MOORLACH UPDATE — OCFA Study — March 26, 2014

The Orange County Fire Authority (OCFA) was a department of the County of Orange. The Orange County Board of Supervisors voted to separate it from the County on December 6, 1994, roughly an hour before the Board voted to file for Chapter 9 bankruptcy protection. With two decades of history to review, the question is whether letting this organization go out on its own was a good decision. Has the OCFA managed itself properly and is it a model for others to emulate or is it caught in a time warp and still operating on a centuries-old model?

The 2011-12 Orange County Grand Jury took on this topic with their report, titled “Emergency Medical Response in Orange County – Where did all the ‘fires’ go? Long time passing (with apologies to Pete Seeger),” see http://www.ocgrandjury.org/pdfs/emergmedresponse/emergmedresponse.pdf. Here is the Summary of the report, provided in the opening three paragraphs:

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 predominantly 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.

This transition from fire emergencies to medical emergencies has not generated major changes in the operation model for responding to these emergencies. Each emergency call generally results in both fire trucks and ambulances being dispatched to the site of the emergency regardless of the type of emergency. The emergency response communities have discussed developing new models, but little change has been accomplished. While the Orange County Emergency Medical Services (OCEMS) sets the medical standards and protocols for both non-emergencies and emergencies. The fire departments handle the actual operations.

The2011-2012 Orange County Grand Jury concluded that the current emergency response models should be re-evaluated by independent outside consultants. This re-evaluation should consider the strengths, weaknesses, opportunities and threats to the economics and operations of both the OCFA and city fire department’s emergency response models. This Grand Jury recommends that these studies be completed and made public by July 31, 2013.

For another great study on the topic, go to http://www.scscourt.org/mwg-internal/de5fs23hu73ds/progress?id=9NvAn0gyNp. The 2010-2011 Santa Clara County Civil Grand Jury did an excellent report. The opening sentence is priceless: “With police and fire department expenses constituting the majority share of city budgets, the public may well wonder what public services will be left if these agencies remain entrenched in old service and old cost structures.”

I don’t recall that the Grand Jury’s request, to have an overall analysis, was provided on July 31st of last year. And I’m not optimistic that we’ll see one by July 31, 2019. And if we did, I’m less optimistic that it will be implemented. I do not serve on the OCFA Board of Directors, but I have John Wayne Airport (JWA) in my District. I know that OCFA was strongly opposed to reducing the number of firefighters on the night crew, arguing that it should be staffed at the same levels as the day crew. JWA has a curfew and does not accept commercial flight arrivals from 11 p.m. to 7 a.m. (8 a.m. on Sundays). I also know that when JWA went out for bid, a private sector proposal would save the airport $10 million over a five-year period (see recent postings in MOORLACH UPDATE — Joy of Competition — August 8, 2013, MOORLACH UPDATE — Voice of OC — November 26, 2012, MOORLACH UPDATE — Voice of OC — November 1, 2012, and MOORLACH UPDATE — JWA Firefighters — November 23, 2011). It prompted OCFA to submit a bid that was lower than its current contract. It also motivated OCFA to threaten litigation, arguing that it cannot be outsourced. This premise is not accurate, but the courts are an unreliable venue for making proper rulings, and does give an excuse to maintain the current model.

There have been other awkward stories emanating from OCFA. Firefighters rigging seat belt alarms. Charging businesses for hazardous material inspections that never occurred. What I see of OCFA is not encouraging. Its model is antiquated, expensive, and fraught with complacency.

We all pay property taxes, directly or indirectly, and we expect public safety services for our “contributions.” To be billed by a public safety agency in our hour of need is insulting. It’s a tax. And it’s needed by OCFA because the organization is in need of additional revenues in order to pay for its high personnel costs. I have been harping on the increase of costs due to the enhancement of defined benefit pension plan formulas, retroactive to the date of hire, for more than a dozen years. These costs have now manifested themselves and it has created a critical reason to re-evaluate fire services. The fact that the city of Irvine has found a disturbing flaw in the property tax revenue allocation component of OCFA’s funding is another important reason for a study. And that private citizens on Grand Juries are blatantly aware of the need for structural changes should be evidence enough to pursue them.

The Board has discussed this matter earlier this month, see MOORLACH UPDATE — ALS/CCW/CCP/AOT — March 5, 2014. We saw OCFA bungle the ambulance RFP process, see MOORLACH UPDATE — Twitter Musick — October 9, 2013. The Board showed restraint, but the State of California did not, and transferred the RFP process back to the County. Now that it is in the County’s wheelhouse, it’s time to perform the study that needs to be done. Especially when one ponders that 69 percent of firefighters in the United States are volunteers. This is a very complex and multi-layered topic. But if OCFA and local fire departments can be improved and be more cost efficient, then those modifications must be made. Our constituents deserve a better model. And Orange County is the best place on the planet to show how it can be done.

BONUS: Congratulations to Vanguard University of Southern California, which won its first National Association of Intercollegiate Athletics (NAIA) Men’s Division I Basketball National Championship last night!

Mission Viejo

Supes Decide to Pass Along Cost of Paramedics to Residents who Call for Them

The Orange County Fire Authority’s fee amounts to about $300 for a resident requiring "advanced-level life support," which includes an ambulance and a paramedic.

Posted by Penny Arévalo (Editor)

The Board of Supervisors today gave the Orange County Fire Authority the go-ahead to pass along expenses for paramedic services to residents who call for an ambulance.

The board vote was 3-2, with Chairman Shawn Nelson and Supervisor John Moorlach casting the dissenting votes.

The Orange County Fire Authority’s fee amounts to about $300 for a resident requiring "advanced-level life support," which includes an ambulance and a paramedic. The fee is included in the bill residents get for ambulance service.

Nelson and Moorlach favored another plan that would compel firefighters to collect the fee on their own.

Supervisor Patricia Bates said the plan backed by Nelson and Moorlach would generate "a burden of paperwork," which could boost administrative fees.

Nelson and Moorlach said the fee amounts to "double taxation" since the fire authority receives property taxes that should cover the cost of ambulance service.

"You’re paying these (paramedics) the same whether they go on a run or not, so why charge a taxpayer for their time?," Moorlach said after today’s board meeting.

"Is it really a justified fee? Therefore, if you want to charge for it then charge it separately," Moorlach said. "The whole (funding) model needs to be reevaluated, but you’ve got a firefighters union that’s resistant to making any changes."

According to Nelson, firefighters don’t usually spend much time battling blazes these days. Mostly, they are responding to medical calls and traffic crashes, the chairman said.

Authority officials compare the fee to the extra charges that come with specialized services such as from a planning department in some cities. The fee covers the ongoing costs of training and certifying the authority’s paramedics, said Lori Zeller, the OCFA’s assistant chief of business services.

One issue that remains unresolved is a proposal to reduce the number of contracts for ambulance service from 19 to five. The supervisors will likely decide that issue in April, Zeller said.

Nineteen cities in the county contract with the OCFA for ambulance service, but officials want to reduce the number of contracts to five and have the service handled regionally instead of city-by-city. They say it will drive down costs.

The OCFA’s contracts with ambulance companies expire Aug. 31, Zeller said. A request-for-proposal process takes about four weeks, but officials want enough time to handle appeals and in some cases a transition period if a new company wins a bid, Zeller said.

Ambulance service in the county costs residents less than most other counties throughout the state, officials said.

The most expensive last year was in Butte County, where residents are charged $2,399 for advanced-level service. Orange County charges $1,096.82. Fresno’s rate is the cheapest at $913.88.

–City News Service

Supervisors Call for Comprehensive Review of Fire Authority

By NICK GERDA

Two Orange County supervisors on Tuesday called for a comprehensive discussion about how the countywide fire agency is funded and delivers services, just as county leaders move toward issuing a new bid request for ambulance providers.

“We should lead that discussion,” Supervisor Todd Spitzer said during a discussion about paramedic fees.

“I think we need to understand what the potential future of the [Orange County] Fire Authority is, and what it would mean to Orange County” if Irvine leaves the Fire Authority and the agency is dismantled as Spitzer said he fears.

Irvine officials have raised concerns they are overpaying for fire services and have had public discussions about potentially leaving the Fire Authority, which was set up in the wake of the 1994 county bankruptcy and funded primarily through property taxes.

Meanwhile, Chairman Shawn Nelson cautioned that Irvine’s threat is unrealistic.

“Irvine can’t just leave,” Nelson said. “They don’t have the option to just walk” because all of their money is dedicated to the Fire Authority by law.

But Nelson did signal support for a broader discussion.

“If this thing needs to be refigured, let’s get the adults involved in this” and figure it out, said Nelson, adding that he has “a problem with this entire funding structure.”

“Perhaps we can huddle up offline.”

The discussion came as the Board of Supervisors considered whether to continue having ambulance companies bill for Fire Authority paramedic services.

Supervisors decided 3-2 to stick with the current process and require upcoming ambulance contractors to bill patients for the Advanced Life Support or ALS fee.

Nelson and Supervisor John Moorlach opposed the fee’s inclusion, with Nelson asserting that the cost for paramedic services is already covered through property taxes.

“They’re already on the clock. There’s no additional cost to ride with a patient to the hospital. They’re already being paid,” Nelson said.

Fire Authority officials have said the ALS fee revenue covers only 60 percent of their costs for the paramedic service.

“It’s a very normal process” to collect the ALS fee, said Dave Kendig, the Fire Authority’s general counsel.

As the discussion winded down, one supervisor openly critiqued how a fee discussion emerged into a philosophical debate about how services are delivered.

“To me it was an overreach. We needed to solve the billing issue,” said Supervisor Pat Bates.

For his part, Spitzer criticized how the board keeps having “piecemeal discussions” instead of taking a broad look at issues.

And Nelson said the nature of fire service has changed dramatically in recent decades.

“In excess of 98 percent of the calls have nothing to do with putting out fires,” said Nelson.

As supervisors prepared to discuss the issue on Tuesday, a local resident publicly reminded them that past ambulance contracts in Orange County have been awarded to firms, such as Shoreline Corp., that were ranked lower in the bidding process.

Violations by Shoreline “endangered public safety,” said Westminster resident Darrell Nolta, adding that he questions “how this process is going to be truly conducted fairly.”

In Westminster, Shoreline Corp. was nearly disqualified because of inadequate disclosures.

The company lacked the required two new ambulances for the contract, failed to have a required radio system and misrepresented its ability to offer a computerized patient-monitoring system, according to a report.

Yet the Westminster City Council awarded their contract to Shoreline in 2012 over competitor Care Ambulance.

Even after Shoreline received the contract, it still failed to comply with the contract requirements to buy ambulances and radios.

Nolta also criticized Supervisor Todd Spitzer’s suggestion that the supervisors place themselves on the panel that reviews and ranks the bids.

The makeup of the panel wasn’t discussed by supervisors on Tuesday.

The draft request for proposals is expected to go to supervisors next Tuesday for comment and review.

Then final comments are set to be collected by the county Health Care Agency before the document is sent to the state Emergency Medical Services Authority for approval.

Nolta reminded supervisors that many people are keeping tabs on the bidding process, as evidenced by a letter from state officials.

“I’m watching, and I know from the letter other people are watching it,” he said.

You can contact Nick Gerda directly at ngerda and follow him on Twitter: @nicholasgerda.

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