For City Council Meeting [September 10, 2019]
TO: Honorable Mayor and City Council
APPROVAL: Rod Foster, City Administrator
FROM: Brian Park, Acting Fire Chief
Title
Request City Council to Approve a Contract Agreement between the City of Rialto and Dr. Michael M. Neeki for Medical Director Services in the amount of $20,000 per Fiscal Year starting July 1, 2019 (FY20).
Body
BACKGROUND
The Rialto Fire Department provides Paramedic Response and Emergency Ambulance Transport Service for areas within the City’s legal geographic boundaries. The Inland Counties Emergency Medical Agency (ICEMA) has statutory medical control over the delivery of these services. ICEMA requires that all pre-hospital Advanced Life Support (ALS) providers retain a Medical Director who oversees certain aspects of prehospital medical care administered by that provider.
The Fire Department currently has a medical director that has worked under contract with the City since 2011. The annual fee for services under this contract is $17,500. Over the last five years, the scope of practice for our paramedics has expanded, and will continue to expand with new life-saving drugs, techniques, and response models. With these improvements in service delivery, the complexity of the Medical Director’s role and the time commitment continues to increase.
Arrangements to retain a Medical Director for these purposes are the responsibility of the provider agency. Agreements for these services generally include a scope of work and agreed upon fees for service. These fees are intended to be compensation for time spent meeting the scope of work, and to offset the increased insurance rates that are incurred by the physician for allowing paramedics to operate under the physician’s license. Annual insurance rates can range from between $5,000 and $7,500annually and continue to increase as the scope of practice for paramedics increases.
ANALYSIS/DISCUSSION
Paramedics in the ICEMA region have a broad scope of practice which includes the use of advanced life-saving procedures and the administration of certain approved drugs. Some of these drugs are listed as controlled substances by the Drug Enforcement Agency (DEA). Although paramedics are approved to carry and administer these drugs, they can only be purchased by a licensed physician. Additionally, some of procedures associated with the administration of paramedic care are only authorized under the license of a physician. Therefore, ICEMA requires that each paramedic provider have a designated physician Medical Director under contract to facilitate the purchase of regulated items, and oversee the overall training and quality control of this advanced scope of practice.
As a licensed Medical Doctor (MD), the Medical Director facilitates the purchase and administration of pharmaceuticals and controlled substances that are within our paramedic’s scope of practice. The Medical Director also oversees medical training, quality improvement, trail studies, tactical paramedic program, and acts as a liaison between hospitals physicians and the fire department.
In 2015 staff surveyed seven surrounding Fire Departments to determine an average compensation and job responsibilities for Fire Department Medical Directors. The average pay for Medical Directors in seven surrounding Fire Departments is $16,000 per year. However, the job responsibilities for Medical Director in most of these other departments do not include ambulance transport, which adds to the scope of expectations for the Director. The Fire Department also endorses a very progressive approach to Emergency Medical Service, taking advantage of new technology and treatment modes. This is to the benefit of our community members, and brings with it a higher level of oversight, participation and training by the Medical Director.
Therefore, staff recommends approval of the Medical Director’s Independent Contract Agreement in the amount of $20,000 per Fiscal Year starting FY19/20 through FY 23/24.
Approval of the Medical Director’s Independent Contract Agreement is consistent with the requirements of Rialto Municipal Code section 2.48.440 based on the demonstrated expertise of Dr. Neeki. The term of the contract is a one-year contract with 4 optional one-year extension based on satisfactory performance.
ENVIRONMENTAL IMPACT
The request is not a Project as defined by Section 15378 of the California Environmental Quality Act (CEQA). A “Project” means the whole of an action, which has a potential for resulting in either a direct physical change in the environment, or a reasonably foreseeable indirect physical change in the environment. By definition, a Project does not include: The creation of government funding mechanisms or other government fiscal activities which do not involve any commitment to any specific project which may result in a potentially significant physical impact on the environment according to Section 15378 (b)(4) of CEQA.
GENERAL PLAN CONSISTENCY
The Paramedic Ambulance Program is aligned with the City’s General Plan Goals in the following references:
Goal 1-2 Our neighborhoods will be a safe place to call home.
Goal 1-2 Essential community services and amenities must meet the needs and desires of our families.
Goal 5-1 - “Rialto recognizes the importance of providing a safe living environment for its residents”
Goal 5-2 - “Rialto can be better prepared to deal with emergency situations and adverse conditions and events that threaten the community.”
Goal 5-11 - “Rialto Fire Department is an all-risk fire agency providing fire suppression, emergency medical, technical rescue, hazardous material, and other related emergency services. The Fire Department also conducts public education programs and investigates and mitigates hazardous situations. The Department activity practices hazards mitigation and fire prevention. Firefighting resources in Rialto include four fire stations, emergency response personnel, firefighters/paramedics, and a Hazardous Materials Response Team. The Department is continually looking at its ability to meet the needs of the community and to make sure the Department has adequate and appropriate levels of personnel and equipment.
LEGAL REVIEW
The City Attorney has reviewed and supports this staff report
FINANCIAL IMPACT
Operating Budget Impact
Funds are available and budgeted in the Rialto Fire Department Budget Expenditure Account No. 010-500-5175-2011 in the amount of $20,000 for FY2019/20
Capital Improvement Budget Impact
This actions has no impact to this budget.
Licensing
Prior to execution of the Professional Service Agreement the vendor shall submit a business license application and pay a Business License tax at the rate of $79, as well as Administration and State fees.
RECOMMENDATION
Staff recommends that the City Council:
• Approve the one- year contract with 4 optional one-year extension based on satisfactory performance between the City of Rialto and Dr. Neeki for Medical Director Services.
• Approve a Purchase Order in the amount of $20,000 for each Fiscal Year 2019/20.