All right, good morning, everyone.

Uh, thank you for coming out.

It's a little after 10, it's 10 05.

We're gonna go ahead and call the public safety committee meeting for Tuesday, April 7th to order.

The first item of business's approval of the March 3rd, 2026 uh minutes.

Move to approve.

All right, all in favor is aye.

Any nays?

No, okay.

That one passes.

All right.

Um this next presentation is um actually quite an important one.

Um I never like to rush meetings for the sake of rushing meetings, so I do want to make sure we give this one the time it deserves.

Um, and so with that being said, we're gonna go over workers' compensation overview.

Uh, director Kristen Smith from Human Resources is here to give that.

Or she's not.

Kristen will provide the overview, but I want to do a quick introduction.

And I want to do an introduction to the workers' comp program overview that you're about to receive for two reasons.

One is the former HR director, and second, as the assistant city manager responsible for the oversight of the human resources department that administers the workers' compensation program.

I want to share that the city is part of the state's workers' compensation program that basically regulates the framework around medical care and wage replacement for employees that are injured on the job.

That open that program that we participate in has been around since 1913, and the city has been a participant in that program for decades.

Beyond compliance with state requirements, what you're going to hear in today's presentation are things that we do above and beyond what the law requires.

You're also going to hear that our goal is even just more fundamental, that employees go home safely at the end of a shift.

And so there's lots of efforts that go into that on related to on the job training that our first responders receive.

In addition to that, they also receive PPE and protection equipment.

And then, of course, the safety net of the state state regulated insurance in the event that they sustain a job-related injury or an occupational illness.

The duties of our first responders carry an inherent risk, and we recognize that.

They are the first to go into situations that would prevent that would uh expose them to injuries and illnesses that occur on the job.

And so again, beyond the state regulatory requirements, the city provides support for injury prevention.

We provide early detection, so there's screenings that are provided to our first responders, and then recovery.

Some of the examples that you're going to hear more about are the athletic trainers that are provided to first responders at no cost to those individuals.

You're also going to hear about our nurse case managers that help with complex workers' compensation claims, and then annual health screenings that we provide to our firefighters for early detection of occupational illnesses.

On average, the city receives over a thousand claims every year.

Vast majority of those claims are from our first responders.

And while I say those numbers, I want to say that behind each of those claims and each of those numbers, there's an employee, there's a worker, there's a work group, and there's a family that's impacted, and that perspective matters.

What you're gonna focus, what we're gonna focus on in today's presentation is really about the overall program in the administration.

The individual cases, while those situations matter to the individuals, to the employees, to the city, we are legally prohibited from talking about medical situations of our employees.

So today's presentation is really gonna look at the overall program administration and ways that we can strengthen this program in a consistent and fiscally sustainable manner for the benefit of our employees and the trust of our taxpayers.

So before I allow Kristen to come up, I do want to share that Kristen has been with us for all of six months in one day, and we're gonna lean into her newness to the organization and her public and private experience to really look at how we administer the program and opportunities for change.

So with that, I'm gonna turn it over to Kristen to provide the overview.

Thank you.

Again, I'm Kristen Smith.

I am the HR director here at the city.

I'm here to provide a very high-level overview of workers' compensation, both as a framework outlined by the state as well as provisions that are in place for the city's specific program.

All right.

Alright, so the state actually sets the framework and outlines guidelines for workers' compensation for all employers across the state.

At very fundamental levels, workers' compensation is in place to ensure employees who are injured or become ill as a result of their work that they receive treatment, timely care, and in some situations, compensation for their situations.

The regulatory body for workers' compensation in the state is the Texas Department of Insurance.

They provide both the framework that we are required to follow.

They ensure compliance and they can also take enforcement action.

As a public entity, the city is required to participate in the state's workers' compensation program, like many other employers, again across the state.

I always like to use for reference because everybody typically understands how employer-provided health insurance works.

So, you know, you have an employer, employees pay premiums to that employer to participate in their benefit programs, the employer provides funding, and so it really is the shared pool of resources that helps to cover the cost of employee benefits.

Workers' compensation is not set up with that model.

Employees do not contribute to workers' compensation, it's fully funded, all of the mandates by the state are funded by the employer, which means that taxpayers pay for the cost of workers' compensation.

And again, the city is self-insured, and so all of the state mandates, anything that you know is added in addition to that, other aspects of our programs, they are all funded 100% by the employer.

And then just for reference, and I'll talk more about this, on average, the city has on an annual basis anywhere from roughly 1500 to 1700 claims, and these numbers represent the last year, but they're pretty representative of what our annual participation or claims activity looks like.

And our largest category is strains, followed by miscellaneous and falls and slips.

We obviously have police and fire who have you know very hazardous positions.

So it is not uncommon to see that fire and police and some of our other target departments are some of the highest utilizers of workers' compensation.

The claims numbers that you see here, they span from anything as simple as a you know cut or scrape where somebody gets you know some basic treatment and returns to work on up to the you know full spectrum of injuries and illnesses that our employees may face.

And again, just you know, to support and chime in on Deanna's point.

These are numbers that tell us activity, but at the end of the day, it doesn't matter if we have you know one claim or thousands of claims.

Every claim is specific to that employee.

They only care about the care that they're receiving and how they're navigating their claims, and that is the approach that I and my team are committed to focusing on.

How do we help each individual employee navigate what is sometimes a complicated process under the state guidelines that we have to follow?

Alright, so speaking of state mandated provisions, I do want to dive a little bit deeper into what the regulations require of us as employers.

So again, unlike traditional health insurance where there's a network of providers, you're able to go out of medical necessity to kind of any of those providers and receive care in order for something to be considered compensable and covered under workers' compensation, we have to be able to show causation, and there are two primary areas for that.

So one, workers' compensation is not considered at fault, meaning, in order for an employee to access care, there does not have to be a determination that the employee contributed to its his own his or her own accident or illness.

There are a couple of exceptions to that.

So, for example, if an employee maybe was using an illegal substance and had an accident, that could be a potential possibility of that claim not being covered.

But overwhelmingly, the fault of the employee is not considered when accessing care.

On the legal side, again, it has to be directly related to work.

So not only does it have to occur while that employee is performing work, the type of injury and the extent of the injury has to be directly shown to be connected to the work the employee was performing at the time of injury.

And so a good example for this is you know, maybe I have a shoulder injury, I've you know lifted weights for years, or I have you know other physical demands that have caused me to have prior injuries.

Maybe I've had a treatment on my on my shoulder in the past, and then if I injure my shoulder at work, all of those factors will be considered, and the type and level of care that I need will be reviewed based on the type of work that I was doing at that time and the result.

And then to support that, our workers compensation providers, they're looking for medical causation.

So they are assessing not only the way the employees presenting at time of injury, but they're looking at prior medical records, what's the employees' history, are there comorbidities, other illnesses, other degenerative conditions that may have contributed to the extent of the employee's injury.

And again, these are required under state guidelines.

Sorry, Kristen, real quick before we go on from that one.

The on that last slide, if we go back there real quick, it says the other uh contributing factors are also considered.

Does that mean that something is found that it has to be denied or it's automatically denied, or it could lead to the denial?

Yeah, definitely not that black and white, just that the employees, you know, physical condition, prior medical history are all taken into account when determining the level of compensability and if the injury is directly related to what they were doing at the time of injury and that it happened in the workplace.

So it's just one of several factors that would be considered.

Thank you.

All right, so the exception to that um are presumptive coverages.

So for certain first responders, there are certain illnesses that are assumed to have developed out of the course of employment, and so for presumptive coverages, it places the burden on the employer to determine that it was not caused through the course of their work.

And so the current presumptive list includes tuberculosis, specific type of type of heart attack or stroke, and certain cancers that are listed there.

All right, so for determination for a typical injury, we have roughly 15 days to determine if it is compensable under workers' comp.

I do want to state again, while these timelines are occurring, it does not mean that employees are waiting on care.

Um the goal always is timely and effective medical treatment for our employees.

But for a typical injury, 15 days to determine whether it is truly a workers' comp covered injury, and then for presumptive illnesses, especially for cancers that may require, you know, more medical workup, labs and scans and other screenings, employers are provided with a longer timeline to determine compensability, and that is 60 days.

Um regardless of the outcome, one second.

If I could just interrupt you for a second, do you mind going back to the previous slide real quick?

Yeah.

Um, the list of cancers, where do we um where do we get that list from?

So um this is provided by the state, and do you is it something that you need to think about?

That answered my question, okay.

Thank you.

Sure.

All right.

And then in addition to the timelines for determining initial compensability, um, the state has set up guidelines for dispute resolution.

And so employees have many steps to follow to have their cases or the conditions of their case heard by varying parties, and that starts with just initial proactive outreach with their examiners and could progress up to a final appeal review and potentially litigation if the employee chooses that route.

Alright, so next is claims navigation, and this is an important aspect of how workers' compensation works because you know employees are not looking at regulations and guidelines when they're trying to access care.

They only want to know what their claims experience is.

And so this aspect of care really touches our individual employees, and you know, depending on how complex their conditions are, there could be you know multiple claims that happen.

Maybe I'm you know initially hospitalized or now I'm going to physical therapy.

Now I need in-home therapy.

So there, you know, these claims this claims experience follows employees as their case progresses.

So again, I keep referencing uh employer paid health insurance because it's there are similar aspects to workers' comp.

Third party administrator is one of those aspects that's very similar.

So in an employer sponsored plan, you know, your third party administrator may be something like Blue Cross Blue Shield or Aetna.

Our third party administrators, currently Sedgwick, actually have a couple of representatives from Sedwick that have joined us as well.

They want to make sure that they're here and hearing and you know continue to be an active participant.

Um Sedwick was uh became our partner several years ago through a competitive procurement process.

We do expect to have a new competitive bidding process this uh calendar year with implementation in FY27.

Again, the role that the third party administrator plays is case management, so that includes claims examiners that follow employees throughout the life of their claims, providers that are providing medical care, uh nurse case managers.

They also provide us with reporting and metrics around the city's overall program.

They also focused on compliance, so similar to uh employers, um, the Texas Department of Insurance also regulates and oversees third-party administrators and the services that they provide, and then medical providers are you know extremely important as well.

So we have medical providers with varied specialties, varied locations.

If we have medical providers that we have a medical need of an employee, and a provider is not represented in the network that can provide that care.

We do also direct contract with providers that may have a specialty that's not readily available.

We are adding roughly two providers per month on average to the network.

There is a uh third party that partners with Sedwick to help us identify providers, but we add providers from many different sources.

So our nurse case managers, and I'm going to talk about in just a second make recommendations.

We are actively looking for partners as well.

We may have employees that are recommending providers, so providers can be added to our network in many ways if they are willing to participate.

Ms.

Smith, one second.

Uh Councilman Boys.

Uh thank you, Mr.

Chair.

Um, I'll ask this right now before we get uh you know further in the layers here of how uh third parties interface with uh you know city processes, et cetera, but specifically with what the city manager had informed us that at the city level we were going to implement to have a case manager or to advocate for the worker who's you know going through this process right now.

Uh if I remember correctly, and Jay, correct me if I'm wrong.

Uh, I think you alluded to some time before that's implemented.

Uh first question is where are we with that?

I mean, has it been officially fully implemented?

Sure.

So there are human resources.

We uh are currently recruiting for two uh senior HR analysts, they will be directly assigned for police and fire.

They both will share police and fire, so there's redundancy.

Um, but um in addition to that, the city already partners with secondary nurse case managers that are independent, they're not employed by Sedgwick or our third-party administrator, um, and they right now partner directly with our employees that have more complex injuries or illnesses.

But we are actively recruiting for the addition.

Um, our human resources workers compensation team right now consists of three people, a manager and two employees.

So the addition of the two analysts, again, they will be dedicated for police and fire.

It's important that employees have an escalation point that they trust that is you know easily accessible, and that is why we're adding those additional care coordinators.

Okay, and and they can interface with slides you have up there right now, third-party administrators.

Yes.

They can interface with that.

They can interface with Sedgwick, they can interface with our nurse case managers.

They will also be able to interface with the department liaisons.

So for our larger departments, especially police and fire, and some of our higher utilized departments, there are medical records coordinators and other liaisons, wellness coordinators in the departments, and so uh these care coordinators will also be um liaisons for them.

All right.

Thank you.

On that one too, real quick for the varied specialties.

Uh, if they're if we don't have one that's in the network, and we've seen this recently, and there's been a handful of cases, um, this the specialist is either not in network or um they just prefer to go to a specialist that deals with you know athletes or um first responders.

What is the process for that first responder to either get a waiver uh for someone outside network or to get someone who's not in network?

For example, uh again, won't name names, but uh police officer severely injured, they don't have a special specialist who could take care of the jaw.

Uh there is a 10-month delay for her getting care.

Um, but she found a provider that could provide care right away.

Like, what is that process look like for them to say, I want to go to this doctor?

And they've agreed to take workers' comp.

Okay.

So I'll answer that in kind of two parts.

So, our additions to the network represent a medical need, so meaning it is driven by medical necessity.

A provider, an employee has an injury.

I'll just use a um a dentist.

Someone, you know, got hit and they have to have dental work.

A dentist would not typically be represented in a workers' comp network.

We don't have a lot of claims, and so there's a medical need, and that's where it originates.

This person needs this specialty type of care.

If we don't have that, then we are actively working with the employee, um, working with our third party that partners with Sedgwick to reach out to providers to see if they have a willingness to direct contract with us.

Um, and so in those cases, it doesn't have to be, well, you have to now take all of workers' comp.

We're trying to address a specific need.

Um, if an employee has a preference, but there is representation already in the network.

We typically, and we don't have a formal waiver process for that.

So, you know, I need to have shoulder surgery.

There, you know, 20 surgeons that can provide that surgery in network.

Um, we don't typically change our introduce new providers just because of an employee preference, but we do actively reach out if if it is determined that there's a need.

So I'm saying a lot to say we we like for these changes to originate from a medical condition that we cannot meet within network, but because we are focused on the employees and we want to make sure that we have specialists that are preferred that are close to them, um, you know, many other factors go into that.

Even if there is representation in the network to meet that employees' need, if they are very passionate that they want to do something different, then we do advocate and reach out to additional providers of their choice.

We can't make them join our network, but we do actively reach out to those providers to see if they have an interest.

If they do fully join our network, then yes, part of that commitment is providing services to all of our employees, not just one specific.

I explained a lot, but it's kind of two entry points.

You know, one is you know, absolutely, if we don't, if we cannot support someone because we don't have that coverage, we're going to find an option to address that single employee.

Um, if we have the coverage but it's employee preference, then we try to advocate to have those providers, if they are interested, join our network.

But there are parameters for joining the network.

Should it be a pretty quick process for the for those who are they don't have one in network, for example, and I teach my Marines all this or this all the time.

The only one who care more about you is you.

So if that uh first responder or any employee, they find somebody who is out of network because we don't have anyone in network.

They come to HR and they say, I found a doctor, they're willing to take workers' comp.

Uh we don't have anyone in network.

What is that process to get that that approved?

And I will um early in the presentation when I'll ask Danielle to come up.

Danielle is our workers' compensation manager, and she could talk more about adding that.

I do just want to um speak for a minute about um cost containment as well.

You know, again, like an employer provided network, part of the benefits uh to the employer of having providers in network is that they have pre-negotiated rates, and um, you know, they go through a vetting process, and so you know it it is not that everybody can join.

There are parameters, uh, and part of that is making sure that we, you know, have a a sound network that's been officially vetted.

Good morning.

All right, so if we do not actually have a provider in the 504 that we currently have established, we will make a one-time single case agreement with that provider, acknowledging that they're willing to accept workers' compensation rates and partner with us, and we bill them directly.

Is that a pretty quick process as far as it can be?

It depends on the provider's office.

So a lot of times we're having to reach out to the office, we're talking with the person that may answer the phone or receptionist, and then we're navigating between their building department, the provider themselves, and trying to work with them.

So typically it can happen fairly quickly.

And as far as the billing goes, it's the correct if I'm wrong, because I usually am uh workers' comp as far as the rates, it's that's established by a state.

Yes, correct.

So like they're not really negotiating a rate that so in network provider is gonna be charging the same as an out of network provider.

Correct, typically under workers' compensation, it'll fall similar to the uh Medicare fee guidelines.

Awesome.

Thank you so much.

I have a question.

Because we're talking about specialties and network providers.

I have uh an injury, and um, I say I've had shoulder surgery before, and I'd like to go back to that same surgeon for like continuity of care, but that surgeon is not in network.

So is that a situation where preference would matter?

Or in that case, would we still be required to use um an in-network position?

It would be considered, and so all ultimately it's gonna determine whether or not the uh specialist is gonna be willing to join with us or to work with us in this case.

A lot of times when you have a surgery from a prior injury, no additional surgeon usually wants to treat that injury.

They want you to stick with that older surgeon.

So usually we would um review that for adding them into the 504.

Okay, and so um what if my surgeon says um I don't like your reimbursement?

You know, I don't like I don't do workers' comp, I don't like the reimbursement rates.

So in that instance, is there um is that just a no that that employee would not be able to use that physician moving forward?

So it would be a direct contract agreement.

We would either have to work with them to directly contract on a rate.

Um sometimes we are gonna run into a situation with a specialist.

I'll use myself for an example.

Um had a tooth extraction issue.

I needed to see an endodonist, they don't accept insurance anywhere.

It's a specialty, and they don't have to.

So I went, got my tooth procedure done, paid out of pocket.

I submitted the reimbursement request to my insurance.

So we usually will always try to find some kind of a in-between agreement with the provider and contract directly.

If we can't, then we will try to work with our in-network providers to see if we can address the employees' needs.

Okay, thank you.

All right.

I I have addressed most of this slide, but I do want to go to the nurse case managers and make sure we don't go over that point.

So again, as I mentioned with Sedgway, they do have nurse case management services, but um the city um has gone above and beyond that.

We have nurse case management agreements.

Um, one of them, the the one that we use most frequently actually originated in police, but um we assigned these nurse case managers for employees that may have more complex injuries.

Um they are literally physically present for employees, so they're at the hospital, they're able to go to medical visits, uh they are communicating uh with us, they're communicating with providers, they can work with employees uh family members if the employee is not in a uh condition to be able to partner.

So that nurse case manager uh is helping with that personal touch for employees that have you know more severe injuries or where they they're where they may be managing uh multiple injuries and need that support.

Alright, so for state mandated requirements under financial support, in addition to medical care, employees receive potentially temporary income benefits or other payments for first firefighters and police officers, they have access to up to one year of injury leave if it is requested under typical guidelines, and then there are survivor benefits or line of duty death benefits if you know God forbid an employee succumbs to their injuries or illnesses.

In addition to that, the city has expanded.

So for general employees, there's a disability supplement pay that provides based on employees' years of service, additional supplemental pay up to maximum medical improvement.

And then as you know, city council is also extended the one year of injury leave for first responders, which we call O days or occupational days to allow for up to two years, or maximum medical improvement, and those O days are available based on injury.

Alright, so the goal is always as much as medically possible, you know, returning employees to work.

And so we are actively working.

Our nurse case managers also help us with this, our departmental liaisons, looking for light or full duty opportunities.

So, you know, maybe if I've had again, you know, shoulder surgery, I can't move one arm, but I'm still able to do meaningful work.

They may reassign them, maybe they're doing desk work or something else that you know would not irritate their current injury, but it does you know require lots of collaboration, and the departments are always you know very helpful in helping us find additional assignments, and then maximum medical improvement, another framework that's established by the state, just means that an employee has reached a point where further medical treatment will not improve their condition, does not mean that they're not still managing symptoms and pain or dealing with conditioning, but it is defined under the reg and at uh MMI the temporary income benefits in.

Alright, so if an employee does get to a point where they are unable to fully return to work, we do have through our retirement uh employees' retirement fund, uh occupational disability retirement.

So we you know work with employees, help them very as early as possible start that process.

There are requirements to receive that, but it at least does provide an additional pathway if for some reason employees are not able to return to work on a permanent basis.

All right, so outside of the state mandated guidelines, I just want to highlight a few of the programs that the city has in place to support our employees.

Again, the nurse case managers, I can't stress you know how important these types of partnerships are.

They really help us with expediting return to work, but the main benefit that these partners provide is medical expertise and improved outcomes for our employees.

So, you know, of all of the things that I've heard about workers comp and the things that I've learned in the last six months in one day is that our employees really appreciate our nurse case managers, and that is you know definitely an area that would be a recommendation for expanding in the future.

We also offer early detection for fire specifically as well for presumptive type conditions, offering we have the city provides funding towards preventive screening, uh early detection, and that is a program that is deeply rooted in our departments to help our employees have better outcomes and be able to be proactive about their care and treatment.

And then we also have athletic trainers, so the city currently partners with Baylor Scott and White to provide athletic trainers.

These trainers are available to all employees, regardless of the type of injury.

They are again provided at no cost and help with conditioning.

They also outside of injuries just help with overall wellness.

So again, just another factor to help our employees stay healthy and return back to work fully.

Again, there is no one person or no one change that is going to move the needle on workers' compensation.

It really is a collaborative effort.

It requires lots of conversation, lots of dialogue.

I have had lots of meetings, lots of discussions since the very beginning, just trying to understand our current state.

But I am one of many, many people, several in the audience, several in this room that are dedicated and focused on making sure that employees get what they need.

So again, circle of care, it really depends on our departmental liaisons, all of our care providers, our network, holding our third-party providers accountable.

It is a conversation that will continue indefinitely.

Being able to have quantifiable metrics, that way we have better visibility on outcomes of our employees and what the activity actually looks like across the city.

Also getting perspectives of workers.

We already have touch points.

Cedric has proactive surveying that they do throughout the claims process.

But one of our goals for this fiscal year is to get independent surveying and independent feedback touch points for employees.

That way they're not having to funnel their comments or concerns through the TPA, but they're able to come to us directly.

And then also, you know, the ideal scenario is that people are not getting hurt at work and that we're not having injuries or illnesses.

And so, you know, making sure that we're working very closely with our safety team and risk management to identify how we can start to reduce some of our numbers and doing deeper dives into accidents and injuries to see how we can prevent future occurrences.

I've already mentioned the addition of positions, but again, collaboration and that collaboration also includes our employees.

They are the ones that are having the direct experience, so they are the ones that we want to hear from, and so finding ways to be able to surface that in a way that is collaborative and proactive and helps us to improve the program and move the needle forward.

And then again, our third party administrator is a very critical player, and the city will be going out for competitive bidding this calendar year with plan implementation of the results of that procurement in fiscal year 27.

So I will pause here.

So we have a second agenda item on mental health that I'll speak to and have a couple members here, but I'll pause here and open for questions on workers' compensation specifically.

I think we're I know we'll have a lot of questions too on the other mental health side.

So first I'm gonna open it up to colleagues if you all have any comments or questions right now on this on the workers' coffee.

Mayor.

Thank you for your presentation, Kristen.

My first question is in your experience, both before you're here in the city of Fort Worth and then today, are there legislative constraints within the state law that you think we should work on as a city to work with our state partners that maybe are limiting our ability to better serve our employees?

As I mentioned earlier, you know, our employees are not looking at the regulations and guidelines.

They just want to know that they're getting access to care and the support that they need.

And so, in my opinion, where we can have the most impact is making sure that we have a robust support network for employees that the city can manage and control, meaning you know, third-party administrators and provider networks, you know, they have structure, they are regulated, but we have the ability to provide support that looks the way that we want it to look.

So our nurse case management model, that's a great example of how one-on-one care and really focus support can really drive outcomes and behaviors.

So I would, in my own personal opinion, I would focus a lot of effort around how do we make that as viable and expansive as possible for our employees.

And then another question is without giving specifics, because I know we can't talk about individual cases.

Have there been incidents or cases that you've seen in the past six months in your employment here that were less than optimal results that we were disappointed with how we were able to handle it?

Maybe it wasn't totally a fault situation, just things went wrong.

And how do we learn from those moving forward?

I think all things point back to that circle of care, having employees one, understand um what their options are.

I think we have some opportunities around education and resources.

If I am injured today, today is when I should understand what is next for me, right?

So we can provide lots of training, lots of resources.

People are not connected to that until it's time for them to utilize it, right?

Like what was that?

Oh, this is for me.

So having something that helps people right away understand what their choices are, but also having someone with metal medical expertise, our claims navigation expertise that can walk them through the process, especially for our more complex cases.

So, you know, again, overwhelmingly, people are getting very minor, you know, cuts and scrapes and things that are, you know, it makes sense, you're back to work.

But when somebody has lost work time or they are hospitalized or have higher level care, then surrounding them with support is going to always present the best outcome.

In best case scenario today, when you have a um first responder or an employee injured critically, they're hospitalized.

How quickly does that nurse case manager make contact with that particular employee, or more importantly, their family member who's here?

Our nurse case managers are there at the hospital.

Once they know somebody is hospitalized, they're there.

Um Danielle and her team, they play an active role, they're monitoring these higher level cases.

Um I see the departments, especially for police and fire being very critical.

Our police and fire associations are also very critical.

Employees dealing with these situations need somebody that they can trust, and sometimes we have to, you know, rely on our departmental representatives to kind of be the liaisons for us.

Like, hey, we're trying to get the nurse in there, we're trying to get some support.

What are you hearing from the family?

How can we help them?

And so it really is just a circle of all of us working together to make sure people have the best experience.

And just one last question related to the RFP on the TPAs.

How many additional TPAs out in Texas do you anticipate would bid on a contract this large for a four?

So, you know, not gonna sugarcoat it.

There are not a lot of options.

Um, we are a large employer, but I think that the most important aspect of the RFP is making sure that the scope is reflective of the services that we expect.

Um, that it's very reflective of the metrics uh and outcomes focused care that we want articulated from our provider.

Um, so I want to focus on making sure the scope is very robust and then finding the right partner that matches that, whoever that may be.

When you say not very many, how many does that include?

Um, two or three.

Okay.

Is there anybody any consideration?

This is a longer question that we would need to break up our workers' comp into different employee groups to have more competition among workers' comp providers.

Um I am not aware of any conversations about that now.

Uh as far as TPAs, I have seen other organizations kind of break down care, meaning they may have a TPA that provides one aspect, they may have a provider network that provides another, a nurse case management profile, and all of those providers are coming together to provide services.

So that, you know, is a conversation that we need to have as well as we're approaching next steps.

I think that's something I would like to explore at a later time as we get closer to the RFP process.

Thank you, Kristen.

Back to you, Charlie.

Thank you, Mayor.

Um, okay.

So first I want to preface this comment with the fact that I don't think anyone is intentionally doing anything to not take care of our first responders, and that's where the focus is today is on the first responders, this process.

Um, I know we just met.

Um, I know Diana, I know how much she truly cares about a first responder, so I don't think there's any ill intent.

I don't think anything anything's intentional, but there's clearly a process in place, but I think the issue that we really need to explore is why the process is breaking down, where it's breaking down, and what can we do as a city, especially being self-insured, uh, to be better and to provide a better level of care.

Um, I know looking at the first slide, I know the goal uh is that, you know, workers including first responders are treated with dignity and respect, but there's been more and more and more stories.

I mean, just 30 plus first responders that come directly to me where we're not doing that.

And I'm glad Cedric is here because I did see some emails from Sedwick to some of these uh employees that had someone sent their loved one that email, it I'm sure it would have upset them as well.

Um so with that being said, um, I really like to brief this is gonna be a much longer conversation uh to tackle it because I know we're not the only ones in the state that have workers comp issues, however, I think we can do better.

Um, but one of the uh gentlemen I I asked to uh to come come answer some questions is Skylar Ainsworth, uh, one of our uh one of our firefighters who's well versed in this, Skyler.

Do you mind if uh ask a couple questions?

So for those that don't know Skylar, um he actually went through the process to become a licensed adjuster, if I'm not mistaken, so he could actually understand the process that some of these adjusters are going through, including one week of anatomy, which we won't go into all that.

Um but from a first responder, so Skyler, you heard the process for workers' comp uh, for the city of Fort Worth.

Um, as far as what's actually happening on the ground uh for the boots on the ground who are having these issues, where is the process breaking down that we really need to make sure we're focusing as a city on uh and and really aiming to fix?

Because again, we know no one's doing anything with malintent, but where do we where's the breakdown?

Because there's clearly a breakdown.

Absolutely.

I mean, that's obviously why we're here, right?

Um, and from a backstory standpoint, I've been in this role for about 12 years.

I've seen our system work well.

Well, I saw it fail, work well, and then we're not doing something right again.

Um I think the the presentation on the procedure is accurate, but that's in that's in the workers' compact.

That's that's kind of a law situation.

Um where we're probably failing right now is we're listening to Cedric too much.

Or a TPA in general, you can change Sedgwick out.

It's gonna be the same problem.

Their business model exists to save money.

And so in the past, there's been times where things were going well because we were able to have a dialogue with the city, we were able to overturn denials because it made sense.

Um, and that's not happening now.

We are we have we are a different set of employee groups, right?

And and I don't mean that to disparage general employees at all.

Um burning roofs don't land on everyone.

Um these officers get shot.

That's not a that's not a line of duty injury for a general employee.

So we have a different set of injuries, and there's doctors out there that are world class that just want to treat first responders.

In the past, we were allowed to do that.

And the stance right now is it's a no.

And I'm talking about Zoom meetings with office managers and the physicians trying to get approval for these things.

And some of these firefighters are here today.

Uh they can answer those questions better than I can because they're the one that needed the treatment.

And we're not doing that right now.

And the stance has been we're gonna we're gonna stick to the network.

And I was around when the network uh came about.

Those early meetings, and this was our concern those years ago when when uh Mark Barda brought up the idea of a 504 network for the city, these were our concerns is what do we do when you're not here anymore and we don't have the dialogue?

We don't have the common sense approach to how do we fix this.

And that day came, and we're here.

Mark doesn't work here anymore, Chris Lamb doesn't work here anymore.

And that's what led to where we're at.

It's no no coincidence that they are they left in 2024, and when we pulled or when uh the news pulled their data for 2024, 2025, you found a spike in denials.

And that's because I believe, because there's a change in city administration that decided to change it, to change the stance of the city.

We can't have that dialogue anymore.

Uh we blame it on Sedgwick, but that's the truth is the city is self-insured, and within certain confines of the law, we can be better.

And that's not happening right now.

Are you saying there's a spike or is there a sustained increase in the number of denials?

If you looked at the the two-year data going back that that was uh pulled in the uh public information request, there was a spike in denials.

Absolutely.

Okay.

In your opinion, do you see this as uh something maybe trending to an increase in the number of denials?

Um denials, frequency of denials, absolutely.

Surgeries are consistently denied.

Uh it doesn't even make sense.

It's why doctors don't want to join the network.

Because if you join the network, you would think your treatment plan would be approved.

But we deny our own doctors treatment plan.

So we have a treating physician, uh a specialist and a surgeon all recommending surgery.

But Sedgwick denies it in lieu of physical therapy and injections.

I went to claims adjuster schools.

Councilman Lowe's uh alluded to.

I spent one week or uh in a one-week course, I spent one hour on anatomy, and so we're using an hour of anatomy and a guidebook to decide whether or not this injury is compensable or whether the surgery should be approved when we have physicians with a lot more training than that saying absolutely it should be.

We're denying it, and I don't know why.

Thanks.

I appreciate I appreciate your words.

Um I think what is useful for this conversation is really an understanding on how the workers' compensation system, that framework of laws came to be.

Um, there's been pendulum swings in the state of Texas from the quote, wild and woolly days of workers' comp when everyone was getting paid.

You know, every employee was getting paid.

They literally had lawyers that were giving out loans.

It was just, I mean, it was a racket, um, and you saw business cities, organizations come in and lobby for greater oversight, greater laws.

And so then you saw that pendulum swing and it become much harder for employees to get that care than you've seen it come back, right?

Now you have not necessarily in our system, but you can see your own doctor.

You know, they've they've that system is complicated, it's overly complicated.

And so I think um it's easy for us to sit here at this table and be like, well, duh, that's the you know, that's the the easy answer.

Uh, but when you get into it, as I'm sure you know, because you went to claims adjuster school, and our city attorneys can tell you it's an incredibly complicated framework, and a lot of it our hands are tied.

Um, and so I think understanding that it's not as easy as sometimes Sedgwick saying yes or no, or a doctor saying, I want to be in network, or I want to, you know, I don't want to be in network.

Um, but also keep in mind that Sedgwick is no different than any other third party claims administrator, their job is to save you money, to have you spend the least amount for medical care.

It is industry standard to start with the lowest form of the least invasive form of treatment.

So that's you know, physical therapy, or I mean, I think that's standard across the board.

So that's not something that I necessarily want us to look at changing in the way that that we recommend care, because that care, while I agree, adjusters um should be leaning on the medical advice, and that's a whole nother regular role.

Um I want to be careful that we're not trying to change what's standard of care and understanding that a lot of those um protections were put in place.

There's protections for the employee, but there's also protections for entities like us, the city of Fort Worth, so that we don't have runaway workers' compensation costs, which was what was happening and why we have those in place.

So we do have a fiduciary responsibility, we have a responsibility to our first responders and our general employees.

We also have a fiduciary responsibility to our taxpayers, and which is why we engage with organizations like Sedgwick.

I won't share my personal opinion on them, but you know, my personal opinion on most third party claims administrators is um, you know, they're there to be obtuse, and so that's what we see.

Um, you mentioned people left with the city, and then we saw started to see a breakdown.

Sedgwick is our friend and our foe in this situation.

They protect us as a city because just two years ago we had to kick a provider out of our workers' compensation system specifically for first responders because it was found that they were um not doing right by the city and they were overcharging us and they were extending care when they shouldn't have.

And so it's those kind type of protections that we have to balance.

Um, and that's what we're trying to do here.

I think what we need at this from what I'm hearing and what I heard you say is it seems to rock and roll when it's easy workers' comp claims.

You know, if I fell, broke my wrist, you know, needed repair, you know, needed to get that wrist taken care of, had surgery, came back, easy peasy.

It's when we get more complicated, which tends to come with our first responders because they have, as you mentioned, more complicated injuries that it gets it gets murky.

I appreciate that we're bringing on these two new positions.

I know um within the fire department and I believe within the police department, they have individuals that work specifically on workers' comp within the departments.

What I want to see is a better system internally, so that when I'm dealing with Sedgwick, which whether it's Sedgwick or one of the other um third party claims administrators, if I'm not getting the care that I need, I have an immediate number, direct bat phone, so that they don't have to call me.

They don't have to call Charlie, they don't have to call anyone on this dais to get that level of attention.

Um I also think we need to have make sure employees understand what clearly what their options are when seeking care.

If I have a preferred doctor and you know, and they don't want to enter the system, they don't want to um take those state mandated um payments, there's not much that we can do for that emplo employee if we if we can't negotiate, we can't force a doctor in the network.

Um it's our job to make sure that network is robust as possible.

And so my charge to you would be really do an examination of our network and see where we can't expand it.

I would highly recommend um reaching out to some local partners like UT Southwestern and um our local hospitals to see where we can partner and and add specialties to that network, and then making sure that we have that bat foam here at the city, whether that's uh both in fire and PD but also at the HR level, so that um that we can look at these one on one and that we can intervene when we need to intervene, and we need to make sure that we are intervening when appropriate because we do know that that in Sedgwick we say Sedgwick because that's who we're using, but the truth is any third party administrator that we have, even after you go out for that RFP, we're gonna run into the same issues, and so what can we do internally to fix this system?

There's a several several things in there uh mind responding to.

First off, uh the case managers, for example.

We have this isn't the first time we've discussed case managers specifically for first responders.

We've gone down this path before.

Um one of the issues though is they don't have decision making power, they just have recommendation.

Um, and so they recommend treatment, they advocate for it.

Even those still get denied.

I mean, um, and I have um I have some of our current um case managers that that they reach out going, Hey, can you help?

Because even what I'm trying to get approved is getting denied.

So, these case managers, I'm sorry to interrupt, I just these case managers are they at Sedgwick or they No, they're an additional third party um fourth party, I don't know.

Uh so uh no, they do not work for Sedgwick.

Um, it's a contract, or is that be a correct way of saying that?

Okay.

Um, you know, uh, one of them, uh this worked with us the probably the longest.

Uh she used to uh she used to refer to me as her secret weapon.

She could contact me, I would get a hold of the city, we'd talk through it, and things would move.

Uh I I can't say that.

I don't have that.

I don't have that anymore.

Uh and so um, right, Kristen, can I can I ask a relate.

It would be rude, but you're batting average with me.

Uh so can I ask a relationship question?

Um, the way Cedric, our third party and we work, right?

So uh I'm assuming that the third party case managers report, you know, they're the nurses, they're on the ground, they're making quote unquote medical recommendations in addition to what the doctors are making.

They report that to Sedgway, correct?

And then what happens, so then I guess what happens when there's conflict.

Say for instance, we've had some recently, right?

Where Cedric has said no, but it's been the city's position that we want to cover that, right?

And that's happened with council before where we've had discussions about from a policy perspective, do we cover a specific injury for a first responder?

So when that happens, do we have the authority in our as a self-insured entity to tell to to mandate that they cover a particular claim?

What happens in that conflict?

Um I think it may be helpful to have um the law department address this as well.

Um, but I can tell you the difference, and I want to make sure we have a clear distinction between our nurse case managers and the care coordinators that will be added to HR.

But um Skylar is right, the nurse case managers are not making care decisions.

They're there as informed medical professionals.

Um they are, you know, looking at quality of care.

They're also helping employees navigate, um, which is separate, but as far as what council is able to do as a self-insured provider, is there anyone that can speak to that?

Good morning.

Stephen Cumbey assistant uh city attorney.

Yes, uh council can decide to to accept a claim uh or require the city to provide or surgery or uh just the council can make any decision that the the city could make um that Danielle could make is uh in her job as the uh manager of the workers' compensation program for the city.

So if Sedgwick said if Sedgwick said no to a particular surgery, we could then direct from our perspective, we could direct the city to cover that, and would it be covered through our workers' compensation?

It would be covered through that scheme.

It wouldn't be some sort of out outside it.

Oh that's correct, it would be through workers' compensation.

You could accept the claim.

Uh the city could accept the claim at your direction.

So so all so what I'm hearing then is ultimately every claim that is filed, the the city we don't because we use Sedgwick, but the city has the authority to thumbs up or thumbs down each claim that comes through, correct?

That's correct.

Okay.

And that's been utilized in the past before, uh, which I think highlighted a lot of the concerns, which you know one of the the things I'd like for this body to explore as far and with legal and finding out if there's a a way a path forward um is if something is denied at the first benefits review conference before it goes down to c contested case hearing, which coincidentally it's usually approved the day before that hearing.

Um but if it is denied at the benefits review conference, uh then you know, go to mayor and counsel for approval uh or denial.

Uh, because I mean I think we can all do an hour of anatomy and get the same level of training as an adjuster.

Um, and so we can make those those calls, especially for these uh the larger complex issues, because one of the other things I know we're kinda running up against time, but again being an important issue, uh especially when you looked at presumptives, and there should be a standard as far as you know, no two cases are the same, but they should be treated equally.

We have one um member with uh with cancer, other existing issues that was d uh approved, another one with the same exact situation uh denied, and now he's twenty thousand dollars plus out of pocket, a lot of stress all the time, and they're actively planning his funeral because he might not make it past uh December 2027.

Um, and so adding one more layer of complexity and stress to these families is just unacceptable.

Um, and asking that individual what would have changed in the claims process if it would have changed his outcome, no real definitive answer there, but it certainly would have lowered stress and saved them a lot of money from things they're having to do out of pocket.

So just some things to consider uh there as well and how big of an issue this is, because we're not talking about a pencil pusher like me who strains his back trying to pick up a twinkie I dropped on the floor.

Um, you know, I've dealt with back strain issues in the Marine Corps, and it took you know years to finally get the surgery because battling VA.

I never want to see our employees, uh, our first responders having to have a tougher fight on the administrative side than they are with any claims process.

Um, even talking with the chaplain, one of the things they screen for is PTSD, not just from the event itself, but from the actual process, uh, which blows my mind.

I mean, there's times when a lot of our first responders are lucky to be alive.

I know firsthand, what that means, thinking like, hey, this is gonna be my last day.

If it wasn't for powerful guy and some well-aimed shots, I probably wouldn't have been here myself.

Um, but these first responders should not be dealing with this level of denial, especially when the city does have that capability uh to approve when it is a common sense approach.

Because again, we're not talking about your average stub toe.

So that's what I really want to make sure we're we're focusing on.

Um, so thank you.

Skylar, anything else to add?

Um, yeah, just in kind of closing because you're talking about the presumptions.

Um, it was in the presentation, even the law is supposed to be that it's presumed that it happened in the line of duty, and that's not what's happening.

It's still the causation and the uh um the burden of proof is still on the firefighter, um, we're still having to provide all the documentation, and if we run into that 60 day timeline, it's denied.

Now that now they have to appeal.

And um, like you said before, oftentimes, more often than not, that goes to the the day before, like you said, the day before a contested case hearing, and then sometimes that denial is overturned, not always.

Um, but I don't believe we're applying that presumption correctly.

Um we look at the definition of the word, um it the firefighters should have the benefit of the doubt in this situation.

If they fall into one of those uh presumed cancers, it's not happening.

Um, and we can do again, we can do better better than that.

Um again, we're not asking anything, we're not asking for the city to pay more money, we're not asking for doctors that cost more than other doctors, it's the same rate.

Uh they just may be better doctors and they would like to treat firefighters and police officers.

Um, we also you're absolutely right.

There's a fiduciary responsibility.

But when we drag out a claim six to nine months and backfill this injury with overtime, and then ultimately do the surgery that was recommended from the get-go, that is not being fiduciary responsible at all.

And again, those claims could be handled completely different.

We could have our employees back to work.

Uh, we're not paying that overtime, and we have them in a situation where the worst thing for us is to leave us at home.

We hate it, we just want to come back to work.

Um, and I think there's data to support that if you look at lost time from work.

It's interesting that we do have such a high injury rate, but when we look at amount of days missed from work, it's incredible how quickly our folks want to come back to work.

Um, it it really is truly the worst thing you can do to us is make us stay home.

And all we're trying to do is get back, and we can't do that in this system.

Can't do that with uh denials of treatment plans that physicians are recommending, and we don't follow through on it.

Physical therapy isn't gonna fix some of these injuries yet.

That is the recommended course of action.

Athletic trainers, it's fantastic that we have them, but they can't they can't fix some of these problems.

It's surgery.

And when it takes nine months to get your surgery approved, we're not getting anywhere.

We're actually doing more harm than good, both to the employee and to the budget.

Okay.

Well, no, we're about to move on to the next one.

Well, not the next question, but awesome.

Thank you very much.

I I'll just say this.

Um, thank you for being here and speaking, and I'll reflect back as we're right.

Sounds like we're wrapping this up.

Um what Deanna said earlier.

We get thousands of claims a year, and behind each of those claims is a person.

And I think that what we're forgetting is that there's a person behind that and a family that's they're supporting.

These people have answered the call to public service, and that we're leaving them hanging.

We absolutely have to be cautious with taxpayer dollars, but ultimately there's a person behind those claims.

So we should be doing whatever we can to make it efficient as possible for them to get the care that they need so they can get back to work, as he said and back to their jobs.

That's my point.

I think we're ready to roll on to mental health.

Actually have a couple of representatives in the uh in the audience that can speak to this better but I want to kick us off with just what's um provided from a regulatory perspective for mental health or behavioral health.

So if it is an extension of an employee's injury or illness if they're having um behavioral health issues need mental health support and that's medically supported it will be covered under workers compensation just like a traditional injury or illness.

And then we also have a state provision for traumatic events this is specific to sworn peace officers and telecommunicators and the city has a policy on this for leaf protections for three days up to five days but um this is just a small snapshot of of what the city offers for behavioral health I'll ask um Buck and Cliff if y'all can come up right quick the experts so step aside.

Morning I just want to address specifically because it's on the agenda and if of course there's any questions I'll be glad to answer those but in terms of time used for a lot of our resources for the police department one program that we have that we haven't seen at this level first of its kind across the nation is our R3 program.

It's for all first responders for the city of Fort Worth and what I mean by that is our telecommunicators fire police and retirees for the police department let me back up with the R3 program it is a large scale public private partnership and we partner with nonprofit groups that provide non-clinical resources that specifically address moral injury and because they do that in a format where there's objectives and goals our department allows our officers to attend these programs since they are providing tools for stress management and resiliency they do not have to use their own time they can attend using training time.

So for our three resources we do have that covered where officers do not have to do that.

So I wanted to speak to that real quick Cliff I'll turn over to you for fire.

Yeah we do not have the paid training time on the fire side we're a little bit we have minimum staffing standards.

So when we do when somebody reaches out and says I want to participate in the R3 program, we have to backfill that position on the truck because we're we have to have four minimum staffing every day.

So uh the hope is that this is a proactive program is how it was built one of the slides that was put up here is like risk management and we want to lean into health the R3 program is being developed for that very purpose that it is a proactive thing.

You do not have to be in a bad space in order to reach out and participate.

On our side we're kind of utilizing it as a reactive program at the moment with hopes that we eventually get just like our counterparts on the PD side paid training time to utilize these resources.

Along with that we started sending our first responders uh on these programs their week long five day trips uh fully funded at no cost to the first responder when they started coming back uh we saw a need for follow-up afterwards some of these uh individuals were coming back after having processed through heavy trauma uh on the job uh so along with that we have uh started a counseling program that backs up the R3 program so with the help of American Warrior and our community uh we've also partnered with PD to get uh quite a bit of funding from outside resources uh mainly grants to uh give our first responders seven free sessions and we might say well we have the EAP so why do we need these additional free sessions of counseling and uh one of the things we're running up against is cultural uh competency in our uh counseling so um we've had numerous stories in the past where we send a uh firefighter to go talk to somebody about a horrific scene that they uh had to witness and were a part of, and the therapist ends up crying because it is that traumatic.

And so we've gone out now in partnership with PD and American lawyer, and um got culturally competent counselors that are first responders themselves, their spouses they're veterans, uh, they understand what we're going through.

And so we've seen um, I mean, we are spending anywhere between 15 to 20,000 a month out of uh community resource and grant funding paying for these uh these sessions as well.

You said that's paid for just by grants, no city funding?

Correct.

And that one, and then as far as the uh the uh so there's no they're having to use vacation time or the pay time off to uh a portion are using vacation time.

So we have uh around six spots allotted per month, and that was set up by the previous fire chief.

So we could send about six individuals a month above and beyond that.

Um individuals are using their own vacation time.

This is probably one of those other deeper dives that we'll take to figure out you know what we what we're doing and what we can do better as well by our first responders.

Yeah, Dr.

Hall.

I don't know if you'll have the specifics, but when you say that you're getting this through grant fundings and different partners, um can you specifically name what that grant funding, one of those grantors, um, just where you're sourcing those funds from or where you're sourcing or that partnership has been established with.

If I'm honest with you, we piggyback on PD with that uh because it is more geared towards police officers, uh and we kind of wheel weasled our way in for lack of better terms.

They were they were generous enough to work with us and uh bring the fire side in.

Uh a lot of the community resources uh are coming through American Warrior and just other community members uh that are really trying to have our backs.

Thank you.

Thank you so much, Chaplin.

Appreciate it.

That's all that I have we have, you know, many takeaways.

Just want to open up to see if there are any additional questions or comments.

Anything else?

I just I want to reiterate what you brought up and as it relates to fire, and I understand that they staff differently, so it makes it much more difficult to find the time the way that uh PD does, but I think it's imperative that we do find that time and that there is parity between the two uh departments as far as the um access and availability to to participate in mental health um programs without having to take vacation time.

There is uh there are some other distinct differences between those two contracts.

Um vacation time is considered productive time in the fire department, so they're not technically the same, right?

So uh the time that they may use for those things still count towards over time, it's almost as if they're still at work.

So they don't really a major difference between in terms of the hours that that's used following.

No, I'm not.

So a vacation hour.

Uh-huh.

In the fire department is productive time, okay, which means that it's as if they're still at work in terms of how they're compensated and paid.

Okay.

So I guess I'm not following because I I get what you're telling me that that vacation time goes towards, but why can't we have some sort of carve out?

I mean, we create we create that policy.

So why can't we create a policy that allows for specific to these types of support that that they're able to that we're able to work that into the system without creating the overtime issues?

It's not to say that we can't.

I just wanted to make sure that it's clear that those that that is a distinct difference between those two contracts.

Oh, I I guess what I would challenge, and just to kind of find some middle ground, I understand what uh councilwoman Beck is saying, but it would seem to me that if the topic was brought up at the podium, that there is some type of disparity or perceived disparity.

And so I would say that there's an opportunity to either outline what that policy or practice is to eliminate that disparity or perception of.

Agreed.

Okay.

Any other questions for Kristen?

Kristen, thank you so much.

Uh, we appreciate it.

Um we're gonna go ahead, we're gonna be uh punting the e-bikes and scooters, uh, although a very important topic as well.

Um, but for the sake of time, we're gonna push down to the next uh public safety committee uh meeting.

Um, but to the the first responders and the the residents, um, one bringing this all all to light.

Um, you know, thankfully you have a mayor and a council and city staff who truly does care.

Uh and so I have no doubt that you know we can be at the forefront in this nation for how we address these issues.

Um, we're starting to find some some some cracks and where we can fill those and how we can just do better by our first responders.

Uh, and I'm looking forward to having that discussion, bringing, you know, all the stakeholders and those who are culturally competent, great use of words there, and bringing first responders who understand it, uh, as well as providers who understand the uh you know what it's like to get a first responder back to the elite warrior um status they were before their injury.

So um for those came out, we certainly appreciate it.

Um and there was certainly this was not the end of the discussion.

I think it's really just the beginning of it.

Uh so this is mayor Johnson, thank you for putting all this together.

Um, we have uh any questions or uh any future discussions?

Future agenda item request.

Right, all right.

I'd like uh for staff to see uh what the number of um surgery and treatment um denials by the city and what percentage of those denials were overturned uh on appeal.

Uh I know that we have SEGWIT data that we can um utilize, but also I'd like to uh ask staff to also uh consider uh prior provider historical data.

Yeah, I'd like an IR on officer involved um accidents related to police uh pursuits in the last we'll say 12 to uh 24 months.

Uh specifically, I'd I'd like to know um uh injuries, any cost that the city has paid out as a result of those injuries.

Um I think it's um important to note um if those injuries were the the criminal or if they were you know bystanders, and then I'd also like as part of that presentation um PD to bring forward some potential um technology resources that um can aid us in uh those pursuits.

Just for clarity, that's officer involved injuries that occurred to the people that they're pursuing or bystanders or officers.

Or the officers.

Correct, all three.

Okay, thanks.

I know that we don't we're on limited time.

I did appreciate the informal report regarding uh cardiovas uh arrest survival reporting.

Um in the RR, there were a number of opportunities that were identified, and I would love the opportunity um to have a conversation or hear more about what we're going to do to address those opportunities that we have with the city.

Okay, uh, we're gonna take a quick break uh before starting the legislative committee for those uh sticking around for that.

So uh with that meeting adjourned.