Assembly Standing Committee on Emergency Management

We're going to be waiting for a few more Mark, before we start the meeting, so just bear with us. It's a busy afternoon as we have a lot of committees going on. So once I get a few more Members up here, we can get started. So hopefully they'll join us soon. So hang tight. Well, good afternoon, folks. I'm Assembly Member Freddie Rodriguez, chair of the Emergency Management Committee, and welcome to this afternoon's hearing. First, let's turn to today's agenda. Remind everyone of the ground rules for today's hearing.

As always, we seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation and decisions on the critical issues facing Californians. In order to facilitate these goals, we will not permit conduct that disrupts, disturbs or otherwise impedes the orderly conduct of the legislative proceedings. At today's hearing, we will take public comments from those in the room.

Members of the public may also submit testimony to the Committee at AEM.Assembly.ca.Gov in the absence of a quorum, we'll go ahead and start as a Subcommitee. And with that, one of our second Bill is AB 1168. Mr. Bennett, I believe you are in the audience, so you can proceed when you're ready, sir.

Good afternoon, Mr. Chair and Members, and thank you very much for this special hearing on this item. I'd like to start by accepting all of the Committee's amendments that are listed in the document. This is an important bill, and there's been a significant period of time that we've been out here, 40 years plus, with the current arrangement. And recently a court decision has created the need for us to look at the arrangement that is out there.

1186 is an attempt to try to fix that and fix a challenge that we have with the system. And first of all, let me just say what 1186 is important bill. It does three things. It allows a narrow set of cities and fire districts to retain their authority to not be part of a JPA. And, fundamentally, what's happened is a court has ruled that if you joined the JPA before the law was created, you don't have the right to get out of that JPA.

That seems to me to be both fundamentally unfair but, more importantly, not good government because it doesn't put any pressure on people to perform or puts less pressure on people to perform if they feel like you're trapped in to the particular system.

The City of Oxnard in my district needs to have a recognition of their right to be able to leave, and it clarifies, going forward, as in some other Assembly Members districts, they actually have fire districts and cities that want to join a JPA but are hesitant to because the way the judges ruled it, once you join, you can't back out of that and that will actually discourage people from forming JPAs. I just don't think that that's a healthy system going forward. At the same time, I know it's very important for us to not have fragmentation of the system, and we want to make sure that the system stays whole and makes sense in terms of the delivery of service.

And that's why when the sponsors of the bill, the California Professional Firefighters, City of Oxnard, came to me, I insisted that we put a provision in there that says you have to, if you decide to leave, you can't just leave and take everybody in your particular city or your particular fire district area. You have to take everybody in the service area so that there aren't pockets of low income rural areas that are left out and you create that kind of fragmentation.

There are at most 10 areas that would be affected by this. I think if you look at it, it's very unlikely that 10, so that's the most in terms of the impact that it could have in the state, is these 10 JPAs, I believe. Legally somebody could say, well, there are some of these districts that have dispatch only. I don't think you're going to see this kind of effort with dispatch. It really comes down to ambulance service as the primary issue that we have out there.

So the recent amendments make it really clear that if you pull out, you have to meet standards that are set, that the EMS authority still gets to set the standards, and you have to actually commit to standards that are equal or better than the standards that were there in the district that you are starting to take over. There are. Pardon me for not getting this off. There are disagreements by the opposition.

We are committed to meeting with the opposition, and we made that commitment at the Health Committee to meet with the opposition, and try to see if we can address concerns that they've raised. I do have that meeting scheduled, and I look forward to having all the representatives from both sides at that particular meeting. And we will endeavor to address every legitimate concern about fragmentation that could be out there. And with me today to testify is Oxnard Fire Chief Alexander Hamilton and Doug Subers, representing the California Professional Firefighters. And I'll ask them to go ahead and speak.

Thank you. When you're ready.

Good afternoon, Chair and Committee Members. My name is Alex Hamilton. I'm the Fire Chief for the City of Oxnard and the President of the Fire Chiefs Department for the California League of Cities, which is sponsoring this measure. This measure seeks to clarify Section 201 of the EMS Act, which grandfathered in rights for entities that were delivering prehospital EMS services prior to the act becoming law.

And as Assembly Member Bennett mentioned, I also look forward to sitting down with all stakeholders, including the opposition, to get to a point where we get to a better understanding of the intent of this bill. However, I'd like to take a moment today to address some of the arguments in opposition that were in the legislative analysis. First, that as a fire chief, I'm imposing my will in a jurisdiction. That is not so.

I'm simply representing my City Council's interest in providing equitable ambulance service to our residents. It also mentioned taking a wealthy jurisdiction out of control of the counties. Again, not so. The City of Oxnard payer mix is 60% Medi-Cal, Medicare, or both. Very much a blue collar working class city. The legislation also addresses the existing area surrounding a jurisdiction that wants to leave a JPA to ensure that no one is left out. Opposition mentions an increase in a cost to patients. Again, this is not so.

Under the alliance model that we had built, rates were going to be cheaper than the rate being charged in the rest of the county, and additionally our City Council would be allowed to determine compassionate billing policies for our most vulnerable residents. The arguments in opposition talking about cities or fire districts creating fiefdom and thumbing their noes at the LEMSA, which is also just not true. Every single 201 agency in the state follows local EMS agency regulations and medical control. Oxnard would be no different.

The final point about fragmenting the system is also not true. I'm actually trying to integrate the system. Currently there is no coordination between fire and EMS units, yet together we make up the bulk of the prehospital care system. Having no ambulances available 1200 times in a single year in a city the size of Oxnard is a symptom of a greater problem. Regardless if that problem is staffing, deployment, mismanagement, or brownouts, it is a system that is already fractured.

Again, I do hope to sit down and work through the issues so that stakeholders opposing this legislation can see that our goal is to improve the system through better integration and a focus on outcomes. And one last thing before I close. I wanted to address hardworking EMTs and paramedics that are here today and that attended that last Committee meeting. This is not an attack on them, they are just as dedicated and hardworking.

My firefighters in Oxnard enjoy an excellent operational relationship with our private ambulance company staff. Indeed, our goal was to build a public private alliance model with a private ambulance provider, and I am still a strong supporter and a big believer in that. This legislation is about the system, not any provider, and the current system is not equitable for our most vulnerable residents. So I thank you for your time today.

Thank you.

Thank you, Mr. Chair and Members. Doug Subers on behalf of the California Professional Firefighters in strong support of AB 1168. CPF represents more than 34,000 professional firefighters and emergency medical services personnel statewide. We'd like to thank Assembly Member Bennett for bringing this measure forward and thank the Committee for their work on this bill, as well.

I believe the analysis does a good job of providing a detailed assessment of the scope of this proposal, outlining the specific JPAs and entities as we know it, the scope of the field, and talks in detail about the provisions. This measure will create clarity around the provision of prehospital EMS services and the rights to deliver those services.

The Oxnard decision has raised ambiguity and potential negative policy outcomes, and we firmly believe it's appropriate for the Legislature to step in and provide clarity through as proposed in AB 1168. In addition to addressing the issues with City of Oxnard directly, this bill seeks to ensure that jurisdictions that are providing prehospital EMS as a result of a joint exercise of powers agreement are not negatively impacted by the Oxnard decision, should they seek to pursue their own system in the future.

Further, this measure will ensure statutory clarity for a fire department to enter into a future agreement with a county to deliver prehospital EMS without losing their rights. Assembly Member Bennett noted in his comments that this measure contains a failsafe. Section two, Subdivision D of the measure outlines a process to ensure that communities have continued access to EMS services, should a city or fire district exercise rights under this bill.

In connection with that failsafe, the amendments taken today in Committee, noted on page seven, will also ensure that there is clarity about performance standards so changes to EMS delivery occur under the provisions of this bill. All EMS personnel in the state care deeply about their community. EMS delivery is a vital portion of CPF members' work. In many areas, firefighters provide first response services where they're first on scene in a medical emergency and begin rendering aid on a patient while waiting for an ambulance to transport that patient to the hospital.

It is imperative that this system be efficient. Delays or inefficiency impact the entire prehospital EMS system and impact the working conditions of CPF members. Finally, I would just like to say and echo the comments by Assembly Member Bennett. We look forward to engaging with the opposition to this bill and hopefully driving towards solutions that address some of the concerns that have been brought forth. With that, we would respectfully ask for your aye vote. Thank you.

Thank you. With that, anybody else in the room in support of AB 1168?

Malinowski-Ball on behalf of the Fire Districts Association of California and the California Fire Chiefs Association in support.

Michael Arnold representing the City of Oxnard, also in very strong support.

Good afternoon. Elisa Arcidiacono with the League of California Cities. Proud sponsors of the measure. Thank you.

Thank you. Anyone else in support? With that, we go to opposition. Opposition, come forward.

The EMS act promised, and for 40 years counties would argue, has delivered a coordinated, integrated, and readily available system of prehospital emergency medical care and specialty hospital resources for everyone in California, regardless of where one lives or their socioeconomic status. EMS systems of today are not stagnant entities. They are dynamic and continuously evolving with the latest science and best practices.

Local EMS agency physician medical directors like myself provide objective insight in the planning, implementation, and monitoring of the EMS system and advocate for the safety of our communities by focusing on patient needs through impartial assessment of system performance. Proponents have argued this measure ensures cities or fire districts will retain their 201 authorities if they enter or have entered into a joint powers agreement for the provision of ambulance service. The Assembly Health Committee identified 10 existing JPAs where 1168 would apply.

However, we would note, despite claims to the contrary, nothing currently precludes a JPA agreement from ensuring those administrative responsibilities could be maintained in the context of the JPA if the parties agree to those terms. Furthermore, of the 10 JPAs identified, one entity will qualify. Six are made up of non tool one entities, one is a mix of some tool one entities and some that are not. One is likely not. A JPA, though, has 201 authorities, and the final one is Ventura.

The County of Ventura has administered EMS services in the City of Oxnard for over five decades and long before the enactment of the EMS act, with virtually no involvement by the city. We fundamentally reject the argument that Oxnard was ever a 201 entity for ALS or Ramos transport services and vehemently opposed the abrogation of the Oxnard versus Ventura appellate court ruling, as AB 1168 proposes.

While recent amendments narrow the intent of the Bill, we still believe the result of AB 1168 will likely be widespread fragmentation of the organized, efficient and effective EMS system of today and a reversion to the disjointed state that existed prior to the implementation of the EMS act. We still believe some cities and fire districts will be able to deem themselves 201 entities moving forward, allowing them to leave existing agreements with counties at will.

Counties would then be forced to open up already complex ambulance contracting processes while scrambling to provide continued services to their impacted residents. We foresee a reduction in quality of care and deepening of health disparities for rural communities and low income or historically underserved populations.

Mr. Chair, while we understand your goal with the Committee's proposed amendments, we have continued concerns with the broader provisions in the Bill regarding how counties may reconfigure their EMS systems if an EOA is abended for the reasons I outlined. California county strongly urge you to stand for our communities and vote no on AP 1168.

Hello, my name is Nathan Navardo. I'm a 17 year Sonoma County EMT and progressive paramedics. I've been excuse me, I'm here to oppose this Bill and I am a Member of the United EMS membership and I am here to represent more broadly, roughly 70% of California's emts and paramedics. I must first oppose this because the loss of regional competitive bidding hurts patients and communities as competition drives quality up and costs down.

Please remember, a regional contract ensures a standard of equality over the entire region, just as fundamental as the competitive process is to quality. The complete loss of contract language that sets standards creates a lack of any accountability and increases the costs to the patients and the community. Without a standard, there is no standard. I also must respond to statements that this Bill will contribute to improved working conditions for me and my coworkers.

The likely outcome of this type of 201 right assertion and the future servicing of that area will in many cases lead to the direct subcontracting to the very people and companies providing the service. Currently, the ambulance providers will directly subcontract to the fire departments. The assertion is that since the fire Department owns the contract or owns the service, they will use that to improve my working conditions. The subcontract relationship actively is happening in Contra Costa County where many of my fellow union Members are currently serving.

Their experiences speak to a much different reality. A common theme in these relationships experienced in Contra Costa is an attitude of subservancy between the company and the Department and the employees and the firefighter personnel. This commoditization of the ambulance service creates attacks on the identity, morals and distances the labor relationship between the contract holder to navigate working conditions.

I challenged anybody to show me a time when subcontracting outwork created improved working environment for the employees providing the service with what is witnessed in Contra Costa County, the attitude of subordination, union challenges in withholding contract language or upholding, excuse me, contract language, the abuse and control over the contractor, and even at times transfer of liability and work onto the ambulances. I ask you to hear me clearly. This model will devalue and degrade my profession.

Respectfully, I must say you cannot both appreciate and value the work that I do and support the move in a certain direction. In conclusion, this is not about improving on the model that has been occurring over the past 40 years. This is, excuse me, the past 40 years since the implementation of the EMS act of 1980. This is taking us backwards in time. I ask you to vote no. Thank you.

Thank you. Anyone else in opposition, come forward. State your name and position. Organization.

Good afternoon. Janice O'Malley with the American Federation of State, County Municipal employee of the Committee, and unfortunately, the amendments still don't get us to lay off the Bill, but really appreciate the author and his staff on helping us come together and try to reach an agreement. So thank you. Good afternoon. Yereli Marion, on behalf of San Mateo County Board of Supervisors and respectful opposition.

Marshall Bennett, on behalf of Contra Costa County, we oppose.

Betsy Armstrong with the county Health Executives Association. We remain committed to continuing to work with the author and the proponents and seek resolution, but still opposed. Thank you. Latifah Alexander with the Association of California Healthcare Districts, respectfully, in opposition. Catherine Houston. On behalf of United Steel Workers District 12 tons of USW Local 12911 and USW Local 121853 in opposition. Thank you. Good afternoon. Jill Vincent. On behalf of American medical response, in opposition. Good afternoon. Karen Lang.

On behalf of the boards of supervisors and their emergency services planners in the counties of Placer, Shasta, Tulare, Nevada, Kern, Napa and Merced, and in addition, the San Joaquin County Emergency Services Agency is also in opposition. Thank you. Good afternoon. Sarah Duquette, on behalf of the Rural County Representatives of California, in opposition. Thank you. Good afternoon, Mr. Chair. And Members Jolie Onadera with the California State Association of Counties, also in opposition. Also look forward to continued conversations with the author and sponsors. Thank you.

Good afternoon. Josh Goger, on behalf of the Urban counties of California and the Ventura County Board of Supervisors, both in opposition.

Thank you. Good afternoon. Sean Henshaw. On behalf of global medical response, regrettably. Still opposed, but want to thank the author for making the time to meet. Thank you. Jeff Neal, on behalf of Yolo County. Board of Supervisors, also opposed.

Good afternoon. John Poland representing Sarah, Sacramento Valley EMS Agency and the Emergency Medical Services Association of, California, and we remain opposed. Good afternoon. Mark Thomas, Norcal EMs. We opposed. Chair Members Jonathan Feldman with the 911 Ambulance alliance, in opposition.

Mr. Chair, Members of the Committee, Assembly Member Bennett Marco Prayer, representing Covalent health and their ambulance companies, pro transport one and PRN ambulance. Respectfully, in opposition, and we look forward to working with the author.

Thank you. Anyone else in opposition? See none. We'll bring you back to the Committee. Committee Members, any questions? Go ahead. Senator Alvarez, have a question. Comment?

Thank you, Mr. Bennett, thank you for bringing this forward. I'll support moving this forward today. One, I see that the amendments were taken, but two, because, two other reasons.

Second, because I know this is really important in your district and your community and you're trying to create more access to services, but I do want to ask you, just on the record, I didn't recognize until I saw this earlier today, the opposition, which seems to be quite a bit, but everyone indicated that there's been communications that's happened. If you could make me aware of what some of those communications have been and where you think this is going to lead.

Thank you for the question, because that's one of the things I wanted to cover in my wrap up. So I was approached by the sponsors of Bill, League of California Cities, and of course, the support of the City of Oxnard and California Professional Firefighters. And we began the process of, first, just trying to make sure that in my mind that the big issue I think in front of us is, is this going to lead to inappropriate fragmentation, lack of coordination, et cetera, that's out there.

So we spent considerable time because in my mind, it wasn't easy to say, how do you assert this right to change and still protect? And we came up with what I think is the most expansive answer.

We said, if this is the area and you're a city in the middle of it and you want to pull out, well, if you can't work out an arrangement with the county for how the whole area is going to be handled, then if you decide to pull out, you have the responsibility for the whole area, the Low-income areas, everything. And you have to do that with that response time. That's about as comprehensive as I think you can get in terms of avoiding fragmentation.

And the sponsors were willing to accept that. So after achieving that, we began the process of starting to talk to people. We didn't achieve that sort of agreement until not long before we went into the hearings. But we have now, as a result of the hearings, identified all of the. Well, I think we identified the major stakeholders in opposition once we put, floated that idea out there. And we have a meeting scheduled in early May with all of the stakeholders.

And I think that's part of why that's what they're referring to. In terms of that meeting, I intend that meeting to be a robust meeting where the strongest arguments on both sides should be pointed out. I walk into that meeting ready to learn what are things that we haven't thought about yet, what are concerns that are out there, what are potential issues. And I don't anticipate that that will be the last meeting as this moves forward.

And actually my next question was going to be on that, because respectfully to the opposition, I guess I'm not fully comprehending what needs to be fixed and what needs to be addressed. And so I'd give the opposition opportunity now to maybe express some of that once again in a way that perhaps I can understand by you saying it a second time, because I'm still missing.

That I can try to, try to distill it down there can get a bit complex, or to discuss it in a way that really is accessible. I think where we stand, where our sort of main concern is on the ability of agencies who haven't provided Amos transport services in the past to leave systems that already have functioning EMS systems, where we are providing care throughout the community at a good standard or a high standard, to remove themselves from that system and begin providing Ramos services.

I think we're open to the idea of jpas and entities that provide those services, having jpas for training, if they're going to share resources as an existing Amos transport provider, I think that's something that we're really open to considering and discussing with the author and the supporters. I think our concern is that systems function. A lot of systems are functioning very well, and to remove certain entities from those systems could be very detrimental.

And not all counties and communities in the state have the same ability to weather that sort of change. Some will be more able to than others.

I appreciate that. That makes it a little bit clear to me as to what the concerns are, and I think those are valid concerns. By the same token, I hear the author acknowledging that as a concern and as something to be addressed.

But maybe, Mr. Bennett, if you want to provide a response to that, because I don't think you're trying to create a situation or a scenario where you're creating these potential either conflicts or diminishing level of services for communities, I don't know if you want to respond to that, Mr. Bennett.

Certainly do. Thank you very much. First, just to try to specifically address that, the statement was just made that there are many places where they don't have much experience at doing this, or they're not going to do it professionally, et cetera I think in my mind it'll be hard pressed to think that those communities would step forward and do this. That may happen. I'm not saying that's, but in this situation it's a narrow group of communities, 10 communities, most of them won't be doing this early.

This is an opportunity for us to actually look and see how this works. Let's see how Oxnard does with this without having it be something that's blanket, that's just a change of rules for the whole State of California. It's narrow. It gives us a chance to look at that. Number one. Number two, I think it's probably most important for me to say this. I think there are three major groups or points of interest in opposition.

And one, I think, represented by the Doctor in my county, I might point out I've got the County of Ventura in opposition and I have the city in my district, the largest city in the county, in support. And I feel very comfortable with this because I think I know this issue really well and I know what the county wants to do.

After spending 20 years on the Board of Supervisors, after spending a term on the City Council and working with fire, I understand it from the city's point of view also. So the professionals, as represented by the Doctor and many others in the room, they're just concerned. They've got a system, they think it's working reasonably well. Why change? Right. And I think I want to make sure that we address all of the concerns that they have.

But the one thing that I'm not willing to do is to say, well, you know what? We're not going to make a change at the state level. We're never going to make a change because the current system is working well enough. It doesn't recognize the fact that although the professionals say the system is working well, the cities in many places, but certainly in Ventura County, will say we're frustrated with how the system's working.

We go and we talk to the professionals about our frustrations and we don't get any change, we don't get any response, and there's nothing we can do about it because we are trapped permanently, according to the court ruling, into this arrangement. And yes, the contract comes up for renewal, but they're part of the system doesn't. So I'm trying to get that changed.

The second thing, if I could, is that the second group is the group represented here by this gentleman who I think spoke at our last meeting, very eloquently representing the concerns and the fear that you've been working in the industry, and now suddenly you're going to lose your job or you're going to get downgraded into the subcontract status of Contra Costa that he's referring very legitimate to be concerned about that.

And I think that's another reason why a small, I almost want to call it a pilot attempt. Let's see, in five years or 10 years, how many of these people actually exercise this right. Let's see what actually happens. But even if they all exercise the right, it won't be the whole state, it won't be the whole workforce that will be affected, only these people in this area. But there is a very clear focus of the discussions that I have scheduled for the first week in May.

I've talked to the unions that represents these workers. They have a number of issues that they want to raise. I've already informed the proponents of change to be ready. Those are the issues that they have to be ready to discuss, and I hope that we can have some conversations. We actually have a bargaining unit that represents fire, we have bargaining unit that represents the EMS employees, and they both have an interest in collective bargaining rights and protecting workers and all of that.

So that takes me to the third group that's in opposition, and that is the major ambulance providers, the people who, after EMS, establishes the standards, after the workers are hired and professionally trained, they are the ones that decide where the ambulances are going to actually be located on a day to day basis. That's where the greatest frustration is by cities, and that's where they go. Why was there no ambulance in our city during that time?

And you find out, well, because the management of that system decided that they wanted to use the ambulance for transport from one hospital to another hospital. I'm not saying that's not a valuable service, because it's valuable to move people from one hospital to another.

But the cities are pretty far removed from the details of that, and they don't know, and they question whether, was that really a good decision on the part of management there, or was that a decision that was made for other reasons other than just what's in the best interest of the public? And I think we know what those other reasons could possibly be. In General, I think you find, when I've been involved in this before, management wants no change at all.

They're not necessarily willing to come to the table and say, what change? I think there's quite a few things that the good Doctor here and I could agree on in terms of a change that might be beneficial I think the same thing with the worker representatives, but they've been the most difficult for us to try to agree to any change because they know a first change might lead to another change and another change.

And I reject the idea that one change, this change, means we're going to unravel the whole thing in the state. And so in the arguments listed by the opposition, the exact language they use is know this would gut the EMS act. Well, if this is going to gut the EMS act, I think it'd be a lot more substantial than this. So there is a tendency by some of the people who are opposed to inflate how dramatic a change this Bill is.

They use the term that it's going to decimate. Let me find, I want to make sure, decimate coordination and planning by ems. I don't think it'll decimate it. There is a legitimate concern that it may hurt it, but I don't think it'll decimate it. So I say, pardon me for going on a bit, but I really wanted to try to frame a big issue that has lots of concerns on both sides. We're trying to thread the needle to come up with something better.

And that is an EMS system where when the cities say, we've got a concern, there is more potential responsiveness because people know, hey, they don't get to trap the cities in forever. So thank you very much for the. Thank you.

Appreciate the response.

Thank you, Mr. Chair, real quick, before we go, can we go ahead and establish a quorum since we have everybody here now? So, secretary, can you call the role, please?

Quorum, call. Rodriguez. Here. Rodriguez. Present. Waldron? Waldron. Present. Aguirra? Curry? Aguirra. Curry. Present. Alvarez? Alvarez. Present. Calderon. Dahle? Dahle. Here. Chiavo? Chiavo. Here.

Okay, good. Aquarium established. So go ahead. Something to remember. Chiavo, you have a question.

Thank you. I want to thank you so much for your willingness to talk with folks and bring people together around concerns. I know this is a complicated issue and think the goal of it is so important to make sure that we're really responding to folks when they need us. Right. One of the questions that I had, and I've been having lots of conversations around this Bill with folks, certainly around the labor concerns. I share those.

And so it sounds like that's important to you to address through this process and ongoing conversations, which I appreciate very much. I also had a question about. So let's say that the city pulls out and says, fire Department wants to do their own contract. Right? But they have the ability to then turn around and subcontract it, even theoretically, to the people who are just doing it before, in some scenarios, nothing may change.

It seems like, except for, I understand there may be, like, different reimbursement rates depending on who's got the contract. So could those be maybe by you? Anyone who wants to answer, if you could kind of flesh out what that looks like. Is that an accurate interpretation?

I have a response to that, but I would like to have the chief respond to that first. I think as we go through, and of course, anybody else. And then I'd like to respond. Go ahead.

Thank you for the question. So, for our experience, what we went through in the City of Oxnard, we noticed to the county that we were going to be leaving the joint powers agreement, and we gave the 180 days notice that was required. And it was at the end of an existing contract, so it was the least disruptive time to be able to make a change like this. We went out to bid for a contract and sourced a new provider.

The difference is, when I talk about fragmentation versus integration, the system would be more integrated because there's coordination between those EMS units and those fi units. And so an example of that would be that we would always maintain a spread of ALS resources, advanced life support, paramedic resources, whether it's from the fire Department or an ambulance, to make sure that the entire jurisdiction has a rapid response from a paramedic. And so that was the goal that we set out to work towards.

It was one of the reasons why we started our paramedic program originally in the City of Oxnard, was because prior to 2018, we were relying solely on the ambulance company for paramedic services, for that ALS component. And with the increasing level of delays and everything else, we were really struggling with adequately serving our residents. And so that's where the city stepped up, started an ALS program.

Unfortunately, what ended up happening again, because of the way the system currently is, is that the ambulance company actually moved their units away from our new paramedic squad because there was an extra two minutes built into their response standard. And so it's issues like that under the current system are very difficult to solve. One of the other things that, and this came up in the Health Committee hearing, is that we were very conscious of ensuring that the emts and paramedics for that ambulance company were paid.

Were. Going to be receiving pay increases. We were able to find an agreement with the amidst company to improve the level of the ppes that those workers were wearing, including making sure they all had bulletproof vests, for example, and things of that nature that they don't currently enjoy. So we were trying to address labor concerns in addition to addressing equitable service concerns for our residents. Hopefully that answers that question.

If I could respond with just two additional things, technically that could happen, I suppose somebody could exercise their rights. But of course, they have to go through, number one, the whole negotiation. Two, they have to be committed to taking all the areas outside of their city also and commit to those response times with all of the ramifications that come if you don't meet those response times. Right.

I don't think this is something Willy nilly people would do and just go, zero, we just want to mess the system up and do this. But two things that are different with the scenario, I think. One, the fire chief pointed out you can now have better integration between the ambulance and the fire Department in terms of services. Right now there can be a frustration.

The city fire Department will go to EMS and say, we think we can actually improve things in our city if we could do this kind of coordination. But because it's a separate ambulance contract with EMS and it depends on how responsive the EMS authority is in terms of trying to push that, and there's already been a contract established, et cetera. That's one.

Two, the elected representatives of that city have more direct voice in that city because they can say, we're unhappy with this service and they've got a City Council they can go to. Do you know who the EMS people are that you can go to if you're unhappy with the. I mean, we don't, none of us do. Right. Where do I go? If I'm unhappy, I'm going to go to my local City Council Member. Right. But the City Council Member goes, we don't control that. Right.

So it does give that opportunity for that control. Happy to again, address the labor issues that you've talked about. More and more creative ideas keep coming into my head as we're doing this, but we'll see whether there's anything that can work. But appreciate the question and just wonder.

If the opposition also has responses.

Thank you. Yes. So a couple of responses I'd like to give. So under the situation where a fire Department pulls out and that area is left underserved or not served at all, I'm hearing the statement that they will be responsible to go and run those calls so that those people aren't left out or abandoned.

I understand, though, that to receive compensation for that service, that county who was previously under the RFP, receiving those ambulance responses, in essence for free, would now have to be paying the fire Department or the responder to provide that service. So there would be a billing of the county to provide the service. So cost to the county and therefore the citizens goes up next.

The response that I would like to point out is that in a RFP, it dictates not only response times and standards, but billing costs and what you can and can't Bill for and how much you can Bill and can't Bill. If there's not an RFP, there is no required standard for billing. So the Bill could be whatever the Bill is. And then on top of that, there are certain services that are just considered part of providing 911 services.

Like you go out and lift somebody off the ground or the patient doesn't want to go to the hospital, so you do like an against medical advice and send them out. Those traditionally in rfps are covered within the language of that contract as being part of the service that you provide and don't get to Bill for. Without the RFP, there's a lot of creative billing that starts to occur for first responder fees, for Ama, fees for stuff like that.

So there's again, another layer of added fees that the patients have to receive that aren't even captured inside of an RFP relationship. The only other comment that I wanted to address was the comment around.

Where. Ambulances are placed and how staffing goes. Ambulance companies have very complex strategy for where they place ambulances, how many ambulances are needed. I'm on my county's Committee that analyzes this all the time. Right? And it's a big game of chess, basically, is how I describe where you put them, where they move, when a call goes out, and all of these different things. And there is a very dynamic world that occurs to constantly move ambulances around unpredictable call volume. And I hear the concerns of level zero.

I would say, though, that I'm not challenging the gentleman's numbers, but there's a lot of times that a level zero page is announced and then level one, meaning an ambulance is back into the system, is 5 seconds later. Right. So those numbers need to be kind of digested properly to really understand. I don't think we're talking about great periods of time that it's level zero.

And I also have to impress, there are many, many things that affect level zero in ambulances being available and not available, and only one of them is the ambulance company's decision making about where they go. Right. We have one city that just, it's this weird fluke of nature that one call goes out and within two minutes another call goes out. Right? And then there's a flurry of calls and suddenly one area is without ambulances. That occurs to anybody, regardless of public private contracts, not contracts.

Just last week, we had to send ambulances from inside our operating area to an area served by a fire Department with their own ambulances all day long because their hospital was too busy to get the ambulances back out. And that's just part of what we call mutual aid. It's an expected reality of ambulance service.

So I unfortunately have to reject a little bit the statement that this will somehow fix that reality of level zero, because no matter who you are in this industry and in this job, that happens. And it's just the nature of the service. And there might be different strategies, there might be different ideas about how to manage that strategy, but level zero will not be resolved unless you flood areas with so many ambulances that it's cost prohibitive. So hopefully that sheds some context to your question.

Thank you.

Go ahead. Thank you. I would say, I think ultimately, if there are concerns, you come to me, you go to your local EMS agency. I'm responsible for the efficacy of the system, and I consider EMS patients my patients, just as if I was in the emergency Department seeing them. So we're who you should come to if you have concerns. I don't see how the collaboration that they describe can't happen outside of legislation.

Like, we integrate with lots of stakeholders, fire departments, ambulance agencies, hospitals, community health districts and clinics. So I think we can achieve this sort of collaboration and integration as systems evolve, and we're capable of doing that.

And I think part of the current structure building on the RFP statement is the competitive procurement process is a public process where the county can evaluate the proposals and see what's best for the community and what their goals are for the ambulance system and have a proposer demonstrate they have the ability to provide the service to the best degree possible. And I think that's a benefit to the public.

Any other Aguilar Curry question?

Yeah, quick like. I just want to thank the author. You took amendments in health, you took amendments today, and you've promised us to continue to work on this on May 9. And with that, I would like to move the Bill.

There's a motion, a second. Any other questions? Vice Chair, do you have a question? No. So with that, obviously, this is a very difficult Bill for me. As I've said before, I have friends on both sides, from public safety to private sector EMS I mean, some of my good friends are firefighter paramedics and private sector paramedics. I started in the field in 1984.

Things were so different back then, how we're providing service, not only how we provided service, but the type of calls we got when people were calling 911 for really true emergencies. Fast forward to now. It's changed. It's evolved. Right. I think the pandemic has really highlighted some of the issues facing how we provide EMS care throughout the state. Obviously, a lot of folks don't call for the typical, the chest pain, shortened breath. This, all the other stuff now that really is part of the problem. Right.

You talked a little bit, sir, about level zero. I can tell you back in my days in our station, in some of our colleagues, we had these t shirts, level zero hero, because level zero was pretty much every day. And I could take you in one more step further that back in my time, we would have one ambulance because we get so busy covering three cities first in 911 calls. And imagine how hard that was.

It would put us like off a freeway, off ramp to respond to whatever call. We didn't even make it there half of the time because we get a call, one of those cities. So we talk about evolving service and care. I mean, it's come a long way, but I think now facing that this Bill is only once again catered to 10 jpas. Correct. And just want to make sure there's nothing in the language that says, zero, it's going to go statewide once again.

It's just reaffirming these 10 jpas, correct?

That's correct. And that's with regard to ambulance service. There are more jpas when you talk about dispatch, only service or those kind of things, but only 10 that fall under the category of the ambulance service that I think everybody is talking about. And it's likely to be where this is going to apply.

We just wanted to clarify that because I know there's some confusion whether this could just the beginning and we're going to open it up to.

But there's no intention on my part to open this up. And there's nothing that I think your staff has found or that I'm aware of in the Bill that says the intention is to go. And if this works for three years, it's automatically going to go. The Legislature can obviously do anything, but they would only do something if for some reason, there was some reason to make some other change later.

Okay. Just wanted to clarify that and put it on the record, so to speak.

Thank you.

And once again, this whole system has evolved. I know once again, when I started in 1984, back in the areas I worked in, we had 24 hours stations in every city. We provided coverage that seemed to work right. Things evolved. Those were the small mom and pop companies. Now we have the big corporations doing service a little bit differently with the system status. That is something that I think probably causes some of the issues.

Right where we move ambulances around every day because we have data that tells us on this day at this time we should have x amount of ambulances. When we know the EMS, things fluctuate. They change day by day. We can't really say, but I know folks think that they can predict it, but you really can't. Once again, Assembly Member, I know you've taken a lot of amendments, the First Committee in this one, and I think it's still a work in progress.

And I know you talked about still continue working with the opposition. So I urge you to continue to work with the opposition, hopefully get this in a better place. And not all one side is going to get 100%. This is why we legislate. We come together and find common ground on things. We're not going to get everything, but as long as we are starting to address this issue, because 40 years of EMS service, I think it's time to start doing some changes on it.

What happened 40 years ago to what we're dealing with now is totally different out there in the streets, what we do, and my big whole thanks to all the EMS workers, whether you're private or public sector EMS, and sometimes I would think of, it doesn't matter what patch you have coming to my house to provide care, as long as you're there in a respectable time during that contract, whatever it is, within the nine minute, five minute, whatever the case may be.

I know it's different in the rural settings and urban cities, but at least we get somebody to our house or a place of work or whatever may be providing us care and treatment. So with that, I do have an ireco and I think we got everybody else and I think Assembly Member, would you like to close?

Thank you very much. I just would like to thank the Committee Members, all of you, for your thoughtful questions and thoughtful analysis about this. It's a challenging issue to get right, and that's why we want to go slow and careful and make sure we get it right as we move forward. So thank you to everybody for your interest and your staff has done a remarkable job and we really appreciate the amendments and are happy to accept the amendments that they've made today. Thank you for an aye vote.

Thank you. And we do have a motion to do pass as amended, to the Committee on Appropriations. So secretary like to call the roll.

That motion is out.

AB 1168. Bennett. Motion is do pass as amended to appropriations. Brody?

Chairman Rodriguez, could I say something, just while we have so many people listening. Just an open invitation for our May 9 meeting that we're going to have. If people have questions or issues that they'd like to make sure addressed, then if they submit them to us earlier, if Assembly Members have them, if anybody in the audience has them, if any stakeholders have them, they tell us about those early. We can plan a better meeting on May 9. So just an open invitation for that. Thank you very much.

Okay. Thank you. With that, that motion is out once again. And now we'll move on to the consent calendar. We have a motion a second to move the consent calendar. With that consent calendar is filed in number one. AB 1770. Secretary, you'd like to call the role.

On the consent on consent AB 1770. Committee on emergency management. The motion is due. Pass. Rodriguez, aye. Rodriguez, aye. Waldron. Waldron. I. Aguirre. Curry. Aguirre. Curry. Aye. Alvarez. Alvarez. Aye. Calderon. Calderon. Aye. Dahle. Dahle.

And the consent calendar is up. Want to make sure everybody got everything. And with that, I must say, this hearing is over. Thank you.