The More Things Change, the More They Stay the Same
By Tom O'Connor, Treasurer
During the recent transition team meetings for incoming Mayor Gavin Newsom, some startling facts came to light concerning the EMS section of the Fire Department. Apparently, EMS Chiefs have been negotiating a contract for ALS services in San Francisco, without the knowledge of the entire suppression command staff. In fact this contract, if signed, not only would have transferred power from the Fire Department to the Department of Public Health (DPH),it also would have required the hiring of more personnel during a budget crisis. But that isn’t the worst of it, this “agreement” would have even allowed the Department of Public Health to determine rig placement, daily details and even long term assignments of personnel. In effect, this contract would have finally achieved what our EMS Chiefs have seemingly been striving for ... complete control of the Fire Department.

This surreptitious contract and its detrimental effects displayed for the incoming Mayor just what has

become of the modern-day San Francisco Fire Department; a dysfunctional organization with two diametrically opposed command staffs. The San Francisco Fire Department is now a two headed monster composed of a suppression command staff that continues to try and deliver services during San Francisco’s most severe budget crisis, and then there is the EMS command staff that appears to be continually trying to takeover the department.

The fact that this contract, or “provider agreement”, was negotiated without the knowledge of the suppression command staff has raised some eyebrows at headquarters, as well as at City Hall. According to sources at the Department of Public Health, only Chiefs Jane Smith and Earhardt Groothoff negotiated on behalf of the department, without even consulting the department’s Medical Director , Dr. Marshall Issaacs. Chief Treviño could not be reached for comment, but Deputy Chiefs Asaro and Balzarini were also unaware of the gravity of this document until they were alerted to it by Local 798. If Chief Treviño had signed this “provider agreement” the San Francisco Fire Department would have been dramatically altered, perhaps even permanently.

What is the “Provider Agreement”?

Essentially, the “provider agreement” is an MOU between the Department of Public Health and the San Francisco Fire Department. State law mandates that EMS providers enter into these “agreements” with the local regulatory agency. But what is so unusual about San Francisco’s still unsigned “provider agreement” is that it was negotiated by two entities that stood to gain significantly from it; the little known EMS section of the Department of Public Health and the EMS division of the SFFD.

Had this document been signed by Chief Treviño, the department would have been legally required to hire more rescue captains, more paramedics, and possibly even close down engine companies to fund these changes. The ever expanding EMS empire would have been legally required to hire more personnel, and the EMS section of DPH would have been provided with more free labor to calculate their statistical justifications for a failed emergency medical services model.

In fact, this seemingly innocuous “provider agreement” was almost the final chapter in what some have called the “hostile takeover” of the SFFD.

What does the “Provider Agreement” call for?

The “provider agreement” was an attempt to set the parameters of service, and resource allocation, for the fire department for the next decade. Under the “Benefits Granted” section of the MOU the department was basically allowed to operate ALS engines and ambulances ... and then the “Obligations of the SFFD” were laid out. Under the “Obligations” section, the department was responsible for the following:

• The collection of data under the L.E.M.S.I.S. or Local Emergency Medical Services Information System. A part of California’s mandated quality improvement program, only more labor intensive and requiring the hiring of additional “data collectors” at headquarters.

• The SFFD would also have been responsible for meeting impossible response times, mandated by the contract. What this would have resulted in is unknown. If the department was out of compliance with the response times would more ambulances and medics have been required, or would more units be thrown downtown in an effort to skewer the data and give the appearance of making the contractual mandates? Regardless, it would have resulted in less service for the outlying neighborhoods, which was the entire focal point of the EMS merger seven years ago.

• The contract also called for an ALS engine deployment plan to be submitted to DPH for approval. In effect, the SFFD would no longer be in charge of the configuration of the fire department ... it would now fall to bureaucrats behind the scenes who have no experience within the SFFD, or the fire service for that matter.

• “Fatigue Prevention” plays an important role in this MOU also, but it isn’t addressed by staffing more ambulances or triaging calls better. No, fatigue prevention is addressed by the creation of a new statistic called the TTU, or the Time on Task Utilization. Essentially, if a paramedic or EMT spends more than 20% of their shift working, they will be reassigned. If a paramedic or EMT spends anymore than 60% of their first 12 hours “on task” they would be pulled off of their ambulance. These two standards would have resulted in the constant detailing of medics and EMT’s out of their firehouse every other shift ... or more significantly, halfway through any busy shift on an ambulance. Could you imagine the chaos this would have created?

• Lastly, this secretly negotiated “provider agreement” would have required the hiring of even more rescue captains for supervision, and would have mandated that paramedics spend “no less than one third of their time on an ambulance.’ This provision would have mandated just what the department doesn’t need ... more time spent on an ambulance monitored by an ever increasing management rank.

This “provider agreement” essentially required the San Francisco Fire Department to hire more managers, hire more data collectors to sit behind a desk, possibly close engine companies to fund the expansion and worst of all, work the paramedics even harder...

What does the “Provider Agreement” really mean for the SFFD?

The surprise discovery of the “provider agreement” means many things to the SFFD. For starters, it means that the dueling command staffs of the fire department are still pushing the department to the brink of disaster. Contracts negotiated in a clandestine manner only further divide the department and create more animosity towards finally fulfilling the goals of the EMS merger. This secret contract also makes it more difficult for employees to have trust in management ... a factor that was always paramount in the fire service.

It also means that when a new administration is named by Mayor Newsom, it had better be organized and singular in it’s path. The full and final integration of EMS services has to be determined before the signing of any sort of MOU.

The EMS model that the “provider agreement” was based on was developed almost ten years ago, and is no longer applicable to the needs of San Francisco. Most importantly though, the EMS model constructed ten years ago was done in a time of budgetary largess, and the creation of more jobs was not that big an issue. In this increasingly hostile fiscal climate, one can expect that if more employees are called for, the Board of Supervisors will tear the department apart . This year’s budget is not going to be any easier than last years, and if the SFFD presents an unrealistic budget, cuts are going to be made somewhere...

The discovery of the “provider agreement” also calls into question the negotiating parties involved and how they were allowed to create such a document without the knowledge, or involvement, of the entire SFFD command staff. How could the Fire Department Chiefs be “out of the loop” on such an important contract? How could the Medical Director, the very Doctor under whose license the department operates, be left out of negotiations this critical? Was there something to hide? Is the EMS section of the fire department accountable to no one?

This secretly negotiated contract also raises questions from a labor perspective. Can two city agencies enforce an MOU that affects the working conditions of its employees without any Union involvement? Is this yet another example of union-busting tactics by the EMS command staff intent on imposing its sole vision of EMS upon a group of angry and frustrated workers?

The discovery of this “provider agreement” really means just one thing though, the SFFD and citizens of San Francisco deserve far better. Emergency services and public safety are two issues that should not be bargained for secretly, and they should not be bargained for without the input of the very men and women that provide those services. We deserve far better...


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