Hawaii Mayoral Candidate Blames Mayor for Ending 9-1-1 Overuse Outreach Program

Sept. 19--Mayoral candidate Charles Djou has chastised Mayor Kirk Caldwell for eliminating a program designed to reduce the overuse of ambulances by chronic 911 callers.

The decision demonstrates how Caldwell and Emergency Services Director Mark Rigg have mismanaged the short-handed Department of Emergency Services, Djou said at a forum Thursday hosted by the Native Hawaiian Chamber of Commerce.

Administration officials, after some initial confusion, told the Honolulu Star-Advertiser that staffing shortages led them to discontinue the community paramedic program, and that other moves they've made have cut down on staffing and overtime problems.

The community paramedic program was initiated in November 2012 by then-Mayor Peter Carlisle and Dr. James Ireland, Carlisle's emergency services director, after research found that the top 10 callers to 911 had taken an average of 52 ambulance rides annually.

Hoping to reduce the number of calls for people with nonemergency needs such as medicines or substance abuse treatment, the program tasked two community paramedics with visiting the top 50 callers to look into the root causes of their problems and point them toward more appropriate care.

Speaking after Caldwell at Thursday's forum, Djou said that a small percentage of ambulance users regularly use EMS, and those people "have adopted 911 almost as taxi service. And this tiny minority overburdens our system."

Djou called for re-establishing the community paramedic program, which dedicates a small group of paramedics to addressing chronic, nonemergency 911 callers.

"It's a good, smart, valuable program" that he would work to reinstate, he said.

The program was terminated shortly after Caldwell took office in January 2013, with Rigg citing the need to focus resources on the struggle to fill shifts caused by a large number of vacancies at the time, which also triggered wide absenteeism.

On Thursday, shortly after the mayoral candidates' forum at the Willows, Caldwell and spokesman Jesse Broder Van Dyke told the Star-Advertiser that the program had ended under Ireland and Carlisle.

When the Star-Advertiser showed administration officials evidence that the program was canceled during Caldwell's tenure, Rigg on Friday said he had lost track of when the program ended and had given wrong information to the mayor and Broder Van Dyke the previous day. Rigg, who was Ireland's deputy, said the program had made a few trial runs in November 2012 but was never fully operational, primarily because of the funding considerations.

Broder Van Dyke, on Saturday, said the program was suspended during the 2012 holidays, and then never reinstituted by Rigg "as he determined that staffing our ambulances would be the priority."

Ireland, when reached for a response, said the program had proved effective.

"It was fully operational." he said. "They had engaged patients from that top 10 of frequent callers. It was successful in reducing some of those calls from that top 10 list. ... because they redirected those callers to the more appropriate resources in the community."

For instance, one woman the paramedics reached did not have a primary care doctor.

"They connected her with the Waikiki Health Center," Ireland said. "If the mayor canceled the program, and it was a good program, he should just admit his mistake."

In a June 2013 Star-Advertiser article about the program ending, Rigg said he recognized the merits of a community paramedic program but said that the state Department of Health, from which the city receives compensation for emergency services, was in a better position to manage such an endeavor.

Dr. Linda Rosen, then chief of the Emergency Medical Services and Injury Prevention Branch of the Health Department, told the Star-Advertiser that her agency was eager to look into it.

Health Department spokeswoman Janice Okubo said Friday that Rosen likely had been looking into it but then was appointed health director in early 2014, and then moved to become chief executive officer of the Hawaii Health Systems Corp. later that year.

The 2016 state Legislature adopted a resolution asking the DOH to look into development of a community paramedic program, and the agency will submit a report in the coming session, Okubo said.

Djou, at Thursday's forum, also criticized the Caldwell administration for failing to address an ongoing shortage of paramedics and emergency medical technicians, a situation that has forced the city to either shut down shifts or pay overtime for EMS workers to avoid the cancellations.

"The problem here is we're spending too much money (on overtime)," Djou said. "And the reason we're spending too much money is we're not sufficiently recruiting enough paramedics."

The issue last became news in July when multiple shifts were forced to close one weekend due to staffing shortages after personnel called in sick. Under the 12-hour pilot project, EMTs and paramedics are not required to work beyond their scheduled shifts, and private company American Medical Response filled in.

Djou, a major in the Army Reserve, proposed that the city relax its requirements for EMS personnel to allow military veterans to gain required hours while on the job as full-time paramedics and EMTs instead of going to classes to gain those hours.

Rigg, in response, said a pilot program converting paramedic and EMT shifts to 12 hours from eight hours that was implemented in August 2014 led to increased employee retention, a decrease in overall leave, a drop in shift closures and a reduction in non-holiday overtime.

Closures like the ones in July are rarer occurrences since the 12-hour shifts were put in place, city officials said.

EMS employs 247 paramedics and EMTs, and there are currently 13 vacancies, the department reported.

There were 68 EMS unit closures from Aug. 31, 2014, to July 9, 2015, and only 21 closures from Jan. 1 this year, the department reported. Non-holiday overtime has dropped to $3.7 million in fiscal 2016 from a high of $5.6 million in fiscal 2014.

On Djou's idea of relaxing restrictions for military paramedics, Rigg said: "It is a great idea to potentially hire people and train them. However, there is no set program as each individual situation is unique. Not all programs for national certification, even the military, follow the same amount of set hours." Additionally, such a program would need additional funding from the state, he said.

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