* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.
          [00:00:02]
          SAFETY COMMITTEE MEETING ON THIS DAY. 
          WELCOME EVERYONE. 
          WE'RE GONNA GO AHEAD AND GET THANK YOU. 
          CALL TO ORDER. 
          HI. 
          THANK YOU FOR EVERYBODY FOR COMING TONIGHT TO OUR PUBLIC SAFETY MEETING. 
          I HAVE THE GREAT HONOR OF BEING THE NEW CHAIRWOMAN TO THE PUBLIC SAFETY COMMITTEE. 
          . 
          THANK YOU. 
          SO BEAR WITH ME AS, AS I, UH, WE GET THROUGH THIS. 
          UM, SO I'LL ASK THE CLERK TO PLEASE CALL ROLL HERE, HERE, HERE. 
          AND CHAIR HERE. 
          THANK YOU. 
          TONIGHT, UH, WE ARE FOCUSING ON MENTAL HEALTH. 
          THANK YOU EVERYBODY FOR BEING HERE, UM, TO WHAT I'M CALLING THE PUBLIC SAFETY ROAD SHOW. 
          SO WE'RE VERY GRATEFUL TO BE HOSTED BY OUR ESTEEMED COLLEAGUE, MY ESTEEMED COLLEAGUE, COUNCILWOMAN SULLIVAN, UH, ANDREW SULLIVAN IN DISTRICT TWO. 
          UM, WE'RE GONNA FOCUS ON MENTAL HEALTH TONIGHT, AND I'M LOOKING FORWARD TO BOTH PRESENTATIONS. 
          I'M SORRY. 
          FIRST ITEM ON THE AGENDA. 
          OH, THE FIRST ITEM ON 
          [1. 20-1370 Approval of the November 19, 2019, Public Safety Committee Meeting Minutes]
THE AGENDA WILL BE, UM, APPROVAL OF THE NOVEMBER 19TH, 2019 PUBLIC SAFETY COMMITTEE MEETING MINUTES. 
          MOTION TO APPROVE. 
          UH, MOTION. 
          I'M SORRY. 
          I'LL SECOND. 
          OKAY. 
          . 
          UH, ALL THOSE IN FAVOR SAY AYE. 
          AYE. 
          OPPOSED? MOTION CARRIES. 
          UH, FOR THOSE OF YOU WHO ARE HERE TO SPEAK AS CITIZENS TO BE HEARD, PLEASE REMEMBER TO KEEP THE REMARKS TO THE SUBJECT MATTER FOR THE ITEMS POSTED. 
          AND, UM, SHOULD YOU NEED TO SPEAK ON OTHER TOPICS, WE INVITE YOU TO ATTEND OUR CITY COUNCIL, BE SESSION CITIZENS TO BE HEARD. 
          [Public Comments]
AT THIS TIME, WE'RE GONNA GO AHEAD AND TAKE, UM, THE, UH, OUR CITIZENS FOR PUBLIC COMMENT. 
          I'M GONNA START WITH, UH, BEN LA ROSA UHHUH , HOW MANY MINUTES? OH, THREE. 
          GIMME THREE MINUTES, PLEASE, BEN. 
          OKAY. 
          THANK YOU, SIR. 
          THIS IS YOUR OPPORTUNITY, THOUGH. 
          SO, UM, DO YOU MEAN FOR NOW, FOR TONIGHT, OR, OKAY. 
          THIS IS YOUR OPPORTUNITY TO SPEAK THOUGH, IF YOU WANT TO. 
          OKAY. 
          I JUST WANNA MAKE SURE. 
          NO GOING, NO. 
          UM, OH, I SEE TED BONNET. 
          WE INVITE YOU TO SPEAK MR. BONNET. 
          HERE'S LOT THINGS THAT I WANTED TO DISCUSS IN THE AGENDA TONIGHT. 
          IT'S BEEN CHANGED OR POSTPONED, SO I WAS JUST IN FAVOR OF, UH, YOU KNOW, PEOPLE LEARNING HOW TO SHOOT AND GOING OUT AND EXERCISING THEIR SECOND AMENDMENT RIGHTS AND GET PROPER TRAINING AND EVERYTHING. 
          AND, UH, I NOTICED THERE'S SOME PLACES HERE ON CAMPUS THAT APPARENTLY YOU CAN CARRY AND THEY'VE GOT CERTAIN BUILDINGS WHERE YOU CAN, OKAY. 
          AND I'M CERTAINLY IN FAVOR OF INDIVIDUALS HAVING THE RIGHT TO THEIR ARMS AND PROTECT THEMSELVES. 
          WE APPRECIATE YOUR COMMENTS AND WE INVITE YOU TO SPEAK IT AS CITIZENS TO BE HEARD. 
          IF YOU WANNA SPEAK MORE ON THAT PARTICULAR TOPIC TONIGHT, IT WILL BE ABOUT THE, THE TWO PRESENTATIONS. 
          OKAY. 
          THE MENTAL HEALTH PRESENTATIONS. 
          THANK YOU, SIR. 
          UM, LAURA GARZA, GIVEN HOW MUCH CALIFORNIA HAS BEEN IN THE NEWS FOR THEIR FAILED ACCOMPLISHMENTS IN SAN FRANCISCO, LA, OTHER PLACES, HOW DOES METHADONE PROVIDING METHADONE, PROVIDING SAFE SPACES FOR PEOPLE TO SHOOT UP, HELP MENTAL ILLNESS AND HOMELESSNESS IN SAN ANTONIO? DO YOU HAVE NUMBERS? WHAT WE DON'T WE'RE SPENDING AND, AND WHAT, GIVEN THAT IT'S HAD NO IMPACT IN THOSE CITIES, IT'S ACTUALLY MADE THINGS WORSE, IN MY OPINION. 
          UM, WHY, WHY IS SAN ANTONIO SPENDING THAT MONEY ON THAT INSTEAD OF MAYBE PUTTING IT INTO THE PAYCHECKS OF THE POLICE OFFICERS? WE CAN GATHER THAT INFORMATION FOR YOU, TYPICALLY, AND CITIZENS TO BE HEARD. 
          IT'S JUST A, A OR, UM, OPPORTUNITY FOR PUBLIC COMMENT. 
          WE DON'T RESPOND ON THAT, BUT WE CAN GET YOU, UM, YOUR NAME AND INFORMATION, AND WE CAN GET BACK WITH YOU IF YOU'RE LOOKING FOR HEALTH MM-HMM. 
           AND METHADONE, AND YOU'RE GIVING IT TO PEOPLE, ISN'T FACTORED INTO YOUR MENTAL HEALTH. 
          AGAIN, WE DON'T TYPICALLY RESPOND TO QUESTIONS. 
          THIS IS JUST YOUR OPPORTUNITY TO BE HEARD, BUT YOU HAVE A FULL THREE MINUTES, AND IF YOU HAVE QUESTIONS AFTER, I ABSOLUTELY WILL TAKE YOUR INFORMATION AND GET BACK WITH YOU. 
          DO YOU WANT OKAY. 
          THANK YOU, MS. GARZA. 
          UH, 
          [00:05:01]
DENISE HORNER. 
          HOMER. 
          HOMER. 
          I'M SORRY. 
          OKAY. 
          THANK YOU, MS. HOMER WITH THE PRESENTATIONS. 
          UM, 
          [2. 19-8697 Briefing on the San Antonio Police Department Mental Health Unit[María Villagómez, Deputy City Manager; William P. McManus, Chiefof Police]]
SECOND ITEM ON THE AGENDA IS BRIEFING ON THE SAN ANTONIO POLICE DEPARTMENT MENTAL HEALTH UNIT. 
          GO AHEAD, CHIEF. 
          THANK YOU. 
          GOOD EVENING, EVERYBODY. 
          SO, WE'RE GONNA TALK A LITTLE BIT ABOUT OUR MENTAL HEALTH UNIT, AND I THINK A LOT OF, UH, OR AT LEAST SOME OF WHAT IS IN MY PRESENTATION, WILL BLEED OVER INTO CHIEF HOOD'S PRESENTATION. 
          SO, UM, UM, WE'LL START WITH, UH, THE, UH, MENTAL HEALTH UNIT ONE. 
          IT WAS CREATED, UH, THAT WAS BACK IN 2008. 
          WE STARTED WITH TWO. 
          UM, WE STARTED WITH TWO MENTAL HEALTH OFFICERS AND ONE SERGEANT. 
          AND FROM 2008 TO PRESENT, WE GREW TO 12. 
          IS IT 12 OR, YEAH, 12. 
          AND A SERGEANT. 
          AND THEY, THERE, THERE'S A, A VARIETY OF THINGS THAT THEY DO, UH, UNDER THE UMBRELLA OF THE MENTAL HEALTH UNIT. 
          AND WE'LL GET INTO SOME OF THOSE THINGS AS WE GO THROUGH THE SLIDES. 
          UH, THE MENTAL HEALTH UNIT OVER THE, THE PAST FEW YEARS AT LEAST, HAS GAINED NATIONAL RECOGNITION FOR THE WORK THAT WE'VE DONE, UH, THE WAY WE'VE TRAINED OUR OFFICERS AND THE WAY THAT WE RESPOND TO, TO FOLKS WHO ARE IN MENTAL CRISIS, UH, ON THE STREET OR, OR IN A HOME. 
          UH, FORTUNATELY, WE HAVE NOT HAD, UH, SINCE WE'VE STARTED THIS MENTAL HEALTH UNIT, WE HAVE NOT HAD SOME OF THE ISSUES THAT WE'VE SEEN IN SOME OF THE OTHER CITIES AROUND THE COUNTRY, UH, THANKS TO THE TRAINING AND THE, UH, AND THE, UH, UM, THE WORK THAT THE MENTAL HEALTH UNIT HAS DONE. 
          SO, THE MENTAL HEALTH UNIT WAS, WAS MADE, UH, OR WAS, UH, UH, IMPLEMENTED INITIALLY TO, UH, RESPOND TO HOMELESS ISSUES ON THE STREET. 
          UM, IN, IN THE PAST, THE POLICE DEPARTMENT, UM, UM, USED ENFORCEMENT METHODS TO DEAL WITH THE HOMELESS. 
          UH, WE'D MAKE THEM MOVE IF THEY WERE, UH, IF THEY WERE COMPLAINED ABOUT, IF THEY WERE CAMPED OUT SOMEWHERE, WE, WE WOULD MAKE A MOVE AND, AND, UH, UH, TO COMPLY WITH THE CITY'S CAMPING ORDINANCE. 
          UH, IF THEY WERE DRINKING IN PUBLIC, WE WOULD ARREST THEM. 
          I MEAN, THERE WAS, IT WAS, IT WAS AN, AN EFFORT IN ENFORCEMENT, UH, THE WAY WE DEALT WITH, WITH THE HOMELESS ISSUE. 
          UM, WE SHIFTED FROM AN ENFORCEMENT CENTRIC, UH, WAY OF DEALING WITH THE HOMELESS TO AN ASSISTANCE, UH, CENTRIC METHOD NOW. 
          SO WHEN WE COME ACROSS HOMELESS, WHETHER THEY ARE, UH, BEING COMPLAINED UPON OR NOT, WE OFFER THEM ASSISTANCE. 
          WE WORK WITH THE HAVEN FOR HOPE. 
          WE WORK WITH CENTER FOR HEALTH HEALTHCARE SERVICES. 
          UH, WE WORK WITH THE FIRE DEPARTMENT TO DEAL WITH PRETTY MUCH ANY HOMELESS ISSUE THAT WE HAVE ON THE STREET. 
          SO THE WHOLE, THE WHOLE REASON THAT THE MENTAL HEALTH UNIT WAS DEVELOPED AND THE TRAINING WAS DEVELOPED WAS TO ASSIST THE HOMELESS, BECAUSE IT'S NOT GONNA GO AWAY THROUGH ENFORCEMENT, AND IT DOESN'T HELP TRYING TO ENFORCE IT AWAY. 
          THIS IS A, A JUST, UH, A STRUCTURE OF, UH, THE HOME, UH, THE, UM, MENTAL HEALTH UNIT. 
          IT, IT, IT USED TO FALL UNDER THE BIKE PATROL IN THE DOWNTOWN, UH, AREA, UNDER THE CENTRAL, UH, CENTRAL SUBSTATION. 
          AND SINCE THEN, TO PROVIDE BETTER COORDINATION TO THE VARIETY OF THINGS THAT THEY DO, AND TO, TO HELP WITH CASE MANAGEMENT. 
          AND WE, WE'VE KIND OF MORPHED INTO MANAGING, UH, REPEAT, UM, PEOPLE IN CRISIS CASE MANAGEMENT, WE'VE DEVELOPED THAT AS WELL. 
          AND THAT IS ALL RUN OUT OF THE FUSION CENTER, AND IT JUST SHOWS THE CAPTAIN HERE. 
          THE, IS THE, UH, THE, UH, THE TOP BOX HERE IN THE, UH, ORG CHART GOES. 
          LIEUTENANT FUSION SERGEANT, THE FUSION SERGEANT DEALS WITH THE THREAT ASSESSMENT TEAM THAT YOU SEE THERE ON THE LEFT OF THE SCREEN. 
          AND ALSO THE PATROL RESPONSE TO THOSE THREAT ASSESSMENTS, AND ALSO TO, UM, UH, ASSISTING ON THE STREET WITH PEOPLE WHO ARE IN CRISIS AND WHO NEED ASSISTANCE. 
          AND OUR, OUR, OUR TYPICAL RESPONSE TO A, UH, A PERSON IN CRISIS ON THE STREET, WHETHER THEY'RE HOMELESS OR NOT, IS TO PROVIDE ANY KIND OF ASSISTANCE THAT, THAT, THAT WE CAN PROVIDE. 
          WE WILL TAKE THEM ANYWHERE THEY NEED TO GO, AND WE'LL TAKE THEIR PETS, WE'LL MOVE THEIR PROPERTY, WE'LL GO, WE'LL GO TO GREAT LENGTHS TO GET THEM TO SERVICES THEY NEED. 
          UH, THE HAVEN FOR, FOR HELP. 
          THE HAVEN FOR HOPE IS A BIG HELP IN DOING THAT. 
          [00:10:01]
THE IMPACT TEAM IS, WAS THE INITIAL, UH, START OF THE, UH, MENTAL HEALTH UNIT. 
          IT'S COMPRISED OF S A P D, UH, A, I MEAN THE FIRE DEPARTMENT, UH, E M S MOBILE INTEGRATED HEALTHCARE TEAM. 
          AND WHAT WE, WHAT WE DO WHEN WE COME ACROSS FOLKS ON THE STREET WHO ARE IN NEED IN NEED OF MEDICAL ATTENTION, THEN THAT MEDICAL ATTENTION IS PROVIDED BY THE, BY E M S. 
          AND, UH, AND THEN AGAIN, WE'LL FOLLOW UP WITH ANY FURTHER SERVICES THAT ARE NEEDED AT THAT TIME. 
          UM, WE, AND ALONG WITH THAT, YOU KNOW, WE'VE INTRODUCED, AFTER WE GOT INTO THAT, WE INTRODUCED CASE MANAGEMENT TO PROVIDE LONG-TERM SUCCESS SO THAT WE'RE NOT REPEATEDLY GOING AFTER, UH, OUT AFTER THE SAME CALLS AND THE SAME PEOPLE, AND THE SAME ISSUES. 
          OUR HOPE TEAM IS A, IS ANOTHER, UM, INNOVATION THAT STEMMED FROM OUR MENTAL HEALTH UNIT. 
          MANY OF THE PEOPLE ON THE STREET WHO ARE HOMELESS DON'T HAVE IDS. 
          THEIR IDS EITHER GET STOLEN OR LOST, AND WITHOUT AN ID, YOU CAN'T DO VERY MUCH OF ANYTHING IN TERMS OF SOCIAL SERVICES OR, UH, OR ANYTHING ELSE. 
          SO WE HAVE AN OFFICER THAT, THE OFFICER YOU SEE IN THE PICTURE THERE IS JOE FERRIS. 
          UH, HIS DAD WAS ALSO A POLICE OFFICER BEFORE HE PASSED AWAY A FEW YEARS AGO. 
          BUT YOU, YOU SEE THE NUMBER OF CONTACTS, REFERRALS, AND ID RECOVERIES THAT WE'VE GOTTEN, UH, SINCE IT STARTED IN 2016. 
          AND THAT'S QUITE A FEW, THAT'S QUITE A FEW PEOPLE, UH, THAT WE'VE DEALT WITH. 
          OVER A FOUR YEAR PERIOD. 
          WE HAVE A, UH, A CRISIS STABILIZATION INITIATIVE THAT DEVELOPED OUT OF THE MENTAL HEALTH UNIT OR, OR FROM THE MENTAL HEALTH UNIT. 
          AND, AND WE IDENTIFY THOSE FOLKS WITH SERIOUS MENTAL ILLNESSES THAT REPEATEDLY CALL 9 1 1. 
          AND WE'RE REPEATEDLY GOING OUT, UH, EXTENDING RESOURCES TO DEAL WITH THESE FOLKS. 
          SO WE NOW DO CASE MANAGEMENT ALONG WITH THESE FOLKS, WHICH CUTS DOWN, WHICH CUTS DOWN ON THE NUMBER OF CALLS THAT WE HAVE TO RESPOND TO. 
          UM, AS A RESULT, AT THE 2018, UH, RESULTS, 43 INDIVIDUALS WERE PLACED IN THE PROGRAM UNDER CASE MANAGEMENT, AND WE REDUCED LAST QUARTER OF THE CASE LOAD BY APPROXIMATELY 68%. 
          THEY, UM, THEY ALSO DEAL WITH THE, UH, WHEN WE HAVE, UH, FOLKS CALLING IN, MAKING THREATS, UH, WHATEVER THOSE THREATS MAY BE, UH, IF THERE'S A MENTALLY ILL PERSON THAT'S INVOLVED IN, IN MAKING THOSE THREATS, THEN WE SEND OUR ASSESSMENT TEAM OUT TO, UH, TO WORK WITH THEM AND ASSESS THE THREAT AND MAKE SURE THAT THEY GET ANY HELP THAT THEY NEED. 
          AND THEN OUR PROGRAM, AGAIN, EXTENDING FUNDAMENTAL HEALTH UNIT FOR INTENSIVE CARE COORDINATION IS A COLLABORATION BETWEEN, UH, SS A P D, SS A F D, UH, CENTER FOR HEALTHCARE SERVICES, AND THE SOUTHWEST TEXAS REGIONAL ADVISORY COUNCIL OR STRAC. 
          AND, UH, THAT FUNDING COMES FROM STRAC AND IT, AND IT, IT HELPS US WITH THE HIGH VOLUME OF EMERGENCY DETENTIONS THAT WE NORMALLY HAVE. 
          AND WHAT THEY DO IS THEY WILL DIRECT US TO THE HOSPITAL THAT WILL PROVIDE THE, THE QUICKEST SERVICE FOR THE OFFICER SO THAT THEY CAN DROP THOSE INDIVIDUALS OFF FOR EVALUATION AND GET BACK INTO SERVICE. 
          AND THEN I MENTIONED THREAT ASSESSMENTS A LITTLE BIT AGO. 
          UH, WE HAVE A MENTAL HEALTH THREAT ASSESSMENT TEAM, UH, THAT, THAT WORKS, UH, OFF OF THE MENTAL HEALTH UNIT, THE FUSION CENTER, THE FIRE DEPARTMENT, AND ALSO THE BEARER COUNTY SHERIFF DEPARTMENT. 
          AND THEY ASSESS AND MANAGE PUBLIC THREATS THAT ARE MADE BY INDIVIDUALS. 
          AND THEN LASTLY, UH, OUR TRAINING, UH, FOR CRISIS INTERVENTION. 
          UH, WHEN WE STARTED OUT, IT WAS A VOLUNTARY, UH, PROGRAM THAT YOU COULD ASK TO BE, GET, GET THAT TRAINING. 
          UH, SINCE THEN, WE HAVE, UH, MADE THAT A, A REQUIREMENT. 
          UH, TCO REQUIRES 16 HOURS. 
          WE REQUIRE 40, UH, OFFICERS HAVE TO GET THAT 40 HOUR TRAINING. 
          BUT WHEN WE FIRST STARTED IT, THEY HAD TO GET THAT 40 HOUR TRAINING BEFORE THEY WERE ISSUED A TASER. 
          NOW THE, THE REQUIREMENT IS MANDATORY FOR EVERYBODY IN THE DEPARTMENT, AND THEY HAVE THAT TRAINING PRIOR TO GRADUATING FROM THE ACADEMY. 
          AND THEN EVERY YEAR IT'S A EIGHT HOUR, UH, IN-SERVICE TRAINING, RETRAINING. 
          AND THAT CONCLUDES MY PRESENTATION, IF YOU HAVE ANY QUESTIONS. 
          I BEEN ANSWERED. 
          THANK YOU, CHIEF. 
          OKAY. 
          THANK YOU, CHIEF. 
          THANKS FOR THAT PRESENTATION. 
          UM, I HAVE ARE YOU ALLOWED TO ASK ANY QUESTIONS? UH, NO, SIR, NOT THIS TIME. 
          IS THERE ANY GOOD QUESTION? UM, YOU KNOW WHAT, IF YOU WILL ASK HER FOR ME, I'LL, I'LL FIGURE OUT. 
          AND THE, THE BEAUTIFUL BLONDE LADY THERE, SHE WILL HELP YOU OUT, . 
          SHE'S VERY BENEFICIAL TO THE CATHOLIC CITIZEN. 
          OKAY. 
          ASK HER, IS THERE ANY, IF YOU'LL ASK HER AND WE CAN, WE CAN GET 
          [00:15:01]
IT, MAKE SURE THAT WE GET AN ANSWER FOR YOU. 
          OKAY. 
          UM, CHIEF, WHO IS THE CALLER TY TYPICALLY CALLING FOR SERVICE? IS IT THE PERSON THEMSELVES IN NEED? IS IT A, A PARTNERSHIP THAT WE HAVE WITH THE CITY? TYPICALLY, THE, THE A A RELATIVE OR, OR SOMEONE WHO'S WITNESSING, YOU KNOW, A CERTAIN BEHAVIOR WILL CALL IN AS A, AS A COMPLAINANT AND WILL RESPOND FROM THAT CALL. 
          AND I, I DIDN'T MENTION THIS, CAPTAIN AOL ZUNIGA, CAPTAIN ZUNIGA IS THE, UH, CAPTAIN ON TOP OF THAT BOX THAT ORG CHART OVER THE FUSION CENTER. 
          THANK YOU. 
          AND, UM, ACTUALLY, I'M GONNA GO AHEAD AND ASK MS. GARZA'S QUESTION ABOUT, UM, DO YOU HAVE ANY INFORMATION ON, UH, CITY FUNDED METHADONE CLINICS? HAS, UH, DR. 
          BRIDGER, UH, THE GENERAL LADY ASKED ME THAT QUESTION EARLIER, AND I TOLD HER THAT, UH, WE DIDN'T HAVE THAT INFORMATION IN THE POLICE DEPARTMENT. 
          THAT WAS PROBABLY A, A QUESTION BETTER ASKED BY METRO HEALTH. 
          DR. 
          BRIDGER, IF YOU DON'T MIND, GO AHEAD. 
          THAT'S WHAT, UM, METHADONE, WELL, IT'S VERY DIFFERENT. 
          UM, NALOXONE REVERSES IMMEDIATELY AN OVERDOSE, UM, AND STABILIZES THE PATIENT UNTIL THEY CAN GET TO THE HOSPITAL. 
          UM, METHADONE IS A, A ONGOING REPLACEMENT FOR HEROIN, UM, THAT IS DISPENSED BY PRESCRIPTION AND ONLY AT SPECIFIC CLINICS THAT ARE PRIMARILY OPERATED BY THE CENTER FOR HEALTHCARE SERVICES. 
          AWESOME. 
          OKAY. 
          SO METHADONE IS THE PRESCRIPTION REPLACEMENT, AND THEN NALOXONE IS ALSO KNOWN AS NARCAN IS, UM, WHAT IS COMMONLY USED IN THE FIELD BY OUR EMERGENCY RESPONDERS TO REVERSE AN OVERDOSE. 
          SO WE ARE NE WE HAVE NEVER DONE A SAFE INJECTION SITE IN THE CITY OF SAN ANTONIO. 
          OKAY. 
          THANK YOU, DR. 
          BRIDGER. 
          I APPRECIATE IT. 
          ALRIGHT, THANK YOU. 
          UM, WE HAVE THANK, THOSE ARE ALL MY QUESTIONS. 
          THANK YOU. 
          UM, COUNCILMAN MI ARAN. 
          HELLO. 
          THANK YOU. 
          UM, THANK YOU CHIEF FOR THE PRESENTATION AND FOR ALL OF THE WORK OF OUR, OF OUR MENTAL HEALTH UNIT TOO, BECAUSE I KNOW THAT THEY'VE ALSO BEEN HIGHLIGHTED, UM, NATIONALLY, UM, AND DONE TRAINING THEMSELVES. 
          CORRECT. 
          CAN YOU SPEAK TO THAT, UH, AND THE TRAINING THAT THEY'VE ACTUALLY DONE, UH, TO OTHER PLACES THROUGHOUT THE UNITED STATES? SURE. 
          THE, THE, UH, THE 40 HOUR, UH, CRISIS INTERVENTION TRAINING IS WHAT I BELIEVE THAT THEY'RE, THEY'RE, THEY'RE AT LEAST IN PART WHAT THEY'RE TRAINING, BUT I THINK A LOT OF WHAT THEIR, THEIR, UH, CONVERSATION AND TRAINING IS WHEN THEY, WHEN THEY GO OUT IS, IS ABOUT WHAT THEY DO AND HOW THEY DO IT AND WHY THEY DO IT. 
          UM, AND THEY, AND I THINK MATTER OF FACT, A A LOT OF, UM, A LOT OF THEIR STREET TIME HAS NOW GOTTEN TAKEN UP BY, BY TRAINING BECAUSE IT'S, THEY'RE IN SUCH DEMAND, UH, BECAUSE OF THE, OF THE SUCCESS OF THE PROGRAM. 
          UM, AND ON SLIDE NUMBER FOUR, THE ORGANIZATION HERE, UM, SO IN 2018, DID WE GO FROM, SO IT BECAME PART OF THE FUSION CENTER. 
          AND SO, UM, YOU CAPTAIN ZUNIGA, YOU'RE THE TOP OF THE, THE ORG CHART, BUT THEN WE HAVE THE FUSION SERGEANT WHO IS ALSO PART OF THE THREAT ASSESSMENT TEAM AND THE PATROL RESPONSE, DO YOU SEE THAT THAT'S WORKING IN A MORE EFFICIENT MANNER? OR, OR HOW IS THAT WORKING? CAPTAIN ZUNIGA? YES. 
          I BELIEVE THAT WE'RE MORE EFFICIENT, MORE INFECTED. 
          YOU KNOW, ONE OF THE THINGS, WHEN WE BROUGHT THE MENTAL HEALTH UNIT UNDER THE FUSION OF ROMA, WE WERE BEING INNOVATIVE AND CREATIVE WITH THE UNDERSTANDING THAT WE NEEDED TO IMPROVE IN REGARDS TO MANAGING THREATS ARE OUR BREAD AND BUTTER AT THE FUSION CENTERS IS MANAGING THOSE THREATS. 
          AND WE WERE WELL AWARE THAT INDIVIDUALS SUFFERING FROM MENTAL ILLNESS, UM, WAS ONE OF THE BIGGEST, BIGGEST CONTRIBUTORS TO THE THREATS BEING MADE BY THESE INDIVIDUALS. 
          SO BECOMING MORE EFFECTIVE, WE WERE IN LINE WITH ONE ANOTHER, THE MISSION OF THE FUSION CENTER AND THE MISSION OF THE MENTAL HEALTH UNIT TO HELP BRIDGE THE GAP IN COMMUNICATION. 
          SO THE FACT THAT THE MENTAL HEALTH UNIT WAS UNDER THE FUSION UMBRELLA, IT INCREASED THE COMMUNICATION, THE BETTER MANAGEMENT OF THESE MENTALLY ILL INDIVIDUALS SO WE CAN PROPERLY MANAGE THEM, NOT ONLY TO PREVENT DETER, BUT ALSO TO STOP ANY POTENTIAL THREAT OF VIOLENCE THAT WAS PLANNED FOR THE 
          [00:20:01]
FUTURE. 
          THANK YOU. 
          SO DO Y'ALL HAVE ANY, UM, SO I HAVE, YOU HAVE YOUR NUMBERS FOR THE HOPE TEAM, BUT DO YOU, IN LOOKING AT THE, THE THREAT ASSESSMENT, HOW MANY PEOPLE HAVE YOU ALL, UM, IN CONTACT WITH, I MEAN, TO STOP OR TO HELP PREVENT? DO YOU HAVE THOSE NUMBERS THAT YOU CAN PROVIDE FOR US THAT HELP STOP? AND ANOTHER SECTION OF, OF, OF NUMBERS THAT I'D LIKE TO SEE IN, IN ALL OF THESE THREAT ASSESSMENTS WHERE YOU DEESCALATE OR YOU, YOU MANAGE IT OR YOU TAKE CARE OF IT, HOW MANY OF THESE INVOLVED, UM, GUNS EITHER THREAT UPON THEMSELVES OR THREAT TO OTHERS THAT THE MENTAL HEALTH UNIT HAD TO COME, UM, AND KIND OF STOP? I THINK I'D LIKE TO SEE THOSE NUMBERS IF YOU HAVE THEM, AND IF IT'S, IF IT'S JUST EITHER OR INJURY TO THEMSELVES JUST, UH, WITHOUT, UM, A FIREARM OR IF THERE'S WHERE FIREARMS PLAYED A PART IN ANY OF THESE SITUATIONS THAT ARE SS A P D, UM, OFFICERS ROLLED INTO THAT, WE ALSO HAD TO BRING OUT THE MENTAL HEALTH UNIT. 
          NO, ABSOLUTELY. 
          WE CAN CERTAINLY PROVIDE THOSE STATISTICS TO YOU. 
          ONE THING I CAN TELL YOU THAT SINCE MARCH OF 2019, UH, BECAUSE WE DID INTERCONNECT, UH, INTERFACE, THE MENTAL HEALTH UNIT INTO THE FUSION CENTER, NOW COMBINING THOSE RESOURCES, WE'VE BEEN ABLE TO ADDRESS, UM, NEARLY 300 CASES OF INDIVIDUALS THAT MADE THREATS IN SOME FORM OR FASHION. 
          UM, SO WE RANK THOSE, WHETHER THEY'RE, UM, HIGHLY LIKELY, UH, A MEDIUM OR A LOW RISK. 
          AND SO OUT OF THOSE 300, UM, WE WERE ABLE TO NOT ONLY MITIGATE, BUT ASSESS THOSE TO STOP ANY, ANY FUTURE VIOLENCE FROM OCCURRING. 
          AND SO I FEEL THAT WE'VE BEEN VERY SUCCESSFUL IN, IN CONNECTING THOSE DOTS TO STOP THESE INDIVIDUALS AND TO CATCH THOSE RED FLAGS BEFORE THEY TOOK SOME SORT OF ACTION TO COMMIT AN ACT OF VIOLENCE. 
          AND SO THE THREATS AS THEY COME IN, THEY COME IN EITHER THROUGH, UM, A FAMILY MEMBER THAT'S REPORTING IT, THE INDIVIDUAL THEMSELVES, WHERE THEY'VE MADE AN OUTCRY OR SOMEBODY POSTING THIS INFORMATION OR INTELLIGENCE ON SOCIAL MEDIA. 
          AND SO OUR FOLKS IN THE FUSION CENTER ARE VERY GOOD AT DOING RESEARCH. 
          AND BASED ON THIS INFORMATION, THEY'RE ABLE TO PUT TOGETHER SOME ACTIONABLE INTELLIGENCE. 
          AND SO THE RESOURCES THAT WE'VE MENTIONED THAT ARE A PART OF THE MENTAL HEALTH THREAT ASSESSMENT TEAM, UH, WE COMBINE OUR, OUR MINDS TO ENSURE THAT WE COME UP WITH A PROPER PLAN OF ACTION TO, TO STOP THIS THREAT. 
          AND SO, EVEN THOUGH THEY MIGHT BE A LOW RISK, WE CONTINUE TO MONITOR THESE INDIVIDUALS BECAUSE WE KNOW THAT AS QUICKLY AS WE CATEGORIZE THEM AS A LOW THREAT, THEY COULD RISE TO A LEVEL OF, OF A HIGHER THREAT. 
          AND SO THE POTENTIAL FOR VIOLENCE IS INCREASED. 
          AND SO WE DO OUR, OUR VERY BEST TO ENSURE THAT WE'RE PUTTING OUT THE BEST PRODUCT EACH AND EVERY DAY BECAUSE WE BELIEVE AND WHOLEHEARTEDLY UNDERSTAND THAT IT'S, IT'S OUR PRIMARY JOB TO STOP THESE INDIVIDUALS AND PROVIDE PROTECTION FOR THE CITIZENS OF SAN ANTONIO. 
          AND SO, AS YOU LOOK AT THIS THREAT ASSESSMENT, AND I KNOW ON SLIDE NINE YOU HAVE, UM, THE MENTAL HEALTH UNIT, FUSION CENTER, THE FIRE DEPARTMENT, BEXAR COUNTY SHERIFF, ARE THERE OTHER LAW ENFORCEMENT AGENCIES? AND WHEN, IF THEY'RE UP IN A HIGH LEVEL OF A THREAT, WHERE DO WE, I GUESS I'M ASKING, UM, I'M LOOKING FOR WHAT IS THE PROCESS OR THE LINE TO FOLLOW TO SAY, OKAY, WE KNOW THIS IS A HIGH THREAT ASSESSMENT. 
          IF, DO YOU GO AND LOOK AND SEE, DO THEY HAVE ACCESS TO FIREARMS AND HOW DO WE REMOVE THOSE? OR HOW DO THEY, DO THEY STILL HAVE THEM? AND DO YOU ALL KNOW IF THEY HAVE THEM OR NOT? IF THEY'RE HIGH THREAT ASSESSMENT? YES, MA'AM. 
          SO YES, WE, WE DO HAVE A CHECKLIST. 
          WE HAVE A, A WORKFLOW THAT WE FOLLOW, UH, AS I MENTIONED EARLIER, WE COMBINE OUR RESOURCES BECAUSE WE BELIEVE THAT, THAT TOGETHER WE'RE THE SUBJECT MATTER EXPERTS. 
          AND SO RELYING ON THOSE RESOURCES, IT'S NOT JUST, UH, THE MENTAL HEALTH UNIT, THE FUSION CENTER, THE SAN ANTONIO FIRE DEPARTMENT, OR THE BERK COUNTY SHERIFF'S OFFICE, BECAUSE THESE INDIVIDUALS THAT I JUST MENTIONED, WE MEET THREE TIMES A WEEK. 
          AND SO WE, WE GO OVER THESE, THESE, UH, THREADS, THESE THAT THESE INDIVIDUALS HAVE, HAVE MADE, AND IT FITS THE CRITERIA. 
          WE BRING IT TO A LARGER GROUP THAT MEETS, UH, ONCE A MONTH. 
          SO NOW IT'S THE PUBLIC SAFETY THREAT ASSESSMENT GROUP. 
          AND IN THIS GROUP, WE BRING IN, UH, PSYCHOLOGISTS FROM THE SAN ANTONIO POLICE DEPARTMENT, THE SAN ANTONIO FIRE DEPARTMENT. 
          IT ALSO INCLUDES MEMBERS FROM THE F B I, UH, D P SS, THE DISTRICT ATTORNEY'S OFFICE, PROBATION, PAROLE, UH, THE A U S A, AND AS WELL AS SCHOOL ADMINISTRATORS 
          [00:25:01]
AND THE SCHOOL POLICE AS WELL, DEPENDING ON WHERE THE VENUE OF THE THREAT IS MADE AGAINST. 
          AND SO, AGAIN, TOGETHER AS, AS A GROUP, WE COME UP WITH A, A ACTIONABLE PLAN TO ENSURE THAT, THAT WE'RE STOPPING THIS THREAT AND NOT ONLY JUST STOPPING IT, BUT THAT WE CONTINUE TO MONITOR IT SO IT DOESN'T REOCCUR AGAIN, SO THAT THESE FOLKS ARE PROVIDED THE PROPER RESOURCES SO THAT THEY COULD GET WELL IN THEIR MENTAL HEALTH. 
          THANK YOU. 
          I APPRECIATE THAT INFORMATION, AND ALSO FOR GIVING CLARITY AND, UM, JUST PEACE OF MIND TOO THAT ALL OF THIS IS GOING INTO, INTO PLAY AS WHAT TOO. 
          SO THANK YOU VERY MUCH. 
          UM, AND I JUST WANT TO THANK YOU, AND AGAIN, I WOULD LIKE TO SING THE PRAISES OF THE HOPE TEAM ON SLIDE NUMBER SIX. 
          AND GRATEFUL FOR MY COLLEAGUES TOO, BECAUSE WE DID PUT MORE, WE DID PUSH FOR MORE MONEY IN THE BUDGET THIS YEAR BECAUSE WE KNOW OF HOW MUCH WORK THE HOPE TEAM DOES. 
          AND, UM, IT'S A LOT OF WORK, AND IT'S, IT'S NOT REALLY, IT'S NOT EASY, AND IT TAKES A LOT. 
          SO I WANNA, I, I APPRECIATE THEM AND ALL THE WORK THAT THEY DO AND THE, UH, COLLABORATION WITH OUR RESIDENTS AND OUR COMMUNITY MEMBERS LIKE MS. TRAINER, UM, WHO DOES A LOT OF WORK. 
          AND, UH, I DON'T THINK SHE'S HERE TODAY, I AM SURPRISED. 
          BUT, UH, SHE'S, SHE'S DONE A LOT OF WORK WITH THE HOPE TEAM, SO APPRECIATE THEM. 
          AND BROOK HILL BAPTIST CHURCH, THOSE ARE ALL MY QUESTIONS, CHAIR. 
          THANK YOU. 
          THANK YOU. 
          COUNCILMAN. 
          UH, COUNCILWOMAN VRAN. 
          COUNCILWOMAN. 
          ANDREW SULLIVAN. 
          THANK YOU, CHAIR. 
          SO I DO HAVE A FEW QUESTIONS. 
          WHEN IT RELATES TO DOCUMENTATION OF SINCE BEFORE THE FUSION TEAM WAS IMPLEMENTED, AND NOW THAT IT IS, HOW HAVE WE SEEN THE INCREASE OR DECREASE IN OFFICER INVOLVED SHOOTINGS WHEN IT COMES TO THOSE THAT HAVE A MENTAL HEALTH ISSUE? I THINK THE, UH, LEMME SEE IF IT'S ON HERE, WHICH LINE THAT IS. 
          I THINK IT WAS A 68% REDUCTION OF REPEAT CASES. 
          AND I, I MENTIONED DURING THE, MY PRESENTATION THAT I CAN'T RECALL, UH, A, A CONFRONTATION OR SHOOTING THERE, THERE WAS ONE RECENTLY ACTUALLY ON, ON, I THINK IT WAS 35 ON THE SIDE OF THE ROAD THERE, WHERE, UM, THE, UH, THE PERSON WHO WAS THREATENING TO JUMP OFF THE, OFF THE, THE BRIDGE, PULLED WHAT APPEARED TO BE A GUN FROM HIS WAISTBAND, AND HE WAS FIRED UPON. 
          BUT THAT IS THE ONLY ONE THAT I CAN RECALL, UH, THAT THERE WAS A MENTAL, A MENTAL HEALTH ISSUE INVOLVED, WHERE THE OFFICERS WERE FORCED TO USE DEADLY FORCE. 
          I, THERE, THERE MAY HAVE BEEN OTHERS I'D HAVE TO RESEARCH, BUT I CAN'T RECALL ANY OTHERS. 
          THANK YOU, CHIEF. 
          AND THEN, AS FAR AS CONTINUING EDUCATION, IT'S ONLY THE EIGHT HOURS, IT'S EIGHT HOURS IN SERVICE EVERY YEAR. 
          YES. 
          OKAY. 
          AND THAT'S YEARLY. 
          THAT'S IT. 
          YES. 
          THERE'S NO ADDITIONAL WITH EVERYTHING THAT'S COMING OUT, ESPECIALLY WHEN WE HAVE VETERANS COMING BACK FROM WAR WITH P T SS D AND HOW THEY CAN REALLY GO INTO THAT MANIC, UH, STATE. 
          AND SO IN THEIR MINDS, THEY'RE LOOKING AT EVERYTHING AS A WAR SCENARIO. 
          UM, THERE HASN'T BEEN A CONCENTRATION ON HOW TO DEESCALATE SPECIFICALLY WITHIN THE REGIMEN OF VETERANS THAT ARE COMING BACK FOR WAR. 
          WE, WE HAVE EXTENSIVE DEESCALATION TRAINING IN THE ACADEMY. 
          MATTER OF FACT, EVERYTHING THAT WE DO KIND OF CENTERS ON DEESCALATION IN, IN THE SCENARIOS THAT WE TEACH. 
          UM, WE HAVE A, A TEAM OF PSYCHOLOGISTS FOR ANYONE WHO'S, WHO'S ANY POLICE OFFICER WHO HAS, UM, UH, UH, CONCERNS OR, OR, UH, PROBLEMS WITH, UH, GETTING THE JOB DONE, I GUESS, UH, MENTAL ISSUES. 
          SO WE HAVE PSYCHOLOGISTS FOR THAT. 
          AND, UH, THEY'RE, THEY'RE READILY AVAILABLE 24 7 FOR ANY OFFICER WHO NEEDS THEM. 
          AWESOME. 
          AND THEN I KNOW THAT WE DO A LOT WITH STRAC. 
          WHAT OTHER AGENCIES ARE YOU PARTNERED WITH WHEN IT COMES TO CERTIFICATION? SAY AGAIN? WHAT OTHER AGENCIES ARE YOU PARTNER WITH FOR CERTIFICATION? CERTIFICATION AND MENTAL HEALTH? WELL, WE DO THE C I T TRAINING AND, AND OUR, UH, I KNOW YOU PARTNER WITH STRAT, BUT WHAT OTHER PARTNERSHIPS DO YOU HAVE? SO WE ALSO PARTNER WITH THE BEXAR COUNTY SHERIFF'S OFFICE, UM, CENTER FOR HEALTHCARE SERVICES, OUR FOLKS AT THE TRAINING ACADEMY. 
          AND SO WE ALSO, UM, GAIN SOME VOLUNTEERS THAT COME OUT AND DO SOME ROLE PLAYING WITH US, BUT PRIMARILY THE SS A P D INSTRUCTORS ARE THE ONES THAT INSTRUCT THESE, UH, C I T CLASSES, AND THEY'VE BEEN DOING IT FOR, FOR A VERY LONG TIME. 
          SO, UM, I FEEL CONFIDENT THAT THEY ARE SUBJECT MATTER EXPERTS IN REGARDS TO THAT. 
          [00:30:01]
WE ALSO RELY HEAVILY ON OUR PSYCHOLOGISTS, UH, WHO HELP US A, A, A GREAT DEAL IN ENSURING THAT WE'RE PUTTING OUT, UH, A HIGH LEVEL PRODUCT TO ENSURE THAT OUR OFFICERS UNDERSTAND EXACTLY WHAT WE'RE TRYING, UM, TO MEET. 
          SURE. 
          , BUT YOU'RE ALSO PARTNER WITH NAMI AS WELL, CORRECT? CORRECT. 
          OKAY. 
          SO I KNOW NAMI IS ONE OF THE LARGER MENTAL HEALTH PROVIDERS AND CERTIFICATIONS. 
          AND SO THAT'S WHERE I WAS GOING WITH THAT QUESTION. 
          'CAUSE WE ALREADY KNOW WHO YOU'RE PARTNER WITH, BUT A LOT OF THEM DON'T KNOW THAT'RE PARTNER WITH NAMI. 
          AND NAMI DOES A LOT OF THESE CERTIFICATIONS WHEN IT COMES TO VETERANS MENTAL HEALTH, UM, CRISIS. 
          AND SO THAT'S WHERE WE WERE GOING. 
          WE, WE RECEIVED A NATIONAL AWARD FROM NAMI ABOUT, UH, I DON'T KNOW, SIX, SEVEN YEARS AGO FOR THE, FOR THE WORK THAT WE'VE BEEN DOING IN MENTAL HEALTH. 
          THAT'S WHAT I WAS LOOKING FOR, CHIEF. 
          THANKS. 
          NO FURTHER QUESTIONS. 
          THANK YOU, COUNCILWOMAN. 
          ANDREW SULLIVAN. 
          COUNCILMAN PERRY? YES. 
          THANK YOU VERY MUCH, CHIEF. 
          THANKS FOR COMING OUT OUT AND CAPTAIN Z THANK YOU. 
          UM, GOT A COUPLE OF QUESTIONS HERE. 
          UM, AND I ASKED THAT QUESTION LAST TIME. 
          I WANNA MAKE SURE THAT WE'RE STILL ON THE SAME PAGE WITH THE DA BECAUSE Y'ALL DO COORDINATE WITH THE DA ON CRIMINAL TRESPASS. 
          AND, AND, AND WE HAD THAT PRESENTATION HERE A WHILE BACK, AND I ASKED THAT QUESTION. 
          I WANT TO JUST MAKE SURE WE'RE STILL ON THE SAME PAGE. 
          HOW DOES A DA HANDLE CRIMINAL TRESPASS? NOW, WHEN WE MAKE AN ARREST FOR CRIMINAL TRESPASS, THE DA, UH, ACCEPTS THE CASE, WHEREAS BEFORE THEY WERE, UH, REJECTING THEM AT MAGISTRATION AND THEY ACCEPT ALL THE CASES THESE DAYS. 
          UH, LET ME PUT IT THIS WAY. 
          THEY WERE REJECTING CERTAIN CASES BACK, UH, BEFORE THEY STARTED TO ACCEPT THEM ALL. 
          AND THAT'S BEEN MAYBE AT LEAST A FEW MONTHS. 
          AND, UM, THEY WILL EVALUATE THE CASE AND AFTER A PERIOD OF TIME THEY'LL EVALUATE AND DECIDE WHETHER OR NOT TO, UH, FILE THE CHARGES OR NOT. 
          OKAY. 
          AND THERE WAS A, A DATA POINT THAT I WAS TRYING TO GET, AND I DON'T KNOW, MARIA, IF Y'ALL HAVE HAD A CHANCE TO GET THAT FROM THE DA, IS ON THOSE CASES THAT COME IN AND ARE ACTUALLY ACCEPTED, HOW MANY ARE THEN RELEASED OR TAKEN THROUGH THE SYSTEM THROUGH, UH, PROSECUTION WISE? AND, UH, I'D LIKE TO GET THAT NUMBER SOME KIND OF WAY FROM THE DA TO SEE WHAT THE YOU DISCUSS. 
          YOU MEAN NOT ACCEPT THE NOT CHARGED? YES. 
          YES. 
          OKAY. 
          YEAH, I'D, I'D LIKE TO GET THAT TO SEE, YOU KNOW, WHERE, WHERE WE STAND, ARE WE WASTING OUR TIME AND TAKING 'EM DOWN THERE, OR ARE THEY TAKING ACTION AGAINST THOSE? UM, SO YEAH, THAT WOULD BE GREAT TO GET THAT INFORMATION ON SLIDE SIX. 
          UM, CHIEF, IF YOU COULD HELP ME UNDERSTAND A LITTLE BIT ABOUT THAT SLIDE. 
          NOW THIS IS, THIS IS DATA COLLECTED OVER FOUR YEARS. 
          YES, SIR. 
          OKAY. 
          YOU GOT 4,088 CONTACTS, BUT YOU GOT 4,863 REFERRALS. 
          WHERE, WHERE ARE THOSE EXTRA REFERRALS COMING FROM? I DON'T, I DON'T QUITE UNDERSTAND THAT, THAT YOU GOT LESS CONTACTS, BUT MORE REFERRALS. 
          I'M NOT EXACTLY SURE ON, ON THESE NUMBERS ONLY BECAUSE THE HOPE TEAM FALLS UNDER BIKE PATROL AND IT DOESN'T FALL WITHIN THE MENTAL HEALTH UNIT. 
          BUT WHAT I BELIEVE THE NUMBERS ARE REFERRING TO, UH, THE 4,088 OR ACTUAL, UH, CONTACTS PERSON TO PERSON OFFICER TO, UH, AN INDIVIDUAL OUT, UH, ON THE STREET, THE ADDITIONAL 790 SOMETHING, UH, REFERRALS YEAH. 
          ARE CAME IN AS A REFERRAL THROUGH LIKE A THIRD PARTY. 
          AND SO THESE INDIVIDUALS WERE REFERRED TO US NOT BECAUSE THEY MADE THE INITIAL CONTACT THEMSELVES, THE OFFICER DIDN'T MAKE THE CONTACT OUT OF THE STREET. 
          AND SO THAT'S WHAT I GATHER FROM, FROM THE INFORMATION HERE, UH, ON THAT PARTICULAR SLIDE, UH, WE WOULD HAVE TO GO BACK JUST TO CONFIRM THAT THAT IS ACCURATE, BUT BASED ON THESE NUMBERS, THAT'S THE INFORMATION THAT I OKAY. 
          YES, MA'AM. 
          JUST TO CLARIFY, COUNCILMAN, UH, WHAT CAPTAIN SUNGA I REFERRED TO AS CORRECT, BUT THIS NUMBERS REPRESENT THE 4,088 ARE DIRECT CONTACTS BY THE HOPE TEAM. 
          WE WORK WITH NONPROFIT ORGANIZATIONS WITH HIM FOR HOPE FOR DIFFERENT CHURCHES ACROSS THE CITY, AND THEY MAKE REFERRALS TO THE HOPE TEAM SO WE CAN HELP 'EM WITH THEIR ID RECOVERY. 
          SO THE 4,866 REFLECTS THOSE, UH, REFERRALS THAT WE, THAT WE WORK TOGETHER. 
          THERE'S ACTUALLY A CHURCH IN DISTRICT THREE THAT WE WORK VERY CLOSELY WHERE WE GET, UH, QUITE A BIT OF REFERRALS, INCLUDING HIM FOR HOPE. 
          OKAY, GREAT. 
          UH, AND OVER THAT 4,088 OR THE 4,863 FOR 
          [00:35:01]
REFERRALS, HOW MANY HAVE ACCEPTED THOSE SERVICES? WHAT'S, WHAT'S THE, WHAT'S OUR, UH, LET'S SAY SUCCESS RATE OF THEM ACCEPTING THOSE REFERRALS AND GOING INTO THOSE PROGRAMS? THAT'S A KEY DATA POINT BECAUSE WE'VE SEEN A LOT OF CASES THAT THE REFERRALS ARE OFFERED, BUT THEY'RE NOT ACCEPTED. 
          RIGHT. 
          AND THEY JUST GO RIGHT BACK OUT ONTO THE STREET OR INTO HOMELESS ENCAMPMENT, WHATEVER. 
          UH, I'D, I'D LIKE TO GET THAT DATA POINT. 
          HOW MANY ARE ACTUALLY ACCEPTING IT. 
          MY MY INTERPRETATION OF THAT IS THAT 1,175 ACCEPTED THE SERVICE AND HAD THEIR IDS RECOVERED AND 400, UH, ADDITIONAL FOR THE CERTIFICATES. 
          BUT WE CAN CLARIFY THOSE NUMBERS. 
          YEAH. 
          UM, I, AND I UNDERSTAND WHAT THOSE ARE, BUT I, I DON'T, YOU KNOW, THAT DOESN'T NECESSARILY MEAN THAT THEY WERE ACCEPTED INTO A PROGRAM FOR ADDITIONAL HELP, YOU KNOW, WHETHER IT'S HAVEN FOR HOPE OR WHATEVER OTHER NONPROFIT AGENCY OR, UM, CITY AGENCY TO, UH, ACCEPT FURTHER TREATMENT. 
          RIGHT. 
          SO THAT'S, THAT'S WHAT I'M TRYING TO GET TO. 
          THE, THAT ID RECOVERIES IS GREAT, THE BIRTH CERTIFICATES ARE GREAT, BUT HOW MANY ARE ACTUALLY BEING PROCESSED INTO SOME KIND OF A TREATMENT FACILITY? THAT'S WHAT I'M INTERESTED IN. 
          OUT OF THOSE, UH, ALMOST 5,000 REFERRALS, AND I'M SORRY, I'M GONNA INTERRUPT FOR JUST A MOMENT. 
          CAN, CAN YOU PUT SLIDE SIX UP ON THE SCREEN FOR THE BENEFIT OF THE COMMUNITY? YOU CAN LOOK AT THE NUMBERS THAT WE'RE, WE'RE TALKING ABOUT. 
          OKAY. 
          UM, SO YEAH, IF YOU COULD CLARIFY THOSE NUMBERS, THAT WOULD BE GREAT. 
          AND I'M LOOKING BACK AT, YOU KNOW, ON, ON THESE NUMBERS, I THINK IT WOULD BE REALLY HELPFUL TO, SINCE WE'VE HAD THIS PROGRAM IN FOR FOUR YEARS NOW, IS TO DEVELOP THOSE METRICS TO SEE TRENDS GOING UP, GOING DOWN, YOU KNOW, WHERE, WHERE ARE WE AT IN ON THAT CONTINUUM? AND IF THE EFFORTS AND, AND MONEY THAT WE'RE PUTTING INTO THIS PROGRAM ARE THEY BEARING FRUIT? AND THAT'S, THAT'S REALLY CAN BE TRACKED AND EXPLAINED VERY WELL THROUGH METRICS. 
          SO WE'D REALLY LIKE TO SEE SOME METRICS PUT TOGETHER ON THIS. 
          UM, ON THE NEXT SLIDE, SLIDE SEVEN, AND IT KIND OF GOES BACK TO THAT SLIDE SIX ON ALL THE NUMBERS, THE 40 DOWN AT THE BOTTOM, 2018 RESULTS, UH, 43 INDIVIDUALS PLACED IN THE PROGRAM. 
          AND AFTER CASE MANAGEMENT, WE REDUCED THE CALLS BY 68%, 48, 43 INDIVIDUALS OUT OF HOW MANY, AND THAT'S JUST FOR ONE YEAR. 
          AGAIN, IF WE COULD DEVELOP THE METRICS TO KIND OF SHOW THE RESULTS OF THAT, I I THINK THAT WOULD BE GREAT. 
          'CAUSE REALLY THAT'S NOT 43 INDIVIDUALS OUTTA HOW MANY, YOU KNOW, I DON'T KNOW WHAT WHAT THAT NUMBER, WHAT, WHAT'S THE, WHAT'S THE DIFFERENTIAL THERE? WHAT'S OUR SUCCESS RATE? THAT'S WHAT I'M LOOKING FOR. 
          CORRECT. 
          SO IN THIS PROGRAM, IN IN PARTICULAR, IT WAS ONLY 43 INDIVIDUALS THAT WERE HIGHLIGHTED IN THIS INITIATIVE. 
          AND SO WHAT WE'RE SAYING HERE IN THIS SLIDE THAT OUT OF THE 43 INDIVIDUALS, UM, IN THE LAST QUARTER, THE CALLS FOR POLICE SERVICES WAS REDUCED BY 68%. 
          SO IT AVERAGED OUT TO 1.25 CALLS, UH, PER CONSUMER. 
          YEAH. 
          AND, AND THAT'S WHY I'M SAYING THE METRICS TO KIND OF TRACK THAT OVER TIME. 
          YOU KNOW, ARE THE NUMBERS GOING UP? ARE THEY GOING DOWN? ARE THEY ACCEPTING THE TREATMENT? ARE THEY, YOU KNOW, UH, AND HOW DOES THAT RELATE TO THAT REDUCTION IN, UH, CALLS, THAT KIND OF THING. 
          SO I, I THINK IT'S, IT WOULD BE, TO ME, IT WOULD BE PRETTY EASY TO PUT SOME METRICS TOGETHER TO ACTUALLY TRACK THESE NUMBERS AND, AND, UH, PERIODICALLY SHARE 'EM WITH US ON THE SUCCESS OF, OF THIS PROGRAM AND HAVING IT INVOL, HAVING IT CENTRALIZED, IF YOU WILL, IN THE FUSION CENTER CENTER THERE. 
          UH, THE, UM, ON THE ORGANIZATIONAL CHART, THE ONE DOWN AT THE BOTTOM, AND I WOULD SAY THAT'S REALLY WHERE THE RUBBER MEETS THE ROAD, ESPECIALLY WITH MENTAL ILLNESS. 
          UH, THE, WHAT IS THAT? THE, UH, CLINICIAN CONTRACTORS AND THE D H S CLINICIAN, UH, DR. 
          BRIDGER IS THAT, UM, IS THAT, UH, MS. JUAREZ INCLUDED IN THAT NUMBER? TIFFANY DHS. 
          OKAY. 
          SO THAT'S, THAT'S HER POSITION RIGHT THERE. 
          AND NOW WE'VE CONTRACTED OUT THREE OTHER INDIVIDUALS TO HELP, OR HOW, HOW IS THAT ALL WORKING AND WHAT'S THE WORKLOAD FOR THOSE INDIVIDUALS? 
          [00:40:01]
SO THE THREE INDIVIDUALS THAT WE'RE BAPTIST CLINICIANS ARE NOW FALLING UNDER STR SO THAT THERE'S BETTER COLLABORATION BETWEEN THE CENTER FOR HEALTHCARE SERVICES CLINICIANS AND THESE CLINICIANS. 
          UM, AS FAR AS WHAT THEIR WORKLOAD NUMBERS ARE, THEY HAVEN'T CHANGED, BUT I DON'T KNOW WHAT THOSE ARE OFF THE TOP OF MY HEAD. 
          YEAH. 
          AND I THINK, I THINK THAT'S IMPORTANT BECAUSE, YOU KNOW, AGAIN, THAT'S, THAT'S THE PEOPLE WHO CAN REALLY HELP. 
          YOU KNOW, YOU HAVE THE POLICE DEPARTMENT, YOU KNOW, THERE'S ONLY SO MUCH YOU CAN DO FOR AN INDIVIDUAL. 
          YOU REALLY NEED THAT CLINICIAN TO DIAGNOSE AND ALSO GET 'EM TO THE RIGHT AGENCIES TO HELP OUT. 
          SO I THINK THAT'S VERY IMPORTANT FOR US TO TAKE A LOOK AT. 
          UM, YOU KNOW, WE STARTED THAT IN DISTRICT 10 WITH TIFFANY, THE D H S EMPLOYEE. 
          AND FROM WHAT I HAVE SEEN AND THE DATA THAT I'VE BEEN PRESENTED WAS THAT IT SEEMS TO BE A SUCCESSFUL MIX THERE AND A SUCCESSFUL PROGRAM. 
          AND I WOULD REALLY LIKE TO TAKE A CLOSER LOOK AT THOSE, YOU KNOW, THE OVERALL PROGRAM IS, IS THIS ENOUGH? WELL, IT'S PROBABLY NEVER ENOUGH, BUT IS THAT AN AREA THAT WE NEED TO INCREASE? OR IS THIS ENOUGH FOR THE CITY? OR, YOU KNOW, AGAIN, YEAH, IT'S NEVER ENOUGH, BUT IT, WHAT'S THE RIGHT NUMBER THAT WE NEED TO HAVE IN THE MIX TO GET MORE OF THESE FOLKS OUT THERE ON THE GROUND AND BASICALLY HOLDING THEIR HAND, THOSE THAT ARE AFFECTED AND GETTING THEM TO THE RIGHT PLACES, PLACES INSTEAD OF JUST DUMPING 'EM OFF AT A DOORSTEP AND EXPECTING THEM TO STAY AND NOT WANDER OFF AND GO BACK INTO THE FIELD. 
          THAT KIND OF THING. 
          OKAY. 
          WELL, WE CAN GET YOU, UM, MORE INFORMATION ABOUT THE, THE ADDITIONAL THREE CLINICIANS THAT ARE WORKING AS CONTRACTORS AND WHAT THEIR CASELOAD LOOKS LIKE AND IF THERE'S AN ESTIMATED UNMET NEED, WHAT THAT LOOKS LIKE. 
          OKAY. 
          GREAT. 
          YEAH, AND, AND I'M SURE TIFFANY IS JUST SPENDING ALL OF HER TIME IN DISTRICT 10, RIGHT? YEAH. 
          ALRIGHT. 
          SHE REALLY IS. 
          THAT'S WHAT I WANNA HEAR. 
          YES, SIR. 
          THAT'S WHAT I WANNA HEAR, SHOULD HAVE SAID. 
          YES, SIR. 
          YES, SIR. 
          OKAY. 
          WELL, UH, YES, I, I, I THINK AGAIN, THAT THAT EXTRA PERSON ON THIS TEAM REALLY ADDS TO THE FLEXIBILITY AND HAVING THAT INDIVIDUAL THERE TO, AGAIN, GET THAT INDIVIDUAL TO THE HELP THAT THEY NEED AND HOLD THEIR HAND THROUGH THAT PROCESS. 
          BECAUSE AS I UNDERSTAND IT, WHAT WE'VE DONE BEFORE, WE'VE KIND OF DROPPED 'EM OFF AT THE DOORSTEP OF WHATEVER ORGANIZATION AND THEY EITHER STAY OR THEY CAN GO AND THEY, THEY NEED THAT EXTRA HELP IN PROCESSING INTO ONE OF THESE FACILITIES BECAUSE IT'S NOT EASY. 
          IT'S A LOT OF, LOT OF INFORMATION AND A LOT OF WORK TO GET THEM INTO THESE INDIVIDUAL ORGANIZATIONS. 
          COUNSEL. 
          IT GOES A LITTLE BIT BEYOND JUST DROPPING THEM AT THE DOORSTEP. 
          WELL, THEY, WHAT I'M SAYING IS THESE FOLKS HOLD THEIR HAND AND TAKE 'EM THROUGH THAT PROCESS AND MAKE SURE THAT THEY GET ALL REGISTERED, ALL, ALL THE, ALL THE DATA INPUT, ALL, ALL THAT. 
          SO I THINK THAT'S A CRITICAL LINK THAT WE FOUND THAT CAN REALLY HELP IN GETTING THESE FOLKS THE HELP THAT THEY NEED BY THE RIGHT ORGANIZATION. 
          SO, UM, YEAH, THAT'D BE GREAT, DR. 
          BRIDGER TO GET, GET THAT INFORMATION AND, UM, TAKE A LOOK AT THAT CASELOADS, UM, YOU KNOW, HOW MUCH, HOW MUCH THESE CONTRACTED POSITIONS ARE COSTING. 
          I KNOW HOW MUCH THE D H S POSITION IS, BUT I, I DON'T KNOW HOW MUCH WE'RE PAYING THE CONTRACTED POSITIONS AND, AND ARE THERE PEOPLE, YOU KNOW, QUALITY FOLKS COMING ONLINE TO, TO FILL THOSE POSITIONS ALSO? SO  WITH THE CONTRACTORS? YES. 
          UH, THE SAME PEOPLE WHO WERE WORKING UNDER THE BAPTIST CONTRACT WERE TRANSFERRED TO THE STRAT CONTRACTS. 
          AH, OKAY. 
          SO THOSE POSITIONS ARE FILLED AND, AND FUNCTIONING. 
          OKAY. 
          UM, THROUGH THAT TRANSFER. 
          GREAT. 
          BUT I'M, I'M WRITING EVERYTHING ELSE DOWN THAT YOU'RE LOOKING FOR. 
          ALL RIGHT, GREAT. 
          THANK YOU VERY MUCH. 
          APPRECIATE IT. 
          UM, SO YES, SIR, WE DIDN'T, WE DIDN'T SKIP A BEAT AT ALL WHEN THE NEW CONTRACT WAS SIGNED AND APPROVED. 
          OKAY. 
          AND SO ONE OF THE REASONS WE'VE BEEN VERY SUCCESSFUL, NOT ONLY IN IN THE, UH, THE PICK PROGRAM, BUT SOME OF THE OTHER INITIATIVES HAS BEEN BECAUSE WE WERE ABLE TO ADD THAT RESOURCE TO OUR TEAM, UH, BASED ON THE EXPERIENCE OF THE OFFICERS, UH, THE OTHER PARTNERS. 
          BUT A LOT OF THE CREDIT NEEDS TO GO AS CLINICIANS. 
          SO I AGREE WITH YOU WHEN YOU SAY WE, WE, WE NEVER HAVE ENOUGH, AND THEY'VE BEEN A VALUABLE RESOURCE TO OUR SUCCESS. 
          YEAH. 
          AND, AND MY CONCERN IS THAT, UH, ACROSS MY DISTRICT, I DON'T KNOW ABOUT OTHER DISTRICTS, BUT I ASSUME THAT IT'S PROBABLY THE SAME AS LIKE OUR SAFE OFFICERS ARE SPENDING MORE AND MORE TIME HANDLING THE HOMELESS POPULATIONS 
          [00:45:01]
THAT'S TAKING THEM OFF OF, YOU KNOW, OTHER THINGS THAT THEY SHOULD BE DOING. 
          AND, AND WE GOTTA SEE ABOUT REVERSING THAT TREND AND, YOU KNOW, TAKING CARE OF THIS ISSUE IN OTHER INNOVATIVE WAYS, UH, TO REDUCE THAT WORKLOAD ON OUR POLICE DEPARTMENT SO THAT THEY CAN BE OUT THERE CHASING OTHER BAD GUYS IN THE FIELD. 
          SO, UH, GREAT, I REALLY APPRECIATE THIS INFORMATION AND, AND LOOK FORWARD TO SEEING, UH, YOU KNOW, SOME METRICS BEING DEVELOPED ON THIS THAT CAN COME BACK ONCE IN A WHILE AND SHOW US WHAT, UH, WHAT WE'RE, WHAT WE'RE ACCOMPLISHING OUT THERE. 
          SO, THANK YOU, CHIEF. 
          THANK YOU CAPTAIN. 
          APPRECIATE IT. 
          THANK YOU. 
          COUNCILMAN PERRY. 
          UM, I WANNA ACKNOWLEDGE QUICKLY THE ID RECOVERY PROGRAM. 
          I HAD THE OPPORTUNITY TO GO OUT BEFORE THE HOLIDAYS AND, UM, FIRSTHAND WITNESS THE ID RECOVERY PROGRAM AND HOW HARD OUR OFFICERS ARE WORKING. 
          AND A LOT OF VOLUNTEERS, I WAS SURPRISED AT HOW MANY PEOPLE GIVE OF THEIR OWN TIME TO HELP, UM, THOSE WITHOUT IDS TO GET BACK ON THEIR FEET. 
          AND THEY REALLY WANT TO GET BACK TO CONTRIBUTING TO SOCIETY AND TO SOCIETY. 
          AND SOMETIMES THAT LACK OF AN ID IS A BIG, UH, HURDLE THAT THEY HAVE TO JUMP. 
          SO I APPRECIATE THAT PROGRAM. 
          UM, IF THERE ARE NO OTHER QUESTIONS, I WANNA THANK CAPTAIN MARIA AND CHIEF FOR THE, FOR THE INFORMATIVE PRESENTATION. 
          JUST A REMINDER THAT I REALLY LOOK FORWARD TO SEEING THE DATA THAT WE'VE ASKED FOR TODAY, THE METRICS, AND WE WILL BRING YOU BACK TO ANOTHER, UM, PUBLIC SAFETY COMMITTEE MEETING TO, TO FOLLOW UP ON THAT. 
          THANK YOU. 
          OKAY. 
          [3. 20-1419 Briefing on the San Antonio Fire Department Mobile IntegratedHealthcare Program [María Villagómez, Deputy City Manager; CharlesN. Hood, Fire Chief]]
NEXT, I'D LIKE TO INVITE CHIEF HOOD AND MARIA ONCE AGAIN TO GIVE US OUR PRESENT PRESENTATION ON THE FIRE DEPARTMENT'S MOBILE INTEGRATED HEALTH PROGRAM. 
          GOOD EVENING. 
          AND, UM, SITTING WITH ME WILL BE, UH, ASSISTANT CHIEF ANDREW ESTRADA AND, UH, CHRIS VELAZQUEZ, WHO IS, UH, BASICALLY A SHEPHERD GUARD, SHEPHERDED OUR M I H PROGRAM. 
          UM, ALSO I'VE GOT JOE  AND BRIAN MORRIS HERE WITH ME TONIGHT. 
          SO WE'RE HAPPY TO BE HERE AND WE'RE GONNA GIVE YOU REAL QUICK PRESENTATION. 
          I'M GONNA, SO FIRST THING YOU SEE IS, UM, WE RECENTLY WON THE E M S AWARD, UH, OF THE YEAR FOR, UM, OUR DEPARTMENT. 
          AND SO THE ONLY REASON THAT WE WON THE, UM, AWARD LIKE THIS IS BECAUSE OF THE ENHANCEMENTS THAT WE HAVE CREATED OVER THE YEARS TO TAKE CARE OF PEOPLE IN A MORE EFFICIENT, UH, NEXT BEST PRACTICE. 
          AND SO WHEN I SAY BEST PRACTICE, WE TALK ABOUT NEXT PRACTICE. 
          SO, UM, WE'RE REALLY PROUD OF THIS AWARD AND WE WOULD NOT HAVE GOT IT WITHOUT YOUR SUPPORT ALSO, UM, BY GIVING US THE RESOURCES THAT WE NEED. 
          UM, I'M GONNA GO AHEAD AND, UM, PLAY A VIDEO REAL QUICK FOR YOU. 
          ON THE NIGHT BEAT OF SAN ANTONIO, MOTHER LEFT PARALYZED DURING A SURGERY, ALMOST LOST EVERYTHING AS THE 19TH COURTNEY FRIEDMAN REPORTS, IF IT WASN'T FOR A PAIR OF SAN ANTONIO PARAMEDICS, SHE WOULDN'T HAVE HAD HER LIFE BACK. 
          IT WAS SUPPOSED TO BE A SIMPLE SPINAL SURGERY. 
          UNFORTUNATELY, YOU KNOW, THERE WAS A MISHAP AND I BECAME PARAPLEGIC. 
          WITHIN MONTHS, I WAS IN A COMA, HOSPITALIZED FOR ALMOST THREE MONTHS. 
          I WAS IN NURSING HOME FOR TWO MONTHS. 
          SINGLE MOM, MINDY SYLVESTRE, HAD TO QUIT WORKING AND WAS FORCED TO GIVE UP HER HOME. 
          JUST THINKING, YOU KNOW, MY LOVED ONES WHO'S GONNA TAKE CARE OF MY SON. 
          I WAS BASICALLY HOMELESS. 
          THEN A TRIP TO THE HOSPITAL FOR KIDNEY ISSUES, CHANGED EVERYTHING. 
          SOME ANGELS CAME TO MY RESCUE. 
          THE AMBULANCE PARAMEDIC WAS MICHAEL DIXON, WHO'S ON THE SAN ANTONIO FIRE DEPARTMENT'S NATIONALLY RESPECTED MOBILE INTEGRATED HEALTH OR M I H TEAM, TAKING EXTRA STEPS TO LINK CHRONICALLY ILL OR FREQUENT ER VISITORS TO MUCH NEEDED RESOURCES. 
          DIXON HELPED SYLVERE GET THE RIGHT INSURANCE. 
          SHE BEGAN TO RECEIVE SERVICES THAT SHE WAS ENTITLED TO. 
          SHE JUST WASN'T AWARE OF IT. 
          DIXON AND TEAM MEMBER BRIAN HARKINS CONTINUED VISITING SYLVESTRE FOR THE NEXT YEAR AT FAMILY MEMBERS' HOMES, NONE OF WHICH HAD HANDICAP ACCESSIBLE SHOWERS. 
          I GUESS THE TIPPING POINT FOR ME WAS, UH, THE DAY IT WAS IN THE FORTIES OUTSIDE, AND SHE WAS GOING OUT ONTO THE BACK PORCH TO SHOWER. 
          WITH THE HELP OF GORDON HARTMAN FROM MORGAN'S WONDERLAND AND SEVERAL HOUSING ORGANIZATIONS, HARKINS FOUND SYLVESTER THIS NEW APARTMENT IN HER BRAND NEW APARTMENT, AN AUTOMATIC LIFT HELPS HER GET IN AND OUT OF BED. 
          AND THEN HERE IN THE BATHROOM, TONS OF SPACE FOR HER TO MANEUVER IN HERE. 
          HANDLES THAT ARE EXTREMELY HELPFUL AND LOTS OF EQUIPMENT SO SHE CAN BATHE IN AN ACTUAL 
          [00:50:01]
SHOWER. 
          WOO. 
          UM, THAT'S INCREDIBLE. 
          DESPITE ALL THE HARDSHIPS, SYLVESTRE FINDING COUNTLESS THINGS TO BE THANKFUL FOR, JUST TO BE COURTNEY FRIEDMAN CASE AT 12 NEWS. 
          NOW, MANY LARGE CITIES AROUND THE NATION ARE TRYING TO MIRROR SAN ANTONIO'S M I H PROGRAM BECAUSE OF ITS RARE FUSION OF SOCIAL AND MEDICAL CARE. 
          AS FOR AS FOR SYLVESTRE, SHE HAS CONTACTED ATTORNEYS ABOUT THE SURGERY PLANS TO FILE A LAWSUIT. 
          SHE STILL HASN'T BEEN TOLD THE EXACT CAUSE OF HER PARALYSIS. 
          UM, I WAS A PARAMEDIC FOR 17 YEARS IN PHOENIX, AND YOU WOULD GO ON A ELDERLY MAN IN THE MIDDLE OF THE NIGHT, CONGESTIVE HEART FAILURE, UM, HE'S IN REALLY BAD SHAPE AND START AN IV ON AND GIVE HIM LASIX, PUT OXYGEN ON AND TAKE HIM TO THE HOSPITAL. 
          TWO WEEKS LATER, WE'RE BACK THERE AGAIN, PICKING UP THE SAME GENTLEMAN BECAUSE HE HAD GONE TO THE HOSPITAL, HE HAD GOTTEN BETTER. 
          HE CAME HOME AND ATE TOP RAMEN, WHICH IS LOADED WITH SODIUM. 
          HE DIDN'T HAVE ACCESS TO MEALS ON WHEELS. 
          UH, HE WAS NON-COMPLIANT WITH HIS MEDICATIONS BECAUSE HE'S FEELING BETTER. 
          SO IT WAS A CONSTANT TREADMILL THAT PATIENTS WOULD GO ON EVERY SINGLE DAY. 
          AND WE WERE RUNNING OUT OF AMBULANCES. 
          UH, OUR RESOURCES ARE BEING STRETCHED, SO IT'S LIKE, LET'S DO SOMETHING DIFFERENT. 
          SO IN, UH, 2013, COUNCILMAN GRO, YOU REMEMBER VERY WELL, YOU WERE HERE, I THINK YOU MIGHT HAVE BEEN OVER PUBLIC SAFETY. 
          AND WE LOOKED AT 302 CITIZENS IN SAN ANTONIO THAT CALL 9 1 1 MORE THAN 10 TIMES ON AVERAGE A YEAR. 
          AND THOSE PEOPLE BASICALLY WERE RESPONSIBLE FOR 4,435 RESPONSES AND, UM, 2,636 TRANSPORTS AND, UM, 1,799 NON TRANSPORTS. 
          SO WHAT THAT MEANT IS THAT ENGINE 37, ENGINE FIVE, LADDER ONE, WHOEVER IT WAS, AND THE MEDICS WERE GOING ON THESE CALLS ON PEOPLE THAT NEEDED SOMETHING ELSE AND JUST A RIDE TO THE HOSPITAL. 
          SO WE CREATED A PILOT, AND WE'LL GO TO THE NEXT SLIDE. 
          AND SO, AS YOU CAN READ ALONG WITH ME, UM, OCTOBER 1ST, WE, UM, HAD A SIX MONTH PILOT PROGRAM. 
          AND WE HAD TWO PARAMEDICS, TWO TEAMS OF PARAMEDICS, FOUR PARAMEDICS TOTAL THAT, UM, WERE WORKING EIGHT HOURS A DAY. 
          AND WE WANTED TO SEE WHAT WE COULD DO WITH THOSE NUMBERS. 
          AND SO, UM, WE BUILT UPON THAT. 
          AND SO WE REPORTED BACK TO COUNCIL. 
          WE, UM, IMMERSED CHERYL AND, AND ERIC AND, AND MARIA AND THE FOLKS THAT, UM, WERE GONNA HELP US GET THE RESOURCES AND THE VALUE OF THIS PROGRAM. 
          AND, UH, SO IN MAY, MAY 1ST WE STARTED OUR PROGRAM, I'M SORRY, OCTOBER 1ST. 
          WE STARTED OUR PROGRAM, SORRY, MAY 1ST WE STARTED OUR PROGRAM AND MADE IT PERMANENT. 
          SO WE'VE ADDED, UH, ONE LIEUTENANT, UM, SEVEN PARAMEDICS AND THE EQUIPMENT, THEY RIDE AROUND IN SMALL VEHICLES. 
          THEY'RE MARKED, UH, FIRE DEPARTMENT, M I H VEHICLES. 
          AND, UH, SO WE INCREASED OUR OPERATION HOURS TO 24 HOURS A DAY BECAUSE WE REALIZED IN THE SHORT TIMEFRAME THAT PEOPLE HAD EMERGENCIES 24 HOURS A DAY. 
          AND WE WANTED TO BE ABLE TO GET OUT AND TAKE CARE OF THEIR NEEDS AND KEEP THOSE UNITS AVAILABLE FOR FIRES AND MORE CRITICAL EMERGENCIES. 
          UH, AND SO WE ALSO STARTED A CONSORTIUM, WHICH INCLUDES THE AGENCIES THAT ARE NOT UP THERE, BUT, UH, ON MY NOTES HERE, STRAC SHIRTS, CANYON LAKE FIRE DEPARTMENT, NEW BRAUNFELS, AND OURSELVES. 
          SO WE HAD OTHER AGENCIES THAT WERE LEARNING, UH, AND, AND TAKING CARE OF THE SAME TYPE OF CUSTOMERS WE ARE. 
          'CAUSE ONCE WE STARTED THIS, WE REALIZED THAT OUR REACHES WOULD BE OUTSIDE OF THE CITY. 
          SO WE STARTED A CONSORTIUM WITH THESE OTHER AGENCIES. 
          AND, UH, NOW I'LL PLAY ANOTHER QUICK VIDEO FOR YOU. 
          IT'S BEEN ALMOST A YEAR SINCE THE SAN ANTONIO FIRE DEPARTMENT LAUNCHED A PILOT PROGRAM AIMED AT REDUCING UNNECESSARY 9 1 1 CALLS. 
          MANY OF THOSE CALLERS NEED MEDICAL HELP, BUT NOT THE KIND OF HELP. 
          A NINE ONE ONE CALL OFTEN DICTATES. 
          PAUL ENEMA TAKES A LOOK AT HOW THE MOBILE INTEGRATED HEALTHCARE PROGRAM IS WORKING THROUGH THE EYES OF A PARTICIPANT AND THE FIRE CHIEF. 
          THIS IS THE IMAGE THAT COMES TO MIND WHEN YOU THINK OF A NINE ONE ONE CALL POLICE FIREFIGHTERS AND AN E M S UNIT ON THE SCENE. 
          BUT OFTEN THE CALLS TO 9 1 1 DON'T DICTATE THAT NEED. 
          THERE ARE CALLS TO WHERE A PERSON NEEDS HELP. 
          THEY NEED HELP NAVIGATING A SYSTEM. 
          UM, THEY'RE NOT FEELING WELL. 
          YOU OPEN THE DOOR TO THAT. 
          CASE IN POINT, PENNY TIES, SHE'S AMONG THE PATIENTS ENROLLED IN THE MOBILE INTEGRATED HEALTH PROGRAM. 
          [00:55:01]
REALLY, I MIGHT BE DEB IF I WOULDN'T HAVE MET MIKE, BECAUSE I WOULD FLAT ON MY BACK. 
          AND DEB, SHE'D MADE 23 CALLS TO 9 1 1 IN ONE YEAR PRIOR TO ENROLLMENT. 
          THAT'S WHEN PARAMEDIC MIKE DIXON WAS ASSIGNED TO HER CASE. 
          THEY NEED TO HELP US HELP THEM, AND THAT MEANS PROVIDE THE WILL TO WANT TO GET BETTER. 
          AND IN PENNY'S CASE, THAT'S EXACTLY WHAT SHE'S SHOWN. 
          TYCE HAS GONE FROM BEING BEDRIDDEN TO UNDERGOING REHAB AND NOW USING A WALKER FOR THE FIRE DEPARTMENT. 
          THE PROGRAM IS A WIN-WIN PROPOSITION. 
          THIS IS A WAY FOR US TO SEND A TEAM OF FOLKS OUT TO, UH, IMPROVE THEIR QUALITY OF CARE, THEIR LIFESTYLE QUALITY, AND TO KEEP OUR UNITS ON THE STREETS. 
          NEXT STOP FOR THE CHIEF IS HERE AT CITY HALL. 
          THE PROGRAM IS A MAJOR COMPONENT OF THE DEPARTMENT'S BUDGET PROPOSAL THAT YOU'LL MAKE TO THE COUNCIL HERE NEXT MONTH. 
          ALL VENE, MY CASE HAD 12 NEWS. 
          AND SPEAKING OF THE BUDGET, THE PROPOSED BUDGET FOR THE PROGRAM, WHICH INCLUDES MANPOWER AND EQUIPMENT, A LITTLE MORE THAN $979,000 ANNUALLY. 
          SO WE HAD ONE PATIENT THAT CAUGHT US 93 TIMES, 93 TIMES THAT WOULD'VE MADE HER ADDRESS ONE OF THE BUSIEST ADDRESSES IN THE CITY. 
          SHE WOULD BE RIGHT THERE BEHIND THE AIRPORT HAVEN FOR HOPE. 
          SOME OF OUR BUSIEST PLACEMENT, 93, UH, CALLS A YEAR. 
          AND SO AFTER SHE WAS, UH, ENROLLED IN OUR M I H PROGRAM, SHE CALLED US 22 TIMES. 
          AND, UM, SO THE NUMBER OF CALLS FOR HIGH VOLUME UTILIZERS FOR A ONE YEAR PERIOD, UM, BEFORE WAS, UH, 1,142 CALLS. 
          UM, AFTER THE M I H PROGRAM STARTED FOR THESE UH, PATIENTS, UH, IT WAS REDUCED TO 236 CALLS, WHICH IS A 78% REDUCTION, WHICH IS AMAZING. 
          AND SO THAT IS SAVING US AMBULANCES, THAT'S SAVING US FIRE TRUCKS THAT IS KEEPING US AVAILABLE. 
          SO SINCE THE INCEPTION, WE'VE HAD 2,132 PEOPLE ENROLLED. 
          WE'VE HAD 16,762 PATIENT CONTACTS AND AN OVERALL 60% REDUCTION FROM ALL, UH, OF OUR, UH, ENROLLEES, WHICH IS AMAZING WORK. 
          UH, WE'RE GONNA GO AHEAD AND GO TO SLIDE FIVE. 
          SO SOME OF THESE THINGS THAT WE'VE TALKED ABOUT, I THINK PD TALKED A LITTLE BIT ABOUT IMPACT AND, UM, WE'RE WORKING EIGHT HOURS WITH PD ON SATURDAYS. 
          UH, WE'RE GOING OUT AS CHIEF MCMANUS TALKED ABOUT. 
          WE ARE PART OF THE MEDICAL COMPONENT. 
          AND, UH, SO WE ARE PARTNERING UP WITH THEM. 
          UM, THESE PATIENTS ARE IDENTIFIED BY PD, THE M M H U UNIT, AND, UH, A PATIENT LIST FOR HIGH VOLUME UTILIZATION WITHOUT A CONSISTENT LOCATION. 
          SO YOU CAN IMAGINE SOME PEOPLE CALL US A LOT, BUT THEY DON'T HAVE A CONSISTENT ADDRESS. 
          SO THIS WAS TRYING TO, UM, LOOK AT THESE PATIENTS, WHICH PREDOMINANTLY ARE HOMELESS. 
          SO, UH, WE, WE TALKED A LITTLE BIT ABOUT IMPACT, SO WE'LL GO AHEAD AND GO TO THE NEXT PROGRAM. 
          SO HOSPICE, I HAD AN OPPORTUNITY A COUPLE YEARS AGO TO RIDE ON ENGINE 24, EASIEST ENGINE COMPANY IN THE CITY. 
          AND WE WENT ON A CALL FOR A FAMILY THAT HAD BROUGHT THEIR DAD HOME. 
          THEIR DAD WAS STAGE FOUR CANCER, AND, UH, THEY HAD TAKEN HIM TO THE HOSPITAL. 
          THE HOSPITAL SENT HIM HOME, AND AS SOON AS HE GOT HOME, THEY GOT, HE GOT SICK AGAIN. 
          SO THEY CALLED US, IT WAS GONNA BE AN HOUR OR MORE FOR THE HOSPICE NURSE TO GET THERE. 
          SO IT'S LIKE, YOU KNOW WHAT, WHY DON'T WE SEE IF WE CAN FILL THE GAP? UM, BECAUSE HOSPITALS DO NOT WANNA SEE PEOPLE THAT ARE IN HOSPICE, HOSPICES DO NOT WANT TO SEND PEOPLE TO THE HOSPITAL. 
          AND SO HOW CAN WE ADD VALUE TO THIS TRAGIC SITUATION AND, AND FILL THAT GAP? SO AT THIS TIME, WE ARE WORKING WITH THREE DIFFERENT HOSPICES. 
          AND SO WE CAN GO OUT AND BASICALLY PROVIDE THE, THE NEEDS TO PREVENT THAT PERSON FROM GOING TO THE HOSPITAL TO PREVENT THAT PERSON FROM GOING IN AN AMBULANCE, UH, TO HELP THEM REMAIN, UH, HAVE THAT DIGNITY AT HOME AND BE THAT STOP GAP UNTIL THAT HOSPITAL'S NURSE CAN GET THERE. 
          UM, AND WE MANAGE THOSE TYPES OF PATIENTS. 
          SO THIS IS A PROGRAM THAT IS BENEFICIAL. 
          WE SEE A GREAT OPPORTUNITY OF GROWTH, UH, AS THIS PROGRAM CONTINUES. 
          AND SO THIS PROGRAM STARTED IN JULY, UM, 2018. 
          AND, UM, YOU KNOW, WE ARE LOOKING AT BASICALLY, UM, TO CONTINUE THIS, BUT WE ARE USING 
          [01:00:01]
OUR PARAMEDICS, UM, AND AGAIN, THEY ARE TRAINED AT A HIGHER LEVEL, UM, TO PROVIDE HELP IN THAT GAP. 
          AND, UH, SO WE'VE HAD 285% INCREASE IN PATIENT . 
          SO, UM, I'LL CLOSE THIS SLIDE OFF WITH SAYING THAT THIS IS A RESULT OF A PUBLIC AND PRIVATE INDUSTRY PARTNERSHIP. 
          THE HOSPICE COMPANIES THAT WE ARE USING RIGHT NOW, INCLUDING EMBRACE HOLY SAVIOR HOSPICE, ALAMO HOSPICE IN SAN ANTONIO, ALAMO HOSPICE IN BERNIE. 
          SO, UM, THIS PROGRAM I THINK WILL CONTINUE TO INCREASE AND BE EFFICIENT. 
          AND AGAIN, IT'S GONNA REDUCE THE CALLS THAT WE'RE SITTING, OUR FIRE TRUCKS AND AMBULANCES ON ACUTE CARE STATIONS. 
          EVERYONE KNOWS HAVEN FOR HOPE IS OUR NUMBER ONE ADDRESS FOR 9 1 1 CALLS IN THE CITY. 
          UM, I HAVE A STATION RIGHT DOWN THE STREET, STATION 11. 
          THEY'RE THE SAME MEN AND WOMEN THAT YOU SEE WHEN IT FLOODS THAT THEY'RE THE ONES THAT ARE ON BOATS AND GETTING DEPLOYED AND DOING ALL THE TECHNICAL RESCUES. 
          HAVEN FOR HOPE IS, UH, LESS THAN A MILE FROM THEIR STATION. 
          SO THEY WERE SPENDING AN INORDINATE AMOUNT OF TIME AT HAVEN FOR HOPE. 
          AND WHAT DOES THAT MEAN? THAT MEANS THAT IF I HAVE A WATER RESCUE, I HAVE A HOUSE FIRE, THEY ARE GONNA BE TIED UP. 
          SO HOW DO WE, UH, HELP OUT? BECAUSE THE CLINIC CLOSES AT EIGHT O'CLOCK AT NIGHT. 
          AND SO WE WOULD SEE OUR CALLS RISE BECAUSE SOMEONE NEEDS A DENTAL APPOINTMENT, SOMEONE NEEDS AN ASPIRIN, UH, IT'S COLD OUT, THEY CALL 9 1 1. 
          SO WHAT WE HAVE DONE, WE HAVE, UH, PLACED A PARAMEDIC AT HAVEN FOR HOPE DURING THE HOURS THAT THE CLINIC IS CLOSED. 
          AND SO, UH, THEY'RE WORKING 12 HOURS FROM SEVEN TO SEVEN, AND THEY ADDRESS THE NEEDS OF THE FOLKS AT HAVEN FOR HOPE. 
          AND, UM, SO WE USE A POOL OF ABOUT 140 PARAMEDICS THAT ARE FROM FIRE, FROM ARSON, FROM DISPATCH THROUGHOUT OUR SYSTEM. 
          AND, UH, WE UTILIZED THEM. 
          SO PRIOR TO THE PROGRAM, WE HAD 586 PATIENT CONTACTS DURING NIGHTTIME HOURS WITH 392 TRANSPORTS WITH A TRANSPORT RATE OF 67%. 
          SO THAT, AGAIN, IS TYING UP UNITS THROUGHOUT THE CITY BECAUSE WHEN OUR E M S UNITS ARE BUSY AND COUNCILMAN PERRY, WE'VE HAD THIS CONVERSATION WHEN OUR UNITS ARE BUSY, WE'RE PULLING UNITS FROM OUTSIDE OF 1604, WE'RE PULLING UNITS FROM INSIDE OF FOUR 10 TO COME DOWNTOWN. 
          SO IT WAS A HUGE DRAIN FOR EVERYONE IN THE CITY THAT MIGHT NEED HELP. 
          SO, UM, SINCE THE PROGRAM, UM, WE'VE HAD FIVE, UH, 1,516 PATIENT CONTACTS DURING NIGHTTIME HOURS, AND THAT'S A 282 TRANSPORTS WITH A DECREASED TRANSPORT RATE OF 19%. 
          SO WE'VE GONE FROM 67% TO 19%. 
          AND, UM, SO OUR PARAMEDICS THERE ARE ABLE TO GIVE, UH, SINGLE DOSES OF ANTIBIOTICS BECAUSE IT'S FLU SEASON. 
          THEY'RE ABLE TO GIVE ASPIRIN, THEY'RE ABLE TO SET UP APPOINTMENTS THE NEXT DAY BECAUSE A LOT OF TIMES THESE PEOPLE DO NOT NEED TO BE TRANSPORTED. 
          BUT WHAT WE WERE DOING PRIOR TO THAT, WE WERE TRANSPORTING AT A RATE OF 67%, WHICH IS NOT SUSTAINABLE UNLESS YOU ADD RESOURCES. 
          SO, UM, A 285% INCREASE IN PATIENT CONTACTS, BECAUSE THOSE NUMBERS ARE GOING TO CONTINUE TO GO UP. 
          AS FAR AS THE CALLS, WE'VE HAD AN ACTUAL, UH, DECREASE OF 28% IN, IN TRANSPORTATION. 
          SO IN 285% INCREASE IN RUNS, BUT WE'VE HAD A 28% IN ACTUAL DECREASE IN TRANSPORTATIONS, WHICH IS AMAZING. 
          AND I, AND I CAN'T THANK, I CAN'T THANK THE, THE GUYS TO MY LEFT AND RIGHT FOR THEIR INNOVATION. 
          SO AGAIN, THIS IS A PROGRAM THAT TRULY WORKS AND WE'RE VERY EXCITED ABOUT, ABOUT IT. 
          SO, TEXAS TARGETED OPIOID RESPONSE. 
          AND SO I THINK, UH, THERE WAS SOME, UH, DISCUSSION A LITTLE WHILE AGO BETWEEN NARCAN AND METHADONE AND ALL OF THOSE THINGS. 
          BUT BASICALLY IF, IF YOU CALL OUR SYSTEM AND WE TRANSPORT YOU AND WE FIGURE OUT THAT YOU'VE OVERDOSED ON, UM, AN OPIOID, NOT THAT YOU OVERDOSED ON ASPIRIN WITH A SUICIDE, BUT IF IT IS AN OPIOID, IF IT'S A HEROIN OVERDOSE, UH, WE ARE GOING TO CONTACT 
          [01:05:01]
YOU, UM, WITHIN A 72 HOUR PERIOD, BASICALLY BECAUSE WE DON'T WANT YOU TO OVERDOSE AGAIN. 
          AND SO, UH, WHAT WE DO IS WE GIVE YOU C P R INSTRUCTIONS, WE WILL GIVE YOU NARCAN TO MAKE SURE THAT WE CAN GET YOU TO A PLACE TO WHERE YOU ARE NOT GOING TO BE SO FRAGILE THAT YOU ARE GOING TO OVERDOSE. 
          UM, THE CALLS FOR GETTING SOMEONE INTO REHAB, THAT IS ANOTHER PROGRAM. 
          BUT RIGHT NOW, THESE PEOPLE THAT WE ARE ADDRESSING ARE THE ONES THAT WE JUST TRANSPORTED THEM. 
          THEY'RE PROBABLY GONNA OVERDOSE AGAIN IN THE NEXT DAY OR SO. 
          SO HOW DO WE PREVENT THEM FROM DYING NEEDLESSLY, GIVING THEM THE TOOLS THAT THEY NEED THAT MAY HELP THEM IN THEIR EVENTUAL SOBRIETY? SO WE HAVE TWO PARAMEDICS ASSIGNED TO THIS PROGRAM, AND, UM, IT, IT'S WORKING VERY WELL. 
          CAPTAIN ZUNIGA GAVE YOU A REALLY GOOD, UM, EXPLANATION OF, UH, THE THREAT ASSESSMENT GROUP. 
          THIS IS A LIST OF BASICALLY, UH, EVERYONE THAT'S INVOLVED IN IT. 
          AND, UM, THE CITY OF ORLANDO, AFTER THE PULSE NIGHTCLUB SHOOTING, CITY OF LAS VEGAS, AFTER THEIR TRAGIC SHOOTING, THEY INSTITUTED THREAT ASSESSMENT GROUPS. 
          I'M GOOD FRIENDS WITH BOTH OF THOSE FIRE CHIEFS. 
          AND WE HAD SUTHERLAND SPRINGS AND WE STARTED THIS PROGRAM THREE WEEKS AFTER SUTHERLAND SPRINGS. 
          SO WE'VE BEEN VERY PROACTIVE, AND AS CAPTAIN ZUNIGA SAID, WE MEET ONCE A MONTH. 
          I'VE HAD A CHANCE TO MEET WITH SOME OF THOSE GROUPS AS FAR AS REGION 20 U SS A A, UM, SOME OF OUR, OUR, OUR, OUR LARGEST INSTITUTIONS IN THE CITY. 
          AND SO WE DON'T OPERATE IN A SILO. 
          SO SAY IF U S A A FIRES SOMEONE AND THEY'RE A THREAT, IT'S PROBABLY IMPORTANT THAT WE KNOW. 
          'CAUSE WHAT HAPPENS IN EVERY ACTIVE SHOOTER THAT HAPPENS. 
          EVERYBODY GOES BACK AFTER YOU GET THE BODY COUNTS, AFTER YOU GET THE NUMBER THAT ARE INJURED. 
          AND THEY SAY, WELL, YOU KNOW WHAT? THERE WERE ALL THESE RED FLAGS. 
          THIS GUY WAS DISENFRANCHISED, HE GOT FIRED, HE LOST HIS JOB, THIS STUDENT WAS ANGRY. 
          UM, HOW DO WE SHARE THAT INFORMATION? AND THAT'S WHAT WE DO WITH THIS THREAT ASSESSMENT GROUP. 
          WE FIGURE OUT WHERE THOSE RED FLAGS ARE, AND IT MAY NOT PREVENT A SHOOTING, BUT IT'S GOING TO AT LEAST GIVE US, UM, SOME CLOSURE AND UNDERSTANDING, YOU KNOW WHAT, THIS IS THAT PERSON. 
          WE COULDN'T GET TO 'EM, BUT WE KNEW WHAT WAS GOING ON AND WE SHARE THAT INFORMATION. 
          BUT WE HAVE HAD EFFORTS THAT HAVE SAVED LIVES ALREADY. 
          SO THIS WORKS AND, UH, WE'RE VERY PROUD OF THIS. 
          BUT THIS WAS SOMETHING THAT WAS, UH, A PROACTIVE EVENT TO WHERE WE ACTED TO DEVELOP THIS GROUP, TO BUILD THESE STRONG RELATIONSHIPS BEFORE WE HAD A TRAGEDY IN THE CITY OF SAN ANTONIO. 
          SO I THINK PD TALKED A LITTLE BIT ABOUT PICK, UM, AND, UH, WE ARE PARTNERS WITH, UH, PD AND, UH, WORK HAND IN HAND. 
          IT IS A NEWER OF OUR PROGRAMS. WE INSTITUTED THIS IN JULY, 2019. 
          SO ALL THESE PROGRAMS THAT I MENTIONED, THEY'RE IN CHRONOLOGICAL ORDER. 
          SO THIS IS OUR LAST PROGRAM. 
          AND, UM, WE'VE HAD, UM, ONE PATIENT THAT HAD 101 EMERGENCY DETENTIONS IN A YEAR. 
          SO THAT'S A COMBINATION OF PD AND FIRE RESPONDING TO THIS PERSON 101 TIMES A YEAR. 
          SO, UM, WE HAVE A RATIO THAT WE USE. 
          IF YOU TAKE A MENTAL HEALTH PATIENT TO AN ER, UM, IT'S GONNA TIE UP A BED FOR SOMETIMES 24 HOURS. 
          THEY COULD DO SIX CARDIAC CATHETERIZATIONS TO ONE PSYCH PATIENT. 
          SO WE'RE LOOKING AT A SIX TO ONE RATIO OF NOT HAVING BEDS AVAILABLE. 
          WE WANT TO GO TO THIS HOSPITAL, BUT GUESS WHAT? WE CAN'T BECAUSE IT'S FILLED WITH PSYCH PATIENTS. 
          SO HOW DO WE NAVIGATE THEM AND GET THEM TO A PLACE WHERE WE ARE NOT ARRESTING THEM AND WE'RE NOT TAKING THEM TO THE HOSPITAL BY AMBULANCE? AND SO THAT'S WHAT THIS PROGRAM IS DOING. 
          AND, UM, I DO THINK WE'RE GONNA SEE SOME, UM, GREAT NUMBERS WITH THIS PROGRAM. 
          THE NEXT SLIDE, AND THIS IS OUR LAST PROGRAM. 
          I'VE GOT SO MANY PROGRAMS. I GOT ALL THESE DIFFERENT PAGES HERE. 
          AND SO, UM, WE ARE, UH, LOOKING AT THE PATIENT THAT HAS DECIDED, OKAY, 
          [01:10:01]
YOU KNOW WHAT? I DON'T WANT TO LIVE THIS LIFESTYLE OF CONTINUING GETTING HIGH. 
          I'M NOT GETTING HIGH ANYMORE. 
          IT'S NOT DOING ANYTHING FOR ME. 
          UM, I NEED SOME HELP. 
          AND SO THIS IS AN OPPORTUNITY FOR US TO GO OUT AND, UM, WORK WITH THEM TO, UM, GIVE THEM, UH, SUBOXONE, WHICH IS, UM, HELPS WITH THE WITHDRAWAL SYNDROMES. 
          AND SO AGAIN, UM, WE FACILITATE THE INTAKE, THE TRANSPORT, UH, TO A AVAILABLE DETOX BED. 
          SO, UM, THIS PATIENT POPULATION IS CREATED THROUGH REFERRALS. 
          SO AGAIN, WE ARE TRYING TO GET PEOPLE, FIRST OF ALL, WHEN THEY OD TO NOT LOSE THEIR LIFE ON A SECOND OD WHEN THEY ARE READY TO, UM, TRY TO CHANGE THEIR LIFESTYLE. 
          THIS PROGRAM IS AVAILABLE FOR THEM, UM, TO DO THAT. 
          NOW THIS PROGRAM STARTED, UM, DECEMBER 19TH, AND IT OPERATES SEVEN DAYS A WEEK FROM 9:00 AM TO 5:00 PM I DON'T HAVE REALLY GOOD METRICS AS YOU COULD IMAGINE, BUT THIS IS SOMETHING THAT WE LOOK FORWARD COMING BACK TO REPORT TO YOU, UH, IN THE NEAR FUTURE. 
          AND SO I WOULD JUST LIKE TO CLOSE, WE TALKED ABOUT THE E M S AWARD OF THE YEAR. 
          UH, WE WERE, LOOK, WE ALSO THE RECIPIENT OF THE 2019 ELDER AWARD. 
          UH, AND THAT'S FROM THE SAN ANTONIO BAR ASSOCIATION. 
          AND, UM, THAT BASICALLY, UH, TALKS ABOUT THE PARTNERSHIPS THAT, UH, WE'RE A COMMUNITY PARTNER IN ADDRESSING THE COMMUNITY'S NEEDS. 
          AND THE OTHER ONE'S THE RECIPIENT OF THE TEXAS, UH, HUMAN SERVICES COMMISSIONS AWARD. 
          AND THEY NORMALLY ONLY AWARD THAT TO TEXAS, STATE OF TEXAS AGENCIES. 
          SO WE'RE THE FIRST FIRE DEPARTMENT THAT REACHED OUT AND GIVEN THIS AWARD TOO. 
          SO I STAND READY TO ANSWER ANY QUESTIONS. 
          I'M REALLY PROUD OF THE PROGRAMS. UM, I THANK YOU FOR YOUR SUPPORT. 
          I THINK YOU SHOULD BE REALLY PROUD THAT YOUR COUNCIL PEOPLE HAVE A REALLY EXCELLENT FIRE DEPARTMENT'S, ONE OF THE BEST ONES IN THE WORLD. 
          SO THANK YOU FOR YOUR ATTENTION. 
          THANK YOU, CHIEF HOOD, AND CONGRATULATIONS ON THE 2019 E M S SYSTEM OF THE YEAR, SAN ANTONIO FIRE DEPARTMENT. 
          AND OUR, UM, UH, FIRE MEN AND WOMEN CONTINUE TO EXCEL. 
          AND, UH, I KNOW MY COUNCIL COLLEAGUES AND I ARE VERY GRATEFUL TO THAT, UM, FOR THAT, BUT ESPECIALLY FOR THE CITIZENS OF OUR CITY. 
          SO THANK YOU. 
          UM, I HAVE A COUPLE OF QUESTIONS. 
          ONE IS, HAVE THE, THE BUDGETS, WHAT HAVE THE BUDGET SAVINGS BEEN BECAUSE OF THESE PROGRAMS? UM, I'M THINKING MORE OF LIKE, YOU KNOW, YOU'RE NOT HAVING TO SEND OUT THE BIG APPARATUS, THE BIG ENGINES. 
          YOU'RE, YOU'RE SENDING OUT THESE SMALLER UNITS. 
          HAVE YOU BEEN ABLE TO QUANTIFY THE BUDGET SAVINGS? ABSOLUTELY. 
          WE HAVE. 
          I DON'T HAVE A SLIDE FOR THAT, BUT, UM, AND COUNCILMAN VIA GRAHAM, PROBABLY COUNCILMAN PERRY, YOU MAY REMEMBER, WE WOULD RUN SLIDES TALKING ABOUT THE, THE MAN HOURS, THE UNIT AVAILABILITY THAT THIS INCREASES. 
          AND SO THE MAIN THING IS, UM, IT IS A, IT IS A FINANCIAL SAVINGS THAT I'M LOOKING AT KEEPING MY UNITS AVAILABLE FOR OTHER RUNS. 
          AND SO IF YOU LOOK AT THE RUNS, IF YOU FACTOR IN THE RUNS THAT WE TALKED ABOUT THAT WE'VE ALLEVIATED AND YOU PUT A COST ON THEM, IT'S A HUGE SAVINGS. 
          BUT THE BIGGEST SAVINGS FOR US IS KEEPING THOSE FIRE TRUCKS AVAILABLE AND ADDING VALUE TO OUR CITIZENS. 
          BECAUSE WHEN WE STARTED THE I H PROGRAM, WE KNEW IT WASN'T GONNA MAKE MONEY. 
          IT PROBABLY WAS NOT GOING TO PAY FOR ITSELF. 
          AND WE, WE'VE HAD THOSE DISCUSSIONS, BUT WE ARE ADDING VALUE TO PEOPLE THAT CALL 9 1 1 AND HOPEFULLY WE'RE TAKING THEM OFF OF A CULTURE OF CALLING 9 1 1 EVERY TIME THEY NEED HELP. 
          AND SO THAT IS THE BIGGEST BENEFIT OF ALL OF THESE PROGRAMS. THANK YOU, CHIEF. 
          UM, I JUST WANNA POINT OUT TOO, ON SLIDE 11, YOU HAD SOME NUMBERS, SOME DATA TO SHOW. 
          UM, IF WE COULD GO TO THAT SLIDE. 
          THE, THIS IS, UH, I LOOKED AT THE FINE PRINT HERE. 
          THESE ARE NATIONAL NUMBERS IN 2018 AND 19, IS THAT CORRECT? YES, MA'AM. 
          OKAY. 
          I WONDER IF WE COULD, UM, PARE THAT DOWN TO THE CITY OR BEXAR COUNTY. 
          I'D LIKE TO SEE THAT. 
          I THINK WE COULD, BUT YOU KNOW, OUR PROGRAM JUST STARTED, AS I MENTIONED IN DECEMBER. 
          SO WE REALLY DON'T HAVE THE GRASP ON GOOD NUMBERS YET. 
          BUT WE'LL COME BACK TO YOU. 
          WE LOOK FORWARD TO GIVE IT SOME MORE TIME. 
          OKAY. 
          YES, MA'AM. 
          OKAY. 
          THANK YOU. 
          CHIEF HOOD, UH, COUNCILWOMAN. 
          ANDREW SULLIVAN. 
          THANK YOU CHAIR. 
          UM, THANK YOU CHIEF. 
          THANK YOU TO EVERYONE THAT SERVES ON THE SAN ANTONIO FIRE DEPARTMENT. 
          UM, EVERYONE 
          [01:15:01]
THAT I KNOW GOES ABOVE AND BEYOND, WHETHER IT'S DELIVERING A BABY AT HOME OR OR SAVING A LIFE FROM A DRUNK DRIVER. 
          AND SO WE KNOW THAT THE WORK THAT YOU DO THROUGHOUT THE CITY TRULY DOES SAVE LIVES. 
          AND THIS PROGRAM, THESE PROGRAMS THAT YOU HAVE IMPLEMENTED SHOW JUST THAT. 
          AND SO WE COMMEND YOU ON BEING INNOVATIVE. 
          WE COMMEND YOU ON BEING, UH, ABOVE AND BEYOND WHAT YOU NORMALLY SEE A FIRE DEPARTMENT TRULY DO, OR A PARAMEDIC. 
          THANK YOU SO MUCH FOR EVERYTHING THAT YOU DO. 
          WHEN IT COMES TO THE RESPONSE TEAMS, I KNOW YOU DEAL A LOT WITH MORE OF THE CHRONIC, UH, CALLS OR THE CONTINUOUS CALLER. 
          UM, BUT WHAT HAPPENS WHEN IT'S A PERSON THAT'S ON INSULIN OR HAS BLOOD PRESSURE ISSUES? UM, TYPICALLY IF THEY'RE OUT OF INSULIN AND THEY'RE NOT ABLE TO, TO FIND THAT REPLACEMENT, THEY CONTINUOUSLY CAN GIVE YOU THOSE CALLS. 
          OR WHEN IT'S BLOOD PRESSURE AND THEY'RE HAVING THE HEADACHES OR THE SORENESS AND STIFFNESS. 
          AND WHAT, WHAT DO YOU TYPICALLY DO FOR THOSE PARTICULAR PATIENTS? UM, WE RUN A LOT OF DIABETIC EMERGENCIES. 
          AND SO, UM, IF IT WAS SOMEONE THAT WAS RUNNING OUT OF THEIR INSULIN BECAUSE IT WAS A, UH, ISSUE WITH THE PHARMACIES AND THEY'RE A HIGH VOLUME UTILIZ, UTILIZER, THEN WE'RE GONNA FIGURE OUT A WAY TO NAVIGATE THEIR MEDICATIONS TO WHERE YOUR MEDICATIONS CAN BE DELIVERED. 
          YOU DON'T HAVE TO GET UP AND GO DRIVE. 
          YOU CAN GET YOUR MEDICATIONS WHERE YOU HAVE INDIVIDUAL PACKETS THAT TELL YOU WHAT TO TAKE. 
          IF YOU ARE INVOLVED IN A PROGRAM AND YOU'RE, YOU'RE SIGNED IN, THEN WE'RE GONNA GO IN AND MONITOR AND TAKE CARE OF YOU AND MAKE SURE THAT YOU ARE FUNCTIONING. 
          BUT IF IT'S THAT PERSON THAT CALLS US, WHICH IS USUALLY NOT A, A HIGH VOLUME UTILIZER, UM, THEY CALL THE SUGARS LOW, UM, WE MAY GIVE 'EM SOME ORANGE JUICE AND MAKE 'EM SOME EGGS 'CAUSE THEY HAVEN'T EATEN. 
          UM, AND WE MAY GET THEIR SUGAR UP THAT WAY. 
          WE MAY HELP MANAGE THAT AND NOT TAKE THEM TO THE HOSPITAL. 
          IT KIND OF DEPENDS ON THE SITUATION. 
          BUT I THINK FOR THOSE THAT ARE HAVING PROBLEMS GETTING MEDS, THEY'RE PROBABLY THE SAME ONES THAT ARE CALLING US, UH, MULTIPLE TIMES. 
          AND SO WE'RE GONNA BE ABLE TO WORK TO HELP NAVIGATE A CARE PLAN FOR THEM AND NAVIGATING, GIVE THEM GETTING MEALS, POTENTIALLY NAVIGATING THEM, GETTING THEIR PRESCRIPTIONS. 
          WE HAVE HAD PEOPLE THAT THEY NEEDED A CAN OPENER. 
          WE HAVE HAD PEOPLE THAT NEEDED FALL PROTECTION, SO THEY NEEDED A RAMP. 
          WE'VE HAD PEOPLE THAT NEEDED LIGHTING SO THEY DON'T FALL AND PUT THEIR HIP. 
          AND, UM, 65% OF PEOPLE DIE THAT ARE AT A ADVANCED AGE IF THEY BREAK THEIR HIPS. 
          AND ACTUALLY THAT NUMBER IS 85%. 
          AND SO THIS PROGRAM IS, THAT ADDS VALUE. 
          SO ALL OF THOSE THINGS ARE CONCERNS, BUT IF THEY'RE ENROLLED AND THEY'RE A HIGH VOLUME UTILIZER, WE'RE GONNA TAKE CARE OF THOSE NEEDS FOR THEM. 
          AWESOME. 
          THANK YOU CHIEF. 
          THANK YOU. 
          THANK YOU COUNCILWOMAN. 
          ANDREW SULLIVAN, COUNCILWOMAN . 
          THANK YOU CHIEF. 
          THANK YOU, UH, GUYS FOR  YOUR HELP, UM, AS WELL. 
          AND, AND YES, CONGRATULATIONS ON THE E M S SYSTEM OF THE YEAR. 
          AND ALSO THANK YOU CHIEF AND YOUR TEAM, UH, THAT COMES OUT AND THAT WE HAVE BLOOD ON OUR E M S. 
          AND I KNOW I DONATED BLOOD THIS WEEKEND, AND I KNOW OUR CITY EMPLOYEES ARE GOING TO, ARE STILL ABLE TO DONATE BLOOD AND THAT WE STILL NEED PEOPLE TO GIVE, UM, AND TO GIVE, SO ONE PERSON DONATION CAN SAVE THREE LIVES. 
          SO PLEASE, UM, DONATE. 
          UM, SO FOR THE HIGH UTILIZERS, YOU JUST MENTIONED SOME THINGS ON, YOU KNOW, HAVING ORANGE JUICE, MAKING EGGS, BUT LOOKING FROM THE, THE FINDINGS OF THE FIRST YEAR, THE PILOT PROGRAM NUMBER OF CALLS FROM 1142 TO 2 36. 
          SO WHAT WAS IT, WHAT WAS THE ISSUE THAT MADE IT CLICK FOR SOME PEOPLE THAT THEY JUST NEEDED TO HAVE THEIR AHA MOMENT TO STOP CALLING 9 1 1? WHAT, WHAT WAS IT? AND, AND, AND I'LL LET CHRIS JUMP IN TOO, BUT I THINK FOR SOME OF THEM IS THERE'S A LIGHT THAT CAME ON FOR THEM THAT'S LIKE, YOU KNOW WHAT, SOMEBODY CARESS ABOUT ME, SOMEBODY CARESS ABOUT WHAT'S GOING ON WITH ME AND THEY'RE NOT GONNA JUST THROW ME IN THE AMBULANCE EVERY TIME I CALL. 
          OR WE HAD TO EDUCATE THEM THAT YOU DON'T NEED TO GO TO THE HOSPITAL EVERY TIME YOU CALL. 
          AND SO, UM, THERE'S A MILLION STORIES WITH WHY THESE NUMBERS WENT DOWN AND YOU SAW A COUPLE OF 'EM ARTICULATED UP ON THESE FILMS HERE BY, BY THE NEWS. 
          BUT IT IS, EACH ONE IS INDIVIDUAL 
          [01:20:01]
AND, AND CHRIS, YOU GOT A GOOD STORY YOU WANT SHARE WITH ME? YEAH, ABSOLUTELY. 
          I THINK THE, UM, THE ACCESS TO HEALTHCARE WAS THE LIMITING FACTOR TO THESE FOLKS. 
          THE ACCESS IS ALWAYS THERE. 
          THEY JUST DIDN'T KNOW IT. 
          SO I DON'T KNOW NECESSARILY THAT WE, I DON'T THINK WE WERE THAT BIG OF A FACTOR. 
          WE JUST CONNECTED THEM A LOT WITH THINGS. 
          UM, WE DO DELIVER MEDICINES, WE DELIVER FOOD. 
          UM, IF THEY DON'T HAVE FOOD, WE DON'T JUST, OKAY, SORRY, WE DON'T CARRY FOOD IN THE CAR. 
          WE'RE LEAVING. 
          WE GO, WE FIND A WAY. 
          WE DON'T, WE'RE NOT, AND I, AND THE PROGRAMS ARE VERY SUCCESSFUL AND IT'S NOT JUST BECAUSE I WORK WITH THEM. 
          IT'S BECAUSE THEY ARE, UM, WE DON'T LET YOU KNOW WE'RE, WE'RE NOT SUCCESSFUL BECAUSE WE EXPECTED TO SUCCEED. 
          WE ARE SUCCESSFUL BECAUSE WE DIDN'T LET ADVERSITY OR OR ANYTHING GET IN OUR WAY FOR THAT SUCCESS. 
          AND THE PATIENT ENGAGEMENT IS HOW WE'RE SUCCESSFUL. 
          SO THE PATIENTS, IT, IT, AND IT'S, UH, VARYING THINGS. 
          UH, COUNCIL OMI, IT'S, IT'S, UH, ACCESS TO MEDICATION, IT'S LACK OF FUNDING. 
          A LOT OF PEOPLE DON'T KNOW THAT TWICE A YEAR, UH, C P S AND SAWS, THERE'S, THERE'S GRANT PROGRAMS THAT WILL PAY YOUR BILL. 
          THEY DON'T KNOW THAT. 
          UH, WE KNOW WE MAY TRIVIALIZE A COUPLE HUNDRED DOLLARS, BUT I'M TELLING YOU THAT TO SOME FOLKS, FOUR OR $500 A YEAR IS, IS A LOT OF MONEY. 
          UM, AND IT'S, IT'S A, YOU KNOW, YOU HAVE A LOT OF VETERANS IN THIS TOWN THAT DIDN'T REALIZE THAT THEY WEREN'T ACCESSING A LOT OF THEIR VA BENEFITS. 
          THEY HAD SPOUSES THAT SERVED IN THE MILITARY 30, 40 YEARS AND THEY DIDN'T KNOW THEY COULD GET ALL THESE BENEFITS. 
          SO CONNECTING 'EM AGAIN WITH THE RESOURCES, AND IT'S NOT JUST THAT, IT'S THE PATIENT ENGAGEMENT, UH, AND IT'S FOLLOWING THROUGH. 
          SO EVEN AFTER THE VISIT, WE'RE STILL AVAILABLE, RIGHT? WE'RE ALL RISK, ALL HAZARD FIRE DEPARTMENT, BUT NOW WE'RE KIND OF ON ALL SERVICE AS WELL. 
          SO THERE'S NOT REALLY NOT ONE CAP WE DON'T WEAR IN THE COMMUNITY. 
          WE JUST, AGAIN, IT'S, IT'S THE PATIENT ENGAGEMENT THAT'S KEY. 
          AND, YOU KNOW, UH, CHIEF, I WON'T, I WON'T FORGET THE, THE MAP THAT YOU SHOWED US THAT VERY FIRST TIME IN PUBLIC SAFETY, TALKING ABOUT THE HIGH, UM, VOLUME UTILIZERS AND HOW THAT WAS, YOU MAY SAY MAYBE WE DON'T SEE THE COST SAVINGS, BUT WE ARE SEEING IT AS TAXPAYERS TO OUR, UM, TO, TO THE SYSTEM, TO, UM, UNIVERSITY HOSPITAL, TO OTHERS. 
          BECAUSE WE KNOW THIS WAS ALSO IMPACTING, LIKE YOU MENTIONED ALL THE BEDS AND HOW MANY, UM, ON, ON ALL THE HOSPITALS THAT ARE ALSO WANTING TO KNOW, WELL, I DON'T HAVE ACCESS HERE. 
          I DON'T HAVE ACCESS HERE. 
          SO THIS IS A, A GREAT SUCCESS STORY. 
          AND YOU'RE RIGHT, CHRIS, WHAT YOU WERE JUST SAYING, YOU ALL MAKE A WAY, YOU FIND A WAY TO MAKE SURE THAT THIS IS SUCCESSFUL. 
          AND I THINK THAT'S WHERE THE RESOURCEFULNESS AND THE SOLUTION ORIENTEDNESS OF YOU ALL. 
          BUT I THINK THAT'S WHAT MAKES SAN ANTONIO SPECIAL TOO. 
          AND WHAT MAKES OUR, OUR, UH, FIRE DEPARTMENT SPECIAL GOING TO THE HOSPICE. 
          UM, AND I'M LOOKING AT YOU CHRIS, 'CAUSE YOU'RE IN ALL THE PICTURES. 
          SO MAYBE YOU CAN ANSWER THESE, THESE, UM, THESE QUESTIONS . 
          UM, SO WHEN DID THIS PROGRAM START? AND TALK TO ME A LITTLE BIT ABOUT THESE HOSPICE, THESE PRIVATE HOSPICE CENTERS. 
          WHAT, WHAT DO WE DO WITH THEM? HOW DO YOU PARTNER WITH THEM? DO THEY COME OUT TOO? DO YOU, DO YOU TAKE THEM THERE? WHAT, WHAT IS THAT? SO IT, IT'S A LITTLE IN DEPTH, IT'S A LITTLE, I, MY, UH, TAG TEAM WITH CHIEF ESTRADA HERE JUST A LITTLE BIT. 
          SO, UM, WE, LEMME WHERE DO I START? SO WE GET THEIR, THEIR CENSUS AND WE FLAG THEIR ADDRESS IN OUR COMPUTER AIDED DISPATCHING SYSTEM. 
          SO WHEN, UM, AND THEY'RE ENROLLED AND THEIR, THEIR, THE GOAL OF OUR PROGRAM, AGAIN, IS NOT TO DISSUADE THEM. 
          IF THEY WANT TO GO TO THE HOSPITAL BECAUSE THEY NO LONGER BELIEVE IN THE HOSPICE MISSION, THAT IS WHAT WE ARE GOING TO DO. 
          OKAY? WE ARE THERE TO OFFER THE PATIENT OPTIONS. 
          IT'S WHAT WE ARE DOING IS EXTENDING OUR REACH INTO THE COMMUNITY AND TO THE CITIZEN. 
          WE ARE NOT THERE TO DISSUADE THEM. 
          IF THEY NO LONGER, LIKE AGAIN, THEY, THEY'RE NOT ON THAT MISSION. 
          THEY MOVE ON. 
          WE CAN, WE CAN HELP 'EM MOVE ON TO THE HOSPITAL. 
          UM, BUT THE VAST MAJORITY OF FOLKS DON'T WANT THAT. 
          THEY WANT TO DIE WITH DIGNITY IN THEIR HOME AS THEY WISHED IN, IN THE BEGINNING. 
          SO SOMETIMES IT'S NOT, ACTUALLY, MOST OF THE TIME IT'S NOT THE PATIENT THAT THAT DIALS NINE ONE ONE. 
          SO WHEN THAT CALL IS INITIATED, WE GET ACTUALLY OUR TEAM, A WHOLE TEAM WILL GET A TEXT MESSAGE THAT THIS, UH, HOSPICE, UH, PATIENT DIALED 9 1 1. 
          AND THEN WE, WE, WE WERE, WE ARE IN ADDITION TO, SO WE DON'T CHANGE THE RESPONSE. 
          THEY STILL GET THE, THE DISPATCH DOES NOT SAY, WELL, WE'RE NOT GONNA SEND A FIRETRUCK OR AN AMBULANCE INSTEAD OF, WE'RE JUST GONNA SEND M I H AND THE REASON FOR THAT IS WE DON'T WANNA MAKE SURE THERE'S NO MISCOMMUNICATION IN THE CALL. 
          RIGHT? WE DO KNOW THAT THERE IS SOME, SOMETIMES IT COULD BE A 95 YEAR OLD CHOKING AND REALLY IT'S A FIVE YEAR OLD CHOKING. 
          SO WE WANNA MAKE SURE THAT THAT DOESN'T HAPPEN. 
          SO WE JUST GET ADDED TWO. 
          SO OBVIOUSLY OUR RESPONSE TIMES ARE VERY GOOD. 
          MM-HMM. 
          . 
          AND SO THE AMBULANCE OR FIRETRUCK GETS THERE AND THEN WE'RE IN CONSTANT COMMUNICATION EN ROUTE AND WE'RE JUST, YOU KNOW, WE, WE JUST KIND OF QUARTER BACK IT. 
          AND THEN WE USUALLY GET THERE AND WE, WE TAKE OVER AND WHAT DOES THAT MEAN? TAKE OVER. 
          RIGHT. 
          THE HOSPICE AGENT IS ALSO, IS ALSO IN RESPONSE AS WELL. 
          OKAY. 
          SO WE, UH, WE'RE IN COMMUNICATION WITH ALL THREE AGENCIES, THE THE FIRE DEPARTMENT, THE HOSPICE AGENCY, AND OUR TEAM. 
          AND WE, AGAIN, WE OFFER 'EM OPTIONS. 
          WE GET THERE AND THE FIRST THING WE USUALLY ASK IS, WHAT WOULD YOU LIKE ME TO DO? UM, YOU KNOW, UH, WE ASK THE PATIENT AND IF IT'S A PAIN THING, IF IT'S PAIN MANAGEMENT, WE GIVE THEM PAIN MEDICINE. 
          IF IT'S THEY'RE DEHYDRATED, IF THEY'RE HUNGRY, IF THEY'RE 
          [01:25:01]
NAUSEATED, WE HAVE ALL THE MYRIAD OF MEDICATIONS THAT WE CAN OFFER THESE FOLKS MM-HMM. 
          . 
          AND AGAIN, UH, YOU 90% I'D SAY MAYBE HIGHER. 
          I DON'T HAVE AN EXACT NUMBER. 
          IT'S NOT THE PATIENT THAT CALLED 9 1 1. 
          RIGHT. 
          WE SEE AN INCREASE IN THE HOLIDAYS. 
          WE SEE A INCREASE AT MOTHER'S DAY AND SPRING BREAK. 
          WHY? BECAUSE PEOPLE ARE HOME AND THEY'RE SEEING THEIR, THEIR LOVED ONE. 
          AND MAYBE THEY ARE UNCOMFORTABLE, MAYBE THEY AREN'T SUFFERING, MAYBE THEY'RE NOT COMFORTABLE WITH THE SITUATION AND IT'S, IT'S, OR THEY DON'T KNOW JUST WHAT TO DO AND THEY, THEY DON'T WHAT FREAK OUT AND THEY NEED TO CALL 9 1 1. 
          THAT'S IT. 
          YEAH, EXACTLY. 
          THAT'S EXACTLY IT. 
          COUNSELING. 
          YEAH. 
          THEY DON'T KNOW WHAT TO DO. 
          AND WE, SO WE THERE AND WE GIVE 'EM THE OPTIONS AND WE, WE MAKE SURE THAT, AGAIN, WE ARE ADVOCATING FOR THE PATIENT. 
          MM-HMM. 
          , WE DO NOT ADVOCATE FOR ANYONE OTHER THAN THAT PERSON THAT'S, THAT'S CALLING US. 
          SO CHIEF ESTRADA, UH, SO YOU TALKED ABOUT FIRST THE CALL TIMES THAT SOME PEOPLE SAID, OH, IT'S GONNA TAKE THREE HOURS FOR THEIR HOSPICE, A PROVIDER TO COME ON THERE. 
          SO WHERE HAVE, DO WE KNOW THAT I, YOU SAID THAT WE GET THERE QUICKLY, SO IT'S FILLING THE GAP AND WHEN DID THIS START, WHEN DID THIS PROGRAM START AND WHAT IS THE, THE RATE OF HOW WE CAN ADDRESS THE NEED FASTER, AS IN NOT THE THREE HOUR WAIT FROM THE PROVIDER, THE HOSPITAL PROVIDER? YES, MA'AM. 
          SO THE, UH, PROGRAM STARTED IN JUNE OF 2017. 
          OKAY. 
          AND SO THE PRIMARY PURPOSE FROM THE FIRE DEPARTMENT'S PERSPECTIVE IS THIS ALLOWS US TO MAINTAIN THE PATIENT AT HOME. 
          SO PRIOR TO THIS PROGRAM, THE ONLY OPTION WE HAD WHEN WE SHOWED UP WAS TO TRANSPORT TO THE HOSPITAL. 
          OH. 
          AND THAT'S ALL WE COULD DO. 
          SO THE, THERE LITERALLY, ONCE WE GOT THERE, IT WAS, IT WAS, WE WERE GONNA HAVE NO CHOICE BUT TO TAKE YOU BECAUSE THE HOSPICE COMPANY COULD NOT GET THERE IN TIME. 
          SO WE WEREN'T ALLOWED TO STAY THERE FOR AN HOUR, EVEN FOR 20 MINUTES TO WAIT FROM 'EM. 
          SO WE HAD NO CHOICE. 
          SO THIS BECAME A REALLY, UH, FROM THE, UH, I SEE HOSPICE COMPANY PERSPECTIVE, IT'S DIFFICULT TOO BECAUSE ONCE THEY GO BACK TO THE HOSPITAL, THEY'RE, THEY'RE NOW REVOCATED OFF HOSPICE. 
          AND SO IT BECOMES A BIG, UH, FINANCIAL BURDEN FOR BOTH THE FAMILY AND THE HOSPICE COMPANY. 
          SO THIS RELATIONSHIP ALLOWS US TO SHOW UP FOR THE AMBULANCE TO ACTUALLY LEAVE. 
          SO THE FIRE TRUCK AND AMBULANCE WILL LEAVE AND THE M I H MEDIC WILL SHOW UP AND THEY ACTUALLY KIND OF HOLD IT DOWN UNTIL THE, UM, HOSPICE COMPANY NURSE WILL SHOW UP. 
          AND SO THAT'S ALLOWED US TO HAVE MUCH MORE FLEXIBILITY WITH OUR AMBULANCES. 
          WE'VE ACTUALLY HAD, LAST YEAR WAS THE FIRST TIME IN, I THINK OUR HISTORY OF E M S THAT WE ACTUALLY WENT DOWN ON E M SS ROOMS. SO THAT'S, A LOT OF THESE PROGRAMS ARE AFFECTING DIFFERENT WAYS FOR US TO ACTUALLY, UM, RESPOND IN, IN VARIOUS WAYS WHERE WE'RE NOT ACTUALLY SENDING AN AMBULANCE. 
          SO PRIMARILY WHAT WE'VE DONE HERE IS, IS CAUSED THAT ABILITY. 
          AND OUR, OUR RESPONSE TIME IS, IS, IS GENERALLY SIX TO EIGHT MINUTES. 
          'CAUSE IT'S GONNA BE THE CLOSEST FIRETRUCK AND AMBULANCE. 
          SO THAT'S OUR NORMAL RESPONSE RATE IS VERY GOOD. 
          SO WE'RE GONNA SHOW UP AS WE ALWAYS DO WITH THE FIRETRUCK OR AMBULANCE. 
          AND THEN WHEN THE MED, WHEN THE M I H MEDIC SHOWS UP, THEY LEAVE THE SCENE AND THEN WE'RE ABLE TO STAY THERE FOR ANOTHER HOUR IF WE NEED TO. 
          UH, IF IT'S PAST THAT, THEN WE COULD DO THAT WITH OTHER ARRANGEMENTS. 
          UH, BUT GENERALLY SPEAKING, THEY'RE PRETTY QUICK ONCE WE'RE THERE, UH, CHRIS AND THE OTHER MEDICS ARE, ARE MAKING IMMEDIATE CONTACT WITH THE HOSPICE COMPANY AND KIND OF UNDERSTANDING WHAT'S HAPPENING ONCE THEY'RE THERE ON SCENE. 
          UH, WE ARE, WE'RE DELEGATED PRACTICE STATE. 
          SO, SO WE'VE GOT, UH, PROTOCOLS THAT WE CAN DO QUITE A BIT OF THINGS ON SCENE TO HELP THE PATIENT EITHER RELAX OR BREATHE A LITTLE EASIER AND CALM THEM DOWN. 
          AND MOST OF THE TIME WE'RE ACTUALLY CALMING THE FAMILY DOWN. 
          MM-HMM. 
          . 
          SO SOMEBODY COMES TO VISIT AND THEY'RE NOT REALLY, WEREN'T REALLY PREPARED TO SEE THEIR LOVED ONE HAVING DIFFICULTY BREATHING OR REALLY, YOU KNOW, HOW MUCH THEY'VE DECOMP, UH, DECOMPENSATED. 
          AND SO THAT, THAT, THAT, OH MY GOD, WHAT DO WE DO? WE'RE ALL TRAINED TO CALL NINE ONE ONE, SO THEY IMMEDIATELY CALL 9 1 1 MM-HMM. 
          . 
          AND SO THERE'S, THAT'S USUALLY HOW WHAT HAPPENS. 
          SO, SO THERE ARE THREE HOSPICE, UH, COMPANIES YOU'RE WORKING WITH. 
          SO DOES THAT MEAN YOU CAN ONLY, UH, FILL THAT GAP ON THOSE MEMBER PEOPLE WHO ARE WITH THOSE THREE COMPANIES? IT'S A FEE FOR SERVICE. 
          SO THEY'RE PAYING US AH, OKAY. 
          FOR THAT RELATIONSHIP. 
          GOT IT. 
          OKAY. 
          AND SO, UH, OUR LIMITING FACTOR, WE WOULD LOVE TO DO MORE. 
          IT'S JUST VERY LABOR INTENSIVE SURE. 
          TO PUT EACH OF THOSE NAMES INTO OUR COMPUTER AID DISPATCH AND THEN TO TAKE THEM OUT. 
          OKAY. 
          SO THAT'S, YOU KNOW, WE'RE TRYING TO FIGURE OUT A WAY TO AUTOMATE THAT OR TO USE A DIFFERENT TYPE OF SYSTEM AS WE MOVE FORWARD. 
          AND WE'RE ACTIVELY LOOKING FOR THAT, THOSE TYPE OF APPLICATIONS. 
          AND WE'RE ACTUALLY DESIGNING SOME STUFF, UH, INTERNALLY TO, TO DO THAT. 
          BUT RIGHT NOW WE'RE, WE'RE SERVICING A LITTLE OVER A THOUSAND PATIENTS A MONTH THAT WE'RE LOOKING AT. 
          AND ARE THOSE PATIENTS CITYWIDE OR JUST IN CERTAIN PARTS? THEYRE IN PARTS IN OUR CITY. 
          BUT ARE THEY IN CERTAIN PARTS OF THE CITY OR ARE THEY CITY? THEY'RE GEOGRAPHY ANYWHERE. 
          ALL ALWAYS THE CITY. 
          OKAY. 
          THOSE ARE ALL DISTRICTS. 
          THANK YOU ALL VERY MUCH. 
          AND ALSO THANK YOU VERY MUCH FOR TAKING CARE OF MY MOM. 
          SHE'S DOING MUCH BETTER. 
          THANK YOU. 
          THANK YOU. 
          THANK YOU. 
          YOU KNOW, AND, AND I'D LIKE TO ADD, WHEN YOU TALK ABOUT THAT MAP, AND SO THE TWO OF YOU HAVE PROBABLY NOT SEEN A MAP, I KNOW YOU TWO HAVE, WE PUT ALL OF OUR HIGH VOLUME UTILIZERS ON A MAP. 
          THERE'S NO DISTRICT THAT IS IMMUNE TO HAVING THESE CUSTOMERS IN THEIR DISTRICT. 
          AND, UM, YOU THINK, OKAY, THEY'RE ALL GONNA BE OVER HERE ON THE EAST SIDE OR THE WEST SIDE. 
          THEY'RE ALL OVER. 
          AND, UM, SO THIS PROGRAM BENEFITS EVERYONE, THESE PROGRAMS. THANK YOU, CHIEF. 
          THANK 
          [01:30:01]
YOU. 
          COUNCILWOMAN GERRAN, COUNCILMAN PERRY. 
          HEY, THANKS CHIEF. 
          THANKS FOR THE PRESENTATION AND THE INFORMATION. 
          I KIND OF THE SAME COMMENTS, MARIA, ABOUT PUTTING TOGETHER METRICS ON THIS SO THAT WE CAN TRACK THIS, THESE OVER TIME, SEE WHAT THE, UH, UM, SEE HOW THINGS GO OVER, OVER THE YEARS AND WHAT OUR, WHAT OUR BENEFITS ARE ON THESE. 
          AND I HAVE SOME QUESTIONS ABOUT THAT. 
          UM, WHO DETERMINES THESE REPEAT CALLERS? I MEAN, IS THAT SOMETHING THAT WE DETERMINE OR YOU SAID THERE'S A REGISTRATION PROCESS? WHAT'S, WHAT? HOW DOES THAT WORK? ARE YOU TALKING ABOUT THE HIGH VOLUME UTILIZERS? YES. 
          YES. 
          YES. 
          WELL, WE'RE GONNA SEE IN OUR CAD SYSTEM THAT WE'RE GOING TO THIS ADDRESS A HUNDRED TIMES A YEAR. 
          RIGHT. 
          SO BASICALLY WE ARE GOING TO MAKE CONTACT WITH THAT PERSON BECAUSE THEY ARE CALLING THEM. 
          SO WE, WE HAVE DATA THAT'S SAYING, OKAY, THIS PERSON'S CALLING US. 
          SO YOU, YOU BASICALLY DEVELOPED THE REGISTRATION THAT NOBODY'S CALLING IN TO REGISTER TO BE NO PUT ON THIS LIST, RIGHT? NO, WHEN, WHEN, WHEN WE ARE TALKING ABOUT THE HIGH VOLUME UTILIZERS, UM, THEY'RE RECORDED BECAUSE THEY ARE CALLING US, THEN WE DETERMINE, OKAY, WE NEED TO GO SEE THIS PERSON. 
          BUT I COULD HAVE AN ENGINE COMPANY THAT GOES OUT ON A PERSON AND MAYBE THEY DON'T REACH THAT CRITERIA, BUT THEY'VE BEEN THERE A COUPLE TIMES AND THEY'RE FALLING AND IT'S LIKE, OKAY, SO DO WE NEED ADULT PROTECTIVE SERVICES? UM, THERE'S NOBODY HERE WITH THEM. 
          SO THEY CAN GO BACK TO THE STATION AND THEY CAN CALL M I H AND THEY CAN INTRODUCE THEM TO THAT SITUATION. 
          SO IT COULD COME IN FROM US GOING ON CALLS, OR IT COULD COME IN BY THEM MAKING THAT MANY CALLS TO AN ADDRESS. 
          OKAY. 
          ALL RIGHT. 
          UM, THEN WE'VE, WE'VE REDUCED, I'M, I'M TRYING TO KIND OF PUT THIS IN CONTEXT. 
          YOU'RE SAYING WE'RE SAVING BY THE HEAVY EQUIPMENT AND AMBULANCE RESPONSES, THAT KIND OF THING, BUT THERE IS A COST ASSOCIATED WITH THIS ALSO BECAUSE YOU HAVE MANPOWER, YOU KNOW, ASSIGNED TO IT, YOU GOT EQUIPMENT ASSIGNED TO IT AND THAT KIND OF THING. 
          AND I DON'T RECALL SEEING THAT AS A SEPARATE LINE ITEM IN, IN YOUR BUDGET, HOW MUCH IS ACTUALLY BEING ASSIGNED TO THIS, THIS UNIT HERE? WAS THAT CALLED OUT SEPARATELY IN YOUR BUDGET FOR THIS LAST YEAR OR FOR 2020? IT, IT WOULDN'T BE CALLED OUT SEPARATE. 
          UM, OKAY. 
          THE, THE PARAMEDICS WORK IN OUR E M SS DIVISION, I COULD EASILY KEEP THEM ON AN AMBULANCE AND THEY'D MAKE THE SAME AMOUNT OF MONEY. 
          THEY'D COST THE CITY THE SAME AMOUNT. 
          BUT WHAT I'VE DONE IS I'VE CHOSE TO, UM, RELOCATE THEM IN ANOTHER ROLE INSTEAD OF AN AMBULANCE. 
          THEY'RE RIDING AROUND IN A SMALL VEHICLE AND GOING TO CALLS AND PREVENTING THAT AMBULANCE AND FIRE TRUCK GOING. 
          WHAT WE DID DO IS WE ADDED THE LIEUTENANT AND THE, UM, ADDITIONAL PARAMEDICS. 
          BUT AGAIN, YOU LOOK AT IT, DO I ADD 'EM IN THIS WAY OR DO I PUT ANOTHER E M S UNIT ON? YEAH, I'D, I'D LIKE TO MAKES, MAKES SENSE. 
          I'D LIKE TO TAKE A CLOSER LOOK AT THAT IF YOU WOULD. 
          IF I MEAN, COME ON IN, LET'S SIT DOWN IN THE OFFICE AND I'D LIKE TO TAKE A LOOK AT THOSE COSTS ASSOCIATED WITH THIS SEPARATELY VERSUS WHAT, WHAT IT WOULD COST UNDER THE, WITHOUT THIS SYSTEM AND WHAT, WHAT THOSE TRADE-OFFS ARE, UH, ASSOCIATED WITH THAT. 
          THERE WAS A COMMENT WHILE AGO SAID THAT, UH, THIS IS A FEE FOR SERVICE. 
          WHAT, WHAT COST RECOVERY ARE WE GETTING FOR THIS PARTICULAR, FOR THE HOSPICE? AND ARE WE GETTING A, A FEE FOR SERVICE FOR ALL THESE REPEAT CALLERS AND, AND OUR AMBULANCE SERVICES? IS, IS, ARE THOSE BILLS BEING SENT OUT TO ALL OF THE USERS OF THESE SERVICES? SO THERE IS NO FEE FOR THE HIGH VOLUME UTILIZERS. 
          OKAY. 
          UM, WE'RE SAVING MONEY. 
          YOU AND I AND THE TAX PAYERS, WE'RE SAVING MONEY BY NOT GOING ON THEM. 
          WE'RE SAVING, UM, AVAILABILITY FOR OUR UNITS THAT AREN'T RESPONDING ON THEM. 
          SO THERE IS NO FEE FOR A HIGH VOLUME UTILIZER, UM, UNLESS, UNLESS THEY'RE TRANSPORTED BY AMBULANCE. 
          RIGHT. 
          IF THEY'RE TRANSPORTED. 
          BUT AGAIN, OUR GOAL IS TO LIMIT THOSE TRANSPORTS. 
          SO YEAH, IF WE TRANSPORT THEM, THERE'S GONNA BE A CHARGE. 
          BUT AGAIN, WE ARE TRYING TO ELIMINATE THEM FROM CALLING AND, AND HAVING TO CALL. 
          BECAUSE EVERY RUN THAT WE GO ON, THERE'S A CAUSE TO SEND A FIRETRUCK, THERE'S EXPOSURE TO THE CITIZENS WITH TRAFFIC. 
          SURE. 
          AND SO THIS IS A, THIS IS A SAVINGS THAT, AGAIN, WHEN WE STARTED THIS PROGRAM, UM, IT WASN'T CREATED TO MAKE MONEY. 
          UH, BUT WHAT WE HAVE DONE, WE HAVE CREATED SOME 
          [01:35:01]
PROGRAMS THAT WILL HELP US SUSTAIN SUCH AS HOSPICE. 
          BUT THE MOST IMPORTANT THING WE'RE OFFERING COUNCILMEN IS ADDED VALUE AND KEEPING ENGINE 40 AND LAB 40 AND ENGINE 14 AND ALL YOUR UNITS KEEPING THEM IN SERVICE BY NOT RUNNING ADDITIONAL FOUR OR 5,000 CALLS ON THESE HIGH VOLUME UTILIZERS. 
          THAT'S WHAT WE'RE DOING. 
          OKAY. 
          YEAH. 
          UM, SURE. 
          COUNSEL. 
          YEAH. 
          SO I'D LIKE TO JUST REITERATE THE FACT THAT 10 RUNS, 10 E M S RUNS AND 10 TRANSPORTS ARE NOT 10 PAID TRANSPORTS. 
          MEDICAID, MEDICARE IS OUR HIGHEST PAYER IN THE CITY OF SAN ANTONIO IN THE NATION FOR THAT MATTER. 
          UM, AND THEY HAVE TO DEEM IT A MEDICAL NECESSITY FOR THAT PAY FOR A CITY OF SAN ANTONIO TO GET PAID PAYMENT FOR THAT TRANSPORT. 
          I'LL GIVE AN EXAMPLE. 
          IF I CALL E M S 10 TIMES THIS MONTH, THE REST OF THE MONTH, YOU KNOW, AND IT'S POSSIBLE, WE HAVE FOLKS DOING THAT AND WE GET, I GET TRANSPORTED 10 TIMES BECAUSE IT'S VERY SUBJECTIVE CHEST PAIN, RIGHT. 
          IF I CALL FOR CHEST PAIN, MEDICAID, MEDICARE IS LIKELY TO PAY, OR EVEN MY, OUR, YOU KNOW, OUR INSURANCE, IT'S LIKELY TO PAY THAT ONE TRANSPORT. 
          THEY'RE NOT GONNA, THEY'RE NOT GONNA PAY ANOTHER NINE TIMES IN EIGHT DAYS BECAUSE I HAD CHEST PAIN REMAINING, EVEN THOUGH I WAS AT THE HOSPITAL NINE OTHER TIMES. 
          SO, UM, AGAIN, ME, THEY, THEY ARE OUR HIGHEST PAYER, BUT THEY DON'T PAY EVERY SINGLE TRANSPORT IN RESPECT TO THE HIGH VOLUME UTILIZERS. 
          YEAH. 
          I'D LIKE TO SEE THAT PUT DOWN ON PAPER, HOW MANY, HOW MANY CHARGES ARE GOING OUT, HOW MANY REIMBURSEMENTS WE'RE GETTING BACK, AND WHAT, WHAT THAT DELTA IS TO SEE WHAT THE COST IS TO THE CITY. 
          AND THEN YOU MENTIONED THAT THERE IS A FEE FOR SERVICE FOR THE HOSPICE PROGRAM. 
          IS THAT A A HUNDRED PERCENT REIMBURSEMENT FOR OUR SERVICES OR WHAT, WHAT PERCENTAGES? WHO, WHO'S PAYING THAT? SO WE'RE PAYING, WE'RE, WE'RE CHARGING A CERTAIN AMOUNT PER PERSON THAT'S BEING, BEING LOOKED AT. 
          SO WE HAVE THAT, THAT DATA. 
          WE CAN GET THAT. 
          YES, I'D LIKE TO SEE THAT AS WELL. 
          AND THAT'S A, SO THESE, THESE CONTRACTS TYPICALLY RUN THROUGH STR TO US. 
          OKAY. 
          SO WE HAVE, UH, A REGULAR PAYMENT SYSTEM THAT WE SET UP, ARAC AND ALL THAT IS INVOICED, AND WE CAN BRING YOU THAT INFORMATION. 
          OKAY. 
          AND THEN GETTING BACK TO THE VEHICLES, ONE WAY TO LOOK AT THIS, IT MAKES IT, UM, A LITTLE EASIER AND YOU SEE THE LOGIC OF IT PRETTY QUICKLY. 
          SO THERE'S ONE LIEUTENANT AND SEVEN, UH, MEDICS ASSIGNED TO THIS UNIT. 
          IT'S A TOTAL OF EIGHT. 
          THAT'S NOT ENOUGH TO PUT ONE UNIT OF ONE AMBULANCE ON, SO IT TAKES 12 PEOPLE TO PUT ON AN AMBULANCE MM-HMM. 
          . 
          BUT WITH THIS, THE WAY WE HAVE THE MANPOWER SET UP, WE HAVE FOUR UNITS THAT ARE ON EIGHT TO FIVE THAT ARE INDIVIDUAL UNITS. 
          AND THEN WE HAVE ONE UNIT THAT'S A 24 HOUR DAY UNIT. 
          SO WITH THE EIGHT PEOPLE THAT WE HAVE STAFF, WE HAVE EVERY DAY ON FIVE UNITS COMPARED TO ONE AMBULANCE. 
          AND WE DON'T HAVE ENOUGH IN THIS MODEL TO FILL EVEN ONE AMBULANCE. 
          SO JUST LOOKING AT THE STRUCTURE OF HOW WE'VE DONE THIS, THE EFFICIENCY THAT WE'VE CREATED IS ACTUALLY PUTTING FIVE UNITS ON, ON THE, ON THE STREETS FOR LESS THAN THE PRICE OF ONE AMBULANCE. 
          OKAY. 
          YEAH. 
          SEE, THAT'S THE KIND OF ANALYSIS I WOULD REALLY LIKE TO SEE. 
          WHAT ARE WE, WHAT ARE WE GETTING FOR OUR SERVICE AND FOR OUR MONEY? AND YOU KNOW WHAT THAT, WHAT IS THAT FEE FOR THE HOSPICE? SURE. 
          YOU KNOW, WHAT, WHAT ARE THOSE CONTRACTED FEES VERSUS WHAT IT'S REALLY COSTING US? THAT KIND OF THING. 
          SO THAT'S, THAT'S WHAT I WANT TO, WOULD LIKE TO TAKE A LOOK AT THAT. 
          UM, AND IT, ON THE AMBULANCE RUNS, UH, I'M, I'M ASSUMING WE'RE UPSIDE DOWN ON COST OF AMBULANCES.
* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.