commentary LEARNING FROM PAST SUCCESSES
BY CARLOS R. HAMILTON JR., MD In the past, private sources provided emer- gency medical response services in large urban areas, such as Houston. In some cases, local funeral parlors owned and staffed ambulances. Their responses were often erratic and too costly for those requiring the services. With the support of the Harris Coun- ty Medical Society (HCMS) and our city’s hospitals and trauma centers, those services relocated to the Hous- ton Fire Department (HFD). A highly trained cadre of paramed-
ics and emergency medical techni- cians (EMTs), working under the di- rection of full-time physicians with expertise in emergency medicine, saved thousands of lives. By 1999, their response times and expert medical care set new standards for emergency care in the nation. The Houston Emer- gency Medical Services (EMS) had a 17-percent recovery rate for patients suffering cardiac arrest compared to the average of less than 5 percent in most big cities. The city could be justly proud of its EMS and trauma centers. In May 1999, HCMS and the medi-
cal community received an early morning phone call requesting a
meeting of the society’s leadership with then-Houston Fire Chief Les- ter Tyra. He said a lawsuit had been filed against the City of Houston alleg- ing violations of the Fair Labor Stan- dards Act of 1938 (FLSA) with respect to firefighters assigned to EMS. We learned the potential claim could be as high as $60 million. FLSA was the depression-era leg-
islation that required time-and-a-half pay for overtime hours worked. Fire- fighters and some other public em- ployees could be exempt from this restriction if their union contracts supported the revised work schedules. FLSA didn’t specify that firefighters involved in services other than fire suppression, or EMS duties, would qualify for this exemption, hence the lawsuit. The City of Houston Legal De- partment determined the city should change the workweek rules for HFD EMS personnel. The city’s mayor di- rected Chief Tyra and David Persse, MD, the highly regarded EMS medi- cal director, to immediately imple- ment the changes, aimed at reducing the number of uninterrupted off-days expected by EMTs. Chief Tyra and
Dr. Persse were certain many would request to transfer out of EMS and to focus on full-time fire suppression. This would severely impair EMS staff- ing and likely would disrupt the qual- ity of care. The lawsuit had been filed in a
federal district court in Houston, and Chief Tyra asked HCMS to file an am- icus brief expressing concern about the public health implications of such a ruling and policy change for the HFD. Having no idea how to prepare such a petition and having no knowl- edge of public labor law, I called Jona- than Day, who had served as Houston city attorney for a prior administra- tion. Within a few days, he referred us to a colleague, Matthew Hoag, an expert in federal labor law. The HFD firefighters union strong-
ly supported the status quo and appre- ciated HCMS’ support. Chief Tyra also informed us of legislation that had been filed by Rep. Robert L. Ehrlich Jr. (R-Md.) to amend the FLSA by in- cluding EMS workers who were a part of the fire department in the same ex- emptions as those personnel involved in fire suppression. Mr. Hoag also pointed out that an
official position on this matter by the firefighters union would preclude any future claims by the plaintiffs, as such an agreement had precedence over ei- ther state or federal regulations.
The medical community … was part of the solution to a critical health care issue.
July 2015 TEXAS MEDICINE 11
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