Recommendation to request a public report from City Manager, with input from the Fire Chief and Financial Management, on the contingency plans and budgetary impacts of the decision by the Los Angeles County Emergency Medical Services Agency (EMS) to terminate the Long Beach Fire Department's Rapid Medic Deployment Pilot Project (RMD), effective immediately, and the EMS requirement that, effective October 1, 2015, all approved Long Beach Fire Department ALS Units must be staffed with two State Licensed and County Accredited Paramedics.
Item 27 is a recommendation to request city attorney to draft a resolution in support of Long Beach hosting the National League of Cities 2018 Cities Summit. I'm sorry, Tate. I was just checking if you were in detention. That was on 28. You were talking about 27. 28 is the recommendation to request a public report from the city manager with input from the Fire Chief and financial management on the contingency plans and budgetary impacts of the decision by the City of Los Angeles. I'm sorry. Los Angeles County Emergency Medical Services EMS to terminate Long Beach Fire Department's Rapid Medical Deployment Pilot Project RMD effective immediately and the EMS requirement that effective October one, 2015, all approved Long Beach Fire Departments, LLC units must be staffed with two licensed and county accredited paramedics. The City manager. Vice Mayor. Council members. If we can get the PowerPoint up. You go to the first page. So here's. There we go, vice mayor councilmembers. We're here to make a quick presentation regarding the R&D program and you'll see the background alternatives approval process, the training implementation, data collection analysis, where we now and what the next steps are. So as you are all aware, late last week we received notice from the county's emergency medical services agency that they are discontinuing our pilot rapid medical deployment program, R&D. We have also recently learned that there is no opportunity to appeal this decision. As your city manager, I want to let the council and the public know that we fully intend to comply with the direction of the agency. We certainly plan to meet with the commission and the agency soon to discuss returning to our previous paramedic model as well as to do a review of the highs and lows of the R&D program. Before we go into the presentation, I do want to take this opportunity to personally thank our entire fire department management team Chief Terry, Deputy Chiefs Sergeant Segura, and Brandt's Assistant Chiefs Kean and Rowe and Administrative Bureau Manager David Honey. As a team. They have worked tirelessly for the past three years on an outside the box program to present a budget solution, which also allowed us to enhance services, if only temporarily. In a moment, I will turn this over to Chief Terry and the management team to simply go over the history of the program, how it came about, how it has been measured, and what we view to be some of the more impressive successes. Obviously, the EMS agency, as sometimes is the case with new approaches to service delivery, has reached some different conclusions in a few areas. But we would like to present to you, per your request, the results of the program and remind us all why we pursued this, pursued this approach in the first place. So the next slide. So let's go back to post-recession and let's look in 2011. So to that assessment, here's what we've been doing with our fire department. We eliminated engine 101 due to budget cuts. We eliminated Rescue 12, the ALS unit, we reduced staffing at Station 14, and we began the daily engine reduction program, sometimes called a brownout. The following year, in 2012, there were more tart cuts. We eliminated another engine. This time, engine 18, we eliminated a truck, truck 14. In 2013, there were still cuts. We eliminated engine 17, we relocated Engine eight to Station 14, and here we adopted the RMD program in the budget to deal with these cuts that we wouldn't have to be facing cutting more engines or cutting more trucks or cutting more or less programs. So in 2014, we implemented the RMD pilot program. While we implemented this program as a budget saving measure. To save the budget, we're also able to do some service enhancements. We added rescue number 12. That's converted vehicles to an A+. We added rescue number 22, converted a bill to an A+. We added rescue three, converted a blessed to an A+. And we also added two more ambulances. Blaze ambulances. Come 2015. No more cuts. The pilot program continued and we were able to add one more ambulance Bell's unit. So with that, I'm going to turn it over to Chief three and the management team to go over the deployment alternatives and the next steps. Mr. Mayor, council members, we thank you. On behalf of my entire team, we thank you for allowing us the opportunity to discuss the recent developments with the Rapid Medic deployment or RMD pilot program. As you are well aware, since July 10th of 2014, we have deployed our paramedics in a different configuration than we had done previously over the past year of the program's implementation. 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. Last week, however, we received a letter from the local EMS agency that is both surprising and alarming. I want to recognize that if I were in your shoes, I would have a number of questions as to why the EMS agency would shut down a program that we, as the fire department said, is functioning well. Tonight with this presentation, I will recap how this program came to be and provide you with a number of specific data elements that support the fact that the RMD program is an effective service delivery model and has shown statistically significant improvements in a number of areas versus our previous model. However, I do want you to know that we will comply with the direction given us by the EMS agency. As the city manager mentioned, the idea for RMD was not something we created on our own. Of the 33 emergency medical services agencies in the state, 29 of them had already implemented a version of the RMD program. We found that in Los Angeles County, the city of Los Angeles had actually been granted the approval of a single paramedic system in 1999, but never moved forward with the implementation. During our research, we determined that there was value in maintaining a two paramedic system, but did not see why those two paramedics necessarily needed to arrive on a single apparatus. So taking examples, we found that we're functioning at a high level from throughout the state. We made some adjustments to those models to fit our needs here in Long Beach. In 2011, we sent a letter to the EMS agency requesting the ability to engage in a pilot program for deployment of our paramedics. The letter was addressed to Emergency Medical Services Director Kathy Chidester and the medical director, Dr. Bill Koenig. At the time, we presented the idea to the city manager and the City Council for discussion. Concurrently, we engaged in meetings with the EMS agency to develop a guidance policy that would provide the guidelines for the pilot program and also kept the City Council informed through study sessions, budget oversight committee, public safety committee and full city council meetings. In addition, we engaged in discussions with our union on multiple occasions regarding the effects of implementing this program. Excuse me. In June of 2013, the pilot project was endorsed by the full EMS Commission, and we reported to the City Council that we had been granted approval to move forward. Shortly thereafter, we were informed by the agency director that we could not move forward with implementation until policy reference 407 had been vetted by the various subcommittees of the agency. During that process, at an EMS commission meeting, a request to establish the Data Safety Monitoring Board or DSB was made and approved by the Commission. This was codified in the draft 407 guidance policy. Back at one. As noted earlier, the idea for R&D program, the R&D program was initially presented to the EMC Agency by then Fire Chief Allan Pat Alano as a pilot study. The concept for the pilot program was vetted through multiple committees and stakeholders in Los Angeles County, and in May of 2013, the Long Beach Fire Department submitted our pilot project to the EMC Agency for their approval. The next step for us at this point was to update the policy reference number 407, which outlined all of the requirements of the RMD pilot project. Finally, the Data Safety Monitoring Board was created and officially formed by the EMC Commission as part of the policy reference. 407 The EMC Commission created the DSM-V. The board is comprised of four distinguished physicians and etiquette educators from Los Angeles County. The board was tasked with collecting raw data from the RMD program to review and analyze program performance and to identify any issues that could be a cause for concern related to patient care and safety. During the past year of program implementation, we have sent raw data once a month to the DSM B and Agency for review. The DSM-V focused their review on 32 specific data points and provided periodic updates to the full EMC Commission regarding the effectiveness of the program. Concurrently to seeking EMC Agency approval to begin the pilot program, we also provided regular briefings to the City Council through budget process and through periodic status updates to the full City Council, the Budget Oversight Committee, the Public Safety Committee. And in addition, we met with the Firefighters Association on numerous occasions to discuss the effects of the R&D program meetings. Those meetings were held on August of 2012, December of 2012, January of 2013, April of 2013. July of 2013. October of 2013 and April of 2014. During the discussion phase of the pilot program, we highlighted a number of potential advantages and some disadvantages of the proposed program. Implementation of the program would increase the number of advanced life support or ALS units citywide. We would shift from a system of paramedics on only 17 units in the city to a system with paramedics on all 29 units and around 29 units in the city. The program did provide the ability to add paramedic ambulances to stations that currently had none. Specifically stations 12, station three, and Station 22. Response time citywide to get a paramedic on scene of a critical call would improve with the new system. And we realized a dramatic reduction in a reliance on automatic aid from Los Angeles County Fire Department and Orange County Fire. In a year prior to RMD, we relied on L.A. County. Over 200 times to run calls for service in the city of Long Beach. And during the past year of armed implementation, we have only relied on them ten times for assistance. Additionally, we saw a number of enhancements in patient care outcomes and finally, implementation of our M.D. stabilized our budget. The disadvantages of the program centered around the impact of change. The change of deployment would alter a system that had been in place since the early 1970s. We did not minimize this concern and knew going into initial discussions this would be a hotly contested issue by our union, by neighboring unions in Los Angeles County and other stakeholder groups. For the past three years, the EMS agency has received numerous communications from groups that opposed this change. Another disadvantage of the program is a reduction in daily sworn staffing. This reduction, which enabled us to meet our budgeted goals, did reduce the number of sworn firefighters on duty each day and caused us to change our standard operating procedures and revise how we respond to certain non-emergency medical service related calls prior to the implementation of the RMD. Prior to implementation of the program, we engaged in a very robust training effort to ensure our people were well versed on the new program components. We assembled a team of department members to help create the Armed Manual that covered specific operating procedures on various call types not related to EMS that our people face. We conducted department wide training on the RMD program. We established a lengthened academy for our ambulance operators and increased driver training they received prior to moving to field operations. We continued to solicit feedback from the rank and file to identify potential areas of concern that needed to be addressed. And we provided continuing education and ongoing review process of the program and the various components. We convened an armed working group to address staff concerns and discuss potential improvements. R&D after all of this was implemented on July 10th, 2014, after over two years of discussion, meetings and preparation with the implementation, we began a two year pilot program on the new deployment model. We immediately began the process of collecting data that was required of the pilot program that we agreed to send to the SMB and the agency monthly, talking about how we collect our data. One big component of the R&D program is data collection. In order to effectively monitor the system, data was required to be sent to the by an emergency medical services agency on a monthly basis. Initially, we had planned on utilizing electronic patient care records, but a decision was made by the EMS Commission prior to the start of the RMD program that we should continue to submit our data in the same method in which it had been submitted for the two years of retrospective retrospective excuse me, study material. Our data originates a few different ways. First is a CAD or computer aided dispatch data. Second, the majority of the data that we see that comes from comes from individual emergency medical service or EMS report forms that are generated by our field personnel. These forms are manually filled in either by a company officer or captain or the paramedic while on a call for service. This has historically proven to be the most accurate form of data we collect as the information is compiled by the rank and file members in the field and includes a number of data sets not found with the CAD data. Lastly, many pieces of equipment used in the field timestamp the data being produced by those machines and for example, Cardiac Monitor has the ability to electronically transmit data directly to a hospital telemetry machine and show real time what paramedics are seeing in the field. This year, we sent nearly 15,000 emergency medical reports to the DSM-V, an agency to review. These reports were sent over in their raw form, not manipulated or altered in any way. And the Data Safety Monitoring Board evaluated those reports to evaluate our program. This slide shows some key data points that the Data Safety Monitoring Board was reviewing and a comparison between pre RMD and post RMD outcomes. Those areas that are highlighted in green on this slide indicate enhancements in our system over the past year. Next slide. This. Here is a summary of more specific data points that clearly show some enhancements in our system. The response time section at the top. Chest pain, cardiac arrest and trauma are all data sets that were generated by the Data Safety Monitoring Board and show pre RMD and post RMD response times for the first paramedic arrival on scene. The second area down below call volumes per rescue shows this is an average of all of our rescue ambulances pre RMD we averaged 13.1 calls per day per ambulance and post RMD 11.7 calls per day and at the bottom are reliance on automatic aid with Los Angeles County pre rmd 292 calls for service and post ten calls for service and Orange County 450 calls and post 218 calls for service. Since the inception of the pilot program, we've been in constant contact with the Emergency Medical Services Agency regarding the overall performance of the system and the specific data points being monitored in conjunction with our medical director, Dr. Steve Shea, who is here this evening. We have been responsive to any and all questions or concerns that the agency may have. In addition, we have brought forward a number of issues that we felt needed to be adjusted to make our system more effective. During the pilot project, we have only received formal communication from the agency on three occasions. Issues raised by the EMS Commission and EMS agency have been shared with the city manager and the City Council and the previous City Council and meetings throughout the pilot project. The first was the first communication we received from the agency was related to an issue we brought to the attention of the agency when we informed them that due to the large number of basic life support or BLS level non-emergent patients in certain areas along beach. We wanted to put basic life support ambulances into service to address those calls. On the heels of that move, we received a letter from the and the EMS agency stating that that we were not meeting the three minute time differential for arrival of the second paramedic, which was specified in the 407 policy. This specific section of policy states that we need to have a second paramedic arrive within 3 minutes of the first paramedic. 95% of the time, after receiving a letter from the agency stating they were putting our program on a plan for improvement. We met with the director regarding this requirement. We then went before the full EMS commission to discuss this section of policy, and their response was a decision to defer any penalties imposed on the noncompliance of Long Beach Fire Department in meeting this requirement that a one plus one staffed ALS or advanced life support units arriving at the scene of an incident within 3 minutes of 95% of each other of the time. And that that we would report back with calculated, budget driven data as to why we couldn't provide more units. One of their questions there was, why can't we just add more ambulances into the system? The second communication we received came in May. This was a letter that came from the Data Safety Monitoring Board, and it was related to the review of our data. Excerpts from this letter will be shown on the next slide. And finally, the last piece of formal communication came to us last Wednesday stating that the program would be terminated. And I will discuss this letter in a few slides. A new medical director, Dr. Gachet Hill, was appointed to the position of medical director for the local EMS agency on July 1st, after the retirement of medical medical director Dr. Cavanagh, who had been with us since the start of the program. The DSM v letter. This slide shows excerpts from the letter that we received in May of this year from the Data Safety Monitoring Board. This same information was presented to the full EMS commission in June of this year. This, of course, is a very positive letter from the Data Safety Monitoring Board about the RMD program. On August 5th, the newly appointed medical director asked to conduct a ride along to see the R&D program firsthand. This was the third such ride along conducted by a member of the EMS agency over the past year. Medical director Dr. Gachet Hill Road, along at Station one for 4 hours. Following this ride along, the medical director asked for a meeting regarding her observations. On August 13th, we met with the EMS agency and brought up and they brought up numerous concerns with the RMD program, which are now referenced in their letter. We we responded to all issues that they raised at that at this meeting. We're also very clear that our own medical director, Dr. Steve Shea, who is the architect of our paramedic program in Long Beach and who has been our medical director for over 30 years, would be the first person to pull the plug on a program that was a risk to public safety or a degradation of patient care. At this point, I'd like to welcome Dr. Steve Shea to come up to the microphone, and he's going to specifically address one component of the letter that was related to the fallouts that specifically deal with medical conditions and medical complaints. These were items that were put in by the medical doctor, and our medical director wanted to respond to those issues just as way of introduction. Dr. Steve Shea is our medical director. He's the medical director at St Mary Medical Center. He has been the primary and chief architect of the paramedic program in Long Beach since the early 1970s and has been with us every step of the way through this pilot project up until this point. So with that, Dr. Shea. I've been here. A long time. Yeah. I've been here a long time, and I've seen this program grow and develop and become. I think the premiere program in all of Los Angeles County, and there's lots of reasons for that. But when we got the termination letter, I was very surprised, too, to actually have gotten the letter and was surprised by some of the language in the letter. They talked about fallouts and, you know, fallout to me. Sounds like we did something wrong. And when you look at what a fallout really is, we looked at the four or seven requirements that actually we helped develop. And one of the requirements of that was that we guaranteed we'd be having two paramedics in the ambulance transporting Tier one patients. Now, a Tier one patient is somebody that has more likelihood to become unstable and require more treatment than our average patient. So we put that in the 407. We would accomplish that 100% of the time. And we do not accomplish that 100% of the time. And so those all came back as fallouts. Now, we reviewed all the fallout. We sent all the fallouts to the DSM-V. And in my way of thinking, fallout is something where there's an adverse patient outcome. In the fallouts, all the fallouts that we reviewed, we saw no adverse patient outcomes. So even though the numbers that and and we dispute the numbers we got from the county, we actually gave them the reports. I reviewed the reports that they reviewed. I they're their numbers aren't entirely accurate, but there are some fallouts in that. There were cases where two paramedics were not in the back of the ambulance transporting a Tier one patient to the hospital. In most of those cases, the patient improved at the scene, was stable, and there was no need for two paramedics in the back of the ambulance. In our old system. We had two paramedics in the ambulance, but one was driving the ambulance. So what we were doing certainly was above and beyond what we had done in the old system. So to call those fallouts, I think, is a little bit of a misnomer. Now. Do I think this system is better than the old system? Yes, I do. And I'll tell you why. We know that we get paramedics to the scene quicker in the new system than we did in the old system. There are a few time sensitive emergency conditions where that makes a difference. Patients with chest pain. Patients in cardiac arrest, trauma patients. The data from the DSM-V confirmed that in each of those emergencies, we were getting paramedics to the patient quicker than the old system. So I think it's a better system. Our numbers for resuscitated cardiac arrest went up significantly. Some people can say that maybe that's not statistically significant because the numbers aren't that big. But if you look at the data, there's a definite trend to more patients being successfully resuscitated under the new system. So do I think it's a better system? Yes, I do. Do I think we should close the system down? No, I don't. I think that. I think the county. Is jumping the gun with their fallout and how they've been analyzed. And I would like to get a meeting with Dr. Gachet to go over every single one of the fallouts individually. And determine whether or not we really have an issue. I don't believe there is I don't believe we we we have not uncovered one case where a patient was put in jeopardy because we didn't have two paramedics in the back of the ambulance and the county to this at this time has not given us any as well. So that's. That's kind of my read on the fallouts in and the system, and I still believe it's a better system. Thank you, Dr. Shay. So next steps. We do plan to meet with the EMC Commission at their next scheduled meeting to review the letter and discuss transitioning back to the previous model. We will develop solutions to meet fire department budget goals and we will work closely with the city manager and financial management to identify viable solutions. We will comply with the direction provided by the EMS agency and we will revert our system as per their requirements in this letter back to the pre RMD staffing model. With that, I would like to turn it over for to the last slide for Budget Manager Leah Erickson. In regards to the budget impact because we received this notice at this late date in the budget process. We are not recommending reopening the budget process. This termination of our M2, you will have an estimated $1.4 million budget impact to fire and rather than having fire come up with structural service reductions to cover those costs, we have a three pronged approach. First, we will house fire to make adjustments to minimize the FY16 budget impact within their budget. But then we'll also be tracking the first responder fee revenue that is being received in FY 16 and we'll be using that to help cover the additional costs. And if those two are not enough, we also recommend reserving 1.4 million of any 515 year end savings. Typically year end, we do have savings that do occur and that money will be a backstop in case there is not enough first responder fee revenue or other reductions in the fire budget to cover these additional costs. That is the solution for a proposed solution for 16, and any permanent fix will need to be addressed in the FY17 budget process. So mayor, vice mayor, councilmembers would be happy to respond to any questions now. Thank you. I'm going to turn this over to the makers of the motion first. Councilmember Austin. Thank you, Mr. Mayor. And I want to thank Mr. Manager, the fire chief and financial services for the report. I will just tell you that I was extremely taken aback last week when we received this information and this news. And so that is why I took a lead. And I want to thank Council Member Supernova and you Ranga for for signing on to this supplemental agenda item because it's obviously has a major impact on our governance, our budgeting, and particularly for FY16. The information that we read from the the County Emergency Services Emergency Medical Services Agency is a 180 degrees different from what was represented to us on August 18th at our budget meeting from the fire department. And so I'm I'm really perplexed here. I appreciate the the detailed report chronicling how we have arrived to this this point. I have been a I think I've been critical of this this model from from day one, because I was concerned about patient care. I and to Dr. Shea's point, I mean, I do appreciate your opinion, sir, and your service to our city. But it's clear that the the the agency for the county clearly disagrees with your assessment of our program. I do have a couple of questions, and I know there are probably many others behind the rail. But but during the hearing on the 18th, Chief, do you consistently cited reports of the Debris Data Safety Monitoring Board and stated that the data indicated that R&D posed no risk to patient safety. However, the EMS agency later indicated the DMA. The SMB monitoring is only one aspect of the evaluation and not reflective of the entire program evaluation. Did any other parts of the evaluation process raise any other red flags along the way for you, as apparently it did for the agency staff? Were there any other red flags? Councilmember. As we went through the process, the only other formal red flag that came up was when we were sent a letter from the EMS agency stating that we were not complying with a section of the four or seven policy that stated we would have the first paramedic and the second paramedic arrive within 3 minutes of each other. That came to us in the form of a of a letter and a formal kind of plan for improvement. We then went back to the EMS agency and discussed what we would do to to work toward that. We had multiple discussions on that issue. Ultimately, we ended up going before the full EMS commission to discuss that specific issue, to discuss that specific section of the policy and its applicability to any other EMS provider in Los Angeles County, which it was not. And ultimately, the EMS commission, the EMS commission, by by motion and a unanimous vote stated that they didn't want to take that section out of the policy, but they were not going to hold us accountable or punish us for not meeting it. But other than that, the vast majority of the communication we had from the EMS agency over the past year of the program has been positive. So so when was that that when did you get that communication from the MSA? That was you know, I don't have I we'll look up the exact date of the letter, so I give you the exact date. I don't have it off the topic. Was it within the last month? No, it was it was it was a while back. It would have been. I don't want to give you a I don't want to speculate on the date, but I'll get it for you right now. So so in your comments in your report, you also mentioned that there was a four hour ride along. And then after the ride along, there was there was some comments and some concerns raised. Is that true? Yes, sir. Okay. Is there any reason why you chose to withhold that information from the council when you were asked about the validity or any any risk with in terms of the armed process moving forward? COUNCILMEMBER Well, we've had, as I mentioned over the past year, on three occasions, we've had members of the EMS agency come right along with us just to evaluate or just to watch the program, monitor it, evaluate it. Doctor, the new medical director asked for asked for the ability to go ride along. She went and rode along. That's a fairly normal practice, not something I would normally bring up to the council. I didn't see any reason to inform the council that the agency was riding along with us on that date. And back to your previous question, that letter on the on the three minute time differential was sent to us on October 22nd, 2014. Okay. And then I'm also in reviewing the letter, it cites a review of 269 records provided by the fire department in which this patient was transported prior to the arrival on scene of a second paramedic. Okay. And if I understand that letter correctly, the EMS indicated that the the fire department deemed all of those cases to be appropriate departure from Tier one transport criteria. Or, in other words, that the patient would be transported by two paramedics. The however, the EMS stated that 48% of the cases, nearly half of them had significant concerns about patient stability in the field. These cases included acute stroke patients, patients in respiratory distress, trauma patients, children with apparent life threatening events, among others. And the letter stated that these issues are too great to ignore and pose immediate threat to patient safety. First of all. Would you agree with that characterization that these cases represent an immediate threat to patient safety? And if not, why not? No, sir, I do not agree with that. I believe that I. I do not agree with that. So of the 268, 269 patients that they're referring to, they cut that number down to 128 that they say were still in question, which amounts to out of the 15,000 reports we sent them over the past year, it amounts to 0.08% of our calls for service. And as Dr. Shea mentioned, each and every one of those calls for service that are questioned as to whether or not they are in in compliance with the policy or out get manually reviewed and manually evaluated by both our education team, by Dr. Shea and by the EMS director. We've had a number of these calls that we've looked at as recently as earlier today. And I'll give you an example of one, a patient, 40 year old male that was presenting with cool and clammy skin with a blood pressure of 80 over 40 at the beach after being stung by a stingray. The the patient had just been stung by a stingray. He was cool and clammy because he was wet because he had just been taken out of the ocean. And 5 minutes later, 10 minutes later, when they reevaluated his vital signs, his blood pressure came back up to a normal limit. The EMS agency said that was a fall out, that it had fallen out of our Tier one transport criteria when in fact, the patient had no medical reason to be transported to the hospital at all. So we evaluate each and every one of those things that are considered fallouts, as does Dr. Shea and the EMS agency. And so, no, I would not say that they just automatically constitute an emergent situation for the community. So is the EMS agency considered a credible authority in terms of governance over over help services in the county, other fire departments? Yes, sir. The EMS the EMS agency provides all the pre-hospital guidelines that we follow to deliver emergency medical service. Yes. So it sounds to me like we have some serious dispute with with this this credible body, and that that raises some some serious concerns with me. I mean, I don't know that we're in a in a position to necessarily take them on as a as a as a city, particularly citing the fact that they they do have some regulatory authority. I do have some some some practical questions for you. What is our current staffing level? And are there no firefighters currently in our department to restore these positions, or will it have to be accomplished through overtime? Councilmember the we have enough firefighters to staff the organization. What will happen when we revert back to the to the old system is a number of the people who are in a paramedic position now will not be they will revert back to they will revert back to a firefighter position and lose the they will not be functioning as a paramedic in our system anymore. So they are firefighters and they'll just go back into the system the way they were. If you recall an earlier slide, we go from 11 ambulances currently with one firefighter paramedic on it down to eight. So we believe we have enough firefighters to manage. And as a system, there could be we'd have to have I'd have to look at that with my deputy chief of operations. But there could be a need for overtime in some places, but I believe we have nothing. And in the budget presentation and I believe on August 18th, you know, the plan was to eliminate 24 positions from the budget. Is that that still going to be the plan? Yes, sir. So we're still going to eliminate 24 positions from our budget. And because I think I ask you to question whether or not the elimination of those positions were tied to the R&D program. And you answered affirmatively. Actually, no, sir. The elimination of those 24 positions, those 24 positions were related to the daily engine reductions or the brownouts that we were carrying in our budget from a number of years back that had never that had remained in our budget, but had never been filled. So those positions had nothing to do specifically with R&D. All right. So now I'm really confused. And lastly, and I'll let my my colleagues answer their ask their questions. Are we I heard that we're not planning to appeal it, but I saw a communication earlier that we were planning to appeal it or plan to go to the Imus agency to to to challenge this race and ask questions about this on September 16th. Is that correct. Councilman? But we have no plan. We've been informed that there is no appeal process. However, the department and our medical director, Dr. Shea, will be there at the EMS commission because they're going to be giving an update on the fact that we're they're closing down the pilot program. We're going to revert back to our old system, at which point we will speak to the EMS commission about our findings throughout the program. But we're not we're not calling it an appeal. We're just going to go meet with them and discuss how we're going to revert back to our old system. Q Mr. GROSS and Lisa, thank you. I think the solutions put forward to mitigate this issue, I think they're they're they're credible options for us to consider as a council. And I just got to say, I'm really disappointed that we are at this point. I know there were high hopes for this R&D model to be successful and forward for it to be a model for for fire agencies across the state. I still think that our model was unique to Long Beach and and and, you know, even though it was implemented and similar models are under are being practiced in other areas of the state, none are as large as our department. And the the the the ideal of putting a sworn firefighter on a rig with a non sworn EMT is. It was I think it was it was fatally flawed. And yes, there were challenges to that. But, you know, at the same time, you know, you have to to step out there and be bold sometimes. But at the same time, I'm going to just be very straightforward. When I read this, I felt like I was was misled. I felt like I was misinformed by by our staff. And that was disappointing to me. Councilwoman Price. He. I'm sorry. Go. Don't go there. Thank you, Mayor. I'm seconding this motion. I agree with. With the Councilmember Austin. Either make a motion. So the motion is to receive and filed this report and to direct city management, not to appeal the the decision of the Emergency Medical Service Agency. Okay. This procedure. I too was very disappointed in the letter. Obviously, when this first came up to me last year, I did question the. Pilot program aspect of this of this whole whole thing and wanted to go ahead and and approved it at the time, considering that it was a pilot program. However, the last budget hearing that we had with the fire department was that it was moving forward, that it was budgeted fully as a pilot project. And yet this letter says they want to go back into contingency to your contingency plan. It's clearly stated here, I didn't see a contingency plan in here. So I'm guessing that the contingency plan is a reversion to pre rmd service levels. Council member. Yes, that's true. We sent email communication, a memo type communication to the EMC Agency as part of the creation of the governing document of this program. That that basically said it would be the responsibility of the fire department, the city manager, and ultimately the city council determined to determine how we would revert back to a previous deployment model should we be required to do it. We we didn't get very specific in that in that communication with the county because we didn't want to relinquish the control of this city council or the city manager or the fire department administration to make decisions on how we deploy our resources. And that's that's good. However, when it comes down to the budget, we're it's not there. I mean, we now have a hole of 1.4 million that we're looking at. Financial management is proposing a a fix, if you will, looking at the. What's that? I misplaced it near the end here. The. First responder fee using those in addition to any savings that we have at the end of the year. And then some other I guess some other fees that will be addressed out there. And that's my that's that's my problem. That's my concern, is that now that the pilot program basically has been terminated, from what I understand, there is no appeal process to this. So we're stuck with a pilot program that did not work and and without a budget to fix it. So now we're looking at trying to fix a hole in in the fire department's budget to get to revert back to a process that we should have. Basically, I think prudence would have told us to keep that budget in there somewhere in case or in the event of an emergency where this pilot program failed. And we didn't do that. So I'm very concerned with with that aspect of what we're dealing with today. So I'm checking in this motion. Councilmember, I do want to point out, though, we're no worse shape off than we were when this started because we had a $1.5 million hole. This program backed it up. So we're just back to where we started. So rather than eliminating an engine or a truck, we tried to do this program. So no one has that intent to make that recommendation. Now, you heard what Mr. GROSS and Ms.. Erickson are saying to to deal with the 1.5 million. But we had a $1.5 million hole, whether we did this program or not. Come tomorrow. You are wrapped up. Okay. Councilman Price. Thank you. I appreciate the presentation tonight by city staff on this issue. I know that you have been working diligently since you received. The letter on last Wednesday. So I appreciate your efforts in trying to update us. And I get the sense from the the presentation tonight that all parties, in terms of city staff, are in agreement that there was a good faith basis in regards to the implementation and the operation of the project. And I respect that and I appreciate that. And while I appreciate the opinions regarding the effectiveness of the model and some viewpoints, I will say that that conclusion is very much in dispute at this juncture, and the authors of the report are not here to defend their findings. And so while I appreciate the position that our staff has taken in, our leadership has taken in regards to the effectiveness of the model and the foundations that led to the findings of the EMS report maybe being different. We are now in a situation where we as a city are in receipt of a letter from a regulatory agency that raises some very serious concerns about patient care standards. And that is that's the reality. That's the reality that we find ourselves in. And I think it's very important. At this. At this juncture that when I wanted to offer a friendly, although it was implied in the presentation, that we immediately cease the R&D model in light of the findings that have been given to us in writing and appear to in no uncertain terms, indicate a concern from a regulatory agency regarding the safety of this model for potential patients. So I'd like to offer that friendly. Except hey, there's a motion and a friendly that was accepted. Councilman Price, did you have anything additional? I have. Please go ahead. In regards to the funding. You know, I think we as council members do our very best, each and every one of us, to understand areas where we don't have expertize in regards to staffing. And, you know, some of the data that you presented tonight, it's very natural for you to present this data. It's this is the language that you speak. But to us, many of us don't have that expertize. And so the big picture issue, I would say, and I don't mean to speak for my colleagues, but I think we look to our city leaders to come up with the innovative ways to resolve this issue. This is now an issue that we've all found ourselves in a predicament. And how we respond to this predicament is, you know, as a member of the city council in this body, I would be looking to our city leadership, specifically our city manager and his team, to help come up with innovative ways to resolve this issue that we now are faced with. And so. I think while I will be open, I'll be open to hearing what some of the ideas and and thoughts of where the funding will come from. And while I appreciate our financial management team coming up with some temporary fixes, I think this presents more of a long term issue that we're going to have to think about, because moving forward, we had all hoped and expected. And I. I do believe that. The fire chief and city management staff believed that the pilot program was something that was going to be well-received and something that was going to be a long term methodology to be used by the city. And so we've based a lot of budget projections on that. And now that has changed. That reality has changed. So, you know, I'd be interested in finding out how we deal with this tomorrow, how we deal with it in FY 16 and what the plan is long term moving forward. And I look really I look to you for guidance. I look to our city management team for guidance in that regard. This is your area of expertize we're looking for from direction for we're looking for direction from you as a team and specifically our city manager who who helps guide us in all things impacting the city through his various department heads. So I want to thank you for the presentation. And again, you know, regardless of of what happens in resolving some of the findings and whether or not there is some agreement on those disputes in regards to the foundations of the either parties opinions, I think all of that is is to be discussed at some future time because at this juncture, we have a report that we need to deal with and act upon. And and I believe we're doing that by tonight's action. So thank you very much. Thank you. A Councilmember Richardson. Mr. Mayor, can we have the friendly repeated? Absolutely. Mr. City Turner. We actually repeat the whole motion as it stands. Mayor members of the Council, the motion, as I understand it, by council member Austin and seconded by Councilmember Iraq, is. To receive and file the report and not to appeal the decision and that the friendly amendment was to terminate the. R&D program immediately. I would like some clarification on immediately, I believe. The letter indicated. By October 1st and. That if more time was needed, the city needed to notify the department by I. Think it was September 15th. I, I certainly am not the person to answer that question of whether what is immediate and what is immediately. Well, I will try to clarify that the intent of my motion was immediately as and as of tomorrow. And the reason for that is because although we may want to be in compliance with the letter, which allows us some time, the letter also has a finding that says we're practicing a methodology that is potentially causing patient care risks. And I just don't know how we continue. Now, we're on notice in writing of a potential issue in the manner that we're delivering medical care. So I guess I would maybe. Ask the city attorney, do you believe that it would be prudent for us in light of these findings to continue the methodology, even though the regulatory agency is giving us time to comply? Well, I guess the question I would have is, is what could be done? Practically speaking, how can they convert back to the other program? And I would leave that, obviously, to the experts in the in the fire department. I think the direction that I'm taking from this, as I understand the motion, is to do it as expeditiously as possible, protecting the safety of the individuals. I, I. Also think that there is. Credible evidence and an argument to be made that, you know, there's a disagreement with. Some of the decisions and the letter itself. So the letter itself. Isn't evidence of specific conduct or instances. It's where they had concerns. And I don't have enough of the specifics and each one would be factually based. But if we had to go through each one of those, we would have to do that and we would have obviously someone looking at those two. And I and I understand that and I appreciate. But wouldn't we cease the practice and then discuss the disputes and then. I mean, to me, it seems like we would the prudent approach would be to cease a practice that is potentially detrimental. Now, that's that's my my thoughts on it. But again, I think your wording is probably better as expeditiously as practical, perhaps under the circumstances, because I do understand there are some staffing, major staffing issues that need to be worked out, and I respect that. So the intent behind the friendly is to. Respond to the findings. If we want to take them on or challenge them, that's another thing. I don't think this is the time and place to do it because I think the prudent thing to do is to err on the side of caution. If I can interrupt. We have no intention of. Of appealing. We have no intention of going up against the commission on anything. So we're accepting this totally 100%, and we're going to begin immediately. I can promise you that. We definitely I've just talked to the chief. We will have it back to the previous situation by October 1st. If we can do it before October 1st, we certainly will. But again, I just want to point out that we have no intention whatsoever about revisiting anything with the commission. We simply want to talk to them about putting going back to the. They wanted us to talk to you about going back to the the old system. Had something because I just want to weigh in, Mr.. Mr.. West. And I just want to just add to that that I am 100% in agreement with that. Just for the record, there is no appeals process. I personally talked to the medical director today, both the medical director as well as her boss. And there is no appeals process. We're not going to appeal. I think that they're aware that the chief and his team are planning to attend the meeting, in particular to share how they would kind of discontinue and go back to the old system by October one. I think the plan has always been to go and go back to the system for the letters request, but there is absolutely not going to be an appeal and there is no even if the city want it to. There's not a process. And so that's not happening. And thank you, Mayor. And I do want to point out, too, though, the EMS agency, certainly they've invested a lot in this program, too, and they want to talk to us as we unwind it, because they certainly want to review. They want to come back and interview our paramedics, interview our employees and talk to everybody in the department over the next three, four or five months on what was strong about the program, what was weak about the program. So because they're all about change as well and they see change coming to this is just a program they couldn't get behind. And we are accepting that and recognizing that. And we'll work with them after the program's concluded, because they do want to do a an analysis of the program and publish it and what went right, what went wrong. So other fire agencies can look at this. And I think and Mr. West, thank you for sharing that, because I think that's an important point. Again, we're not involved in the the details to the level that the city manager is and certainly the fire chief. And so, you know, maybe there's an aspect of this that they feel most strongly about that might have been modified or changed or tweaked. I don't know. I just want to make sure that we are respectful of the process and their intent and that we are not doing anything that could potentially appear to be ignoring. I can assure you that that will not be the case. Thank you. I appreciate that. And again, like I said at the outset, I really do believe there was a good faith basis. And I do believe that the fire chief received information along the way that was encouraging. I know that for a fact. In fact, the parts of the letters that he's shared. Prove that. However, the decision, as unexpected as it may have been, has caused us to be in a bit of a predicament, and we need to respond to that. I think in the most prudent, cautious and conservative manner. Thank you, Councilwoman. Councilmember Richardson. Thank you, Mr. Mayor, and thank you for the presentation and the proposed budget solution. I clearly see that some work has been been been done in the last few days since we've gotten this notice. My top concern is the safety of our residents. And and I want to get down to some facts. I'd like to get more clarity on this particular budget solution. So to begin, I personally I know that we strive in almost everything we do budgetary to be we tossed around words like prudence and fiscally conservative. I think we've learned a good lesson. Well, I think the entire city of Long Beach has learned a good lesson that we can't if we don't control our own fate, we can't gamble by putting the lives of our residents into the hands of some other regulatory agency. So so to get to the specific questions I have number one in the presentation today, I there were a few questions I had. So first it references that we were not the first we were not the first agency to implement this. And it says that Los Angeles I think it says Los Angeles implemented the program. Is that correct? Or Los Angeles approved the program. A councilmember in 1999, then fire chief Mama Autry actually brought this brought a similar version of our M.D. before the city council and the mayor there. It was approved. It was taken over to the EMS commission, where it was also approved. So they had approval to move forward on it. It was going to be a localized deployment only in the San Fernando Valley area. And ultimately the Los Angeles City Fire Department never went into that deployment model. So the presentation, so it was approved, but it was never implemented or tested? That's correct. Now, not in Los Angeles County, no. So the presentation is misleading and makes it just at first view. I'm thinking that it just says it says where did it come from? R&D not invented. In Long Beach, 1999, City of Los Angeles Fire Department received approval. Just at a glance. I would want clarity to see, to say it was a received approval, but it was never implemented or tested. So this just appears just a bit misleading. I think secondly and I see in here there's some reference to some communication with the Data Safety Monitoring Board or or or is it, I think, August 13th, some conversation with the medical director. I know that two weeks ago I asked the question on whether we had a sense on whether or not the county would reject this program and what would be our contingency plan. And then I believe the response that we got was, Councilmember, I don't have any indication that the county would step in given the data that was submitted to them over the past year and given the data safety monitoring boards letter that they submit to the full EMS commission, I don't have any indication that the agency wouldn't look at the data and see clearly that the program is effective based on the data. So I think there's I'm unclear on to today's presentation says that that there was some conversation but last week it it says that there wasn't some conversation. And then the letter the letter that came in says that the agency conducted multiple ride alongs with different agency staff from July 2014 to August 2015 and identified major concerns regarding training, mentoring, oversight and system performance. And while some of these are expected at the beginning of the pilot, the persistence after a year is most concerning. These issues have been brought to your attention on multiple occasions, most recently during our August 13, 2015 meeting. And then and then it goes on to say that because my original question was about the contingency plan, and what I heard was that it's really not necessary to have a contingency contingency plan. But it says here that per March 14, 2014, the contingency plan for City of Long Beach paramedic pilot staffing model was referenced. So what I would have preferred to what the more clear, direct answer would have been, there is a plan. It's not very it you know, it hasn't been fully developed, but there was a plan submitted until 2014 because that was the question. So I guess I'd like for you just to respond to these three areas where I left the last council meeting with some certainty that there was no indication from EMS. But then the letter references, not only an indication, but also that we submitted a contingency plan. If you could just respond to that. COUNCILMEMBER The August 13th meeting that we had came on the heels of of a phone call, the new medical director, she did her ride along. She ended up making a phone call to Dr. Steve Shea, basically stating that she had some concerns, wanted to have a meeting. We set up the meeting on August 13th and a number of my staff went and met with the EMS agency. I need to point out clearly that this was a fairly common practice, even with the previous medical director. We. Since July 10th of 2014 to that August 15th, August 13th, excuse me, it was fairly common for them to have a question or concern come up at the EMS agency and we would mobilize our staff. Sometimes I would go some most of the time it was our staff would respond out to the agency. They would sit down and they would engage each other on whatever the issue was, whether it be a specific data set issue or response time issue or whatever. Those meetings were very, very common. And so this meeting that we had scheduled for August 13th was we viewed it as a very common practice. This was consistent with what we had dealt with all the way along when we left that meeting on that day. Everybody in the room, including Dr. I'm speaking for Dr. Shay is including Dr. Shay. And my entire staff felt that, yes, we still have some unresolved issues as we have had in the past. And we're going to continue to engage in discussions with the EMS agency, agency to ensure that they are in a comfortable place. We're in a comfortable place and we will continue to move forward. When I told you at the City Council meeting at my budget presentation that I had no expectation that based on the data we had submit to the county, that we would be in a situation where they would terminate our program. I didn't I didn't use those words there, but that was honest. We were in the midst of discussions that were consistent with probably 15 other meetings we had had over the previous year. So I had no reason to believe when we walked out of that room that the that I would we would receive a letter a week later or a week and a half later that would terminate our program. Going back to the contingency plan, the contingency plan was merely, we felt, a simple kind of budgeting exercise. If we had a $1.5 million hole in our budget that we used at that time, or $1.4 million budget, and we created armed so as to avoid a future engine closure or closing another ambulance if if that system were to be unwound. We viewed that as a simple kind of budgeting exercise for us. And we would then be faced with a $1.4 million hole in our budget, at which point I would bring my staff together. We would work with the city manager, we'd work with financial management to determine feasible solutions to the budget hole that existed if they were to unwind the program. So the contingency letter that we sent back to the agency, while not overly detailed and specific we felt was sufficient enough to give us the ability to determine what we wanted to do, should that should that situation ever arise. And, Chief, I think I understand the intent, and I think it was all well-intended, and I do understand the miscommunication on. I asked for certain things, but I think you were asking for you interpret it as did you receive anything outside of the norm? And I get that as well. As a leader, you have to make those calls. But I think I think we all understand that there are ramifications for the decisions City Council makes. I think we're elected to make those decisions with full information, not necessarily filtered information. We'd like to just know that whether there was communication or not so we can make, you know, an informed decision on our own. And that's just my opinion, I would say, next, I think the way that's been framed tonight is that this this has been a program that the city of Long Beach has openly welcomed and that this you know, this comes as a surprise. But the truth is, I've been in every city council meeting the last five years for the most part, and this has been controversial since day one. And so in that said, I know that there have been very vocal opponents and the rank and file I know that certain council members have expressed concerns with this program. And I understand your role as a leader and I totally understand the budget ramifications. My question is, what have we done over the last two years? Have we had any specific outreach in terms of joint labor management meetings to meet and consult on an informal basis, on an ongoing basis about this program so that you can bring the rank and file on on board so that maybe we wouldn't have had this this this sort of outcome. So has there been some ongoing joint labor management discussions about this program? Councilmember We, as I mentioned in my presentation, we we had seven specific meetings where we discussed the RMD implementation and the specific effects of that of this program. As we went into the program during the period of the program's implementation, we've had a number of labor management meetings scheduled, which the labor group has canceled or not showed up on about three months ago. We actually it was almost three months ago, right about three months ago under Chief Rose Leadership, he established a working group within the Department of Members of all ranks to come in and offer their opinions. What we wanted to know through that. We knew what the data says. We know what the the call the response times are. We know what the outcome data says as as I showed you in the presentation. But we wanted was more of kind of an experiential. Employee satisfaction how they feel about the program and we were going to put to see if we could identify some themes that we could put together and address with the input of, of the work, the actual people who are doing the work in the stations we have at this point, those those groups are still functioning at at this point, we may be best suited to have them turn their direction on to what the department looks like going forward into fiscal 17 or something else will continue to utilize that. But yes, we've done we've made numerous attempts to reach out and in a collaborative manner ask for and solicit input from all stakeholders in the organization . So I think and so I think it's in just as much in your interest and our department's interests that we that we build and cultivate that relationship with the rank and file and not necessarily leave it up to the union to attend certain meetings. This isn't necessarily about the the union. I think this is we bet on this. And we left it our relationships up to a non-binding board when there was essentially a number of individuals who could have canceled this program. I think considering how fluid and how volatile this program was, we should have we should moving forward, work on that rank and file relationship because it matters. Employee morale certainly matters. And it actually was represented here in this in the letter employee morale. So I would that's my suggestion moving forward now regarding the budget. I see that there are budget solutions that restore the a million and a half hole that R&D filled. Now. If we were to return to pre armed levels, how many rescues are in place at the two 2013 pre Ahmadi levels as opposed to today? Councilmember there currently we have eight advanced life support rescue ambulances in excuse me we have 11 advanced life support rescue ambulances and service. When when we revert back to the old system, we will we will have eight. So again, the the budget for the presentation today, if the question wasn't specifically asked, I think that the public might have saw it as we have a solution to where there's no service impacts. And that's not true. There will be at least three there will be three taken out of service which it which have major budget, major impacts to the quality of life of our residents. And I think that's something we need to just be upfront about and address. So that said, in terms of now that we're going back to this baseline of eight. What will be our process for deploying those eight and making sure that we that we have as as in as efficient a program as possible or a process as possible. Councilmember over as we move forward over the next few weeks, what we will do is we will utilize our run modeling software systems that we've used traditionally over the past ten years to make data driven decisions. We typically use them, unfortunately, for when we're going to select something to take out of service. In this case, we will apply all of our historical call volumes into the run modeling systems, and we will make decisions on where it's not only about rescue ambulances, because we're going from 11 rescue ambulances down back down to eight. But right now, we currently have a firefighter paramedic on every fire engine in the city. And we're going to take that back down to only nine engines in the city. So we will use our run modeling software to determine where those paramedic assessment engines should be and also where those rescue ambulances should be in order to meet the needs of the community to the best of our ability when we move forward. Thank you. So as I understand it, what you just said, we're not going to use some methodology from the past and 2013 methodology, but we're going to use data from today current data to justify how we implement this model. Is that correct? Councilmember That's correct. I mean, the data from a year and a half ago in the fire service tends to change constantly, which is why we constantly evaluate it. And because this is a big change to go go back to a system with fewer resources in it. We're going to need to reevaluate the existing data, the best up to date data that we have to determine. We're placing our resources where they need to be. Okay. So it's fair to say that whatever happens now may not be the exact same deployment strategy as it was in 2013. That's quite possible. Yes. Okay. I will I will agree with that. I think there's no magic wand to solving this. I think that we we need to look at this as we're going back to rebuild our system. We're going down eight and going to rebuild our system the right way based on today's data. And we're going to be upfront and honest about how we build that. And we're going to, you know, and acknowledge that we do need to make investments again in our fire department. So those are my statements. Thank you. Councilwoman Gonzales. Thank you. Thank you for the presentation. I have a few questions myself. Of course. First, why did we believe that there was an appeal process? I understand yesterday there was mention of an appeal and now there's no option for that. Counselor. That was probably my problem. So this all just hit us pretty fresh last Thursday. So we thought there was an appeal process. I assume there was one. And as I delved into a deeper, I discovered there was not. Thank you. And then next question, which it says budget adjustments will be made, of course. Will they be in addition to the 24 eliminating the 24 vacant positions? I mean, what else are we looking at in terms of budget implications for the fire department at this time? Councilwoman Gonzalez, the fire department is tasked with trying to find ways to reduce their cost to minimize the impact of the 1.4 million. But we are not asking them to make like a fire truck eliminations or other other types of service impacts. So we really believe that the the mass vast majority of this will be covered by the first responder fee revenue and if not that, the backstop of the year and savings. Okay. And if for any reason that doesn't isn't sufficient, is there another idea? The so the we're recommending 1.4 million be set aside at year end 15 as the backstop to cover the additional costs. And so that that would assume like $0 came in with first responder fee. And we do know that there will be some revenue coming in with first responder fees since that has been approved. And then last point here. So I see in the letter it says no effective mechanism to aid high risk. And also mentions data collection is not robust enough. But then in ours, of course, it says it is. So where is the. In that sense? Where is the confusion or where is the difference? Because we see. That that's a huge. Difference. And I don't know how we work through that and still believe that that's a good model for us. Councilmember with this with the first question specific to an inability to identify high risk patients, nobody in my command staff, nobody in my in my education team, in EMS and even my medical director have the slightest idea what that is. What it refers to, we have no idea. We are baffled by that statement completely. The the robust data collection we believe that that is referring to. If you recall, prior to implementation of RMD, we had talked about going to an electronic patient care reporting system. In fact, we were all kind of ramped up to do that. We were ready to go. But just prior to implementation of our M.D., the EMS Commission came back to us and said, We want you to continue to provide your data to us the same way prospectively as you have retrospectively. So we for an apples to apples comparison, we want you to collect your data the same way going forward. So we stopped the electronic patient care reporting in our last meeting with the the director of the agency, Kathy Chidester. She pretty much she pretty much came right out and said that the way that we're collecting our data, the pen and paper reports did not provide them she felt did not provide them, and an ability to kind of query information out of the data fast enough. And we believe that that line in that letter is basically saying that they would like to see us move to electronic patient care reporting or whoever else is going to do this program, use an electronic means of communicating that data to the agency. That's what we believe. Okay. That makes sense. Thank you. And then. Okay. All my other questions were answered. I will just touch on the point that Councilwoman Price and Councilmember Richardson mentioned, and it is the relations between the rank and file and management. And I can't stress that enough. I know we know that there's issues there. And I just would hope that I think some of this could have been resolved on maybe the the back end if we would have had better relations between the two. And I think I would ask that our city management staff really step up to be able to be that liaison in between, because I think it's very important. Now we're put in a situation where on paper and. Whatever the case is, it just doesn't look. Good. And now we have the perception that we've been we have a model in place that just hasn't worked out. And whatever side we're on, it's this is now the reality that we're faced with. And so I would just really stress that somewhere along the line that we're working on that relationship somehow, some way, I think it's very important. So thank you. Thank you. Next speaker, please. Yes, thank you. You know, I think everyone kind of realized that the public safety is our most important, you know, priority to the local government, the city of Long Beach. You know, I'm always supporting our firefighters and our police because I think they do a great job and the safety, you know, to protect our city. You know, I've seen how hard that these Long Beach firefighters and the police department work. You know, so the first firefighters and the paramedic California then I am proud to support at any and all times. But. When the chief first proposed the Earth M.D. program to the city. To the city council. I have some concerns. In my opinion, our previous EMR system with the two professional firefighters and paramedics response to each serious medical call was working very well. But along with the rest of the city council was assured that the new AMD program would save our city money that would not be diminished and the quality of care would provide to our residents. In fact, we were all told that the AMD program would actually improve our emergency medical response system. And because of the cheap shots I supported and proposed our M.D. plan, as did a majority of the City Council in the Art AMD program, has been in effect for, I think, more than two years now. And throughout this time all I've heard from the fire chief is that the program was working well. And now we found out that this is not true. I am disappointed. And sadly, by this transfer, I have lost trust and confidence because the fact that all we asked for, each one of you, you know , top assistance is the true. And that says an opportunity like that, especially we're dealing with safety and protection. I think the truth is the most important thing. You know, the L.A. County Emergency Medical Services Agency canceled the R&D because it had failed. And let me read just a few of the lines from the letter sent to Chief DAVIES, director of As Agency. You know, the RDM has created an environment that is not conducive and good patient care. Rescue ambulance are being shipped with a newly trained paramedics and EMT who has very limited experience. You know, I could go on, but why should I? Because we've heard most of this tonight. Colleagues. I am disappointed that I am even in this position tonight made of the proposed project never measured up to the promise made. I'm not interested in hearing any more of the same things tonight and trying to say that program. So I think it's time for us to terminate R&D once and for all and get back to the system that provides first class care for the people of Long Beach. Thank you. Thank you. Vice Marie Lowenthal. Thank you, Mr. Mayor. I know there has been a lot that's said today, and I wanted to thank my colleagues for articulating their thoughts on the position that we're in right now. I especially want to thank staff having been on the council almost as long as council, actually a little couple of weeks longer than Councilman Andrews. I recognize my role in in this, and I will reiterate what Councilwoman Pryce stated, which is we look to our staff, our department heads and our city manager to come up with strategies, especially during the horrible budget times that we experience, to come up with strategies and ways to close our deficit, our budget deficit. And so we provided parameters for each department. And the chief came forward with a model that, while it may have been unique to Long Beach for a Long Beach's history is not necessarily unique in the state of California. I believe we did this in earnest and that the staff did it in earnest and also did it in good faith, as Councilwoman Pryce mentioned. And so what I hope I know that we have shared a lot of frustration this evening, and it's rightfully placed. I, I don't dispute that. I think our challenge today and what I hope that we can focus on going forward, we have a week and a half, two weeks before the charter requires us to pass the budget. While Ms.. ERICKSEN indicated that this does not impact our current budget process structurally, we do have to look forward. Councilwoman Pryce articulated that very, very well. Looking forward, our obligation is to work with our department head, work with our city manager, and ensure that we have a structural solution to this and. While it doesn't necessarily have to be visited tonight, we did earlier in the Budget Oversight Committee have a short discussion on this. And as it is the case with any other department, the department will have to manage any deficit that comes up. So and I say that just to acknowledge my role in all of this, my personal role in all of this, there is no city staff versus council leadership. This is this is all of us. And we find ourselves in this position. And I would like us to be focused on doing, again, exactly as Councilwoman Price indicated. Let's move forward. Let's terminate the pilot. I believe it was a good effort. I believe in our data. I don't want to dispute. Our own staff information at this time, I don't think that's that's healthy to do that. And I also don't want to go line for line into what the letter indicated. I that's not what we are called to do today or call to move forward. And we're called to move forward in a very judicious way. And so I support Councilwoman Price's friendly. We will move forward. And I look forward to the next couple of weeks hearing about the three prong plan that Ms.. Erickson laid out for how we will manage this deficit if there is a deficit after we look at the first responder fee within the department, because we don't need a reminder that we do not have resources in the remaining 20% of the departments to extract any deficit that comes from this. This will have to be managed by the department. And so. To the fire. Chief, I want to thank you for coming forward with. What I believe is still a good effort and coming forward tonight in sharing your thoughts on it. But I look to you to get us through this and figure out how we're going to manage our deficit. Thank you. But thank you. Jason, your comment? Yes, I was going to say thank you, vice mayor. The the reality is and I just I feel I need to say this. This is this is a profound disappointment for me and my staff as well. And the men and women in the fire department that worked so very hard on this, my entire command staff, the deputy chiefs, the assistant chiefs, our nurse educator, our director of education, the all the educators there worked very, very hard to make this program successful. Unfortunately, as a result of the letter from the EMS agency, we will revert back to the previous program. And that's that's okay. But I don't want to diminish the work, the good work that our folks did. We took a very bold step at a very uncertain time, given our budget, given a series of reductions that impacted our operational capability. And I just don't want to minimize the impact and the chance that our folks took to do the right thing for the city. And I want to thank you for saying that. I do want to state that I believe every day the good men and women of fire show up every single day to do right by our residents. And they do it not in consideration of any budget model or any particular model, but they do it because they're doing right by our residents. So thank you for that. Councilman Price. Thank you. I'll be very brief, but I do think it's very important, given the the time that. Staff and the chief and his command staff have put into this project just to say one thing, and that is we consistently ask our department heads to look for innovative ways to deal with our budget. And you did that. And I know there's a lot of department heads who are sitting in this council chamber tonight, and I don't it would be a shame if even one of them walked away from this and thought, I'm not going to try anything new. Because of a risk of what might happen. That would be a shame. And I say that. And when things like this happen, I mean, you can really only analogize them to your own life experience. And I can't tell you how many times I personally have gone to court and a judge has given a ruling or a jury has done something. And I've come back to my colleagues and said, I have no idea where that came from. That was totally unexpected. And there's a disappointment there. And I and I completely get that. But that doesn't mean I don't keep trying innovative things and ways to do things. So, you know, that may be a very lame analogy, but I say it because we have a lot of department heads who are sitting in the council chambers. And I want you to know that personally when we say please think of innovative ways to help us with this problem, I speak only for myself when I say I mean that meaningfully and authentically. It's not just lip service. It's not like try something new and if it doesn't work out, shame on you for trying something new. I'm not going to say that. The bottom line is, and I agree with the vice mayor that, you know, we don't want to be in a position where we're going line by line because it's a disputed issue. You know, there are very few facts that are undisputed in this right now at this time. Maybe that will change in the future upon further discussions with the entities, I don't know. The one thing I will say, and I respectfully I don't even know that I disagree, but I will say that if in fact, there is going to be a necessity for a budget. Cut. Let's say that are you know, the only thing that I would change is, you know, we try innovative programs and we have a definitive contingency plan. If it doesn't work out, here's what we're going to do. I know that we now have a plan that Ms.. Erickson has articulated that seems great, and I'm very hopeful that that works out for us. But if in fact, it doesn't and cuts are necessary, I will say, speaking very personally, I cannot imagine that I would support any further cuts to public safety. I'm just going to and I may be alone, a lone council member on that voting on my own, but I cannot imagine that I would support any cuts to our police department, our fire department, including our lifeguard services. I just can't imagine a scenario where I just think that everyone is operating on a bare bones level right now. And so I would be interested if there is going to be cuts to look at where else cuts might come from. Because, you know what, maybe we put off our fleet program. Maybe we I mean, I'm not I'm not saying suggesting that. I'm just saying we need to look at please, nobody nobody from Fleet get upset. I'm definitely not suggesting that. But we as a city have to work together to get through these next few years of tough times. And we have tried the proportional share model. It's it's working. There's data that supports it. But maybe as a result of this predicament, we need to do something different for a few years to make sure that we're keeping up the public safety standards that we need to keep up. Maybe we need to cut more in administrative resources. I don't know. But I'm just speaking personally on my own behalf that I would put up a very strong opposition to any further cuts for the next few years of our fire department and our police department. I just think that those are two areas where we need you more now than ever. So that's just, again, total personal opinion on that. Thank you. Thank you, Councilor Richardson. Thank you. Just a couple more questions that that I forgot to ask. So. One of them. What is our what, chief? What would you say would be your timeline to evaluate and get back to the council and to form for your approach to deployment moving forward? Well, Councilmember, we have already started having these discussions. We will run our system, ah, run modeling system here over the next the remainder of this week and get into it next week. There's a system that we have, a process that we're going to have to go through in addition to determining where the resources go. But we're talking about rebidding. We're going to have to rebid the entire department, move people all around to different places. We're going to have to engage in a meet and confer with the union. We're going to have to talk about station moves where you move the apparatus, all that stuff. So at this point, I mean, the process, the earliest we can even consider being ready to go or being able to articulate to you what's going to happen is probably, I would say, October 1st. So that was problematic about that date. And thank you for for clarifying all the work that needs to be done to actually explain that to the Council. The challenges, the budget, the next budget will be adopted by then, and I'm not entirely sure that I want to move forward with the next budget until I actually have certainty and clarity on what our staffing models are going to be once the new fiscal year. And just another question we have. How much does one rescue cost now? And I remember the figures back in back a couple of years ago, but what do they cost today? It's about $1.1 million. 1.1 million. And then and then are we still moving forward with our academy and how much does that cost? We were budgeted just a little over $1,000,000 for Academy. We're in the process of of interviewing candidates for that academy. But we'll make a determination based on attrition months down the road as to whether or not that's going to be needed at this point. Okay. So so the the the evaluation, is there any way you can speed that up so we can get that done, say, in a week? Councilmember I don't think that's going to be possible. We want it to be accurate, which means we're going to have to load the system with a lot of data and rely on our contract partners from Deccan to put that together. So I don't think we'd be able to put that together in a week and have it be accurate. Okay, so so what? You'll get back to us October one and then so we won't know when we approve this budget, what our staffing model is going to going to look like. Okay. That's enough for me to digest at this point. Thank you. Councilmember Supernova. Thank you. Thank you, Chief, for the presentation. I'd also like to thank Council Member Price for articulating that brilliant legal analysis of where we are right now without any legal. And she had four days to do that without any legal background. Last Friday, we're under a deadline. We had to have this item in by noon, and I had to make that same decision in 5 minutes. And I guess I was just lucky. Our guest. Right. But that was a point. I thought this letter was incredibly serious. And to me, this item here simply states, what is plan B and how much will it cost? That's what we're here for tonight. I don't want to look back at how we got here. I'd also like to thank Councilmember Richardson for bringing up the issue of morale. My dad was a Long Beach firefighter, so I do have a little bit of an understanding of how important that is. Very few jobs in this world other than the military may be do the employees live together? And morale is a critical piece. So I agree with Councilmember Richardson that we need to get that fixed very quickly. I guess other than that, I do have a couple of questions. I guess, to Dr. Shea's point about that he would like to talk to the medical director. My big question is if we can get a system in place where that happens instantaneously, because I know it seemed like a quick timeframe, but that was ten days that we lost where, you know, then it just all came crashing down. It seems like if there were questions there and maybe you didn't have a heads up, that it was that this serious. But I see some room for improvement in the medical director of Long Beach speaking to the EMS agency, maybe directly and and more often. And other than that, I think that just just moving forward here, my other concern last Friday was the budget, because it's not completed. That was my other thought is how do we fix this? Councilmember Price says she can't imagine any more cuts and she still has three fire engines in her district. As I pointed out weeks ago, my district council district four is the only district in Long Beach without a single fire engine. Guess what? I can't make any more cuts there. It's just not going to work. Okay? Yep. Yeah. 414 and 22. Okay. So, anyway, that's. That's all I have to say. Thank you. Okay. Thank you. At this time, we go to public comment on the item and I'll come back to the council. Any public comment on the item? Seeing no public comment on the item. Then I'll come back to the city council. I don't think any more public no more council comment at this time. There is a motion on the floor which is to receive and file and also to. You essentially eliminate the program? There's no appeal. I mean, there isn't an appeal anyways, but I think that's the the nature of it. There was an also a friendly by Councilman Price and Mr. Parker. You want to just repeat it one last time so we all know what we're voting for. Certainly, Mayor, members of city council, the motion to receive and file the report and. As you mentioned. Not to appeal the decision of the EMS agency and. To terminate the program as and I believe, as the chief has indicated, as quickly as possible. Councilman Richardson. Before we vote, I'd like to ask for a friendly amendment. Councilman Austin I think waiting a month is a long time, but I get it. It takes that much time. So I'd like a weekly update on where we are in this process, because I'd like to know I'd like to track this as we approve this budget. Would you accept that? I'm actually I will accept that because I think in light of the fact that we are moving forward with our budget situation here and we're trying to approve a budget in the next few weeks, it's it's important that we have as much information regarding this situation as possible. And I just wanted to clarify the not appealing means. I was really trying to to to emphasize the point that, you know what? Let's let's let this go. Let's let's not go back and contest this with the emergency in any way and let's move forward. I do agree with Vice Mayor Lowenthal. There's no future in the past. Okay. Thank you. Members, who's going to cast your votes? They all spoke. Motion carries nine zero. Okay. We did consent calendar already. So we're going to go on to, I believe, item number 19, please.