By Ian Bauer
The Honolulu Star-Advertiser
HONOLULU 鈥� Questions over how effectively city Emergency Services Director-designate Dr. James Ireland leads the agency鈥檚 Emergency Medical Services division also prompted the City Council鈥檚 Public Safety Committee last week to defer a vote on Ireland鈥檚 future tenure in that post.
Ireland, like other department heads who comprise the mayor鈥檚 executive Cabinet, is seeking reinstatement.
But in recent months, allegations have arisen among the ranks of city paramedics regarding unit closures鈥攚hen an ambulance is not available to respond to 911 calls for service.
To seek relief, paramedics backed recently adopted Council Resolution 24-272, which urges the city administration to study whether EMS should be merged into the Honolulu Fire Department. The integration, according to the resolution, 鈥渃ould prove over time to be fiscally responsible, while also providing better care through decreased response times and an increase in the number of available units and personnel.鈥�
But during the Thursday committee meeting, Ireland defended his record for a position he鈥檚 held since Mayor Rick Blangiardi鈥檚 first term began in 2021.
鈥淲hen I came into this position four years ago, the challenges to EMS were essentially staffing, budget 鈥� and (unit ) closures, 鈥� Ireland said.
He claimed progress made involved 2023 data, which shows 鈥渁n 11.4 % daily ambulance closure rate, and very roughly, with 21 ambulances, that comes to about two per day.鈥�
鈥淪o when I came in, one of the first things I did was (contract ) with a private ambulance to supplement our operations to mitigate that effect of two city ambulances being down, 鈥� he said. 鈥淪o we brought in initially two ambulances a day and later, three ambulances a day.鈥�
But for those who submitted written testimony鈥攐f which 12 opposed Ireland鈥檚 directorship, with none in support鈥攐r for those who verbally testified on the matter, all refuted Ireland鈥檚 claims of progress or his reappointment to lead EMS.
鈥淭he dedicated men and women who serve in our communities are highly committed to their roles and of putting their lives on the line to ensure public safety, 鈥� said Laurie Grace, a former 33-year city paramedic. 鈥淗owever, even the skilled and most dedicated need support or the productivity and effectiveness decline.鈥�
鈥淭hey deserve better, and so do the people of Honolulu, 鈥� she added.
鈥淭here has been (a ) continued and clear lack of commitment to and prioritization of the recruitment and retention of essential EMS personnel, 鈥� she said. 鈥淢oreover, the prioritization of personal agendas over the core mission of EMS has caused morale to plummet in their tenure. Personnel are actively seeking employment elsewhere due to the toxic work environment and favoritism.鈥�
Grace also claimed the dire situation caused EMS workers to 鈥渜uiet quit 鈥濃�攚hereby city employees do only the bare minimum while working on the job鈥攁nd 鈥渁 continued exodus of skilled personnel to better career opportunities.鈥� She also noted many in EMS were afraid to speak out on the problems in the department for fear of retaliation.
Jonathan Lee, a retired 33-year city EMT /paramedic, agreed.
鈥淚n my time in EMS, I鈥檝e seen good leadership, good administration, I鈥檝e seen average and I鈥檝e seen poor, 鈥� Lee told the committee. 鈥淎nd right now this is the worst it鈥檚 ever been. Dr. Ireland puts up stats and numbers; on paper it looks good. The reality is that鈥檚 not happening in the field.鈥�
Lee added, 鈥淚t looks like every unit is open, but there could be three or four of those units that are basic life support, 鈥� versus advanced life support units, which deal with more critical injuries.
鈥淛ames Ireland has had four years to turn this department around and move it forward, and the only thing he鈥檚 done is move it backwards and laterally, 鈥� he said. 鈥淗e has shown little to no leadership ability.鈥�
鈥淭here鈥檚 definitely a 鈥榥o-confidence鈥� feeling within the field personnel. 鈥� It鈥檚 time for HESD to have new leadership with a clear vision, feasible plans to move forward, that the entire department understands where it鈥檚 going and how it鈥檚 going to get there, 鈥� Lee added.
Eddie Fujioka, a 45-year EMS district chief who鈥檚 now retired, also testified.
鈥淚鈥檝e never testified against a director before, but I felt that it was my responsibility to come forward to oppose his nomination, 鈥� he said.
He said EMS has not progressed forward but that 鈥渆veryone else has鈥攑olice and fire.鈥�
鈥淭here鈥檚 no strategic action plan that employees can look at. No one knows what direction that the department is going, 鈥� Fujioka said, adding when he asked an employee about an overall plan at EMS, 鈥淭hey said, 鈥業t鈥檚 top secret.鈥欌��
鈥淚 said, 鈥榃hat do you mean it鈥檚 top secret ?鈥� They said that it鈥檚 so top secret that Dr. Ireland and Deputy (Director Ian ) Santee don鈥檛 even know what it is, 鈥� Fuji Oka related. 鈥淎nd that鈥檚 a clear indication that morale is really bad at EMS.鈥�
Saying those who spoke in opposition to his EMS leadership were ex-employees, Ireland said the overall process to improve EMS鈥� current 21-ambulance fleet service has taken, and will take, time to show results.
鈥淚 think I鈥檝e said at previous hearings on the (EMS ) budget, and just in general, that we need to get to 30 ambulances in Honolulu, 鈥� he said. 鈥淏ut that鈥檚 incremental, with time. They鈥檙e funded incrementally, and you have to hire incrementally because we don鈥檛 want to generate these big vacancy holes.鈥�
鈥淎nd I think I said four years ago that鈥檚 an eight-to 10-year process, 鈥� Ireland said. 鈥淲e did add two ambulances last year, and I think we鈥檙e going to propose to add more next year鈥攐ne or more next year鈥攕o that is an incremental process that does drive up costs, but at the same time we鈥檙e responding to more calls, which generate more revenue.鈥�
He asserted EMS鈥� acquisition of the optimum number of 30 ambulances would likely coincide with the end of the mayor鈥檚 term鈥攐r by the year 2028.
Other questions about Ireland linger, however.
Citing one testifier鈥檚 written comments, Council member Andria Tupola asked Ireland, a physician, whether he鈥檇 written personal doctor鈥檚 notes 鈥渇or any employees 鈥� to allegedly allow them 鈥漷o manipulate leave policies and evade accountability.鈥�
鈥淚 own a medical practice鈥擨 own a few of them; one of them I don鈥檛 work at, but I own it鈥攁nd there are people who work at the city, and state and even elected officials who are patients there, 鈥� Ireland replied. 鈥淎nd they do get notes, technically from physicians who work for me, but I have nothing to do with their care.鈥�
He said he also does 鈥渃ontract work 鈥� one day a week at the Waianae Coast Comprehensive Health Center 鈥渂ecause there鈥檚 a huge doctor shortage on the West side.鈥�
鈥淎gain, I鈥檓 contracted with them. I don鈥檛 get anything from those patients in Waianae, but I do do that, 鈥� he explained. 鈥淎nd if it鈥檚 a patient who needs a note, just in general, I give them a note.鈥�
鈥淲hether or not they work at the city, I try not to see anybody who directly works for me. And I don鈥檛 think I do, but people who are employed by me, or my colleagues at Waianae Comp, may write notes for people who work in our department, 鈥� he added. 鈥淚 really just stay clear of that relationship, because it鈥檚 their business between them and their doctor.鈥�
In December the Council adopted Val Okimoto鈥檚 Resolution 272, which asks the city administration to establish a task force to explore whether the paramedic program should be integrated into HFD.
Asked about the status of the city鈥檚 evaluation of a possible first-responder merger, city Deputy Managing Director Krishna Jaya Ram told the Council that 鈥渨e鈥檙e very much in the beginning stages of that process.鈥�
鈥淭hat will be something that we鈥檒l be mapping out and thinking through over the course of the next fiscal year or so, 鈥� he said. 鈥淎ll of these types of considerations are very complex. I don鈥檛 see us coming back within the next six months, certainly 鈥� in a conclusion of that matter.鈥�
Ultimately, Okimoto, chair of the Public Safety Committee, postponed Ireland鈥檚 recommended nomination as EMS director to a date to be determined.
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