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Fire Alarm … Ambulance Reform Would Challenge Firefighters Union

By Craig Powell

In some sense, the city’s fire department is a 20th century relic operating in a 21st century world. And with its entrenched practices staunchly protected against change by what’s acknowledged to be the city’s most powerful union, Fire Fighters Local 522, the fire department has been essentially immune to efforts by city officials to drag it into modernity. Few have even tried to reform it; none has come anywhere close to succeeding.

To his credit, freshman Councilmember Jeff Harris has stepped up to the plate and is making cost-saving reform of the city’s ambulance service, operated by the fire department, a major priority. What’s more, he may very well succeed where most haven’t even bothered to try.

Why is the fire department so resistant to change? Fire chief Walt White is only the 21st chief in the department’s 165-year history. And he’s the first chief in city history to be appointed from outside of the ranks of the fire department. Organizational change is not exactly a prevailing value in the fire department. White didn’t have to travel far to take the job. Before joining the fire department last year, White spent his career with the Sacramento Metropolitan Fire District, a nearby district with a long history of paying firefighter salaries that are among the highest in California and a district board dominated by members elected with the financial support of Local 522.

Apart from history and tradition, the status quo in the fire department is vociferously defended by Local 522, whose political action committee typically brings in $150,000 annually and whose cash balance stood at $330,000 at the end of last year. It showers money on candidates for city council. When Angelique Ashby ran for the council in 2010, Local 522 not only gave her campaign $6,500; it spent another $26,826 in an independent expenditure campaign on her behalf. Such outsized political “investments” buy influence and power.

Once elected, Ashby quickly became the council’s most stalwart advocate for the interests of firefighters, opposing all city efforts that could negatively impact them and consistently advocating for actions that would benefit them. On three occasions in recent years, Ashby and the president of Local 522 have co-authored ballot arguments on proposed city ballot measures. To this council observer, there has never been a ray of sunshine between the positions of Ashby and Local 522.

Local 522 is led by Brian Rice, an acerbic retired Sac Metro firefighter who penned a June 2 editorial in The Sacramento Bee entitled “Pensions Aren’t Being Paid at Expense of Filling Potholes,” which argued that city coffers are flush and the city’s rapidly rising pension costs are not “crowding out” public spending on potholes, park maintenance and other city services. It was a novel argument that was recently rebutted, line for line, by the California Policy Center, a nonprofit group that performs in-depth analysis of municipal finances in California.

The CPC rebuttal also noted that Rice, who spent 28 years with Sac Metro Fire before retiring in 2011, collects an annual pension of $183,000, plus an estimated $10,000 in additional benefits, on top of his current salary as president of Local 522, which could put him in the running for the poster boy of pension reform.

The combative posture of Local 522 was on full display in budget hearings in May when Rice asserted that the city’s 13 ambulances generate a profit for the city. He also claimed that the city is “not on the edge of a fiscal cliff” and that the prospect of a fiscal cliff was merely a “picture being painted by city manager John Shirey and finance director Leyne Milstein.” Immediately following Rice’s statements, Milstein provided the city council a detailed accounting that demonstrated that, instead of generating a profit, the city’s ambulance service is projected to lose $6.5 million in the fiscal year that began last month.

When the city council in 1993 gave its approval for the city to operate ambulances, it received assurances that the service would be self-supported with user fees. It didn’t quite turn out that way. The city’s ambulance service has been a major source of losses for the city for years.

At Jeff Harris’ first council meeting last December, a fresh two-year contract with Local 522 was up for a council vote. It called for raises amounting to 12.5 percent over two years, offset by some additional firefighter contributions to their pension and retiree health benefits. Harris made it clear that he didn’t like the contract, but he was looking to the future and hoping that Local 522 would work with him to support changes he had in mind to reform work rules that were driving up taxpayer costs. He voted in favor of the contract with assurances from Local 522 that it would work with him on work rule reforms.

Thus began Jeff Harris’ education in hardball politics at city hall.

The reform that Harris had foremost in mind was to change the way the fire department staffs its ambulances. Currently, the city staffs every ambulance with workers who have “dualrole” qualification, meaning they must be qualified to work as both a firefighter and a paramedic. Harris wants to see the city to adopt a “single-role” policy, requiring that ambulance workers be trained solely as paramedics. After all, they aren’t putting out fires; they’re providing medical attention and transporting people to area hospitals. Moving to single-role paramedics would save the city $405,000 annually for each of the 13 ambulances it operates, according to Harris. Why the big savings? Because under the city’s contract with Local 522, it costs the city an astonishing $67,500 more each year to employ a firefighter/paramedic than it does to employ a paramedic— for doing precisely the same job.

Allowing ambulances to be staffed by paramedics also opens up opportunities for increasing minority hiring in the fire department, and since paramedics often seek to become firefighters, it creates the potential for greater diversity among firefighters in the future. Currently, city firefighters are overwhelmingly white in a city that’s not. The prospect of a more diverse fire department is very appealing to councilmembers, but there is serious roadblock to the reform: Local 522, which opposes the reform. Ironically, and rather hypocritically, Local 522 signed a letter of understanding with Sac Metro Fire in 2012 allowing Sac Metro to begin staffing its ambulances with single-role paramedics. But apparently the union doesn’t want to lose any highly paid firefighter/paramedic positions in Sacramento to lower-cost paramedics.

The reform would not require that any firefighter/paramedics be let go. A switch to single-role paramedics would mean that current firefighter/paramedics would likely return to the fire service, although they’d miss the 17 percent premium in pay they currently receive for serving on ambulances. According to Harris, shifting to single-role paramedics would produce more than $5,250,000 per year in cost savings, enough to pay for 52 new police officers or more than 100 new park maintenance workers.

The change is supported by both the city manager and the fire chief. A key question: Is Local 522 in a legal position to block the reform? According to Shirey, it isn’t. He believes the current labor contract with Local 522 does not require the union’s consent for the city to adopt the policy change. If that’s the case, the only remaining impediment would be council politics. Are there five votes to approve the change in the face of Local 522 opposition?

When I asked the city manager if the votes were there for such a change, he said, “I don’t get paid to predict how the council will vote. I do know that they are interested in making taxpayer dollars go further and they’re open to new ideas and new ways of doing things.”

Shirey and Harris both identified a public safety issue with the way ambulances are currently staffed: fatigue. A work rule under Local 522’s labor contract calls for firefighters, including firefighter/paramedics, to work 48 hours straight every week. Given that the overwhelming majority of service calls to the fire department these days is for emergency medical care/transport (only around 10 percent are for fires), the firefighter/paramedics who operate city ambulances end up being called out three times as often as fire engines responding to fires. A firefighter can expect to get longer, less interrupted periods of sleep in comparison to a firefighter/paramedic who may have to scramble from one medical call to the next, particularly since the volume of medical calls has spiked, from an average of 200 calls a day five years ago to an average of 400 calls a day today, according to fire chief White.

The result is serious sleep deprivation and fatigue among ambulance workers. Shirey asked the city’s chief medical adviser, an emergency room doctor, whether he thought it would make a difference in the quality of care if paramedics worked 12-hour shifts instead of their current 48-hour shifts. After observing ambulance crews arriving with patients for a six-month period, the ER doctor reported that he could tell the difference in mental acuity and alertness between firefighter/paramedics who were working the first day of their 48-hour shift versus those who were working their second day. White reports that the majority of city ambulance crews are now exceeding the “time on task” standards set by the International Association of Firefighters. How would you like to have a paramedic working the 47th hour of a 48-hour shift trying to locate a vein in order to insert an IV into you or a member of your family? No thanks.

By shifting to single-role paramedics, shifts would be reduced to just 10 or 12 hours, allowing them to go home and sleep between shifts. It would also give the city the scheduling flexibility to beef up paramedic staffing during peak hours for ambulance calls and reduce staffing when call volume is typically low, which would save base labor costs, reduce overtime costs and improve ambulance response times. Under current rules, staffing levels are constant, which puts stress on staff when call volume is high and wastes labor dollars when volume is low.

I told the city manager that the current system looks almost as if it were designed to maximize the waste of taxpayer dollars, reduce the quality of care and increase ambulance response times. It may also be exposing the city to significant liability if substandard care results in serious harm to patients.

During spring budget hearings, Angelique Ashby pressed the council hard to fund staffing of a second ambulance in North Natomas. She mobilized North Natomas residents to fill the council chambers and insist upon staffing for a second ambulance. Ashby told the crowd that such staffing was “promised” to her constituents two years ago, in the fiscal year 2013/2014 budget, but hadn’t been delivered. That budget, approved by the council, did call for two new ambulance units, one in North Natomas and one in the south area, but its language was quite clear: “It is anticipated that these medic units will be staffed with non-sworn personnel [meaning single-role paramedics].”

Ashby said she “didn’t care” whether the new units were staffed with dual-role or singlerole paramedics. Well, if she had cared and had pressed her friends at Local 522 to accept single- role paramedics for the new units, it would have saved enough money on those two units alone ($810,000) to fully fund staffing of a new ambulance unit in North Natomas two years ago.

She followed up her dismissive attitude toward the cost-saving reform by taking a gratuitous shot at the city manager at a May 19 council meeting, blaming Shirey for Local 522’s intransigence: “What you can’t do, Mr. City Manager, all due respect, is fund it at the level that you want and then force the hand and hold the community hostage.”

If anyone has been engaged in hostage taking, it’s been Local 522 by refusing to allow the two new units to be staffed with single-role paramedics. Instead of holding her most important political patron accountable, however, Ashby chose to malign the city manager as a hostage taker when all he sought to do was exactly what the council directed him to do: staff the new ambulance units with single-role paramedics.

While at the end of the day Ashby got her way, securing council funding for two new ambulance units staffed with more expensive dual-role firefighter/paramedics, the split vote on the issue and ensuing council discussion revealed that support for single-role paramedics is growing, leaving Jeff Harris with a rare opportunity to put this major fire department reform over the goal line. This is just the first of several needed major reforms of the fire department, but those are topics for another day.

Councilmember Harris recently released a four-page memorandum laying out the case for single-role paramedics. It can be viewed at eyeonsacramento.org