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