The Eagle Grove city council, minus councilman Matt Jergens, gathered in person and by phone in the council chambers inside city hall on Monday, September 6th. Aside from the basic business of approving permits and the like, there were four items on the agenda, which really boiled down to two things. The first was laying the financial groundwork for the upcoming North Lift Station project, designed to modernize and bring up to code Eagle Grove's sewage and drainage system, enabling the city to better deal with significant rain events. The second was a bit of fiscal and paperwork housekeeping regarding the city's disclosure policies and procedures with respect to securities.
But that wasn't what was on the agenda as far as those citizens gathered to attend the meeting were concerned. Mostly a group of folks engaged in the Betterment Committee, they had come to discuss one thing: the EMS service.
One Mayor McGrath opened the public forum, Denise Baker raised the question right away. "I would just like to inquire what's going on with the ambulance service in town," Baker said. "I'm just curious, you know I mean I've seen a lot of people have been gone from their positions, and I just want to have that comfort level of knowing that if I dial 911 and I need an ambulance, that there's going to be somebody there to answer that call in a timely fashion.I mean, I don't… I don't know what's going on.I just know that we've lost a lot of people very quickly."
"Okay, well, we addressed ambulance service a couple of months ago," Mayor McGrath responded calmly, "but we can also… that'll be in department reports, so we can talk about that and what Bryce's plan is and how that's going."
At that point Tommy Yackle chimed in, asking, "Did you get those questions we emailed?"
"So, well, that sounds like operations," McGrath responded, trying to keep the meeting on track, "so that's department, so we will address that in our department meetings, minutes, at the end of the meeting. Public forum is typically used for questions and concerns that are on the agenda."
"I didn't see EMS on there," remarked Baker.
"That's why I'm saying it's a department report," McGrath explained. "Otherwise anything that's not on the agenda can't really be addressed or voted on or taken under matters from the council.So we will address that at the end with our department meetings or minutes, or reports. Otherwise–"
"Would you like to answer any of the questions," Yackle interjected, cutting McGrath off mid-sentence, "or no?"
"You know, you need to address the chair before you just speak," McGrath remarked, gently rebuking Yackle after his second interjection thus far. "The public forum doesn't mean you just–"
"Yeah, I got that," Yackle snarked in response.
"No," the Mayor attempted to explain, "that's how we run a meeting–"
But Yackle interjected again, "Oh yeah?"
McGrath pushed through the cross-talk, however, finishing her sentence with, "…and how we stay on task."
Yackle seemed to accept that for the moment, nodding, and muttering, "That's Roberts," referring to the rules of order that such meetings typically run under.
"Maybe we can kind of speed up the EMT thing," suggested Steven Asche, "so that way people don't … it's not really just a department thing. It's kind of been a hot topic around town. And it's getting kind of old dealing with it, kind of deal."
McGrath agreed with that sentiment, but when Asche suggested skipping through "just to get it out of the way" McGrath pointed out "well, we only have four items on the agenda." Which Asche accepted, "all right, just asking."
From there City Administrator Bryce Davis explained in clinical detail precisely what the North Lift Station project will be, what it is intended to do, how it will do so, why it is necessary, and how to fund it. To sum that up, the current system is badly outdated and worn out, the pumps need to be manually activated and run at very low efficiency, causing drainage and sewage issues, especially during a significant rain. The new system will be automated, remotely manageable, and substantially more powerful and efficient. And the whole thing would be funded through a combination of Community Development Block Grant (CDBG) funds, and State Revolving Fund (SRF) loan funds, through Prestage Foods, and paid back by cash flow. All to be subrogated to the city Utility Board's management.
Discussion of the securities procedures and disclosures went off without a hitch, and the council came to a unanimous decision to address them and stay in compliance with IRS rules.
At that point, at the top of the department reports, Administrator Davis got right into the discussion of the EMS. He began by noting that the ambulance was at that moment on a call, "so that's positive news" adding that, "There has been some changes and resignations from the volunteers," Davis said, "so everything that has been circulating on Facebook is true," referring to rumors that volunteers had resigned. He then explained that as Administrator, he appointed EMS Director Lashelle McGrath and is her direct supervisor. And evaluating her performance, which has been called into question by the Betterment group, is his responsibility.
"So looking at the data, and ensuring that we're making the right decisions to ensure continuity of care, which is our number one concern," Davis stated. "Our number one concern is making sure that when someone calls 911 the ambulance leaves and takes care of that individual."
Davis then referred to the emailed questions to which Yackle had earlier referred. "So the question is, do we have a shortage of EMTs", Davis summarized. "I'm going to switch it over to medics," Davis said, "because EMTs are just technicians, we need EMTA's, we have PRNs, we have paramedics or we have the ability to have paramedics, we have a different variety of providers throughout the city. So just using the term 'medic' to cover everybody is how I'm gonna approach that."
Davis then went on to note that when he started with the city in December of 2017, the city had a total of 7 medics. And likewise, as recently as June of this year, we had 7 medics. "Now, currently," Davis stated, "we have 13 medics." And so although there have been some resignations, the city actually has more emergency medics at its disposal at present, than it has previously. And when a few more currently in training complete that training, the city will be able "to double the EMTs, or the medics, that we have on the payroll, or as volunteers."
"So what about losing experience, is that a factor," Yackle asked. He then brought out the axe he was there to grind, adding, "or can we talk about the leadership at all? I mean, is that something we talk about? Or is that just a big elephant in the room?"
Davis reiterated that as Administrator, he is in charge of personnel issues, but that to discuss them would be illegal. "Iowa code kind of dictates how we can and cannot discuss personnel matters from a city perspective," Davis pointed out.
"But, we have to look at the data," Davis said. And then addressing the other big elephant in the room, bluntly noted "and the data tells us differently than what your rhetoric says online."
Yackle, an open covid denier, was taken aback slightly by such a direct reference to his online comments, and his Facebook group's agitation against the Mayor, who is also the county Director of Public Health, and her daughter, also a healthcare professional as the EMS director. In response, he wrapped himself in the mantle of "the people", suggesting that he spoke for the people of Eagle Grove, saying "well, that's straight from the people themselves."
Mayor McGrath, who like many parents would, has shown little patience for attacks on her daughter, and was quick to insist Yackle allow Davis to finish his report, and observe the rules of behavior at the council meeting. Both a bit flustered, McGrath told Yackle to "stop or leave", and Yackle accused the Mayor of nepotism, stumbling over the word itself as they spoke over each other. "This is a free country," Yackle said. "This is a meeting," the Mayor countered, adding that they were trying to answer the questions that Yackle's group had sent.
Davis then directly addressed the assertion of nepotism by examining Burger's performance, through hard data. "So, currently we've had 302 calls for 2022, and in 2021 we've had 499 calls. So the calls have increased dramatically," Davis began. He then noted that the city had been refining it's EMS processes since late 2017. "We've been able to reduce our drug costs," Davis said, also delving into the mechanics of how those savings have been achieved.
"And from what I know, that seems to be working very well," Baker observed.
"And we've also switched over our inventory," Davis remarked, "because in the past we've had different service directors," who had difficulty managing the inventory of emergency medical supplies. Which results in ordering supplies that go unused, expire, and have to be wasted. But under the current director, "we've been able to shift our inventory control over to the pharmacy, and we've been able to save some dollars. Which allows us to offer a bonus structure for the volunteers."
Next, Davis brought up the data around the number of calls serviced by the recently resigned volunteers, as compared to the number of calls serviced by Director Burger, personally. "So we had 302 calls. One recently resigned EMT had 7 of those 302 calls. Another one, 42. So, almost 50 calls between the two that recently resigned. The service director attended 170 of those calls." And, Davis noted, this was despite the fact that the majority of those calls were not during the day shift, when Burger is typically on duty, but during the night shift, when volunteers are normally on duty.
"So when we're looking at how do we make a decision and who do we keep," Davis said, "it's obviously very tough, but I know one decision is making sure an ambulance leaves that bay and attends care."
Davis pointed out that one data set that was very revealing was that Burger had suffered an injury on duty, and been unable for a while to take shifts. And during that time, it became necessary for Eagle Grove to rely on Clarion's EMS significantly. Which led to the "realization" of the significance of Burger's contribution.
"So in those situations," Rogers asked, "are we waiting for someone to come from Clarion or Renwick?"
"Or the hospital," Davis responded. Adding that the rules have changed so now it would be necessary to be staffed at all times.
"That, in and of itself, when you look at the call hours, and the amount of time one individual takes, that's a factor worth considering," Davis said. "But then we also have to look at the Data. We have to look at our Compass Reports. And our Compass Reports tell us our trend that we're moving into. And that's the data we have to look at to see if we're heading in the right direction."
Davis then explained that the statewide average for correctly determining a patient's pain level is 61%, but that the Eagle Grove EMS service is achieving much higher accuracy, correctly diagnosing 77% of pain levels. Which is an improvement which took place since 2017, and Burger became the EMS Director. Likewise with administering aspirin for chest pain, which is proven to be beneficial to patients when done immediately at the scene of an EMS call. Eagle Grove EMS is at 76% compared to the statewide average of 56% in that metric. And Eagle Grove's EMS is beating the statewide average in checking vital signs, even when a call seems insignificant, by a similar margin. On reaction time, "the benchmark for the state is 5 to 8 minutes to react and be in route," Davis said, "we're at 6.09 minutes. We went down from over 10 minutes." Likewise with time on the scene, with Eagle Grove's EMS departing for the hospital on average 4 minutes sooner than the statewide average. In fact, Davis pointed out, the only metric in which Eagle Grove's EMS is not beating the statewide average is in the use of lights and sirens. Which, Davis explained, is due to the amount of time our ambulances spend on the highway, versus city streets, getting patients to the hospital, and then getting ambulances back at the ready.
"So," Davis concluded, "when I was given an ultimatum on the decision making on who to insure, who to keep, and who to allow to exit, we looked at this data, we looked at it trending the right direction, and we looked at we have more calls, we have more medics, all of our data is moving in the right direction. And that is in a sense what you want from a service director." And if there is a personality conflict, Davis noted, you need to keep the people who are effective. "You can't just hire anyone with a heartbeat," Davis said, "because then you're going to have conflict."
In Yackle's case, the evidence Davis pointed to seemed to fall on deaf ears. "That's what we get to with leadership and we talk about that we want the right people in," Yackle said. "It's leadership, I mean there's numbers we can talk about all day. But at the same time we're humans, and leadership is a very big aspect. Especially with integrity. So I'd just like to note that when we're talking about the EMS and leadership. Because I think that's a big issue that we're not talking about right now but everyone wants to know. So if we could maybe rock that a little bit that'd be great."
"Well, since those resignations Eagle Grove EMS has not missed a call, and we've been fully staffed," Davis responded, noting that the local EMS has not had to rely on other services either. "So I can assure you, that ambulance leaves the bay. I can assure you of that."
"Absolutely," Yackle momentarily conceded, "not disregarding that, at all." Before whipsawing back to questioning leadership again. "What we're talking about is leadership. And leadership stems down far, to the children everywhere. So I think that having the right leadership is key."
"As Bryce pointed out–" Mayor McGrath attempted to say, but was swiftly cut off by Yackle.
"But we don't like… Are we not discussing that? Or is that just a numbers game? Because we know the numbers, obviously, Bryce just told us every single one. So, what about leadership? What about that?"
"Well apparently leadership is working," McGrath said.
"Is it," Yackle challenged, "is it? Are we having the right people stay?"
"Well that ambulance is leaving the bay to take care of somebody, and–" McGrath noted, before being cut off again by Yackle, now raising his voice.
"But we're not in such a conflicted town Sandy! Sandy! We live in Eagle Grove," Yackle blustered, loudly, before accusing the mayor of losing her temper.
"What do you think is wrong with our leadership anyhow," asked a clearly frustrated councilman Al Pamperin.
"You know what's wrong with our leadership! Neptosism (SIC) is wrong with our leadership, and everyone knows it. Every single person in this town," Yackle alleged, contrary to the evidence just presented. "and until you wanna actually address the elephant in the room nothings gonna get fixed. So that's our problem."
"So address it," Pamperin said, simply.
"Well what do you think I'm doing right now, Al," Yackle chided angrily, "what do you think I'm doing? Sandy doesn't want to address it!"
At this point Yackle's co-admin in the Betterment Group, Laura Dicke spoke up. "I would like to address it," she said, before walking back some of Yackle's dismissal of the data Administrator Davis presented, contradicting their claims. "Thank you for the report and the data points, I'm glad to hear that. That's reassuring, that we can all rest safe. That's great."
"However," Dicke pivoted, "these people quit specifically because of Lashelle and they said they would come back and volunteer if Lashelle is not the director, or on the service. Was that in consideration when you decided to keep her on as the director?"
"Yes, it was," Davis replied, and attempted to elaborate, but was spoken over by Dicke.
"And you're just going to disregard these people who have volunteered for many years," Dicke asked.
To which, as a last resort he seemed pushed to, Davis brought up issues with the performance of the volunteers in question. Each point immediately discarded out of hand by Dicke and Yackle, who started tag teaming in speaking over people.
After lengthy back and forth of Dicke and Yackle insisting there's a problem despite the data, McGrath observed, "this sounds like a personal vendetta."
"This sounds like nepotism," Yackle shot back, still stumbling on the word.
"It's not about that it's your family," Dicke said, less than a second later.
"I know you always say this, but we're trying to fix this city, Sandy," Yackle added, his voice full of derision.
Pamperin noted that it's complicated to run a city, and that with personnel matters, it can be tricky.
"Can we talk to Lashelle and see if she can work something out so these volunteers can come back," Dicke asked.
But before an answer could be given to that Yackle pronounced, "sooner or later the people will get sick of this, so…"
"Well, until then–" Pamperin began.
"Oh it's comin', Al, bud," Yackle said, ominously, "Ok? It's comin', bud." Yackle then loudly asserted that he knows what's going on and is trying to work with the council, but the council doesn't want to work with him, growing more agitated.
It should be noted here that police officers were standing by in the doorways, observing, but made no effort to detain or silence Yackle or anyone else, even when the Mayor insisted loudly "that's enough!" Under the rules posted in the chamber, had the Mayor given the word, police could have intervened. She did not do so.
To the end of the meeting, despite further attempts to explain the current situation, the Betterment group members held firm to their assertion that the departure of the volunteers was a clear sign of a failure of leadership, as the council members continued to assert that the evidence showed otherwise, and the EMS service was better staffed than ever before. And in spite of entreaties to find ways to work together offered by people on both sides, it didn't happen in this meeting.
