City Emergency Services Director-designate Dr. James Ireland, whose nomination has faced some vocal opposition, received strong endorsements from numerous supporters this week at a City Council committee meeting.
In February at a Public Safety Committee meeting, opponents to his nomination — largely former EMS workers including paramedics — leveled complaints and allegations about low morale, chronic understaffing, employee favoritism and frequent resignations that have allegedly affected the timely response of ambulances to emergencies across Oahu.
But on Thursday the same committee heard a chorus of support, including from Gov. Josh Green, who came to the defense of his fellow physician.
Green made a rare personal appearance inside Honolulu Hale’s Council chambers to praise Ireland’s commitment to the community, leadership skills and character.
“My reasons are many, but first let me say it is a really difficult job,” Green said.
Ireland, he said, “has to be an innovator because we’ve gone through incredibly difficult times, dealing with all the challenges that are out there, as we’ve lost resources from sometimes the federal side or because we’ve had increased needs in health care surges … over the last decade.”
The governor added, “Dr. Ireland has convinced me personally to commit tens of millions of extra dollars to the programs that serve the people of this county.”
“He makes his case. He makes it analytically. He shares with me as a clinician what our needs are, and I buy into what he has asked for and what the mayor has asked for,” Green said. “And so it has been an extraordinary partnership; we work seamlessly together, and I would be devastated to lose him personally.”
After an hourlong hearing, the panel — which in February had deferred a vote on Ireland’s future — unanimously passed a resolution confirming his nomination to lead EMS.
Council member Val Okimoto, the committee’s chair and a skeptic of Ireland’s ongoing directorship, voted to recommend his nomination “with reservations.”
The full Council is expected to review the matter for final approval April 16.
Before Thursday’s vote Ireland spoke to the challenges of leading EMS, a position he’s held since Mayor Rick Blangiardi’s first term began in 2021.
“I think we’ve done exceptional work the last four years,” he told the panel, “but I recognize there’s still a lot more work to do.”
He added that work should include purchasing more city ambulances — possibly up to 38, over the 23 rigs the city currently owns — to reduce response times as well as to handle what he said are tens of thousands of 911 calls that “are overwhelming our system.”
“And it’s creating issues with retention, morale and staffing, and this is unfortunately a problem nationwide, but we need some local solutions,” said Ireland. “And one of those solutions is adding more ambulances, which we plan to do through the mayor’s budget in Kaimuki … and some other select communities on Oahu.”
Ireland said he also wants to see the number of ambulance trips reduced to one trip every three hours, versus the current one trip every hour he said are currently being made, especially in urban Honolulu.
“It’s just astronomically busy,” he said, “and I think that’s creating some of the issues with burnout, morale. And so we really do need to add more ambulances to achieve that (three-hour) goal, for patient safety … and for overall wellness of the system.”
But Council member Andria Tupola, who is not a member of the Public Safety Committee, questioned Ireland over the bulk of opposition he’s received as EMS leader.
“No leadership position comes without critique, and so I was wondering … what steps you thought, moving forward, would make a difference for those in opposition?” she asked.
In part, Ireland replied, “I definitely recognize our personnel are running too many calls. … Offloading that call volume … will be key to giving the proper balance at work, so people will do the lifesaving work we ask of them, and at the same time, not just running calls back to back to back, which is happening all over Oahu.”
But Tupola countered, “I didn’t hear too many testimonies about high call volume.”
“A lot of it just had to do with management,” she said, “wanting communication, asking for transparency. It sounds like a lot of managerial things.”
Tupola then asked Ireland about his method of leadership.
“With respect to management style and leadership, we do our best to follow city rules and regulations and procedures,” Ireland replied. “And I think, again, nobody’s perfect. But I think we run an organization that respects people’s opinions; I have an open-door policy, and if people have a problem they come directly to me, usually.”
Allegations had arisen in recent months 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 Okimoto introduced in November, urging the city administration to study whether EMS should be merged into the Honolulu Fire Department.
During the mayor’s State of the City address March 18, Blangiardi vowed he’d form a task force to study EMS’ possible integration into HFD.
To that action, Okimoto asked Ireland, “Where do you see your position should the merger happen?”
“That’s a great question,” he replied, “and I think that’s what we need to determine with the merger task force.”
However, Ireland said he did not feel a need for “an appointed (EMS) director or deputy director in that model.”
Ireland’s opponents also spoke at the meeting.
Among them, Eddie Fujioka, a former 45-year EMS district chief, stated most of those who testified in support of Ireland are “coming from people who are administrators in the medical field, and very little personnel from within EMS.”
