilot program that has conflict of interest written all over it” will “seriously erode emergency medical service” for citizens. County officials rejected this criticism too.

Driven by ‘Ideology’

The OCFA firefighters see this minimal use of paramedics as the first step toward introducing private paramedics for potentially wider emergency use in the future, said Joe Kerr, the union’s spokesman. The program is driven by “ideology,” he said, and was implemented in “a cloak and dagger” manner.

The 15-firm Ambulance Association of Orange County also opposes the paramedic-transferring concept, with its current president, Bill T. Weston, saying the HCA’s move gives one firm an unfair competitive advantage for future service.

Weston, who is operations director for Care Ambulance Service of Fullerton, OCFA’s primary ambulance provider, added that the pilot “doesn’t make any sense” as less trained personnel will be caring for patients.

But HCA officials offer a more benign description of the program — which was planned for at least a year, and didn’t draw much interest until implemented.

In fact, the HCA’s Dr. Samuel J. Stratton, medical director for emergency/disaster services, said he had to “recruit” Lynch, as no ambulance company volunteered for “the study.”

“We didn’t get any takers,” said Stratton, saying his agency put out notices and sought comments and providers for the study. Stratton said he then approached officials at Lynch Ambulance and those at Doctors Ambulance Service of Laguna Hills; the only two companies that met HCA qualifications.

“Doctors Ambulance felt due to the politics, it was best to sit back and see how the pilot works,” Stratton said.

Pilot ‘Makes Perfect Sense’

Lynch Ambulance is the county’s largest inter-facility transporter of patients with critical-care nurses, officials say.

Given this record, Walter J. Lynch, the firm’s chief executive, said it “makes perfect sense” for his firm to conduct “a pilot designed to make sure policy makers receive accurate data to make an informed decision about what is best for patients.”

The number of patients requiring the advanced life-support provided by critical-care nurses is relatively low, from 4 to 6 percent of all transports, some ambulance officials estimate.

The Hospital Association of Southern California said in a statement that Orange County facilities will continue to send patients with “medical staff” as determined by physicians. It had no comment “on the potential easing of requirements” for inter-facility transports.

Paramedics are used widely for inter-facility transports elsewhere in California, Lynch noted, calling it “an established standard of care.”

For decades, Orange County has had no private paramedics, with public agencies seen as providing the highest level of care with maximum accountability.

For non-emergency cases, ambulances staffed by emergency medical technicians (lesser trained than paramedics or nurses) transport certain patients between medical facilities.

In 911 rescue cases, paramedics from fire agencies respond to the scene, and then use ambulances for the rapid runs to the most appropriate and nearest general, acute-care hospital. The pilot study will have no involvement with 911 rescues, HCA officials say, adding that paramedics involved in inter-facility transfers are prohibited from participating in them.

For more than a year, Stratton has expressed concerns about overcrowded emergency rooms being unable to admit patients brought by paramedics because no beds were available, either in the emergency bays or in intensive-care units. At times, emergency crews cared for patients until they could be admitted, officials say.

It can take up to three hours to secure a registered nurse-staffed ambulance to get a patient transferred, said Stratton. By offering a paramedic to care for a niche of the least serious patients, Stratton says, he hopes to reduce that transfer-time response to 30 minutes, as required in the study.

On March 14, Stratton sent a memo to various emergency system leaders, notifying them of the inter-facility paramedic program to start on March 18.

But the launch caught a number of fire department and rescue personnel by surprise, as they believed it was still in the analysis phase. And by March 19, some emergency agency officials didn’t know if the program had begun or not.

Fire Chiefs Have Concerns

Among those who didn’t know was Wolfgang Knabe, who is fire chief for the departments in Fullerton and Brea — which are in the northern Orange County region where the paramedic study is being conducted.

Noting that fire chief’s largely weren’t supportive of the idea when it was discussed in December at the county’s advisory Emergency Medical Care Committee, said Knabe, who was named as the Orange County Fire Chiefs Association representative on the EMCC.

“It took us aback; we thought the proposal had been tabled; that there would be a lot more discussion before it was approved,” he said.

On Thursday, March 21 at a fire chiefs’ regular meeting, Stratton briefed them on the paramedic study.

Afterwards, Knabe said, the fire chiefs have opted “to see how the pilot program works” before making further comment. But he added that concerns remain about using paramedics, because of what was termed “a denigration of service skills.”

Countywide, the emergency services system remains divided with concerns and distrust about a potential move toward privatization — with authorities privately saying they fear some politicians looking to save money don’t understanding the consequences for saving lives.

For instance, the OCFA has not endorsed Stratton’s study. OCFA Fire Chief Keith Richter declined to be interviewed, through his spokesman, Kris Concepcion, who said OCFA “was not taking a position” on the paramedic inter-facility transport at this time.

However, the paramedic study quickly earned the letter from the OC firefighters’ union over charges of a conflict of interest.

Lynch’s business development director, Patrick J. Powers, is a former county regulator of paramedics, who now sits on the EMCC, which by state guidelines is to advise on various services.

Supervisor John Moorlach, who is known statewide as a strong advocate for privatization, appointed Powers to the EMCC.

Despite the criticism, Stratton said county executives have given him full support for the pilot.

With least eight patients transported by paramedics between facilities in the opening three days, Stratton said, “It is going better than expected.”

“We are optimistic this pilot will be a huge success for Orange County, its citizens and our patients,” added Lynch.

Rex Dalton is a San Diego-based journalist who has worked for the San Diego Union-Tribune and the journal Nature. You can reach him directly at rexdalton

FIVE-YEAR LOOK BACKS

March 29

2008

Jeff Overley of the OC Register provided a great tutorial titled “Orange County islands cling to independence – Government officials launch new effort to annex unincorporated areas that aren’t part of any city. But resistance is strong.” A reporter recently asked me why I placed such an emphasis on annexing these islands. I believe that once all of the unincorporated islands are within cities, then we can take a very serious look at restructuring the current government model that is being utilized in Orange County. I’ll leave the shaping of that model to those who will follow me in this position.

An old landfill, an asphalt plant, two golf courses and a couple dozen neighborhoods – this is about all that’s left of Orange County.

And if state and local policymakers get their way, there’ll be even less to speak of in the near future.

That’s thanks to new enticements, such as fee waivers and fast-tracked studies, announced last month to coax cities into annexing the last few county islands – pockets of often-nameless land that don’t belong to any city.

Impossible to pigeonhole, the unincorporated areas are variously industrial, recreational, or residential; they can be home to the rich, the poor or the middle class.

To the county, though, they’re simply inefficient.

Government officials aim to end an unwieldy arrangement where, for example, a county street sweeper cleans half a road in Santa Ana and a city street sweeper cleans the other half; an arrangement where sheriff’s deputies are responsible for an unincorporated cul-de-sac with four homes in La Habra but city police patrol the surrounding neighborhoods.

"It just doesn’t make sense from a governance standpoint," said Stephen Dunivent, an Orange County deputy chief executive.

It makes perfect sense, though, in the minds of many island inhabitants, who often harbor a separatist’s sense of autonomy, perpetually hostile to outsider intrusion on a way of life that’s supposedly more free.

"Nobody here wants to be annexed – everybody just wants to be left alone," said John Roberts, a retired resident of the Country Club island inside of – er, in direct proximity to – Yorba Linda.

"No one bothers you here," explained Robert Wurth, owner of a hilltop clapboard house in Olive Heights, an island in the northwest corner of the city of Orange.

"I think we enjoy being left alone," said Amber Bailey, a longtime resident of a triangle-shaped island that, oddly, belongs to Orange County but can only be accessed through La Mirada.

While three dozen islands were annexed in the past decade, almost three dozen more remain, and they are likely to be tougher nuts to crack.

"We’ve taken care of all the low-hanging fruit, so to speak, and now we’ve got tougher ones," said Supervisor John Moorlach, who has jokingly referred to himself as the "Mayor of Sunset Beach," an unincorporated coastal island he represents.

With that in mind, local leaders are ambivalent about the odds of reining in the maverick neighborhoods.

"These little enclaves develop their own identity, based not on what they are, but what they’re not," said Supervisor Chris Norby, whose district includes 10 islands.

"I think the (annexation) prospects are good," he said, "but human nature is resistant to change – especially change they don’t understand."

BEGINNINGS

Resistance is at the root of why islands exist – that and shaky political will.

As cities expanded over the years, they often bypassed areas unenthusiastic about incorporation. Such opposition was often a pocketbook issue, since joining a city meant higher property taxes before the 1978 passage of Proposition 13.

The resulting geographic crazy quilt has created bureaucratic headaches, with counties responsible for farflung nooks and crannies of land even though cities are better situated to serve them.

Also, while cities have strict code enforcement and rigorous building codes, counties have regional prerogatives, allowing islands to stay under the radar and develop unique characteristics, for better or worse.

IDENTITIES DEVELOP

Within Stanton, there’s an island that consists of just one street – Kermore Lane – that is home to at least five dog kennels and breeders, businesses that face tight restrictions in many cities.

"We need ’em," said resident Carole Hansen-Baws, owner of Hansenhaus Kennels, about county islands. "They’re A-1, and they’re the only place we can have dog kennels."

In the Anaheim area known as West Island, a house on Banta Avenue has had its driveway overrun by weeds. Five vehicles, as well as an office chair and furniture covered with blue tarp, sit in front of the house.

"The county’s focused on providing regional services, and not necessarily worried about every car on a front lawn," Dunivent said.

In Olive Heights, a mosaic of clashing styles is on display. On one street, an apartment building has aging stucco and windows blocked with aluminum foil. Next door, a charming craftsman home has two bulldozers in its driveway. And a block away, there’s a Tijuana-style adobe painted bright orange.

"Live and let live – that’s part of living here," said Wurth, who recalled being irked by a neighbor’s yard strewn with tractors and debris, but never complaining about it.

But discontent does exist. Katherine Smith, a resident of a lavish neighborhood within the 495-acre West Island, says surrounding parts of the island have gone downhill because of lax county oversight.

"I believe in freedom. I believe in people being able to live their lives without government control," Smith said. "But times have changed. The reality is, to not have code enforcement, it brings down property values, and it brings down the conditions of the neighborhood."

USING AUTHORITY

California lawmakers, who wield authority over city boundaries, have tried to respond. In 1977, they approved expedited annexations, which later expired, that helped incorporate hundreds of islands statewide.

In 1999, with almost 600 islands left in California, legislators pondered a bolder approach "to just by decree move all islands into cities," said Bill Chiat, executive director of the California Association of Local Agency Formation Commissions, which oversees annexations.

"Obviously that didn’t fly with anybody," Chiat said.

The Legislature eventually approved streamlined annexations that allowed small islands – those 150 acres or smaller – to be annexed despite resident objections.

That action helped get about 200 more islands annexed, including three dozen in Orange County. But cities are often hesitant to apply brute force.

HONEY, NOT VINEGAR

La Habra, for example, has seven islands, the most of any Orange County city. "The city’s position has always been that we’re more than happy to take the islands," said Jennifer Cervantez, assistant to the city manager. "But if the residents don’t want to be part of the city, we’re not going to force them."

Westminster wants control of Midway City, a collection of four islands with 8,500 people, partly for financial reasons. Though the county is responsible for law enforcement, Westminster police responded to nearly 500 calls there last year because they were closer.

The city receives no payment for those services, but nevertheless is reluctant to be aggressive.

"It would help us significantly if they were in our city, but the residents are incredibly vocal about not becoming part of Westminster," said Tami Piscotty, city economic development manager. "We’re not going to take them against their will."

It’s unclear if the recently devised fee waivers and fast-tracked applications will change attitudes. Chiat said such measures have had modest success across California, usually in smaller cities where financial incentives are more important.

Regardless, obscure legal rules can occasionally help cities overcome opposition without appearing belligerent.

Many islands use septic tanks, for example, but legal code requires homes undergoing major remodels to hook up with a sewer line if it’s nearby. To hook up with the sewer, though, a homeowner typically must join the city.

Wurth, the Olive Heights resident, has seen that provision chip away at the edges of his ever-dwindling island.

"Slowly but surely," he said, "they’re picking them off."

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