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HomeMy WebLinkAboutAgenda Report - September 5, 2007 K-05A619HOA ITEM Kp� CITY OF Lom COUNCIL COMMUNICATION TM AGENDA TITLE: Authorize Response to San Joaquin County Grand Jury Regarding its Investigation of the Requestfor Proposal Process Used by San Joaquin County Emergency Medical Services. MEETING DATE: September 5,2007 PREPARED BY: C i Attomey's Office RECOMMENDEDACTION: Authorize Staff to Respond to the San Joaquin County Grand Jury Regarding its Investigation of the Request for Proposal Process Used by San Joaquin County Emergency Medical Services. BACKGROUND INFORMATION: The 2005/2006 Grand Jury investigated a complaint concerning San Joaquin Counties award of the ambulance and dispatch contract to American Medical Response (AMR), and complaints alleging r*qJ gent AMR dispatch. The Grand Jury issued its Final Report on June 12,2007 and requested that the involved City Councils respond to various recommendations made in the Report. Response is required no later than September 10,2007. San Joaquin County sued the cift of Lodi, Stockton and Manteca over the very issues raised by the Grand Jury investigation. In partial response to the Grand Jury Report, the parties engaged in earnest settlement negotiations. However, because the matter remains in litigation, the settlement process could be compromised by a further response. Staff anticipates negotiations between the parties will conclude in late September and a full report on the resolution will be provided to the Grand Jury at that time. As such, staff requests authorization of the Council to provide the Grand Jury with a statementthat: "The City of Lodi has taken the San Joaquin County Grand Juries concerns seriously and engaged in a process to bring an expeditious resolution to the dispute. A full report on the resolution of the dispute will be provided to the Grand Jury by the early fall of 2007. " FISCAL IMPACT: None Cit Attorney cc: We Pretz, Fine Chief APPROVED: %rimb Avg County of San Joaquin Courthouse 222 East Weber Avenue -Room 303 Stockton, California 95202 (2091468-3855 CASE # 10-06 FINAL REPORT SAN JOAQUIN COUNTY EMERGENCY MEDICAL SERVICES REASON FOR INVESTIGATION: The 2006106 Grand Jury investigated a complaint concerning the Request for Proposal (RFP) process used in the awarding of the ambulance and dispatch contract by the San Joaquin County Board of Supervisors(BOS). This procurement process included the provision of all emergency ambulance responses within the County, as well as the operation of the ambulance provider's dispatch center, which was to be an approved Emergency Medical Dispatch (EMD) center and 911 secondary answering point. The investigation of the 2005106 Grand Jury was focused upon the RFP process as it pertains to policy and procedures only and not upon the feasibility/viability of the services that may be delivered. The 2005106 Grand Jury recommended that the BOS should provide an analysis of the ambulance service at six and twelve month intervalsto the succeeding Grand Jury in order to assess the impact of this change on the health and safety of County residents. The 2006107 Grand Jury decided to continuethe review of ambulanceand dispatch services based on that recommendation. Subsequently the members received two formal complaints alleging serious dispatch failures byAmerican Medical Response, Inc. (AMR) which have affected the response and provision of emergency medical services to the residents of San Joaquin County. One of the complaints submitted to the current Grand Jury was mostly a personal attack on the Emergency Medical Services Agency (EMS) and its Director. The management of the contract was called grossly negligent, covering up careless and dangerous practices of AMR. It also claimed that the transfer to a "lesser facility" was illegal, proven faulty and lethal. It noted that many of the problems have gone unreported in the media. In addition, it alleged that the Director of EMS has acted to protect AMR by manipulating response times and hiding the very careless behavior of AMR. In addition, the complaint called for the examination of the contract accountability by the EMS Agency and so called "misconduct" fines to be paid by the Company (AMR). BACKGROUND: San Joaquin County is served by seventeen fire departments. Prior to the AMR contract, three of the fire departments provided Advanced Life Support (ALS) services and fourteen provided Basic Life Support services. All emergency 71 ambulance service dispatching as well as fire dispatching within the county before the awarding of the contract was done by the Stockton Fire Department's Regional Dispatch Center. On May 1,2006 services underthe AMR contract began at 8 a.m. METHOD OF INVESTIGATION: Organizations Visited AMRILifeCom Call and Dispatch Center in Salida (twovisits) City of Stockton Fire Department Call and Dispatch Center City of Stockton Police Department Call and Dispatch Center California Highway Patrol Call and Dispatch Center San Joaquin County Sheriffs Call and Dispatch Center City of Tracy Fire Department San Joaquin County Emergency Medical Services Office City of Manteca Fire Department City Ripon Consolidated Fire District City of Lodi Fire Department At the call and dispatch centers we visited, in addition to interviewing call takers and dispatchers, the Grand Jury observed and listened to calls and dispatching. People Interviewed AMR San Joaquin County Operations General Manager Vice Presidentof LifeCom Support Director of Communications-LifeCom EMS & Fire Dispatch EMS Administrator EMS QI/Trauma Coordinator EMS Specialist President, Inspironics Corporation Deputy Chief, City of Stockton Fire Department Captain, Emergency Communications Director, City of Stockton Fire Department. Dispatch Supervisor, Stockton Police Department Chief, City of Tracy Fire Department Chief, City of Ripon Consolidated Fire District Chief, City of Manteca Fire Department Chief, City of Lodi Fire Department Lieutenant, San Joaquin County Call and Dispatch Center Supervisory Communications Dispatcher, SJC Call and Dispatch Center GIS Manager, SJC Community Development Department/GIS GIS Coordinator, City of Stockton Lieutenant, California Highway Patrol (CHP), Stockton Area Public Safety Dispatch Supervisor, CHP, Stockton Area 72 Documents Reviewed: 1. San Joaquin County Emergency Medical ServicesAgency EMS Liaison Contact List 2. San Joaquin County EMS Quality Improvement Council Membership 3. Paramedic Services Agreement between San Joaquin County and the City of Stockton, April 9, 1986 4. List of All ALS and BLS Fire Departments in San Joaquin County 5. Letterfrom AMR to EMS dated August 9,2006, Re: Appeal of fines for May and June 2006 6. Letter from EMS to AMR dated October 4, 2006, Re: Appeal of Fines for May andJune2006 7. Summaries from the EMS Incident Reporting System concerning Incidents Per Primary IncidentType, Incidents Per Reporting Company, Incidents Per Company Rpt Pertains To, 05101/2006-01/31/2007 8. Incidents List, Detailedfrom the EMS Incident Reporting Systemfor05/01/2006- 12/31 /2006 9. Incidents List, Detailedfrom the EMS Incident Reporting System for 01101/2007- 01/31 /2007 10. Incident Detail Report, Incident number: 06082553, Incident Date: 10/07/2003, 23:54:12 11. EMSAgency Reporton the Exclusive EmergencyAmbulance Provider Contract Compliance for AMR for the months of May and June, dated August 13,2006 12. EMSAgency Reporton the Exclusive EmergencyAmbulance Provider Contract Compliancefor American Medial Responsefor the months of July and August 2006, dated November9,2006 13. EMSAgency Reportonthe Exclusive EmergencyAmbu lance Provider Contract Compliance for American Medial Response for the months of September and October 2006 14. EMSAgency Reporton the Exclusive EmergencyAmbulance Provider Contract Compliance for AMR for November and December 2006 15. Letter to EMS from Stockton Fire Department Consultant/]nvestigator re: Medical Dispatch -Keyser Drive dated November 8,2006 73 16. Letterto the Chairman of the San Joaquin County Board of Supervisorsfrom the Mayor of Stockton dated July 27.2006 17. Tritech CAD -to -CAD (Computer Assisted Dispatch) Functional Specification Documents 18. Logisys CAD -to -CAD Functional Specifications Documents 19. Unusual Occurrences Filed bythe Stockton Fire Departmentwith Delayed Calls Highlighted. 20. CAD -to -CAD Links report (ComputerAssisted Dispatch)from AMWLifeCom to the Stockton Fire Department from September 9, 2006 to March 19, 2007 of responses that were two minutes or longer. 21. Structure Fire Call Times submitted by AMWLifeCom to EMS that conflict with the times AMWLifeCom submitted to the Stockton Fire Department. 22. Series of Letters (May 1 and May 2, 2006) from Chief Hittle, Stockton Fire Departmentto Kenneth Cohen, Director, San Joaquin County Health Care Services, detailing perceived dispatch and communication problems. 23. May 3"' Letter from Kenneth Cohen to Chief Hittle responding to Chief Hittle's letters of May 1 and May 2. 24. Series of Letters (May 5, May 9) from Chief Hittle to Kenneth Cohen detailing perceived EMS system failures. 25. Memorandum dated December 19. 2003 from the San Joaquin County Fire Chiefs Association to Chico Research Foundation with a subject of Redesign of County EMS System. 26. San Joaquin County EMS Agency Continuous Quality Improvement Meeting Rules 27. Letterfrom the Chief of the Tracy Fire Department, dated February 13,2007, to the Director of the Administrative Services Department for the City of Stockton concerning the issue of public safety radio frequencies 28. Letter from Chief Hittle of the Stockton Fired Department, dated February 26, 2007, to Chief Bosch of the Tracy Fire Department concerning the Public Safety Radio Frequencies. 29. Report to the Board of Supervisors by the Fire Chief, Ripon Fire District, Chairman, San Joaquin County Joint Radio Users Group (SJCJRUG) 30. March 29 communication from the Stockton Fire Department to EMS, Re: Information Exchange. 31. Unusual Occurrence Case #06489, Public Report, January 29,2007 Relevant Law and Regulations: 32. Health and Safety Code, Division 2.5, Section 1797.200 33. Health and Safety Code, Division 2.5, Section 1797,204 34. Health and Safety Code, Division 2.5, Section 1798 35. California Code of Regulations, Title 11, Division 9, Chapter 12, EMS System Quality Improvement Relevant San Joaquin Countv EMS Agency Policy and Procedures: 36. San Joaquin County EMS Policy No. 540.01 Unusual Occurrence 37. San Joaquin County EMSAgency No. 3001, Guidelinesfor EMS Call Screening by Primary PublicSafety Answerins Points 38. San Joaquin County EMSAgency No. 3001A, PSAP Call type Flow Sheet 39. San Joaquin County EMSAgency No. 3101, Emergency Ambulance Service Provider Dispatch Reauirements 40. San Joaquin County EMSAgency No. 6620, Continuous Quality Improvement Process 41. EMS Form #6002, Unusual Occurrence Report, August 16,2006 Relevant LifeCom EMS and Fire Dispatch Policies and Procedures: 42. MPDS Implementation and EMD Call Processing 43. Emergency Call Taking and Law Enforcement/Fire/First Responder Call Notification 44. GIS/GEO File Troubleshoot Procedure 45. Sentinel Event Notification Matrix 46. Letter from EMS to Stockton Fire Department dated November 22, 2006, Re: Unusual Occurrence Report, SJCEMSA Case #6459 47. Letter from EMS to Stockton Fire Department dated November 22, 2006 Re: Unusual Occurrence Report, SJCEMSA Case #6443 75 48. Data Reduction Methodology used by Inspironics for January 2007 49. Listing of Unusual Occurrence Reports Categorized by Type for EMS Continuous Quality Improvement Meeting of March 15,2007 FINDINGS: 1. The current method of dispatch has land line 911 calls going to primary Public Safety Access Points(PSAPs). Depending on the location of the call, the call goes to the Stockton Police Department for Stockton, Lodi Police Department for Lodi, etc., and anything in the unincorporated County area goes to the San Joaquin County Sheriffs Department. The fire and medical emergency calls for Stockton, Lodi and Manteca go to the Stockton Fire Department. Stockton dispatchesthese tire departments as before and at the same time informs the LifeCom center of the medical emergency. County 911 calls go to the Sheriffs Departmentwith fire calls transferred to Stockton as before and medical calls transferred to AM Rs LifeCom Center. Since this process is the same as before the new contract was implemented, the dispatch times and service should be comparable. 2. All 911 cell phone calls go to the California Highway Patrol (CHP). In the past the CHP would transfer tire and medical calls to the Stockton Fire Department for dispatch. Since May 2006 the CHP transfers fire and medical calls to AMRs LifeCom Center. As a result of this change some dispatch problems and delays have been occurring. If it is a medical emergency call, both the tire department and ambulance are dispatched virtually simultaneously over the CAD -to -CAD system between LifeCom and Stockton Regional Dispatch Centerwith a subsequentfollow- up phone call. The CAD -to CAD system from LifeCom to Stockton was set up to transfer medical information, not fire information. So if the cell phone call is a tire call, it has been necessaryfor LifeCom to phone Stockton with the fire information, causing delays longer than before the contract was implemented. 3. Following an extensive review and investigation of the allegation of serious dispatch failures, the Grand Jury has determined that there are at the presenttime few dispatch failures by AMR which are affecting the response and provision of emergency medical services to the residents of San Joaquin County: given the approximate 3,000 calls dispatched by AMR each month, the failure rate isvery low. There were problems at the beginning of the contract; however, with the CAD -to - CAD communications now in place, significant dispatch delays for emergency medical service are not occurring. Many of the Fire Departments noted that there were similar problems in the 1990'swhen they beganto be dispatched by Stockton. 4. In addition to the general investigation of the Emergency Medical Dispatch System, the Grand Jury investigated the specific allegations made by two Fire Departments as well as those contained in the original complaint. 76 On March 20, the Grand Jury received a list of Structure Fire Incidents that purported to document unacceptable delays as a result of issues with the LifeCom Fire Dispatch Center operated byAMR in Salida. The document indicated that the average time from call receiptto dispatch on structurefires for the lastyearwas 51 seconds. The Grand Jury already had the results of an investigation of these same incidents conducted by the San Joaquin County Radio Users Group (SJCRUG), which had concluded the following: "Nodelay exists that is inconsistentwith those inherent calls coming into the systems from cellular phones." This group also discussed the inherent problems with cellular phone calls and the difficulty of determining location. The full report of this group's findings was presented to the County Board of Supervisors on February 6th, 2007, including a table noting the actual times LifeCom received the call and subsequent dispatch to Stockton. Of special note is the following conclusion from the report: "SJCRUG is pleased with the services we are receiving from LifeCom and are looking forward to our partnerships in the future." The SJCRUG is comprised of representativesfrom the following fire departments and districts: Escalon, Ripon, Lathrop -Manteca, Farmington, Linden -Peters, Clements, Woodbridge, Tracy, French Camp, Liberty, Mokelumne, Collegeville, Waterloo-Morada, Thornton, Montezuma, and Manteca. The Grand Jury therefore concludes that the current response time is acceptable. 5. Another continuing allegation is that LifeCom does not have an up-to-date Geographic Information System (GIS) file and therefore does not have all of the addresses in the City of Stockton as well as the County. As noted in one Unusual Occurrence Report. there were problems with the GIS used by LifeCom from a private company. However, subsequent to that time, the GEOIGIS database was updated with the County and City Database on November 16, 2006. This action was confirmed by the EMS Office in letters to the Stockton Fire Department dated November 22, 2006. In addition, to confirm this update, the Grand Jury visited the LifeCom Center, observing that an update had been completed, and verifying it with the Stockton GIS Coordinatorand the GIS Managerfor San Joaquin County. These databases are now transferred to LifeCom on the 15`h of each month using File Transfer Protocol (FTP). 6. The Grand Jury found in interviews with staff from the Stockton and Lodi Fire Departmentsthat they believe a private company should notdo emergency medical dispatch. Based on this presumption, these cities, plus Manteca, have refused to dispatch medical calls through LifeCom. Some of the background in this matter includes a Memorandum dated December 19,2003, from the San Joaquin County Fire Chiefs Association to the Chico Research Foundation with a subject of Redesign of County EMS System which they believe was ignored. An earlier agreement between the Stockton Fire Department and AMR to submit a joint application for dispatch fell apart when AMR dropped out of that agreement and subsequently was awarded the contract for dispatch in San Joaquin County. The end result has been a continual process of submitting unusual occurrence reports, which often appear to exaggerate problems and response times. Based on the interviews, documents reviewed, and organizations visited, and as noted above, this process seems to have continued to this day including problems that have already been investigated and/or resolved. 77 Of particular note, of the 558 Unusual Occurrence reports for January, 117 were generated by the Stockton Fire Department complaining about LifeCom and 423 were generated by LifeCom complaining aboutthe Stockton Fire Department. The remaining unusual occurrence reports, which did not contain so-called "dispatch" problems, have been resolved. A significant numberof these Unusual Occurrences were complaints about data missing from the CAD -to -CAD system. It now appears that after many months of replicated complaints about missing data, Stockton and AMR are going to be working on a Phase If of the CAD -to -CAD systemsthat should include both medical as well as tire dispatch data. 7. Subsequentto the refusal of Stockton, Lodi, and Manteca to change the medical dispatch, San Joaquin County filed a lawsuit to make them comply. Part of the issue now focuses on allegedly contradicting statutes, with the cities noting that the 911 law says that local governments decide where 911 calls go and the County noting an EMS law that assigns responsibility for EMS questions to the County. 8. The Grand Jury investigated the allegations made in the complaint, including negligence, illegality, manipulation of data, and questions regarding the "misconduct fines." a. The Grand Jury hasfound no validity in any of these charges. As to covering up problems, they are all examined inthe compliance reports presentedto the Boardof Supervisors and the public has access to all reports on the County's website. In fact, this web site has a great amount of relevant information. The Grand Jury found no indications of a cover-up. b. As to the manipulation of emergency call receipt, turn over of calls and dispatch, the Grand Jury's investigation found no such manipulation. On the contrary, all data is entered into a database which is immediately replicated a number of times both for backup but also for analysis and compilation by EMS. Only one EMS edit of any item is allowed and it is highlighted for later review. The response data itself is also analyzed and compiled by an outside contractor (Inspironics) who provides this service for five other counties. This data is then sent back to EMS for further review and submission to the Board of Supervisors. Thus the data is examined by both EMS and an outside company. To believe that this Companywould jeopardize its reputation and/or contracts with other counties just to manipulate data does not seem reasonable. c. As to the so-called "misconduct fines," the only actionswhich have resulted in the reduction of tines are again publicly available on the internetwith a letterfrom AMR to EMS dated August 9,2006, appealing the fines for May and June 2006. A follow- up letterfrom EMS to AMR dated October 4,2006 has the subject: Appeal of Fines for May and June 2006. This letter notes that the fines were reduced after a review and recommendation by the Ambulance Contract Advisory Group (ACAG). No subsequent exceptions have been given nor fines reduced. 9. The Grand Jury Inds that the only real threat which might affect the response and provision of emergency medical services to the residents of San Joaquin County has been identified by the EMS Agency itself in its Contract Compliance Report for November and December dated February 27, 2007. The problem identified is the growing problem of delays of transferring carefrom the ambulances to the emergency departments in the local hospitals. In some hospitalsthe transfer of care has exceeded four hours with six or more ambulance crews treating.their patients in the emergency department hallwayswaiting for the hospital to accept the patients. The report notes that this problem can lead to AMR's request of more exemptions related to response time, but more importantly it significantly degrades the number of ambulances available for subsequent emergency service and transport. The Grand Jury supports the EMS Agency's efforts to resolve the growing problem of delays of transferring care in the emergency department. RECOMMENDATIONS: 1. It is time for all agencies to set aside their differences, stop using the Unusual Occurrence process to discredit each other and to work together on improving Emergency Medical and Fire Dispatch in San Joaquin County and resolving any problems that exist. A number of organizations are already in place to provide a forum for this cooperation, includingthe EMS Quality ImprovementCouncil, the San Joaquin County Fire Chiefsgroup, the San Joaquin County Radio Users Group and the 911 Primary PSAP Organization. This collaborative process is crucial to the health and safety needs of the people of San Joaquin County. 2. The EMS Agency, AMR, and Stockton Fire Department need to ensure that Phase it of the CAD -to -CAD system goes forward quickly to resolve any missing data issues. 3. The Grand Jury recommends that the cities of Stockton, Lodi and Manteca immediately begin to have their Emergency Medical Needs dispatched by LifeCom. However, the members recognize that there is a litigation issue concerning the control of 911 calls by local governments. When this litigation is decided, no matter the outcome, these Cities 5noUld reevaluate their stance on Emergency Medical Dispatch and work togetherto serve the residents of San Joaquin County. RESPONSE REQUIRED: Pursuant to Section 933.05 of the Penal Code: The Stockton City Council (all three recommendations), the Lodi City Council (recommendations#1 and #3), and the Manteca City Council (recommendations#1 and #3) shall report to the Presiding Judge of the San Joaquin County Superior Court, in writing and within 90 days of publication of this report, with a response as follow: As to each finding in the report a response indicating on the following: a. The respondent agrees with the finding. 79 b. The respondent disagrees with the finding, with an explanation of the reasons therefore. As to each recommendation, a response indicating one of the following: a. The recommendation has been implemented, with a summary of the action taken b. The recommendation has not yet been implemented, but will be with a time frame for implementation. c. The recommendation requires further analysis, with an explanation of the scope of analysis and a time frame not to exceed (6) six months d. The recommendation will not be implemented, with an explanation therefore. 80