After receiving a letter last week from the Los Angeles County Emergency Medical Services demanding that it terminate its “rapid medic deployment” pilot program because of “significant safety issues”, the Long Beach City Council directed its fire department to abide by the letter, which will shut down the program by next month.
Long Beach Fire Department Chief Mike DuRee was on hand to present to the council his contentions that the RMD program was not a threat to public safety, and that by staffing only one paramedic per unit, instead of the two-medic system it previously operated, it actually expanded the department’s ability to respond to calls.
The program was hailed as a cost-cutting measure, as it replaced paramedics on ambulances with EMTs and placed those medics on fire engines throughout the city. DuRee said the move put medics on all 29 apparatuses operated by the department instead of just the 17 that had been fully staffed before the program was instituted.
According to DuRee, the announcement from the agency came as a surprise, because the department’s data reflected a positive direction, including reduced response times and a dramatic cut in the reliance on Los Angeles and Orange Counties' fire personnel to carry out calls for services in Long Beach. In the year before the RMD program, Long Beach relied on 292 responses from LA and 450 from Orange County. Those numbers dropped to 10 from LA and 218 from Orange Country since July 2014.
According to DuRee, all other correspondences leading up to the letter did not raise a red flag that such an announcement was coming.
“I have often stated publicly that the program was functioning well, and the data that was being produced showed no signs of care degradation or cause for concern,” DuRee said. “Last week, however, we received a letter from the local EMS agency that is both surprising and alarming.”
There will be no challenge to the letter and the city will be forced to go back to its old model for paramedic distribution. Budget Manager Lea Eriksen said the move will result in a $1.4 million impact on the fire department’s budget, that because of progress of the budget talks already under way, is currently not accounted for.
Eriksen said to help mitigate the impact of the dissolution of the program the department will take on a three-pronged approach, which includes making adjustments to the current budget to help limit the impact and using the recently approved first-responder fees and end-of-the year budget savings as a “backstop” for the estimated budget hit.
“That is the proposed solution for 16 and any permanent fix will need to be addressed in the FY17 budget process,” Eriksen said.
The issue hinged on what the county classified as “fall outs”, or shortcomings caused by the department’s move to put only one medic on each apparatus. The agreement called for a second medic to arrive at the scene within three minutes of the first one at least 95 percent of the time.
Both DuRee and the department’s medical director, Dr. Stephen Shea, disputed the findings by the county, downplaying the fall outs listed in the letter as overblown or inaccurate. DuRee noted one such instance occurred when a patient whom had been stung by a stingray was pulled from the water and was wet and clammy to the touch but no second medic was dispatched. His condition was the result of being in the water and not due to life-threatening circumstances that would’ve necessitated the second medic to be dispatched.
Shea, calling the Long Beach program the “premiere” program in the county, agreed that the charges were misrepresentative. He noted the term “fall out” implied something wrong had been done when there had been no evidence that adverse patient outcomes had resulted from the RMD program.
“I think the county is jumping the gun with their fall outs and how they’ve been analyzed,” Shea said. “I have not uncovered one case where a patient was put in jeopardy because we did not have two paramedics in the ambulance. And the county, at this time, has not given us any either.”
Nonetheless, council members took turns questioning the timeline of events that led up to county’s letter being delivered last week. Eighth District Councilman Al Austin said that he had been critical of the program “since day one” because of his concern that it might affect patient care. Despite being presented with the charts and statistics from DuRee, Austin remained unmoved in his support to honor the letter’s request to dissolve the program.
“It’s clear that the agency for the county disagrees with your assessment,” Austin said to DuRee.
Seventh District Councilman Roberto Uranga asked why safeguards weren’t put in place for a program that had just entered its second year of existence. He said that if there was no guarantee that it was going to be successful, there should’ve been money set aside to avoid the now $1.4 million budget hit the department is facing.
“We’re stuck with a pilot program that did not work and without a budget to fix that,” Uranga said. “Now we’re looking at trying to fix a hole in the fire department’s budget to revert back to a process that I think, prudence would’ve told us so, to keep that budget in there in the event that this pilot program fails. And we didn’t do that.”
Although the language of the letter provides for some time for the city to end the RMD program, letting it run to October 1—the proposed deadline for the program’s end—presented some potential issues that led Third District Councilwoman Suzie Price to ask why the city wasn’t pressing to end it “tomorrow, as in Wednesday.”
The city would be in compliance if it ended the program by October 1 and the letter also provided provisions for an extension if the city needed more time to implement it’s old model. Price’s issue presumably comes from the position that now that the city is on notice as having potential violations, any mishap in ambulance responses between now and the end of the RMD program could open the city to potential lawsuits.
“Do you believe it would be prudent for us in light of these findings to continue a methodology even though the regulatory agency is giving us time to comply?” Price asked the city attorney.