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HomeMy WebLinkAboutMinutes - Minutes - City Council - Meeting Date: 9/1/2015 City of Glendale 5850 West Glendale Avenue Glendale, AZ 85301 GLE Meeting Minutes - Final Tuesday, September 1, 2015 1:30 PM Workshop Council Chambers - Room B3 City Council Workshop Mayor Jerry Weiers Vice Mayor Ian Hugh Councilmember Jamie Aldama Councilmember Samuel Chavira Councilmember Gary Sherwood Councilmember Lauren Tolmachoff Councilmember Bart Turner City Council Workshop Meeting Minutes-Final September 1,2015 CALL TO ORDER Present 7- Mayor Jerry Weiers, Vice Mayor Ian Hugh, Councilmember Jamie Aldama, Councilmember Samuel Chavira, Councilmember Gary Sherwood, Councilmember Lauren Tolmachoff, and Councilmember Bart Turner Also present were Richard Bowers, Acting City Manager; Jennifer Campbell, Assistant City Manager; Tom Duensing, Interim Assistant City Manager; Michael Bailey, City Attorney; and Pamela Hanna, City Clerk. WORKSHOP SESSION 1. 15-567 LOW ACUITY RESPONSE PILOT PROGRAM Staff Contact and Presenter: Chris DeChant, Interim Fire Chief Guest Presenter: Mr. Harry Beck, Mesa Fire Chief The Fire Department identified opportunities for fire-based emergency medical services utilizing smaller vehicles with two medically trained personnel to engage and navigate transforming the health care system. Programs implemented include the Mesa Fire and Medical and Chandler Fire and Health Department. Harry Beck, Mesa Fire Chief, said this program improved care for patients who did not need to go to the emergency room and relieved the demand for fire vehicles and firefighters leaving them available for other calls. He explained later the program was upgraded to include a physician's assistant that they were able to provide through grant funding. He said a physician's assistant is able to do many procedures right on scene, but he said they were very conservative in the tasks they allowed the physician's assistant to perform in the field. He said this program was to help protect the resources they had that were overwhelmed. He said their call volume was very high and compared to the high call volume being experienced in Glendale. He noted their department found significant relief with just one unit. Chief Beck said although this program was successful,they decided to partner with a hospital to continue this program as they were not in a position to hire a physician's assistant as a full-time city employee. They did find a hospital to partner with and for about four years,that hospital has assisted that level of service. Their agreement with the hospital is they will only bill insurance companies and will not bill the citizen directly. They were assured that they could respond on every patient the 911 system could offer. Chief Beck said one of their main goals from the beginning was to collect data. He said their primary services were severely impacted and they wanted to find a way to lessen that impact. He said they wanted to learn how the medical bills were being paid,whether through private insurance, Medicare,AHCCCS or Medicaid. He said the data they collected showed they would be able to provide cost recovery for any entity that partnered with them. City of Glendale Page 1 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 Chief Beck said after reviewing their data,they found that at least 30 percent of the calls received involved patients having some issue with behavioral health. The found they were not doing a good job in managing this problem. These behavioral health patients were being taken to an emergency room because firefighters were not trained to handle these problems and there wasn't any type of 24/7 service to assist these patients. He said their department found a contractor,who agreed to only bill insurance to handle these calls. He spoke about the high cost to treat behavioral patients and the cost to hold them over until a psych bed was available. He said they found several facilities that would take these patients directly so they wouldn't have to go through the emergency room process for treatment. He said this also helped police officers who were involved with patients with psychiatric needs to get the patients more immediate help and get the officers back on the street. He explained they are 7 years into the program and are now doing EMS prevention and working with insurance companies to assist patients who have mental health needs. He said their data also showed that over 40 percent of their EMS calls were for patients that had been in the hospital within the last 30 days. He said the insurance companies are very interested in working with their department on these issues and these programs have been a huge benefit to the community as well. Chief Beck continued they are able to intercept patients who might end up back in the ICU. He said they are able to check on elderly patients to make sure they are taking their medications correctly, improving care to patients and avoiding additional costs. He said they are looking at another program where insurance companies will pay the department to perform these services and they are building out these programs from 1 to 3 units.They are now able to collect a considerable amount of data. He said this process is EMS prevention, protects availability of resources needed for high emergencies and to cost recover those services. He said they are the first fire department in history to receive a grant from Medicaid to this research project. Councilmember Chavira asked if the template they were following is brand new. Chief Beck said they have evaluated old information and rolled some of that into new ideas and new opportunities. He explained until the grant is over,this is still a trial process. He said the overall savings in the medical system to provide these services is $375,compared to a$2,500 emergency room visit, or$6,000 for a behavior patient. Councilmember Aldama was interested in the department's ability to write prescriptions while on scene, such as for a patient with the flu. Chief Beck said regarding prescription, etc.they will check back the next day with the family to make sure the patient is following through with the instructions for care. He said this is a tremendous service to the community and reduces return calls. Councilmember Tolmachoff asked how Chief Beck receives the referrals for the behavioral health patients. Chief Beck said all behavioral health patients come through the 911 system and they are in the process of working with Mercy Maricopa Hospital to work with these patients in a City of Glendale Page 2 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 proactive way. He said their behavioral health unit is capable of getting the patient into treatment in a facility,even against their will. Councilmember Tolmachoff said she saw a lot of opportunity there, especially with all the recent shootings and events in the news. Chief Beck said in the past they have had only minimal training on behavioral health, but said they are now in a position to bring true corrective action to the table. Mayor Weiers said the 911 system is celebrating its 30th year. He asked Chief DeChant about his pilot program and how it would compare with Chief Beck's program with all their patient follow up. Chief DeChant said this pilot program would align with the city's busiest days of the week. He explained Chief Beck started with just trying to respond on low acuity calls on 911. The second phase included a PA or other response vehicle. He explained they needed to start with the one year pilot program to begin gathering the data. Mayor Weiers asked if they could use some of the data that Chief Beck has compiled and not have to go through the same extensive process. Chief DeChant said Chief Beck has been an excellent partner and they will use all the data, but they need to start running the calls in Glendale's demographic. Although there may be some similarities,they also need to look at extreme differences. He said emergency calls are very similar between the two cities, but Glendale needs to obtain their own data. Mayor Weiers said some of the hospitals have expressed a major desire to partner in this program. Chief DeChant said partnering with facilities would be in phase 2 or 3 of this process. He explained today they are only talking about starting with one unit with a paramedic and EMT. He said they need to see how effective they are going to be immediately and then look at where it would make sense to begin those other programs. He explained they won't have the background data until they can launch this pilot program. Councilmember Sherwood asked Chief Beck how many units they are running today. Chief Beck said with the grant,which is paying the full price for this,they are running three 24/7 nurse practitioner/physician assistant units, as well as a fourth unit during peak times. He said they are also running two 24/7 behavior health units and one peak time behavioral health unit. He said the peak time units are moved according to their data showing call volume and day of the week. Councilmember Sherwood said when you first started with one unit, how many calls were you able to do in a 40 hour week. City of Glendale Page 3 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 Chief Beck said they were averaging about 10 to 12 calls a day. He explained that was a 10 hour day. He said at that time they were only using a physician's assistant and were not doing behavioral health. He explained the difference in time spent on behavioral calls and other calls. Councilmember Sherwood asked when they got their grant. Chief Beck said today was the one year anniversary of the notice they received they were going to get the grant. He explained they were not funded until February. Councilmember Sherwood asked how many units they were running before they received the grant. Chief Beck said they had one nurse practitioner and one behavioral health unit. He explained that was all they could provide as a city without a cost recovery mechanism in place. Councilmember Sherwood said they had the data to prove it was working. Chief Beck said they did. Councilmember Chavira said they do live in a data driven society. He said it is great to see such a synergy for getting everyone on board for this program. He said high quality care will be a priority as well as patient follow up. Councilmember Tolmachoff asked Chief DeChant where the pilot unit would be based and how the data would be collected. Chief DeChant said the unit would run 9 am to 7 pm, Monday through Thursday, starting at Station 158. He said they will concentrate on the red zone area. Councilmember Tolmachoff asked if this would be separate from the automatic aid system. Chief DeChant said it would be kept separate and will only respond in the City of Glendale. Councilmember Aldama said it was important to keep boots on the ground so firefighters and police can be ready to respond to calls instead of waiting with a patient at a hospital or care center. Councilmember Turner said he is a proponent of experimenting to improve call response times and provide relief to the firefighters and paramedics. He asked if they would also be transporting patients. Chief DeChant said in an attempt to keep costs down, patients would be treated on scene and offered alternative transportation. He said they can work with cab companies City of Glendale Page 4 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 if patients need a ride or they can take them in the ambulance, but they would not be able to bill for that transportation like the ambulance companies would. He said their end goal is to keep the four person units available to run the high acuity emergency calls. He said they are using an ambulance to have the ability to treat very sick patients if necessary. Councilmember Turner spoke about the upcoming item to purchase a new ambulance. He asked if that ambulance would be used for this project. Chief DeChant said about a year ago, one of their ambulances was involved in an accident and this ambulance is a replacement for the ambulance damaged in the accident. He explained they will figure out which ambulance they will use as they move forward with this program. Councilmember Turner asked Chief Beck if they noticed any change in the way their 911 system was utilized, and asked if they had any data showing it was not just being used for emergency calls. He said he didn't want this to create a larger problem. Chief Beck said those concerns were identical to the Mesa City Council when they first presented this program idea. He said they were required to revisit community awareness of the 911 system and what it was really for. He said they did reach out to the community to determine why some calls were placed to 911 if they were not true emergencies. He said there are still community members that depend on the 911 system. He said they identified early on they needed to do nurse triage at their dispatch center, so if there was any question about the nature of the emergency, the call would be routed to a nurse. He said the nurse would assist with making the determination and the nurse might be able to assist right over the phone, so no one would be sent to the call. He said in other cases,the nurse could connect the caller with someone to assist within the system. He also explained that sometimes the nurse will even call the patient's doctor's office when dealing with a non-emergency caller. He said there are many variations available in this program, but respect for 911 is one of the major issues built into this program. Chief DeChant said they also would take the time to educate the patient or refer them back to their primary care physician instead of taking them to the emergency room. This way they can have that impact at the patient level. Councilmember Turner said this was very important and said the nurse triage is another way to get the most appropriate care. He also asked if there were many cases where the triage was not accurate or a two person crew was not enough. Chief Beck said that has not occurred, however, occasionally a caller might update their initial call to get a larger or faster response. He said they have also had occurrences where the low acuity unit was closer to a true emergency, such as a heart attack, and they responded and were on scene before the advance life support team arrived. Chief DeChant said the best benefit is Glendale will be using an ambulance in response City of Glendale Page 5 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1, 2015 to these calls,which does have a computer terminal, so that updated information can be received immediately. Councilmember Turner said Glendale has had some experience in the past with two man crews and asked how this will be different. Chief DeChant said that program was effective for about 10 years and about 6 months ago the department switched to a model where they transfer stable paramedic level patients to ambulance attendants with Southwest Ambulance. The funding that was saved with this change has been put toward the low acuity unit. Councilmember Chavira said this does involve a culture change through education. He agreed there are certain buzz words in a call to determine the level of emergency. Councilmember Aldama asked for a definition of low acuity. Chief Beck said Mesa defined it as non-life threatening and a low threshold of pain or no pain. He said the pain issue is a major issue and shock symptoms can start to occur which will cause a lower call to become a true emergency call. He also explained certain words will cause a higher priority call. He said when in doubt,they will always send a four person unit. Councilmember Aldama asked where chest pain falls and asked if that was low acuity. Chief DeChant said chest pain will always be viewed as high acuity call. He said if there is additional information on the way,they will downgrade as necessary. He said they will always make sure there is an appropriate level of care responding to the call. Mayor Weiers said there are some regular customers who call for emergency services. He asked if this program would service those customers. Chief Beck said Mesa called those value customers. Chief DeChant said those were exactly the type of calls they were looking for. He said they do not want to put a four person unit on that call, taking that unit away from a true emergency,they also want to take the time to educate the caller on what the appropriate level of care might be. Councilmember Turner said Glendale is blessed to now have four emergency rooms in the city. 2. 15-566 COUNCIL ITEM OF SPECIAL INTEREST- DONATION DROP BOXES, Staff Contact: Sam McAllen, Director, Development Services Staff Presenter: Sam McAllen, Director, Development Services Staff Presenter: Jon M. Froke, AICP, Planning Director Mr. McAllen said this is a report on a Council Item of Special Interest from City of Glendale Page 6 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 Councilmember Aldama on February 3, 2015 regarding regulating donating drop boxes throughout the city. Staff researched codes adopted by Surprise, Peoria and Phoenix. Currently, Glendale does not address regular donation drop boxes; however the other cities mentioned do regulate them. Phoenix approved a zoning text amendment in 2013, and Peoria and Surprise also approved zoning text amendments in 2015. Mr. Froke said regulating donation drop boxes is possible through a zoning text amendment(ZTA). He explained the zoning text amendment would potentially provide a definition of donation drop boxes, bins, etc., identify which zoning districts donation bins would be permitted, establish criteria for where donation bins could be located, such as paved surfaces, outside of landscape buffers, outside of required building setbacks, etc., and identify the process in which donation bins would be approved, such as administrative, establishing a process such as a temporary use permit. Mr. McAllen provided a comparison of what Peoria, Phoenix and Surprise have enacted in their zoning ordinance components. He also said each of those cities has modified their ordinance to regulate the placement of the donation drop boxes. He said they have used the temporary use permit for the legal placement of these drop boxes. He explained each city has placed limits on where the boxes can be located,the number of boxes per locate, site specific restrictions, box identification requirements, as well as other performance standards. He also said the three do require proof of permission from the property owner to place a box at the location, and require that boxes be clearly marked to identify owner, contact information, listing of type of materials collected, and temporary use permit number. He said the cities or the property owner also has the ability to remove the box if it is illegally placed. The cities also require the property owner or box owner to remove materials placed outside the box with 24 hours' notice, and also have similar requirements regarding graffiti and damage to the boxes. Mr. McAllen said enforcement of the ordinance is handled by each city's code compliance department. He explained the temporary use permit is tied to a land use and any violations of the ordinance would ultimately be the responsibility of the property owner on which the donation bin has been placed. Mayor Weiers asked for clarification that the property owner is responsible. Mr. McAllen said it is tied to land use and the property owner is responsible. He also said two of the cities have language in their ordinance clarify that the property owner is basically in control of the temporary use permit,so at any time the property owner has the ability to withdraw their support for the temporary use permit. Mayor Weiers said the city wouldn't give permission for that temporary use permit knowing the location if the boxes weren't justified to be there in the first place. Mr. McAllen said that was correct. Mayor Weiers wanted to clarify to make sure the land owner approved the box being on his property and then could get cited after a permit was issued. City of Glendale Page 7 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 Mr. McAllen said in case the box was moved around or in case the conditions around the box were not being maintained,then the city would be asking the property owner to bring their property into compliance with the code. He said ultimately the responsibility does land on the property owner. He said with other cities,the property owner does have to give permission to have those boxes legally on their property initially. Mayor Weiers asked the property owner or the box owner. Mr. McAllen said the property owner. He said the property owner has to provide permission to the box owner to allow the box to be placed on his property. Mayor Weiers asked if a management company was included in the definition of a property owner. Mr. McAllen said the code has not yet been written, but said it is usually the property owner or the person who manages the property. He said a similar definition could be put in the ordinance to reflect that. Mayor Weiers said when he had discussions regarding the boxes, he said managers would give permission without the property owner's knowledge. He said this could create other problems. He also spoke about putting required language on the boxes so the parties would know what their rights are regarding moving the boxes. He said it is important that the land owner does not get fined for doing something they didn't even know was wrong. Mr. McAllen said the ability to remove the box has been adopted by Peoria and Surprise. Councilmember Aldama said by allowing the property owner to hold the permit,they would be able to get the box owner to clean up the property. Mr. McAllen said that was his understanding of the ordinance. Councilmember Aldama said if the operator is not following the rules,then ABC Hardware can pull it, and they won't be fined from the city. Mr. McAllen said that is the way it is drafted in Peoria and Surprise. Mr. Bailey said if there is a citation, it goes against the owner, but the owner has the right to call a towing company to have the box removed. Mr. Froke said if Council approves this item, a zoning text amendment would be prepared,which would take about 9 to 12 months, including a citizen'participation process. He said the three people that attended a public meeting on this issue expressed support. Mayor Weiers asked who was attended the meeting. City of Glendale Page 8 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 Mr. Froke provided the names of those in attendance at the public meeting. Councilmember Sherwood asked what the fees were going to be. Mr. Froke said they would look at the fee schedule, probably in the hundreds of dollars. Councilmember Sherwood said many of these bins are commercial instead of non-profit and asked if there would be a two tier system for fees. Mr. Froke said they would also look at this, speak with stakeholders and see what other cities are doing. Councilmember Tolmachoff asked if the fees would offset the manpower it would take to run this program. Mr. Froke said the answer is probably no, it would not offset staff time. Councilmember Tolmachoff asked if it would take less staff time than a regular application. She said she didn't want to see projects that bring revenue to the city put on hold because of this issue. Mr. Froke said he felt the best route to go would be the same as the three other cities and to process these administratively through a TUP. This would save staff time. Mayor Weiers asked if the applicant could apply electronically. He wanted to make sure this was self-supporting. He was also concerned about the donations to assist airmen and their families. Councilmember Aldama said he supports the company that donates to those causes. He doesn't want to ban the boxes, but does want to have some regulation. He said blight will be cleaned up and encouraged honest business operators to come to the city. He also said this is an additional service to the city and residents. Councilmember Turner said he would like to see what a cost recovery fee model would look like. He also asked for a brief description of the temporary use process. Mr. Froke said the city does not have a temporary use permit process. He envisioned something not quite over the counter, but certainly handled administratively. He thought a time frame would be a couple of weeks. Councilmember Turner had questions about notarizing the documents, as it would take the process out of being strictly electronic. He wanted staff to look at whether notarization should be required for this process. Councilmember Aldama asked if the three cities previously discuss require notarization. Mr. McAllen Surprise and Peoria are working through their process right now. The City of Glendale Page 9 Printed on 9/14/2015 City Council Workshop Meeting Minutes-Final September 1,2015 processes are new for them, and they need to have some sort of proof that the owner has granted permission for the box to be on the property. Mayor Welers spoke with the attorney who was interested in this issue and said piecemeal of this issue city by city didnt make much sense. He asked why they werent pushing this item as statewide legislation. Mr. McAllen asked for direction from Council to begin work on the zoning text amendment. Mayor Weiers said there seemed to be consensus to proceed. CITY MANAGER'S REPORT City Manager Bowers had nothing to report. CITY ATTORNEYS REPORT City Attorney Bailey had nothing to report. COUNCIL ITEMS OF SPECIAL INTEREST Councilmember Aldama said the city has done its work on displaying diversity and requested taking a look at establishing a commission on diversity. 1. CALL TO ENTER INTO EXECUTIVE SESSION The motion was made by Councilmember Sherwood, and seconded by Councilmember Chavira,to enter into Executive Session. The motion carried by the following vote: Aye: 7 MayurYVeiem. YiceMoyorHugh. Counci|memberAldoma. CounoUmembarChmvinm. Cnunui|memborGhmnwood. Counci|membarTo|machofCundCuund/mombarTumor EXECUTIVE SESSION The City Council entered into Executive Session at 2:45 p.m. City of Glendale Page 10 Printed vomvwzom