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February 8, 2022
ITEM TITLE
Agreement: Approving the Fourth Amendment to the Medical Director Agreement With the Regents of the University of California San Diego to Support the Chula Vista Fire Department’s Emergency Medical Services
Report Number: 22-0048
Location: No specific geographic location
Department: Fire
Environmental Notice : The activity is not a “Project” as defined under Section 15378 of the California Environmental Quality Act State Guidelines; therefore, pursuant to State Guidelines Section 15060(c)(3) no environmental review is required.
Recommended Action
Adopt a resolution approving the fourth amendment to the Medical Director agreement with the Regents of the University of California San Diego.
SUMMARY
With the implementation of the First Responder Advanced Life Support (ALS) program on July 25, 2013, the need for support for the Chula Vista Fire Department’s (CVFD) emergency medical services increased significantly. Additionally, the implementation of the City of Chula Vista Fire Department-based ambulance transport services effective April 9, 2021 , has also increased the need for support for emergency medical services. The program has been a success and continues to provide critical services to our community. With the professional guidance of the Medical Director, the Fire Department will continue to update policies and procedures to ensure that the highest quality care is provided to our citizens and visitors. The team will also continue to improve processes in place, evaluate care and recommend improvements to ensure that appropriate high-quality training is provided as issues of care become more complex.
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ENVIRONMENTAL REVIEW
The Director of Development Services has reviewed the proposed activity for compliance with the California Environmental Quality Act (CEQA) and has determined that the activity is not a “Project” as defined under Section 15378 of the State CEQA Guidelines because it will not result in a physical change in the environment; therefore, pursuant to Section 15060(c)(3) of the State CEQA Guidelines, the activity is not subject to CEQA. Thus, no environmental review is required.
BOARD/COMMISSION/COMMITTEE RECOMMENDATION
Not applicable.
DISCUSSION
Emergency Medical Services (EMS) has become a core function of the fire service over the last 40 years. Calls for medical assistance now constitute 85 percent of the requests for service in the City of Chula Vista. CVFD has been a provider of Basic Life Support (BLS) for the last 30 years. BLS care does not involve the administration of medication or the performance of procedures based on independent assessment and judgment. By contrast, Advanced Life Support (ALS) involves the delegated practice of medicine through the state, county, and provider agency regulations. The City has provided ALS services starting in 2013.
The California Code of Regulations, Title 22, defines the scope of practice for paramedics. The state delegates the administration of practice to the Local Emergency Medical Services Agency (LEMSA) who determines what the local standard of medical care shall be. Standardized medical treatment protocols are developed to guide paramedics in their delegated practice. O nline medical direction is provided by designated base hospitals through their physician staff. The provider agency can further define what their policies shall be concerning medical care and equipment.
An integral member of support for the ALS program an d the overall Fire Department team is the Medical Director. The Medical Director is a physician who has received prehospital emergency medical services training and provides expertise that guides the Department’s policies and procedures, quality improvement, and training activities. The Medical Director also provides leadership in representing the City and the Fire Department within the medical community as well. The Medical Director serves as a liaison and advocate for the City of Chula Vista and its Fire Department with outside regulatory agencies such as the State of California, County of San Diego, and local groups such as the base hospital physicians and prehospital audit committees.
The primary role of the Medical Director for the provider agency is t o assist in establishing policies and procedures that enhance the quality and safety of pre -hospital care provided to the citizens and visitors of Chula Vista. The Medical Director is an integral part of the quality improvement process where the care provided is evaluated and improvements are recommended.
Starting April 9, 2021, the Fire Department implemented a City of Chula Vista Fire Department-based ambulance transport program, where ALS-based care and transport services are provided to citizens, visitors and employees. The implementation of this program has significantly increased the need for the Medical Director to provide assistance and guidance as the Fire Department has expanded its involvement in the pre- hospital care provided to individuals.
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Another role for the Medical Director is the direct provision or guidance of medical training, based on evidence-based medicine and best practices. The Medical Director serves as a liaison to state and county agencies as well as to the local medical communit y. During the current COVID -19 pandemic, the Medical Director has assumed the role of liaison to County Public Health for the City. It is anticipated that this assistance will be required for the next year to provide consultation to city leaders in the recovery of efforts as the immediate crisis continues.
The only facility in San Diego County with the ability and expertise to provide medical director services is the University of California, San Diego, School of Medicine, Department of Emergency Medicine (UCSD). UCSD has a unique performance capability because it is the only academic medical center in San Diego County with the resources, staffing, and experience to provide medical direction and access to academic facilities. There are no other academic med ical centers in San Diego County that are associated with other healthcare systems. UCSD is the only facility that participates in the training of paramedics, emergency medicine physicians, and emergency medical services directors. As a designated Base Hos pital, they are active in the medical control of paramedic care. Consequently, staff is requesting the City Council waive the bidding requirements contained in the Chula Vista Municipal Code and enter into a sole source contract with UCSD for these services.
The City does not employ staff with the level of expertise in this specific area of the prehospital medical practice of emergency medicine. Given the complexity of the ALS program, this expertise is obtained in a contractual relationship for medical director services.
UCSD has a unique performance capability because it is the only academic medical center in San Diego County with the resources, staffing, and experience to provide medical direction and access to academic facilities for ALS training. Ther e are no other academic centers in San Diego County with the resources and ability to provide the Medical Director Services.
UCSD is willing to have one of its doctors, Jennifer Farah, M.D., to serve as the Medical Director for the Chula Vista Fire Department provided that the City is willing to compensate UCSD for her services for $84,000 per annum until the expiration of the current contract on September 30, 2023. To have Dr. Farah serve as the Medical Director it is necessary for the City Council to waive the bidding requirements due to UCSD’s sole source professional services.
DECISION-MAKER CONFLICT
Staff has reviewed the decision contemplated by this action and has determined that it is not site-specific and consequently, the real property holdings of the City Council members do not create a disqualifying real property-related financial conflict of interest under the Political Reform Act (Cal. Gov't Code § 87100, et seq.).
Staff is not independently aware and has not been informed by any City Council member, of any other fact that may constitute a basis for a decision-maker conflict of interest in this matter.
CURRENT-YEAR FISCAL IMPACT
These funds are budgeted and available in the current ALS program budget and will result in no impact to the General Fund.
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ONGOING FISCAL IMPACT
The ongoing cost of services will be $84,000 as specified in the contract (a total of $112,000 for 16 months).
These funds are already included in the ALS Program budget, with no impact on the general fund.
ATTACHMENTS
1. Two-Party Agreement
Staff Contact: Emily Folker, Raymond Smith, Harry Muns