Fallout from “Gerbergate” Reveals Significant Public Safety Concerns

When my youngest daughter was 7 months old she started choking.  My wife, who is a trained medical professional as a registered nurse, could not help her dislodge the obstruction and called 911.  I am deeply grateful for the first responders from Torrance Fire Department (TFD) and Gerber ambulance that arrived that day to help my family.  All of our first responders do deserve a lot of credit and gratitude for how they serve our community each and every day.  That said, it was a terrifying experience for our family, and in those situations you realize just how much every second counts.

I had always assumed, as I would imagine so do most of the residents of Torrance, that when you call 911 because your baby girl is choking that the ambulance is coming lights blazing to render aid.  That’s why I was absolutely shocked to recently discover that is not necessarily the case in Torrance.

The patient record for my daughter reveals that Gerber ambulance had a box on the form indicating whether they had to stage at the incident. Staging is when Gerber would park a block or two away from the scene awaiting for the TFD to arrive. The form also indicates whether Gerber was called to the scene “Code 2” (no lights or sirens – obeying all traffic laws) or “Code 3” (lights and sirens). Typically, Code 2 is designated for non-life threatening events while Code 3 is for life threatening situations.  In Torrance, however, it’s standard for the transport provider to be called Code 2 irrespective of the life threatening nature of the call.

In my daughter’s case the ambulance did not stage as they arrived after TFD, but as is the norm they were called Code 2 to the scene.  Thank God my daughter is fine and all turned out okay for us, but I am troubled to think that in the panic of that situation that an ambulance could have been sitting around the corner waiting for TFD to arrive, or that life saving treatment could have arrived sooner had the ambulance been called Code 3 instead of Code 2.

I raised some of these issues that I believe delay patient emergency care at the Council meeting last week and I was very pleased to receive a direct response from the City Clerk’s office this morning. I commend City Council and staff for providing a timely and transparent response to my inquiry. The City response found here stated that the staging practice was discontinued several years ago in an effort to “improve our overall service to the community.” I am left wondering why this seemingly misguided policy was ever standard practice, but I am pleased to hear it is no longer in effect. In the same response, however, the City did confirm that the practice of calling the transport ambulance Code 2 remains in place.

I believe this presents a significant public safety concern. Yes, the TFD responds Code 3 to all emergencies, but depending on the location of the emergency it’s still possible that the ambulance transport provider could get to the scene more quickly due to their initial proximity to the incident.  In fact, it was not uncommon for the Gerber ambulances to arrive first on scene even though they responded Code 2.  In those situations, a Code 2 response by the transport provider inhibits the patient from being reached by trained first responders as quickly as they otherwise could be if the ambulance were to be called Code 3.

In conversations with Gerber personnel, some have revealed that the TFD was sometimes slow to call them thereby delaying their response to the scene.  If this were true, this practice could also delay patient care.

I can’t speak for all other residents of Torrance, but I know that if the same incident happened again with my daughter, or any other life threatening incident occurred with someone I care about, that I would want the nearest trained first responders coming as quickly as they could, whether they were TFD personnel or a private transport company such as Gerber or McCormick.

In raising this issue with the Council, I remember that many of them promised to make public safety their top priority during the recent election. As evidence of that I recall receiving a mailer from one of the Public Safety Departments advocating on behalf of their endorsed candidates. That mailer, which I kept, included the following statements:

“Pat Furey knows that public safety is of the utmost importance”

“Heidi Ashcraft is dedicated to ensure the safety and security of our residents”

“Keeping the citizens of Torrance safe is Geoff’s first priority”

“A vote for Tim is a vote for public safety”

“Mike will keep public safety his top priority and give first responders the tools needed to keep Torrance safe”

Based on these statements, I am hopeful that the current Council will be mindful of their commitment to public safety they made during the past election and do what they can to correct what appears to be a wrongheaded policy that is not in the best interests of the public.  In an emergency every second counts, and if there is anything we can do to get aid to those in need more quickly, then we should do it.  After all, for someone it could literally mean the difference between life and death.

“Gerbergate” Highlights Need for Council to Exercise Proper Judgment and not Blindly Trust Staff Recommendation

In approving the recent emergency services award to McCormick ambulance Mayor Furey and several others on the Council based their decision on the need to rely on City Staff as they are the subject matter experts.  Mayor Furey even admitted that he could try and read a proposal but would have “no idea of the content.”  In contrast, Councilmember Ashcraft – who opposed the award to McCormick – noted that the “buck stops here” and questioned why the City would even need a Council if all they did was rely on staff recommendation.  Ashcraft is right of course and nothing makes that more apparent than a close examination of the complaints filed by Torrance Fire Department (TFD) against Gerber ambulance.

I took Mayor Furey up on his invitation made at the last Council meeting for the public to stop by the City Clerk’s office and examine the complaints TFD made against Gerber.  These complaints are relevant as several members of the Council have repeatedly blasted Gerber and used their supposed poor performance as justification for their decision to award the contract to McCormick.  Councilmember Rizzo even went so far as to say that Gerber’s continued operations would have exposed the City to lawsuits.  He was quoted as saying, “Gerber had issues, was deficient in its contract. To have Gerber continue to provide [services] would have opened us to huge liability”.

It is true that TFD submitted two notices of default against Gerber.  The first was on June 17, 2013 and the second was submitted February 4, 2014.  It should be noted here, however, that the contract included a Termination of Agreement Clause that allowed the City to terminate the contract for no reason as long as they gave 30 days notice.  The same Clause also allowed the City to terminate the contract immediately upon default or breach by the contractor.  Thus, if the City was concerned about liability as stated by Rizzo, then how come the City did not exercise its right under this Clause and continued to allow Gerber to operate for nearly 19 months after the original notice of default?  Given this context, Rizzo’s statements about liability concerns make very little sense.

So what did TFD actually allege in the notices of default.  According to TFD, Gerber’s primary sins were 1) inability to meet the required response time of 8 minutes (92%) of the time, 2) failure of their communication system to integrate with the City’s Computer-Aided Dispatch System (CAD), and 3) failure to dedicate a minimum of 16 ambulances maintained in good condition to answer TFD calls during the day and 8 ambulances at night.

Was Gerber actually in default to some of these requirements?  The answer is yes.  Gerber won’t deny it.  In fact, Gerber will admit to being in default ever since they signed the initial contract roughly 20 years ago.  Gerber’s continuous failure to meet the requirements of the contract does beg the question, if the City let Gerber off the hook for so long why did their non-compliance suddenly become such an issue in June of 2013 just about the same time now Mayor Furey was kicking off his mayoral campaign?  For insight, let’s examine the claims further.

Allegation One – Response Times

Two of the three evaluated bidders admitted they could not meet this requirement.  One of those bidders even mentioned in their proposal that “the standard response time approved by LA County EMS was 8 minutes and 59 seconds for a code 3 (lights and sirens) response (90%) of the time.”

Gerber is almost exclusively called Code 2 (no lights and sirens obeying all traffic laws).  They also claim that they often have to wait on the dispatch line as precious seconds tick away after an emergency call has come in waiting for TFD to give them the approval to move out.  Due to this, meeting the 8 minute response is a challenge.  Nevertheless, Gerber did have high numbers.  The scores reported by TFD said they responded within the 8 minutes in the high 80’s to low 90’s percent – very close to the (92%) requirement.

McCormick differentiated itself by promising they could meet the response time requirement.  They provided no evidence, however, that they have actually ever met the requirement at a Code 2 response in any of their other contracts.  Their proposal also stated that the majority of the ambulances they would dedicate to TFD would be stationed at locations outside the City of Torrance in places like Redondo Beach, Gardena, Hawthorne, Lomita, and Palos Verdes.  Obviously, I am no expert, but if McCormick plans to bring ambulances from outside the City, I have serious doubts they can meet the 8 minute requirement at a Code 2 response.  That’s definitely something to look for going forward.

Allegation Two – Systems Integration       

In reference to this allegation, Councilman Weidemen was quoted as saying, “If the customer says ‘You have to integrate with our systems as part of the contract,’ you have to do it”.  So why didn’t Gerber?

Again, the TFD didn’t submit a default notice on this requirement until June 2013.  As mandated by TFD, Gerber operates their system using Zoll software.  TFD operates their system with Spillman software.  Gerber, TFD, and the software companies engaged in lengthy negotiations with the result being that Spillman agreed to allow the requested interface as long as Gerber purchased a $30,000 modification to their software agreement.

Spillman submitted that purchase order to Gerber in early 2014.  Knowing that the contract was going to be re-bid, Gerber decided to wait for the outcome of the new contract before deciding whether to purchase the software modification.  Gerber’s position on this sounds reasonable and given the above you have to wonder why Weidemen appeared so hard-nosed about this requirement.

McCormick also uses Zoll.  As part of their proposal, they promised that the required interface would be implemented between McCormick’s Zoll software and the City’s Spillman upon award of the contract.  Whether McCormick has completed this interface as promised is another thing to look for.

Allegation Three – Number of Dedicated Rigs

This requirement is where I think the difference between government and private industry creates natural tension.  TFD sees this as a black and white requirement, for private industry it is more an art than a science.  Gerber has to remain profitable, TFD doesn’t.  To a certain extent, Gerber has to try and match their number of crews to the amount of calls they get.  Gerber simply can’t survive if it has crews and ambulances sitting throughout Torrance not being utilized.  TFD just wants them to meet a number of dedicated rigs whether they are used or not.  Gerber tries to meet the number, but it appears they play it pretty close to the line.

What should really matter here are response times and Gerber has proven to do a pretty good job of that.  One reason for this is because Gerber maintains a competitive advantage as they also have several units operating throughout the City conducting what they call Inter-Facility Transfers (ITF’s) from local hospitals.  Thus, if all rigs dedicated to TFD are in use, they can pull from other units assigned to ITF’s to help.

A concern about McCormick is that they don’t have the pool of available back-up ambulances that Gerber has operating within the City.  If McCormick needs rigs beyond the 5 they will have dedicated to TFD, they will likely have to come from outlying cities at a very significant increase in response times.  That’s something else to watch.

Formal Complaints-Specific Instances Worthy of Note

The City provided documentation about several minor complaints with regard to the maintenance of Gerber ambulances such as faulty lighting, air conditioning, reclining seats, tire tread ware, etc.  All of these seemed to be quickly taken care of by Gerber.  Three of the specific complaints, however, do seem worthy of a more detailed discussion.

May 2013 Incident

In a 36 minute period, there were 4 emergency responses requiring 7 Gerber ambulances.  Gerber only had 6 immediately available versus the 8 supposed to be dedicated per the contract and had to place a call to their back-up provider for what they claim was the first time in their 20 year history under the contract.  Knowing it would take awhile for the back-up provider to respond, and not having ever used the provider before, a Gerber supervisor working at dispatch decided to take an ambulance to the scene so TFD could use the equipment in the rig if necessary and to ensure the back-up provider arrived.

When the supervisor arrived on scene, they called the back-up service who gave them an ETA of 20 minutes.  The supervisor couldn’t transport the patient in the rig, because there was no attendant to care for the patient while the supervisor drove.  Not wanting to delay patient transport, TFD decided to accompany the Gerber supervisor to Little Company of Mary and not wait for the back-up service.

Afterward, TFD filed a formal complaint with the LA County Department of Health against Gerber for transporting a patient with only a driver and not an attendant as is required per regulations.  TFD also cited this instance to Gerber as failure to meet the required number of rigs dedicated to TFD and response times.  The complaint about the number of rigs and response times appears valid, but filing a formal complaint with LA County Health for transporting without an attendant seemed like overkill.  After all, the Gerber employee could have just insisted they wait for the back-up provider.

Other complaints were far less substantial.

September 25, 2013 Incident

I found this incident in particular very revealing as to TFD’s attitude toward Gerber employees.  The subject of the complaint was Gerber Operating Outside Job Description. In that incident, the Fire Captain complained that when they arrived on scene that the “Gerber attendant was literally racing into the structure.” Upon entering the room and seeing that the Gerber employee was assessing the patient, the Captain “informed him [the Gerber employee] that his role is not to race in and start an assessment before [TFD] arrived and that his job description is transportation of the patient.”

The Captain then went on to say that “these actions seem to be happening with increasing frequency,” and that “for some reason they [Gerber employees] seem to think [that] without TFD on scene permission, that they can start an assessment [on the patient].  So essentially, the Fire Captain filed a formal complaint against Gerber because one of their trained EMT’s arrived on scene before TFD and ran to assess the patient.  Are trained Gerber EMT’s not to assess patients without TFD supervision?  I don’t get this one at all.

December 23, 2013 Incident

In this complaint TFD responded to a report of a possible psych patient.  Upon arriving on scene they found the patient very upset and trying to leave a rehabilitation center where she had been staying while recovering from a knee fracture.  Upon calming her down, they learned that she wanted to leave the rehabilitation center and return home.  TFD instructed Gerber to take her home.  According to TFD, Gerber changed their mind in transit and determined they should take the patient to Little Company of Mary ER instead of to her home. TFD filed a complaint against Gerber claiming that transporting the patient to the hospital versus her home amounted to kidnapping.  Kidnapping, really?

The primary interface between Gerber and the TFD and the person that brought forward all the complaints against Gerber is TFD employee Captain Hudson.  Captain Hudson also served as one of the 4 City employees on the evaluation committee for the proposals.  Given that Captain Hudson had such close interactions with Gerber and considering the questionable nature of some of these complaints, it does raise questions as to whether Captain Hudson provided an unbiased voice and whether the Council should have trusted as much as they did in the so-called experts.   Interestingly, rumors are circulating within the community that Captain Hudson was put on suspension with pay about two weeks ago for an undisclosed disciplinary action.

A Letter from the Gerbers

Dear Torrance Community,

As our 20 year stretch of serving the citizens of Torrance through responding with the 911 calls comes to an end, our hearts are breaking and our guts are wrenching! I personally know that we at Gerber gave this city the highest priority! Our focus was only on you 24-7.   This seriously worries me with McCormick being that they cover many cities and Torrance will not be their priority! They are not giving you as many ambulances in the city- they are spread out with their other contracts miles away. We gave you 23. They are giving you 5! They contract with LA County which is part of PV. Why did it take them 30 min to get to an injured PV student? That’s why the high school demanded us to attend all football games because McCormick was unreliable! I worry about my friends and family in Torrance!

We have been beat down with false allegations for years! Our training is superior to all others!! We are given the highest ratings from CHP for vehicle inspections and with County EMS! We have been told to operate (not in the best interest of the patient!) by the rules of TFD. We follow those rules and then are told we are “noncompliant”! We spent hundreds of thousands of $$$, to buy their specified equipment, then we’re told to never install it! Their software company would not cooperate with us to link with our system (the one they told us to buy), so we were blamed for that! They told us to purchase a model of rigs that didn’t exist!! That was also our fault!! Our biggest fault was that we were getting to the scene to early!! Yes- we were told that!!

We have done everything to work with TFD but there are people in high positions with their own agenda. Councilman Rizzo commended them but if he knew how they constantly put the citizens at risk for their personal gains- he would handcuff them! We have been told by an operational fire chief (“it’s not about patient care, it’s about the money!) He also told us not to use the closest rig to the scene.

We have fought against these issues and tried to operate with putting the patient first. This is why we have been targeted for years and it’s a crying shame!

The only way McCormick could get us out was to be Dirty!! The guy who runs them is not a medical professional, he is a accountant! He threw money at the fire union and for the candidates who supported the fire union. Well, we never played that game and continued to donate and give back to the city by helping out endless local and non-local charities.

We are so proud of our employees and their exceptional professionalism during the trials and tribulations that TFD has put them through. They all know that they are the best for this city, and that this bid process was tainted. They are the true backbone that has brought the highest level of patient care first and foremost and we have the utmost respect and admiration for them.

Again, I can’t and won’t play those games and now it’s just disgusting that it went down this way!   We here at Gerber are very proud of what we have accomplished over the years and appreciate all the support, letters, and phone calls recently and throughout the years. I have lifelong memories. We will carry on with other transports, but this whole process has changed our outlook on many people and we have to move past the anger and disbelief! We just can’t believe that after all these years of being all encompassed and completely loyal to the city and so involved with many charitable events, that it will definitely be a hole in our life. That of course doesn’t mean that we have stopped giving (Bob just wrote a check today to a charitable organization).

Thank you again Torrance residents for your caring words and concern. Please don’t lose your concern for this city and the activism that is needed now.

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