Hawaii Rejects Merger of Honolulu Fire, EMS

July 20--State Health Director Loretta Fuddy said she is not prepared to support a merger of the city Department of Emergency Services with the Honolulu Fire Department as outlined in a study that's mired in controversy.

"It is our conclusion that (the Honolulu Fire Department) has not yet demonstrated the suitability of taking on the EMS medical mission for the City and County of Honolulu," Fuddy said in a letter to Mayor Peter Carlisle on Thursday.

Under contract with the Health Department, the city provides emergency medical services for the public on Oahu, and any changes in the delivery of those services would have to be approved by the department.

Traditionally, most fire officials appear to support a merger, while most emergency services personnel appear to oppose it.

The 2010 report by Oregon-based Emergency Services Consulting International did not provide enough evidence that a merger would be beneficial to the well-being of Oahu's residents, said Linda Rosen, deputy health director in charge of the Emergency Medical Services and Injury Prevention System Branch.

The $175,000 study showed the city could save $10 million over five years if the two departments merged and duplicative functions were eliminated.

"We didn't feel they addressed the medical care aspects in a way that would convince you that there would be an improvement in medical care with a merger," Rosen said. "Their emphasis was on cost savings, and I don't think their cost savings were well substantiated."

The report failed to factor in additional considerations such as training costs that would come with a merger, she said.

"For us, savings are desirable, but the medical care is the most important thing," Rosen said. "We are happy with current medical care. We would be concerned about an organizational change that would not appear to preserve or improve the level of medical care we have today."

The consultant also failed to speak to the Fire Department's medical director or any emergency room or other type of physician about their views on a possible merger, she said.

The 2010 study recommending the merger is at the center of an investigation being conducted by the city Ethics Commission. Commission Executive Director Chuck Totto said the investigation, launched last month, centers on the selection of Emergency Services Consulting International to conduct the study.

Totto declined to provide specifics of the complaint, but confirmed that the investigation centers around "if proper procedures were followed and if there's been special treatment or conflicts of interest."

In Hawaii County, emergency services are merged with the Fire Department. In Maui and Kauai counties, the state holds a contract with privately owned American Medical Response.

Fuddy's letter got support from Carlisle as well as Emergency Medical Services Director Jim Ireland.

"The letter reinforces my position that this issue must be approached with caution, and protecting public health and safety is still the top priority," Carlisle said in a statement.

Ireland said that, like the mayor, he supports "baby steps" and "focusing on small-scale efficiencies that can make the two departments work better together."

One step in that direction has been the merging of the dispatch functions of the fire, emergency services and ocean safety agencies, Ireland said.

Honolulu fire officials could not be reached late Thursday to comment on Fuddy's decision.

City Council Chairman Ernie Martin said Fuddy's comments reinforce the need to create a working group to discuss a potential merger or other ways of improving emergency medical services. Such a working group would include all affected parties, Martin said.

It's unclear why the Health Department decided to issue its stern rebuke of the merger plan now.

The study, released in August, was commissioned under the administration of former Mayor Mufi Hannemann.

Kirk Caldwell, Hannemann's managing director, has been the only one of the three mayoral candidates this election season to voice strong support of a merger. Caldwell was endorsed by the Hawaii Fire Fighters Association.

Former Gov. Ben Cayetano also is challenging Carlisle's bid for re-election as mayor.

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