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Commissioner Steve Novick

Official Website for Commissioner Steve Novick

Phone: 503-823-4682

fax: 503-823-4019

1221 SW 4th Ave. Suite 210, Portland, OR 97204

Reno 9-1-1: Nurse Triage Edition

As you know, the United States spends far more on health care than other industrialized nations. That excess spending is a drag on our economy. So I see one of my jobs as a City Commissioner as looking for ways to reduce unnecessary medical spending. And as Commissioner in charge of Portland’s 9-1-1 system, I have a little piece of the health care system, because many 9-1-1 calls are medical calls. And although many callers absolutely need to get an ambulance to the emergency department (ED) right away, research shows that our system generates a fair number of unnecessary emergency room visits.

Some jurisdictions have reduced unnecessary ambulance trips to the ED by having 9-1-1 direct some callers to a “nurse triage” line. Last week, I joined a group from the Portland region on a trip to Reno, Nevada, where a Nurse Health Line offers 24/7 access to assessment, clinical education, triage, and referral to health care and community services. Reno believes that this service ensures that people get the right kind of care at the right time when they call 9-1-1 with a medical concern. The site visit offered some important insights that we can use here in Portland.

Reno’s program, which is managed by REMSA (Regional Emergency Management Services Authority, a nonprofit ambulance service), provides patients with quicker access to medical information and more care choices from a team of specially-trained experienced registered nurses. REMSA’s nurses don’t substitute for primary care, but they help patients access the right level of care, including connecting uninsured patients with available resources.

In Portland, a similar initiative would require collaboration between Multnomah County, which is responsible for providing Emergency Medical Services, and the City, which is responsible for providing 9-1-1 service. It would also require an investment - both financial and non-financial - from the health care community. The group that traveled to Reno included: 

  • Multnomah and Clackamas Counties
  • Clark Regional Emergency Services Agency in Vancouver
  • AMR, which provides ambulance service in Multnomah County
  • Health Share of Oregon
  • FamilyCare Incorporated
  • Providence Medical Group

My personal observations after reflecting on what I learned in Reno include:

  • We cannot overstate the need for excellent community outreach. Reno decided to offer a non-emergency phone number for anyone to call with any medical issue or question. At the same time, they triage some lower acuity calls from 9-1-1 to the Nurse Health Line. Regardless of the approach, we would need to allocate time and resources to develop the new program for the community.
  • All partners must engage early to design a program that will work here in Portland. REMSA engaged a broad array of partners in the areas of health care, community, quality improvement, and technology. The group that traveled to Reno from Portland is a great start for the range of stakeholders who would need to be involved for an initiative here.
  • Dedicated funding is critical – but if we have the right stakeholders involved, the value will far outweigh the cost. REMSA received a $9.8 million Health Care Innovation grant from the federal government for their Nurse Health Line. Their grant funds expire later this year, and they are planning to sustain the innovation by working with partners and insurers who have realized savings because the Nurse Health Line has kept people out of ambulances and emergency rooms. Without a federal grant to help us get started, Portland would need to have the partners together at the start to align the value of this innovation with those who would benefit.
  • We must make outcomes a priority. REMSA has carefully established its goals for the Nurse Health Line and collected data to track progress toward those goals. Preliminary results show the line saved over $3 million over fourteen months by avoiding 2,296 emergency department visits and 414 ambulance transports. REMSA has also tracked the safety of the Nurse Health Line and has identified zero adverse outcomes --- and, they ask patients about their experience and receive comments like, “I love the program, you helped me through a hard and scary time.” If we decided to move forward with a similar initiative here in Portland, we would need to identify and track these kinds of outcomes from the outset.

 

 

Remembering Leonard Nimoy

Star Trek is literally the first TV show I remember watching, and I was always a Spock guy (maybe all of us were). I took comfort in the fact that Leonard Nimoy was still with us. It is strange to have him gone. The Oregonian’s Kristi Turnquist does a great job of capturing the significance of his character, and of the show:

"While aspects of the original 'Star Trek' series have inevitably dated -- those papier-mache boulders on strange new worlds, the new life and new civilizations that regularly consisted of babe-a-licious alien women with big hair and skimpy outfits -- Spock was a revelation.

He was a revolutionary character for the mid-'60s, in that his superior intellect and emotional reserve made him more elegant than Captain Kirk, with his womanizing ways; Chekhov, and his emotional outbursts; and Scotty, with his cries that the engines can't take any more strain.

Only Uhura (Nichelle Nichols) and Sulu (George Takei) came close to Spock's level of dignity, and all three characters stand as examples of "Star Trek" creator Gene Roddenberry's goal of using sci-fi to comment on the need for equal rights and to condemn intolerance of those considered 'different.'"

-Oregonian (February 27, 2015)

My thoughts on why Portland should stay out of the Joint Terrorism Task Force

This is not an easy decision.

I do not dismiss the threat of terrorism – I once tried a case in the courthouse next to the Oklahoma City Federal building that was blown up by domestic terrorists. And I think that in the abstract, the idea of local law enforcement, with their broader knowledge the community, working with the FBI is a good one.

I do not think we should make decisions about working with the FBI now based on how bad J. Edgar Hoover was.

I have met with the local Special Agent in Charge, Greg Bretzing, and his leadership team, and I think they are good, well-intentioned people.

I was impressed by the argument that if we have police in the Joint Terrorism Task Force (JTTF), they are in a position to raise concerns about FBI operations that seem inconsistent with Portland values. And I very much appreciate the Mayor’s statement about the conversation he would have and the instruction he would give to officers participating in the JTTF.

In short, I think there are good arguments for joining the JTTF.

But I also think there is a strong argument against joining the JTTF.

One of the main arguments for the value of having the Portland police in the JTTF is that the police have a broader knowledge of our community and the stronger relationships in our community than the FBI.

But we have heard from representatives of some communities in our city that joining the JTTF would weaken the relationship that they have with the police, and formally leaving the JTTF would strengthen those relationships.

We received a letter recently from a number of groups with Muslim constituencies expressing their concerns. The letter was signed by the Islamic Center of Portland, Islamic Society of Greater Portland, Muslim Community Center of Portland, Bosniaks Education and Cultural Organization, Oregon Muslim Citizens Alliance, Islamic Community Center of Hillsboro, Oregon Islamic Champlain’s Organization, Muslim Educational Trust, and Islamic Social Services of Oregon State. I encourage you to read the letter in its entirety: READ HERE.

Now, I know that not all Muslims in Portland feel the same way. We received a letter from the Somali American Council of Oregon urging us to join the JTTF.

And I am sure the FBI would take issue with some aspects of the Muslim coalition’s description of the FBI’s activities.

But I cannot ignore the fact that the leaders of numerous organizations in the Muslim community say that many Muslims do not trust the FBI and would trust the Portland police less if we joined the JTTF. I do not want to take the risk that people might not warn us of real potential threats because they don’t trust us.

I am also encouraged by the message that these Muslim and Arab leaders are interested in reviving American Muslim Police Advisory Committee (AMPAC), especially if we withdraw from JTTF. And I think we should take them up on that, and hope that can happen even if we join the JTTF.
If my view had prevailed today, I do not think it would have had to be the last time we considered this issue. As I said, I was impressed by Special Agent in Charge Bretzing, and I expect that he will work to improve relations with communities throughout Portland, including the Arab and Muslim communities. It may be that a year or two down the road, there would not be such community concern about joining the JTTF.

And again, I do not think this is an easy decision. I have been making calls and reading letters on this issue up to the last minute. Just this morning, I called Laura Dugan, a University of Maryland criminologist (and former colleague of my wife’s) and a member of the National Center for the Study of Terrorism and the Response to Terrorism. She told me that other things being equal, participating in the JTTF would be a good idea, but when I told her about the concerns raised by members of the Muslim community, she said that those relationships are very important and those concerns have to be taken seriously. She added that regardless of whether we formally participate in the JTTF, we could do emergency preparedness drills with the FBI; she said that in Boston, local law enforcement’s history of engaging in such drills was a key factor in the effective response to the Boston Marathon attack.

Again, I very much appreciate the approach the Mayor is taking to membership in the JTTF. But I respectfully vote Nay.

Come have your say about taxi service, safety measures for Uber, Lyft & other taxi companies Feb. 26

  • How’s taxi service in Portland?
  • What safety measures do we need for Uber, Lyft, taxis and other transportation companies?
  • What consumer protections do we need?

The taxi industry faces growing challenges to meet the needs of consumers and adapt to new technology. Accessible, reliable and safe for-hire transportation options are an important part of Portland's transportation network.

Commissioner Steve Novick convened an Innovation Task Force to help modernize the for-hire rules of the road. Come meet the task force and share your ideas and experiences with private for-hire transportation. 


We want to hear from you about how Portland can improve taxi and other for-hire transportation service:

PDX Rides Community Forum
Thursday, February 26, 2015  |  6 - 8:30 p.m.  
Portland Building, Second Floor
1120 SW Fifth Ave.

Lincoln on Government

by Steve Novick-- The following is adapted from a piece of mine that the Register-Guard was kind enough to print a few years ago:

Abraham Lincoln is, of course, best known as the first Presidential candidate to win Oregon. (As you know, we became a state in 1859 – and we made the right choice.) Then of course there was that whole business of freeing the slaves and winning the Civil War. But Abraham Lincoln should also be remembered as one of America’s most eloquent explainers and defenders of the role of government.

In a July 1854 essay, Lincoln wrote:

“Why … should we have government? Why not each individual take to himself the whole fruit of his labor, without having any of it taxed away?” He answered his own question: “The legitimate object of government, is to do for the people whatever they need to have done, but which they can not do, at all, or can not do, so well, for themselves – in their separate and individual capacities … There are many such things … roads, bridges and the like; providing for the helpless young and afflicted; common schools … the criminal and civil [justice] departments.”
In the same essay, Lincoln made this observation: “The best framed and best administered governments are necessarily expensive.” In other words: in government, as in life, you get what you pay for. That seemed obvious to Lincoln – but today, most supporters of government services would probably be too scared to be that blunt.

Lincoln’s views on taxation were somewhat out of sync with modern Republicanism; he thought that the wealthier members of society should pay a good deal of the cost of government. As President he enacted a progressive income tax. As an Illinois state legislator in 1839, he defended a proposed tax increase this way: “I believe it can be sustained, as it does not increase the tax upon the ‘many poor,’ but upon the ‘wealthy few.’”

He added, with a touch of mischief:

“The wealthy can not justly complain, because the change is equitable … If, however, the wealthy should, regardless of the justness of the complaint, as men often are, when interest is involved, complain of the change, it is still to be remembered, that they are not sufficiently numerous to carry the elections.”
Smart guy, that Lincoln.

Originally posted on blueoregon.com on Feb. 12, 2009

Photo credit: Smithsonian