MedStar says response times to critical emergency calls in Fort Worth have been reduced after the first phase of a reprioritization plan was put in place. But Fort Worth’s firefighter union says the plan is leaving residents without the emergency care they need.
On March 1, MedStar narrowed its definitions of a priority 1 call to reduce the number of non-life threatening calls to ensure “the sickest patients are given the highest priority,” according to an informal report presented to City Council Tuesday. The report touted quicker response times and fewer fire department dispatches as a result of that reprioritization.
“The reduction in calls that require a Fire Department response creates capacity for fire companies to engage in other activities,” the informal report states.
The union representing Fort Worth firefighters disagrees. In an email to council members Monday, Sherman Dedrick, director of governmental affairs for IAFF Local 440, raised concerns about the consequences of such a reprioritization effort.
“On paper such sleight-of-hand accounting has immediately decreased our city’s ‘reported’ EMS calls; and arguably improved EMS response times,” he wrote. “In reality, the consequences of this on citizen health are quite grim.”
He cited 11 EMS calls for service over the past two weeks that were either disregarded or had their priority level lowered, with negative results.
The fire department was dispatched to one call, on March 26, for an overdose, only for MedStar to cancel the dispatch before they arrived. According to records provided by IAFF 440 to City Council, the firefighters were told that the resident canceled their EMS call. A nearby fire engine decided to go to the scene anyways, and when they arrived, the resident said they didn’t cancel the call.
In another instance on April 2, MedStar initially dispatched the fire department to a stabbing incident, and then reprioritized it so that a fire response was not required. Fire staff decided to go to the scene despite the cancellation, where they found police officers trying to put tourniquets on the victim. The fire department took over helping the victim until MedStar arrived, and helped in the ambulance on the way to the hospital.
“In short, MedStar’s ‘reprioritizations proposal’ is a smoke screen to cover up their management FAILURE over the past decade to provide ambulances in a timely fashion,” Dedrick wrote in his email to council members.
‘It’s about patient care’
Ken Simpson, chief executive officer of MedStar, told council members that while MedStar is committed to working through concerns, the reprioritization plan is in response to long-held concerns about how resources are best used.
“We would get a lot of concerns to the other side of it, on the number of low acuity calls that resources were being sent to and how that’s not necessarily the best utilization of those resources,” he said.
Several council members expressed uneasiness over the reprioritization plan. District 7 council member Leonard Firestone said he was primarily concerned about EMS relying on the words of a caller, who might be panicked and not speaking clearly, to determine the priority level.
District 5 council member Gyna Bivens brought up the prompt fire/paramedic response to her own stroke, and how thankful she was for their urgency.
“Fire is always first, always has been,” she said. “People know they can depend on fire to get there. It seems like there’s a battle between fire and MedStar.”
Mayor Mattie Parker requested that city staff prepare another presentation, after more data has been collected on the reprioritization’s impacts.
“There’s a lot of concern over how we interface between our fire department and MedStar,” she said. “At the end of the day, it’s about patient care. And everybody agrees with that… You want to have optimal patient care no matter what happens. So let’s get to that place.”
City management, fire union disagree on path forward
MedStar’s reprioritization plan comes as fire union representatives jostle with city management about the fire department’s staffing levels. Two separate studies commissioned by the city and the fire union affirmed the need for more fire department staff to ensure prompt response times across Fort Worth, one of the fastest growing cities in the United States.
City Council created the Ad Hoc Fire Staffing Committee to discuss these findings and present budget recommendations for 2024. So far, seven months after the first study was completed, the committee has only met twice. City budget planning generally begins in late spring to early summer, putting the committee on a tight deadline to turn around its recommendations.
“I’ll remind people we’re still in the middle of, and council member Flores has graciously chaired this effort, (figuring out) staffing as we prepare for the next budget cycle,” Parker said. “And that is really where a lot of these tough decisions need to be embedded. But this council, they want to be just as involved in making sure we’re prepared for the next fiscal year.”
The staffing studies also highlighted concerns around the financial sustainability of the MedStar paramedic system, formally known as Metropolitan Area EMS Authority.
A 2022 presentation from MedStar showed the cost per patient has been rising steadily since 2020, while the revenue per patient continues to drop. The organization projects that costs per patient will be higher than revenue per patient for at least the next several years.
The CityGate study, commissioned by the city, mentioned MedStar’s reprioritization plan and gave initial support to more narrowly tailoring what counts as a priority 1 call. However, CityGate said such reprioritization should not come at the cost of longer wait times.
“Just like fire stations in every neighborhood, that provide a layer of equitable access to a prompt first response, so should be the access to prompt paramedic care, whether used once a day or once a week,” the study’s authors wrote.
Fire Chief Jim Davis told council members that he is keeping track of potential concerns around the reprioritization plan. If concerns are brought up by specific fire engines, he said, they are forwarded to the MedStar System Review Committee.
District 9 council member Elizabeth Beck asked city staff to provide more information on what exactly the reprioritization plan means for the fire department’s own response choices.
“I’d like to know to what extent you’re tied to MedStar,” she said. “So if MedStar has this new prioritization, are we bound by that or can the Fort Worth Fire Department say, ‘This is your prioritization, but we choose to continue this particular band of calls.’”
Emily Wolf is a government accountability reporter for the Fort Worth Report. Contact her at firstname.lastname@example.org or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.