Tag: EMS

Citizen Comment: Five people talk.

They all talk about EMS, so I’ll put their comments down below.

…

The backstory:

There are nine different Emergency Service Districts, called ESD #1 – #9, which make up Hays County. Some are fire, some are just EMS, and some are both.

The districts with EMS are 1, 2, 3, 7 and 9:

Hays County ESD #1: Dripping Springs, Driftwood, Henly.
Hays County ESD #2: Buda
Hays County ESD #3: San Marcos
Hays County ESD #7: Wimberley.
Hays County ESD #9: Kyle and all the country bits around those towns.

This map of the districts is hard to read, but it’s the only one I could find:

In 2020, Wimberley and Buda were running their own EMS.

The other three ESDs all shared an EMS service. We all contracted out with San Marcos-Hays County EMS, (SMHC-EMS), a nonprofit EMS.

Great!

In 2022, SMHC-EMS decides to start forming a union:

It took them about 2 years, but they finally negotiated a new contracted with their board of directors which included things like this:

Great!

About 30 seconds later, ESD #1 and ESD #9 both cancel their contracts with SMHC-EMS, and vote to open their own EMS departments. Pretty much textbook union-busting.

…

So San Marcos is stuck holding the bag, by ourselves. What do we want to do? Last August, we commissioned a study with some consultants.

January 2026: The consultants give us three choices:

1. Renew the contract with SMHC EMS and just carry on.
2. Roll EMS into our fire department. This is called Fire-based EMS.
3. Make a new standalone City EMS department.

There’s a long conversation about collective bargaining and labor rights, and whether a City-based EMS could be granted some form of negotiating power.

A majority of council votes for Option 3, but they ask city staff to look into the laws around collective bargaining and EMS.

…

Let’s talk about union-busting for a sec.

Forming a union is a big hassle, and so my guess is that the grievances with management were significant. (I don’t have any details, though.)

Pre-union-busting, how much did EMS cost everyone? Here’s what I found from 2022:

ESD #1: $3.3 million in taxes (here)
ESD #9: $3.84 million in taxes (here)
San Marcos: $4.22 million in taxes (here)

Total:  $11.36 million of taxpayer money to SMHC-EMS.

Post-union-busting, we now have three separate departments. Here’s what tax-payers are paying in 2026:

ESD #1: $8 million in taxes (here)
ESD #9: $10.2 million in taxes (here)
San Marcos: I can’t locate this for the life of me.  Let’s ballpark $9 million in taxes, for our City EMS, based on the consultant study from January.

Total: $27.2 million of taxpayer money, to three separate EMS departments.

Bottom line: Way to go, asshats. You’re spending $16 million extra of taxpayer dollars, but at least you’re screwing over the people who keep us alive in an emergency.

…

Which brings us to tonight! 

The point of the workshop is to update Council on how it’s going, planning for a new City EMS department.

The staff presentation

First off: city staff say there is absolutely no way to give EMS collective bargaining power under state law.

Police and Fire Departments can unionize, which is known as “Civil Service”.

But EMS doesn’t qualify as Civil Service, because San Marcos is too small:

You have to have 460K people or more. So Austin can do this, but not us.

…

The first step is to hire an EMS Chief:

After this, we’d start hiring everyone else. Current SMHC-EMS workers would have first dibs on applying, and then we’d open it up to anyone else.

There’s a whole lot of medical mumbo-jumbo about credentialing, medical directors, clinical operating guidelines, physician consultations, etc, which I honestly do not have the background to follow.

…

What do people say at Citizen Comment?

Five people speak:

• Former SMPD commander: This is great! City EMS services are the way to go. State of Texas has bad laws around civil service, but the EMS workers are okay letting collective bargaining go.
• Citizen rep on Hays County EMS Board: Same!
• Two longterm field workers: This is the best of a bad situation. City EMS is the way to go.
• Zach Philips, president of the EMS union: you don’t need to rush this process. Our contract runs until 2028. Why not finish the contract and carefully plan your new City EMS to start in 2028?

…

What does Council say?

Alyssa: How did you build the job description for the EMS Chief? What’s the timeline?
Answer: We looked at other city EMS chiefs, and based it on those. We want someone who can build an EMS department from scratch, and also build lots of partnerships. Maybe down the road, we can do mobile community healthcare or something. The hiring process will probably take two months, but it’s flexible.

Amanda: Austin uses a process called “Consultation” instead of collective bargaining. Can we do that?
Answer: Austin has a special bracketed carve out in state law. We may be able to do something called “Voluntary Consultation”.

Note: What is Voluntary Consultation?

It sounds like a soft version of collective bargaining. Here’s an explanation about how it’s used in school districts:

 

While the law explicitly prohibits collective bargaining, many school districts have adopted consultation policies allowing school boards to meet and confer with educators about educational policy and employment conditions. These consulting agreements are related to the concept of collective bargaining but constructed in such a way that the input given is considered advisory rather than legally binding, and therefore does not qualify as a collective bargaining agreement by law. The school districts are not required to act on the input received from the employees and final decisions on matters discussed through the consultation process are decided by school board members.

So it’s not binding, and it would be voluntary by the city. At best, it’s a good-faith effort to foster communication. At worst, it’s thoughts-and-prayers.

City Manager Reyes: this means that certain city employees would get a perk not offered to the rest of city employees. Something to consider.

(Note: We could offer Voluntary Consultation to everyone. Just saying.)

…

Amanda: Is it viable to keep the current contract in place to 2028?

No one really answers this, but this is the central question. Should we build an EMS department from scratch in 5 months? Or should we see whether it works to just keep our contract with SMHC-EMS?

There’s this chart:

Sorry about the screenshot. I know it’s tiny and hard to read. (It wasn’t in the packet, because it was only requested the day before.)

I think this chart is supposed to show that it saves more money to build our own EMS department by October. But it really doesn’t.

Lorenzo makes an excellent point: this chart supposedly compares City EMS and SMHC-EMS. Some of the numbers should be identical either way – for example, the amount of revenue from ambulance rides should be the same. But they’re not – they’re off by $1.3 million. (This is the first row of the chart, comparing the 1st entry and the 4th entry.)

In several places, numbers that should match don’t actually match. This is probably because nobody actually knows the real estimates, and they used different sources to get projections in the different columns.

Point being: no one can really say which will be cheaper, the current contract or a City EMS.

Amanda: This is not solely about revenue. I’m focused on the quality of care and taking care of our community, not taking the cheapest option.

But Lorenzo wasn’t arguing that we should go for the cheapest option. He was arguing that we haven’t really thought through just staying with the current contract. It is a viable option, but we’re acting like it’s off the table.

My read is that staff came in with a lot of momentum towards building a new EMS department. There just isn’t a lot of oxygen in the room to discuss continuing the current contract.

…

Josh: I value people and communication more than I value the nitty-gritty details!

Josh is both right and wrong. He’s correct that when people with power operate in good faith, and value their employees and value communication, you have the best possible scenario. But he’s also wrong: when people with power stop operating in good faith, the only leverage that employees have are the details that are spelled out. When things go sideways, the devil is in the details.

I think Josh believes “Look, I have good intentions and I like being a good boss. That’s enough to make sure we’re in the good scenario!”

…

So what’s the timeline?

If everything was put in motion today, it would take 6 months for the state license to come through. Then we’d coordinate with Medicare, Medicaid, DEA, etc etc.

Matthew: Where would we put city EMS?
Answer: We’d talk to their landlord and try to rent out their current building.

Hopefully everything would be ready to go on October 1st, but otherwise we’d have a contingency plan, which we also would build out.

Jane: How long did ESD 1 and ESD 9 take to create their own plan?
Answer: ESD 1 took 6-8 months, ESD 9 was a bit longer.

Jane: can we compare benefits plans?
Answer: We’re working on it.

Note: It’s not just benefits. At the January meeting, they also mentioned looking to make sure seniority transfers over. Otherwise you are going to lose your most experienced EMS workers.

Alyssa: This is big and complicated, and there are so many ways for it to go disastrously wrong if we rush it.

Fire Chief Les Stevens: The Medical Practitioner oversees these transitions and would not allow care to lapse for one second.

Amanda: In the next legislative session, maybe we can lobby for fixing the Civil Service rules?

….

Ok Council:

1.  Who wants to stick with City based EMS?

Yes: Matthew, Shane, Jane, Josh, Amanda
No: Lorenzo and Alyssa

Alyssa says that she is just not yet satisfied with the open questions about labor protections.

2.  Who wants to look into Voluntary Consultation as a lite-collective-bargaining?

Yes: everyone.
No: no one.

So there you have it.

…

At the very end, the union rep Zach Phillips weighs in again:

• I still have concerns about the timeline and labor protections
• EMS will absolutely not generate revenue. Do not look at this as a revenue source, I promise.
• Yes on lobbying the state legislature. We think we can make progress on this by 2028, which is one reason to wait.
• You all will be the 2nd largest city based EMS, after Austin. What’s the rush?

Alyssa: Will we put a union rep on the hiring committee for the EMS chief?
Answer: Absolutely. Yes.

…

Final notes: How are we going to pay for this? We’re already looking at a $4 million budget hole. As Zach said, this will not generate revenue.

My guess is that that will be a big, messy conversation, and so there just wasn’t time to roll that conversation into the this workshop.

What a mess! Sure do wish we hadn’t done this last year:

But here we are.

Public comment at the 3 pm workshops:

There are three speakers:

• President of the local EMS union. We’ll hear from him throughout the workshop.
• Speaker in support of the current board chair of the San Marcos Housing Authority
• Max Baker, on the SMPD staffing study. (This item was actually postponed.)

….

Workshop: San Marcos EMS

Backstory: This is a mess! It first came up on the blog, back in September.

Here’s my best attempt to reconstruct the timeline:

1983: San Marcos-Hays County EMS is formed as an independent non-profit. All the nearby towns and Hays County all contribute to funding it.

2009: We hire Fire Chief Les Stephens. When he’s hired, he’s told that the SMHC EMS is a total mess, and we want to be prepared in case we need to bail on them. So he starts making sure that all his fire fighters are trained as paramedics.

2010: Buda bails on SMHC EMS, and splits off to run their own program.

SMHC EMS gets its act together and becomes a high-quality organization. So we end up not needing to split off. But we still require that fire fighters be paramedics, because it’s best practices. A lot of times, they’re the first ones on the scene.

All that backstory was provided by the city.

This next piece was NOT provided by the city:

2022: SMHC EMS starts forming a union:

Immediately everyone starts splitting off and forming their own EMS services.

• Kyle votes to leave in November 2024
• Northern Hays also votes to leave in November 2024. This is Dripping Springs, Driftwood and Henly.

If it looks like union-busting and quacks like union busting… it’s union-busting, yeah?

This is the big theme of the night: the EMS workers are getting screwed, no matter how you slice it.

2025: San Marcos asks Kyle and Hays to give us 12-18 months to put together an EMS plan.

2026: The clock is ticking. The first ambulances will be removed in April, and they’ll all be gone by October.

…

Which brings us to today

All the partners left, and now it’s just San Marcos. We have to figure out how we want to provide EMS services to San Marcos residents.

So we commissioned a 6 month EMS study. This workshop is about that study.

These are the three choices:

1. Renew the contract with SMHC EMS and just carry on.
2. Roll EMS into our fire department. This is called Fire-based EMS.
3. Make a new standalone City EMS department.

No matter what, San Marcos needs to be able to provide some basic things:

Here’s how much personnel is required under each model:

Here are the costs:

The reason City EMS is cheaper is partly because it requires less staff, but also because EMS workers would get paid less.

• Status quo? SMHC EMS is unionized. They can demand higher wages
• Fire-based EMS? Our fire department gets partial union perks, like collective bargaining. This is the whole “meet-and-confer” thing. So they can also arrange higher wages.
• City EMS: they’ll get paid along with all the other city employees.

San Marcos prides itself on paying its employees pretty well, but it’s just not the same as having a union. (And in Texas, it is basically illegal for public employees besides Fire and PD to unionize.)

…

Some extra details:

Here’s the summary table:

Sorry, I know it’s small. It’s slide 15 of this presentation, or page 153 on this PDF, if you want to scroll.

The consultants are recommending that we go with City EMS.

And, of course, this is all very urgent. As the contracts dissolve, everyone will start taking their supplies.

The first ambulances will start to leave in April, and the last of the ambulances will be gone by October.

….

What does everyone say?

Zach Phillips is the president of the SMHC EMS union. He says:

• There are inconsistencies in the EMS study. We’d like you to postpone.
• If postponing isn’t an option, our goal is workforce continuity.
• Our priority is providing high quality care. We can best do that by keeping the experience and expertise of our employees together. We know San Marcos really well.

What does Council say?

Amanda: I’m worried about the destabilization of the workforce. What transition process would be recommended?
Answer: The EMS workers would go through the normal city application process, but we’d work closely with them to align expectations and make it as smooth as possible.

Josh: My big concern is the transition.
– You can’t do good work without good people, but our salaries are lower.
– Taking on a whole company in-house is expensive
– We have to be fiscally responsible, but if we’re going to do this, we need it to be rock-solid.
– How would insurance and liability work?
Answer to that last bit: We get insurance through Texas Municipal League.

Shane: When Chief Stevens was hired back in 2009, the plan was to convert to Fire-based EMS. Chief, how do you feel about all of this?

Chief Stevens: Fire fighters do not want to be EMS, and EMS workers don’t want to run into burning buildings. When you talk to the people that work in these departments, they generally do not want to be merged.

Note: This is the biggest argument against fire-based EMS. Several different speakers say the same thing: Medical EMS people like doing the medical stuff, and fire fighters like doing the fire-fighting stuff. They do not want to merge.

Shane: Well, did we waste a bunch of money then preparing SMFD to be ready to convert to EMS?
Chief: No. It’s best practices to get fire-fighters trained as paramedics. We’re usually first on the scene, so we can start medical care while EMS gets here. We’re going to keep requiring paramedic certification.

…

Jane: How would the finances work out?
Answer: We’ve been paying $2.5 million to SMHC EMS. You all allocated an extra $2 million last September.

Jane: But that still leaves about $9 million?
Answer: Well, you bring in some money from patient care.

Mini-rant: the average cost of an ambulance ride is $2673. If we had socialized medicine, like the rest of the sane world, the bill to the consumer would be $0. But we pay twice as much for healthcare in the US and get significantly worse services. Ah, capitalism.

…

Alyssa: There are allegations of union-busting. I need more time before I decide.

Lorenzo: City EMS is cheaper because the workers get a worse deal. If we do Fire-based EMS, they’d get 4% raises every year, along with FD and SMPD. I’m against City EMS.

Amanda: What’s the time frame here?
Answer: We’re a little freaked out! Last July, we asked them to give us 12-18 months. But they’re going to start removing ambulances in April. The dissolution will be complete in October.

Amanda: I’m fine with the recommendation in the report.

Josh: Can I call the union president back up? Sir, what is the union’s position on transitioning to non-union jobs?

Union President Zach: One of our concerns is that all employees are able to transition, assuming they want to.
– Like Chief Stephens said, not all EMS want to be fire fighters. I personally prefer EMS and medical things, and not fire.
– We want to make sure all individuals can come over with their existing seniority.
– We’re worried about the timeline. If it drags out, you’ll lose people with a lot of local expertise because they’ll look for other jobs.

Josh: If you had a way to do it, what’s your preference on the transition? Assuming it’s options 2 or 3?
Zach: Right now, we have collective bargaining.
– The state does not allow public employees to collective bargain.
– But city councils can vote to allow meet-and-confer for City EMS.
– We just want to be able to negotiate.
– There’s no way we could go on strike, and we would not ever try to go on strike.

City Assistant Manager Anderson: I’ve been trying to figure this out. My read on state rules is that City EMS can have an employee association, but they aren’t allowed collective bargaining.

City Lawyer: I need to read up on some of these legal details. I don’t think collective bargaining is allowed. Some of the bigger cities have a similar thing to meet-and-confer between other employees. I just need to look stuff up.

City Manager Reyes: Each option carries budget consequences, so just be mindful.

…

Shane: I’m torn. I need more time, too.

Matthew: how do you transfer seniority?
Answer: We’d have to work it out. We’ve worked it out in other contexts, though.

Matthew: I’m for City EMS then. I want to explore these meet-and-confer options though.

Bottom line:

City EMS plus labor protections: Matthew, Josh, Amanda, Jane

Need more time: Alyssa, Lorenzo, Shane

So we’re going with City EMS, but city staff will bring back some details:

• the inconsistencies in the study that Zach referenced,
• Labor protections, whether we can do a meet-and-confer option
• Quality of care measures.

Hopefully things will get sorted!

…

One final note, just because it’s cute.

Fire Chief Les Stephens, last year when he was inducted into the Texas Fire Service Hall of Honor:

Les Stephens, on the San Marcos city staff webpage:

Did we…. Was he 12 years old when we hired him??

…

There were supposed to be two other workshops:

• the SMPD staffing study,
• an update on the comprehensive plan

But we ran out of time, so both were postponed.