The city is exploring a program to charge for what it sees as too many 911 calls, a fee that could be one of the first in the state, if not the nation.
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EL CAJON - Citing an escalating number of non-emergency calls from skilled nursing homes and similar facilities, the city of El Cajon could become the first in the state to begin charging for 911 service.
The proposed fees, which could be as high as $487, would only be charged after a facility had exhausted its allocation of free 911 calls.
El Cajon City Manager Graham Mitchell presented the proposal to the City Council at its Sept. 10 meeting. Since getting the go-ahead from council , Mitchell said he has begun scheduling meetings with the 20 licensed group care facilities in the city, and he expects a fee structure could be presented to the council early next year.
Mitchell also said he has not found any other city with a similar program, although there are laws across the country that allow cities to charge fees to congregate care facilities for services rendered.
There could be legal challenges ahead. A California law requires licensed care facilities to immediately call 911 if an injury or other circumstances has resulted in an imminent threat to a resident’s health, including but not limited to an apparent life-threatening medical crisis.
At the Sept. 10 meeting, City Councilmember Phil Ortiz said he was aware of how the new fee might be seen by the public.
“I think it’s important for the public to realize that we’re extremely sensitive of the optics that this presents,” he said about the perception that the city will start charging for 911 calls. “I want the public to realize that we’re not just coming down on people who need help.”
Mitchell said the fees will address what he perceives as some facilities taking advantage of city services by calling 911 for non-emergency incidents that could be handled by their own staff .
“This has been on our radar for our three years,” he said. “It started anecdotally, just talking to our fire crews, who were saying that they make a lot of calls in the middle of the night to these facilities.”
Mitchell said the city began looking at data two years ago and found that 44 percent of the calls from the facilities were for non-emergency incidents, meaning mobile medical services are provided but no ambulance transportation is needed. More telling, the study found that some facilities were making significantly more 911 calls than others on a per-bed basis.
The size of the facilities range from the 10-bed Fancor Guest Home, which provides residential care for mentally ill adults, to the 305-bed Country Hills Post Acute skilled nursing home.
On average, the facilities made a median average of about 1.35 calls per bed, but some made six-times that many calls in a year.
“That’s clearly an abuse of the system,” he said.
The city attempted to lower the number of calls with an educational outreach program in 2022. Another study conducted two years later, however, found the number of per-bed calls had decreased at six facilities, but had increased at the other 14 in the fiscal year 2023/24 study.
Mitchell said it’s unclear why the per-bed calls increased, but the jump was significant in some places.
The largest jump came from the 77 calls from the 39-bed VOA Carlton G. Luhman Center for ive Living, which represented a 670% increase from 2022.
In other examples, the 44 calls from 23-bed Orlando Guest Homes was a 205.6% jump, and the 323 calls from the 305-bed Country Hills Post Acute was a 50.2% jump.
Having failed at the carrot approach, Ortiz said the time is right for a stick approach.
The city is considering three fee options.
One option would have a facility charged $486.83 for calls after it goes 25 percent above the 1.35average. The dollar amount is based on the cost of sending a crew on a call plus wear and tear on the vehicle.
Another option is to charge $486.83 for every call 50 percent beyond the 1.35 average, and the third option would be $243 for each call at any level above the average.
Mitchell said slightly over 500 calls in the last fiscal year were above the average number, costing the city about $250,000.
“But the dollar amount is not as significant as the impact it has on the fire department,” he said. “I think we respond to more calls per capita than any other city in the county, so they’re already super busy. There’s a breaking point, and I think we’re very close to that.”
In a presentation to the City Council, Mitchell said the 911 crew responding to the call would not determine whether the incident was a non-emergency, and all calls over a certain allotment would be subject to fine. Those fines could be appealed, he said, so the facilities could make a case that the calls indeed were necessary.
In the Sept. 10 meeting, some council and Mayor Bill Wells said care facilities were using the city’s emergency services as part of their business practice.
