Recommendation to authorize City Manager, Fire Department, Health Department and all other appropriate departments to work together and report back in 120 days on the potential costs, benefits and challenges in forming a Long Beach Community Paramedicine Program. (District 5)
Thank you, Mr. Armstrong. That concludes public comment. We are moving on to item 24, please. Communication from Councilwoman Mango, Councilwoman Price, Councilmember Super nor Councilmember Richardson recommendation to authorize the City Manager, Fire Department, Health Department and all other appropriate departments report back in 120 days on the potential costs, benefits and challenges in forming a Long Beach community paramedic and program District five. Thank you. So for those of you who are not familiar with the community paramedics model, there are many of them that are in pilot phases across the country. It's a model that's based on a health care system designed to provide more effective and efficient services to our residents community. Paramedics in often allows ambulances to drop off at urgent care centers versus the hospital. It also allows them to drop off at sobering centers and other facilities that are appropriate to be allowed to do that. The paramedics kind of it allows them to function outside their traditional role and utilize their specialized training to work in a model that can take it from a place where our ambulances are called to holding the wall, which is standing, waiting for admission into our ERs to actually being able to drop patients at the appropriate care facilities. In 2015, the California Emergency Medical Services Authority, the M. S.A., worked in partnership with the California Health Care Foundation and conducted 13 community paramedics and pilot programs in a dozen different locations. And under the pilot, the community peer medicines provided short term follow up care after hospital discharges for people with chronic conditions. You may remember that our innovation team did a study of the number of individuals who are connected to multiple departments within the city. And sometimes the data related to these individuals is that they're taking the wrong medicines and they are consistent callers to 911 because the issues aren't being resolved, whether it's long lines or wait lists for their health care provider or they don't go to the doctor, they only use the nine on one system. And those short term follow up visits have seen significant improvements in the L.A. County model. Case management services to those frequent users of the EMS system also help allow those resources to be freed up for our very important residents that are calling in on one and then directly residents and or visitors directly observed therapy for people with tuberculosis. Other collaborations include collaborations with hospice nurses to reduce unwanted transport of hospice patients. I recently did a ride along with an agency and we were often visiting hospice facilities and the caretakers at the facilities weren't sure if a transport was necessary. But to be on the quote unquote safe side, then the individuals were being transported, which then in resulted in holding the wall, waiting for admission. So then that unit couldn't get back out into the field. Transportation for people with mental health needs to mental health crisis centers, transportation for people who are acutely intoxicated to sobering centers and patients with low acute medical conditions to urgent care centers. The Health Force Center at UC San Francisco conducted an evaluation of the pilot projects and found that community paramedics are collaborating successfully with physicians, nurses, behavioral health professionals and social workers to fill in the gaps in our health and social services safety net. So the evaluation yielded consistent findings that programs have improved patients well-being and have yielded savings for both the taxpayer and the health care systems. And since Long Beach has its own health department, our own paramedic services and several hospitals, hopefully another one coming back online soon and numerous clinics. Which we also need to talk about the lack of urgent care centers in some parts of our city. We have health care deserts that I know some of my colleagues have discussed extensively. This would help us potentially create a new model for community health care for Long Beach residents with a more effective and efficient method of serving high quality health care needs, high quality health care to the needs of our participants. So we really appreciate staff taking the time to look into what might be possible and how that could best serve the residents of Long Beach. Councilmember Richardson. Thank you, Councilmember. So, Councilmember Richardson. Thank you. Councilmember. So. So I've learned a little bit about this this presentation. Thank you, Councilwoman Mo Mango Mobile. And I spoke with our local firefighters. 1/2, Councilman. Can is there a second on this motion? Okay. Thank you. Thank you for that point of order. So there's you know, so I spoke with our local firefighters about the problem. And it makes sense to me if we see that there's pressure on our local emergency rooms. We've had a lot of conversation about what happens if an emergency room I mean, if you lose, let's say a paramedic , it puts pressure on the entire system. Or if you you know, if in a trauma center, emergency room shuts down how it impacts the entire system. And so these pilots, one of the it seems like not many of the pilots are going to have an opportunity to advance, except for this one, which is really focused on identifying urgent care centers as a space to sort of add into the component. What I think is interesting about that is. It allows, you know, more relief to the system in areas where you may not have very many resources in terms of paramedic rescues or access to emergency rooms, you can deploy to an urgent care center. So that makes sense. But it's also been raised to me the issues concerning, you know, the triage process. So in an emergency room, there's training about triage. And these are ins that conduct, that training. And so they're trained about assessing and understanding, hey, is this a stroke? Is this a certain type of emergency? And this is how it's treated. And so, you know, the big issue at hand here is figuring out whether, you know, there are things or, you know, people who are trained or if our emergency rooms are for firefighters, if we're hiring Marines to make sure that triage, if it's happening at a separate point, is happening at the at the E.R. instead of the emergency room stages happening at the paramedic stage. How do we make sure that the way is designed? You know, it's informed by our trains and nurses and make sure that, you know, we're not somehow creating a bigger issue. And so in general in general, I'm supportive of this conversation, exploring it. But I want to I think that we need to make sure that we engage with our nurses, our CNA, our nurses association, WINGARD Engage with our firefighters, the fire department, local hospitals. And so as we evaluate this, I think all those people need to be at the table to figure out, like, what are we what are we doing? Is this possible or is this a good thing or are we creating issues for ourself? And that's really what we need to figure out. The second thing I would say is we're having a conversation and this conversation has really kicked up and it's really come out of the community hospital conversation about, you know, where where are the areas in town that lack urgent care centers in general. I know that, let's say in my district on the east portion of my district, we're adjacent to Lakewood Regional, which is an emergency room and typically urgent care centers locate near emergency rooms. And so on one side of the district is walking distance access to an emergency room and urgent care centers on the other side of the district, which, you know, which is interesting. It's, you know, is geographically, economically, racially, very different. And on that side of the district, you know, there isn't you know, there's one paramedic rescue and there's no urgent care center, you know, no emergency room. And so the response time in that area of area town is completely different. So we'll be having a conversation about economic development in a conversation at council about how we can identify these sort of urgent care deserts in our city, because we've noticed that they exist on the West Side, they exhaustion exist in North, and they actually exist in the fifth District as well, East Long Beach. How can we leverage our economic development opportunities to to figure out how to, you know, bring in these urgent care centers into these other areas of town? And how do we incentivize them to actually stay open in evening hours when people are home from work? The idea is how do we make sure if people know that they have these facilities in their community, have the access them to take pressure off the emergency rooms? So I think so. There's a lot here to dig in. I'm okay with exploring it, but we all need to make sure that we, you know, engage with our nurses, engage with our firefighters, make sure that, you know, we're very aware of what we're doing as we move forward. Thanks. Thank you for that. Yes. So I'd like to recognize our council member, Urunga. Okay. I'm sorry. Councilmember Supernova. Thank you. I just want to and maybe we get clarification from the city manager. So this is not the report coming back. This is an item that I seconded for you to explore whether or not we can do a report and incur those costs. Is that kind of accurate or how would you frame it? We're coming back with a report that outlines what the what this is, how much it costs, the benefits, pros and cons and things like that. So there would be a follow up report to that report. So this would be an interim step we're approving tonight. The council tonight is requesting us to come back with a report to see if this type of a program is feasible. Not yet. Okay. Well, that's differs from the understanding I had yesterday. So I just wanted to say that the fire is listed here. And I agree with Councilman Richardson that we learned so much from the community hospital experience. I never knew there were that many agencies. I learned a lot more acronyms of county and state agencies overseeing this. So. Let me ask staff again. Are there any costs associated to you bringing what you are bringing back at this time? Just the time and energy to research this and come back within the time period necessary. Okay. So will that be delineated in some form either tonight or at an interim step before you come back? No, we're going to come back. I think it's within 120 days. We'll probably give you an update if we're having difficulty coming back in that time period. But we're going to go ahead and just I believe our public safety team is somewhat familiar with this program. So they'll just outline that and talk about the. Pros and cons and the costs and a recommendation. Okay. Thank you. Come on. Councilmember. You want to. Add. Thank you. Interim vice mayor acting out by acting. You're one of the. Concerns that I had when I first became a council member here was we came in with like slinging guns and we wanted studies on this studies and then we were studying everything and it was costing staff a lot of time for not only doing those studies, but also in terms of the resources that were needed to go into it, especially in studies that were not fully vetted in terms of where we were presenting that study. And I'm not very sure that I'm ready for this study yet. I haven't heard anything from nurses. I have not heard anything from firefighters or police officers because it involves all our our first responders when it comes to these types of issues. And our first responders are not here tonight that I can ask them whether it's something we should pursue. With all due respect to the to the my councilmember in the fifth, you know, I think that we need more information before we can continue on into a study like a pre study type of thing. Because it's it's one of those things where I'm not very clear as to what this is and what its end game is going to be. The endgame, I'm guessing, is eventually create some kind of prayer and medicine response team, if you will, and what is that going to entail and how much of a cost it's going to come to the city? How much more staff time it's going to take to put someone in a ambulance or in a police car? What what the what the dynamics are going to be of such a such program? It's the first time I've heard about it. I don't have any information on it that would be present to me tonight. And so I'm not I'm not ready just yet to to pursue this, but I'm willing to listen to my colleagues. Councilmember Pierce. Thank you. I want to say I applaud the goals and the intent of this item. Obviously, I think we all kind of had our our run at trying to assist in making sure our response times are better and making sure people have access to health care. You know, I guess I have a couple of questions in regards both to that I haven't heard from either nurses or fire, but also questions on any legal concerns. Would we be at risk for any lawsuits? And so when this comes back, if you could outline any legal concerns and then I have a question on our heart teams and how would this overlap or would it complement, since we've already, as a city invested in hard teams, we've expanded our heart teams. Is there opportunities there to utilize that and maybe build on that as well? So those are some of my my general questions. My my staff gave me about five pages of notes of pros and cons and, you know, sort of respectfully seeing that it's a report to come back. I look forward to those next steps. So I will weigh in at this point. I had a couple of things that I liked, the way we are going with this. Councilmember Mungo I think this is a very insightful item and in the conversation should be had about how we can be more strategic in and and utilizing our resources. I thought some of the comments from my colleagues. Were, were. On point and and I think developed deserves some some attention and and exploration. And so, you know, I'm not sure that that all of this is going to be. The study can be done in a six month period. I'd like to just offer a friendly amendment or a friendly to you, too, to include in this within that 120 days. A forum during the Public Safety Committee. To allow the stakeholders to weigh in on the process. And and that will that will help us as a council kind of shape where this is going. I appreciate the option. I think that one of the reasons I'm asking for the item is there's so much diversity in the way that these are being rolled out. So you have some agencies that want to have like a nurse at dispatch. You have some agencies like L.A., FDA, that put a nurse on the ambulance. You have some agencies who have a doctor. L.A. County has a doctor that gets into the ambulance and does the follow up, and they're using them all as pilot. So I don't really know what. All the options that are even out there. So I absolutely would love to have it go back to public safety. I just was hoping for a quick gloss over of. What's out there in the area that's moving to the next step? What has items looked at and would any of them be even possible in Long Beach and or not? And so I wasn't looking for an in-depth study. I was only giving 120 days because I was being generous. Not that it would actually take stuff, any kind of significant staff time there is a fiscal outline at the bottom and I ran it by financial services in advance of the item in accordance with the fiscal policy, and I'm completely open to sending it to committee for a report back. If it's easier on the staff to do a verbal report than a written report, I'm open to all of that. I just know that the dialogs are going on out there and I didn't want those dialogs not to have Long Beach. I want us to be informed so we can decide if we want to engage in those conversations. And I think the point of me and thank you for accepting the recommendation to opt to send this to public safety committee. And in part of my my rationale for for suggesting that is just to give me the opportunity to for other colleagues to have an opportunity to. Absolutely. Review this and understand what this is. And and this is actually kind of new to me. But again, I'm I'm wide open. I think this is a this is headed in the right direction. I just want to make sure that we are processes, our arms are are tight, intact, but also that we're offering opportunities for for stakeholder involvement. More public comment? Absolutely. I think this goes to the point of our long council meetings. It's tipping on 9:00 at night. And the population that's most impacted by this are poor communities that have children at home that need to be in bed, and our senior communities that often don't want to drive after nighttime, much less commute across downtown because similar to Councilmember Richardson, we have the farthest drive to the hospital from a paramedic unit. And so those are the constituencies that probably want to be involved in the conversation. But as we know this but this body has quite a lot to hear at the dias. And so these conversations get late. I have had several conversations with our Fire Fighters Association over the last two years about the potential interest. He also brought some points to light that need to be discussed before we would be there. But I also recognize that as those summer months come and the agendas get even heavier, I mentioned that I'd like to at least get it on on the radar of city staff, and not that it would take 120 days, but just a few hours of staff time to pull that all together so that we at least would have the options to know and understand what's being discussed. And even if we do not choose to go this direction, I think it's still informed that other agencies know our opinions and for us to be able to voice those strongly. So thank you for the recommendation. Absolutely. Great. So we will now go to Council Supernova. Oh. Was that your. You were cued up again. Oh, great. Thank you. Councilmember Silvano. Okay. So the friendly on the floor is to send it to the Public Safety Committee. I sit on that committee, and I just have to say that for the next 90 days, my focus will be the community hospital and getting that facility open. That's a primary concern that I can't have any distractions from. So. That being said I welcome to support that friendly. Thank you. Councilmember Gonzalez. Yes. Thank you to my colleagues for bringing this forward. I think the spirit of the item absolutely gets to the heart of the issue, which is ensuring that we're being expedient and efficient with our public safety resources as much as possible. I, too, want to just say that I would like us to incorporate the discussion around the triage issue respective to the scope of practice that nurses provide. And I think that's really an important discussion we should have. And Public Safety Committee as well as the who would be who had been conducting these pilot programs, because we know that some of them may have been for profit ambulances and we want to make sure that it's done with the right intent for our city so that it it gets to the heart of the issue, as we discussed. But I really like this and I know working with firefighters and and everyone at the table, we will get to a good place. Thank you. Okay. Councilmember Mongo. I want to appreciate Councilman Gonzalez for bringing up that point. I think that that is not being said a lot in the public forum in some of these other cities. And so I think that's one of the reasons that it's so important that we discuss it in a city as big as ours that has the complexities. Ours does. Some of these cities don't even have hospitals within their boundaries. Some of these cities don't do bills or transport. And so it's just a very different dialog that is going on around us. And I feel like since we are surrounded by other cities, serviced by other agencies, some of which have started down this path, we at least need to know what that means. And so I'm excited to hear what that means. Thank you. Members. I think that is there. So have we done public comment on this? Is there any public comment? The notion that. Good evening. Tiffany Davis speaking. I just wanted to say that I support this. Item and I look forward. To. Also possibly hearing input from. SEIU. I know that there's a large contingency. As someone who has been a caregiver for the past decade for chronic kidney disease patient. That this would probably alleviate the situation that I. Deal with in emergency rooms quite often. Thank you. Zero. Further public comment. Harry Nunn members, please cast your vote. And let me just clarify the motion. It was to to support this item and send it to public safety. That's correct. Right. And just from a staff perspective, so we think we're being asked to have the discussion on public safety, bring what what information we can readily bring, and then receive additional direction of public safety, if that's correct. Correct. Okay. Thank you. So moved. Please cast your votes.