Traffic grinds to a halt as an absurdly long hook-and-ladder truck pulls out of Fire Station 9, on Seventh and San Julian streets in Skid Row, lately rebranded as "Central City East." Shining like a fresh tomato, the truck is the cleanest thing on the block. The driver doesn't bother hitting the siren. They're not going far.
About two blocks, in fact, just past San Pedro Street, where an old Asian man lies on the sidewalk, his pants around his knees.
"What's wrong?" asks one of the five firefighters who gather 'round.
"He keeps falling down," a bystander says.
The firefighters ask what seems to be the trouble. Someone hears the man say, "chest."
"Chest? Chest?" They decide to call an LAFD ambulance.
"If someone says 'chest pains,' we're obligated to take them to a hospital," Capt. Walter Duffy explains, " 'cause the city of L.A. is liable."
In a perfect world, an ambulance from Fire Station 9 would be on scene. But life in LAFD is far from perfect. Most stations have one or two ambulances, called "rescues." Fire Station 9 has four — all unavailable just now, because it's L.A.'s busiest station.
"This run is a perfect example of what's going on," says Duffy, slipping on his tortoise-shell Ray-Bans. He's the picture of cool — 60 years old, 33 on the job, two years from retirement. "We got it as 'person down.' It's a guy complaining of chest pains. I say we need a rescue. Now, the next [available ambulance] is at Fire Station 10" — south of Pico Boulevard, a mile and a half away. That means, Duffy says: "There's a delay, maybe a few minutes. If he was having a heart attack, it woulda been bad."
Alarmingly slower response times by LAFD to 911 and emergency calls have generated withering criticism. One-time mayoral candidate Austin Beutner revealed the problem last year, and the L.A. Times confirmed it, showing not only that LAFD crews were slowing down but also that LAFD brass were thoroughly incapable of measuring their own emergency-response times.
Fire Chief Brian Cummings was hauled in front of the angry (and equally statistically challenged) L.A. City Council, which wanted answers but didn't know the questions. Cummings grabbed at an answer — he blamed budget cuts. Council members had no real clue but threw $35.6 million at LAFD, much of it to pay for hiring hundreds of new firefighters.
Since then, the debate has been framed thus: More money means more firemen, which means shorter response times.
That's not the whole truth.
LAFD response times are being inexorably dragged down — not by fire calls, and not by requests for those dramatic life-or-death rescues that make the news. Average response times to those serious events actually decreased by 21 seconds between 2007 and 2012, a City Controller audit found.
No, LAFD slowdowns are being caused by a tsunami of ambulance calls from people with shortness of breath, vague pains, cardiac arrest and all manner of real and imagined maladies.
LAFD gets absurd requests — like help finding the lost remote control. And it gets hundreds of calls, every single day, just for a lift to the hospital.
Almost unnoticed, these often lower-level calls now all but define LAFD's reason for being.
The cost, and the mission drift at LAFD, are vast. A report by Chief Cummings himself concluded that in 2012, LAFD firefighters, who at the basic fireman level earn $187,000 in salary, overtime, health care and pension ($200,000 is the average when all LAFD jobs are included), spent a cumulative 3.2 years simply sitting outside emergency rooms in city ambulances or standing in ER hallways.
The city's well-paid firefighter crews aren't there due to emergencies. They are waiting for people they've transported, with non-emergency complaints, to be booked by busy ER staffs. Some firefighters call it "wall time," as in "holding up a wall" while a patient is admitted for a broken toe or a funny burning feeling in the lower back. The courts say it's medical malpractice to simply leave a patient at the ER.
Darren Evans, a paramedic at Station 9, says wall time is "anywhere from 20, 30 minutes — to four or five hours."
Last year, LAFD ambulances spent a cumulative 28,239 hours parked outside ERs, twiddling their thumbs. It cost L.A. taxpayers $3.4 million in 2012. That's a lot of cheddar.
Wall time also matters because each marooned ambulance, sitting silently outside the ER at Good Samaritan Hospital, USC Medical Center, UCLA or Valley Presbyterian, inevitably causes other LAFD ambulances to be called to incidents outside of their own jurisdictions. That contorted situation means they arrive late, dangerously slowing LAFD's emergency-response times. Sometimes, a "light force" — two large, gas-guzzling, difficult-to-maintain vehicles carrying five or six firefighters — has to respond as well. Or both happen at the same time, stressing the broader system.
What Cummings' report didn't mention is that the elected leaders of San Jose, San Diego and Denver would find the policies long embraced by LAFD brass and the Los Angeles City Council — "wall time" handled by guys making $187,000, for example — just plain weird.
Those cities use private ambulances to shepherd non-emergency patients to ERs, for a lot less money, and they avoid compromising their system for true emergencies. Good luck, however, selling that to the powerful and popular firefighters union, United Firefighters of Los Angeles City, which plays a major role in electing L.A. city councilmen, showering their campaigns with money and getting out votes for council members on Election Day.
"There are different models," Miguel Santana, top budget adviser to both Mayor Eric Garcetti and the L.A. City Council, says diplomatically. "We have a model that's expensive."
That it is.
It may not, however, be sustainable.
Leonard Gilroy, director of government reform for the Reason Foundation, a research organization, calls it a "significant budget item, to have fire teams respond to something medical teams could be responding to."
The City of Los Angeles, straining to replace leaky antique chunks of its 100-year-old municipal water system, and six decades behind on a $3 billion street-paving backlog, somehow became proud owner of a costly shadow health care system: the red-and-white taxi service known as LAFD.
Station 9 proudly calls itself the "Wine-o Nine-os," named after its famed but poverty-stricken area. Matt Ekblad, 27, with a black mustache that curls up, says, "Whereas a normal person would go see a doctor if their arm hurts, if they got a headache ... it just works differently down here."
Some people just walk right in, like an overweight black guy wearing Crocs and a Purdue shirt, holding a bloody paper towel over his left hand. "Bitch cut me with a butcher knife," says the man, as the Wine-o Nine-os wash the cut, blood dripping on the floor like a leaky faucet.
"You don't want to call the cops or anything?" one asks.
"No. I just don't want her at my place no more. I'm done with her. She can't keep pulling knives on me."
The 9's bandage up his hand. The man declines a ride to a hospital, then a firefighter takes a large tub of bleach and pours it on the ground, washing his blood away.
"I'd say someone comes in four or five times a day," says Evans, the paramedic. "There are a few clinics around here, and a lot of people use those. But we're primary care. We're the first line of defense."
And that's an interesting statement. Because Los Angeles County, not Los Angeles City, is tasked as the lead agency overseeing $3.5 billion in state and federal money for public health, emergency care and hospitals. L.A. County turns away no poor person, and it operates a massive ambulance service. L.A. County is, in fact, the official first line of defense for the homeless, uninsured and destitute.
Despite that, in Los Angeles, people use the city's "911 as their medical care," says Mike V., a firefighter who drives for the Wine-o Nine-os. A typical request: " 'I need my blood pressure checked.' And dispatch, because we don't want to get sued, sends a 'resource' " — a city fire crew in an ambulance.
Every city firefighter has a most ridiculous house call. A ring wouldn't come off a finger. A bloody nose. A toothache. A ghost. A lizard stuck in a toilet. A cow stuck in a swimming pool.
"It was moonwalking," says the firefighter who responded to the waterlogged bovine. "I roped it."
"A good percentage of them are headaches," says firefighter Vinny Jenkins, who grew up a few blocks from Station 64, where he works, in Watts. He's been on the job for nearly 30 years. "I went on one the other day," he says. "It was a dog trapped in the car. The thing was — [the caller] had AAA! But it's easier to call us. The red-and-white taxi."
In 2012, L.A. firefighters responded to 376,783 calls (plus 20,000 false alarms). Firefighters handled life-and-death dramas, rescuing hikers, treating drug ODs, cutting electricity to downed power lines.
But mostly, firefighters provided routine emergency treatment — 333,333 calls, or 88 percent, dealt with chest pains, falls, trouble breathing, heart attacks, gunshots, numb legs and so on.
Fires? Just 2 percent of LAFD's call volume, 7,657 calls, were due to fires. Fewer than half were in homes, businesses or structures. Most of the rest were in cars, trash cans or Dumpsters.
"We're a form of nationalized health care," says Capt. Mark Woolf, LAFD's chief statistician. "Everyone has access. Even if you're a tourist from Granada."
May 2 is unofficially opening day of fire season in Los Angeles, as the Santa Anas cut through like a hot knife, sending temperatures into the 90s. Jenkins sends the fire truck barreling down the 110, sirens blaring. "This ain't Skid Row, brother," Jenkins says. "We roll."
Station 64's light force (a fire truck and an engine, which normally move together, since only the engine has water) heads to a fire in Harbor Gateway about 100 blocks south. Because Station 64 is in Watts, central to other areas, it's often called to help.
"Oh fuck, it's a recycling company," says Capt. Chris Bustamante, riding shotgun, as he reads from an ancient-looking computer terminal in the truck.
"Could be hot," Jenkins says.
"We'll take the roof," says Sean Rorden, a tall, corn-fed firefighter.
"46 is on the ticket, too," Bustamante says — meaning Fire Station 46.
"Good lord," Jenkins says.
We get as far the Torrance exit on the 110, and then ... "Light force 64 is canceled," a radio dispatcher says. "Light force 79 is handling." The firefighters groan. It's the third time today they've been called back from a fire.
Back at the station, the 64s watch, almost enviously, KTLA 5's breaking news of another blaze, the Springs fire in the Santa Monica Mountains near the Ventura County line.
City firefighters such as the 64s don't really fight wildfires. The most they'll ever do is make sure flames don't spread to houses. Far more specialized units contain wildfire blazes. "They don't put us in front of those fires," Rorden says. "We just don't have a lot of these within city limits. Some [L.A.] neighborhoods we know, if there's a fire — we're gonna lose them."
Firefighters crave fires — not just the adrenaline rush but performing this almost godlike skill, rushing into a burning building, effectively blind, with 70 to 100 pounds of equipment and gear pulling you down, to kill a fire. They obsess over tactics, forever recall the "good" ones, the really hot ones.
"We don't have as many fires as we used to," Duffy says. "From a public point of view, that's good."
In 1977, there were 3.3 million fires in the country. By 2011, the number had plummeted to 1.4 million, although the population had grown by more than 100 million. In 1917, more than 10,000 people died in the United States from fires; in 2011, just 3,005 died, even as the population had more than tripled. Death by fire is rarer than death by drowning or poison.
You can thank the massive decline in smoking — a lot fewer smoldering mattresses and curtains — as well as home smoke alarms and prevention efforts by fire departments and, most important, those seemingly fussy building regulations.
Los Angeles is especially fire-safe. It has about two-thirds fewer fires per capita than the U.S. average. Last year, fires in Los Angeles killed 24 people. About 125 more people in L.A. each year are killed by hit-and-run drivers, yet no effort is made by the Los Angeles Police Department, Police Chief Charlie Beck or the L.A. City Council to prevent hit-and-run deaths.
Despite these fundamental changes, in Los Angeles the 3,100 city firefighters on the job want more money. They want more firefighters. They seem busier than ever. That's a problem, because total average compensation departmentwide in LAFD, including salaries, OT, health care and pensions, is $200,000 a year.
City firefighters are so well-compensated that they enjoy lives above L.A.'s middle class; they can afford to live in distant, large suburban homes in Orange County and Santa Barbara, often supporting four- and five-member families in which nobody else works. "If you look at a firefighter's check, it is unbelievable and embarrassing how much money they're making," says a former top LAFD official. He refers to typical LAFD earnings, saying: "$160,000? Are you fucking kidding me?"
Many firefighters rake in even more dough by maintaining dual careers or running companies, since many work half as many days as a typical American — albeit 24-hour days, with ambulance shifts that can be particularly grueling (many others work four or five extra days to accrue OT).
A cynic might say that firefighters, and the powerful United Firefighters of L.A., are adding a lot of small, new duties to justify what once were very active, tougher jobs — fighting actual fires.
A more charitable person might say that policies adopted decades ago, when LAFD hired its first paramedics and the city launched the 911 emergency call centers, have long since taken on lives of their own, growing wild on the vine.
"What we basically are is an emergency medical department," says David Fleming, a former president of the Los Angeles City Fire Commission. Fleming thinks LAFD should be renamed the "Los Angeles Fire and Rescue Department."
LAFD runs 134 ambulances, 24 hours a day. It has 91 fire engines that each carry 500 gallons of water and 42 gigantic hook-and-ladder trucks — those massive, rolling toolboxes that show up in neighborhoods, which were designed to battle fires.
The painful, honest truth — ducked by everyone at L.A. City Hall for about 20 years now — is that half of LAFD's money-sucking vehicles, on every shift, and the men who sit on them, are intended for an activity that comprises just 2 percent of what's undertaken — firefighting.
These strangely job-mismatched trucks haul around about two-thirds of the city's job-mismatched firefighters, every shift. The situation compares, neatly, to the U.S. military, large swaths of which are still prepared to fight a land war — with the old, nonexistent Soviet Union.
"Everything the fire department does revolves around seeing a problem, grabbing it by the throat, squeezing it as hard as possible until its head pops off, calling the problem solved and moving on to the next one," says Jon McDuffie, a former LAFD public information officer who, clearly, isn't required to provide PR these days.
"They've never been good at getting out ahead of emerging issues," McDuffie adds. "By nature, they're a response agency."
That's been painfully clear ever since LAFD was caught out by Austin Beutner and the Times for producing utterly false, too-glowing emergency-response time data. It turned out that LAFD had been seriously exaggerating the speed of its 911 response for years, and under many chiefs before Cummings, including Millage Peaks and Douglas Barry.
"The department didn't know what it didn't know," says a former adviser to Mayor Antonio Villaraigosa. Moreover, "The data were so bad, it actually didn't matter what numbers they were giving us."
Today, a year after the 911 response-time scandal, Cummings, a Villaraigosa hire who earns about $280,000 a year, still can barely articulate a meaningful sentence about how LAFD's worsening response times were sold as fake successes.
"Since the system is always the way the system is," Cummings says, "if we keep all those errors for 2011, and then the same errors in 2012, and they were in there in 2009, I think we can make gross comparisons between those, to see, are we doing better or are we doing worse?"
During his mayoral campaign, Eric Garcetti was openly critical of Cummings' leadership. Now that he's mayor, rumor has it Garcetti is thinking of putting Cummings out to pasture.
Garcetti has asked all department heads to reapply for their jobs, and insiders say he wants to fire at least two of the 37 big bosses, to convince people he's serious about overhauling the city government. And it's no secret that Garcetti is unhappy with Cummings' performance.
Nevertheless, Cummings told the Weekly he expects to keep his job for "at least the next five years."
Under Cummings, the practice of intensely training as firefighters those who then will spend most of their time doing emergency medical work and shuttling people to hospitals, at yearly total compensation of $187,000 — on the low end — shows no sign of letting up.
And Frank Lima, president of United Firefighters of Los Angeles City, wants to hire even more firefighters. Maybe build more fire stations.
Create an even more massive red-and-white mobile health care system.
"The problem is," City Councilman Mitchell Englander says, "it's not sustainable."
Although Miguel Santana can sound a bit like a bureaucratic drone, in private he is so thoughtful that you wonder how he became the top budget adviser to both the mayor and City Council. He has incurred the wrath of many powerful city-employee unions in L.A., including firefighters, for making heretical suggestions — like privatizing services now handled by really well-paid City Hall employees.
"We're managing a mobile health clinic," Santana says of LAFD, sitting at a conference table in his office. "So the question is, is that a city responsibility? Our job should be to respond, to assess, to treat immediately. But when does it become an emergency, and when does it become health care?"
A few miles east of City Hall, the Los Angeles County Fire Department headquarters is years ahead of LAFD in answering that question. Its 3,100 firefighters are, as a body, more efficient. Every county fire station employs fewer firefighters and operates fewer vehicles.
Forget the antique truck-and-engine approach. Los Angeles County firefighters use a "quint," a hybrid that carries both the water and the aerial ladder. Together. The more nimble county vehicle looks like a small SUV; it whisks two firefighter-paramedics to the fire or medical emergency.
But here's the political blasphemy: At the scene of every L.A. County 911 call, the county folks are met by a private ambulance.
This would be an act of war, under the anti-privatization politics at L.A. City Hall, where the city government labor unions often wield more power than the 18 elected city politicians (the mayor, controller, city attorney and council members).
But the five elected L.A. County Board of Supervisors have come to a different understanding with their government unions: If somebody needs to go to the hospital, private paramedics, rather than highly paid L.A. County firefighters, take them to the ER.
However, if a patient requires advanced life support — he's having a heart attack, say, or was shot — an L.A. County Fire Department paramedic rides in the private ambulance and tends to the patient.
The private EMTs with whom the county works — trained in basic life support, which includes CPR and use of a defibrillator — earn as little as $11 per hour, plus benefits. They don't go through anything remotely like the rigorous, macho, 19-week LAFD training course involving the "drill tower," in which future city firefighters face endurance tests to prove they're sturdy enough to fight fires. Emergency medical technicians don't need those skills.
Los Angeles City Hall politicians have not come close to considering that public-private system — yet. So L.A. sends firefighters out as EMTs and then bills the patient's insurance, Medicare or Medicaid for the incredibly expensive LAFD lift to the hospital.
That'll be $978 for basic life support, $1,373 if advanced life support is given. Often the patient is uninsured, and the feds aren't always so quick to pay — and when the feds do pay the city back, they skimp.
In 2011-12, LAFD's ambulance services collected more than $66 million, $10 million more than two years before. But this massive ambulance service costs L.A. taxpayers far more than the city ever recovers.
The approach taken by L.A. County, San Jose, Denver and San Diego makes "a hell of a lot of sense" to budget expert and CityWatchLA blogger Jack Humphreville. "Are the [private ambulance] people better trained? I doubt it. But I'm sure these private medical service people aren't chumps."
Who's stuck at the ER, soaking up "wall time" while the broken-finger crowd is getting booked by a nurse? The inexpensive private emergency medical technicians are. Not government firefighters who earn six figures.
"The L.A. County fire model, I think it's about as efficient as it gets," says Joe Chidley, CEO of McCormick Ambulance, one private firm L.A. County relies upon.
McCormick pays its EMTs less than firefighters earn and bills insurance companies more aggressively than L.A. City does. Chidley estimates that L.A. City could save at least $110 million a year by copying Los Angeles County.
Members of the L.A. City Council — about half of whom are transplants from the California state Legislature — hate being compared to the county Board of Supervisors, who often find ways to save money where the City Council does not. And, of course, privatization of anything is anathema to the city firefighters union.
"No disrespect to private ambulances, but it's basically kids that want to get on the fire department," sniffs United Firefighters' Lima.
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Chief Cummings is firmly opposed to the idea, too, arguing, "You need to have that standing army, as it were" to jump into action when the Big One strikes — not to mention the fact that there could be another riot. That standing army at LAFD needs something to do meanwhile, even if taxpayers have to fork over exorbitant salaries while beefy guys stand in ER hallways staring at their iPhones.
Somehow, Los Angeles County firefighters have gotten past those obstacles.
They're leaner, yet the county fire department performance outshines LAFD's. A recent grand jury report found that county emergency-response times in urban areas (excluding the county's extensive efforts on wildfire battles) average 42 seconds faster than LAFD's.
Newly elected Mayor Garcetti cuts every bit the figure of a modern, 21st-century mayor in a city riding toward the future. But his dreams of carving out livable new spaces and funding innovations such as his outreach-based pothole-filling services all cost money — money that could get sucked up by a red-and-white taxi service born of days when women and children screaming from third-floor windows were saved by men on long wooden ladders.