DON'T KNOW. YEAH. OKAY THERE WE
GO. ALL RIGHT GOOD MORNING FOLKS
. ASSEMBLY MEMBER FREDDIE
RODRIGUEZ CHAIRED SEMI COMMITTEE
ON MIRCHI MANAGEMENT TODAY'S
TOPIC HEARING IS ON AMBULANCE
PATIENT OFFLOAD DELAYS. ONCE
AGAIN THANK AND WELCOME. PUSHIN
OFFLOAD DELAYS AND THE IMPACT ON
MERGER SPOTS IN OUR COMMUNITIES
AS YOU ALL KNOW FIRST RESPONDERS
AND EMERGENCY MEDICAL SERVICE
PERSONNEL HAVE FACED A MARATHON
WE NEED CHALLENGES DURING THIS
PANDEMIC. OUR EMS CREWS HAVE
OFTEN WORK IN ENCLOSED SPACES
WHILE TRANSPORTING PATIENTS HAVE
BEEN PUTTING THEMSELVES IN
SIGNIFICANT REST FOR NEARLY TWO
YEARS NOW. AND THE NURSES
PHYSICIANS IN OUR MUNCIE
DEPARTMENTS HAVE BEEN
OVERWHELMED WITH PATIENTS
INFECTED WITH COVE IN NINETEEN.
ON A DAILY BASIS WE CAN OUR EMTS
FIREFIGHTERS PARAMEDICS NURSES
AND DOCTORS TO MAKE. QUICK LIFE
AND DEATH DECISIONS UNDER THE
MOST STRESSFUL WORKING
CONDITIONS. IT'S NO SECRET THAT
ARGUMENT SYSTEM HAS BEEN
STRETCHED BEYOND THEIR
CAPACITIES CAPABILITIES. THE
RECENT CERTAIN COVER NINETEEN
CASE TO DO THE ON THE GROUND
VIRANT IS ONLY MAKING MATTERS
WORSE ESPECIALLY WHEN IT COMES
TO PROVIDING PATIENT CARE AND
TAKING CARE OF PATIENTS AND
FINDS OF THIS PANDEMIC. I THINK
YOU ALL KNOW THAT I'VE SERVED
OVER THIRTY YEARS OF THE FIRST
RESPONDER. BUT AT TIMES WHEN I
WAS WORKING AS AN EMT I DIDN'T
FEEL LIKE THE SYSTEM FOR THE
POLICY MAKERS HAVE MY BACK. FOR
INSTANCE I RECALL WORKING TWENTY
FOUR HOUR SHIFT WHERE I WAITED
FOR OVER TWELVE HOURS AT A
HOSPITAL EMERGENCY DEPARTMENT TO
TRANSFER MY PATIENT. AND ANYONE
HAVE BEEN PART OF IT YOU'RE MY
SYSTEM KNOWS THAT WALK TIMES
ISN'T A NEW ISSUE. THIS PROBLEM
HAS BORN GOT BEEN GOING ON FOR
DECADES IT'S JUST FRUSTRATING TO
CONTINUOUSLY SEE THE REPORTS OF
LONG WALL TIMES. IN THE PAPER'S
MY FEEL FOR THE PATIENT THE
CREWS AND THE MERGING PARTIES
STAFF. LET ME BE CLEAR EXTENT OF
ALL TIMES ARE NOT GOOD FOR THE
PATIENT. THEY ARE NOT GOOD FOR
THE AMBULANCE CREWS THE
FIREFIGHTERS AND MEDICS WHAT
TIMES. ARE CERTAINLY NOT GOOD
FOR SOMEONE MAKING AN URGENT
CALL TO NINE ONE ONE. FOR
MEDICAL ASSISTANCE WHEN THERE
ISN'T AN AMBULANCE AVAILABLE TO
DISPATCH. WE NEED TO DO BETTER.
THE PURPOSE OF TODAY'S HEARING
IS A TO POINT FINGERS. WE HAVE
NO INTEREST IN ASSUMING BLAME TO
ANYONE THAT'S BEEN WORKING
NONSTOP. TO SAVE LARGE FOR THE
PAST TWO YEARS. BUT WE WANT
BETTER PATIENT OUTCOMES TODAY
WE'RE GOING TO HEAR. A SOLUTION
BASED DISCUSSION FOCUSED ON HOW
WE CAN ENHANCE PATIENT CARE. DO
A BETTER JOB OF TAKING CARE OF
THOSE WHO ARE SICK AND INJURED.
AND WE SHOULD ALSO BE OPEN TO
DISCUSSING ANY UNDERLYING ISSUES
HINDERING THE EFFECTIVENESS OF
OUR EMS SYSTEM. IF WHAT TIMES
ARE SYMPTOM OF A LARGER ISSUES
SUCH AS WORKFORCE SHORTAGES.
STRESSFUL AND CHALLENGING
WORKING CONDITIONS. DECREASED
INPATIENT CAPACITY OR HOW DID
THE LAWS OR REGULATIONS WE
SHOULD BE OPEN TO CHANGE. WE
ALSO NEED TO KEEP IN MIND THAT
CALIFORNIA IS A DISASTER PRONE
STATE. AND WE SHOULD NOT BE
SURPRISED BY THE PROSPECT OF
RESPONDING TO A MAJOR FIRE IN A
KENTUCKY. EARTHQUAKE AT THE SAME
TIME. WE NEED TO BE PREPARED FOR
FUTURE SURGES IN DEMAND FOR
MARCH MEDICAL SERVICES AND PLAN
ACCORDINGLY. I LOOK FOR TO THE
SHARING WITH YOUR IDEAS AND
AGAIN THANK YOU FOR EVERYTHING
YOU'VE DONE. TO CONTINUE TO CARE
FOR THE SICK AND INJURED.
WITHOUT LET ME TURN IT OVER TO
MY BACK VICE CHAIR KELLY SORRY
ALSO FOR OPENING REMARKS. THANK
YOU MISTER CHAIR AND I JUST WANT
TO WELCOME ALL OF YOU THAT HAVE.
ATTENDED IN PERSON HERE AND ALSO
THOSE THAT. ARE REMOTE- I AM NO
STRANGER TO THIS. I WAS- IN THE
FIRE SERVICE FOR THIRTY FIVE
YEARS. MY OLD STOMPING GROUNDS
DR KAZON IS NOW- NOW THEY ARE IN
CHARGE OF THE MS- THERE AT L. A.
COUNTY FIRE. BUT IN MY EARLY
YEARS AS ALSO WITH INGLEWOOD
FIRE DEPARTMENT AS A MEDIC. THE
FAMILIAR WITH THE INCEPTION OF
THIS- WHEN WAIT TIMES WHEN THEY
HOSPITAL STARTED BECOMING.
OVERRUN THE E. OURS AND- A LOT
OF IS OVER USE. AND IN. A LOT OF
LIABILITY CONCERNS BY EVERYBODY
TRYING TO SHIFT LIABILITY. WHICH
MEANT EVERYBODY WENT TO THE
HOSPITAL AND- SO NOW HERE WE ARE
TODAY THIS PROBLEM HAS BEEN
EXACERBATED. BY THE PANDEMIC
CONDITIONS THAT WE HAVE. AND SO
IT'S- IT'S HIGH TIME THAT WE ARE
TRYING TO ADDRESS THIS AND OUR
GOAL HERE TODAY. IS TO ENSURE-
THAT WE HAVE A SOME OPTIONS
BECAUSE IN THE LEGISLATURE IT'S
IMPORTANT FOR US TO BE HELPFUL.
A LOT OF TIMES WHEN WE'RE TRYING
TO BE HELPFUL WE WIND UP NOT
BEING SO. AND AND SO IT'S-IMPORTANT FOR US TO HEAR FROM
THE PEOPLE THAT ARE OUT. OUT
THERE TODAY IN THE DISH. TODAY
HELP US UNDERSTAND WHAT WE CAN
TO BE MORE HELPFUL IN- IN IN
FIXING THIS SOLUTION- EMS IN THE
PRE HOSPITAL SETTING WAS NEVER
MEANT TO BE- THE OPTIMAL MEDICAL
CARE IT WAS AN EARLY
INTERVENTION. AND AS WE EXTEND
THAT EARLY INTERVENTION TIME.
THAT MEANS THE INTERVENTION THE
THAT THEY'RE SUPPOSED TO GET AT
THE HOSPITAL- BECOMES REDUCED
AND THAT'S NOT AN OPTIMAL CARE-
TYPE OF A PROGRAM. SO ANYWAY
WITH THAT. I WOULD TURN IT OVER
BACK OVER TO THE CHAIR. AND AND
THEN WE CAN HEAR FROM SOME OF
OUR EXPERTS ABOUT WHAT'S GOING
ON OUT THERE AND HOW WE CAN HELP
SO THANK YOU AGAIN. THANK YOU
CAN OF ICE CHAIR SO WITH THAT
LET'S GET STARTED WITH OUR FIRST
PANEL. DO THE NUMBER OF
WITNESSES ARE ASKED TO KEEP HER
PRESENTATION TO NO MORE THAN
FIVE MINUTES TO ALLOW TIME FOR
QUESTIONS AND ANSWERS. WILL HOLD
ALL QUESTIONS UNTIL AFTER ALL
THE WITNESSES OFFERED THEIR
TESTIMONY. AND AT THE END OF THE
SECOND PANEL WILL TAKE A LIMITED
NUMBER OF PUBLIC COMMENTS. OUR
FIRST WITNESS IS CHIEF RAY GUY.
FROM THE CITY OF MONTR FAR
DEPARTMENT. CHIEF GUY ALSO
SERVES AS THE PRESIDENT OF THE
CALIFORNIA FIRE CHIEFS
ASSOCIATION WITH THE CHIEF GUY.
KALRA MORINGA. JUROR RIGAS CAN
GUYS HEAR ME I'M JUST WANNA MAKE
SURE MY AUDIO WORK IN. YES WE
CAN HEAR. OKAY PERFECT. I LIKE
TO THINK YOU IN THE COMMITTEE
MEMBERS FOR THE OPPORTUNITY TO
SPEAK ON THIS VERY IMPORTANT
TOPIC. OF ALL TIME AND THE
CRITICAL SYSTEM WIDE CRISIS AB
ONE STATION AWFUL OF TIME THE
PLACE. IS CAUSING CALIFORNIA.
ECNL CHIEFS HAVE WE'RE OBVIOUSLY
A PERFECT ASSOCIATION. WE WE
REPRESENT OVER EIGHT HUNDRED AND
FIFTY FIRE AGENCIES WITH OUR
ASSOCIATION. WITH HAD THE
OPPORTUNITY TO OVER THE LAST
SEVERAL YEARS TO HEAR FROM ANY
OF THE FIRE CHIEF THROUGHOUT THE
STATE. AND HELPFUL TIMES ARE
AFFECTING. THEIR RESOURCES AND
THE EFFECTS THAT THEY HAVE ON
THE EMS SYSTEM. I CAN TELL YOU
BASED ON ALL THESE CONVERSATIONS
THIS IS SOMETHING THAT'S GOING
ON UP AND DOWN THE STATE HOWEVER
IT AFFECTS DIFFERENT APARTMENTS-
SLIGHTLY- SLIGHTLY DIFFERENTLY-
WE LIKE TO COOK OTHER COMMITTED
TO CONSIDER A FEW FACTORS IN
EVALUATING THE PROBLEM NUMBER
ONE. WHAT IS THE REAL PROBLEM.
WHAT ARE SOME OF THE CAUSES AND
EFFECTS OF THE PROBLEM- WHOSE
PROBLEM IS THAT. IT WHAT IS THE
MOTIVATION TO FIX THE PROBLEM. I
DEFINITELY WE WOULD LIKE YOU TO
CONSIDER A FEW FACTORS RELATED
TO DEVELOPING SOLUTIONS. ARE
THERE ANY SHORT TIME IS VERY
SHORT TERM FIXES. ARE AT THEIR-
LONG TERM SOLUTIONS SOME OF THE
PROBLEMS WE'RE TALKING ABOUT
TODAY IS OBVIOUSLY WHAT TIME R.
M. S. PERSONNELOF FIRST
RESPONDERS ARE STUCK IN
HOSPITALS WITH PATIENTS UNTIL
THE HOSPITAL STAFF TAKES MEDICAL
CONTROL OF THE PATIENT AND THEN
WILL SAYS ARE PUT BACK TO THE IN
THE SYSTEM. WHAT IS THE COST I'M
GONNA TALK ON SOME OF THESE
ANIMALS. BUT WHAT ARE THE
EFFECTS OF THE FIRE SERVICE. THE
FACT. IS THE EXTENT OF ALL TIME
IS ESSENTIAL THAT WE HAVE FINITE
RESOURCES SUCH AS A RELIGIOUS
EMS PERSONNEL. ARE TAKEN OUT OF
THE EMS SYSTEM. WE CANNOT
RESPOND TO OTHER NINE ONE ONE
EMERGENCY IS ESSENTIALLY TO FAX
THE NINE ONE ONE READINESS. THIS
HAPPENS IN A FEW DIFFERENT WAYS
. BLACK REGENCIES ARE ON SCENE
LONGER FOR CALLS WAITING FOR A
RELIGIOUS WHICH ARE STUCK IN
HOSPITALS. THIS AGAIN DECREASES
THE READINESS TO RESPOND TO
EMERGENCIES. IN ADDITION. FIRE
PERSONNEL OFTEN FOLLOW UP WITH
THE PATIENT TO THE HOSPITAL
WHICH REDUCES STAFFING ON FIRE
EQUIPMENT. THIS IS GOING TO
REDUCE OUR ABILITY AND
EFFECTIVENESS TO RESPOND AND
MITIGATE OTHER CALLS FOR SERVICE
SUCH AS FIRES WILDLAND FIRES
RESCUES HAZARDOUS MATERIALS
INCIDENTS AND OTHER MEDICAL
EMERGENCIES. SO THIS PROBLEM IS
IT. WELL AS WE ALL KNOW A LOT OF
THE DATA THAT'S OUT THERE WOULD
INDICATE THAT THIS IS A SYSTEM
WIDE PROBLEM HOWEVER IF YOU READ
EIGHTY- A DOCUMENT THAT WAS
PRODUCED IN TWO THOUSAND
FOURTEEN FROM THE CALIFORNIA
HOSPITAL ASSOCIATION IN
PARTNERSHIP. WITH THE CALIFORNIA
MERCY MEDICAL SERVICES A FLORIDA
CAL EMSA PUBLISHED A PAPER
CALLED THE TOOL KIT TO REDUCE
AMBULANCE PATIENT OFFLOAD IT
DELAYS AND EMERGENCY DEPARTMENT
. THIS TOOL KIT I. MANY
ASSOCIATED FACTORS CAUSING
DELAYS SUCH AS DECREASED PATIENT
OR IMPATIENT CAPACITY. NURSE
PATIENT RATIOS POSSIBLE
REGULATIONS LIMITING AREAS ARE
CARE INABILITY TO RAPIDLY TURN
OVER HOSPITAL BEDS AND THE LIST
GOES ON AND ON. EXACTLY
IDENTIFIES A LOT OF THE
CONTRIBUTING FACTORS AND SUGGEST
THAT THESE ARE- ALL PROBLEMS ARE
FOUND IN THE HOSPITAL'S NOT
NECESSARILY ON ON THE NINE ONE
ONE SIDE OF- EMS. SO WHAT IS THE
MOTIVATION FOR HOSPITALS TO
SOLVE THIS PROBLEM WELL THE
PROBLEM IS A LOT OF THESE ISSUES
ARE ARE SO. ISSUES IN OTHER
WORDS THEY ARE REAL WE'RE
RELYING ON OLD- TYPES OF SYSTEMS
THAT ARE IN PLACE TODAY. I THINK
TWO OTHER FACTORS NEED TO BE
THEY'RE WHEN ASKED THIS QUESTION
SO WHO'S HOLDING THE HOSPITAL'S
ACCOUNTABLE FOR THEIR ACTIONS OR
INACTIONS. AND THEN ARE THERE
INCENTIVES TO FIX THE PROBLEM.
CHANCE OF THE FIRST QUESTION IT
DOESN'T SEEM LIKE THE
ORGANIZATIONS THAT HAVE
OVERSIGHT OF HOSPITALS ARE
CURRENTLY HOLDING THEM
ACCOUNTABLE FOR. FOR A PART
ISSUES AND PAY AND ALL TIME.
ANSWER TO THE QUESTION ARE THERE
INCENTIVES TO FIX THE PROBLEM. I
WOULD SAY HELLO BECAUSE PRIVATE
AMBULANCES AND FIRE AGENCIES
DON'T CHARGE HOSPITALS FOR LOST
TIME WALLACE SAID ON THE WALL.
BEGIN TAKING THEM OUT OF THE
NINE ONE SYSTEM AND THE FIRE
SERVICE AND PRIVATE AMBULANCE
PROVIDERS. SEEMS TO BE
SUBSIDIZING THE HOSPITALS A LOT
OF REGARDS. SO ARE THERE ARE
SHORT TERM FIXES AND LONG TERM
SOLUTIONS. YES WE BELIEVE SO.
SOME OF THE SHORT TERM FIXES THE
CONSIDER OUR HOLD HOSPITALS
ACCOUNTABLE FOR THEIR ACTIONS AN
ACT IN ACTIONS WHEN IT LOOKS AT
THE ABILITY TO FIX SOME OTHER
INTERNAL PROBLEMS AND SO ON AND
SO FORTH. ALSO DISINCENTIVE THE
HOSPITAL STOCKHOLDER MERCY
PERSONNEL THE HOSPITALS WHICH IS
IT IS IN ESSENCE UTILIZING
PUBLIC TAXPAYER FUNDS TO
SUBSIDIZE THESE HOSPITALS AND
SHIFT THE BURDEN TO OTHER
AGENCIES. MANDATORY REPORTING
AND DATA COLLECTION SYSTEMS SO
WE CAN BETTER IDENTIFY THE
PROBLEM AND FUTURE SOLUTIONS.
DEFINITELY SOME OF THE LONG TERM
SOLUTIONS WE LIKE TO LOOK AT AND
YOU HAD MENTIONED THAT- GERMAN
RODRIGUEZ THE PROBLEM IS THAT WE
HAVE A VERY OUTDATED EMS SYSTEM.
THE HOSPITALS ARE ARE ONLY ABLE
TO DO WHAT THEY CAN DO BASED
UPON THE SYSTEM THE EMS
PROVIDERS ARE ONLY ABLE TO DO
WHAT THEY'RE ABLE TO DO- IN THE
SYSTEM AS WELL AND WE ARE
CURRENTLY OPERATING UNDER A
FORTY TWO YEAR OLD EMS SYSTEM
WHICH IS WHICH IS WOEFULLY.
OUTDATED AND DOES LITTLE TO GIVE
HOSPITALS AND EMS PROVIDERS THE
TOOLS WE NEED TO FIX THE PROBLEM
IN FACT. THE REGULATIONS THAT
WERE THAT WERE WORKING ON A
RIGHT NOW ARE FROM NINETEEN
EIGHTY AND IT IS REALLY
DIFFICULT TO FIX THESE PROBLEMS
TODAY BASED UPON- THESE
REGULATIONS. TRANSIENCE SYSTEM
IS FAILING BECAUSE OF AN
OUTDATED REGULATIONS INCREASED
DEMAND FOR SERVICE. LACK OF
INNOVATION AND A LACK OF WILL TO
FIX THE PROBLEM CALIFORNIA WAS
INSTRUMENTAL IN DEVELOPING THE
EMS SYSTEM IN THE UNITED STATES.
OUR ENCOURAGES COMMITTEE TO TAKE
A DEEP LOOK AT OUR EMS SYSTEM
AND TAKE THE STEPS NEEDED TO
CREATE A BETTER SYSTEM FOR
TOMORROW AND CONTINUE
CALIFORNIA'S LONG TRADITION AND
EMS AND BEING INNOVATIVE. THANK
YOU VERY MUCH. THANK YOU CHIEF
GARC APPRECIATE YOUR COMMENTS
OUR NEXT WITNESSES CHIEF DAVID
WILLIAMS FROM THE CHINO VALLEY
FIRE DISTRICT. CHIEF WILLIAMS
VIA AUDIO. IT CHAIR. A GOOD
MORNING CHAIRMAN RODRIGUEZ AND
COMMITTEE MEMBERS WE WANT TO
THANK YOU FOR YOUR TIME AND MORE
IMPORTANTLY YOU'RE WELCOME TO
STAY HERE AND ADDRESS THE
CONCERNS THAT ARE NEGATIVELY
IMPACTING PUBLIC SAFETY IN OUR
LOCAL COMMUNITIES ACROSS THE
STATE OF CALIFORNIA MY NAME IS
DAVE WILLIAMS AND I CURRENTLY
SERVE AS A FAR CHEAPER THE CHINO
VALLEY FIRE DISTRICT I AM ALSO
HERE TESTIFYING ON BEHALF OF THE
MANY CHALLENGES RELATED TO
EVIDENCE PATIENT OFFLOAD DELAYS
AND OTHER KEY ISSUES THAT
CONTINUE TO PLAY AT THE PLATE
THE FRAGILE EMS SYSTEM IN SAN
BENITO COUNTY. EMS SYSTEM IS
TRULY AN ECOSYSTEM AND FOR EVERY
ACTION AN ECOSYSTEM THERE CAN BE
AN EQUAL AND OPPOSITE REACTION
OUR SOLUTIONS BUT NOT MUST NOT
BE HERE OR WHAT SHOULD CONSIDER
ALL BIBLE. YEAH HELLO. WE SHOULD
GO. EXTENT WALK I WAS AT THE
HOSPITAL'S FOR BE REMISS IF WE
ARE FOCUS. ON SYMPTOMS RATHER
THAN THE DISEASE OVER WITH COST
. WE RECOGNIZE WITH MO DISEASE
THE TRIP PATHWAY NEED TO BE
PRONGED AND WE WOULD LIKE TO ALL
A FEW TREATMENTS IN SOME. AS A
WALL TIMES CONTINUED IN ACROSS
THE STATE. ONE OF THE MOST
SIGNIFICANT IMPACTS IS THE
AMBULANCE DELAYS THAT ARE
OCCURRING IN OUR COMMUNITIES ON
A DAILY BASIS. THIS IS THAT THIS
HAS BECOME ARGUABLY THE MOST
SIGNIFICANT EMERGENCY MEDICAL
PRICES IN THE STATE'S HISTORY.
THESE DELAYS ARE SIGNIFICANT
JEOPARDIZING PUBLIC SAFETY. WELL
IF I DISTRICT UNIQUE LOCATE ON
THE WESTERN BORDER OF SAN DIEGO
COUNTY. THIS IS IMPORTANT TO
NOTE BECAUSE THE ALREADY
STRAINED EMINENT SERVICES
HISTORICALLY CLASS AWAY FROM MY
JURISDICTION. EIGHT PARK ISSUE
INCREASES THE SEVERITY OF
THREATEN MY COMMUNITY. WHEN
AMBULANCES ARE BEING HELD AT
LOCAL MERCHANT APARTMENTS DUE TO
A PARK AND RESOURCES SHIPPED
AWAY FROM THE CHINO VALLEY. IT'S
ONLY A MATTER TIME WHEN A
COMMUNITY MEMBER WILL LIKELY DIE. SIMPLY BECAUSE THEY CANNOT GET
TO THE HOSPITAL. CHINO VALLEY
BALL KINDS OF STE TIMES. OUR
GOAL IS TO GET OUR COMMUNITY WHO
ARE EXPERIENCING A CRITICAL
MEDICAL CONDITION THE HOSPITAL
IN THE MOST EXPEDITIOUS MANNER
IT IS OUR BELIEF THAT THIS
APPROACH INCLUDES. HOLDING
RECEIVING HOSPITALS ACCOUNT FOR
PROCESSING INFORMATION. IN
INCOMING PATIENTS IN A
RESPONSIBLE AND TIMELY MANNER
AND BREAKING DOWN BARRIERS THAT
PREVENT AGENCIES. FROM USING
THEIR AVAILABLE RESOURCES TO
ENHANCE THE PUBLIC SAFETY.
PATIENTS HAVE TO WAIT ON THE
WALL FROM THE HOSPITAL'S OR IN
THE- FOR EXTENDED AMOUNTS OF
TIME IS SIMPLY UNACCEPTABLE. AS
A COMMUNITY AS THE COMMITTEE
SEEKS TO ADDRESS THE A PART
ISSUE WE WILL ALSO ENCOURAGE THE
COMMITTEE TO CONSIDER REWRITING
OUTDATED LAWS. THAT SIMPLY DO
NOT HELP THE CURRENT PRE
HOSPITAL ECOSYSTEM USE ALL OF
ITS CURRENT RESOURCES. AT CHINO
VALLEY FIRE DISTRICT ALONG WITH
DOZENS OF OTHER AGENCIES ARE
WORKING TO COLLABORATE ON THIS
PROJECT. TO ENSURE THE SAFETY OF
OUR COMMUNITY. THANK YOU VERY
MUCH FOR YOUR TIME AND
CONSIDERATION WITH THIS
CRITICALLY IMPORTANT MATTER.
THANK YOU CHIEF WILLIAM THANKS
AGAIN FOR COMMENTS. OUR NEXT
WITH A WITNESSES ASSISTANT CHIEF
ERIC SAILOR FROM THE SACRAMENTO
FIRE DEPARTMENT. CHIEF SAILORS.
HI EVERYBODY- CAN I SHOULD THERE
WE GO WAITING SHARE MY SCRIPT
THANK YOU VERY MUCH. THANK YOU
EVERYBODY FOR HEARING THIS
TESTIMONY. RIGHT NOW WE'RE
LOOKING AT A NEWS STORY IN
SACRAMENTO THIS IS A FAMILIAR
SCENE OF OURS. THIS JUST SHOWS
THE IMPACT OF THE AMBULANCE IS
BEING HELD UP AND YOU CAN SEE
IT'S A MIX OF AMBULANCES BOTH
PRIVATE AND PUBLIC HELD UP AT
ONE HOSPITAL. THE DATA THAT
WE'RE SEEING RIGHT NOW FOR
STUDYING THIS PROBLEM IS THAT
OUR RESPONSE TIMES ARE REACHING
A VERY CRITICAL POINT AS WALL
TIMES HAVE GONE UP OUR RESPONSE
TIMES IN THE DOWNTOWN CORE OF
SACRAMENTO. ARE STARTING TO GET
NEAR TWELVE MINUTES. EVERY TIME
WALL TIMES GO UP OUR AMBULANCE
RESPONSE TIMES GOES UP. TO
TRANSFER SHOULD TAKE NO MORE
THAN TWENTY MINUTES AND LAST
YEAR WE WERE HELD ON THE WALL
FOR OVER TWO HOURS MORE THAN
SEVEN HUNDRED TIMES IN TWENTY
TWENTY ONE. THIS IS THE DATA
THIS IS WHAT THE PICTURE LOOKS
LIKE BUT LET ME TELL YOU WHAT
THAT MEANS TO PATIENT CARE THIS
IS ONE PARTICULAR CALL THAT JUST
HAPPENED LAST WEEK. WERE A
WITNESS TO REST HAPPENED IN THE
DOWNTOWN CORE OF SACRAMENTO VERY
CLOSE TO A MAJOR HOSPITAL-
WITNESS REST MEAN THAT MEANT
MEANT THAT THE PATIENT STOPPED
BREATHING AND THEY LOST THEIR
HEART RATE. SO BYSTANDER CPR
STARTED THE FIRST THING TRUCK
ARRIVED ON SCENE AND STARTED
CPR. AND WAITED FOR AN
AMBULANCE. NOT RIGHT AROUND THE
CORNER. FROM THIS CPR THERE WERE
TWO AMBULANCES SITTING ON THE
WALL THEY'RE JUST. THE WAY THEY
HAD ON THE WALL FROM MORE THAN
OUR AND SOME OF THEM WOULD STAY
ON THAT WALL FOR GREATER THAN
EIGHT HOURS. IN THIS EVENT EVERY
MINUTE COUNTS THESE WITNESSED
CPR'S ARE WITNESSED ARRESTS ARE
VERY STABLE EVENTS. BUT YOU HAVE
TO GET HIM TO THE HOSPITAL IN
TIME AND RIGHT NOW YOU'RE SEEING
MY AMBULANCES SET UP ACROSS THE
CITY WAITING. ON THE WALLS. I
HAD THE SHOULD THE MAN. TO SHOW
YOU THAT'S CAN. SO THE AMBULANCE
THE NEXT RESPONDED THIS CALL WAS
NOT A SACRAMENTO. EIGHT MILES
AWAY THREE CITIES OVER THANK
GOODNESSWE HAVE A GOOD PARTNER
IN AN AMAZING PART OF PART NEXT
TO US IT WAS ABLE TO GIVE US AN
AMBULANCE TO TRANSPORT THIS
PATIENT. BUT THEY WERE TWENTIETH
IN THE PIC FOR AMBULANCES
MEETING THEY WERE THE TWENTIETH
AMBULANCE THEY SHOULD HAVE
RESPONDED TO THIS CALL. WALKABLE
TO AMBULANCES SAT JUST A BLOCK
AWAY. ON THE WALL. ALLEN THIS
NEIGHBORING AGENCY GAVE US THEIR
AMBULANCE THEY ALSO OPENED UP
VERY ENTIRE DISTRICT. AND MADE
ALL OF THEIR CONSTITUENTS
VULNERABLE. SO I WANT TO MAKE
THIS POINT THAT THIS IS THESE
ARE TAXPAYER RESOURCES THAT ARE
BEING USED RIGHT NOW TO STAFF
HOSPITALS THIS IS NOTHING SHORT
OF CRIMINAL THESE ANIMALS ARE
BEING HELD ON THE WALLS UP TO
EIGHT NINE HOURS AT A TIME AND
THEY ARE REMOVED FROM THE SYSTEM
AND THIS ISN'T AN ALL OPEN
PROBLEM THIS IS BEEN GOING ON
FOR OVER A DECADE IN OUR REGION
IF WE HAD SOLVED THIS PROBLEM IN
TWO THOUSAND EIGHTEEN WE
WOULDN'T BE IS BOUND UP AS WE
ARE RIGHT NOW. AND MOVING IN THE
AMBULANCE FROM THE SYSTEM MAKES
THE ENTIRE SYSTEM WORKS. HAVING
ONE AMBULANCE IT ON THE WALL
JUST REMOVES ONE MEDICAL
RESOURCE FROM THE ENTIRE
COMMUNITY IT ALSO CREATES
INCREASES THE PATIENT'S
CRITICALITY MEANING THAT EVERY
MINUTE COUNTS AND WE MAY RESPOND
TO A MINOR PATIENT BUT IF WE
TAKE MORE THAN TWENTY FOUR
MINUTES TO GET IN THE HOSPITAL
THAT MAY TURN INTO A CRITICAL
PATIENT THEN OCCUPIES. AND I
ZERO. SO QUICK SMART GOAL FOR
SUGGESTIONS ON WHERE TO MOVE
FORWARD. I QUIT THIS CHIU THE
OLDER OSHA LAWS THAT FINES WERE
REALLY THE ONLY THING THAT
CHANGED BEHAVIOR AND UNDER TITLE
TWENTY TWO WE HAVE THE ABILITY
TO UP. IT FIND THE HOSPITAL'S
FOR ANYTIME THE HOLES OVER THE
WALL FOR OVER TWENTY MINUTES. WE
ALSO HAVE THAT SAME ABILITY IN
THE HIT HEALTH AND SAFETY CODE.
AND ALSO TO REPORT DEMAND AS
ADVERSE EFFECTS TRUE A TRANSFER
OF CARE COULD NOT TAKE ANY MORE
THAN TWENTY MINUTES IN ANY AND
EVERY TIME THAT HAPPENS THE
HOSPITAL SHOULD BE FINE AND HELD
ACCOUNTABLE AND THAT MAY BE THE
ONLY THING. THAT GETS INTO
CHANGED BEHAVIOR. THANK YOU.
THANK YOU CHIU SAILORS OUR NEXT
WITNESS IS DIRECTOR KEPT THE
CHILDREN AFTER THE MERGER
MEDICAL SERVICES AGENCY DIRECTOR
FROM THE COUNTY OF LOS ANGELES
DIRECTOR JOE DYSTER ARE YOU
THERE YOU VERY
MUCH. IN THANK YOU. CABBAGES
DURING THE DIRECTOR OF EMERGENCY
MEDICAL SERVICES AGENCY LOS
ANGELES COUNTY- I'VE BEEN
DIRECTOR FOR SIXTEEN YEARS I'VE
WORKED IN EMS AGENCY AND I'VE
BEEN IN HEALTH CARE FOR MUCH
LONGER THAN THAT- WE WORK
CLOSELY WITH OUR HOSPITALS ARE
ARE DEPARTMENTS. AND ARE ONCE
COMPANIES AS A TEAM TO TRY TO
ADDRESS THIS ISSUE. OUT I THINK
PEOPLE WILL TALK A LOT ABOUT
WHAT THE PROBLEM IS- AND HOW THE
PROBLEM HE WITHIN THE HOSPITAL-
HOSPITAL IS WORKING- WILL BE
TALKED ABOUT BY MANY PEOPLE BUT
I WANTED TO ADDRESS FROM MY
YEARS OF EXPERIENCE HOW. WE HAVE
BEEN LOOKING AT THIS ISSUE AND
HOW I FEEL ABOUT THE ISSUE OF
ONE TIME- I BASED ON MY
EXPERIENCE I WANT TO SEE WHAT
DOES NOT WORK- TO ADDRESS WELL
TIME. WHAT DOES NOT WORK- TOLD
CAMPUS OUT THERE'S BEEN MANY
TOOL KITS THAT HAVE BEEN
DEVELOPED OVER THE YEARS THEY
SEEM TO YOU ALTERNATELY LANGUISH
ON A COMPUTER FILE SOMEWHERE DUE
TO CHANGES IN STAFFING. DUE TO
CHANGES WITHIN THE HOSPITAL AND
DUE TO CHANGES WITHIN PRIORITIES
ARE WITHIN THE HOSPITAL'S
THOUGH- I DO NOT. ADVOCATE FOR
TOLD CATS. I MEDIAN WITH HANS C.
WE TRIED TO. INDIVIDUAL
HOSPITALS AND WORK WITH THE C.
E. O.'S TO YOU TALK ABOUT- THE
PROBLEMS WITHIN THEIR HOSPITAL
AND GIVE THEM SOLUTIONS OFFER
THEM TOOL KITS. THIS IS A
TEMPORARY SOLUTION C. E. O.'S.
HAVE A POT OF POSITIVE AFFECT OF
MOMENTARILY IT SEEMS WHEN THE C.
E. O. MOVES ON IT WHERE THEY
HAVE OTHER PRIORITIES I'M
BEGINNING TO GO RIGHT BACK TO
WHERE WE WERE WITH A LOT. I THE
VERSION POLICIES L. A. COUNTY
HAS A PLETHORA OF DIVERSION
POLICIES THAT ARE VERY COMPLEX.
ON THE THEY GO FORWARD CAN BE
READ FOR PAGES OUT THESE ARE
SHORT TERM RELIEF VALVES FOR THE
HOSPITALS TO DIVERT AMBULANCES
TO OTHER AREAS. AND OTHER
HOSPITALS THAT CAN ASSISTANTSHIP
. ALL OF OUR HOSPITALS ON
DIVERSION AND WHEN EVERYBODY'S
ON VERSION OF. THE PERSON. SO
I'D LIKE TO MOVE ON TO WHAT
SUCCESS I SEAT WITH MITIGATION
STRATEGIES- I DO AGREE THAT IT
IT'S NEEDS TO BE A FINANCIAL
SOLUTION. SO. THE THINGS THAT
WE'VE DONE THAT WE'VE SEEN.
NEVER MISS THAT'S WHYBUT I
THINK WE NEED TO CONTINUE TO
MOVE FORWARD HERE L. A. COUNTY
AS ANY CONTRACTS THAT WE HAVE
WITH THE HOSPITAL FOR A
SPECIALTY CENTER SUCH AS- OUR
STROKES CENTERS PROMISED THEM
STAMP CENTERS. ONCE WE HAVE A
CONTRACT WITH THE HOSPITAL AND
THEY ARE INTERESTED IN
PARTICIPATING IN THE SYSTEM
WHICH IS A GOOD THING FOR THE
HOSPITAL. IT'S A GOOD THING FOR
THE COMMUNITY AND THEY'RE EACH
THESE PATIENTS DO COME WITH SOME
TYPE OF UP HERE SOURCE TO THE
HOSPITAL ONCE WE HAVE THOSE
AGREEMENTS WE'VE BEEN ABLE TO
PUT IN THE AGREEMENT. FOR
INSTANCE WE ARE STROKES CENTER
AGREEMENT- THE HOSPITALS HAVE
AGREED TO CONTRACT WITH A
PRIVATE AMBULANCE COMPANY IN
HAVE- THE PRIVATE AMBULANCE
COMPANY ON STAND BY TO GO PICK
UP. AT TRANSFERRED STROKE
PATIENTS TO THE HOSPITAL SO THAT
THE HOSPITALS DO NOT CALL NINE
ONE ONE TO GET THAT EACH AND
TRANSFERRED TO A COMPREHENSIVE
STROKE CENTER SO WHAT HAS BEEN
ONE TOOL THAT IS I'M GIVEN A
MINOR RELIEF BUT IT'S THE SMALL.
THINGS THAT WE ARE WORKING WITH
WITH OUR PROVIDER AGENCIES AND
HOSPITALS TO ALLEVIATE SOME OF A
POT- WE ALSO HAVE IMPLEMENTED IN
OUR DIVERSION POLICY IF A NINE
ONE ONE RECEIVING HOSPITAL THAT
IS A SPECIALTY CENTER SUCH AS A
STROKE. CENTER OR- YEAH. IF THEY
A ACT NUMBER INDIAN. WAITING
WEEKS THAT DAMASCUS. AND THAT
AFFECTS THE- FOR. BECAUSE THEY
HAVE STAFF FOR THOSE- SPECIALTY
PATIENTS TO COME IN AND A GOOD
AT MOST MOST PATIENTS COME IN
WITH A GOOD PAIR SOURCE. SO
AGAIN THAT'S A FINANCIAL
INCENTIVE FOR THEM TO KEEP THE
AMBULANCE IS- MOVIE. SO ANY
CONTRACT WITH THE NINE ONE ONE
RECEIVING HOSPITAL SHOULD HAVE
LANGUAGE THAT REQUIRES PAYMENT
WE HAVE BEEN TRYING. TO
IMPLEMENT THOSE THAT OUR SYSTEM-
BUT THEY SHOULD BE BE REQUIRED
TO PAY THE AMBULANCE COMPANY FOR
WAITING TIMES. ARE A SPEAR NOT
NECESSARILY THE HOSPITALS ARE
ALREADY OVER REGULATED THERE ARE
ALREADY PUNISHED WITH FINANCIAL.
PUNISHMENTS WHICH IS NOT THE
ANSWER BUT THEY SHOULD BE ABLE
TO PAY A FAIR WAGE I TO THAT
ONE'S COMPANY. THAT IS WAITING
FOR WE WERE LOOKING A OVER AN
HOUR. THE COMPANY SHOULD BE
ALLOWED TO BUILD FOR THE
INDIVIDUAL HE SHOT THAT THEIR
CITY WEST. ON THIS CAN BE DONE.
TO WHERE IT WHEN THE P. CO THEN
ARE SIGN IN BY THE- AND THE M.
COMPANY. OUT BY NURSE AND THE
AWG CARE RECORD WITH THAT TIME-IS THAT MAN INTO THE HOSPITAL
WITHIN THIRTY DAYS AND THERE IS
A FAIR RATE THAT IS PAID TO THE
AMBULANCE COMPANY. OFF FOR THEIR
STAFF AND HAVING THE AMBULANCE
WAITING AND BEING OUT OF SERVICE
THIS WOULD BRING THE ISSUE TO
THE LEVEL OF THE C. E. O. AND
THEN THE CBO OVER THE COMPANY
WHAT- I THINK THEY WOULD BE ABLE
TO PUT PROCESSES IN PLACE TO
MOVE THE AMBULANCES AND RELEASE
THEM. MORE QUICKLY HOSPITALS ONE
OF THE OTHER THINGS THAT WE'VE
HAD IN OUR SYSTEM THAT HAS BEEN
HELPFUL ESPECIALLY DURING THIS
CALL BIG PANDEMIC. HAS HAVING
HOSPITALS HIRE EMTS ALBION'S OR
OTHER MEDICAL STAFF TO MONITOR
THE PATIENT'S AND RELIEVE THE
AMBULANCES AND GET THEM BACK
INTO SERVICE MORE QUICKLY.
THERE'S NO REASON FOR THAT
HOSPITALS CANNOT HIRE THIS
ADDITIONAL STAFF TO YOU RELEASED
THE AMBULANCES ARE AND LIKE. I
SAID WE HAVE BEEN SUCCESSFUL
WITH THAT. WE DON'T STAY ON THE
HOSP- ENSURE THAT THEY HAVE THAT
WE DON'T HAVE A MECHANISM TO
ENSURE THAT THE HOSPITAL CAMPUS
ADDITIONAL STAFF. SO WE ARE NOT
ON THE HOSPITAL WE NOTICED THAT
THE HOSPITAL THEY MOVE ON TO
OTHER THINGS THEY GET OTHER
PRIORITIES AND THESE THE STAFF
BEING EXTRA STAFFING SEEMS TO GO
AWAY. SO AGAIN THAT WOULD BE A
CONTRACTUAL OBLIGATION THAT UP
IN A SYSTEMS CAN POINT INTO WORK
SOME OTHER MECHANISMS TO ENSURE
THE HOSPITAL HOW DOES IT IS JUST
NOT STOPPING. SO ALL. PRACTICES
NOT PUNISHING HOSPITALS WE NEED
TO WORK AS A TEAM WITH THE
HOSPITAL'S DIVERTING SPECIALTY
CARE PATIENTS ALLOWING AMBULANCE
COMPANIES TO BILL I THINK AFTER
MY THIRTY YEARS HERE AT IT
WITHIN THE EMS AGENCY AND
WORKING WITH THE IS A POT ISSUES
AND TOOL KITS- I THINK THAT THIS
IS A MORE REASONABLE RESPONSE
AND I THINK IT'S CRITICAL THAT A
FINANCIAL INCENTIVE FOR THE
HOSPITAL TO BE ABLE TO MOVE
THESE PATIENTS SO IN CONCLUSION.
WE NEED TO SUPPORT THE HOSPITAL
SYSTEM TO ENSURE THAT THE
MISSION OF CARING FOR THE SICK
AND INJURED ANOTHER THINK RING
COBIT HOSPITALS HAVE BEEN MADE
TO BE POSSIBLE FOR SOCIAL
ASPECTS OF PATIENTS GETTING
HOMELESS OF PEOPLE CONNECTED ALL
OF THESE THINGS ARE NOT
NECESSARILY BUT THE HOSPITAL
SHOULD BE DOING MENTAL HEALTH
PATIENTS SHOULD NOT BE IN THE
HOSPITAL'S HOSPITAL SHOULD BE
CARING FOR THE SICK AND THE-
INJURED. AT THE THAT SHOULD NOT
HAPPEN RIGHT. FORCED ON THAT
ADDRESS SOCIAL ISSUES WE NEED TO
SUPPORT OUR AMBULANCE PROVIDERS.
AND THE FIRE DEPARTMENTS TO MAKE
SURE THAT THEY REMAIN VIABLE AND
THAT THEY ARE AVAILABLE FOR
THEIR MISSIONS TO TRANSPORT THE
SICK AND INJURED. AND FINALLY WE
NEED TO IDENTIFY A MECHANISM TO
ENSURE THAT THE HOSPITAL'S
PURELY PAY OFF FOR THE AMBULANCE
PROVIDERS AND FIRE DEPARTMENT
STAFF- THAT ARE WAITING AND
AGAIN I HAVE NO DOUBT THAT THERE
NEEDS TO BE A FINANCIAL
INCENTIVE. I TO GET THE
HOSPITAL'S TO YOU TO MOVE ON
PATIENTS AND GET THE AMBULANCE
IS BACK IN THE SERVICE AND I
WANT TO THANK YOU VERY MUCH FOR
THE OPPORTUNITY. TO SPEAK TODAY
I AM HAPPY. TO BE ABLE TO
ANSWER. THANK YOU. DIRECT OUR
NEXT WE- MISTER BRIAN HENDRIX A
- TO FOR. AMERICAN MEDICAL
RESPONSE. MR HENDRICKSON. GOOD
MORNING JERRY RODRIGUEZ AND
MEMBERS OF THE COMMITTEE- MY
NAME IS SAM AND I'M A REGIONAL
DIRECTOR FOR AMERICAN MEDICAL
RESPONSE AND REACH AIR MEDICAL
SERVICES IN MARIN REACH ARE THE
LARGEST GROUND AND AIR AMBULANCE
PROVIDERS IN CALIFORNIA- I
PERSONALLY WORKED AS A PARAMEDIC
AND HAVE MORE THAN TWENTY YEARS
OF HIM AS EXPERIENCE IN
DIFFERENT COUNTIES IN
CALIFORNIA. I'M VERY
APPRECIATIVE OF THE OPPORTUNITY
TO SHARE A AMMAR'S EXPERIENCE
BUT AMBULANCE PATIENT OFFLOAD
DELAYS IN THE IMPACT THEY ARE
HAVING ON OUR PATIENTS AND CARE
GIVERS AND THE STRESS THEY ARE
COSTING. THE MS SYSTEMS
THROUGHOUT CALIFORNIA. AND ON
STATION OFFLOAD DELAYS HAVE BEEN
AN ISSUE IN CALIFORNIA FOR MORE
THAN FIFTEEN YEARS DESPITE MANY
EFFORTS OVER THE LAST FIFTEEN
YEARS AS YOU'VE HEARD FROM.
OTHERS SPEAKERS TO RESOLVE THIS
ISSUE NONE HAVE BEEN SUCCESSFUL.
WE HAVE CONTINUED TO SEE
INCREASING WAIT TIMES YEAR AFTER
YEAR OUR AMBULANCE PATIENTS.
WILL KOBE NINETEEN MAY BE
WORSENING THE ISSUE OF THE
AMBULANCE PATIENT OFFLOAD DELAYS
IT IS IMPORTANT FOR ALL OF US TO
RECOGNIZE. THAT THIS IS NOT A
TRANSIENT PROBLEM CAUSED BY A
PANDEMIC BUT INSTEAD A SYSTEMIC
ISSUE THAT REQUIRES URGENT
ATTENTION FROM THE LEGISLATURE.
WHAT SHOULD REMAIN AT THE FOCUS
OF OUR COLLECTIVE DISCUSSIONS IS
OUR PATIENTS IN THE IMPACT THAT
THIS UNSOLVED CRISIS CONTINUES
TO HAVE ON THAT. IMAGINE THAT
YOU OR YOUR LOVED ONE CALLS NINE
ONE ONE AND IS TRANSPORTED BY
AMBULANCE TO A LOCAL HOSPITAL.
ONLY TO BE REQUIRED TO LAY ON
UNCOMFORTABLE INDOLENCE CARNEY
ALONG A HOSPITAL HALLWAY FOR
MORE THAN EIGHT HOURS. DURING
THIS TIME THE PATIENT IS NOT
BEING TREATED BY HOSPITAL STAFF
IS THE PATIENT REMAINS THE
RESPONSIBILITY OF THE AMBULANCE
CAREGIVERS AND HOSPITAL STAFF
ARE TOO BUSY. WE KNOW FROM OUR
EXPERIENCE THROUGHOUT THE STATE
THESE INSTANCES ARE NOT RARE
OCCURRENCES. AND SOME CASES
PATIENTS ON THEIR INCOME AS CARE
GIVERS HAVE BEEN FORCED TO WAIT
OUTSIDE OF HOSPITALS AND THE
BITTER COLD DUE TO A LACK OF
AVAILABLE SPACE AND RESOURCES.
PLEASE CONSISTENT DELAYS IN
TRANSFERRING PATIENTS TO
HOSPITAL CARE ALSO HAVE A
DEVASTATING IMPACT ON PATIENTS
THAT NEED TO USE NINE ONE ONE
AND EXPECT A TIMELY AMBULANCE
RESPONSE. SOMETIMES THESE
AMBULANCE RESPONSES OR DELAYED
SIGNIFICANTLY AS WE'VE ALREADY
HEARD DUE TO MULTIPLE AMBULANCES
NOT BEING RELEASED FROM
HOSPITALS FOR HOURS ON END.
THERE HAS PROBABLY BEEN HARM TO
PATIENTS BECAUSE OF THESE
EXTREME ABOUT DELAYS AND THERE
SEEMS TO BE NO END IN SIGHT. IN
ADDITION TO THE IMPACT ON OUR
PATIENTS AND THEIR HEALTH IS THE
IMPACT WE ARE SEEING IT HAVE ON
THE INCREDIBLE HEALTHCARE
WORKERS WE HAVE IN THE STATE.
AEROBIC GYMNAST HEALTHCARE
WORKERS HAVE SHOWN UP DAY IN AND
DAY OUT DURING THIS PANDEMIC IN
OUR SHIRLEY FATIGUED AND
EXHAUSTED BY TE IMPACT IT'S HAD
ON THEM AND THEIR FAMILIES.
AMBULANCE PATIENT OFFLOAD DELAYS
WORSEN THE WORKLOAD FOR THESE
CARE GIVERS AND MAKE THEIR JOBS
MORE DIFFICULT. R. EMS THEY'RE
GIVERS ARE FREQUENTLY FORCED TO
STAY WITH THEIR PATIENTS FOR
MANY HOURS AT LOCAL HOSPITALS.
THIS OFTEN LEADS THAT I'M
MISSING THE REST AND MEAL BREAKS
PERIODS AND IN MANY CASES BEING
HELD WELL BEYOND THE END OF
THEIR SHIFTS. WELL OUR EMS CREWS
DILIGENTLY TAKE CARE OF PATIENTS
FOREGOING THE ABILITY TO TAKE A
BREAK OR GO HOME TO THEIR
FAMILIES AT THEIR SCHEDULE TIME.
THE FREQUENTLY WITNESS POSSIBLE
STACK EVEN JUST THAT. IN EMS
CARE GIVERS HOSPITALS HAVE
ESSENTIALLY CO OPTED OUR WORK
FORCE TO FULFILL THE
RESPONSIBILITIES OF THE FACILITY
. FURTHER CHALLENGING OUR
ABILITY TO CARE FOR PATIENTS AS
A SIGNIFICANT RISK THAT WE ARE
ASKING OUR PROVIDERS TO BEAR
THAT RELATES TO THEIR SCOPE OF
PRACTICE. WHILE OUR PERSONAL
GAIN COOP THAT IS FREE HOSPITAL
LABOR THEY ARE NOT CREDENTIALED
BY THE FACILITIES TO WORK AS
PARAMEDICS ARE STRICTLY
PROHIBITED FROM CARING FOR THESE
PATIENTS BY STATE LAW.
pNINETY SEVEN POINT ONE NINE FIVE
OF THE HEALTH AND SAFETY CODE.
EXPECTING EMS PERSONNEL THE TAKE
ON PATIENT CARE RESPONSIBILITIES
THAT THEY ARE STRICTLY PROHIBIT
PROHIBITED FROM SHOULD MEAN
ASSEMBLY A LEGAL LIABILITY
CONCERN FOR ALL STAKEHOLDERS
ATTEMPTING TO RESOLVE THIS
ISSUE. A WORKFORCE IS A
CHALLENGE THAT ALMOST EVERY
INDUSTRY IS CURRENTLY FACING
INCLUDING HOSPITALS AND EMS
PROVIDERS. REGARDLESS OF
WORKFORCE AVAILABILITY WE NEED
TO FIND WAYS TO INCREASE
CAPACITY AT OUR HOSPITALS
WITHOUT ADDITIONAL STAFF TO CALL
UPON HOSPITALS NEED TO IMPROVE
THROUGHPUT AND THE CAPACITY GIVE
THEIR EXISTING STAFF TO MANAGE
ADDITIONAL PATIENTS FAMILIES
AMBULANCES TWO PRIMARY. WE NEED
OUR AMBULANCES TO BE READY FOR
THE NEXT CALL AND WHILE I AGREE
THAT THERE MAY NEED TO BE A
FINANCIAL INCENTIVE FOR US TO
MAKE SOME CHANGE THAT IS TRADING
TRADING AT SEVEN THOUSAND NOT
BECAUSE- WE KNOW WITH WORKFORCE
LIMITATIONS THAT ASSEMBLY
REIMBURSING THE AMBULANCE
PROVIDERS FOR THEIR COST TO HAVE
STAFF. AT THE FACILITY WILL NOT
SOLVE OUR PROBLEM OF GETTING AN
AMBULANCE THE NEXT NINE ONE ONE
CALL. SIMPLY PUT THE OPERATIONAL
AND ECONOMIC IMPACTS OF
AMBULANCE PATIENT OFFLOAD DELAYS
IS THREATENING THE STABILITY OF
YOUR NINE ONE ONE EMS SYSTEM
STATEWIDE. IN THE LAST YEAR
AMERICAN MEDICAL RESPONSE
AMBULANCES MORE THAN ONE HUNDRED
AND TWENTY FIVE THOUSAND HOURS
WAITING BEYOND THE TWENTY MINUTE
MARK FOR A HOSPITAL BED AND
EMERGENCY DEPARTMENTS. ONE
HUNDRED AND TWENTY FIVE THOUSAND
AMBULANCE HOURS THAT WERE NOT
AVAILABLE FOR A NINE ONE ONE
CALL. BASED ON STATE AND ON
STRIKE TEAM REIMBURSEMENT RATES
THESE HOURS COME AT A COST OF
MORE THAN TWENTY FIVE MILLION
DOLLARS FOR THE LAST YEAR ALONE.
REPRESENTING SIGNIFICANT COST
SHIFTING FROM HOSPITALS
AMBULANCE PROVIDERS. ONCE
PROVIDERS BOTH PRIVATE AND
PUBLIC ARE BEING HELD CAPTIVE BY
THIS LONG TERM PRICES HIGHER TO
COMMITTEE TO PLEASE HEAR THE
TESTIMONY TODAY AND HELP TO FIND
IMMEDIATE LEGISLATIVE SOLUTIONS.
HAPPY TO ANSWER ANY QUESTIONS
THANK YOU. THANK YOU MR
HENDRICKSON. OUR NEXT WITNESSES
CHEN WARMAN A REGIONAL LABOR
REPRESENTATIVE FOR UNITED EMS
WORKERS ASKED ME LOCAL. FORTY
NINE ELEVEN MS WARMAN. HELLO
MISTER CHAIR AND MEMBERS OF THE
COMMITTEE THANK YOU MISTER CHAIR
FOR YOUR OPENING REMARKS
EXPLANATION OF WHAT WE ARE
FACING IN THE FIELD MY NAME IS
JENNIFER WARMAN I WORKED FOR
AMERICAN MEDICAL RESPONSE IN
SACRAMENTO PLASTER AND YELLOW
COUNTY FOR THE LAST TWENTY
YEARS. EIGHTEEN OF AS A
PARAMEDIC I AM ALSO A LABOR
REPRESENTATIVE FOR UNITED EMS
WORKERS ASKED ME LOCAL. NINE ONE
ONE FOUR YOU
FOR HOLDING THIS HEARING
INCLUDING THE POSSESS
PERSPECTIVE- PUTS ON THE GROUND
WORK FORCE. I'M HERE TO TALK
ABOUT THE IMPACT OF WALL TIMES
IN THE EMERGENCY ROOMS AND HOW
IT AFFECTS OUR PATIENTS MY
FELLOW EMS PROVIDERS. AND THE
IMPLICATIONS. WORKFORCE FIRST
I'D LIKE TO SAY THAT WHILE TIMES
ARE NOON IT HAS BEEN AN ONGOING
PROBLEM FOR AS LONG AS I CAN
REMEMBER. EVERY WINTER FLU
SEASON WE HAVE THE SAME PROBLEM
TOO MANY PATIENTS NOT ENOUGH
BEDS NURSES. I CAN REMEMBER BACK
TEN YEARS STANDING ON THE WALL
CENTER ROADS WILL BE OFFERED
SNACKS BECAUSE WE'D BEEN THERE
FOR MORE THAN FOUR HOURS. MOST
RECENTLY THE WALL TIME ISSUE HAS
GOTTEN WORSE I THINK BECAUSE WE
HAVEN'T HAD A BREAK FROM
BREAKING THE COOPERATE. THIS
PROBLEM IS TWO FOLD IN MY
OPINION THE MOST IMPORTANT THE
IMPACT OUR PATIENTS IT IS
UNACCEPTABLE THAT WE HAVE
PATIENTS. PATIENTS LAYING ON OUR
EARNINGS FOR HOURS SOME AS LONG
AS EIGHT. AND THEN IN A HALLWAY
AT THE ER A GOOD PORTION OF THE
TIME THEY'RE EDERLY PEOPLE WITH
DISEASE PROCESS. AT HAS BEEN
BEDRIDDEN AND UNABLE TO SIT IN A
WHEELCHAIR IN THE WAITING ROOM
THEY'RE STUCK O OUR JOURNEYS
WHICH ARE NOT MADE FOR COMFORT.
THEY'RE MADE FOR EASE OF USE OF
USED DURING AN EMERGENCY THE
PATIENTS ARE UNCOMFORTABLE THEY
START COMPLAIN OF PAIN. SOME OF
THEM HAVE ALZHEIMER'S OR
DEMENTIA SO THEY BECOME
INCREASINGLY CONFUSED- MOST OF
THE ARTS HAVE A SUITE IN A
HALLWAY BY A DOOR SO THE
PATIENTS GET COLD OR HOT
DEPENDING ON THE WEATHER. THEN
WE HAVE THE PROBLEM OF THE
PATIENTS NEEDING TO USE THE
RESTROOM. AGAIN ATTORNEYS ARE
NEED TO BE USED AS LONG TERM
BEDS FOR PATIENTS SO TRYING TO
GET THEM ON THE BENCH. IS
DIFFICULT. THE SECOND PROBLEM IS
THE IMPACT OF THE FIELD WORKERS.
MOST OF THE TIME WE ARE STANDING
IN THE HALLWAY. FOR HOURS WITH
NO WHERE TO SET OUR FEET BACK
LEGS AND HIPS START TO HURT. OUR
JOB IS ALREADY TAXING ON OUR
BODIES. BUT SPENDING HOURS UPON
HOURS STANDING IN ONE SPOT. IS
MAKING AN IMPACT ON OUR BODIES
EVEN WORKS. WE ARE UNABLE TO
TAKE BREAKS UNABLE TO EAT UNABLE
TO GET A DRINK. THEN YOU HAVE
THE REST OF THE CREWS OUT IN THE
STREETS HAVING TO COVER THE-
COVER EVEN MORE CALLS. BECAUSE
THERE ARE A LIMITED NUMBER OF
AMBULANCES AVAILABLE TO RUN THE
CALLS. BECAUSE SO MANY
AMBULANCES ARE SITTING IN THE
HALL AT THE ER. SO THE CREWS RE
GETTING BEAT TO THE GROUND
RUNNING CALLS. AGAIN WITH NO
BREAKS. EVER YOU TURN THE
CRUISER BEING RUN TO RUN RAGGED.
THE BURNOUT RATE HAS INCREASED
PEOPLE ARE MENTALLY AND
PHYSICALLY FATIGUED. ANOTHER
ASPECT OF THESE UNPRECEDENTED.
LONGTIME THAT CAN'T BE
OVERLOOKED IS THAT. IS THAT IT
LEADS TO A FIELD CREW HOLD OVER.
WHICH IS WHEN ARE WE ARE UNABLE
TO LEAVE ON OUR SCHEDULE AND OF
SHIPS. IN PREPARING FOR THIS
TESTIMONY TODAY I WAS TELLING MY
FIFTEEN YEAR OLD DAUGHTER. ABOUT
THIS HEARING AND THE TOPIC SHE
WANTED TO INCLUDE THE POINT.
THAT GETTING AWFULLY AFFECTS OUR
FIELD CREWS. HOMES WHAT HOLD
LIVES YOU END UP MISSING OUT ON
PLANS THAT YOU HAD MISSED SEEING
YOUR CHILDREN. MISSING HAVING
DINNER WITH THEIR FAMILY WHICH.
INCREASE THAN INCREASES THEY
BURN OUT. I THOUGHT IT I THOUGHT
IT WOULD BE HELPFUL TO PROVIDE A
COUPLE OF. SHORT EXAMPLES A FEW
WEEKS AGO I HAD A BURN PATIENT.
BAD 3240% BURNS COVERING. COVER
43240% OF THEIR BODY COVERED IN
SECOND DEGREE BURNS. THEY WERE
IN A LOT OF PAIN AND I HAD
ALREADY MAXED OUT ON MY PAYMENT
ALLOWING A LOT BY PROTOCOL. WE
WERE TOLD TO STAND IN THE HALL
UNTIL THEY COULD GET IT GET A
BED FOR MY PATIENT. FORTY FIVE
MINUTES LATER THEY FINALLY FOUND
A PLACE FOR ME TO PLACE THE
PATIENT. THERE ARE TWO MAJOR
PROBLEMS HERE DESPITE THE WALL
TIME OF FORTY FIVE MINUTES BEING
SHORT. COMPARED TO OTHERS. FIRST
MY PATIENT WAS IN PAIN AND THERE
IT. I CAN DO FOR THEM. SECOND
THE PATIENT HAD EXPOSED BURNS
THAT ARE OPEN TO INFECTION. WE
STOOD THERE IS MULTIPLE PEOPLE
WALKED BY THE BEAR WITH VARIOUS
MEDICAL PROBLEMS. THEY COULD
HAVE BEEN. EXPOSING MY PATIENT
TO MORE DIFFERENT. MORE TO MANY
DIFFERENT POSSIBLE INFECTIONS.
TWO WEEKS AGO ANOTHER WHATEVER
AMBULANCE CREWS OUT ON THE WALL
FOR EIGHT HOURS WITH A PATIENT I
HAVE NOT WORKED A SHIFT IN THE
LAST COUPLE OF YEARS THAT I
DIDN'T HAVE WALL TIME AT LEAST
ONE OF MY PAY ONE OF THEM. OR
MORE OF MY PATIENTS. BUT LABOR
UNIONS STANDPOINT. ARE UNION
MEMBERS WORK HARD THEY DESERVE A
RAISE. AS BRIEFLY MENTIONED OF.
THE CRUISER IN THE FIELD WITH
LESS AMBULANCES TO COVER. WHICH
INCREASES OUR- RESPONSE TIME.
AND WE GET FINED FOR EACH OF THE
LATE RESPONSES. OUR MEMBERS HAVE
BEEN HERE THROUGH THE PANDEMIC
THEY HAVE OVERCOME MANY
ADVERSITIES TO CONTINUE TO
PROVIDE FOR THE COMMUNITIES THEY
WORK AND- THEY'RE TIRED AND
OVERWORKED WE ARE TOO. WEIRD
TOLD ALL OF THE DEPARTMENT OF
HEALTH GUIDANCE FOR HEALTH CARE
WORKERS WHICH MEANS IF WE TEST
POSITIVE BUT A SYMPTOMATIC WE'RE
SUPPOSED TO SHOW UP. PUT ON IN
NINETY FIVE AND GO TO WORK WE
NEED SIX DAYS TO GET THROUGH THE
PANDEMIC BUT WE DON'T HAVE THE
AVAILABLE. AVAILABLE WORK FORCE
TO DO THAT. MAKES OUR JOB WITHIN
THE UNION HARDER OUR MEMBERS TO.
SERVE BETTER AND AS DISCUSSED
EARLIER OUR PATIENTS DESERVE
BETTER THANK YOU FOR YOUR TIME.
THANK YOU MS WARMAN. OUR FINAL
WITNESS FOR THIS PANEL IS FIRE
CAPTAIN SEAN BURROUGHS WHO IS
THE PRESIDENT OF ALAMEDA COUNTY
FIREFIGHTERS LOCAL FIFTY FIVE.
AND VICE CHAIR OF THE CALIFORNIA
EMERGENCY MEDICAL SERVICES
AUTHORITYEMS COMMISSION-
WITHOUT. THE CAPTAIN BERLE'S.
GOOD MORNING CHAIRMAN RODRIGUEZ
MEMBERS OF THE COMMITTEE. YOU
FOR THE OPPORTUNITY TO TESTIFY
BEFORE YOU TODAY. MY NAME IS
SEAN BURKE WAS ABOUT TWENTY SIX
YEAR VETERAN OF THE FIRE SERVICE
AND CURRENTLY SERVE AS A FIRE
CAPTAIN PARAMEDIC FOR THE
ALAMEDA COUNTY FIRE DEPARTMENT.
ADDITIONALLY I SERVE AS THE VICE
CHAIR OF THE CALIFORNIA YOU MUST
COMMISSION. HAVE YOU HEARD FROM
THE PREVIOUS WITNESSES. NEED A
SYSTEM THROUGHOUT THE STATE IS
AT A CRITICAL POINT. WHAT THE
COULD NINETEEN PANDEMIC HAS BEEN
A SERIOUS AND COMPLICATING
FACTOR IN THE SYSTEM CHALLENGES.
IT IS ONLY EXPOSED THE LONG TERM
CRITICAL WEAKNESS IN THE
OPERATION ARGUMENT SYSTEMS THAT.
FOR YEARS I'VE BEEN FAILING OUR
COMMUNITY IT'S AMONG THE PUBLIC
FAILURES AND THE SUBJECT OF THIS
HEARING ALL THE WALL TIMES OR
TIMES THAT AMBULANCES ARE FORCED
TO REMAIN EITHER IN ADVANCE BAY.
OR IN THE EMERGENCY DEPARTMENT
AND HOSPITAL STAFF AND RESOURCES
ARE AVAILABLE TO TRANSFER
PATIENT CARE. THUNDERSTRUCK THE
STATE ARE BEING PUSHED TO THE
BRINK. CONSTANT FALLS ASTERS
WHICH ARE ONLY GETTING WORSE
EVERY YEAR LAYERED OVER A MULTI
YEAR PANDEMIC. HAVE PUSHED THE
NUMBERS OF THE CALIFORNIA FIRE
SERVICE TO THE POINT OF
EXHAUSTION. ALL TIMES ARE A
DIRECT THREAT TO PATIENT SAFETY
AND A SIGNIFICANT DESTABILIZING
FACTOR IN THE EMS SYSTEM.
MINUTEWOMEN IN YOUR FIRE
DEPARTMENTS ACROSS THE STATE
CONTINUE TO ANSWER THE CALL DAN
THEY ARE PUTTING THEIR LIVES AT
RISK TO SERVE THEIR COMMUNITIES.
HOWEVER THESE CHALLENGES ARE
EXASPERATED BY THE LACK OF
HOSPITAL RESOURCES WHEN
TAXPAYERS MUST ON CRITICAL
EMERGENCY MEDICAL INCIDENTS.
FROM A FAR BETTER PERSPECTIVE.
THERE TO MEASURE ROLE IN
CRITICAL IMPACTS TO PATIENT CARE
AND PATIENT SAFETY THAT WE
EXPERIENCE. FIRST BARBARA
PARAMEDICS ARE STUCK ON THE WALL
CELEBRITY DEPARTMENT. NOT ONLY
IS THIS THE LAND EDUCATION FROM
GETTING CARE AT THE HOSPITAL BUT
THIS TAKES CRITICAL NINE ONE ONE
RESOURCES OUT OF THE FIELD.
SECOND PART PART PARAMEDICS ARE
CONSISTENTLY WAITING ON SCENE
FOR AN AMBULANCE TO ARRIVE WHEN
ZERO AMBULANCES ARE AVAILABLE IN
THE SYSTEM. AS I NOTED IN MY
OPENING I WORK FOR THE ALAMEDA
COUNTY FIRE DEPARTMENT WE DO NOT
TRANSPORT PATIENTS TO THE
HOSPITAL IN THE COUNTY BUT
PARAMEDICS FROM MY DEPARTMENT
ARE CONSISTENTLY FIRST ON SCENE.
WHEN PEOPLE CALL NINE ONE ONE
EMERGENCY MEDICAL SERVICES.
EARLY ON A CAREER THAT SPANS
OVER TWO DECADES WE REGULARLY
ARRIVED. ON SCENE WITH THE
PRIVATE AMBULANCE PROVIDERS
SIMULTANEOUSLY. TODAY IT IS NOT
UNCOMMON FOR OUR PARAMEDICS TO
START RENDERING AID TO A PATIENT
AND THEN WAIT THIRTY MINUTES OR
MORE FOR AN AMBULANCE ARRIVAL TO
TRANSPORT THAT PATIENT TO THE
HOSPITAL. I PERSONALLY WAITED
LONGER THAN EIGHTY MINUTES. YES
EIGHTY MINUTES ON SCENE FOR AN
AMBULANCE TO ARRIVE. ON MULTIPLE
OCCASIONS. THESE WAIT TIMES ARE
NOT A NEW PHENOMENON IN THE EMS
SYSTEM THROUGHOUT THE STATE IN
FACT. SERVICES BEEN DEALING WITH
THESE TYPES OF DELAYS. FOR FIVE
PLUS YEARS. OUR COMMUNITIES USE
THAN I WANT SYSTEM WHEN THERE IS
AN URGENT THREAT TO THEMSELVES
OR THEIR FAMILIES THEY
RIGHTFULLY EXPECT FAST RELIABLE
AND PROFESSIONAL SERVICE FROM
THEIR EMS PROFESSIONALS
ESPECIALLY WHEN SOMEONE'S LIFE
IS ON THE LINE. IT'S
UNACCEPTABLE THAT THE TELLER
CITIZEN OF THE LARGEST STATE IN
OUR NATION THAT THEY MUST WAIT
TO RECEIVE CRITICAL MEDICAL CARE
BECAUSE THERE ARE NO AMBULANCES
AVAILABLE TO TAKE THEM OR THEIR
LOVED ONES TO THE HOSPITAL. WE
URGE THIS COMMITTEE TO CONTINUE
TO EXAMINE ALL THE DEFICIENCIES
IN THE WAY THE AMBULANCE
SERVICES ARE PROVIDED IN
CALIFORNIA AND THE CURRENT
LIMITATIONS ON FIRE DEPARTMENT'S
ABILITY TO OFFER RESOURCES. BUT
FOR TODAY'S FOCUSED WALDHEIM'S
MCCORMICK IMPACT RESOURCES OUT
OF SERVICE AT THE E. D.
INTRODUCED ACCEPTABLE DYLAN'S IN
THE FIELD. THESE UNNECESSARY AND
AVOIDABLE DELAYS HAVE REAL
CONSEQUENCES FOR MEMBERS OF OUR
COMMUNITIES AND I THINK IT IS
IMPORTANT TO THINK ABOUT THE
IMPACT OF THESE DELAYS IN THE
CONTEXT. OF THE IMPACT ON THE
INDIVIDUAL. RECENTLY AS THECALL
NINE ONE ONE DUE TO WORSENING
CHEST PAIN. FIREFIGHTERS ARRIVED
ON SCENE IN UNDER FIVE MINUTES.
AS A FIREFIGHTER PARAMEDICS
BEGAN TO ASSESS AND TREAT THE
PATIENT THEIR SYMPTOMS WORSEN TO
THE POINT WHERE THEY WERE THE
PATIENT LOST CONSCIOUSNESS. I
REQUEST WAS MADE FOR A TRANSPORT
IN AN ESTIMATED TIME OF ARRIVAL.
FOR THE MEDIC UNIT TO ARRIVE ON
THE SCENE THE RESPONSE THE
PATIENT WOULD HAVE TO WAIT AT
LEAST TWENTY FIVE ADDITIONAL
MINUTES UNTIL THE END IT'S GOING
TO RISE. THE CLINTON FOUNDATION
DETERIORATED AND EVENTUALLY WENT
INTO CARDIAC ARREST. THE
FIREFIGHTER PROJECTS CONTINUE TO
TREAT A PATIENT WITH ALL THE
ADVANCE CARE THEY CAN PROVIDE.
THEM THAT UNIT FINALLY ARRIVED
ON THE SCENE NEARLY THIRTY
MINUTES AFTER THE INITIAL NINE
ONE ONE CALL. FORTUNATELY IN
THIS CASE THE PATIENT WAS
REVIVED REVIVED BY THE
FIREFIGHTER PARAMEDICS. BUT NOT
ALL PATIENTS EXPERIENCE THE SAME
OUTCOMES. AND FOR SOME. EXTRA
MINUTES COULD MEAN THE
DIFFERENCE BETWEEN LIFE AND
DEATH. AS I'M SURE YOU'RE ALL
AWARE WHEN DEALING WITH MEDICAL
EMERGENCIES TIME IS OF THE
UTMOST IMPORTANCE. AMBULANCE
PROVIDERS PLAY A CRITICAL ROLE
IN OUR EMS SYSTEM DELIVERY
POSSESS THE VEHICLES TO
TRANSPORT PATIENTS TO IT
FACILITY TO RECEIVE THE
DEFINITIVE CARE THEY NEED.
AMBULANCES SITTING HOSPITALS
UNABLE TO OFFER THEIR PATIENTS
SOMETIMES FOR HOURS IS THE
ANTITHESIS OF THE PATIENT CO OUR
CITIZENS DESERVE. AND PUTS AN
UNNECESSARY STRAIN ON THE REST
OF THE SYSTEM. OFTEN WAKING
CRITICAL MOMENTS NEEDED TO SAVE
A PATIENT'S LIFE. ALL THE
CURRENT OPERATE SYSTEM IS BROKEN
WATER DANGEROUS THERE ARE
POTENTIAL SOLUTIONS TO THESE
CHALLENGES. FOR EXAMPLE IN
ALAMEDA COUNTY. THE CITY OF
HAYWARD RECENTLY BEGAN BEGAN TO
DISPATCH AND RESPOND WITH THEIR
OWN AMBULANCES WITHIN CITY
LIMITS. TO PROVIDE SEARCH
PROTECTION WHENEVER THEIR
FIREFIGHTERS ARE ON SCENE OF
CRITICAL PATIENTS. AND NO PRESS
RELEASES ARE AVAILABLE. THIS
PROVIDES A LETTER PROTECTION
WITHIN THE CITY OF HAYWARD AND
INSURERS. THERE CITIZENS RECEIVE
THE HIGHEST LEVEL OF DEFINITIVE
CRITICAL CARE AND DO SO IN A
MATTER OF MINUTES NOT HOURS. OUR
DEPARTMENT STRUCK CALIFORNIA ARE
EMPLOYING CREATIVE SOLUTIONS TO
PATCH THE SYSTEM TOGETHER BUT
MORE AMBULANCES IN THE SYSTEM
STILL MEANS MORE AMBULANCES ON
THE WALL. IF THE ROOT PROBLEM IS
NOT ADDRESSED. I GENERALLY
APPRECIATE APPRECIATE YOUR
INTEREST IN HEARING ABOUT THE
CHALLENGES OF THE BEEN RPMS
SYSTEMS AND SINCERELY HOPE THERE
ARE SUBSTANTIAL CHANGES TO COME
VERY SOON TO ADDRESS CRITICAL
WALL TIMES BUT ALSO REAL QUICK A
SYSTEM CREATED OVER FORTY YEARS
AGO. THAT IS FAILING OUR
COMMUNITIES. I THANK YOU FOR THE
OPPORTUNITY TO TESTIFY TODAY.
THANK YOU CAPTAIN BERLE'S- NOW
WITH THAT WILL BRING IT BACK
HERE TO THE COMMITTEE- I'M A
LOST FOR WORDS AFTER IN THE
TESTIMONY FROM EVERYBODY IT'S
FRUSTRATING MORE THAN EVER. TO
CONTINUE TO HEAR THIS ISSUE
THAT'S BEEN GOING ON FOR DECADES
AND OVERSEE THE PANDEMIC COULD
JUST ELEVATED TO ANOTHER LEVEL.
AND QUITE CLEARLY TO ME WERE
OPERATING IN A CRISIS MODE IN
THE STATE OF CALIFORNIA AND ARE
MERGING DEPARTMENTS ARE FOR
SPONSORS- IT'S VERY CHALLENGING-
I WOULD LIKE TO KNOW FROM
ANYBODY THAT FROM THE FIRST
PANEL- WHAT DO YOU THINK WE CAN
DO NOW TO FIX THE PROBLEM RIGHT
NOW I KNOW THERE'S PROBABLY SO
MANY THINGS OF- GOING THROUGH MY
MIND FROM HEARING FROM.
EVERYBODY BUT ANYTHING
IMMEDIATELY THAT WE CAN TAKE A
STEP TO START ADDRESS THIS ISSUE
ACROSS THE STATE. ANYONE WOULD
HAVE A ANY THOUGHTS OR
SUGGESTIONS ON THAT. THIS IS
CHIEF SAILORS ARE YOU ABLE TO
HEAR ME YES WE'RE HERE CHIEF-
THE HOSPITALS CAN AFFORD TO HIRE
PARAMEDICS ND AT LEAST CREATE A
- SPACED ALTHOUGH THE PATIENTS
FROM ONE PARAMEDIC TO THE NEXT
WE DID A TRIAL RUN IN SACRAMENTO
WHERE WE ACTUALLY PAID FOR THE
PARAMEDICS TO WAIT OUT TO THE
HOSPITAL'S AND TRANSFER THE
PATIENTS. WHEN WE TRANSPORT WHEN
WE TRANSFERRED ONE PATIENT FROM
OUR AMBULANCE TO THE PARAMEDIC
WAITING ON SCENE- THAT AMOS WAS
ABLE TO ONE FIVE CALLS WHILE
THAT ONE PATIENT WAS WAITING
WITH THAT HERMETIC ON AT THE
HOSPITAL THAT TRIAL WORKED I
KNOW THE STATE IS TRYING TO DO
IT AGAIN WITH HIM OF PARAMEDICS
BUT THAT CAN AT LEAST GET OUR
AMBULANCES OFF THE WALL. I'D
STILL ALSO BELIEVE THAT THE
FINANCIAL INCENTIVES THAT ARE
NEGATIVE FINANCIAL CENTRAL
HOSPITAL CAN THE IMPLEMENTED
RIGHT NOW WITH TITLE TWENTY TWO
. ANYBODY ELSE FORTY THOUSAND
SUGGESTIONS ON THAT. I THINK
THIS IS YOUR I AGREE I THINK FOR
AN IMMEDIATE FIX- THE HOSPITAL'S
A NEED TO EITHER HIGHER OR BE
SUPPLIED WITH- PARAMEDICS EMTS
LPN OR CNA. Q. AT SS THE PATIENT
AND ES IST WITH TAKING THE
PATIENT OPPOSITE EVERYONE
SECURITY MONITORING PATIENT FOR
THE HOSPITAL WE ACTUALLY HAVE
OUR HOSPITALS LAKE COUNTY HAVE
ACCESS TO TENANTS ADDITIONALLY.
FOR ADDITIONAL SPACES. THE PUT
YOU CAN DEFINITELY FIX I AM
STATE THAT WE NOT QUITE MODE I
DO FIND THAT WE ARE NOT TREATING
THE HOSPITALS AS THEY ARE IN A
CRISIS MODE AT THE HOSPITALS
HAVE ASKED FOR STAFFING RELIEF-
AND THEY HAVE NOT BEEN APPROVED
FOR ANY STAFFING RELIEF. FOR I
EAT RATIOS THEY HAVE ARE STILL
EXPECTED TO OPERATE AS A NORMAL
DAILY BASIS BUT ALL THE
REGULATORY PROCESSES. AT THROUGH
THIS CRISIS SO WHAT THEY COULD
GET SOME RELIEF AS LONG AS WE
ARE IN THIS CRISIS MODE SO THOSE
ARE SHORT TERM FIXES THAT CAN BE
IMPLEMENTED IMMEDIATELY. ANYONE
OUT- IT. YES TOM PARKER JUST SO
SUPPORT SOME OF THE THINGS THAT
WE DID FOR BECAUSE OF IT- MORE
ALTERNATE DESTINATIONS- FOR- LOW
ACUITY PATIENTS AND THAT BE A
SUGGESTION THAT- I KNOW THAT THE
A LOT OF LAMB SAYS A LOT OF
THEIR FIRE DEPARTMENTS AND OTHER
EMS PROVIDERS TO DO THAT ON
MAYBE CONSIDER DOING- LOOKING AT
THOSE PROGRAMS IN UP IN A MORE
ABOUT A LONG TERM SOLUTION AND
REALLY START WORKING WITH THE
HOSPITALS AND OTHER ASSOCIATIONS
TO. ALLOW US TO GET. MISSIONS
THAT ARE LOW QT MEDICAL PROBLEMS
TO US ALTERNATE DESTINATION ALSO
LIKE UTILIZING A TELEMEDICINE- I
KNOW WAS WAS TALKED ABOUT A LOT.
AND THE FACT THAT WE CAN- KEEP
PATIENTS FROM GOING TO THE
HOSPITAL WHAT WOULD PROBABLY BE
AN IMMEDIATE- FIX OUR WORK A LOT
OF US ARE HAMSTRUNG WITH THE
TOOLS THAT WE HAVE RIGHT NOW AND
WE'RE NOT ALLOWED TO DO. A LOT
OF THOSE THINGS BASED UPON
REGULATIONS AND SO ON SO FORTH
SO ON I KNOW THERE WAS A LOT OF
EMERGENCY- REGULATIONS THAT WERE
PUT INTO PLACE- I WOULD LOOK AT
THOSE SYSTEMS. AND CONSIDER
THOSE TO BE ARE ALSO NOT ONLY A
SHORT TERM SOLUTION BUT CONSIDER
THOSE FOR A LONG TERM SOLUTIONS
AS WELL. THANK YOU. ANYONE ELSE
. GENERALLY BRIAN BRIAN HENDRIX
AND- I WOULD JUST TRYING IT
AGREE WITH WHAT WE HEARD FROM
EVERYBODY ELSE- ALREADY I WOULD
CAUTION- THE COMEDIAN OF THE
LEGISLATURE FROM- OPENING UP
COMPLETELY- EMS PERSONNEL
WORKING IN HOSPITAL SYSTEMS. THE
ULTIMATE CONCERN THERE IS THAT
WE END UP COMPETING FOR THE
SAME- WORK FORCE- AND THAT
CREATES THE SAME SUPPLY AND
DEMAND ISSUES THAT I THINK WE'RE
SEEING A HOSPITALS NOW ONE
IMMEDIATE FIX- THAT I THINK
SHOULD BE A CONSIDERATION- ON
THE TABLE IS ESPECIALLY WHILE
WEARING CRISIS- IS THE CURRENT-
NURSE PATIENT RATIOS WHICH ARE
ARTIFICIALLY- CREATING A THAT
SUPPLY AND DEMAND ISSUE THAT WE
HAVE IN HOSPITALEMERGENCY
DEPARTMENTS I THINK. THAT BUT
TEMPORARILY FLEXING- DURING
TIMES OF CRISIS THOSE NURSE
PATIENT RATIOS TO MAKE SURE
PATIENTS GET TURNED OVER AND
THAT NINE ONE ONE PATIENTS
AREN'T LEFT WITHOUT- AMBULANCE
OR FIRE PURCHASED BONTA
RESOURCES- IS A CRITICAL STEP
THAT WE SHOULD BE CONSIDERING
AND REALLY APPLYING WITH WHAT WE
SEE- ACROSS THE NATION- THE
CALIFORNIA CERTAINLY ONE OF THE
ONLY STAYED FOR THE NURSE TO
PATIENT RATIOS AS THEY EXIST
AND- FLEXING THOSE- IS AN
IMPORTANT RELIEF OUT. ANYONE
ELSE ON THAT BEFORE HEADED TO
NEWTON MEMBERS. THE QUICK
CHAIRMAN RODRIGUEZ THIS IS A
CHEAP ONES JIM VALLEY FIRE
DISTRICT- I WOULD JUST ENCOURAGE
AGAIN THERE'S A LOTOF LONG
TERM- SOLUTIONS AVAILABLE BUT-
AS A AS A FIRE CHIEF THAT HAS
RESOURCES AVAILABLE TO PUT INTO
THE SYSTEM. IT SIMPLY MAKES
SENSE THAT THERE WOULD BE
PROVIDED THAT OPPORTUNITY TO DO
THAT BOB SHE TODAY WE'RE TALKING
ABOUT FIVE. EIGHT AND OTHER
DELAYS WHICH IS THE SIGNIFICANT
PROBLEM HOWEVER AGAIN WE DO HAVE
RESOURCES AVAILABLE AT MANY
JURISDICTIONS AND WE HAVE A
DESIRE AND A WILLINGNESS TO-
SUPPORTER COMMUTING AND WORKING
WITH PHILIP RUBIN HECK UP SO. A
CONTINUE TO LOOK AT THOSE
OPPORTUNITIES TO ALLOW FIRE
AGENCIES TAT HAVE RESOURCES
ASSEMBLY GET THEIR PATIENTS
STREETS INTO THE HOSPITAL AND
CONTINUE TO WORK TOWARDS- THAT
THE LARGER OF A TOPIC THAT WE'RE
TALKING ABOUT. IS THE EIGHT PART
ISSUE THANK YOU. THANK YOU AND
WITHOUT THE- BECAUSE INTO MY
COMMITTEE MY- THANK. ASSEMBLY
MEMBER WARD YET YOUR QUESTION.
WHAT THE SUMMER SAY ARE DEL WRAP
IT UP I DON'T YOU FOR ALL OF THE
TESTIMONY- CLEARLY LEAD OUT THE
KEYS THAT WE ALL KNOW ABOUT THE
EMERGENCY THAT THAT WE'RE FACING
HERE THROUGH THIS ON THE SYSTEM
I WANT TO GO BACK TO SOMETHING
THAT I THINK IT WAS CHIEF CAKE-
HAD MENTIONED DURING HIS
TESTIMONY AND TAKE A LITTLE
DEEPER AND POSSIBLY IN IN ONE
THE RESPONSES TO. KARAGIAS AS
WELL WHEN YOU TALK ABOUT THE
REGULATION UPDATES- WE KNOW WE
HAVE SOME CAPACITY WE NEED TO
IMPROVE I THINK TOTAL STAFFING
FROM INOTES START TO FINISH- I
WANT TO HEAR MORE FROM THE
HOSPITAL- SYSTEMS WIDELY WILL
HAVE THAT THE SECOND PANEL- WE
CAN'T DROP OF COURSE THE PATIENT
CARE YOU KNOW FROM- PICK UP ALL
THE WAY THROUGH THAT THAT WARM
HAND OFF- BUT IF THERE ARE
REGULATIONS THAT NEED UPDATING
AND THAT IS SORT OF YOU KNOW LOW
HANGING FRUIT FROM YOUR
PERSPECTIVES I'D BE INTERESTED
TO KNOW MORE SPECIFICALLY. WHAT
THOSE MIGHT LOOK LIKE AND THEN
ALSO I'M WONDERING I DIDN'T HEAR
ANYTHING THE TESTIMONY BUT I'M
WONDERING ABOUT- WHAT IT LOOKS
LIKE IN IN PRACTICE- WHEN YOU'RE
GIVING A HEADS UP TO A HOSPITAL
RIGHT SO YOU JUST DON'T SHOW UP
AND THEN YOU START TO IN
PROCESSING- ACTIVITIES RIGHT.
HOW DO YOU HAVE THE WHOLE
HOSPITAL- RECEIVERS KNOW WHO'S
COMING HOW MUCH TIME YOU'RE
COMING IN SO THAT THEY MIGHT BE
ABLE TO SHORTEN THAT WINDOW AS
WELL AND BE PREPARED- TO RECEIVE
I I'D LIKE TO HEAR A LITTLE BIT
MORE ABOUT- THAT PROCESS. DO YOU
WANT TO. WEIGH IN ON ON THAT
CIRCLE YOU'RE GOING. OKAY SO AS
FAR AS REGULATIONS GO- I WENT TO
PARAMEDIC SCHOOL OVER THIRTY
YEARS AGO AND- THE SYSTEM THAT
IS IN PLACE WAS LARGELY. THE
SAME ONE THAT JOHNNY AND ROY
WERE WORKING ON FROM EMERGENCY
BACK IN THE DAY AND- THE PROBLEM
WAS IS THAT WHEN YOU GET CALLED
TO A NINE ONE ONE CALL. AND YOU
HOPE YOU ARRIVE THE PARAMEDICS
OUR ARE DOING THEIR JOB THEY
THEY- THEY ASSIST THE PATIENT
THEY START DOING TREATMENT OF
THE PATIENT NOW WE'RE WAITING
FOR A MELISSA GET THERE AND- THE
ONLY OPTIONS WE HAVE CURRENTLY.
ARE WE CAN EITHER TRANSPORT THE
PATIENT TO AN EMERGENCY ROOM. OR
WE CAN- HAVE THE PATIENT SIGN
OUT WHAT'S CALLED A MA WHICH IS
AGAINST MEDICAL ADVICE AND THOSE
ARE REALLY THE ONLY TWO OPTIONS
THAT WE HAVE- IN OUR IN OUR
REGULAR SYSTEM. NOW IF. IF WE
CAN USE OUR DISPATCH WE HAVE A
MERCY WILL DISPATCHING WE HAVE
THAT IS A RESOURCE. WE COULD
POSSIBLY TAKE THOSE PATIENTS
THAT ARE MAYBE DON'T NEED TO GO
TO THE HOSPITAL OR WE DON'T EVEN
NEED TO RESPOND ENABLES OR A
FIRE DEPARTMENT THERE. WE CAN
USE THE NURSE HOTLINE TO SEND
THEM OVER TO YOU- IF WE DO GET
ON SCENE WE HAVE THE ABILITY TO
WE HAVE THE TECHNOLOGY AND THE
ABILITY HOWEVER WE DON'T REALLY
HAVE THE- ABILITY TO
REGULATIONS. TO USE TELEMEDICINE
SO WE CAN HAVE A- FAR APARTMENT
PARAMEDIC OR A NAMELESS
PARAMEDIC ESSENTIALLY HAVE A
PATIENT TALK TO A POSITION OR A
PA ON A TELEMEDICINE CALL AND
ACTUALLY GET THAT PATIENTS THE
CARE THAT THEY NEED. AND SO ON
AND SO FORTH THE OTHER PART OF
THAT IS ALTERNATE DESTINATIONS.
DOES EVERY SINGLE PATIENT NEED
TO GO TO THE MOST EXPENSIVE-
MEDICAL CARE FACILITY WHICH IS
AN EMERGENCY ROOM NO THEY DON'T.
ONE OF THESE PATIENTS OFTEN NEED
LESS CRITICAL CARE THEY CAN GO
TO URGENT CARE- THEY NEED TO
POTENTIALLY GO TO A SOBERING
SYSTEM. THEY POTENTIALLY HAVE
BOB MAN- IS THAT THEY TO DEAL WE
HAVE THE THEM TO. THE PROBLEM IS
THAT WE ONLY HAVE A ONE SIZE
FITS ALL SYSTEM RIGHT NOW WHICH
IS THEY GO TO. THE EMERGENCY
ROOM AND THAT'S THE ONLY OPTION
WE REALLY HAVE. SO AND THEN THE
OTHER- I THINK THE CHIEF BOB
WILLIAMS POINT. IS THAT THESE
REGULATIONS THAT WERE PUT INTO
PLACE. ARE YOU LOCAL FIRE
DEPARTMENT THAT WASN'T
TRANSPORTING BEFORE NINETEEN
EIGHTY. DOESN'T EVEN HAVE THE
OPTION OF. A LOT OF DEVELOP OF
DOING AMBULANCES AND ACTUALLY.
ADDING TO THE- THE RESOURCES
THAT WE HAVE. WE HAVE NO ABILITY
TO TRANSPORT PATIENTS OR USE A
BILL AND SALAS. IF WE WERE DOING
THAT PRIOR TO NINETEEN EIGHTY.
AND THAT'S THAT'S PART OF THE
PROBLEM THAT WE HAVE IS THAT-
CHIEF ONCE OUR COMMENT. IS THAT
WE HAVE A LOT OF FIRE
DEPARTMENTS ARE WILLING AND ABLE
TO PROVIDE THE SERVICES. HOWEVER
BUT BECAUSE THE REGULATIONS WERE
NOT ALLOWED TO DO THAT. SO THE
POINT IS THAT. WE HAVE A ONE
SIZE FITS ALL. TYPE OF PMS
SYSTEM. AND THAT IS YOU EITHER
GO TO THE EMERGENCY ROOM OR YOU
DON'T GO AT ALL. THERE IS
NOTHING IN BETWEEN. I THINK WHAT
WE'RE TALKING ABOUT IS THERE'S A
LOT OF OTHER OPTIONS THAT ARE
AVAILABLE OUT THERE. THAT ARE
SIMPLY NOT BEING IMPLEMENTED NOW
AS FAR AS- WHEN WE NOTIFY THE
HOSPITAL EVERY TIME YOU'RE GOING
TO GO TO A HOSPITAL. N TO
RECEIVING FACILITY. THE
PARAMEDIC FROM THE EMPTY HOUSE
TO CALL THE HELP THE HOSPITAL
LET THEM KNOW THEY'RE COMING
WHAT TYPE OF PATIENT OR THEY
HAVE. AN APPROXIMATELY THEIR ETA
OTHER ESTIMATED TIME OF ARRIVAL
BEFORE THEY GET THERE SO EVERY
SINGLE ONE OF THESE PAY. IS NO.
THE HOSPITAL THAT THEY'RE COMING
WHAT TYPE OF PATIENT OF THIS AND
SO ON AND SO FORTH. NOW I
TOTALLY UNDERSTAND THAT THE
HOSPITALS ARE ARE ARE INUNDATED.
WITH PATIENTS THAT PROBABLY
SHOULDN'T BE AT THE MERCY ROOM.
HOWEVER WE DON'T HAVE THE TOOLS
IN OUR TOOLBOX IN THE FIRE
DEPARTMENTS AND OTHER EMS
AGENCIES TO. TAKE THOSE PATIENTS
TO A MORE APPROPRIATE ARE
RECEIVING FACILITY AND THAT'S
THE CHALLENGES THAT WE HAVE
RIGHT NOW- QUESTION. THINKING
THANK YOU. VICE CHAIR- QUESTION
COMMENT. THANK YOU- HER HEARD A
LOT OF TESTIMONY THAT HAD LIVED
AND- SO I APPRECIATE EVERYBODY-
WEIGHING IN- I DID WANT TO
CORRECT ONE PERSON A SAID THIS
IS BEEN GOING ON FOR FIFTEEN
YEARS- I CAN GUARANTEE YOU IT'S
BEEN GOING ON FOR PROBABLY JUST
ABOUT MORE THAN FORTY- THAT'S
WHEN I ENTERED INTO THIS SYSTEM.
AND SO I DID GET TO WATCH IT
EVOLVE ESSENTIALLY FROM EIGHT
YEARS PRIOR THE INCEPTION OF THE
PARAMEDIC PROGRAM. AND ONE OF
THE THINGS THAT HE HAS EVOLVED
AND I WANTED TO GET. SOME SOME
COMMENTS FROM SOME OF THE CHIEFS
IS. YOU KNOW THE USE OF THE NINE
ONE ONE SYSTEM AND HOW THAT HAS
INCREASED BY THE PUBLIC. AND IF
THEY THINK THAT THAT HOUSE.
BECAUSE THAT'S THE SUPPLY SIDE
THAT'S WHERE WE'RE SUPPLYING
PATIENTS TO THE HOSPITALS. AND
THAT HAS INCREASED. WHAT I'VE
SEEN IS IT'S INCREASED
DRAMATICALLY. AND AND I'M
CURIOUS- IF THAT STATISTIC IS
STILL. INCREASING BECAUSE OF HAS
BEEN INCREASING FOR FORTY YEARS
I CAN IMAGINE IF WE STILL HAVE
THE SAME AMOUNT OF HOSPITALS.
WHICH I KNOW DOWN IN MY REGION
WE'VE ADDED A COUPLE HOSPITALS-
BUT THERE'S A LOT OF AREAS THAT
HAVE NOT ADDED HOSPITALS AND
THEY'RE STILL DEALING WITH A-
THEY'RE DEALING WITH THE PATIENT
LOAD TODAY THAT WAS MEANT FOR A
PATIENT LOAD. BACK IN. NINETEEN
EIGHTY NINETEEN SEVENTY FIVE. IN
IN THAT THAT ERA SO- FROM SOME
OF THE CHIEFS AND CHIEF GUY GUY
APPRECIATE. YOUR IT ENLIGHTENING
US ABOUT THAT WHAT YOU'RE WHAT
BASICALLY IS TALK ABOUT IS
PREHOSPITAL TRIAGE. AND DECIDING
WHO IS ACTUALLY NECESSARY TO GO
TO AN ER- BECAUSE I CAN TELL YOU
FROM PERSONAL EXPERIENCE.
BECAUSE OF THE LEGAL ENVIRONMENT
THAT'S ALSO INVOLVED THAT WEIGHS
IN A LOT. THAT- EVERYBODY DOES
NOT NOBODY WANTS THE LEGAL
RESPONSIBILITY OF TELLING
SOMEBODY WITH A CUT FINGER THAT
HEY YOU KNOW WHAT YOU JUST NEED
TO PUT A BANDAID ON THAT AND
KEEP IT KEEP IT DRY WILL THREE
DAYS LATER THEY HAVE A HEART
ATTACK. AND YOU'RE BEING SUED
MIXING NO YOU'RE BEING SUED
BECAUSE YOU DIDN'T TRANSPORT AND
FOR THAT CUT FINGER THREE DAYS
PRIOR. SO WHAT HAPPENS IS
EVERYBODY MAKES THAT DECISION ON
THEIR OWN AND THAT DECISION IS.
OUT I DON'T CARE WHO WE GO ON
WHAT THE PROBLEM IS WE'RE
TRANSPORTING. AND THAT HAS LED
TO AN OVER SATURATION OF YARDS.
AND THAT IN TURN HAS LED TO IN
IN CASES WHERE I WORK- THE
CLOSING OF SOME VERY PROMINENT
HOSPITALS DANIEL FREEMAN
MEMORIAL HALL. IS NO LONGER I
THINK IT'S AN APARTMENT BUILDING
NOW AFTER THEY USED IT FOR TV.
DRAMA ON THE ER AND STUFF- BUT-
AND AS THOSE CLOSE DOWN GUESS
WHAT IT OVER IMPACTED THE
HOSPITALS THAT ARE ADJACENT AND
CENTINELA HOSPITAL. RFK HOSPITAL
CLOSED. SO IT JUST IT THIS
SATURATION OF YARDS AND YET I
DON'T CARE WHAT THE NURSE RATIOS
ARE. I CAN TELL YOU IS IT IS A
PERSON THAT. UNDERSTANDS THIS
YOU KNOW THE SYSTEM. WHEN YOU GO
TO THE HOSPITAL YOU DON'T FEEL
LIKE THE NURSE RATIOS THE NURSE
TO PATIENT RATIOS ARE THAT
ADEQUATE BECAUSE- YOU KNOW IT'S
HARD TO GET A HOLD OF YOU KNOW
GET GET A NURSE THAT HAS. GOT SO
MANY PATIENTS GOING AND HARD TO
GET. HARD TO GET THEIR ATTENTION
SOMETIMES AND IT'S NOT THEIR
FAULT- THAT'S THAT'S THE SYSTEM
IT IS OVERTAXED IT IS OVER. OVER
DOWN WE HAVE TO FIGURE OUT A
BETTER WAY OF DOING- THAT PRE
HOSPITAL PART OF IT- WHERE
WHERE. WE CAN TELL PEOPLE WITH A
CUT FINGER JUST WHAT YOU DO. AND
THEY DON'T NEED TO GO TO THE ER
. SO BACK TO MY QUESTION I'M
SORRY GOT OFF ON A LITTLE RAN.
BACK TO MY QUESTION FOR THE
CHIEFS- THE CHANGES IN USE BY
NINE ONE ONE BY THE PUBLIC- WHAT
HAVE YOU SEEN IN YOUR EXPERIENCE
OVER THE YEARS OF YOUR
INVOLVEMENT. THIS IS CHIEF
SAILORS FROM SEGMENT CITY FIRE
DEPARTMENT- YOU'RE ABSOLUTELY
RIGHT THE USE OF THE PUBLIC'S-
ON NINE ONE SYSTEM IS INCREASING
CONTINUES TO INCREASE OUR CALL
VOLUME IS CLIMBING STEADILY YEAR
BY YEAR. BUT TO YOUR POINT ON
THE POTENTIAL SOLUTION. IN
TWENTY SIXTEEN I PUBLISHED
PAPERS RESEARCH PAPER LOOKING
OUT THIS NOT ONLY COUNTRYWIDE
BUT WORLDWIDE TO SEE IF ANYBODY
WAS COMING UP WITH ANY VIABLE
SOLUTIONS I DON'T SEE THE- FROM
A SYSTEM STANDPOINT OF LOOKING
AT. FROM PATIENT CARE FOR THE
TIME IT DOWN ON A ONE TO LEAVE
THE HOSPITAL THE MOST VIABLE
SOLUTION WAS SOMETHING CALLED
HERE INTRIGUED. C. ENTRY ENTRY
IN TRANSPORT AND THAT IS EXACTLY
WHAT YOU'RE TALKING ABOUT IS
THAT TRIAGE THE PATIENTS BEFORE
THEY WENT TO THE HOSPITAL. IT
WAS A QUICK CONVERSATION OVER
THE PHONE TO EVALUATE THE
PATIENT- THE U. K. IS CURRENTLY
USING THIS AND THEY WANT TO DO A
TELEMEDICINE SESSION WITH THE
PATIENT. PRIOR TO ANY ONE GOING
OUT SO THEY CAN GET THAT PERSON
TO THE APPROPRIATE SOLUTION
BECAUSE THEY ALMOST ALWAYS HAVE
A PROBLEM- BUT THIS WILL GET
THEM TO THE APPROPRIATE SOLUTION
THAT IS NOT ALWAYS THE E. R. A
C. INTRIGUED AS THEY WILL SEND
SOMEBODY OUT TO ACTUALLY LOOK AT
THE PATIENT EVALUATED MAKES
THEIR VITALS ARE STABLE. DO
TELEMEDICINE CONGRESS WITH A
DOCTOR THE EXACT SAME THING GET
ON TO THE SOLUTION THAT THEY
NEED BECAUSE EVERY PATIENT IS A
PROBLEM. JUST NOT NECESSARILY
THE E. R. AS THE SOLUTION AND
THE TREE TRANSPORT IS WHAT WE DO
NOW. THE IMPLEMENTATION OF THAT
PROGRAM IN THE U. K. IN TWENTY
ELEVEN I KNOW DROP THE CALL
GOING BY NINETEEN PERCENT. OF
THE- NOW. A WE CAN'T COPY THAI.
BUT IT IS A GREAT FRAMEWORK TO
START FROM LOOKING AT A SYSTEM
WIDE PROBLEM OF GETTING PATIENTS
TO THE APPROPRIATE RESOURCES.
THAT ARE NOT ALWAYS THE ER SO
THE DVR IS RESERVED FOR THE
CRITICAL PATIENTS THAT ACTUALLY
NEED. AND A FOLLOW UP ON THAT
REALLY QUICK YOU CRITICAL
PATIENTS YOU'RE TALKING ABOUT
WHEN A CRITICAL PATIENT GETS
INTO AN ER. WHAT HAPPENS WITH
ALL THE STAFF. THERE YOU GO WORK
ON THAT CRITICAL PATIENT. AND
THAT FURTHER REDUCES THE AMOUNT
OF PEOPLE- TRYING TO TREAT THESE
OTHERS TO GET THEM OUT OF THE
BEDS SO THAT THEY CAN TAKE MORE
PEOPLE COMING IN. SO I THINK THE
ON PEOPLE UNDERSTANDING THAT
IT'S REALLY IMPORTANT- THAT-
THERE ARE VERY SICK PEOPLE THAT
GO TO THE ER AND- AND WHEN THEY
ARE THERE IN ADDITION TO. WITH
ALL THE RISK- THAT THAT THAT
PERSON WINDS UP- DOMINATING THE-
THE RESOURCES THAT ARE THERE. SO
MANY OTHERS I'M SORRY GO AHEAD
CHIEF. ABSOLUTELY CORRECT IN THE
SAME AS ON THE PREHOSPITAL SIDE
THE RESOURCES THAT ARE THERE ARE
RESERVED FOR THE MOST CRITICAL
PATIENTS AND IT TAKES A TON OF
RESOURCES- TO KEEP A CRITICAL
PATIENT ALIVE AND WHEN WE DO ON
THE HOSPITAL CRITICAL PAGE THEY
DO AN EXCELLENT JOB- THERE ON A
VERY FAST AND THAT'S WHAT
THEY'RE DESIGNED TO DO BUT TO
YOUR POINT IT SLOWS DOWN THE
THROUGHPUT OF ALL THE OTHER LOW
ACUITY PATIENTS. THAT ARE
WAITING IN BEDS OR ON THE WALL
AND THAT JUST HAS A MASSIVE
IMPACT ON A LOT OF THIS LITTLE
CUTIE PATIENTS. THEIR PROBLEMS
AREN'T NECESSARILY SOLVED AT THE
ER THEY HAVE ANOTHER PROBLEM
THAT HOUSE TO BE SOLD SOMEWHERE
ELSE WHETHER IT'S GETTING A
PURCHASE PRESCRIPTION FILLED OR
WHETHER IT'S A MENTAL HEALTH
PROBLEM IT'S VERY RARELY RESULT
IN THE ER IN THE ER IS RESERVED
FOR THOSE CRITICAL TRAUMA
STROKES CARDIAC EVENTS YEAH SO
IT'S A GOOD TO HEAR FROM THE
DELIVERY SIDE OF THIS WHAT THEIR
CURRENT RATE- THE TRIBULATIONS
OF DOING THAT TRIALS AND
TRIBULATIONS OF THAT. WE'RE
GONNA GET TO HEAR FROM THE
RECEIVING SIDE OF IT PRETTY SOON
AND- AND THAT'LL BE INTERESTING
TO HEAR- ALTHOUGH I KNOW A LOT
OF I KIND OF UNDERSTAND BOTH AND
IT'S REALLY DIFFICULT IT'S A
DIFFICULT ENVIRONMENT TO WORK
ON. AND WORK IN AND THAT
TRANSLATES INTO IT NOT WRITTEN
IT TRANSLATES INTO A LOT OF EMS
PERSONNEL AND HOSPITAL
PERSONNEL. HAVING ISSUES FROM
YOUR MENTAL HEALTH PERSPECTIVE
BECAUSE THERE THEY FEEL LIKE
THEY ARE SWIMMING IN A POOL THAT
THEY JUST CAN'T THEY THEY'RE NOT
DOING WHAT THEY'RE TRAINED TO DO
THEY'RE JUST DOG PADDLING. AND
YOU KNOW PATIENTS DIE- YOU KNOW
I I'VE SEEN PEOPLE HAVE EXPIRED
BECAUSE THERE ON THE WALL TOO
MUCH AND- IN THEIR UNDERLYING
ISSUE WENT UNDETECTED- AND THEN
BY THE TIME IT MANIFESTED ITSELF
IT WAS TOO LATE FOR THEM- SO
THOSE TYPE OF SITUATIONS ARE
VERY VERY DIFFICULT EVERYBODY.
NURSES. DOCTORS WE ARE STAFF
CHIEFS BECAUSE YOU GUYS TO. HAVE
TO MANAGE THE- OUTSIDE. AND TRY
TO FIGURE OUT YOU KNOW. WHEN
YOUR RESPONSE TIMES- TEN MINUTES
INSTEAD OF FOUR FIVE- HOW YOU
FIX THAT WITH THE RESOURCES
ESPECIALLY FINANCIAL RESOURCES
THAT YOU'RE GIVEN AND THAT'S
AVAILABLE TO YOU. AS AYE PLOT
ALL OF YOU FOR YOUR INTEREST
TODAY ESPECIALLY AND SPEAKING TO
THIS BODY WE REALLY DO NEED TO
UPDATE THE SYSTEM AND FIGURE OUT
HOW WE CAN. BETTER MANAGE
HELPING PEOPLE AT THE LEVEL THAT
THEY NEED HELP. BECAUSE RIGHT
NOW WE'RE HELPING PEOPLE AT A
LEVEL A LOT OF HELP PEOPLE THAT
THEY DON'T REALLY NEED AND THAT
IS CAUSING A- BACK UP- AND AN
IMPACT ON THE PEOPLE THAT WE DO.
THAT DO NEED THAT LEVEL OF HELL
SO. THANK YOU SO MUCH. THAT'S
ANOTHER CHIEFS I'M SORRY I
DIDN'T GIVE YOU GUYS. CAPITA SIR
IVAN CHEAP IN MY OWN MIND. YES
YOU ARE I JUST. WENT IN TO SEE
HERE I DO KNOW THAT WHEN THERE
IS LARGE SCALE DEVELOPMENTS-
ARE. PART OF THE DEVELOPMENT
OUT. REQUIRES THAT THERE'S A
CERTAIN NUMBER OF FIRE HYDRANTS
AND FIRE STATIONS FOR THAT
ELEMENT BUT THERE IS NOTHING IN
THE LAW THAT REQUIRES THESE
DEVELOP- DEVELOPMENTS TODAY HAVE
ENSURE ACCESS TO EMERGENCY CARE.
AND THAT MAY BE SOMETHING FOR
THE FUTURE THAT THEY THERE IS A
SUPPORT OF THE HOSPITALS IN THE
AREA AND ENSURING THAT THE
HOSPITALS. AND THE EMS SYSTEMS.
ARE AVAILABLE FOR THESE LARGE
DEVELOPMENTS WHEN THEY'RE COMING
INTO. WEST CITY OR AN AREA. YEAH
THE DEVELOPMENTS OF THE- PEOPLE.
HAVE A LOT OF DO CALL GIVE
IMPACT FEES FOR THE SUPPLIES AND
LIKE I SAID FOR THE FIELD SIDE
OF IT THE EMS. SIDE OF IT. WHAT
IN AND IT TO AN EXTENT. THAT
TRANSLATES INTO A LITTLE BIT OF
BETTER SERVICE FOR BUT THEY
STILL HAVE TO GET TO THE
HOSPITAL PART. AND IS A FORMER-
CITY COUNCIL BURNED IN MAYOR
WHICH- MANY OF US ARE- WE
UNDERSTAND THE WATCHING IT CITY
GROW AND NOT HAVING TO HELP HER
YOU KNOW THE HOSPITALS. THAT YOU
NEED IN TRYING TO GET THEM TO
COME AND BUILD AND WE'VE BEEN
SUCCESSFUL THAT MY AREA BUT- AT
THE SAME TIME THAT DOES NOT
ALLEVIATE THE PROBLEM THAT THIS.
OVER SATURATION OF YARS. WITH
WITH THE CHANGING. NEEDS OF THE
PUBLIC. JUST ONE OTHER THING
BONTA SERMON. I CAN PUTT TALK
REAL QUICK- IN SEVERAL COUNTY-
WE DEVELOPED A PILOT PROGRAM AND
THIS IS ONE OF OR PARTNER
DISPATCH CENTERS- CAR FIRE IN IN
SEMINOLE COUNTY. AND THEY THEY
THEY BASICALLY STARTED A PILOT
PROGRAM WITH THE MERCY
COMMUNICATION- SYSTEM ALSO KNOWN
AS THE C. N. S. AND THAT'S WHEN-
WE HAVE A LOW CUTIE CALL THAT
CAN BE TRANSFERRED- IT DOESN'T
GO TO THE FIRE DEPARTMENT AT
THAT POINT ACTUALLY GETS
TRANSFERRED TO A- A NURSE. A
TRAINED NURSE THAT'S ABLE TO
TAKE THAT CALL AND PEOPLE THAT
DON PATIENTS NEEDS- DIRECTLY AND
THE CHALLENGE WITH THAT IS- IT'S
NOT FUNDED. AND IT'S A IT'S A
PILOT. BEING YOU KNOW PRUDENT BY
THE FIRE DEPARTMENTS TO DO THAT
AND IT IS PART OF THE SYSTEM
BECAUSE ULTIMATELY- THE
PATIENT'S STILL GETTING A GOOD
OF PATIENT CARE. HOWEVER THEY'RE
NOT BEING PUT INTO THE NINE ONE
ONE SYSTEM SO THAT'S SOMETHING
TO CONSIDER- AS A AS A LONG.
TERM SOLUTION BUT THAT WAS UP
AND RUNNING IN SEMINOLE COUNTY
AS A PILOT PROGRAM AND I KNOW
THEY BASE THAT AROUND A RENO-
STUDY THAT THEY DID IN THE
PROGRAM THAT THEY HAVE SO THAT'S
JUST A CONSIDERATION. THAT THIS
COMMITTEE MAY- LOOK AT- IN THE
FUTURE AND ALSO HELPING FOR SOME
FUNDING WITHOUT WOULD ACTUALLY
BE. VERY HELPFUL AND ALLOW WOULD
ALLOW US TO KEEP SOME OF THE
THINGS THAT SHOULDN'T BE. IN
NINE ONE. OR AT THE HEART SAYS
WELL IT'S JUST IT'S- THE SILVER
BULLET BUT IT HELPS OVERALL- ON
THE SYSTEM. THAT'S ALL I
AFFECTED A GREAT THANK YOU
CHIEF. MISTER JESTER I YOU'VE
BEEN SO INVOLVED IN THE EMS
SYSTEM FOR SO LONG- YOU KNOW IF
YOU WERE THERE WHEN I WAS THERE.
AND AND- SO I APPRECIATE THAT
AND I REALIZE YOU DON'T HAVE THE
TITLE OF CHIEF BUT YOU'RE
CERTAINLY A CHEAP LEVEL PERCENT.
OF OF EMS IN L. A. COUNTY SO
THANK YOU FOR YOUR SERVICE.
ASSEMBLY MEMBER WOULD YOU HAVE A
QUESTION THEY THEY GET HERE FOR
THE EQUITABLE FALL BUT ACTUALLY
THE CHEAP ACTUALLY JUSTANSWER
TODAY YOU KNOW IT WAS RECALLING
ON THE GROWING CONVERSATION THAT
WE HAVE IN OUR REGION AROUND
COMMUNITY PARAMEDICINE IN THE
ABILITY TO INTERVENE AND HAVE AN
ALTERNATIVE- YOU KNOW BOTH POINT
OF CONTACT BUT ALSO MAKING SURE
THAT. THERE WAS A SOLUTION FOR
THAT INDIVIDUAL THAT IT NEED TO
GO TO THE ER AND SO- OTHERS
THAT- HEARTENING TO HEAR THAT
THAT'S SOMETHING THEY'RE
WITNESSING IN SAN BENITO COUNTY
AS WELL AND- MAYBE THAT'S AN
AREA FOR AND FOR INVESTMENT THAT
BOTH- IS COST EFFECTIVE. ALSO
RELEASE ON SOME OF THE
OPERATIONAL CHALLENGES THAT
WERE- YOU KNOW HEARING ABOUT
THIS HEARING TODAY SO WE'LL LOOK
INTO THAT A LITTLE BIT MORE
THANK YOU. THANK YOU FOR HAVING
US. SO WITHOUT ALSO WANTED JUST
TO THANK ALL THE PANELISTS ON
THE FIRST PRESENTATION. THANK
YOU FOR SHARING YOUR THOUGHTS.
COMMENTS SUGGESTIONS- SOMETHING
WILL DEFINITELY FOLLOW UP ON.
OBVIOUSLY THERE THERE'S A LOT A
LOT OF WORK TO BE DONE BUT
THAT'S WHY WE'RE HERE. TO
DISCUSS THESE CHALLENGES WERE
FACING ESPECIALLY IN OUR NINE
ONE ONE SYSTEM HOW IT'S EVOLVED
FROM THE BEGINNING. TO TREAT THE
SICK AND INJURED AND NOW IT'S
DEVELOP IN. TWO OR DOING WHAT
THE PANDEMIC AND EVERYTHING ELSE
THAT COMES WITH THAT- WE CAN GO
ON FOR HOURS ON THE ISSUES THAT
BROUGHT US FOR OUT BUT-
HOPEFULLY WE CAN FIND SOME
SOLUTIONS AND THAT'S WHAT WE'RE
HERE FOR TODAY. SO WITHOUT WILL
MOVE ON TO OUR SECOND PANEL. ARE
WE ARE. ONCE AGAIN APPRECIATE
YOUR TIME WILLINGNESS TO SHARE
EXPERIENCES AND RECOMMENDATIONS
ON OUR SECOND PANEL. WE WANT TO
PREACH REMIND FOLKS TO TAKE
KEEPER COMES FROM MORE THAN FIVE
MINUTES WE HAVE ADEQUATE TIME
FOR QUESTIONS AND ANSWERS. OUR
FIRST WITNESS WILL BE MISSED
THIS BASSINET. ACTING DIRECTOR
OF THE MARCH MEDICAL SERVICES
THIRTY DIRECTOR BASSINET ARE YOU
THERE. YES I AM CAN YOU HEAR ME
YES WE CAN- GREAT. SO GOOD
MORNING CHAIR AND MEMBERS THANK
YOU FOR HAVING ME HERE TODAY TO
DISCUSS THIS IMPORTANT TOPIC- MY
NAME'S ELIZABETH ABSENT ON THE
ACTING DIRECTOR FOR THE
EMERGENCY MEDICAL SERVICES
AUTHORITY AND ALSO CHIEF
RESILIENCE OFFICER FOR
CALIFORNIA HEALTH AND HUMAN
SERVICES AGENCY. I UNDERSTAND
THAT TODAY THAT YOU'RE A MEMBERS
WOULD BE INTERESTED IN KNOWING A
LITTLE BIT ABOUT OUR CURRENT
RESPONSE EFFORTS AS WELL AS OUR
LONG TERM STRATEGIES TO.
MITIGATE AMBULANCE PATIENT
OFFLOAD DELAYS- SO WILL KIND OF
MOVE THROUGH THOSE BRIEFLY- AS
THE NATION'S HEALTH CARE SYSTEM
DEALS WITH THE IMPACTS OF CARBON
NINETEEN. THE EMS AS YOU'VE
HEARD AND EMERGENCY DEPARTMENTS
ARE MANAGING A LARGE INFLUX OF
PATIENTS AND EMERGENCY
DEPARTMENT VISITS. AS WE KNOW
THE CALIFORNIA HOSPITAL SYSTEM
AS FULL CURRENTLY. AND THIS IS
COMPOUNDED BY EMERGENCY
DEPARTMENT OVERCROWDING SO FOR
EXAMPLE- IN JANUARY OF TWENTY
TWENTY ONE. IN CALIFORNIA THERE
ARE APPROXIMATELY JUST AVERAGING
OUT ABOUT TWENTY NINE THOUSAND
EMERGENCY DEPARTMENT VISITS
DAILY. NOW IN JANUARY OF TWENTY
TWENTY TWO WE'RE SEEING
APPROXIMATELY AVERAGING FORTY
FOUR THOUSAND EMERGENCY
DEPARTMENT VISITS DAILY. THESE
NUMBERS DO SHIFT UP AND DOWN AND
THIS IS AN APPROXIMATION BUT
IT'S ALSO A TO SHOWCASE THE
LEVEL OF THE VOLUME OF EMERGENCY
DEPARTMENT OVERCROWDING- THAT
DOESN'T WANT TO THE HOSPITAL
SYSTEM. SO WHAT ARE WE DOING
RIGHT NOW- INSENSITIVE PHD WORK
TOGETHER ARE THROUGH THE STATE
EMERGENCY MANAGEMENT SYSTEM ARE
SOME SYSTEM TO FILL THE RESOURCE
REQUEST BUT WE'VE OFFICER
REDEPLOYED OUR STATE SURGE OF
SUPPORT PROGRAM SO. WE DO THIS
IN THREE WAYS AND I FEEL LIKE
THE BEST ANALOGY TO TALK ABOUT
THIS IS KIND OF THE FRONT OF THE
HOUSE INSIDE THE HOUSE AND THE
BACK DOOR OF THE HOUSE IF OR
SPEAK OF A HOSPITAL SO. THE
FRONT OF THE HOUSE THE EMS
SYSTEM. EMERGENCY ROOM
OVERCROWDING WE ARE WORKING WITH
EMERGENCY DEPARTMENTS AND
HOSPITALS TO TRY TO HOBBIES
TRIAGE UNITS OR TENS WHICH ARE
ATTACHED TO THE EMERGENCY
DEPARTMENTS TO HELP WITH THE
OVERFLOWING OF EMERGENCY ROOMS.
TO EXPEDITE THE TRANSFER OF CARE
OF THE PATIENT AND TO ALLOW OUR
AMBULANCES TO GET BACK IN
SERVICES. AND WE DEPLOYED THOSE
ARE WORKING. ON THE STATE WIDE
OUTSIDE OF OUTSIDE OF THE HOUSE.
INSIDE THE HOUSE WERE DEPLOYING
RESOURCES INTO THE HOSPITALS TO
MAKE SURE THAT IF THE PATIENT IS
INDEED VISITING THE EMERGENCY
DEPARTMENT AND ADMITTED INTO THE
HOSPITAL AND THE STRUCTURE. THAT
THERE'S SUFFICIENT STAFF TO TRY
TO- TRANSFER THIS PATIENT UP TO
THOSE FLOORS AND THEY'RE NOT
STUCK IN THE E. D. WAITING FOR
AN INFINITE ADMIT TED SPREAD.
AND THEN OUT OF THE BACK. DOOR
ONCE A PATIENT HAS. AARON IS
READY TO BE DOES EITHER EITHER
TO THEIR HOME OR TO A LOW STEP
JUST. WE TO MAKE THAT THERE'S
NOT A HINDRANCE TO MOVE THAT
PATIENT THROUGH THE- SYSTEM AND
DECOMPRESS THE HOSPITAL SO WE
WORK WITH SKILLED NURSING
FACILITIES AND STEP DOWN
FACILITIES. STAFF AND- MAKE SURE
THEY FEEL COMFORTABLE TAKING
THESE POSITIONS AND THIS
ALLOWANCE MOVING A PATIENT
THROUGH THE PATIENT'S CARE
CONTEND YOUR- IS WHAT ALLOWS
ALSO EMS TO BE SUCCESSFUL AND TO
NOT SEE. THIS BACKLOG THAT WE'RE
SEEING RIGHT NOW. PROGRAM WE
HAVE OVER THREE THOUSAND MEDICAL
STAFF DEPLOYED IN OVER A HUNDRED
EIGHTY SEVEN FACILITIES RIGHT
NOW IN THE STATE AND THAT NUMBER
IS INCREASING EVERYDAY- TO
TRIGGER- HAVE THIS IMMEDIATE
SUPPORT TO THE FACILITY AND
MITIGATE. AMBULANCE PATIENT
OFFLOAD LOW DELAYS. SO THE
CURRENT INSISTING LEVELS OF
EMERGENCY DEPARTMENT OFFLOAD
DELAYS ARE DOING THE THINGS THAT
YOU'VE HEARD ABOUT AND I WANT TO
SIMPLY SUMMARIZE THAT MEANT FOUR
MAIN. AREAS RECALLING A
SIGNIFICANT INCREASE IN A PARTY
PATIENT OFFLOAD DELAYS.
IMPACTING THE MSN SYSTEM ABILITY
TO RESPOND TO NINE ONE ONE. IT'S
STRAINING THE RELATIONSHIP
BETWEEN PRE HOSPITAL CARE AND
HOSPITAL CARE OUR EMS SYSTEM OUR
HOSPITAL SYSTEM THAT ARE BOTH
VITAL TO SUPPORT OUR PATIENTS.
AND IT IS IT MAY COMPROMISE
PATIENT CARE OUTCOMES. DAY SO I
LOOKING FORWARD AND THIS A
SOLUTION BASED CA. WHICH IS WHAT
WE'RE ALL HERE FOR. WE HAVE A
KNOWLEDGE THIS IS A NEW ISSUE
AND COBIT IS EXACERBATING
SOMETHING THAT EXISTS. I THINK
YOU KNOW THE GRADUAL INCREASE AS
I THINK SOMEBODY MENTIONED IN
TWO THOUSAND FOURTEEN. YOU KNOW
ANSWER AND CALIFORNIA HOSPITAL
ASSOCIATION DID RELEASE A TOOL
KIT ALTHOUGH NOT A TOTAL
SOLUTION WE BELIEVE IT WAS A
STEP IN THE RIGHT DIRECTION TO
ADDRESS THIS ISSUE. AND TWO
THOUSAND SIXTEEN EMS COMMISSION
REQUESTED AND SOCKS TO COLLECT.
DATA ON- WOULD WHICH WAS
VOLUNTARY. TO FURTHER EVALUATE
THIS- ASSEMBLY BILL TWENTY NINE
SIXTY ONE MANDATED JULY ONE TWO
THOUSAND NINETEEN THAT ALL THE
LIMITS. FORGETS MADE THERE. ARE
A PART DATA TO ANSWER EARLY AND
THEN IN DECEMBER TWENTY TWENTY
ONE- WE REPORTED TO THE
LEGISLATURE COMMISSION ON ITS
EVALUATION. SO IN THIS
ACKNOWLEDGEMENT IN MID TWENTY
TWENTY ONE THE EMS OF FORTY
CREATED AN AMBULANCE PATIENT
OFFLOAD TIME COMMITTEE. THIS
COMMITTEE IS MADE UP OF SEVERAL
THE STAKEHOLDER GROUPS HERE
TODAY. INCLUDING A CALIFORNIA
HOSPITAL ASSOCIATION NURSES
ASSOCIATION LOCAL YOUR MASTER
OUR REPRESENTATIVES AS WELL AS
PUBLIC AND PRIVATE PROVIDERS AND
THE OF THIS COMMITTEE IS TO
DRAW. RECORD FOR STATE
LEADERSHIP INCLUDING CITY PAGE
AND SO DIRECTORS ON HOW TO
REDUCE AMBULANCE PATIENT OFFLOAD
TIMES AND IS MEETING TWICE
MONTHLY. I THINK MOVING INTO THE
FUTURE WE MUST REMAIN DILIGENT
AND THREE OVERARCHING PRINCIPLES
TO SOLVE THIS PROBLEM. ANY
SOLUTION TO PUT PUT FORWARD MUST
KEEP THE PATIENT AND THE CENTER
OF ALL WE DO WE HAVE TO CONTINUE
THE COMMUNICATION COLLABORATION
OPENLY BETWEEN THE PRE HOSPITAL
SYSTEM AND THE HOSPITAL SYSTEM.
AS WE SEEK TO OF ALL OF THESE
INDEPENDENT SYSTEMS THOSE
SOLUTIONS IF THEY'RE ABLE TO
WORK TOGETHER WILL TIME OUT WE
LEAD TO THE BEST PATIENT CARE
OUTCOMES. AND WE MUST ENSURE
STANDARD. FOR TRANSPORT TO
TRANSFER OF CARE DOESN'T CHANGE.
AS WE'VE SEEN WITH THE INCREASED
WALL TIMES OUR GOAL MUST REMAIN
AT TWENTY MINUTES. FOR AMBULANCE
PATIENT OFFLOAD TIMES THIS IS
THE STANDARD PRACTICE AND THIS
IS WHAT WE NEED TO CONTINUE TO
WORK TOWARD. TOWARD SO I THINK
AS- AND SUMMARIZING WITH FOUR
MAJOR BUCKETS FOR SOLUTION. THIS
IS WHAT WE BRING FORWARD. I
THINK THE WORKFORCE DEVELOPMENT
BY YOU FOR A LITTLE BIT OF POWER
AND- WELL I DO NOT AND THE
GOVERNOR'S BUDGET THE
PARTNERSHIP WITH CAL HHS AND L.
W. D. A. TO CREATE AN EMERGENCY
MEDICAL CORPS. TURNING YOUTHFUL
ROLES AS EMERGENCY MEDICAL
TECHNICIANS OF HOW WE CONTINUE
TO BUILD UPON WORKFORCE
DEVELOPMENT STRATEGIES TO KEEP-
TO KEEP THIS WORKFORCE GROWING
IS KEY. THE SECOND MAJOR
SOLUTION WOULD BE THE DATA I
THINK. WE'VE TAKEN SOME VERY
GREAT STOPS. TO ENHANCE OUR DATA
ACCESS AND DATA REAL TIME DATA-
AND IT IS SHE AND A SENSE FOR.
DECISION MAKING INFORMED
DECISION MAKING SO ENHANCING OR
REFINING OUR DATA OPERATIONS. IS
KEY. COLLABORATION I THINK. TO
STRESS THE POINT MAINTAINING A
COLLABORATIVE RELATIONSHIP
BETWEEN PRE HOSPITAL CARE AND
HOSPITAL CARE- ESPECIALLY
THROUGH THIS A PART COMMITTEE
PROCESS SO THAT WHEN THE
COMMITTEE BRINGS THEIR
RECOMMENDATION FOR WE KNOW THAT
THEIR HOLISTIC COMPREHENSIVE AND
ADDRESS THE ENTIRE PATIENT CARE
CONTINUUM. AND THEN FINALLY
WHICH I THINK WE'VE HEARD A LOT
ABOUT TODAY IS OPTIMIZING THE
SPOKES IN THE WHEEL OF THE
PATIENT CARE CONTINUE ON. EVERY
SPOKE ON THAT WHEEL IT'S
EVOLVING OUR EMS SYSTEM AND OUR
HEALTH CARE SYSTEM. ANALYZING
AND LOOKING AT STRATEGIES FOR
ALTERNATE DESTINATIONS
TELEMEDICINE AND MAYBE EVEN
THINGS WE HAVEN'T THOUGHT OF AN
EVOLVING OUR HEALTH CARE
IMPROVING ACCESS TO PAY FOR
TAKING FOR BEHAVIORAL HEALTH
PATIENTS. IMPROVING ACCESS TO
CARE FOR PRIMARY HEALTH
PATIENTS- OPTIMIZING EMERGENCY
DEPARTMENT THROUGHPUT AND EVEN
WHAT WERE YOU LOOKING AT
REVIEWING- ASSESSOR FOR
POLICIES. I THINK THIS ALSO
MEANS A STRONGER RELATIONSHIP.
WITH OUR FEDERAL PARTNERS FOR
CENTERS FOR MEDICARE AND
MEDICAID FOR REIMBURSEMENT EMS
TRANSPORT TO ALTERNATE
DESTINATION AND HOW WE LOOK AT
THESE THINGS MAY BE IN A NEW WAY
AS A NEW OPTION- WITH FAT- I
CONCLUDE MY TESTIMONY AND HAPPY
TO TAKE ANY QUESTIONS. THANK YOU
DIRECTOR OF OUR NEXT WITNESSES
DR CLAYTON HAZAN WHO IS THE
MEDICAL DIRECTOR FOR THE LOS
ANGE COUNTY FIRE DEPARTMENT. AND
PRESIDENT OF THE CALIFORNIA
CHAPTER OF THE NATIONAL
ASSOCIATION OF EMS PHYSICIANS-
DOCTOR SON EITHER. I'M HERE YOU
CHAIRMAN RODRIGUEZ AND GOOD
MORNING EVERYONE. MY NAME IS
CLAYTON CAUSING AND I AM AN
EMERGENCY PHYSICIAN AND EMS
PHYSICIAN I'M PRESIDENT OF AS
THE TERMS OF THE CALIFORNIA
CHAPTER OF. THE NATIONAL
ASSOCIATION OF YEMEN'S POSITIONS
AND I AM THE MEDICAL DIRECTOR OF
THE LOS ANGELES COUNTY FIRE
DEPARTMENT. AS AN EMERGENCY
PHYSICIAN I UNDERSTAND THE
CHALLENGES THE HOSPITAL'S FACE
WITH THE EVER RISING VOLUME OF
PATIENTS PRESENTING TO THE E. D.
REPORT DIFFICULTY STAFFING
SHORTAGES I WAS AN EMERGENCY
DEPARTMENT CHAIRMAN AND MEDICAL
DIRECTOR AS WELL. NOT ONLY IN MY
SENSE OF THESE PROBLEMS I
EXPERIENCE THEM FIRST HAND WHEN
I WORKED AT MY HOSPITAL AS IT
DID LAST WEEKEND. BUT WE CAN'T
ALLOW POSSIBLE CHALLENGES TO
PARALYZE THE NINE ONE ONE SYSTEM
AND THAT'S EXACTLY WHAT'S
HAPPENING. ABRAMS'S TO LANGUISH
IN HOSPITALS FOR HOURS ON END.
OF MY PERSONAL RECORD THAT I AM
AWARE OF FROM LAST WINTER. WE
HAD TO PATIENTS AT ONE FACILITY
WHO. THE CARE WAS NOT TRANSITION
FOR TWENTY FIVE HOURS. I ALSO
VISIT HOSPITALS IN MY ROLE AS
THE FIRE DEPARTMENT MEDICAL
DIRECTOR AND HAVE WITNESSED THIS
FIRST HAND HOW AMBULANCES ARE
HELD UP WELL CALLS CONTINUE TO
GO OUT WITH NO AMBULANCE TO SEND
. AMBULANCES ARE A LIMITED
COMMUNITY RESOURCE FOR YEARS
HOSPITALS HAVE TREATED BILLSAS
AS AN UNLIMITED RESOURCE. AND
ALLOW THEM TO WAIT FOR THESE
HOURS AND OVERTIME IT'S GOTTEN
OF COURSE PROGRESSIVELY WORSE.
BUT EMS SYSTEM ALWAYS MANAGED TO
BE SUCCESSFUL IN SPITE OF THE
WALL TIME ISSUES BECAUSE THAT'S
WHAT THE FIRE SERVICE AND M. S.
DO. THEY SOLVE PROBLEMS AND THEY
MANAGED TO HOLD THAT SAFETY NET
TOGETHER. BUT NOW WITH ANOTHER
CALL THAT SEARCH LARGE NUMBERS
OF THE EMERSON HOSPITAL
WORKFORCE ARE OUT SICK WITH COLD
IT. AND THE SURGEON EMS CALLS
EMERGENCY DEPARTMENT VISITS IS
UPON US WE FIND OURSELVES AT A
CRISIS POINT. EVERY DAY EMS
SYSTEMS ACROSS OUR STATE OR FIND
THEMSELVES COMPLETELY OUT OF
AVAILABLE AMBULANCES TO SEND THE
CALLS. BECAUSE THEY'RE BEING
COMPLETELY CONSUMED AT THE
HOSPITALS. SO WHAT HAVE WE DONE
TO MITIGATE. IN RESPONSE TO THE
CRISIS THE EMS SYSTEM HAS
RESORTED TO A NUMBER OF
MITIGATION MEASURES. WE HAVE
SPECIALTY UNITS IN TELEMEDICINE
PROGRAMS LAUNCHING WITH THE HOPE
OF IDENTIFYING AND MANAGING LOW
ACUITY PATIENTS WITHOUT SENDING
THEM TO HOSPITALS. IT IS A BILL
SINCE THIS WAS JUST MENTION
IMPORTANT TO NOTE THAT OUR OUR
DEPARTMENT ALSO APPLIED FOR A
FEDERAL GRANT TO SET UP A NURSE
TRIAGE LINE IN OUR DISPATCH
THERE WAS A NOTICE OF FUNDING
OPPORTUNITY THAT GOT REVOKED BY
THE FEDERAL GOVERNMENT. DESPITE
LOTS OF AGENCIES LIKE OURS-
APPLIED TO GET FUNDING TO DO
JUST THAT. WE HAVE COMMUNITY
PARAMEDICINE TEAMS ACROSS THE
pAPPROPRIATE PATIENTS THE
PSYCHIATRIC URGENT CARE CENTERS
AND SOBERING CENTERS IN ORDER TO
SAVE HOSPITAL CAPACITY. IN SPITE
OF ALL THESE MEASURES WERE STILL
HAVING CRITICALLY ILL PATIENTS
WAITING ON SCENE BECAUSE OF A
LACK OF AVAILABLE AMBULANCES. SO
WE RESORTED TO TRANSPORTING
THOSE PATIENTS BY ANY MEANS
NECESSARY TO GO OUT TO GET THEM
TO THE HOSPITAL. WE TRANSPORTING
CRITICAL PATIENTS AND FIRE
ENGINES AND PARAMEDICS SQUADS
LAW ENFORCEMENT PATROL VEHICLES.
AND EVEN WE'LL CROSS A BUSY
STREET FROM THE NURSING HOME TO
THE HOSPITAL IN THEIR CAR FROM
THE NURSING HOME. AT THE
HOSPITALS WE CONSOLIDATED
INSPECTIONS BY GETTING ONE ABLE
TO SCREW TO WATCH MULTIPLE
WAITING PATIENTS. SO THE OTHER
CREWS CAN GO BACK INTO SERVICE
AND PICK UP THE NEXT PATIENTS.
AND IT'S STILL NOT ENOUGH TO
SUSTAIN US IF WE DON'T START
GETTING OUR AMBULANCES BACK
EXPEDITIOUSLY. SO WHAT DO WE
NEED TO DO. WE NEED TO ACT
QUICKLY AND DECISIVELY TO STOP
THE BLEEDING AND OUR EMS SYSTEM
. WE'RE IN A DISASTER. IT IT'S
BEEN GOING ON FOR TWO YEARS IT'S
A SLOW ROLLING DISASTER I
UNDERSTAND BUT IT IS A DISASTER
WE NEED TO RESPOND ACCORDINGLY
IF THERE WAS A PLANE CRASH IT
WOULD NEVER BE ACCEPTABLE FOR A
HOSPITAL TO HOLD UP A BILL SAYS
AND LEAVE PATIENTS IN THE
FLAMING WRECKAGE WAITING FOR
TRANSPORT JUST BECAUSE THEY FELT
OVERWHELMED. THE CULVERT
SEARCHES BEEN NO LESS OF A
DISASTER IT'S THE EQUIVALENT OF
A PLANE CRASH EVERY COUPLE OF
DAYS IN MY COUNTY ALONE BUT
EVERY DAY WE STILL HAVE CRITICAL
PATIENTS WAITING FOR AN
AMBULANCE AT THE SCENE OF THEIR
EMERGENCY. IN TERMS OF ALL TIME
THIS IS ONE AREA IN WHICH
EXISTING LAWS VERY CLEAR. THE
FEDERAL EMERGENCY MEDICAL
TREATMENT AND ACTIVE LABOR ACT
AND TALA. HAS CLEARLY DEFINED
THAT THE TRANSITION POINT IN
PATIENT CARE RESPONSIBILITY
BETWEEN EMS AND HOSPITALS. IT IS
AS SOON AS THAT PATIENT ARRIVES
AT THE HOSPITAL AND THERE'S
AWARENESS THAT THERE IS A
PATIENT SEEKING THEIR SERVICES.
DESPITE THAT WE CONTINUE TO HAVE
AMBULANCES IN THIS SORT OF
PERPETUAL STATE OF TRANSPORT.
WHERE THEY'RE SITTING ON THE
WALL BUT THE HOSPITAL'S REFUSING
TO ACKNOWLEDGE THEIR
RESPONSIBILITY. EXISTING LAWS
ENFORCED IN HOSTELS WOULD BE
HELD ACCOUNTABLE TO THEM TELL
OBLIGATIONS. AND THEY'D BE
FORCED TO STOP PRETENDING THAT
THEY CAN STALL THESE OBLIGATIONS
AND DEFINITELY. LONGER TERM TO
MAKE EMERGENCY DEPARTMENT
SYSTEMS MORE SUSTAINABLE BECAUSE
OUR CURRENT SYSTEM IS NOT
SUSTAINABLE WE NEED TO STOP
SENDING ALL PATIENTS TO THE
HOSPITAL FOR TRIAGE. WE NEED
YOUR ASSISTANCE AND SUPPORT TO
LOWER THE BARRIERS OF ENTRY TO
HELP EMS ESTABLISH SYSTEMS TO
IDENTIFY AND MANAGE LOW ACUITY
PATIENTS WITHOUT FUNNELING
EVERYTHING THROUGH THE EMERGENCY
DEPARTMENT BOTTLENECK. IF WE CAN
REDUCE OVER UTILIZATION THAT WE
CAN SAVE CAPACITY FOR THE
CRITICAL PATIENTS THE M. S. N.
WORKS TO DEPARTMENT SYSTEMS WERE
INTENDED TO SEARCH. WE ASK FOR
YOUR COMMITTEES SUPPORT FOR
PROGRAMS LIKE COMMUNITY
PARAMEDICINE ALTERNATE
DESTINATIONS TELEMEDICINE AND
OTHER INNOVATIVE PROGRAMS. THANK
YOU AND I'LL BE HAPPY TO ANSWER
ANY QUESTIONS. THANK YOU DOCTOR
OUR NEXT WITNESSES DOCTOR PATEL
OWNER THE CHAIR OF THE
CALIFORNIA MARCH MEDICAL
SEARCHES THIRTY EMS
COMMISSIONER. COMMISSION DR
OWNER ARE YOU THERE. I BELIEVE
AND THERE CAN YOU HEAR ME YES WE
CAN HEAR. OKAY GREAT I APOLOGIZE
IF I'M NOT ON CAMERA I DON'T
KNOW THAT SO I HAVE SOME SOFTER
PROBLEMS. GOOD MORNING MY NAME
IS DR GILLIAN ARE I AM A BOARD
CERTIFIED EMERGENCY PHYSICIAN
AND THE CHAIR OF THE CALIFORNIA
MUSCLE SORENESS COMMISSION ON
PMS I'M A PROFESSOR OF EMERGENCY
MEDICINE AND NURSING. AND I'VE
BEEN WORKING IN SOUTHERN
CALIFORNIA MERGING TWO
DEPARTMENTS FULL TIME. FOR THE
pIS A SYSTEM OF CARE OF THE
DEPENDS ON HOSPITALS TAKING
PATIENTS FROM EMS AMBULANCES
PICK UP PATIENTS AND DELIVER
THEM TO HOSPITALS. WE DO NOT
HAVE A PATIENT. I'M BILLS
PATIENT UPLOAD DELAY WE HAVE AND
BILLS PATIENT OFFLOAD DELAYS THE
HOSPITAL RECEIVING SIDE IS THE
BOTTLENECK. M. THIS PATIENT
OFFLOAD DELAYS ARE EIGHT OVER
TWENTY YOUR PROBLEM HAVE LITTLE
TO DO WITH COBIT OR ANY SEARCH
AMBULANCE PATIENT OFFLOAD DELAYS
HAPPEN EVERY DAY OF EVERY MONTH.
OF EVERY YEAR. WILL WAS SO
SEVERE THAT AND M. C. A. POT
COMMITTEE ISSUED A HUNDRED
TWENTY PAGE DOCUMENT ON HOW TO
FIX IT IN TWENTY FOURTEEN.
PUBLISHED BY THE CALIFORNIA
HOSPITAL ASSOCIATION. BUT THE
PROBLEM IS EVEN WORSE TODAY.
OFTEN OVER HALF OF THE OUR BEDS
ARE OCCUPIED BY PATIENTS WHO ARE
ADMITTED TO THE HOSPITAL IN
SHOULD BE UPSTAIRS IN A HOSPITAL
WARD. THIS INCREASES PATIENTS
SUFFERING AND MORTALITY AND
DECREASES PATIENT SATISFACTION.
THE LIGHTS ARE NEVER OUT THESE
PATIENTS GET NO REST. THE
EMERGENCY DEPARTMENT IS AN EIGHT
CYLINDER ENGINE RUNNING ON FOUR
CYLINDERS DUE TO THESE BLOCKED
BEDS BUT IS STILL EXPECTED TO
PULL ITS LOAN. EMERGENCY
DEPARTMENT BEDS DEPEND ON
HOSPITAL THROUGHPUT WHICH IS IN
CONTROL OF THE HOSPITAL NOT EMS
FOR THE EMERGENCY DEPARTMENT.
THURMOND GUIDELINES ESTABLISHED
SINCE THE EARLY TWO THOUSANDS TO
AMELIORATE THIS PROBLEM AND THEY
ARE NOT BEING FOLLOWED IN THE
HOSPITALS. M. AS PATIENT OFFLOAD
DELAYS CREATE A HUMAN TOLL ON
PATIENTS AND ON EMTS TO WAIT FOR
OUR STANDING NOT SITTING IN
HALLWAYS WITHOUT REST PERIODS.
ISSUE SUFFERING ON SMALL
STRUCTURES NOT DESIGNED FOR
PROLONGED STAY THE NAY OF CARE
INCLUDING NO PAIN MEDICATION NO
ANTIBIOTICS NO PRIVACY AND NO
DIGNITY. ATIONS WAITING IN THE
WAITING ROOM FOR CARE FOR MANY
HOURS THEN LEAVING WITHOUT BEING
SEEN OR TREATED. THIS IS NEITHER
SAFE NOR DIGNIFIED. ATIONS
ALASKA'S RESPONSIBILITY AS SOON
AS THE AMBULANCE ARRIVED AT THE
HOSPITAL THIS HAS BEEN
DOCUMENTED IN THE TWENTY
FOURTEEN A PART TOOL KIT. IT
EVERYDAY I SEE PATIENTS ON
AMBULANCE STRUCTURES LINING THE
HALLWAYS WITH EMPTY EMERGENCY
DEPARTMENT BEDS RIGHT NEXT TO
THEM. THIS HAS BEEN ONGOING FOR
SO LONG THAT HOSPITAL STAFF I
THINK IT IS NORMAL THAT EMS
PERSONNEL WATCH HOSPITAL
PATIENTS ON PMS EQUIPMENT IN
HOSPITAL HALLWAYS. I WOULD
SUBMIT THAT CLINICAL OBSERVATION
OF A PATIENT'S HEALTH STATUS
REQUIRES MEDICAL JUDGMENT IT'S
SORT REQUIRES MEDICAL EDUCATION.
AND SO IT IS THE PRACTICE OF
PARAMEDICINE OF NURSING AND OF
MEDICINE. ANY DOCTOR OR NURSE
WORKING IN A HOSPITAL HAD TO GO
THROUGH A LENGTHY CREDENTIALING
PROCESS TO ASSURE COMPETENCE.
BUT EMS PERSONNEL ARE NOT
CREDENTIALED TO PRACTICE
MEDICINE ON HOSPITAL GROUNDS.
THE OVER TWENTY YEAR PRACTICE OF
EMS CONTINUING TO WATCH PATIENTS
IN THE HOSPITAL VIOLATES THE
HOSPITAL'S OWN CREDENTIALING
REQUIREMENTS. HOSPITALS ARE IN
CONTROL OF THEIR INTERNAL
PROCEDURES AND THEY ARE FAILING.
EMERGENCY DEPARTMENTS ADMITTED
10220% OF PATIENTS THEY SEE
WHICH MEANS THEY SENT 8290% HOME
AFTER WORK UP WITH TREATMENT AND
FOLLOW UP AS NEEDED. NO IN
PATIENT BED REQUIRED. AS AN
EMERGENCY PHYSICIAN IF I HAVE
ALL TEST RESULTS I NEED I CAN
EITHER ADMIT OR DISCHARGE 80% OF
MY PATIENTS ON THE SPOT. ONLY
FEW NEED CLINICAL OBSERVATION
OVERTIME IN THE E. R. TO FOR
TREATMENT TO WORK. IT LAB AND
IMAGING TURNAROUND TIMES ARE
ATROCIOUS BECAUSE HOSPITAL
PROCESSES ARE CONVOLUTED AND
INEFFICIENT. HOSPITAL'S REPORT
THE AVERAGE TURNAROUND TIMES ON
THESE TEST. BUT THE PATIENT DOES
NOT WAIT FOR THE AVERAGE JUST TO
RETURN. THEY WAIT FOR THE LAST
TEST TO RETURN IF I DID NOT NEED
THAT LAST TEST I WOULDN'T HAVE
ORDERED IT. HOSPITAL QUALITY
METRICS DO NOT REFLECT THE
PATIENT EXPERIENCE. PATIENT MDMS
ARE SUFFERING FROM HOSPITALS
FAILING TO GET THEIR MOST BASIC
EMERGENCY DEPARTMENT PROCESS
HE'S RIGHT. THEY ALSO SUBMITTED
ALTERNATE DESTINATION IS VERY
LIMITED IN EFFICACY BECAUSE
HOSPITAL EMERGENCY DEPARTMENTS
ARE FAR BETTER EQUIPPED TO
HANDLE A VARIETY OF UNSCHEDULED
VISITS AND ESCALATE OR
DEESCALATE CARE AT A MOMENT'S
NOTICE. WE HAVE SPENT FORTY
YEARS CREATING BOTH THE MEDICAL
AND NURSING SPECIALTY CALLED
EMERGENCY MEDICINE WHICH IS THE
ENVY OF THE WORLD THE
COMPROMISED EMERGENCY CARE
WITHOUT THE NEED TO TRANSPORT TO
ANOTHER FACILITY. ALTERNATIVES
TO NATIONS SUCH AS CLINICS TO
NOT HAVE A MEDICAL OR NURSING
EXPERTISE TO DO SO AND THEY
DON'T HAVE THE EQUIPMENT. MANY
ALTERNATE DESTINATION PROJECT TO
FAILED FOR THIS REASON.
ALTERNATIVES TO NATION MAY BE
COULD CARE FOR AN INDIVIDUAL
PATIENT SAY A PSYCHIATRIC
PATIENT BUT IT WILL NOT SOLVE
THE WIDESPREAD A PUMP PROBLEM.
NO IT TO THE PATIENTS ARE IN THE
WAITING ROOM AND DO NOT COMPETE
FOR ER BEDS THEIR CONTRIBUTION
TO ALL TIMES IS LIMITED. SO WHAT
ARE MY ASKS IN ORDER TO IMPROVE
SAFETY AND DIGNITY FOR THE
PATIENT ONYEMA STRUCTURES AND
FOR THE COMMUNITY WHO DIALS NINE
ONE ONE AND GETS A DELAYED PMS
RESPONSE. WE NEED TO THINK
INSIDE THE BOX NOT OUTSIDE THE
BOX. WE NEED IMPROVED HOSPITAL
PROCESSES FOR BASIC DAILY
EMERGENCY DEPARTMENT SERVICES
LAB IMAGING STAFFING AND MEDICAL
TREATMENTS SUCH AS HEMODIALYSIS.
IF I'LL HAVE TO WORK WITH THIS
FOUR CYLINDERS AT LEAST THOSE
NEED TO RUN SMOOTHLY. M. AS BOTH
PUBLIC AND PRIVATE ARE PAYING
FINES FOR FAILING TO MEET NINE
ONE ONE RESPONSE TIMES BECAUSE
OUR EQUIPMENT AND PERSONNEL ARE
HELD HOSTAGE IN HOSPITALS.
HOSPITALS ALSO NEED FINANCIAL
ACCOUNTABILITY FOR FAILING TO
MEET A PART TIME. AND LASTLY MAY
BE MORE MOST IMPORTANTLY THE
CALIFORNIA CAME OUT YEAH COBIT
EMERGENCY REGULATIONS HAVE.
TAUGHT US THE PARAMEDICS AND
EMTS CAN BE VALUABLE EMPLOYEES
AND HOSPITALS. AND THAT RIGID
NURSE PATIENT RATIOS CAN BE
NIELSEN SAFELY TO TAKE CARE OF
EMERGENCY DEPARTMENT PATIENTS.
THE CURRENT RATIO FOR TO ONE IS
CONDEMNING COLLEGE EDUCATED
PROFESSIONALS TO DO TASKS SUCH
AS COPYING PATIENT MEDICATIONS.
FROM A PROBLEM BY THE PATIENT A
PLASTIC BACK INTO THE COMPUTER
FOR MEASURING URINE VOLUMES.
THESE NURSES COLLEGE EDUCATED
PROFESSIONAL SHOULD BE EMPOWERED
TO DO GET TASKS THAT DO NOT
REQUIRE AN ADVANCED DEGREE TELL
ME ANSWER TECHNICAL PERSONNEL
AND DO WHAT THEY'RE TRAINED TO
DO. WHICH IS PROVIDE ADVANCEDMEDICAL ASSESSMENTS AND CARE. WE
WOULD NEED BOTH OF THESE
MEASURES TO BE MADE PERMANENT.
VERY MUCH. THANK YOU FOR YOUR
TESTIMONY OUR NEXT WITNESS IS DR
LORRIE MORGAN WHO IS THE
PRESIDENT AND CHIEF EXECUTIVE
OFFICER AT HUNTINGTON MEMORIAL
HOSPITAL- DOCTOR MORGAN. GOOD
MORNING. THREE THE MORNING AND
IT HURTS THANK YOU CHAIR
RODRIGUEZ ASSEMBLY MEMBERS AND
COLLEAGUES STAFF FOR BEING HERE
TODAY TO DISCUSS THIS IMPORTANT
ISSUE I'M INTERESTED- DOCTOR
LORI MORGAN PRESIDENT AND CEO OF
HUNTINGTON HEALTH AND PASADENA I
WAS INVITED TO- HERE TO SPEAK
TODAY AS A SEAT YOU KNOW BUT LET
ME ASSURE YOU MY MOTIVATION FOR
BEING HERE IS THAT I'M ACTUALLY
A TRAUMA SURGEON- I RARELY SAW
PATIENT WHEN PRACTICING
CLINICALLY THAT WASN'T BROUGHT
TO ME- FINANCE BILLIONS AND I
KNOW IN A VERY UP CLOSE AND
PERSONAL WAY HOW IMPORTANT THIS
ISSUE IS AND HOW CRITICAL IT IS.
THAT WE WORK TOGETHER TO ADDRESS
WHAT IS A VERY COMPLEX ISSUE IN
ORDER TO ENSURE THE AVAILABILITY
OF EMS TO OUR COMMUNITIES I
THINK IT IS- I DO WANT TO
EMPHASIZE THAT THIS COMPLEX AND
I THINK THAT MANY FOLKS HAVE-
I'VE TALKED ABOUT VERY SINGULAR
SORT OF ISSUES FROM FROM ONE
PERSPECTIVE AND HOPEFULLY I CAN
ABROAD IN THAT A LITTLE BIT
ACROSS THE CONTINUUM
CALIFORNIA'S EMERGENCY SERVICES
SYSTEM IS REALLY MADE UP OF
CAN'T HOSPITAL EMERGENCY
DEPARTMENTS AMBULANCE FIRE AND
LAW ENFORCEMENT IT SAID THE
EPICENTER OF OUR HEALTH CARE
SYSTEM AND IS INSEPARABLY LINKED
TO PUBLIC HEALTH COMMUNITY- OR-
PUBLIC AND PUBLIC. SINCE TO SEE
NINE CARE. OF TWENTY SEVEN.
THREE SIXTY. THE M. SYSTEM STATE
AND FEDERAL LAWS MUST BE
AVAILABLE TO ALL WITHOUT
RESTRICTION OR CONSIDERATION OF
ABILITY TO PAY HOWEVER EMERGENCY
SERVICES ARE LIMITED RESOURCE
AND WHEN STRETCHED BEYOND
CAPACITY AS WE HAVE BEEN FOR THE
LAST TWO YEARS. I CAN RESULT IN
REDUCED AVAILABILITY OF EMS
UNITS LONG RESPONSE TIMES
PROVIDER STRESSED AMBULANCE
PATIENT OFFLOAD DELAYS A
REDUCTION IN THE OVERALL QUALITY
OF THE COMBINED RESOURCES WHEN
PATIENTS EITHER INSURED OR NOT
CAN GET THE CARE THAT THEY NEED
IN THEIR COMMUNITIES DO YOU
ACCESS OR FOR CONVENIENCE THEY
REGULATE TURNED TO HOSPITAL
EMERGENCY DEPARTMENTS. SOME OF
THE REASONS INCLUDING A LACK OF
PRIMARY CARE THE NEED FOR
OBSERVATION PROCEDURAL ISSUES
SUCH AS LAW ENFORCEMENT BRINGING
INDIVIDUALS FOR MEDICAL
SCREENING EVALUATION
OCCUPATIONAL HEALTH NEEDS
EMPLOYEE HEALTH NEEDS. WHO NEED
A CLEARANCE OR PHYSICAL FOR
EMPLOYMENT SAFETY NET HEALTH
CARE BEHAVIORAL CARE AND HAVE TO
TELL YOU I WILL UNDERLINE THAT
FOUR HUNDRED TIMES. HOMELESSNESS
SUPPORT SUBSTANCE USE DISORDERS
AND COVER NINETEEN OTHER COMING
FOR TESTING AND OR VACCINES AND
BUT FOR BOTH. EMERGENT AND NON
EMERGENT CARE AS A RESULT
OVERCROWDING HAS BECOME A COMMON
OCCURRENCE ESPECIALLY AS THE
OMICRON SURGE THAT HAS CRUSHED
THE HOSPITAL'S. CONSIDER THAT
THE GREATEST INCREASE IN ET
VOLUME ARE THOSE PATIENTS WHO
ARE NOT URGENT AND CONFIDENTIAL
WOULD BE CARED FOR AN ALTERNATE
HEALTHCARE SETTINGS AS MANY HAVE
POINTED OUT. FROM TWO THOUSAND
AND TWELVE TO TWO THOUSAND AND
NINETEEN PRIOR TO COPE AND NON
URGENT P. D. VOLUME INCREASED
22% WELL BY IMPROPER MERCHANT
CATIONS INCREASED. WHO NEEDED TO
BE AMENDED INCREASE ONLY NINE
PERCENT. AND TWENTY TWENTY ONE
AND HUNTINGTON OVER 50% OF THE
EMS CALLS WERE TRIAGED AND
EMERGENCY SEVERITY INDEX SCORES
OF THREE TO FIVE. WHICH ARE
LOWER QD SCORE USUALLY THAT DO
NOT NEED TO BE INVENTED AND IN
GENERAL FUND URGENT AND THESE
WERE PATIENTS THAT WERE BEING
TRANSPORTED. NOT WALKING INTO
OUR E. R. HEY GIRL HOW CARE PER.
HAS A LARGE SPIKE WITH THE DIVAS
FOR SO HARM INCREASE OVER 5%
BETWEEN TWENTY SIXTEEN AND
TWENTY TWENTY. AT THE SAME TIME
THE EMERGENCY DEPARTMENT USES
INCREASING THE ABILITY TO
TRANSFER PATIENTS ARE THE
HOSPITAL IS CONSTANTLY
CHALLENGED BY NUMEROUS BARRIERS
THAT ARE OUTSIDE OF THE
HOSPITALS CONTROL AND CAN TIE UP
CAPACITY AND LIMIT INDIAN
MISSIONS AND DECOMPRESSION. THEY
INCLUDE A LACK OF POST ACUTE
CARE BEDS INSURANCE
AUTHORIZATION DECISIONS THAT
DELAYED DISCHARGE ESPECIALLY FOR
OUT OF NETWORK PLACEMENT DELAYS
WERE TIMELY TRANSFER
AUTHORIZATION. OXYGEN WALKERS
WHEELCHAIRS AND OTHER DURABLE
MEDICAL EQUIPMENT HOME HEALTH
AND TRANSPORTATION. LACK OF
DESPERATELY NEEDED HOMELESS
SERVICES FIRST OF ALL I LIKE
HOMELESS SERVICES REPORTING
GETTING HUNDRED REFERRALS AND A
DAY FOR HOMELESS COBIT ISOLATION
FENCE WHEN ONLY TWO HUNDRED AND
SIXTY THREE TOTAL BEDS ARE
AVAILABLE. THERE IS A LACK OF
MEDICAL OR PSYCHIATRIC
MONITORING PLACEMENT RESOURCES
FOR HOMELESS. SERVING YOUR REHAB
HOME AND COMMUNITY BASED
SERVICES FOR THE ELDERLY AND THE
DISABLED AND THEIR MINIMAL
RESOURCES FOR THOSE IN NEED OF
COMMUNITY BASED MENTAL HEALTH
AND SUBSTANCE USE DISORDERS.
CURRENT CHALLENGES WITH CODE FOR
ISOLATION NEEDS AND THE ABILITY
AND ABILITY TO IDENTIFY AND
ASSISTED LIVING GROUP HOMES OR
SKILLED NURSING FACILITIES THAT
WILL ACCEPT TRANSFERS JUST TO
GIVE YOU A SNAPSHOT OF TODAY
WHEN I WALKED IN THIS MORNING AT
SEVEN I LOOKED AT OUR CURRENT
NUMBERS. WE CURRENTLY HAVE
EIGHTEEN PATIENTS THAT WE ARE
UNABLE THAT ARE READY CLINICALLY
TO BE DISCHARGED FROM THE
HOSPITAL WE'RE UNABLE TO
DISCHARGE THEM BECAUSE WE DON'T
HAVE AUTHORIZATIONS FOR
INSURANCE PURPOSES. OR WE HAVE
NO PLACE TO SEND THESE PATIENTS
LET ME TELL YOU ABOUT SO THAT'S
UP STAIRS WE'VE GOT EIGHTEEN
BEDS WE COULD POTENTIALLY HAVE
LET ME TELL YOU ABOUT OUR
EMERGENCY ROOM THIS MORNING. WE
HAVE EIGHT CATIONS THAT THEY ARE
CURRENTLY HOLDING THAT WE NOW
NEED TO BE AMENDED AND THEY'RE
HOLDING THEM WE HAVE ANOTHER
FIFTEEN PATIENTS THAT. ARE
PENDING A PROBABLE AND MISSION
THIS DECISION. THAT'S TWENTY TO
PAY THAT WE NEED BE IN MAY. I'VE
GOT EIGHTEEN THAT I CAN JUST. AT
AND WE KNOW WE HAVE LET'S FACE
IT WE KNOW WE HAVE AMBULANCES
THAT ARE WAITING TO GET AND I
COULD HAVE POTENTIALLY. I COULD
POTENTIALLY HAVE TWENTY TWO BEDS
AVAILABLE TO THOSE AMBULANCES IF
ONLY I COULD GET PATIENTS OUT OF
THE HOSPITAL TO BE ADMITTED.
THAT'S A VERY REAL TIME NUMBER
FROM TODAY AND IT IS NOT ANY
DIFFERENT THAN ANY OTHER DAY TO
BE QUITE HONEST. OUR CURRENT
EFFORTS WE AGREE ARE NOT ENOUGH.
EIGHTY OVERCROWDING AND THE
ABILITY TO DISCHARGE PATIENTS
ARE LEADING TO SOME. TO MANY OF
THE AMBULANCE PATIENT OFFLOAD
DELAYS THAT WERE SAYING WE KNOW
IT'S NOT A NEW PROBLEM WE KNOW
THAT IN TWENTY FOURTEEN
CALIFORNIA HOSPITAL ASSOCIATION
AND MS TO CONVENE. A
COLLABORATIVE WE ALL TALKED
ABOUT THE TOOL KIT THAT CAME OUT
OF THE- STATE WHAT OTHER STEPS
HAVE BEEN TAKEN SINCE THEN TO
TRY TO ALLEVIATE DELAYS. YOU
KNOW THEY THEY INCLUDE THE TOOL
BECAUSE THEY INCLUDE THE
COMMUNITY PARAMEDICINE PILOT
PROJECT LOOKING FOR ALTERNATE
DESTINATIONS WITH AND THE
COMMUNITY THAT PROJECTS ACTUALLY
SUCCESSFUL. GETTING THE PATIENT
TO THE RIGHT PLACE AT THE RIGHT
TIME UNFORTUNATELY TWO OF THE
KEY COMMUNITY PARAMEDICINE
PROGRAMS ALTERNATE NATION TO
URGENT CARE AND PARAMEDIC
READMISSION HOME VISITS WERE NOT
INCLUDED IN AB FIFTEEN FORTY
FOUR. THE COMMUNITY PARAMEDICINE
BELT. STEPS HAVE BEEN TAKEN AT
THE REGIONAL LEVEL TO ADDRESS
EIGHTY ISSUES AND ASSIST IN THE
DECREASE OF E. D. USAGE. I WHICH
INCLUDED EMERGENCY COMMUNICATION
NURSE SYSTEM THAT WAS
IMPLEMENTED BY SAMPOERNA DINO
COLLABORATIVE THE SUCCESSFUL
ALTERNATE DESTINATION SOBERING
CENTER IN SAN FRANCISCO AND
SUCCESS WITH THE ALTERNATE.
DESTINATION FOR BEHAVIORAL
HEALTH CRISES SERVICES AND
FRESNO. THESE ARE NOT
SUSTAINABLE AND AS INDEPENDENT-
EFFORTS WHAT'S REALLY NEEDED
HONESTLY WE NEED BETTER DATA AND
THAT WOULD REALLY PROBABLY PART
OF THE. KEY TO SOLVING THE
PROBLEM THE KERR- SYSTEM.
PATIENT OFFLOAD TO TRACK IS GRIM
. AND ONLY DESCRIBES AND FROM.
INCREMENTS TO DRESSED DELAY WHAT
WE NEED ARE OBJECT AND WE- REAL
TIME DATA. MANY HOSPITALS
EMBRACED NEW TECHNOLOGY TO
IMPROVE THEIR INTERNAL DATA
COLLECTION AND ARE IMPLEMENTING
INNOVATION BASED ON HIS
IMPROVEMENT BUT THE DATA ISN'T
THERE FROM THE EMMA STANDPOINT.
WE NEED TO GET A TO HELP US
IDENTIFY THE GAPS AND COMMUNITY
SERVICES WHICH WE ARE ENDING U
TRYING TO PROVIDE NOT VERY WELL
BECAUSE IT'S NOT WHAT WE DO. TO
PATIENTS SEEKING KNOWN AS AN
EMERGENCY ROOM THE SOCIAL
DETERMINANTS OF HEALTH. MUST
ALSO BE FACTORED INTO THE COST
OF EIGHTY OVERCROWDING AND
AMBULANCE PATIENT OFFLOAD
DELAYS. INCREASES IN
HOMELESSNESS AND SUBSTANCE USE
DISORDER AND DECREASE IT
COMMUNITY SERVICES ARE A FEW
EXAMPLES THAT PLAY OUT
DIFFERENTLY DEPENDING ON. WHAT
IS AVAILABLE AND VARIOUS
COMMUNITIES. STATE CHAMPION
SYSTEM WIDE BY AND AN ABILITY
AND WILLINGNESS TO THE STATE TO
INVEST IN LONG TERM QUALITY
IMPROVEMENT PROCESSES WILL ALSO
BE THE NECESSARY. CALIFORNIA
HOSPITAL ASSOCIATION CONTINUES
TO WORK CLOSELY WITH EMSA AND
THE NEWLY CREATED AMBULANCE
PATIENT OFFLOAD LET COMMITTEE TO
REINFORCE THE DATA COLLECTION
EFFORTS NEED TO BE STRENGTHENED
AND THAT WE NEED TO WORK
TOGETHER TO FIND SOLUTIONS THERE
IS NOT A SILVER BULLET IN AS THE
I THINK WE'RE GONNA NEED MORE
MULTIPLE. EFFORTS AND MULTIPLE
DIRECTIONS TO SOLVE THIS. THANK
YOU FOR THE OPPORTUNITY TO
PROVIDE A HOSPITAL'S PERSPECTIVE
ON THIS IMPORTANT ISSUE C. H.
CHANGE REGIONAL ASSOCIATIONS-
STAND READY AND WILLING TO WORK
COLLABORATIVELY TO IMPROVE OUR
ECONOMIST SERVICES FOR ALL
CALIFORNIANS AND I'M HAPPY. TO
TAKE ANY QUESTIONS WHEN IT'S
TIME. THE YOU DR MORGAN OR NEXT
WITNESS IS DR LARRY STOCK IS
REPRESENTING THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS- DOCTOR
STOCK ARE YOU AVAILABLE. YES I
AM MISTER CHAIRMAN THANK THANK
YOU MISTER CHAIRMAN AND THANK
YOU COMMITTEE MEMBERS FOR
ALLOWING ME TO TESTIFY TO THIS
COMMITTEE ON THIS CRITICAL ISSUE. YEAH THANK YOU. AS A FORMER
PRESIDENT OF THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS. I WANT
TO SAY THAT EVEN AFTER THIRTY
YEARS I LOVE BEING AN EMERGENCY
MEDICINE PHYSICIAN. I LOVE IT
MOSTLY BECAUSE I HAVE THE
OPPORTUNITY EVERY DAY TO HELP
ANYONE WHO COMES FOR HELP FOR
ANY REASON AT ANY TIME THE FEELS
OR HAVE AN EMERGENCY. BUT IF YOU
DO NOT DO THIS ALONE I PART OF
THE OUR TEAM WITH OTHER PARTS
YOU DOCTORS PA INCIDENT HE'S
NURSES. TECHNICIANS THERAPISTS
AND OTHERS. IN YOUR TEAM WORKS
AS A UNIT WITHIN THE HOSPITAL
SYSTEM. THAT'S POSSIBLE SYSTEM
REQUIRES CAPACITY AND THROUGHPUT
TO ADEQUATELY CARE FOR THE
CURRENT AND ARRIVING PATIENTS.
WHAT HOSPITAL CONDITIONS RESULT
IN ADMITTED PATIENTS BEING HELD
IN THE ER IT CREATES
OVERCROWDING WHICH BACKS UP INTO
THE WAITING ROOM AND EVEN THE
ADULTS PLAY IN THE ER FOR EMS. I
FIND MYSELF FEELING STUCK IN THE
MIDDLE. IT WAS PATIENT OFFLOAD
TIME DELAYS ARE DIRECTLY RELATED
TO HOSPITAL OVERCROWDING AND
LACK OF NURSING CARE CAPACITY.
WHICH IMPACTS ON THE STATE
DEPARTMENT AND WAS SECOND
IMPACTS ON PATIENTS ARRIVING BY
AMBULANCE AND EMS TEAMS BRING IN
THESE PATIENTS. FOR CARE. THE
CODEPENDENT BECAUSE HIGHLIGHTED
THROUGH HEALTH CARE WORKERS TOLD
US IN ATTRITION AND A SURGEON
PATIENT DEMAND. POSSIBLE
CRAFTING AND THERE SHOULD CARE
CAPACITY ISSUES THE PRE EXISTING
CODE. YOUR PET'S FULFILLMENT OF
PATIENTS AWAITING MOVEMENT TO
INPATIENT POSSIBLE UNITS ALREADY
AT CAPACITY RESULTANT ALREADY
AND WAITING ROOM CARE FOR NEW
RIDING A NEW ARRIVALS AN
AMBULANCE. THE AMBULANCE WAS
HOLDING THE WALLS WITH THEIR
PATIENTS WELL THE MOST CRITICAL
PATIENTS GET IMMEDIATE ATTENTION
THOUGH SLIGHTLY LESS ACUTE MAY
EXPERIENCE UNPLEASANT AND
SOMETIMES DANGEROUS DELAYS.
WHILE EMERGENCY MEDICINE DOCTOR
WILL EVALUATE THE STATION'S
EARLY AFTER RIVAL THEY NEED A
REGISTERED NURSE TO CARRY OUT
THE ORDERS FOR PATIENT
MONITORING. TESTING MEDICATIONS
IVIES AND OTHER CREEK. PULL BACK
SHE- ADULT CASH FLOW TIME. IS A
SALT PROBLEM. THE NEEDS WHY
OUTSIDE OF EMERGENCY DEPARTMENT
FIRST HOSP OVER RECOVERY IS A
FLETCHER BILL WRITTEN BY THE
ASSEMBLY TED LIEU AB NOT ALLOWED
AND TO NINE THE WHATEVER EACH
ACUTE WHO. TO REGULARLY MEASURE
A HOSPITAL CROWDING AND HAVE A
HOST SURGED. THE MEASURE
OVERCROWDING AND COMPANIONS PLAN
COULD TRIGGER MEANINGFUL ACTIONS
BY INCREASING CAPACITY AND
BETTER MANAGING THROUGHPUT THESE
TOOLS WOULD ASSIST HOSPITALS TO
TAKE ADDITIONAL STEPS TO UNCLOG
THROUGHPUT. WE ARE IN A TIME OF
CRISIS AND EVERYONE CANNOT
CONTINUE TO OPERATE WITH
BUSINESS AS USUAL THE CHOICE IS
LEFT ON THE TABLE ARE PAINFUL
BUT THE DELAYS IN PATIENT CARE
ARE REAL. AND WHILE TIME IS BUT
ONE SYMPTOM OF THIS PROBLEM
POSSIBLES NEED TO SERIOUSLY LOOK
AT WAYS TO CREATE ADDITIONAL
CAPACITY SECOND STREET TARGETED
REGULATORY RELAXATION COULD HELP
ENHANCE NURSING CARE CAPACITY
WHEN SERGE PLAN ACTIONS. FAILED
TO ADEQUATELY MEET PATIENT
NEEDS. THE GROWTH THE PATIENT
ALL. IN CALIFORNIA SB THREE
NINETY FOUR. NINETY NINETEEN WAS
MEANT TO NOT HURT PATIENTS I WAS
NEVER MEANT TO LEAD TO DELAYS IN
CARE. HOWEVER IN TIMES OF NURSE.
CARE CAPACITY SHORTAGES AND HIGH
PATIENT DEMAND THIS IS EXACTLY
WORKERS. EMERGENCY PHYSICIANS
MERCY PHYSICIANS DO NOT HAVE
RATIOS. IN ADDITION TO TARGETED
FLEXIBILITY ANDOR STATION
RACHELS OTHER REGULATORY
RELAXATION COULD BE HELPFUL
RELAXATION OF NURSING
DOCUMENTATION REQUIREMENTS
DURING HIGH DEMAND LOW CAPACITY
TIMES. TO PREVENT MORE FOCUS ON
ACTUAL CARE INPATIENT THE BAND
REQUIRES IT THIS IS ALREADY
COMMITTED DURING DISASTER
MANAGEMENT AND MASS CASUALTY
INCIDENTS. RELAXATION ON
PERMITTING PARAMEDICS AND EMTS
TO WORK UP TO THEIR EMS FIELD
SCOPE WITH INDICATOR HOSPITALS
UNDER OUR AND TO PROVIDE CARE
TEAMS WHO HAS NURSING CARE
CAPACITY COULD ALSO HELP.
SEVERAL OF THESE SOLUTIONS HAVE
BEEN SUCCESSFULLY UTILIZING
CALIFORNIA THE STATE PROVIDE
REGULATORY RELIEF IN TWENTY
TWENTY GET NOW WE ARE
EXPERIENCING THE WORST CREDIT WE
OF EXPERIENCE DURING THE
PANDEMIC. AND THESE RELIEF
VALVES NO LONGER ARE IN PLACE.
ALLEVIATING APPLICATION AWFUL
TIME DELAYS WOULD PROTECT
ELIMINATION CARE DELAYS FOR NEW
ARRIVING AMBULANCE PATIENTS AND
THE RETURN OF THE AMOUNTS TO THE
FIELD THREE READY FOR THE NEXT
RESIDENTS. WILL HAVE AN
EMERGENCY I NEED HELP. EVERYONE
INVOLVED IN THE SYSTEM FROM THE
STATE DOWN TO EACH INDIVIDUAL
HEALTH CARE WORKER NEEDS TO DO
THEIR PART TO HELP SOLVE THE
OVERCROWDING. AND STAFFING
PROBLEMS THEY'RE EXPERT. WE ARE
EXPERIENCE IN ORDER TO DELIVER
SAFER MORE. TIMELY PATIENT CARE
THANK YOU. THANK YOU DAHLE. OUR
NEXT. IS MISS CASE DONNA. WHO IS
THE ACTING DEPUTY DIRECTOR. FOR
HEALTH CARE EQUITY AT THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH. THE DEPUTY DIRECTOR OF
DENIM ARE YOU AVAILABLE. I AM
HERE THANK YOU SO MUCH GOOD
MORNING MISTER CHAIRMAN ASSEMBLY
. IN COMMITTEE MEMBER NUMBERS
TO- AS MENTIONED I'M NOT A SIT
DOWN AMEND THE ACTING DEPUTY
DIRECTOR FOR THE CENTER FOR
HEALTH CARE QUALITY. AT A
COMPANY ARTICLE ABOUT. TO ECHO
OUR PREVIOUS SPEAKERS THE ONES
LONGSTANDING CRITIC. BUT A
COMPLEX ISSUE THAT DEMANDS A
ROBUST SOLUTION WE RECOGNIZE
LIKE OTHERS THAT THIS ISSUE HAS
CERTAINLY BEEN EXACERBATED BY.
THE CURRENT PANDEMIC. I'M HERE
TO PROVIDE YOU AN OVERVIEW OF
CURRENT INITIATIVES UNDERWAY TO
ADDRESS THIS. AMBULANCE IS AN
AWFUL TIME DELAYS. WORK FOR SURE
. BUT HOSPITALS AND OTHER
EFFORTS DURING AND- MEDICAL
SERVICE SYSTEM. IN RESPONSE TO
THE EXCEPTIONAL DEMAND ON
HOSPITALS. BERMAN HAS WAIVED
SOME LICENSING REQUIREMENTS TO
ALLOW HOSPITALS TO EXPAND
INPATIENT SPACE AND CAPACITY FOR
EXAMPLE THIS REMOVED THE NEED
FOR HOSPITALS TO SEEK APPROVAL
TO ERECT EMERGENCY TENTS AND
INSTEAD EXPEDITIOUSLY RE OPEN.
INTERACTIVE SPACES AND CONVERT.
I TO SPEND TRIAGE AN INPATIENT
CAPACITY THUS RID US REDUCING.
THE SIMPSONS WAITING FOR
ADMISSION TO THE EMERGENCY
DEPARTMENT. WE HAVE IMPLEMENTED
MANDATORY. FOR LEVEL LEARNING TO
OTHER HOSPITALS TO REAP IT LEAVE
OVERBURDENED HOSPITALS IS
REQUIRES A HOSPITAL OR THE
REGION THANKS. A TOTAL I SEE YOU
CAPACITY OF LESS THAN 10% OR
MORE FOR THREE CAN. THANK AND-
WHAT'S IN THE HOSPITAL BURDEN
THROUGHOUT FACILITIES IN THAT
REGION. THE CURRENTLY IF THERE'S
NO I SEEK I SEE YOU CAPACITY
THAT REGION ARE EMERGENCY
MEDICAL SERVICES THIRTY MAY
DIRECT AT STATEWIDE
REDISTRIBUTION AND TRANSFER
PATIENTS AND SHIP WITH A
REGIONAL DISASTER MEDICAL HEALTH
SPECIALIST ARGUMENT JUST.
CURRENTLY NO REGIONS ARE UNDER
THAT MANDATORY TRANSFER
GUIDELINES. AS I SEE CAPACITY AS
OF YESTERDAY REMAINS ABOUT THAT
10% BRUSSELS. WE CONTINUE TO
MONITOR THAT DATA ON A DAILY
BASIS. WE'VE ALSO PARTICIPATED
IN COURTNEY ANY ASSET EITHER
DEPLOYMENT OF STAFF RESOURCES TO
SKILLED NURSING FACILITIES TO
ASSIST WITH YOUR CLIENTS AND
DISCHARGES FROM HOSPITALS.
ONGOING EFFORTS ARE UNDERWAY TO
FURTHER INCREASE BED CAPACITY
THROUGHOUT. THE STATE NOT WITH
REGARD TO DEPLOYMENT OF DIRECT
CARE STAFF IN PARTNERSHIP WITH
AMAZON- THROUGH STATE CONTRACTS.
HOLD ON WITH VARIOUS STAFF
REGISTRY ORGANIZATIONS
NATIONWIDE. ALSO IN PARTNERSHIP
AMAZON- WE HAVE DEPLOYED ARE AND
OTHER CAREER RESOURCE. DIRECTLY
TO HOSPITALS. IS EFFORTS AIMED
AT AUGMENTING EXISTING STAFF
RESOURCES AND INCREASING
CAPACITY. TO READ THE SUBJECT
OBJECTIVES- WE HAVE ALL RAISED
ABOUT A STATE STAFF RESOURCES TO
ALSO BE ABLE TO WORK IN
CALIFORNIA. AND WHAT WE
RECOGNIZED- THE VACCINES
CONTINUE TO PROTECT AGAINST
SERIOUS ILLNESS HOSPITAL ARE
REACHING CAPACITY AND STAFF
SHORTAGES ARE REAL MAKING IT
DIFFICULT TO TREAT THOSE IN NEED
CENTRAL KERR- WE HAVE AUTHORIZED
HOSPITALS TO IMPLEMENT THE USE
OF A TEAM PERSON MODEL. OF THAT
MODEL BRINGS TOGETHER LICENSE
NURSES WITH DIFFERENT
EXPERIENCES AND SKILLS TO CARE
FOR PATIENTS IT SUPPORTS THE
MATCHING OF NURSES AND THEIR
CARE TASKS TO THE MOST
APPROPRIATE NURSE FOR A GROUP OF
PATIENTS RATHER THAN HAVING ONE
NURSE PERFORMED ALL CARE TASKS
PERPENDICULAR PATIENT FOR
EXAMPLE AND I SEE YOU HAVING
TWELVE PATIENTS MAY ASSIGN THOSE
TWELVE PATIENTS TO OUR NURSING
TEAM CONSISTING OF. BOTH DO YOU
EXPERIENCE NURSES AS WELL AS MEN
SEARCHER SIMILARLY. EXPERIENCED
NURSES. THE I. C. U. NURSES WILL
. AT WHICH THERE ARE UNIQUELY.
FOR THE GROUP OF PATIENTS AND
THEN THE MED SURGE OR SIMILARLY
EXPERIENCES WILL PERFORM THE
NURSING CARE TASK THAT THEY ARE
QUALIFIED TO PROVIDE. FOR THE
GROUP OF THE PATIENTS ALTHOUGH
THIS DOES NOT CHANGE BINNER
SUFFICIENT RATIO WAIVERS IT DOES
ALLOW THE HOSPITAL TO LEVERAGE
EXISTING RESOURCES TO CARE FOR
COMPLEX PATIENTS. ITERATIVE WAY
. WE'VE ALSO AUTHOR HOUSE AND
NURSING FACILITIES TO ALLOW A
SYMPTOMATIC BOSTON. THE POSITIVE
HEALTH CARE PROFESSIONALS TO
RETURN TO WORK- WITHOUT
REQUIRING A NEGATIVE TEST HEALTH
CARE PROFESSIONALS WHO HAVE
TESTED POSITIVE FOR COCAINE-
THANK AND ARE A SYMPTOMATIC MAY
RETURN TO WORK NEXT I JUST ON
THE OTHER LINE MAY. NOT RETURN
TO WORK IMMEDIATELY WITHOUT
ISOLATION WITHOUT TESTING- AND
THAT DATE DOES A SYMPTOMATIC
PERSONNEL CAN CARE FOR. ALSO
CAMPING OUT PATIENTS AREN'T
THERE ARE REQUIREMENTS FOR- IN-
IN NINETY FIVE RESPECT
RESPIRATORS FOR CONTROL I'M IN
AN EFFORT TO REDUCE EXPOSURE-
BUT AGAIN OUR RECOMMENDATION IS
THAT THE OTHER PERSON I WORK
WITH A POSITIVE. PATIENTS THE IF
THE ADDITIONAL OVER THE
PRINCIPLE BEHIND THIS IS TO LOOK
AT WAYS TO- BRING IN ADDITIONAL
STAFF- IN. YOUR RESTORE-
NECESSARY STAFFING THERE. REALLY
THE BURDEN ON HOSPITALS AND
CERTAINLY PROVIDE ESSENTIAL CARE
TO STOP. AND WE HAVE ALSO
WORKED- TO WAIVE. TRAINING AND
RECERTIFICATION REQUIREMENTS
TEMPORARILY FOR VARIOUS
PROFESSIONALS INCLUDING
CERTIFIED NURSE ASSISTANTS- WHO
HAVE NOT BEEN ABLE TO COMPLETE
THEIR CONTINUING EDUCATION THERE
MANDATORY CONTINUING EDUCATION
OVER THE TIME PERIOD DURING THE
PANDEMIC- I GET INTO TRYING TO
SUPPORT. THE ONGOING CARE THAT'S
BEING PROVIDED IN VARIOUS
SETTINGS I'M WE HAVE IT IN
ADDITION AUTHORIZED A HOSPITAL
AT HOME PROGRAM TO CREATE
ADDITIONAL CAPACITY FOR
HOSPITALS IS ALLOWED HOSPITALS
PROVIDE CARE TO THEIR PATIENTS-
WITHIN THE HOME TO ALLEVIATE
SEARCH CONDITIONS OF HOSPITALS
FOR PATIENTS- THAT ARE ELIGIBLE
. IN THIS TEST OF THE REGRET
FOR. PARTICULAR FOR- WE HAVE
ADDITIONALLY GRANTED WAIVERS FOR
HOURS OF OPERATION ON FOR
CLINICS ON THAT WERE PREVIOUSLY
LIMITED- THIS ALLOWS ACCESS TO
CARE OUTSIDE OF THE EMERGENCY
DEPARTMENT- AND ALTERNATIVES FOR
PATIENTS THAT ARE PRESENTING FOR
LOWER LEVEL. LOWER LEVEL
HEALTHCARE NEEDS. AND THEN OF
COURSE AS I MENTIONED EARLIER-
AUTHORIZING EXPANDED USE OF
SPRINGS- WHETHER IT BE TEMPORARY
CONVERSION OF SACE AND
HOSPITALS ARE INCLUDING- TENTS-
USE AN OTHER OPTIONS. AB TESTING
ARE. ONE OF ANTIBODIES TRIAGE
AND OTHER SOURCES FOR HOSPITALS
TO CARE. I JUST WANT TO
ACKNOWLEDGE THAT WE ARE
EXTREMELY GRATEFUL FOR ALL
HEALTHCARE WORKERS ACROSS IRAQ
CALIFORNIA BOTH PRE HOSPITAL IN
HOSPITAL BECAUSE HOSPITALS ARE
FOR THEIR TIRELESS WORK
THROUGHOUT THE PANDEMIC I THINK
THAT WE ARE TOGETHER I LOOK
FORWARD TO CONTINUING TO
PARTICIPATE IN THE A POP
COMMITTEE AND I LOOK FORWARD TO
RESOLUTION CONSERVE ALL
CALIFORNIANS. MY TO. THANK AT
THE DIRECTOR OUR NEXT WITNESSES
NURSE VICKY BERMUDEZ WITH THE
CALIFORNIA NURSES ASSOCIATION-
VICKI ARE YOU THERE. YES GOOD
MORNING ASSEMBLY MEMBER
RODRIGUEZ ASSEMBLY MEMBER
MEMBERS SAY ARE CHAU AND MEMBERS
OF THE EMERGENCY MANAGEMENT
COMMITTEE THANK YOU FOR INVITING
THE CALIFORNIA NURSES
ASSOCIATION OR NATIONAL NURSES
UNITED TO PARTICIPATE IN THIS
HEARING ON AMBULANCE PATIENT
OFFLOAD DELAYS A PODS. IT'S
NEARLY TWO YEARS SINCE COVERING
ISSUED THE PROCLAMATION OF A
STATE OF EMERGENCY IN MARCH OF
TWENTY TWENTY SINCE THAT TIME
THE ENTIRE HEALTHCARE SYSTEM HAS
BEEN UNDER THE STRICT OF THE
CUPBOARD AND DEMOCRATS HIS.
WAIST OF NEED SERVICES EIGHT THE
OF HIS HEARING IS BUT ONE SIMPLE
THAT STRESS SEEN IS FOCUSED ITS
EFFORTS TO REDUCE A PROJECT'S IN
PROTECT PATIENTS BY PRESERVING
THE R. AND WORKFORCE IT ASSUMES
CARE FROM EMS AMBULANCE
PERSONNEL AND PROVIDE CARE IN
BOTH THE EDT IN THE INPATIENT
SETTING WE HAVE TAKEN A MULTI
MEASURE. CLUED FORSMAN OF MEN.
HUNDREDS REQUIREMENTS SUPPLIES
OF SINGLE USE PERSONAL
PROTECTIVE EQUIPMENT ENHANCED
CONTROL PROCEDURES PROPER
ISOLATION QUARANTINING AND
TESTING OF CODE POSITIVE EXPOSED
STAFF. IMPORTANCE OF MAINTAINING
MANDATED STAFFING STANDARDS WAS
EVIDENCED IN THE STUDY FROM UC
SAN DIEGO DEPARTMENT OF
EMERGENCY MEDICINE PUBLISHED IN
TWENTY TEN. IT CONCLUDED THAT
THROUGHPUT MEASURES PATIENT WAIT
TIMES AND HE CARRIED TMES WERE
SHORTER WHEN EATING OR STOPPING
WERE WITHIN THE STATE MANDATED
LEVELS AFTER CONTROLLING FOR
EDIE CENSUS AND PATIENT ACUITY.
EMERGENCY MEDICINE PRACTICE
COMMITTEE AMERICAN COLLEGE OF
EMERGENCY PHYSICIANS REPORTED
THESE FINDINGS IN THIS MAY
TWENTY SIXTEEN REPORT EMERGENCY
DEPARTMENT CROWDING HIGH IMPACT
SOLUTIONS IN FACT MINIMUM SAFE
PATIENT STAFFING STANDARDS
CONTRIBUTE EIGHTY EFFICIENCY
THAT CAN REDUCE AMBULANCE
PATIENT OFFLOAD TIMES EIGHT
CARDS ARE A PROBLEM IN CANADA
EUROPE AND IN MOST US STATES.
NOT A PROBLEM UNIQUE TO
CALIFORNIA WERE MANDATED RATIOS
PROTECT PATIENTS AND REDUCE OUR
AND BURN OUT MORAL DISTRESS AND
MORAL INJURY THE ASSERTION THAT
MANDATED MINIMUM STAFFING RATIOS
CONTRIBUTE TO A PART RESULTS
FROM THIS IS JUST ARGUMENT.
PLEASE POSSIBLE BUT BROUGHT.
JUST BE THE LAST SEARCHING
COVERED HOSPITAL AMONG CAL WAS
ABLE TO FLATTEN THE CURVE WE HAD
OUR IN MEMBERS WERELAID OFF BY
HOSPITALS IN AREAS WERE ELECTIVE
PROCEDURES WERE CANCELLED AND
HOSPITALS AND- YOU NEVER SEE. A
SURGE CO THE PATIENTS IN OTHER
HOSPITALS CLOSED UNITS AND LAID
OFF KOREANS. LACK OF CREATIVITY
THAT HOSPITALS DEMONSTRATED BY
LAYING OFF LICENSED OUR ENDS
BEFORE THE PANDEMIC SURGE WAS
INEXCUSABLE. THEY HAD THE
OPPORTUNITY TO PROVIDE
ADDITIONAL EDUCATION TORRANCE
AND LOS ANGELES AREAS SO THAT
THEY COULD BE READY TO PROVIDE
CARE TO COVER THE PATIENTS. WHEN
THE CENSUS INCREASE THAT DOWN
TIME WAS WASTED AND HERE WE ARE
NEARLY TWO YEARS LATER IS WHAT
HOSPITALS AGAIN. EXTRA ADDRESS
UNPREPARED TO RAPIDLY. THE
HIRING OF STAFF TO MEET THE
PRESIDENT NEED. CALIFORNIA NEEDS
PRESERVE OUR NURSING WORKFORCE
CONTINUOUSLY ADD NEW GRADUATE
NURSES TO THE WORK FORCE AND
PROTECT THE EXISTING AND NEW
GRADUATE WORK FORCE ALL THE CNA
FOCUSED EFFORTS. IT TWENTY
TWENTY GERMAN NETWORK OPEN
ORIGINAL INVESTIGATION SHOWED
CALIFORNIA WITH A LOWER RATE OF
NURSES WHO LEFT THEIR JOBS
16219% YOU TO BURN OUT. STATES
WITHOUT MINIMUM THINGS SUCH AS
TEXAS FLORIDA NEW YORK AND
NEVADA AT 372408% OF THEIR
NURSES LEAVE THEIR JOB GOING TO
BURN OUT WITH A STRESSFUL WORK
ENVIRONMENT AND INADEQUATE
STAFFING. BEING THE PRIME
REASONS NURSES REPORTED. RIGHT
NOW. A RECENT ARTICLE IN HEALTH
CARE MANAGER STILL AN EPIDEMIC
THE BURNOUT SYNDROME IN HOSPITAL
REGISTERED NURSES FOUND THE
BURNOUT RATES WERE HIGHER IN
HOSPITALS WITH A HIGHER NUMBER
OF PATIENTS TRAINERS. AND AMONG
YOUNGER. IT IS SHORT SIGHTED TO
THINK ADDING HOT UNSAFE LEVELS
OF PATIENTS ON TO ART
ASSIGNMENTS WILL REDUCE A POTS.
WHAT HOSPITALS AND OTHERS LIKE
TO REFER TO AS RATIO FLEXIBILITY
IS EXACTLY THE WRONG THING TO DO
IF WE ARE TO PRESERVE AND
PROTECT THE ARMED WORKFORCE BY
REDUCING BURNOUT. MORAL DISTRESS
AND MORAL INJURY. COMPLIANCE
WITH MANDATED RATIOS DECREASED
PATIENT WAIT TIMES INCREASE ET
THROUGHPUT AND PROVIDE THE SAFE
PATIENT CARE THE CONSUMERS HAVE
THE RIGHT TO EXPECT. DURING THE
TWENTY CARRY THAT THE PANDEMIC
CALIFORNIA. AND FOURTH FIVE
HUNDRED NEW GRADUATE REGISTERED
NURSES. HOWEVER WE CANNOT EXPECT
TO ADDRESS OUR CURRENT AND
FUTURE ARE AND WORKFORCE NEEDS
INCLUDING ADEQUATE NUMBERS OF
THE E. D. NURSES IF CALIFORNIA
IMPLEMENTS SHORTS LIFE'S SHORT
SIGHTED EMERGENCY STRATEGIES
THAT RESULT IN EXPERIENCED. AND
NEWLY LICENSED NURSES LEAVING
THE PROFESSION BECAUSE OF WILL
BRING OUT MORAL DISTRESS AND
MORAL INJURY FASTER THAN WE CAN
REPLACE THEM. CNN WILL CONTINUE
TO CONTRIBUTE TO IDEAS AND
RECOMMENDATIONS ARE REDUCE PARTS
IN CALIFORNIA THERE ARE
PETITIONS OUR PARTICIPATION AS A
MEMBER OF THE AMBULANCE PATIENT
OFFLOAD TIMES ADVISORY
COMMITTEE. FOR THE TWENTIETH
YEAR IN A ROW NURSES WERE
IDENTIFIED AS THE MOST TRUSTED
AND MOST ETHICAL PROFESSION.
ARENDS WORKING CALIFORNIA
HOSPITALS AND CLINICS WILL
CONTINUE TO ADVOCATE FOR SAFE
PATIENT CARE STANDARDS ARE HIGH
STANDARDS FOR THE PROFESSION
THAT HAVE EARNED THEM THE PUBLIC
TRUST THANK YOU AND I'M READY TO
ANSWER ANY QUESTIONS YOU MAY
HAVE. THANK YOU UNDERSTAND AS
OUR FINAL WITNESS OF FOR TODAY'S
HEARING IS NURSE GENDER NOW WITH
THE CALIFORNIA EMERGENCY NURSES
ASSOCIATION. A NURSE DOWN ARE
YOU THERE. YES CAN YOU HEAR ME
YES WE CAN- THANK YOU THANK YOU
ASSEMBLYMEMBER RODRIGUEZ AND
MEMBERS MY NAME IS JENNY AND I
AM AN EMERGENCY DEPARTMENT
NURSE. I'M HERE TODAY ON BEHALF
OF THE CALIFORNIA EMERGENCY
NURSES ASSOCIATION AND WE
APPRECIATE THE OPPORTUNITY TO
SPEAK ON THIS TOPIC TODAY I'VE
BEEN A REGISTERED NURSE FOR
TWENTY FOUR YEARS AND PRIOR TO
THAT I WAS AN EMT. THE
CALIFORNIA EMERGED
DISASSOCIATION AGREES WITH THE
PRIOR SPEAKERS THAT AMBULANCE
PATIENT OFFLOAD DELAY IS A
SYMPTOM OF A LARGER SYSTEM WIDE
LACK OF ACCESS TO HEALTH CARE
BUT IT'S NOT JUST SEEN HERE IN
CALIFORNIA. WE ACKNOWLEDGE AND
APPRECIATE THE DIFFICULTY OUR
FIRE AND EMS PARTNERS FACE AS WE
ARE RIGHT ALONGSIDE THEM IN OUR
BUSY EDIE'S. EMERGENCY CARE IS
ONE COMPONENT OF THE LARGER
SYSTEM AND WHEN SERVICES ARE NOT
AVAILABLE ANYWHERE ON THE
CONTINUUM OF CARE IT IMPACTS THE
ET. A PART IN CRAFTING ARE MULTI
FACTORIAL PROBLEMS PLAGUING MANY
COMMUNITIES. THE EMERGENCY IS
ASSOCIATION AND ITS SIX THOUSAND
MEMBER STRIVE EVERY DAY TO
PROVIDE THE HIGHEST QUALITY ET
CARE TO PATIENTS PRESENTING IN
THE EMERGENCY DEPARTMENT. IN A
MEMBERS WORK IN EMERGENCY
DEPARTMENTS ACROSS CALIFORNIA.
IT I'M SAYS AND IT'S GREAT CARE
TREE. PURSES EACH ET NURSE WANTS
TO OFFLOAD PATIENTS ARRIVING BY
AMBULANCE AS SOON AS POSSIBLE.
HOWEVER EACH NURSE ALSO HAVE TO
BALANCE THE PATIENT LOAD AND
ACUITY THAT HERE SHE IS ALREADY
CARING FOR. WE KNOW THAT THE
PATIENT WAITING HAS MEDICAL
NEEDS BUT ALSO MIGHT BECOMING
AGITATED. AT THE WAIT TIME WHICH
INCREASES THE RISK OF VIOLENCE
TO THE NURSE. HEALTHCARE
VIOLENCE IS A PROBLEM
EXACERBATED BY A PART. THE TIMES
UNFORTUNATELY THERE ARE NOT
ENOUGH RESOURCES TO SAFELY
EXCEPT ONE MORE PATIENT. AND MY
RESOURCES I MEAN STAFF BUT ALSO
PHYSICALLY HAVE A BETTER GURNEY
EMPTY AND AVAILABLE. DURING CO
THAT WE HAVE EXPANDED INTO
SPACES THAT ARE NOT MEANT FOR
PATIENT CARE SUCH AS WAITING
ROOMS LOBBIES INTENSE. EATING
PURPOSES INSTEAD OF CARE FOR
PATIENTS AND FAMILIES WITH MANY
PHYSICAL AND EMOTIONAL AND
SOCIAL NEEDS. FOR EXAMPLE THE AB
NURSE IN THE- WRITING SUPPORT TO
AN OLDER THE WOMAN WHOSE HUSBAND
IS SIXTY FIVE YEARS JUST DIED IN
THE E. D. ALONG WITH SOMEONE WHO
IS BEING EVALUATED FOR PNEUMONIA
AND HE NEEDS TO HAVE INTERESTS.
AND POLITICS A SAP. AND A STROKE
PATIENT WHO JUST ARRIVED WHO
NEED IMMEDIATE KERR. DESPITE
PATIENTS HAVING TO WAIT FOR A
BED WE IS NURSES AND HOSPITALS
HAVE TO MEET REGULATIONS FOR
DISEASE TREATMENT TIME SUCH AS
SEPSIS. WE ARE NOT REIMBURSED AT
THE FULL RATE RATES WHEN WE MISS
THESE TIMES. THE MISMATCH
BETWEEN AVAILABLE RESOURCES AND
THE NEED FOR EIGHTY SERVICES.
CAN BE MORE PATIENTS THAN STAFF
CAN CARE FOR OR MORE PATIENCE
THAN TREATMENT BEDS IN EDIE.
WHICH CAUSES CRAFTING. BUT THE
MISMATCH ETWEEN HEALTH CARE
RESOURCE AND COMMUNITY NEED GOES
WELL BEYOND THE WALLS OF THE E.
B. AB CROWDING AND THEREFORE A
RELIANCE PATIENT OFFLOAD DELAYS
CAUSED BY THE SYSTEMIC FAILURE
OF THE HEALTHCARE SYSTEM TO
PROVIDE NEEDED HEALTH RESOURCES.
ONE OF OUR MEMBERS RELATED TO ME
A STORY ABOUT A PATIENT LIMPING
INTO TRIAGE WITH A SPLINT ON HIS
ANKLE AND X. RAYS. BROKEN HIS
ANKLE THE PRIOR WEEK. THIS WEEK
BUT WAS UNABLE GET AN ORTHOPEDIC
THAT WOULD TAKE HIM. HE MEDICAL
. BUT WE'RE SAYING MANY PATIENTS
WITH EVERY POSSIBLE TYPE OF
INSURANCE THAT HAVE PROBLEMS
FINDING CARE. THESE PATIENTS
THEN TURNED TO THE EP. BUT
COMMON ENDPOINT IS THE EIGHTY
BEDS ARE FULL INCLUDING ADMITTED
PATIENTS AND EDIE CANNOT
RETURNEES AND STAFF TO ACCEPT
NEW PATIENTS. MANY EDIE'S HAVE
USED THE C. H. A TOOL KIT
MENTIONED HERE IN THIS HEARING
TO IMPROVE THEIR ABILITY TO SEE
AS MANY PATIENTS AS POSSIBLE.
TYPICALLY 4260% EMERGENT. ARE
WALKIN AND NON EMERGENT WE HAVE
PIVOTED TO TREAT THESE PATIENTS
THROUGH THE LOBBY WHERE WE ARE
NOT COVERED UNDER NURSE RATIOS
AND MIGHT BE SERVING UP TO FIFTY
PATIENTS. IT'S RUMORED CONSIDER
ALLOWED TO GO OUT OF REACH SO
BRIEFLY IS A PLAN TO GET BACK
INTO RATIO. BUT IT'S VERY
DIFFICULT TO COME UP WITH A PLAN
DURING THE SEARCH TIMES. WE ARE
ALSO COMMONLY HOLDING 25% OF OUR
BEDS SOMETIMES MORE SOMETIMES
LESS WITH BHAVIORAL PATIENTS
WHO CANNOT GET TRANSFERRED OUT
TO APPROPRIATE CARE. THESE
PATIENTS HAVE TO BE IN A ROOM
WITH THEIR VIOLENT SO IT TAKES A
- FOR THE- HEY WE'RE THAT'S NOT
THE BEST FOR THAT I'M SO WITH
ANOTHER PATIENT ARE ALSO
HEARING- ARE BEHAVIORAL HEALTH
PATIENTS IN THEIR CRISIS TIME.
EIGHTIES HAVE ALSO HIRED SOCIAL
WORKERS CASE MANAGERS PSYCH
RESPONSE TEAM SUBSTANCE USE
NAVIGATORS AND OTHER ANCILLARY
STAFF TO MEET THE NEEDS OF ALL
PATIENTS TO SEEK CARE IN THE
EVENING WHEN THEY CAN'T FIND IN
THE COMMUNITY- WHEN. THESE CASES
GET BACKED UP AGAIN THESE
PATIENTS ARE TAKING UP BEDS. THE
NURSES SEE PATIENTS EVERY DAY
WHO CANNOT ACCESS HEALTH KERRY.
IN THEIR COMMUNITY AND HAVE NO
CHOICE BUT COME TO THE E. D. WE
ARE THE LAST RESORT WITH A
PATIENT WHO HAS NO CHOICE OR
AVAILABLE. RESOURCES ENDS UP
COMING. WE PROVIDE SPECIALTY
CARE LIKE ORTHOPEDICS OUTPATIENT
BEHAVIORAL HEALTH DIALYSIS FOR
PATIENTS WHO MISTER DALLAS'S AND
CAN'T GET IN. PATIENTS CONSERVE
DERIVING FOR COKE AT TESTING
THIS CURRENT SURGE- EVEN OTHERS
CAMPAIGNS TO ASK. PATIENTS NOT
TO COME TO THE IN EACH EMERGENCY
DEPARTMENT- JUST FOR COVER
TESTS. WE ARE CREDIT TWENTY FOUR
SEVEN MOST TIMES. EXTORTED BAR
IN STATION ON A DELAY. WE THAT
WITHIN THE PAST TWENTY MONTHS OF
THE PANDEMIC PATIENTS WHO HAVE
BEEN UNABLE TO ACCESS COMMUNITY
RESOURCES ARE NOW HAVING
WORSENING AND UNTREATED HEALTH
CARE PROBLEMS WE SEE THIS EVERY
DAY WITH THE HIGH ACUITY OF OUR
SICK PATIENTS IT'S ALSO TRUE FOR
UNMET PATIENT NEEDS SUCH AS
BEHAVIORAL HEALTH HOMELESS
PATIENTS THOSE WITH CHRONIC
ILLNESS AND THOSE WITH LIMITED
ACCESS TO CARE. AS EVERYONE
MENTIONED TODAY WE DON'T WANT TO
CONFOUND COATED WITH A POT THIS
IS BEEN A LONG STANDING PROBLEM
. AN EMERGENCY NURSES
ASSOCIATION RECOGNIZES THE
FOLLOWING SOLUTIONS THAT MAY
RELIEVE AMBULANCE OFFLOAD
DELAYS. THERE IS NO ONE SIZE
FITS ALL FOR THIS ISSUE. EACH
GEOGRAPHIC REGION HAS DIFFERENT
HEALTH CARE RESOURCES AVAILABLE
AND ADDITIONALLY EACH ET IS
DIFFERENT AS IS GIVE LOCAL EMS
AGENCY AND INDIVIDUAL PRE
HOSPITAL PROVIDERS SOLUTIONS
MIGHT BE BEST WORKED OUT AT THE
LOCAL LEVEL. THE USE OF
ALTERNATIVE DESTINATIONS SUCH AS
PROPOSED IN THE RECENT M. SOME
REGULATIONS AND MAYBE FIFTEEN
FORTY FOUR WE APPROPRIATELY
ALLOW SOME PENSIONS WITH VIRGIN
HEALTH CARE NEEDS TO BE
TRANSPORTED TO OTHER FACILITIES
WHERE THEY CAN GET THEIR NEEDS
MET. THIS PROGRAM SHOULD BE
MONITORED AND EXTEND IT FOR
OTHER USES. ONCE HE SAID HAD
GREAT IDEAS SUCH AS ASSESSING
REFER POLICIES. AND ALSO
UTILIZING NURSES IN THEIR NINE
ONE ONE SECONDS TO HELP TRIAGE
PATIENTS WHO NEED EMERGENCY CARE
VERSUS OTHER COMMUNITY RESOURCES
. FINES FOR HOSPITALS WILL NOT
SOLVE THE PROBLEM THIS COST WILL
GET SHIFTED TO INSURANCE
COMPANIES AND ULTIMATELY THE
GENERAL PUBLIC. MANY HOSPITALS
ARE STRUGGLING TO RECOUP COSTS
FROM THE INITIAL PHASE OF THE
PANDEMIC. AND WITH STAFF HAVING
THEIR OWN BURNOUT RATES NOW WE
ARE HIRING TRAVELER NURSES AT
VERY HIGH COST. SO THERE'S YOU
KNOW UNLIMITED MONEY TO GO
AROUND FOR ALL OF THESE ISSUES.
WE REALLY APPRECIATE THE
OPPORTUNITY TO BE HERE TODAY TO
HELP ADDRESS THIS IMPORTANT
ISSUE WE STAND READY TO ASSIST
THE COMMITTEE TO IDENTIFY
SOLUTIONS TO THE PROBLEM. AND
WORK TOGETHER WITH ALL OF OUR
PARTNERS THANK YOU. THANK YOU UP
NURSE- DENTAL WILL BRING BACK
NOW TO. COMMITTEE FOR A FOLLOW
UP- OFFICE HE ONCE AGAIN I'M-
ARE NOT GOING THROUGH MY MIND
FROM ALL THE PRESENTATIONS WE'VE
BEEN HAVING FROM THE FIRST
PRODUCT UP TO NOW THE SECOND
PANEL. ARE JUST ONE QUICK
QUESTION FOR PROBABLY ANYBODY ON
THE SECOND PANEL UNKNOWNS COUPLE
PALACE WE TALKED ABOUT. THE DATA
THESE COMMITTEES OF THESE BOARDS
THAT ARE BEING DEVELOPED TO
STUDY THIS ISSUE BUT- TO ME I
THINK THE DATA IT'S QUITE CLEAR
THAT. THERE IS A PROBLEM I DON'T
KNOW HOW MANY MORE YEARS OF DATA
OR HOW MANY MORE COMMITTEES OR
BOARDS THAT NEED TO BE. CREATED
TO LOOK AT THIS PROBLEM BECAUSE
IT'S HERE IT'S BEEN HERE FOR
DECADES- I JUST DON'T KNOW WHAT
WHAT THE PROBLEM IS WHY WE NEED
MORE DATA MORE INFORMATION- I
HAVE LETTERS HERE FROM
DEPARTMENTS. TELLING ME THAT
THEY HAVE DATA GOING BACK
DECADES. BUT YET THERE'S NOBODY
SEEMS TO FIX THE SOLUTION OR
WANT TO FIX THE SOLUTION. SO
THAT'S ONE OF THE REASON WHY
WE'RE HERE TO LOOK AT THIS ISSUE
THAT. IF NOBODY WANTS TO MOVE IT
THESE COMMITTEES THESE THESE
DEPARTMENTS THAT ARE HAVE THE
STATE OF THEM. IT'S GOING TO BE
OUR TURN AS LONG. TO COME UP
WITH SOME SOLUTIONS SOME
LEGISLATION THAT FOLKS MAY NOT
LAW. BUT I GUESS IT'S GOING TO
AFTER FOR. SO THE NO ONE
CHRISTOPHER ANYWAY ON ON THE
SECOND WAS. HOW MUCH MORE DATA
DO WE NEED WE ALREADY KNOW THE
PROBLEMS HERE. EVERYBODY CAN
HEAR THAT'S BEEN IN IN THE YEAH
MASS. FIELD FOR YEARS CONTAR
THIS GOING BACK DECADES THE
PANDEMIC HAS JUST ELEVATED TO A
NEW TO A NEW LEVEL BUT WHAT WHAT
CAN WE DO NOW LIKE I SAID. I
DON'T WANT TO DO LEGISLATION.
YOUR TUNING PROCESS I'M GONNA DO
IS I'M A SOLUTIONS RIGHT NOW
THAT I CAN HOPEFULLY SEE WITHIN
THE FEW WEEKS THAT WOULD START
TO SEE SOME ELIMINATION OF THE
PROBLEM WE'RE HAVING I MEAN IT'S
THERE'S SO MUCH RIGHT. FROM THE
CALL OF SERVICE FROM THE MY ONE
CALL TO GET TO THE HOSPITAL HALF
OF THOSE PEOPLE ARE PROBABLY
MORE DON'T NEED TO BE IN THE
HOSPITAL WE TALK ABOUT THE
TELLEMENT MOUNT. TELEMEDICINE
COMMITTEE PERMISSIVE ALL THOSE
OTHER THINGS BUT ONCE AGAIN THE
DATA IS THERE SO CAN ANYBODY
JUST ANSWER A QUESTION OF HOW
MUCH MORE DATA AND WHY DO WE
NEED TO WAIT FOR MORE DATA TO
COME UP WITH PROBLEMS. AND WENT
I THINK IT'S QUITE CLEAR WE CAN
ALL AGREE WHAT THE PROBLEM IS.
THE GENERATOR USES A START
UNIFIED NAME AS COMMISSIONER
STARTED JUMPING BY THAT I'M- IN
THE PANEL I'M- I'M NOT ON
PALISADE CAN'T RAISE MY HAND. I
AGREE WITH YOU I THINK WE HAVE
ENOUGH DATA WE KNOW IT'S AN
URGENT PROBLEM WE HAD A TOOL KIT
EIGHT YEARS AGO THAT IS A
HUNDRED TWENTY VERBOSE PAGES
THAT DIDN'T FIX ANYTHING I AGREE
WITH THAT. KASICH ADJUSTER THE
TOOL KITS WILL NOT SOLVE THE
PROBLEM. WHAT I DO THINK IS THAT
WE NEED TO THINK INSIDE THE BOX
NOT OUTSIDE THE BOX LET'S NOT
GET TOO FANCY WITH SOLUTIONS AND
IMPROVE THE PROCESS. YOU HAVE.
AGAIN IF WE CAN MAKE. AN E. R.
AS EIGHT CYLINDER ENGINE RUNNING
ON FOUR CYLINDERS BECAUSE- BEDS
ARE OCCUPIED WITH PATIENTS THAT
SHOULDN'T BE IN THE YEAR THEY
SHOULD BE UPSTAIRS. BUT IF I CAN
TURN THOSE REMAINING BEDS FASTER
IF I CAN GET MY TEST PAID BACK
FASTER IF I CAN PER IMPROVE THE
EFFICIENCIES WITH. IN THE
EMERGENCY DEPARTMENT. BLOOD
DRAWS LABS X. RAYS WITH READS IF
I CAN DOUBLE THAT SPEED I WILL
DOUBLE THE SPEED WITH WHICH I
TURN THOSE. BEDS 80% OF MY
PATIENTS PLUS 85% ARE NOT BEING
ADMITTED TO THE HOSPITAL. BEING
SENT HOME. WE NEED TO FIX THE
EFFICIENCIES IN THE SYSTEM WE
CURRENTLY HAVE. AND THEN WE CAN
ALSO THINK ABOUT OTHER SOLUTIONS
BUT I REALLY THINK THAT BE THE
BIGGEST BANG FOR YOUR BUCK.
THANK YOU SIR. CHARLES DICKENS A
STARK AND MORGAN I THINK I MIGHT
ANSWER THAT A LITTLE BIT
DIFFERENTLY AND IT GOES BACK TO.
SOME OF THE THINGS THAT OTHER
FOLKS TESTIFIED TO ITS I THINK
ALL UP. INTO ME WHEN I SAY MORE
DATA I GUESS IT'S NOT MORE DATA
TO PROVE THE ISSUE BECAUSE
CERTAINLY THE ISSUE AS WELL
PREVENT. I THINK IT'S MORE DATA.
UNDERSTAND LOCALLY WHAT THE
PROBLEM IS- PERHAPS DOCTOR
OWNERS. HOSPITAL AND I JUST HAVE
A PROBLEM WITH THE EFFICIENCY OF
X. TEST OR Y. X. RAY. THAT MIGHT
NOT BE TRUE ON A IN THE NEXT
COUNTY OVER IN ON THE NEXT
COUNTY OVER MAYBE THERE
ABSOLUTELY. NO AVAILABILITY OF
BEDS TO DISCHARGE PATIENTS TOO
SO. I THINK THAT TO ME THAT MORE
DATA QUESTION REALLY IS. A POP
MAYBE NOT. MORE DATA BY
DIFFERENT DATA WHICH IS PARKS
AND THE DATA. FOR A OF THOSE
LOCAL REGION AND LOOK AREA. WE
CAN MAKE SURE THAT THE THINGS
THAT WE ARE DOING ARE GOING TO
BE HELPFUL YOU KNOW IF SOME. ONE
HOSPITAL RD HAS LAB TURNAROUND
TIMES THAT ARE YOU KNOW IN THREE
MINUTES OR LESS THAN FOCUSING ON
LAND TURN AROUND TIMES FOR THAT
HOSPITAL OBVIOUSLY WOULD NOT BE
USEFUL. SO I THINK WHEN I TALK
ABOUT WE NEED SORT OF BETTER I
WOULD SAY MAYBE THE ISSUE IS-
MORE PARSED DATA. SO THAT WERE
MAKING SURE THAT WE CAN COME UP
WITH SOME BUTTONS- THAT WILL BE
EFFECTIVE OR AT DIFFERENT AREAS
. THANK WHEN I MAKE SPEAKING-
ADJOURNMENT JUST TO ANSWER YOUR
QUESTION WE DON'T NEED MORE DATA
WE DO NEED TO FIX THE DATA
BECAUSE- THAT'S GOING TO HELP US
UNDERSTAND IF THE- THINGS THAT
WE'RE DOING ARE IMPACTING THE
PROBLEM SO I DO THINK THAT WE
NEED TO KEEP WORKING ON THE
DATA. BUT IT SHOULD NOT BE. AN
IMPEDANCE TO ACTUALLY DOING
SOMETHING TO TRY AND SOLVE THE
PROBLEMS ARGUING IF OUR WALL
TIME IN SIXTY FIVE MINUTES.
MINUTES DOESN'T REALLY MATTER IF
SIXTY FIVE MINUTES IS STILL
UNACCEPTABLE. BUT WE STILL DO
WANT TO SOLVE THE DATA PROBLEM.
AND I WOULD JUST SAY AT THIS
THIS I'M FOR AND AGAIN THIS IS.
I UNDERSTAND THE HARMFUL SIDE OF
THINGS BUT THAT THE STANCE HAS
BEEN KIND OF FOR YEARS. THAT WE
NEED TO SOLVE THE HOSPITAL
PROBLEMS TO SOLVE THE M. S.
PROBLEMS BUT- WE HAVE AN
IMMEDIATE NEED WE HAVE PAID.
WITH HEART ATTACKS WITH MAJOR
TRAUMA WE LITERALLY CANNOT GET
THEM TO THE HOSPITAL SO. WE NEED
AN IMMEDIATE SOLUTION TO GET
THOSE HANDLE. OVERALL WE CAN'T
WAIT TO SOLVE ALL OF THE
HOSPITAL THROUGHPUT ISSUES WHICH
I COMPLETELY AGREE DESERVE
ATTENTION BUT- IT JUST LACKS A
SENSE OF URGENCY THAT WE REALLY
HAVE TO HAVE BECAUSE. WE ARE
STILL IN THE MIDST OF A
DISASTER. SO THERE ARE YOU'RE
RIGHT IT'S A 100% TRUE I MEAN
WE'RE WE NEEDED ME TO FIX IS NOW
NOT LATER- IT'S GOING TO BE A
LOT WORK ANYBODY ELSE WANTED TO
FOLLOW UP ON THAT. FROM
COMMITTEE. I WOULD SAY JERRY
THIS IS DOCTOR LARRY STOCK- I
THINK IF YOU WANT TO LOOK FOR AN
IMMEDIATE FIX THE CRUX OF THE
PROBLEM COMES DOWN TO- THE
COMMITMENT TO OWNERSHIP OF THE
PATIENT'S CARE. UPON ARRIVAL TO
THE DEPARTMENT I BELIEVE THAT
MOST DEPARTMENTS HAVE A TRIAGE
NURSE THE TEXT REPORT. AND THE
NEED TO PUSH THAT PATIENT FROM-
YOU MUST. AGREE TO A HOSPITAL
CAREER CHAIR OR THE WAITING ROOM
WHERE RESUSCITATION ROOM. AND
THAT THE WAY FOR WHATEVER REASON
WHETHER IT'S BECAUSE NO NURSE I
DOUBT IT'S BECAUSE THERE'S NO
GUARANTEE- I NEEDS TO HAPPEN TO
RELEASE AT TWO PM. SHE CAN TAKE
CARE. OR INTO. PHASE AND IF THAT
ONE HELLO WAS. IMMEDIATELY A LOT
OF THIS WOULD BE SOLVED
SECONDARILY THAT'S RIGHT BELIEVE
. ANYONE ELSE. YOU KNOW JUST TO
BE BACK ON ON THAT- ANSWER
YOU'RE NOT GOING BACK TO MY
YEARS WORKING AND THE EMPLOYERS
INDUSTRY ALL OF WHICH HAVE BEEN
AT HUNDREDS OF THOUSANDS THE
HOSPITALS TAKING PATIENTS BY
YOU'RE RIGHT AND I THINK A LOT
OF A START WITH THE TRIAGE
ASPECT OF SOME THESE ALSO. OF
THE TOP OF MY HEAD SOME
HOSPITALS DO A REALLY GOOD JOB
OF TRIAGING PATIENT GET HIM OFF
THE GURNEY AND OTHERS AREN'T YOU
HAVE TO SIT THERE AND WAIT. AND
IT'S THE WAY THEY THEY THEY
MANAGE THEIR DEPARTMENTS THE
WORK STUFF EVERYTHING I KNOW
IT'S DIFFERENT BECAUSE OF A
PANDEMIC. BUT I THINK WE CAN
COME UP TO BETTER. AT QUICKLY
WAYS TO GET THOSE PATIENTS OFF
BUT- THAT'S PROBABLY BIGGER
DISCUSSION WITH EVERYBODY ELSE-
SENT UPON MY COLLEGE HAVE SOME.
QUESTIONS SOMEONE ABOARD YOUR
QUESTION THANK YOU MISTER CHAIR-
YEAH I WONDERED WITH- I KNOW
THAT THIS- ECOSYSTEM- YEP WELL
PRETTY. COVED FORTY YEAR- BUT-
DURING THIS TIME. HAVE ANY BODY
FROM A HOSPITAL SYSTEMS- NO
POSSIBLY EITHER LOOKED AT USING
SOME OF YOUR- FEDERAL OR STATE
COVERED RELIEF MONEY- TRIED- YOU
KNOW. NEW OPERATIONAL CHANGES
THAT YOU KNOW MIGHT. BE
SOMETHING THAT THE POINT TWO.
LESSONS KIND OF LEARN FROM THE
LAST TWO YEARS- WITH THE
RESOURCES KIND OF YOU KNOW WITH
THIS I MEAN A HEIGHTENED EMERGE.
THAT MIGHT SHED SOME LIGHT ON ON
OPERATIONAL EFFICIENCIES- YOU
KNOW AT THAT THAT THAT ENTRY
POINT. THE NUMBER OF. NOT
SOMEBODY I COULD CALM ON DR
MORGAN. DR MORE THOUGHT THAN YES
SIR- FIRST- YOU KNOW OUR-
FEDERAL DOLLARS HAD ARE STILL
FOR OUR US ALONE FORTY TWO
MILLION DOLLARS SHORT OF WHAT WE
SPEND TO TAKE CARE OF THE
PATIENTS SO AND THERE WERE NO
EXTRA EXTRA DOLLARS FOR- FOR THE
CARE OF PATIENTS AND I THINK WE
HAVE REALLY DONE A LOT OF THINGS
AND SOME PEOPLE HAVE REFERRED TO
I. T. NURSING WE HAVE USED OUR
TEAM NURSING BUT AGAIN WE'RE
USING TEAM NURSING TO BE ABLE
TO. EXPAND CARE BEYOND NORMAL-
BEYOND THE NORMAL LOCATIONS IN
AGAIN WE'VE TAKEN CARE OF
PATIENTS AND TENTS THAT'S NOT
OUR PREFERENCE TO DO THAT WE'VE
TAKING OF PATIENTS AND A
CONFERENCE ROOMS NOT OUR FRIENDS
TO DO SO I MEAN I THINK MANY OF
THE THINGS THAT WE HAVE DONE TO
EXPAND CARE HAVE REALLY TRULY
HAVE BEEN. CRISIS MEASURES AND
WOULD NOT BE THINGS THAT WOULD
CHOOSE TO DO- PASSED UP PASSED
THE TIME OF A CRISIS I DO THINK
THAT SOME OF THE COMMENTS THAT
PEOPLE HAVE MADE AROUND- ON.
SOME RELAXATION OF THE
REGULATORY ENVIRONMENT IN TERMS
OF WHO CAN PROVIDE A WHAT LEVEL
OF CARE SO YOU KNOW THAT ONE OF
MY EMERGENCY ROOM COLLEAGUES
JUSTIN HAVING AN APPARENT DO ALL
OF- THE ENTRY OF MEDICATIONS
THAT- THAT HAPPENS NOW WHAT
COULD BE DONE AT A DIFFERENT
LEVEL SO I DO THINK THERE ARE
SOME SOLUTIONS LIKE THAT THAT
COULD- PROVIDED- YOU KNOW FOR A
QUICK SOLUTION IF WE DID NOT
HAVE TO WAIT FOR INSURANCE
AUTHORIZATION IF IN A CRISIS.
THERE COULD BE A IF THE PATIENTS
READY TO BE DISCHARGED THEIR
AUTHORIZED TO BE DISCHARGED I
WOULD I WOULD A DISCHARGED
EIGHTEEN PAID. SIXTEEN SO I
THRE ARE SOME MEDIA SOLUTION
THAT BE A- ON ALL ENDS OF THE
SPECTRUM AND- YOU KNOW I'M NOT
INTERESTED PERSONALLY AND- WHO
pAND WHO'S NOT DOING THIS AND WHO
IS NOT DOING NOT I THINK THE
SOLUTIONS ARE ALL REALLY. MULTI
FACTORIAL AND THERE IS NOT GOING
TO BE ONE SINGLE ANSWER TO. TO
CAST THIS ISSUE EITHER WITHIN
THE TIME OF CRISIS OR- AS WAY
HOPEFULLY SOME POINT THIS
HAPPENS THAT WE ARE OUT OF
POCKET CRISIS BECAUSE WE KNOW.
WE WILL STILL BE LEFT WITH THE
ISSUES OF HOMELESSNESS AND I
WILL JUST IN A SHOT OVER THE
YARD ARM RIGHT NOW THE
BEHAVIORAL HEALTH. HEALTH ISSUES
THAT ARE GOING TO COME OUT OF
THE COPA CRISIS WILL BE THE GIFT
THAT KEEPS ON GIVING FOR THE
NEXT TWENTY YEARS. THANK THANK
ALSO- DO WE HAVE A B. J. BORUSAN
REPRESENTING THE CALIFORNIA
HOSPITAL ASSOCIATION ARE YOU ON
THE LINE MAYBE OF ANY FOLLOW UP
TO- ASSEMBLY MEMBER WARTS
QUESTION REGARDING THE DISASTER
RELIEF FUNDS. YES THIS IS B. J.
PART ALSO NOT BE KEY AT THE
CALIFORNIA HOSPITAL ASSOCIATION
THANK YOU- I THINK LAURIE A
DOCTOR MORGAN EXPLAINED IT
PERFECTLY- BALL HOSPITALS ARE
GETTING SOME RELIEF THAT RELIEF
IS COMING OVER TIME AND IT'S NOT
ENOUGH TO COVER THE LOSSES THAT
THEY TOOK- I WOULD ALSO STRESS.
AGAIN DIFFERENT THAN THE
QUESTION THAT WAS ASKED- IN TWO
THOUSAND FOURTEEN ANSWER AND SAY
TO WORK ON THAT TOOL KIT AS
EIGHTY OPPORTUNITY TO REALLY
START EXPLORING THIS
MULTIFACTORIAL PROBLEMS. AND HOW
WE NEED TO SOLVE IT REGIONALLY
OUR STATE AS WIDE COMPLEX AND
VERY DIFFERENT FROM ONE MONTH SO
AND COUNTY TO THE OTHER. AND I
THINK YOU'VE HEARD ALL DAY LONG
TODAY ABOUT THOSE COMPLEX
PROBLEMS AND HOSPITALS NEED HELP
ON BOTH SIDES OF THE EQUATION-
THAT TWO THOUSAND FOURTEEN TOOL
KIT WAS TO HAVE HOSPITALS DO AS
MUCH AS THEY COULD IN THE INSIDE
OF THE HOSPITAL RELATIVE TO EACH
TREE R. AS- A TECHNOLOGY
ANYTHING WE COULD DO TO CHANGE.
THE TIME BUT OF COURSE SINCE TWO
THOUSAND FOURTEEN THE VOLUMES
HAVE EXACERBATED AND WE HAVE ALL
KINDS OF COMMUNITY ISSUES THAT
AREN'T BEING ADDRESSED
BEHAVIORAL HEALTH NEEDS
HOMELESSNESS SO. I WOULD SAY WE
NEED TO START RIGHT AWAY WITH
REGIONAL ANSWER COLLECTIVES JUST
LIKE WE HAD IN TWO THOUSAND
FOURTEEN WHERE WE CAN ADDRESS
THE LOCAL REGIONAL ISSUES WHERE
WE CAN DEVELOP DATA THE MEASURE
CHANGE. DEVELOP ALL THOSE
COMMUNITY PARAMEDICINE ALTERNATE
DESTINATION A TRIAGE ALL OF
THOSE INNOVATIONS THAT ARE
HAPPENING MAKE A LIST OF ALL THE
REGULATORY. AND THAT'S A THAT
WOULD BE A WAY TO GET. MEDIA
THANK YOU FOR YOUR INPUT- WASHER
SORORITY QUESTIONS I DON'T KNOW
THAT I HAVE ANY MORE QUESTIONS I
THINK EVERYBODY HAS COVERED JUST
ABOUT EVERY QUESTION- QUITE
WELL- YOU KNOW A- I THINK DR
MARTIN. POINTED OUT BASS THIS
ISSUE IS REALLY REALLY COMPLEX.
BECAUSE THERE'S SO MANY
DIFFERENT PARTS OF IT THAT NEED
TO BE LOOKED AT AND CHANGE BUT
AT THE SAME TIME CHANGING IT IN
A MANNER THAT DOESN'T. RISK
PATIENT CARE OR OR A COMPROMISE
PATIENT CARE AT THE END OF THE
DAY- YOU KNOW THAT THE SYSTEM
OBVIOUSLY NEEDS TO BE UPDATED-
YOU KNOW IF YOU HAVE A
CONVENIENCE STORE. IT'S MEANT TO
TAKE CARE OF A YOU KNOW A FEW A
FEW CUSTOMERS BUT YOU SEND A
THOUSAND PEOPLE IN THERE AT
ONCE- IT'S NOT GONNA WORK VERY
WELL. IT DOESN'T MATTER HOW MANY
IF YOU GET TWO OR THREE MORE
CASHIERS GOING IT'S STILL NOT
GOING TO WORK VERY WELL. AND SO
IT IT. YOU KNOW HAVING THE
SUPPLY SIDE CONTINUE TO SUPPLY
WITHOUT HAVING THE THROUGHPUT
SIDE. WHICH IS THE E. R.
ESSENTIALLY WERE USING E. OURS
FOR EVERYTHING- ALBERT I RECALL
A CALL WERE WE WERE DEMANDED BY
A INTAKE COMMANDER TO TAKE A
DEAD PERSON TO THE ER. BECAUSE
THEY DIDN'T WANT TO WAIT FOR THE
CORNER THEY WANT TO OPEN A
FREEWAY. WHAT DO THEY DO WITH
THAT. AND SO YOU KNOW WHEN WE
HAVE THAT WHEN WE HAVE P. R.'S
BEING SATURATED BECAUSE WE DON'T
HAVE THOSE ALTERNATIVE THINGS IN
THOSE ALTERNATIVE- DESTINATIONS
TAKE. YOU NO TIME AND RESOURCES
TO DEVELOP IF YOU'RE TALKING
ABOUT URGENT KERR'S YOU KNOW
THAT GOES TO CALIFORNIA'S
BUSINESS CLIMATE IF YOU WANT TO
OPEN UP AN URGENT CARE WHEN YOU
GOTTA GO THROUGH TO BE ABLE TO
DO THAT. THE BUSINESS CLIMATE IS
HORRIBLE I WILL TRY TO OPEN UP
ANYTHING AND THAT GOES TO SOME
OF OUR REGULATIONS AND THE
REGULATIONS THAT ARE AFFECTING
EMS AND EFFECTING ER'S THOSE
NEED TO BE RE EVALUATED AND LOOK
AND SEE IF THEY ARE TRULY
REGULATIONS THAT ARE PROTECTING
THE PUBLIC OR REGULATIONS THAT
LOOK LIKE THEY ARE BUT YOU'RE
ACTUALLY CREATING PROBLEMS IN
THE LONG RUN THAT ARE. THAT HAVE
ULTIMATELY THE EFFECT OF
HURTING. THE PUBLIC- WHEN IT
TAKES. THREE HOURS TO DISCHARGE
A PATIENT. I REMEMBER BEING IN A
ROOM- WITH WITH A PATIENT AND-
THAT IS BECAUSE THEY TOLD ME HEY
YOU KNOW WHAT WE'RE ALL CLEAR
READY GO HOME I'M LIKE OKAY
UNPLUG THAT AND- I'M TAKING
AROUND HERE. AND YET THREE HOURS
LATER I'M STILL PACING THE
HALLWAY GOING YOU GUYS WHAT'S
THE HANG UP HERE. IT'S
REGULATIONS IT'S HEY HAVE TO GO
THROUGH A CERTAIN PROCESS TO
COVER CERTAIN ASPECTS SO THEY
DON'T GET SUED LATER ON IT A LOT
OF IT DOES IT COMES BACK TO. THE
ENVIRONMENT AND WHEN WE MAKE A
REGULATION THAT CREATES A LEGAL
ENVIRONMENT GUESS WHAT. THEY
HAVE TO GO THROUGH THAT AND
THERE'S NO AMOUNT OF. OF YOU
KNOW. THIS IS SHIFTING IT TO THE
OTHER SIDE AND YOU KNOW HAD A
LOT SAYING HEY YOU KNOW WHAT
AMBULANCE- YOU COME IN YOU JUST
LOOK YOU KNOW PUT HIM AND PUT
HIM IN THE PARKING LOT. AND WILL
HAVE ONE PERSON RUN AROUND AND
COULD TAKE CARE OF BECAUSE GUESS
WHAT THAT PARKING LOT WOULD
BECOME FULL. AND THEN YOU HAVE
THE MORE PEOPLE THAT YOU WOULD
NEED THERE. SO THIS IS A VERY
VERY COMPLEX ISSUE AND IT'S
SOMETHING THAT YES OF THE DATA
THAT YOU'RE TALKING ABOUT CAN BE
USED. BECAUSE IT WILL SHOW US.
WHERE SOME OF THIS IS COMING
FROM. AND AS- A FIGURES DR
MORGAN HAD POINTED OUT YOU KNOW
THE BEHAVIORAL HEALTH PART OF
THIS. WHERE DO THEY GO. WELL THE
POLICE STOP YOU KNOW POLICE ARE
CALLED TO DEAL WITH THEM. THE
POLICE GIVEN TO THE PARAMEDICS
IN THE PARAMEDICS TO GO OKAY
WELL WE HAVE TO TRANSPORT HIM SO
THE TRANSPORT OF THE ARE. AND
NOW THEY'RE STUCK WITH SOMEBODY.
KNOW WHAT TO DO WITH. THIS
TAKING UP A BED TAKING UP A ROOM
. AND THEN WE WONDER WHY WE
CAN'T WE CAN'T ACCEPT MORE WORK
MORE PATIENTS THAT ACTUALLY DO
NEED HELP. SO YOU KNOW LIKE I
SAID THIS IS EVOLVED OVER THE
YEARS AND YEARS. IT WASN'T
NEARLY AS BAD AS IT IS NOW IN
WHEN YOU KNOW FORTY YEARS AGO
BUT YOU COULD SEE IT WAS
STARTING. IT WAS STARTING. AND
AND HERE WE ARE TODAY AND WHEN
YOU THROW PANDEMIC IN THERE IT
REALLY. REALLY ILLUMINATES- THE
CRISIS AND- AND THAT'S WHAT WE
HAVE SO WE NEED SHORT TERM
SOLUTIONS BUT WE ALSO NEED LONG
TERM SOLUTIONS. AND WE NEED TO
LOOK AT REGULATIONS WE NEED TO.
LOOK AT WAYS OF STREAMLINING
THINGS THAT MAKE SENSE- SO THAT
TO YOU KNOW THESE PEOPLE THE
EIGHTEEN PEOPLE THAT THE DOCTOR
WAS TALKING ABOUT COULD BE
DISCHARGED. WHEN SOMEBODY SAYS
THEY'RE READY TO GO HOME THERE
THEY KICK ME OUT OF THERE AND
THAT BEDS FREE FOR SOMEBODY ELSE
AND YET NO IT TAKES ANOTHER.
THREE OR FOUR HOURS FOR THEM TO
ACTUALLY GET TO GO HOME- SO I
FEEL I FEEL FOR OUR- EMS WORKERS
I FEEL FOR. THE EVERYBODY
INVOLVED IN THE HOSPITAL SETTING
THE PRE HOSPITAL SETTING.
BECAUSE OF THE SYSTEM THAT ISN'T
WORKING IN CALIFORNIA- WITH THE
RESOURCES THAT WE HAVE AVAILABLE
TO US THAT'S NOT ACCEPTABLE.
IT'S NOT ACCEPTABLE FOR THE
PEOPLE THAT WE SERVE. SO I THINK
IT'S INCUMBENT ON US TO REALLY
WORK WITH THESE EIGHT THESE
ENTITIES- TO COME UP WITH SOME.
REASONABLE THINGS TO DO IN THE
SHORT TERM AND THEN ALSO
CONTINUE TO WORK GOING FORWARD.
ON THINGS THAT TAKE A LITTLE BIT
LONGER TO GET IMPLEMENTED-
BECAUSE OTHERWISE IT'S JUST
GOING TO GET CONTINUALLY WORSE.
SO I SUPER APPRECIATE EVERYBODY
BEING HERE AND EVERYBODY WHO IS
ON A DAY. THE AND JOIN US ON- ON
THEIR THEIR- BECAUSE WE NEED
YOUR INPUT AND WE NEED TO WORK
WITH YOU GUYS AND WE NEED
EVERYBODY TO WORK TOGETHER TO BE
ABLE TO SOLVE THIS. AND SO THANK
YOU THANK YOU MISTER CHAIR FOR
SCHEDULING THIS UP AND- I
APPRECIATED WE SIMPLY. THANK YOU
FOR MUCH OF ANY OTHER QUESTIONS.
SO THAT I WANT TO THANK OUR
SECOND PALACES WELL THANK YOU
FOR SHARING YOUR- REQUIREMENT
SUGGESTIONS CONCERNS FROM YOUR
POINT OF VIEW OVERSEE THIS IS
SOMETHING BIG THAT I WANTED TO
HEAR FROM EVERYBODY RIGHT
EVERYBODY PLAYS. AN INTEGRAL
PART OF FICTION- THIS PROBLEM
WE'RE HAVING THIS SPRING GOING
BACK FOR DECADES AS- WE'VE BEEN
HERE FROM A LOT OF FOLKS I MEAN
I CAN TELL YOU STORIES MYSELF
WHEN. PEOPLE CALL NINE ONE ONE
FOR. HAND PAIN OR OR FOR A
HEADACHE AND NOW RECENT I'M
HEARING PEOPLE CALL NINE ONE. TO
GET A COVERT TEST OVER OR A GET
A VACCINE THOSE THOSE CALLS ARE
UNACCEPTABLE SHOULDN'T BE
HAPPENING. BUT THEY ARE SO THE
OFFICE EITHER TURN THE THERE'S A
MAIN PRO THERE'S A BIG PROBLEM
THERE. THE NEED TO TREAT A FIX
BUT I CAN'T DO IT ALONE I NEED
EVERYBODY'S HELP AND SUPPORT ON
THIS. NUMBER SHOULD BE WAITING
MORE THAN TEN MINUTES FIVE
MINUTES FOR AN AMBULANCE. THEY
SHOULD BE WORKING MORE THAN
TWENTY MINUTES SO THEY TALK
ABOUT IN A HOSPITAL SETTING. GET
HIM OFF THOSE BEDS IN AND GET
HIM INTO THE CARE THEY NEED. SO
YOU'RE RIGHT IT'S A VERY. BIG
COMPLEX ISSUE THAT- WE HAVE TO
GET INVOLVED IN AND FIND
SOLUTIONS BECAUSE ONCE AGAIN.
FOR CALIFORNIA RESPONSE BE
LEADING BY EXAMPLE WE STARTED
THIS PROGRAM. YEARS AGO WITH
THE- FIRE PARAMEDICS IN THE
PERMIC SYSTEM AND NOW LOOK WE'RE
OUT I THINK. WE NEED TO LOOK AT
WHAT WE'VE DONE IN THE PAST.
LOOK AT CHANGING SOME RULES AND
REGULATIONS AND BEING OPEN TO.
CHANGE IN GENERAL WITH
EVERYBODY. THOUGHT THAT AGAIN
WANT TO THANK YOU ALL FOR TAKING
TIME TO PARTICIPATE THIS
MORNING. AND FOR SHARING YOUR
EXPERIENCES AND RECOMMENDATIONS
ON LOOK FORWARD TO WORKING WITH
EVERYONE. ON SOME OF THE
SUGGESTIONS MADE THE DAY. BEFORE
WE END TODAY'S HEARING I WOULD
LIKE TO OPEN UP FOR COMMENTS
FROM THE PUBLIC. THE PUBLIC TOLD
MY NUMBER IS. EIGHT SEVEN SEVEN
SIX NINE TWO EIGHT NINE FIVE
SEVEN. AND THE ACCESS CODE IS
ONE THREE ONE. FIVE FOUR TWO
ZERO TWO. PLEASE LIMIT YOUR
PUBLIC COMMENTS NO MORE THAN TWO
MINUTES. BEFORE WE GO TO THE
PHONES IS THERE ANYONE HERE IN
THE COMMITTEE ROOM. THE LIKE TO
OFFER PUBLIC COMMENTS. ANYONE IN
THE ROOM. SEE NON GOT OPERATOR
OPERATED WE HAVE ANYONE ON THE
LINE READY TO PROVIDE PUBLIC
COMMENT. ENGLISH AND GERMAN IF
YOU WISH TO ADD COMMENTS ON THIS
PLEASE PRESS ONE THEN ZERO AT
THIS TIME. WE DO HAVE ONE NUMBER
TWENTY ONE PLEASE GO AHEAD.
WINDS TWENTY ONE SEVENTEEN
COMMITTEE AS FIFTY EMERGENCY
MANAGEMENT COMMITTEE WITH THE-
ISSUE OF THE AMBULANCE GIVE
SERVICE OFFLOAD ACETABULUM. WHEN
I PLAYED COMES ACTUALLY
BEGINNING TO THINK YOU WERE
GOING TO CALL PATRICK O'DONNELL
AND NOT TAKE PUBLIC COMMENTS
TODAY. BUT GO AHEAD AND MENTION
SOMETHING AFTER LISTENING TO
YOUR SUPPOSED EXPERTS FOR THE
LAST TWO AND A HALF HOURS
PONTIFICATING ON AND ON ABOUT
YOU KNOW ALL OF THE DELAYS AND
THE LACK OF STAFF AND WHAT NOT I
JUST WANT TO MENTION THE
ELEPHANT IN THE ROOM. YOU PEOPLE
FIRED THE UNVACCINATED YOU FIRED
THE NURSE SAYS. AND THE BAY ARE
TAKING BONUSES IN FREE STATE. SO
ALL THE PEOPLE THAT WERE IN
POSITION TO SOLVE THIS PROBLEM.
HOW THE LEFT. AND IF YOU HAVEN'T
PICKED UP ON IT CALIFORNIA IS
LEADING PEOPLE FOR FREE STATE.
BECAUSE PEOPLE DON'T WANT
MANDATE. THEY DON'T WANT THE
GOVERNMENT THE OPPORTUNITY THANK
REQUIREMENTS CAN GO TO THE NEXT
QUESTION. COMMENT ON AVERAGE OF
EVERYONE COMING LINE OF. NEXT
COME IT COMES A LOT OF TWENTY TO
PLEASE GO AHEAD. I APOLOGIZE BY
TWENTY TWO DROPPED. IF YOU WISH
TO COMMENT PLEASE PRESS ONE THEN
ZERO AT THIS TIME. OKAY LET'S
TRY LINE TWENTY TWO OVERTIME.
YES YOU THEIR LINE TWENTY TWO
PLEASE GO AHEAD. THANK YOU OF
FINDINGS- PRESIDENT RAMAPHOSA
STATION THE PRESIDENT MEDICARE
MOST SERVICE. RODRIGUEZ I WANT
TO THANK YOU ALL RIGHT AND THE
COMMITTEE TODAY PREPARING OUT WE
GET SHE- GETS UP COULD BE A ONE
SIZE FITS ALL ISSUE- BIRD FLU
CAN BUT I DO APPRECIATE YOU GUYS
THINK OF THE TIME- PROVIDERS
CABLE PROVIDERS BOTH PUBLIC AND
PRIVATE OF THE DOWNSTATE. I HAD
YOU HEARD IN TESTIMONY AT THE
HEARING THAT I'M FEELING THAT
BOCANEGRA. WORKFORCE IN THE WALL
TIME. SOME I FIND IT YOU KNOW
IT'S I KNOW THAT MY OUR BIGGEST
ISSUE IS. THE THERE'S NO REAL
UPSET FOR. HOSPITALS TO GET-
PICTURES OFF THE WALL. JERRY
BROWN'S PROVIDERS YOU KNOW I
HEARD SOMEBODY SAY FINE DON'T GO
SOLUTIONS FOR HOSPITALS.
HEALTHCARE SEEMS. THAT
ESSENTIALLY A FINE. IS WHAT THE
ANIMAL PROVIDERS YOU'RE STUCK
WITH. WITH A COMPLICATED CARE.
PROVIDING THE CARE AND FREE
LABOR ON THAT THE PUBLIC WILL
AND PUBLIC AND PRIVATE PROVIDERS
ARE PROVIDING INSIDE THE
HOSPITALS. SO WE HAVE TO FIND A
SOLUTION. GICLEE CODED
EXACERBATED IT. THERE ARE
HOMELESS CRISIS AND ALL THE
OTHER CRITERIA THEME TO BE A
PERSONAL CLASS TWO YEARS.
HOWEVER THIS ISN'T A NEW ISSUE.
YEAH SILVA RODRIGUEZ I HEARD YOU
SAY THAT THIS IS NOT A NEW
ISSUE- IT SHOULD HAVE BEEN
NEGLECTED TO FIND A REAL
SOLUTION. I'M SORRY I REALLY
HOPE THAT CALIFORNIA
ASSOCIATION. OF THE CALIFORNIA
ASSOCIATION ALL STAKEHOLDERS-
COVERED FRESNO FIREFIGHTERS CAL
CHIEF- ALL. RIGHT. YEAH THAT WAS
THE WHOLE BOOK PUBLIC AND
PRIVATE ARE REALLY BIG REALISTIC
STAFF- OUR STAFF IS REALLY.
TAKING IT HARD. THE PROVIDERS
ARE TAKING HEART STILL. THANK
YOU AGAIN FOR YOUR TIME AND I
WILL WANT TO WORK WITH YOU AS
BEST WE CAN. THANK YOU OPERANT
ONE OUNCE. THANKS TO A LINE
TWENTY FOUR PLEASE GO AHEAD. SO
YOU CUT THE CALL IF YOU DON'T
LIKE BUT IT DOESN'T MAKE US GO
AWAY YOU ARE CREATING THIS
PROBLEM. ASHES TO MEDICAL
MANDATE. ADVERTIGO THE NEXT ONE
THANK YOU VERY MUCH FOR COMING.
AND WE HAVE NO FURTHER COMMENTS
THANK YOU. THANK YOU ONCE AGAIN
ONCE AGAIN I WANT TO THANK
EVERYBODY FOR PARTICIPATING IN
BOTH- PANELS WE HAD TODAY AND
OVERSEE FOLKS THAT CAME AND
JOINED US THIS MORNING THANK YOU
ALL FOR YOUR SERVICE THANK YOU
ALL FOR THE HARD WORK YOU DO DAY
IN AND DAY OUT. YOUR TRULY
LIFESAVERS IN THE STATE OF
CALIFORNIA AND I APPRECIATE ALL
YOUR HELP YOU DO DAY IN AND DAY
OUT AND LOOK FOR TO WORK WITH
EVERYBODY ON FINDING SOLUTIONS
TO OUR CHALLENGES ESPECIALLY
WHEN IT COMES TO WALL TIMES AND
DELAYING PATIENT CARE SO THANK
YOU ALL. FOR TO WORK WITH
EVERYBODY THIS MEANS JR THANK
YOU.