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2018-11-13 Policy & Services Committee Agenda Packet
Policy and Services Committee 1 MATERIALS RELATED TO AN ITEM ON THIS AGENDA SUBMITTED TO THE CITY COUNCIL AFTER DISTRIBUTION OF THE AGENDA PACKET ARE AVAILABLE FOR PUBLIC INSPECTION IN THE CITY CLERK’S OFFICE AT PALO ALTO CITY HALL, 250 HAMILTON AVE. DURING NORMAL BUSINESS HOURS. Tuesday, November 13, 2018 Special Meeting Community Meeting Room 6:00 PM Agenda posted according to PAMC Section 2.04.070. Supporting materials are available in the Council Chambers on the Thursday 12 days preceding the meeting. PUBLIC COMMENT Members of the public may speak to agendized items. If you wish to address the Committee on any issue that is on this agenda, please complete a speaker request card located on the table at the entrance to the Council Chambers/Community Meeting Room, and deliver it to the Clerk prior to discussion of the item. You are not required to give your name on the speaker card in order to speak to the Committee, but it is very helpful. Public comment may be addressed to the full Policy and Services Committee via email at City.Council@cityofpaloalto.org. Call to Order Oral Communications Members of the public may speak to any item NOT on the agenda. Action Items 1. Review and Acceptance of Fire Department Emergency Medical Services Future Needs Assessment 2. Policy and Services Committee Recommends the City Council Accept the Code Enforcement Audit 3. Review Council Procedures and Protocols Future Meetings and Agendas Adjournment AMERICANS WITH DISABILITY ACT (ADA) Persons with disabilities who require auxiliary aids or services in using City facilities, services or programs or who would like information on the City’s compliance with the Americans with Disabilities Act (ADA) of 1990, may contact (650) 329-2550 (Voice) 24 hours in advance. City of Palo Alto (ID # 8984) Policy and Services Committee Staff Report Report Type: Action Items Meeting Date: 10/23/2018 City of Palo Alto Page 1 Summary Title: Fire Department Emergency Medical Services Future Needs Assessment Title: Review and Acceptance of Fire Department Emergency Medical Services Future Needs Assessment From: City Manager Lead Department: Fire Recommendation Staff recommends that the Policy and Services Committee recommend that Council review and accept the Fire Department Emergency Medical Services Future Needs Assessment, and provide feedback and direction to move forward in exploring viable alternative service delivery models. Background In Fiscal Year 2016, City Council authorized one-time funding for the Fire Department to contract with an expert consulting firm to conduct a study to understand the health risks of the community members based on age, demographics, and utilization of emergency medical services. The Department contracted with Actionable Insights, a respected consulting firm that conducts studies for hospitals and health organizations on the Peninsula, to complete a Community Health Needs Assessment (CHNA). A CHNA is a data-driven examination of the health status indicators that is used to identify key problems and assets in a community, and draws upon research on evidence-based interventions to make recommendations specific to the emerging needs of the community. Typically utilized by hospitals and health providers, the Fire Department worked with Actionable Insights to tailor the research focus and data projection methodologies for the Department with a specific focus on emergency medical needs. This included qualitative and quantitative data collection and analysis; predictive data modeling on the anticipated health needs of the community; literature review of emergency health service provider innovations and best practices; and recommended next steps for the Department and City to consider. City of Palo Alto Page 2 Discussion The Community Health Needs Assessment report is the first of a two phase initiative to identify the current and future community health needs that have an impact on the Department and develop innovative alternative services and programs to meet those needs more effectively and in a less costly manner. The CHNA report includes three primary elements: Information gathering: This included analysis of two years of call volume and patient statistics, and community input from focus groups and key informant interviews. Predictive analysis: Utilizing the two population models from the City Comprehensive Plan and a period life table approach, a prediction of future demographics and call volume was estimated. Distinct predictions were made for daytime and nighttime. The limited data available for Stanford’s daytime population restricted the predictive modeling for Stanford campus to nighttime residential needs only. Literature review of evidence-based interventions and programs: This focused on scientific program evaluations conducted on alternative models for emergency medical service delivery. The programs found to have an impact on reducing reliance on 911 and emergency response are highlighted for consideration of replicating locally. The data shows that the overwhelming need for emergency response is for medical incidents, and with the older population expected to age in place there will be a significant impact on the draw of resources by 2030. The study found a statistically significant correlation with age and engagement of emergency resources for medical needs. Adults age 65 and older represent seventeen percent (17%) of the resident population of the City of Palo Alto, yet make up forty-seven percent (47%) of all Fire Department EMS patients. The predictive analysis estimates that all call types will increase by 2030, with EMS experiencing the largest proportional increase. Emergency Medical Calls are expected to increase between twenty-five to thirty-four percent (25 – 34%), while all other call types are projected to see an increase between ten and sixteen percent (10 – 16%). Proportionally, the largest increase is expected in EMS calls during nighttime hours (8PM to 8AM). However, this increase is not enough to impact the historical trend of most incidents occurring during the daytime (8AM to 8PM). The future of the community needs from the Fire Department will be overwhelmingly for emergency medical services. Some of these calls for service are for incidents that could be treated or prevented without a trip to the hospital. Other jurisdictions already grappling with swells in emergency medical incidents have found great success by City of Palo Alto Page 3 implementing alternative service delivery models. The literature review provides a number of examples that have been proven successful at diverting and reducing the need for emergency response or hospital transport. This includes models such as mobile integrated healthcare; use of nurses or physician assistants in triage; in-home preventive care; or targeted outreach efforts. After the consideration of the data and projected future increases in demand for emergency medical services, the Department will begin the second phase of this project. The Community Impact Planning phase will bring key leaders of health and emergency service agencies together to assess the feasibility of bringing these alternative service delivery models to Palo Alto and explore multi-agency collaboration. At this time, the Department is seeking to inform City Councilthe Policy and Services Committee about the planned future direction and requests feedback as it begins to explore which alternative services would be the best fit for the community. Resource Impact Funding for the second phase of the project, the Community Impact Planning phase, has been identified, and no resource impact is identified at this time. However, the final resource assessment to implement recommended EMS strategies, as described in the study and/or determined during the Community Impact Planning phase, will most likely require a realignment of existing resources and/or new resources to fund these new services. It is anticipated that upon completion of the second phase, additional services will need to be evaluated in the context of the City’s financial outlook, which is currently focused on addressing the projected gap of $2.6 million in the General Fund outlined in the FY 2019-2028 Long Range Financial Report. Policy Implications There are no immediate policy implications at this time, however, as the Department moves forward with the second phase of the project it will be seeking to collaborate with local health service providers to explore alternative models of service delivery. If any innovations are identified as viable, the Department will bring forward proposals to the Policy and Services Committee and the City Council for consideration. Environmental Review Not applicable. Attachments: PAFD_CHNA Final STUDY OF THE HEALTH NEEDS OF THE PALO ALTO/STANFORD AREA AND PAFD EMERGENCY RESPONSE February 1, 2018 1346 The Alameda, Ste. 7-507 San Jose, CA 95126 www.actionableLLC.com PAFD 2017 Report Final Draft © Actionable Insights, LLC ii February 1, 2018 Acknowledgments The Palo Alto Fire Department acknowledges the contributions of the following people and organizations toward this study of the health needs of the Palo Alto/Stanford area and PAFD emergency response: Palo Alto Fire Department Fire Chief Eric Nickel Strategic Operations and Initiatives Manager Amber Cameron EMS Chief Kim Roderick Deputy Fire Chief Geo Blackshire Deputy Fire Chief Catherine Capriles Battalion Chief Kevin McNally Training Battalion Chief Shane Yarbrough Fire Marshall James Henrikson Community partners American Muslim Voice Foundation Stanford Health Care Stanford University Public Safety Stanford University Student Affairs Stevenson House (affordable housing for seniors) Vaden Health Center at Stanford University Veterans Affairs Palo Alto Health Care System Actionable Insights, LLC Co-Founder and Principal Melanie Espino Co-Founder and Principal Jennifer van Stelle, Ph.D. PAFD 2017 Report Final Draft © Actionable Insights, LLC iii February 1, 2018 Table of Contents Acknowledgments ................................................................................................................. ii Table of Figures .................................................................................................................... vi Table of Tables .................................................................................................................... viii Executive Summary ............................................................................................................... 1 Methods .................................................................................................................................................... 1 Pressing Health Needs .............................................................................................................................. 2 Predictive Analysis..................................................................................................................................... 2 Recommendations .................................................................................................................................... 4 Introduction .......................................................................................................................... 4 Study Team ............................................................................................................................................... 5 Situation Overview .................................................................................................................................... 5 CHNA Methods Summary ...................................................................................................... 7 Secondary Statistical Data Collection ....................................................................................................... 7 Sources of Secondary Statistical Data Used in the Assessment ............................................................................ 7 Methodology for Collection, Interpretation, and Analysis of Secondary Data ..................................................... 7 Community Input ...................................................................................................................................... 8 Community Input Gathered Via Key Informant Interviews and Focus Groups ..................................................... 8 Methodology for Collection and Interpretation of Community Input .................................................................. 9 Data Limitations and Information Gaps ................................................................................................. 10 Predictive Analysis Methods Summary ................................................................................ 11 Data Used for Predictive Analysis ........................................................................................................... 11 City of Palo Alto................................................................................................................................................... 11 Stanford .............................................................................................................................................................. 13 Analytical Methods Used for Predictive Analysis .................................................................................... 14 Palo Alto/Stanford Area Geography and Demographics ....................................................... 16 City of Palo Alto ....................................................................................................................................... 17 Ethnicity, Origin, and Language .......................................................................................................................... 18 Age ...................................................................................................................................................................... 18 Stanford................................................................................................................................................... 19 Ethnicity, Origin, and Language .......................................................................................................................... 20 Age ...................................................................................................................................................................... 21 Community Health Needs Assessment (CHNA) ..................................................................... 22 Research Questions ................................................................................................................................. 22 Pressing Health Needs ............................................................................................................................ 22 PAFD 2017 Report Final Draft © Actionable Insights, LLC iv February 1, 2018 Behavioral Health ................................................................................................................................................ 22 Health Care Access and Delivery ......................................................................................................................... 24 Housing ............................................................................................................................................................... 25 Older Adult Health .............................................................................................................................................. 25 Transportation and Traffic .................................................................................................................................. 27 Youth and Young Adult Health ............................................................................................................................ 28 Equity and Cultural Competency ............................................................................................................. 28 Additional Community Concerns ............................................................................................................. 30 PAFD Calls and Medical Emergency Patients: City of Palo Alto, 2015 and 2016 ..................... 31 PAFD CAD Calls Originating in the City of Palo Alto ................................................................................ 31 Current Call Volume and Type ............................................................................................................................ 31 Current Medical Emergency Calls by Time of Day .............................................................................................. 33 PAFD Medical Emergency Patient Volume Originating in the City of Palo Alto ...................................... 33 Current Medical Emergency Patient Volume by Age .......................................................................................... 34 Current Medical Emergency Patient Volume by Gender .................................................................................... 35 Current Medical Emergency Patient Volume by Incident Location (ZIP Code) ................................................... 35 Current Medical Emergency Patient Volume by Type of Illness/Issue ............................................................... 37 Predictive Analysis Findings: City of Palo Alto, Year 2030 ..................................................... 39 Projected Population Overall and by Time of Day .................................................................................. 39 Predicted Medical Emergency Call Volume and Other Call Types by Time of Day ................................. 42 Predicted Medical Emergency Patient Volume Originating in the City of Palo Alto ............................... 44 Predicted Medical Emergency Patient Volume Overall and by Age ................................................................... 44 Predicted Medical Emergency Patient Volume by Time of Day ......................................................................... 45 Predicted Medical Emergency Patient Volume by Type of Illness/Issue ............................................................ 46 PAFD Calls and Medical Emergency Patients: Stanford, 2015 and 2016 ................................. 49 PAFD CAD Calls Originating in the Stanford Area ................................................................................... 49 Current Call Volume and Type ............................................................................................................................ 49 Current Medical Emergency Calls by Time of Day .............................................................................................. 50 PAFD Medical Emergency Patient Volume Originating in the Stanford Area ......................................... 51 Current Medical Emergency Patient Volume by Age .......................................................................................... 52 Current Medical Emergency Patient Volume by Gender .................................................................................... 53 Current Medical Emergency Patient Volume by Incident Location (ZIP Code) ................................................... 53 Current Medical Emergency Patient Volume by Type of Illness/Issue ............................................................... 54 Predictive Analysis Findings: Stanford, Year 2030 ................................................................. 56 Projected Population ............................................................................................................................... 56 Predicted Medical Emergency Call Volume and Other Call Types .......................................................... 57 Predicted Medical Emergency Patient Volume Originating in the Stanford Area .................................. 61 Predicted Medical Emergency Patient Volume Overall and by Age ................................................................... 61 Predicted Medical Emergency Patient Volume by Type of Illness/Issue ............................................................ 62 PAFD 2017 Report Final Draft © Actionable Insights, LLC v February 1, 2018 Recommendations & Next Steps .......................................................................................... 65 Addressing the Expected Increase in EMS Calls ...................................................................................... 65 Successful Strategies to Reduce EMS Calls and/or Reliance on Emergency Transport ...................................... 65 Implementation Challenges and Best Practices in CP/MIHP .............................................................................. 70 Addressing Community Health Needs ..................................................................................................... 72 Next Steps in Addressing Future Needs and Capacity ............................................................................. 74 Appendix 1 .......................................................................................................................... 75 Sources .................................................................................................................................................... 75 Appendix 2 .......................................................................................................................... 84 Methods .................................................................................................................................................. 84 Appendix 3 .......................................................................................................................... 86 Mapping of Primary Impressions to Categories ...................................................................................... 86 Appendix 4 .......................................................................................................................... 92 Call Volume and Call Type Predictions .................................................................................................... 92 Appendix 5 .......................................................................................................................... 94 Population Figures by Age – Current and Predicted ............................................................................... 94 Current Figures, Including Populations by Age ................................................................................................... 94 Year 2030 Predictions, Including Predictions by Age .......................................................................................... 95 Appendix 6 ........................................................................................................................ 101 2030 Predicted ME Call/Patient Volume, Based on CAD Calls and ESO ME Patient Volume................ 101 City of Palo Alto................................................................................................................................................. 101 Stanford ............................................................................................................................................................ 104 Appendix 7 ........................................................................................................................ 107 Total Medical Emergency Patient Volume by Incident ZIP Code by Year: Percentage and Number .... 107 Appendix 8 ........................................................................................................................ 109 Current 2015/2016 Average Patient Volume by Primary Impression and Age ..................................... 109 Appendix 9 ........................................................................................................................ 111 Current 2015/2016 Average and Predicted 2030 Patient Volume by Primary Impression, by City and Time of Day ........................................................................................................................................... 111 Appendix 10 ...................................................................................................................... 113 Palo Alto/Stanford CHNA Data Dashboard ........................................................................................... 113 Appendix 11 ...................................................................................................................... 127 Palo Alto/Stanford Neighborhood Data Dashboard ............................................................................. 127 PAFD 2017 Report Final Draft © Actionable Insights, LLC vi February 1, 2018 Table of Figures Figure 1, Map of the Cities of Palo Alto and Stanford .................................................................. 16 Figure 2, City of Palo Alto Daytime Population by Resident Status ............................................. 17 Figure 3, Ethnicity by Geography, Santa Clara County versus City of Palo Alto Neighborhoods . 18 Figure 4, Population by Geography and Age Range, Santa Clara County versus City of Palo Alto ....................................................................................................................................................... 19 Figure 5, City of Stanford Daytime Population by Resident Status .............................................. 20 Figure 6, Ethnicity by Geography .................................................................................................. 20 Figure 7, Population by Geography and Age Range ..................................................................... 21 Figure 8, Proportion of Population Spending 30% or More of Income on Housing, 2011-2015 . 25 Figure 9, Alzheimer’s Disease Mortality Rate ............................................................................... 26 Figure 10, PAFD Calls for Service Originating in the City of Palo Alto, 2015/2016 Average ........ 32 Figure 11, PAFD Calls by Type and Time of Day, 2015/2016 Average, City of Palo Alto .............. 33 Figure 12, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Counts and Percentages, City of Palo Alto ................................................................................... 34 Figure 13, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Percentages, Compared to Residential Population by Age Category, City of Palo Alto ............... 35 Figure 14, Map of Current Medical Emergency Patient Volume by Incident ZIP Code, 2015/2016 Average ......................................................................................................................................... 36 Figure 15, Current and Year 2030 Projected Populations by Age Category, Daytime, City of Palo Alto ................................................................................................................................................ 40 Figure 16, Current and Year 2030 Projected Populations by Age Category, Nighttime, City of Palo Alto ........................................................................................................................................ 41 Figure 17, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, City of Palo Alto ................................................................................................................. 42 Figure 18, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Daytime, City of Palo Alto .................................................................................................. 43 Figure 19, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Nighttime, City of Palo Alto ............................................................................................... 44 Figure 20, Current and Year 2030 Predicted Age-Adjusted Medical Emergency Patient Volume by Age Category, City of Palo Alto ................................................................................................ 45 Figure 21, Comparison of Actual Average Annual Patient Volume versus Predicted Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, City of Palo Alto, Daytime ................................................................................................................................ 47 Figure 22, Comparison of Actual Average Annual Patient Volume versus Predicted Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, City of Palo Alto, Nighttime .............................................................................................................................. 48 Figure 23, PAFD Calls for Service Originating from Stanford, 2015/2016 Average ...................... 50 Figure 24, PAFD Calls by Type and Time of Day, 2015/2016 Average, Stanford .......................... 51 PAFD 2017 Report Final Draft © Actionable Insights, LLC vii February 1, 2018 Figure 25, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Counts and Percentages, Stanford ............................................................................................... 52 Figure 26, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Percentages, Compared to Residential Population by Age Category, Stanford ........................... 53 Figure 27, Current and Year 2030 Projected Residential Populations by Age Category, Stanford ....................................................................................................................................................... 57 Figure 28, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Stanford ............................................................................................................................. 58 Figure 29, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Daytime, Stanford .............................................................................................................. 59 Figure 30, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Nighttime, Stanford ........................................................................................................... 60 Figure 31, Current and Year 2030 Predicted Age-Adjusted Residential Medical Emergency Patient Volume by Age Category, Stanford .................................................................................. 61 Figure 32, Comparison of Actual versus Predicted Absolute Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, Stanford, Daytime ........................... 63 Figure 33, Comparison of Actual versus Predicted Absolute Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, Stanford, Nighttime ......................... 64 PAFD 2017 Report Final Draft © Actionable Insights, LLC viii February 1, 2018 Table of Tables Table 1, Details of Key Informants Interviewed ............................................................................. 9 Table 2, Details of Focus Groups Conducted .................................................................................. 9 Table 3, Summary of EIR Scenarios: Population and Employment Parameters(1) ....................... 12 Table 4, All Medical Emergency (ME) Patients, Categories of Primary Impressions, 2015/2016 Average, in Order of Frequency for the City of Palo Alto ............................................................. 37 Table 5, Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, by City, in Order of Frequency, City of Palo Alto .......................................................................... 46 Table 6, All Medical Emergency (ME) Patients, Categories of Primary Impressions, 2015/2016 Average, in Order of Frequency for Stanford ............................................................................... 54 Table 7, Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, in Order of Frequency ....................................................................................................................... 62 Table 8, Total Medical Emergency Patient Volume by Primary Impression by Year: Percentage and Number .................................................................................................................................. 86 Table 9, Stanford Projected Growth in Academic Year Residential Population Through 2035 (from Stanford GUP Tab 5.5) ........................................................................................................ 99 Table 10, Stanford Projected Growth in Worker Population Through 2035 (from Stanford GUP Tab 8) .......................................................................................................................................... 100 Table 11, Current 2015/2016 Call Volume, City of Palo Alto ..................................................... 101 Table 12, Current 2015/2016 and Predicted 2030 Call Volume, City of Palo Alto ..................... 102 Table 13, Current 2015/2016 and Predicted 2030 Daytime Call Volume, City of Palo Alto ...... 102 Table 14, Current 2015/2016 and Predicted 2030 Nighttime Call Volume, City of Palo Alto .... 103 Table 15, Current 2015/2016 and Predicted 2030 Medical Emergency (ME) Patient Volume, City of Palo Alto .................................................................................................................................. 103 Table 16, Current 2015/2016 Call Volume, Stanford ................................................................. 104 Table 17, Current 2015/2016 and Predicted 2030 Call Volume, Stanford ................................. 105 Table 18, Current 2015/2016 and Predicted 2030 Daytime Call Volume, Stanford .................. 105 Table 19, Current 2015/2016 and Predicted 2030 Nighttime Call Volume, Stanford ............... 106 Table 20, Current 2015/2016 and Predicted 2030 Patient Volume, Day versus Night, Stanford ..................................................................................................................................................... 106 Table 21, Total Medical Emergency Patient Volume by Incident ZIP Code by Year .................. 107 Table 22, Current 2015/2016 Average Patient Volume by Primary Impression and Age, City of Palo Alto ...................................................................................................................................... 109 Table 23, Current 2015/2016 Average Patient Volume by Primary Impression and Age, Stanford ..................................................................................................................................................... 110 Table 24, Current and Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, by Time of Day, City of Palo Alto ........................................................................... 111 Table 25, Current and Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, by Time of Day, Stanford ....................................................................................... 112 PAFD 2017 Report Final Draft © Actionable Insights, LLC ix February 1, 2018 Table 26, Data Employed for Community Health Needs Assessment: Combined Palo Alto/Stanford Area ...................................................................................................................... 113 Table 27, Data Employed for Community Health Needs Assessment: Cities of Palo Alto and Stanford (Separately) .................................................................................................................. 127 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 1 February 1, 2018 Executive Summary In the spring and summer of 2017, the City of Palo Alto Fire Department (PAFD) conducted a study of the Palo Alto/Stanford area and PAFD emergency response to determine current health needs of the area and to predict future needs. Health needs were defined as physical health conditions and outcomes, mental and behavioral health, and social determinants of health. The study involved three elements: 1. A community health needs assessment (CHNA), which included collection of statistical data and community input; 2. A predictive analysis, which included a review of current data from PAFD and a modified or “period” life table approach to predict future PAFD volume using demographic projections; and 3. A brief literature review to understand alternative models for emergency medical services (EMS) delivery, including prevention efforts. This data analysis and report is the first step towards implementing changes in the community. Following presentation of this report, including some suggestions for consideration, PAFD hopes to convene community partners that play a part in preventative health to develop recommendations and an action plan. Methods Actionable Insights, a professional health research company contracted to complete this study, gathered both primary and secondary data for this study. For the CHNA, our firm blended primary and secondary data to better understand the community’s health needs. The health needs that were identified include physical health, behavioral health (wellbeing), and social determinants of health (including economic factors and education). The secondary data came from a variety of sources (see Appendices 10 and 11 for statistical data and sources). We also conducted primary research for the CHNA by soliciting input, via interviews and focus groups, from community members and professionals who serve the Palo Alto/Stanford area and who have insight into the community’s needs. For the predictive analysis, looking separately at the City of Palo Alto and at Stanford, we analyzed current emergency medical needs using secondary data from the PAFD, and predicted how the need for EMS will change by 2030 based on current information and expected demographic trends. The methods for the predictive analysis are further detailed in the Predictive Analysis Methods Summary section of this report. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 2 February 1, 2018 Finally, we conducted a brief literature review on new models for EMS service delivery, using both scholarly and journalistic literature, in order to make informed recommendations to the PAFD. Based on these research activities, we created a list of health needs, predictions of future call volume by city and call type, and a set of recommendations for action. Pressing Health Needs The CHNA determined the pressing health needs in the Palo Alto/Stanford area to be (in alphabetical order): Behavioral health (mental health and substance abuse) Health care access and delivery (including equity and cultural competency) Housing Older adult health Transportation and traffic Youth/young adult health Predictive Analysis Actionable Insights conducted a predictive analysis of PAFD’s future (year 2030) call volume by call type and EMS patient volume, using population projections and current data from PAFD. The current data, averaged across the years 2015 and 2016, indicate: On average, across the two years 2015/2016, 67% of calls to PAFD originating in the Palo Alto/Stanford area were for EMS. Breaking that down: o Fully 70% of calls originating in the City of Palo Alto were for EMS. o An average of 50% of calls from Stanford were for EMS.1 The most common reason for EMS in the Palo Alto/Stanford area across the two years was altered level of consciousness (ALOC), followed by injury/hemorrhage. More specifically: o The top three reasons for EMS in the City of Palo Alto were ALOC (29% on average), injury/hemorrhage (23% on average), and cardiac-related issues (average of 11%). o The top three reasons for EMS in Stanford were ALOC (29% on average), injury/hemorrhage (28% on average), and behavioral health-related issues (average of 9%). 1 The average of both is higher than one might expect because there are far more calls from the City of Palo Alto than there are from Stanford. Note that these figures are based on PAFD computer-aided dispatch (CAD) unduplicated data for 2015 and 2016. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 3 February 1, 2018 Generally, the patient volume for EMS increases with age. However, Stanford has a larger population of younger residents due to its university, explaining the spike in patient volume for Stanford among those aged 15-24. We calculated year 2030 predictions based on six growth scenarios provided by the City of Palo Alto and on the latest Stanford University General Use Permit Application. The City of Palo Alto’s growth scenarios for the years 2014 to 2030 “test the impacts of various policy changes which would presumably yield different amounts of job and population growth” (Hillary Gitelman, Director, Planning & Community Environment Department, City of Palo Alto, personal communication, December 21, 2016). Findings indicate that the total number of calls will increase between now and 2030 for all call types, and the volume of patients will increase between now and 2030 for EMS. More specifically: The EMS call increase is expected to be proportionally higher than the increase in other call types (for the City of Palo Alto, depending on the growth scenario utilized, between 25% and 34% compared to all other call types’ combined increase of 10% to 16%; for Stanford, about 36% compared to all other call types’ combined increase of between 30% and 42%). For the City of Palo Alto, Scenario 6 (which the Planning & Community Environment Department calls “Housing Tested II”) generally yields the highest increase in EMS volume while Scenario 2 (called “Slowing Growth”) generally yields the lowest increase. The proportion of daytime calls from the City of Palo Alto is predicted to remain the same over time (67%). The predictive analysis suggests that proportion of nighttime calls from Stanford may increase over time, such that daytime call from Stanford is reduced to 58%.2 Finally, the prediction is that by 2030, EMS patient volume will increase between 24% and 33% from the 2015/2016 annual average for the City of Palo Alto, depending on the growth scenario utilized, and about 30% for Stanford. PAFD’s data show that older individuals are more likely than younger individuals to have a medical emergency in the combined Palo Alto/Stanford jurisdiction. Comparatively, a much greater proportion of older adults are being served by PAFD for medical emergencies compared to the proportion of older adults in the resident population. Both cities will have more older medical emergency patients in 2030 than they have had in 2015/2016. However, because Stanford has – and will continue to have – a smaller and younger set of medical emergency patients, despite the increasing median age of area populations, the City of Palo Alto will see both a much greater absolute number and a greater skew towards older adult patients in 2030 than Stanford will. For example, in the City of Palo Alto, in the highest-growth scenario, the volume of annual EMS patients is expected to rise from 4,330 to as many as 5,766, with 68% of those being age 2 We caution that Stanford’s daytime call predictions were made without access to age projections for that population. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 4 February 1, 2018 55+, while in Stanford, the volume of annual EMS patients is expected to rise from 933 to 1,213, with only 32% of those being age 55+. Recommendations The projected increase in future population (especially the senior population) demands that cities across the Bay Area begin planning now to address these changes. The local community’s concerns about today’s health needs are a bellwether of future needs and, as such, deserve attention. Almost all of the community’s top concerns are issues that PAFD currently addresses through EMS. The predicted corresponding increase in the number of EMS patients by the year 2030 raises the question of how the City of Palo Alto can improve its preparedness to address the community’s needs and concerns. The community has expressed a need for preventative health services, health education, and outreach to address the health needs. Many communities have invested in community integrated health care to improve health outcomes for residents and prevent the need for EMS. Actionable Insights recommends implementing interventions that increase access to preventative health services, including a range of options from low-cost efforts to the creation of large-scale programs. These interventions could include services delivered in collaboration with community partners, other health and service agencies, or by the Fire Department itself. Some best practice models to consider are community education through health workers (such as those utilized in the promotores model, see Centers for Disease Control and Prevention, 2016), remote health services (such as firehouse clinics), and/or mobile integrated health units that provide non- emergency treatment and proactive health services. Introduction The City of Palo Alto Fire Department (PAFD) conducted a study of the health needs of the Palo Alto/Stanford area and PAFD emergency response in 2017. The results of this study will inform PAFD’s planning and strategy for serving the Palo Alto/Stanford community. The study builds upon a countywide community health needs assessment (CHNA) conducted in Santa Clara County by Stanford Health Care and other nonprofit hospitals, but with a focus on the Palo Alto/Stanford area specifically. The Palo Alto/Stanford study focused on three questions: 1. What are the community’s current health needs, including emergency medical needs? 2. How are the community’s emergency medical needs predicted to change by the year 2030? PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 5 February 1, 2018 3. What does the research say about successful models for meeting community health needs, including emergency medical needs? Study Team Fire Chief Eric Nickel of the PAFD, who has served as Fire Chief since 2012 and has a background not only as a firefighter but also as a paramedic, initiated and directed the study. Amber Cameron, Strategic Operations Manager for the Public Safety Department, assisted Chief Nickel. PAFD contracted Actionable Insights, LLC, a Bay Area consulting firm, to conduct the study based on its experience in conducting CHNAs in Santa Clara County and other California counties, and to make recommendations for action such as those found in this report. Jennifer van Stelle, Ph.D. and Melanie Espino, Actionable Insights’ principals and co-leads on the Palo Alto/Stanford study, have experience conducting a variety of research and evaluation projects on topics including health and wellness, wellbeing, social justice, equity and diversity, and higher education. Situation Overview According to National Fire Protection Association (NFPA) data, the proportion of total fire department calls nationwide that were solely for medical aid increased from 54% in 1986 to 64% in 2015 (NFPA, 2016). Fire departments nationwide have reported this trend of increasing emergency medical services (EMS) calls (see, for example, Cooper, 2016; Keisling, 2015; Los Angeles Fire Department, 2015; Luthern, 2014). In the two years 2015 and 2016, emergency medical calls to the PAFD from the Palo Alto/Stanford area were 67% of all PAFD calls (based on PAFD CAD unduplicated data). Breaking that down, fully 70% of calls originating in the City of Palo Alto were for EMS, while 50% of calls from Stanford were for EMS.3 It has been projected that the City of Palo Alto’s resident population will continue an ongoing trend of increasing median age (age 32 in 1970, age 42 in 2010), which is similar to the national trend (City of Palo Alto, 2014). However, it has been noted that the City of Palo Alto’s older adult resident population is “larger than typical” (City of Palo Alto, 2014). Indeed, the median age for most of the counties in California is lower (i.e., younger) than the City of Palo Alto’s median of 41.9 years of age (Governing.com, 2017; City of Palo Alto, 2014). The City of Palo Alto’s median age is also higher (i.e., older) than that of all Bay Area counties except Marin (Governing.com, 2017). Older adults tend to require more care, and research reflects the common-sense notion that “ED [Emergency Department] resource use intensity increases with age” (Latham & Ackroyd- 3 The average of both is higher than one might expect because there are far more calls from the City of Palo Alto than there are from Stanford. Note that these figures are based on PAFD CAD unduplicated data for 2015 and 2016. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 6 February 1, 2018 Stolarz, 2014). It is logical to assume (and we do in fact find in PAFD’s current data) that older adults call 911 for medical emergencies more often than younger adults. The Public Safety Department, which includes police, fire service, and EMS for the City of Palo Alto, is in a unique position to take a broad look at the needs of the community and craft a strategy for addressing those needs now and in the future. By bringing together statistical analyses and the wisdom of the community to understand the community health needs, and leveraging existing research on the changing demographics of the Palo Alto/Stanford area, the PAFD can determine how its current structure and staffing aligns with forecasted changes. Specifically, the PAFD wants to understand how well-prepared it is to respond to the growing proportions of emergency medical calls, as well as the expected rise in absolute numbers of all types of calls over time and how the PAFD can increase its preparedness. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 7 February 1, 2018 CHNA Methods Summary In 2017, the PAFD identified community health needs in a process that mirrors that of the IRS requirements for nonprofit hospitals per the Affordable Care Act. The PAFD CHNA identified health conditions and, secondarily, the drivers of those conditions (including health care access and delivery), via both statistical data and community input. Note that experts and community representatives were asked to comment about the entire Palo Alto/Stanford area, and thus we present the CHNA data for the entire area, blended rather than separated out by city. The CHNA data collection process took place over four months and culminated in this written report in January of 2018. Secondary Statistical Data Collection Sources of Secondary Statistical Data Used in the Assessment Actionable Insights collected secondary statistical data on the combined cities of Palo Alto and Stanford from the Community Commons (2017) data platform, a publicly available source that includes a compilation of over 150 health need indicators. The Community Commons data served as the foundation for PAFD’s statistical data-gathering on community health. In addition, Actionable Insights collected secondary statistical data from the Santa Clara County Public Health Department, including their city and neighborhood profiles. Data from the California Department of Public Health (2013) and other online sources were also collected. Demographic data on the daytime population and resident population were collected from the U.S. Census Bureau. Details about specific sources and dates of the data used may be found in Appendix 1. Methodology for Collection, Interpretation, and Analysis of Secondary Data Actionable Insights used a Microsoft Excel spreadsheet to list indicator data. As described, data were collected primarily through the Community Commons data platform and other statistical sources. Actionable Insights generally retained the health need categories used in the Community Commons data platform spreadsheet (rubric) and integrated data indicators from other sources into the spreadsheet/rubric. Refer to Appendices 10 and 11 for the health needs assessment data collected through the two primary sources, Community Commons and Santa Clara County Public Health Department City and Small Area/Neighborhood Profiles. Specifically related to secondary statistical data, PAFD requested that Actionable Insights examine the following: How do the data perform compared to Healthy People 2020 (HP 2020) aspirational goals4 or 4 Healthy People is an initiative of the U.S. Department of Health and Human Services. For nearly 40 years, it has proffered 10-year national aspirational goals for improving the health of Americans based on existing scientific data. The most recent set of 2020 objectives was updated in December 2014 to reflect the most accurate population data available (www.healthypeople.gov). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 8 February 1, 2018 against Santa Clara County and California rates or percentages? Are there disparities in outcomes and/or conditions for people in the Palo Alto/Stanford community? Actionable Insights compiled all the combined Palo Alto/Stanford area data indicators and compared them with existing benchmarks (either HP 2020 aspirational goals or statewide averages, whichever was more stringent) in order to evaluate how the indicators performed against these benchmarks. Indicator data were reviewed by gender, age groups, race/ethnicity, and/or geographies when available in order to discover any health disparities. Actionable Insights presented these data to PAFD and its analysis of which indicators failed the benchmarks in an April 2017 telephone meeting with PAFD. Community Input PAFD contracted with Actionable Insights to conduct primary research. The Actionable Insights team collected community input via key informant interviews and focus groups with health experts, community representatives, and community members. Community Input Gathered Via Key Informant Interviews and Focus Groups Following the guidance provided by the IRS for community health needs assessments conducted by nonprofit hospitals, Actionable Insights consulted with individuals with expertise in health and individuals who represent the Palo Alto/Stanford community, and with Palo Alto/Stanford residents. See the lists in Tables 1 and 2. Table 1 includes key informants’ titles and expertise as well as the date each was interviewed. Table 2 briefly describes each focus group and the date and location each took place. Actionable Insights interviewed these experts and community leaders/representatives by telephone for approximately one hour each, May through September 2017. Actionable Insights also conducted focus groups that ran for approximately one hour each in June and July 2017. In these interviews and focus groups, Actionable Insights asked experts and community members the following: What are the health needs that are most important and pressing in the community? Are there any groups or geographies that may have greater or special needs? What solutions do you suggest for addressing those health needs? Are all members of the community benefiting equally from available services, or are there concerns about equity and cultural competency related to physical and mental health? How do you think health care will change in the future? What do you think about alternative service delivery models that could prevent emergency incidents, such as mobile and remote health models focused on prevention and early intervention? PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 9 February 1, 2018 (Professionals only) What are your ideas about how to address the issue of 911 “super- users?” In all, Actionable Insights consulted with six key informants via individual interviews and 22 community members via focus groups. Table 1, Details of Key Informants Interviewed Title and Organization Date Interviewed Public Safety Chief, Stanford University 5/27/2017 Chief Medical Officer, Stanford Health Care 6/2/2017 Vice Provost for Student Affairs, Stanford University 6/14/2017 Associate Vice Provost for Student Affairs and Director of Vaden Health Center, Stanford University 6/14/2017 Manager of Aging Adult Services, Stanford Health Care 7/14/2017 Director, American Muslim Voice Foundation 7/24/2017 Deputy Chief of Staff, VA Palo Alto Health Care System 9/1/2017 Source: Actionable Insights, LLC, 2017, unpublished data. Table 2, Details of Focus Groups Conducted Group Focus Location Date Nonprofit Professionals Mitchell Park Community Center 6/20/2017 Low-Income Seniors Stevenson House 7/6/2017 Neighborhood Representatives Mitchell Park Community Center 7/11/2017 Source: Actionable Insights, LLC, 2017, unpublished data. Methodology for Collection and Interpretation of Community Input Each key informant interview was recorded for internal use only, with permission from the interviewees, and transcribed for use as a stand-alone data source. When all interviews and focus groups had been conducted, Actionable Insights used qualitative research software tools5 to analyze the information and tabulate all of the health needs that were identified as 5 Dedoose Version 7.0.23, web application for managing, analyzing, and presenting qualitative and mixed method research data (2016). Los Angeles, CA: SocioCultural Research Consultants, LLC (www.dedoose.com). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 10 February 1, 2018 important and pressing to the community. The key findings were combined with the statistical data. This combined articulation was then used to assess community health priorities. Data Limitations and Information Gaps Despite the substantial amount of information collected, data were not available for every single aspect of each community health need, keeping us from being able to fully assess the identified needs. While this is typical for community health needs assessments (CHNAs), it is still important to acknowledge here. Limited data also constrained our understanding of the needs of special populations, including the undocumented, the LGBTQI population, and monolingual speakers of certain languages. Related to this issue, data for these populations can be statistically unstable due to the small numbers or small response rates of community members from these populations, and, as such, are of limited utility in assessing community health needs. Again, these concerns are typical for CHNAs, and are a perennial issue for public health departments and others whose work involves research into community health needs. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 11 February 1, 2018 Predictive Analysis Methods Summary This is a summary of the data and methods used in the predictive analysis. For a detailed description of the data and methods, as well as charts displaying the 2015/2016 data and 2030 predictions, please see Appendices 2-9. Data Used for Predictive Analysis Actionable Insights obtained from PAFD two datasets containing data from the years 2015 and 2016. The dataset from the computer-aided dispatch records system (CAD) contained all calls, by type (e.g., fire, medical emergency, false alarm), and by city for the City of Palo Alto and for Stanford. The dataset from the emergency medical records management system (ESO) contained all patients by age, gender, incident ZIP Code, and primary impression (e.g., diabetic symptoms, respiratory distress, cardiac rhythm disturbance). Both datasets contained information on date and time of day of each incident. For the sake of increased data stability, we generated averages of each call type in the CAD dataset across the two years, and of patient volume, by age, in the ESO dataset across the two years. These averages formed the basis for the year 2030 predictions. City of Palo Alto The City of Palo Alto provided six different growth scenarios for the year 2030 based on 2014 resident, jobs, and housing data, which were developed as part of the Comprehensive Plan. These population projection scenarios were provided to Actionable Insights by Hillary Gitelman, Director, Planning & Community Environment Department, City of Palo Alto, via email on December 21, 2016. In her email, Ms. Gitelman explained: Our EIR [Environmental Impact Report] planning scenarios look out to the year 2030 and are testing the impacts of various policy changes which would presumably yield different amounts of job and population growth. Our Scenario 2 reflects the population in 2030 that we anticipate if Palo Alto keeps building housing at the same rate it has over time and if we take steps to temper the rate of job growth. Our Scenario 4 reflects ABAG projections of jobs and housing. Table 3, on the next page, provides these scenarios. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 12 February 1, 2018 Table 3, Summary of EIR Scenarios: Population and Employment Parameters(1) Population/ Housing Non-Res Sq. Ft. (2) Jobs Jobs/Housing Balance (3) BASE FIGURES (2014) 65,685/28,545 27.0M 95,460 Jobs/Employed Residents Ratio of 3.03 Scenarios: Net Change 2015-2030 (City of Palo Alto Only) Jobs/Housing Balance (3) Population/ Housing Non-Res Sq. Ft. (2) Jobs 1. Business as Usual 6,600/2,720 3.3M 15,480 Jobs/Employed Residents Ratio of 3.20 2. Slowing Growth 6,600/2,720 3.0M 9,850 Jobs/Employed Residents Ratio of 3.04 3. Housing Tested I 8,435/3,545 3.5M 12,755 Jobs/Employed Residents Ratio of 3.03 4. Sustainability Tested I 10,455/4,420 4.0M 15,480 Jobs/Employed Residents Ratio of 3.04 5. Sustainability Tested II 8,435/3,546 2.4M 8,868 Jobs/Employed Residents Ratio of 2.93 6. Housing Tested II 14,080/6,000 2.4M 8,868 Jobs/Employed Residents Ratio of 2.71 Notes: (1) The scenarios also include different ideas for zoning/implementation actions, transportation investments, and sustainability measures. (2) This number includes 1.3M sq. ft. that has already been approved at the Stanford Medical Center. The balance of the new nonresidential square footage would be located in areas both inside and outside of the “monitored areas” referenced in Policy L-8 and Map L-6 in the Comp Plan and in areas both inside and outside of the area subject to the interim annual limit of 50,000 square feet new office/R&D space. (3) The number of employed residents in 2030 is estimated at approximately 48% of total population based on ABAG Projections 2013. The ratio of jobs to employed residents in this column assumes a 2014 base of 65,685 people [i.e., total residents] and 95,460 jobs. Sources: Hilary Gitelman, City of Palo Alto Planning & Community Environment department, personal communication, December 21, 2016; Roland Rivera, City of Palo Alto Planning & Community Environment department, personal communication, November 20, 2017. To align our 2030 predictions with these scenarios, Actionable Insights obtained additional 2014 population data, including resident age breakdowns by city, county, and state from the U.S. Census Bureau (2014). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 13 February 1, 2018 We also obtained daytime visitor estimates for the City of Palo Alto from its Chamber of Commerce, and calculated nighttime visitor estimates for the City of Palo Alto based on reported hotel occupancy rates and related taxes for 2014. Additionally, we acquired U.S. projections of year 2030 population by age from the U.S. Census (Colby & Ortman, 2015). Year 2030 age projections for the populations of Bay Area counties and the state were obtained from the California Department of Finance (CA DOF, 2017).6 Finally, we estimated daytime population figures for the City of Palo Alto based in part on a 2013 City of Palo Alto transportation survey that reported percentages of out-commuters and in-commuters from various nearby counties. Further explanation of these figures, including population proportions by age for 2014 and 2030, are available in Appendix 5. Stanford Stanford University (2016) provided 2015 data, 2018 projections, 2020 projections, and a growth scenario for 2035, both for residents and for its daytime population, in its 2018 General Use Permit Application or “GUP.” The GUP, published by Stanford University on November 21, 2016, provides estimates of the resident population (Tab 5) and of the daytime population (Tab 8), including both workers and students, for the years 2015, 2018, 2020, and 2035 (see Appendix 5). However, the GUP data and estimates are not provided at a granular-enough level to determine population ages, despite requests for the same.7 Use of age groups from other geographies (e.g., San Mateo County, Santa Clara County, the City of Palo Alto) as proxies for Stanford’s daytime or nighttime populations are inappropriate because Stanford is not like these other areas; it has a much larger young-adult population due to its university. After considerable effort by Actionable Insights and discussions with PAFD, it was decided that Stanford’s daytime population would not be estimated by age group. For both current and 2030 Stanford nighttime population projections, we used the U.S. Census Bureau’s estimates of Stanford’s 2014 resident (nighttime) population and age proportions.8 We obtained daytime visitor estimates for Stanford from its Visitor’s Center. Further explanation of these figures, including population proportions by age for 2014 and 2030, are available in Appendix 5. 6 Note that we were unable to obtain age projections by city, and were advised that no agency or organization provides such projections (Stephen Levy, personal communication, December 14, 2016). 7 Note that a request for age-related information about the Stanford daytime population was made to the authors of the GUP. The request netted some additional information from Stanford University’s Human Resources department, but the information provided was still not enough to allow us to determine age groups for Stanford’s daytime population. 8 We used 2014 rather than 2015 data for Stanford because all City of Palo Alto “current” data and the six 2030 scenarios are also based on 2014 figures; this allows for comparisons between Stanford and the City of Palo Alto if desired. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 14 February 1, 2018 Analytical Methods Used for Predictive Analysis After consultation with several statistical experts, it was determined that the most appropriate method for predicting future call volume/type and medical emergency patient volume by age group, gender, incident location, and/or primary impression was a modified life table approach. This is a population ecology approach used to describe a current population and predict future growth or decline (see, for example, Begon, Harper, & Townsend, 1990; Begon, Mortimer, & Thompson, 1996; Krebs, 1985). The U.S. Centers for Disease Control calls this a period life table approach (Arias, 2012). We used a snapshot of the years 2015/2016 and assumed that the cohort of individuals alive at that time in each city, plus the expected increase in individuals in each city over the next 15 years, would be subject (proportionally) to the age-specific Medical Emergency (ME) call/patient volumes, other call types, incident locations, and primary impressions that prevailed for the actual populations in 2015/2016. The greatest factor to affect construction of period life tables for 2030 is the expected increase in the older population in the City of Palo Alto. As one might expect, the 2015/2016 ESO data show that older individuals are more likely than younger individuals to be ME patients in the combined Palo Alto/Stanford jurisdiction. After predicting expected 2030 ME call/patient volume by age group, as well as by location and primary impression, we adjusted the predictions based on CA DOF (2017) age projections. More information about this process may be found in Appendices 6-9. We provide separate age- adjusted predictions for the City of Palo Alto (daytime and nighttime) and for Stanford (nighttime only). Another factor one would expect to affect construction of period life tables for 2030 is gender. While gender is associated with ME patient volume overall (with females somewhat more likely to be ME patients than males), the gender composition of the two cities is not expected to change significantly within the next 15 years.9 Thus, we did not take gender into account in generating the period life tables predicting ME call/patient volume, call types, locations, or primary impressions in 2030. Although it is possible that the proportions of the population of the various ZIP Code areas in the combined Palo Alto/Stanford jurisdiction may change within the next 15 years, no data were available to address population change in such a fine-grained way (i.e., by ZIP Code). Therefore, we did not predict ME patient volume in 2030 by ZIP Code of interaction, either overall or by category of primary impression. 9 Note that while there were no data projecting gender for sub-county-level areas, the projections of gender by county (CA DOF, 2017) suggest that the expected change in gender proportions between now and 2030 is not statistically significant in either San Mateo County or Santa Clara County (Chi-square = 2.00, p > 0.05). Therefore, we do not include gender as a factor in our predictions. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 15 February 1, 2018 Finally, we provide ME call/patient volume and call type projections both overall and separately for daytime (City of Palo Alto only) and nighttime (both City of Palo Alto and Stanford, separately). The nighttime population is equivalent to the resident population plus any estimates of overnight visitors. As suggested by Bhadur (2007), daytime and nighttime populations are fundamentally different, with daytime population including workers, tourists, and business travelers, as well as the residual nighttime resident population that does not leave the area during the day. For PAFD’s purposes, it is important to predict year 2030 call/patient volume and call type, as well as ME patients by location and primary impression, based on these two very different daytime and nighttime populations. Further information on how these populations were constructed and the predictions based on them are available in Appendix 5. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 16 February 1, 2018 Palo Alto/Stanford Area Geography and Demographics The Palo Alto/Stanford area is the focus of the study. Places in the City of Palo Alto are commonly referred to as north and south, with Oregon Expressway/Page Mill Road serving as the dividing line between the two. As shown on the map in Figure 1, the Palo Alto/Stanford area has many distinct neighborhoods. Figure 1, Map of the Cities of Palo Alto and Stanford Source: Amber Cameron, City of Palo Alto Public Safety Department, personal communication, October 4, 2017. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 17 February 1, 2018 The Santa Clara County Public Health Department provides health data for the City of Palo Alto, City of Stanford, and for certain local neighborhoods, which are grouped into five areas to facilitate data analysis in this study:10,11 Barron Park: Includes Green Acres. Downtown North: Includes Crescent Park. Midtown North: South of Oregon Expressway and northeast of Middlefield Road. Includes Palo Verde and Charleston Gardens. Midtown South: South of Oregon Expressway and southwest of Middlefield Road. Includes Ventura and Charleston Meadow (Fairmeadow). Professorville: Includes Old Palo Alto, Duveneck, and St. Francis. City of Palo Alto The City of Palo Alto is the northernmost of the 15 cities in Santa Clara County. The resident population of the City of Palo Alto is approximately 65,700 (U.S. Census Bureau, 2014). However, during the day there is a large influx of workers into the area, as well as approximately 2,400 daily and/or overnight visitors, which together increase the daytime population of the combined area to approximately 132,000 (double the resident population). See Figure 2 for a comparison of resident and non-resident proportions during the daytime. Figure 2, City of Palo Alto Daytime Population by Resident Status Sources: Dawn Billman, Palo Alto Chamber of Commerce, personal communication, April 26, 2017; Hilary Gitelman, City of Palo Alto Planning & Community Environment department, personal communication, December 21, 2016; Thorp, 2014; U.S. Census Bureau, 2014. See Appendix 5 for more details. 10 Visit www.sccgov.org/sites/sccphd/en-us/Partners/Data/Pages/Palo-Alto.aspx for more information on the Santa Clara County Public Health Department’s methodology. 11 Palo Alto Hills was not included in the Palo Alto neighborhood profiles published by Santa Clara County Public Health Department. Non-resident population, 50% Resident population, 50% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 18 February 1, 2018 Ethnicity, Origin, and Language Compared to Santa Clara County, all City of Palo Alto neighborhoods have a higher proportion of White residents (between 50% and 70% compared to 35% in the county overall). Both Midtown areas (North and South) have higher proportions of Asian residents than the county overall, at 38% and 33% respectively, compared to 32% in the county. (See Figure 3 for chart.) Figure 3, Ethnicity by Geography, Santa Clara County versus City of Palo Alto Neighborhoods Source: SCCPHD, 2016. Between 23% and 37% of the residents of each neighborhood are foreign-born (37% in the county overall), and one quarter or more speak a language other than English at home (52% in the county overall). Those speaking a language other than English at home are most likely to live in Midtown neighborhoods (where the rate is 48% in the north, and 43% in the south). While these data do not specify whether these residents also speak English, it is worth noting that in Santa Clara County over half of those who speak one of the county’s top seven non- English languages at home also speak English “very well” (U.S. Census Bureau, 2015). Age The City of Palo Alto has a higher proportion of adults aged 65 and older than the county overall (17% compared to 12% in the county). The proportion of children in the City of Palo Alto under age five is smaller than the county overall (5% compared to the county at 7%). See Figure 4, below. 0% 20% 40% 60% 80% 100% Santa Clara County Barron Park Downtown North Midtown North Midtown South Professorville Black/Af-Am Latino Asian White PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 19 February 1, 2018 Figure 4, Population by Geography and Age Range, Santa Clara County versus City of Palo Alto Santa Clara County City of Palo Alto Source: U.S. Census Bureau, 2014. The neighborhood with the highest proportion of older adults is Downtown North, where one in five (21%) is over age 65 (SCCPHD, 2016). See Appendix 11 for additional neighborhood data. Stanford The City of Stanford is bounded by the City of Palo Alto on three sides; its remaining boundary, to the southwest, is Junipero Serra Boulevard (show on the map in Figure 1 as the road immediately southwest of the small lake depicted on the Stanford University campus). The resident population of Stanford is estimated at approximately 13,500. However, during the day there is a large influx of workers into the area, as well as approximately 370 daily visitors, which together increase the daytime population of Stanford to nearly 40,000. See Figure 5 for a comparison of resident and non-resident proportions during the daytime. 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+ PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 20 February 1, 2018 Figure 5, City of Stanford Daytime Population by Resident Status Sources: D.J. Dull-MacKenzie, Stanford University Visitors Center, personal communication, April 26, 2017; Stanford University, 2016; U.S. Census Bureau, 2014. Note: No estimate is available for overnight visitors to the City of Stanford. See Appendix 5 for more details. Ethnicity, Origin, and Language Just over one quarter of Stanford residents are foreign-born (26%) compared to 37% in the county overall. More than one third (35%) speak a language other than English at home, compared to 52% of county residents overall. While these data do not specify whether these residents also speak English, as mentioned previously, in Santa Clara County over half of those who speak one of the county’s top seven non-English languages at home also speak English “very well” (U.S. Census Bureau, 2015). Compared to Santa Clara County, Stanford has a higher proportion of White residents (44% compared to 35% in the county overall) and Black residents (5% compared to 2% in the county overall). Stanford has a lower proportion of Latino residents than Santa Clara County (11% compared to 27% in the county overall). See Figure 6. Figure 6, Ethnicity by Geography Source: SCCPHD, 2016. Non- resident population, 66% Resident population, 34% 0% 20% 40% 60% 80% 100% Santa Clara County Stanford Black/Af-Am Latino Asian White PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 21 February 1, 2018 Age Due to its university, Stanford has much higher proportions of young adults aged 15-19 and 20- 24 than the county overall (respectively, 29% and 35% compared to 6% for each age group in the county overall). The proportion of children residents in Stanford under age five is smaller than the county overall (3% compared to the county at 7%) and the older adult resident population (age 65+) of Stanford is also smaller than the county (5% compared to 12% in the county overall). See Figure 7, below. Figure 7, Population by Geography and Age Range Santa Clara County Stanford Source: U.S. Census Bureau, 2014. 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+ 0-4 5-9 10-14 15-19 20-24 25-34 35-44 45-54 55-64 65+ PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 22 February 1, 2018 Community Health Needs Assessment (CHNA) Research Questions The PAFD’s CHNA focused on three main questions: 1. What are the pressing health needs in the Palo Alto/Stanford area? 2. Are all Palo Alto/Stanford area residents benefiting equally from available health care services? 3. What suggestions does the community have for improving health in the Palo Alto/Stanford area? We review each of these questions in the sections below. Pressing Health Needs Actionable Insights reviewed statistical data about health needs in the Palo Alto/Stanford area and combined this with the community feedback (six key informant interviews and three focus groups). Note that experts and community representatives were asked to comment about the entire Palo Alto/Stanford area, and thus we present the CHNA data for the entire area, blended rather than separated out by city. The list below was derived by comparing statistical data to benchmarks (county statistics or statewide statistics) and by analyzing the community feedback for common themes. (Please see Appendices 10 and 11 for detailed statistical data.) The following pressing health needs emerged from this analysis (in alphabetical order): Behavioral health (mental health and substance abuse) Health care access and delivery, including equity and cultural competency Housing Older adult health Transportation and traffic Youth/young adult health The PAFD did not engage in ranking the health needs; the goal was to bring together both available statistics and community perceptions to identify the set of most pressing community health needs. Behavioral Health Behavioral health is a category of health needs that includes mental health and substance use. This umbrella designation is often used in health settings, including public health departments, since mental health and substance use issues (including use of illegal drugs, misuse of PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 23 February 1, 2018 prescription drugs, excessive use of alcohol, and the use of tobacco) co-occur so frequently.12 While data on illegal drug use in the Palo Alto/Stanford area are lacking, the data do show that Palo Alto/Stanford area residents spend 18% of their household expenditures on alcohol compared to 13% in California households overall (Community Commons, 2017). Substance use was mentioned by four of six key informants, and excessive alcohol use was mentioned specifically by those who serve the students of Stanford University. Further data on accessibility of alcohol and tobacco are found in the Housing section below. Mental health was discussed in all focus groups and in all but one key informant interview. Many concerns related to mental health were discussed, including the prevalence of mental health issues within the homeless population, youth suicide, social isolation, and PTSD among veterans. The Veterans Affairs (VA) representative also mentioned that veterans with traumatic brain disorders (TBIs) may also have mental health issues, and sometimes TBI symptoms are mistaken for mental health problems. Also, some mentioned the difficulty that first responders face when addressing medical emergencies where there are also mental health concerns. The third-highest type of primary impression among patients whose incidents occurred in the Stanford area is behavioral health, representing over 9% of Stanford’s annual Medical Emergency patient volume on average (see Table 6 on page 54). “One thing that is weighing heavily on me these days, mostly because of the criticism that we’re taking, really is more of around mental health. Are we, as a community, as a nation, addressing mental health issues appropriately?” – Key Informant Regarding proximity to tobacco retail outlets, all of the City of Palo Alto’s neighborhoods have a lower density of those establishments compared to the county (Santa Clara County Public Health Department [SCCPHD], 2016). However, Downtown North, Midtown North, and Midtown South have higher densities of alcohol retail outlets than the City of Palo Alto overall (SCCPHD, 2016). In Downtown North and Midtown North, the number of establishments that sell alcohol per square mile exceeds that of the county overall at 5.1 and 3.7 respectively (compared to 2.7 in the county) (SCCPHD, 2016). Excessive alcohol use can drive the rate of violent crime (National Institute on Alcohol Abuse and Alcoholism, 1997). We note that Downtown North has the highest rate of violent crimes within one mile – 11.6 per 100,000 – among the City of Palo Alto’s neighborhoods, which is 28% lower than the county overall (at 16.0), but 84% higher than the City of Palo Alto overall (at 6.3) (SCCPHD, 2016). 12 See SAMHSA website for more information: www.samhsa.gov/disorders. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 24 February 1, 2018 Health Care Access and Delivery Health care access was mentioned in every focus group and key informant interview. Nearly two thirds (65%) of Palo Alto residents say that the availability of affordable, quality health care is good or excellent, and 74% say that the availability of preventative health care services is good or excellent (Palo Alto City Auditor, 2016). Indeed, 2012 data indicate that in most neighborhoods, only between 4% and 10% of adults are uninsured (SCCPHD, 2016). The highest estimates of uninsured are in Barron Park (13%-15%) and Midtown South (10%-13%), which are still better than the national baseline of 58% (SCCPHD, 2016). Indeed, many community members who participated in this study perceive that most Palo Alto/Stanford area residents have health insurance and the means to afford health care.13 Despite the low proportions of uninsured, the community is concerned that some health care is unaffordable, especially for those in the middle class. While many programs exist for those with low incomes, the community feels that many in the middle class who do not qualify for Medi- Cal or other subsidies may struggle to afford health care. This may be particularly true for seniors in the City of Palo Alto who own homes and do not qualify for Medi-Cal. Affording in- home services may be difficult for those who want to remain in their homes (a significant asset) but have limited incomes. It is also worth noting that the Palo Alto/Stanford area has fewer Federally Qualified Health Centers than the county (1.3 compared to 2.4 per 100,000) (Community Commons, 2017). Regarding mental health care access, fewer than half of the City of Palo Alto’s residents (46%) say there is good availability of affordable, quality mental health care, worse than in 2014 when 63% said so (Palo Alto City Auditor, 2016). Community input validates this finding. One participant explained that traditional mental health office hours (ending at 5:00 p.m.) do not serve the student community well. This limited access puts the burden of addressing mental health crises on the police department or emergency paramedics. “In the U.S. . . . insurance companies have increasingly restricted access to psychiatrists, psychologists, and counseling as part of their health care plans. And what it means is psychiatrists and psychologists have increasingly gone to pay out-of-pocket plans. And so, it restricts who can access those services to just the wealthy.” – Key Informant Our discussion of equity and cultural competency in health care access and delivery may be found in the next section, since focus groups and key informants were asked a distinct and separate question about this topic. 13 We appreciate a reader comment noting that availability and the ability to access are not the same. Further research is suggested to determine whether residents of neighborhoods with relatively higher proportions of uninsured receive the necessary information and resources to access affordable and high-quality health care. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 25 February 1, 2018 Housing Quality and type of housing are important determinants of health, and substandard housing is a major public health issue. Residents of the City of Palo Alto and Stanford are more likely than county residents overall to live in multi-unit housing, with 38% in the City of Palo Alto and 90% in Stanford, compared to 33% in the county (SCCPHD, 2016). However, a smaller proportion in the combined Palo Alto/Stanford area live in overcrowded households (3% or less compared to 8% in the county) (SCCPHD, 2016). Housing in the county is extremely expensive, as evidenced by 38% of the population spending 30% or more of their income on housing. In the Palo Alto/Stanford area, this applies to 35% of the population. See Figure 8. Figure 8, Proportion of Population Spending 30% or More of Income on Housing, 2011-2015 Source: SCCPHD, 2016. Older Adult Health With older adult populations making up a disproportionate share of patients, it was important to consult seniors and professionals who serve seniors for this study. Many concerns were expressed, including concerns about chronic conditions. In the county, 8% have been diagnosed with diabetes, and 10% have been diagnosed with pre-diabetes (SCCPHD, 2014a). The prevalence among those aged 65 and older is highest, at 18% with diabetes and 16% with pre-diabetes (SCCPHD, 2014a). Heart disease prevalence among adults in the county (5.3%) overall is better than the state (6.3%), but worse among Latino adults in the county (5.0%) (University of California Center for Health Policy Research, 2012). It is estimated that 27% of the county’s residents have been diagnosed with high blood pressure (SCCPHD, 2014c). (Data on diabetes prevalence and high blood pressure are not available for Palo Alto/Stanford.) It should be noted that in Palo Alto/Stanford the rates of overweight/obesity, stroke mortality, heart 38%35% 0% 10% 20% 30% 40% 50% Santa Clara County Palo Alto/Stanford Area PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 26 February 1, 2018 disease mortality, and diabetes hospitalizations are favorable compared to the county, but heart disease prevalence is essentially the same compared to the county (both 5.3) (SCCPHD, 2016; University of California Center for Health Policy Research, 2012). However, Alzheimer’s disease mortality data do indicate reason for concern (discussed further below; see Figure 9). “I think senior care is a big problem in a lot of areas. If you’re wealthy, you can look at the fee or whatever, and you get great care. And there are a couple of very good chronic care facilities in Palo Alto, but there’s still lots of [seniors] that have problems accessing care. . . So, I think that population is relatively underserved.” – Key Informant Figure 9, Alzheimer’s Disease Mortality Rate Source: SCCPHD, 2016. Note: See Demographics section for neighborhood definitions. Dementia and cognitive functioning were also big concerns. The mortality rate for Alzheimer’s disease in the City of Palo Alto is 32.4 per 100,000, similar to that of the county overall (at 34.6 per 100,000) (SCCPHD, 2016). In Midtown South, the rate is 40.0 per 100,000, which is 15% higher than the county rate (SCCPHD, 2016). While this rate is not age-adjusted, the proportion of residents aged 65 and older in Midtown South is lower than in most other neighborhoods (15%, compared to 17% in the City of Palo Alto overall) (SCCPHD, 2016) , which may indicate that the likelihood of dying from Alzheimer’s disease in Midtown South is higher than in other neighborhoods (SCCPHD, 2016). Further research is required to better assess this issue. 14 Regarding senior falls, county data show that seniors in Santa Clara County are less likely to be hospitalized but are more likely to die from a fall than California seniors overall (county rate of 14 This rate may be related to skilled nursing facilities and/or senior home care facilities in the area. Mapping these various facilities was beyond the scope of this assessment. 34.6 32.4 34.0 31.9 28.7 40.0 25.7 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 Santa Clara County City of Palo Alto Barron Park Downtown North Midtown North Midtown South Professorville PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 27 February 1, 2018 55.4 deaths per 100,000 people compared to state rate of 36.1 per 100,000, not age-adjusted) (California Department of Public Health EpiCenter [EPIC], 2013). Seniors also talked about social isolation and the need for a community where people look out for one another. “In my neighborhood, we are so separated because we have larger lots and actually you don’t see them. Most of the time, you don’t see the neighbors except for an annual function that we have.” – Focus Group Participant Transportation and Traffic Transportation and traffic are public health hazards that can affect individual decisions about health, and can compromise community members’ health through exposure to pollution and other harmful elements. Transportation and traffic were mentioned in all three focus groups, and by two out of six key informants. Residents are concerned with the amount of traffic causing stress, traffic accidents, and threatening the safety of pedestrians and bicyclists. As described earlier, two thirds (64%) of the City of Palo Alto’s daytime population are non- residents and thus commute to the city (Actionable Insights, unpublished data, 2017). We also know that the most common mode of transportation to work among the City of Palo Alto’s residents is driving alone (65%) (SCCPHD, 2016), which contributes to the amount of traffic experienced in the community. The vast majority of Palo Alto/Stanford area residents live in close proximity to public transportation (within a half-mile of a regional bus or train and within a quarter-mile of any bus/light rail) (SCCPHD, 2016). However, in the Midtown North neighborhood, this proportion is only 59%, compared to 85% in the City of Palo Alto overall (SCCPHD, 2016). Twelve percent of the City of Palo Alto’s residents carpool to work or take public transportation most of the time, which is similar to the county (13%) (SCCPHD, 2016). But there has been a substantial decrease in the proportion of City of Palo Alto residents who say that public transportation is easy to use, dropping from 60% in 2006 to 28% in 2016 (Palo Alto City Auditor, 2016). A concern of study participants may be related to the large influx of daytime workers in the Palo Alto/Stanford area; some participants believe that car commuters are using neighborhood streets to get to work. Community members in the study (and those in the countywide study, Stanford Health Care, 2016) expressed concern about the increased risk of traffic and pedestrian accidents in their neighborhoods, as well as the increased noise from traffic. Airplane noise was also cited as a cause of noise pollution and stress. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 28 February 1, 2018 Youth and Young Adult Health Referring back to Figure 7, nearly two thirds of the Stanford population (65%) are adults aged 18-24, due in part to the undergraduate and graduate student populations at Stanford University. Youth and young adult health was mentioned by several study participants, including three key informants. Mental health (and specifically suicide) is a problem that the community has been very aware of since 2009, and the issue has been the subject of a CDC study (Garcia-Williams et al., 2016) and numerous media articles across the country (Lee, 2017; Rosin, 2015). According to the Santa Clara County Public Health Department’s 2016 report, the suicide rate among youth and young adults 10 to 24 years old is highest in the City of Palo Alto, at 14.1 per 100,000, more than double the county rate of 5.4 deaths of those aged 10-24 (Garcia-Williams et al., 2016). Project Safety Net is a collaborative that was formed in 2009 in response to this crisis, and includes the Palo Alto Unified School District and the Santa Clara County Public Health Department (City of Palo Alto, 2017a). Indeed, many new programs related to suicide prevention have been instituted in the community since 2009, which were known to study participants. Some community members indicated that youth and young adults are well aware of resources for mental health crisis supports. However, mental health was not the only health need mentioned in the context of youth and young adult health. Participants who serve Stanford University students also discussed the risk of injury and death due to alcohol consumption. There was concern among participants that the problem of alcohol consumption can mask more complex mental health issues. For example, students with mental health problems who have consumed excessive alcohol may be treated for drunkenness but in fact may also need help for underlying mental health issues. Likewise, a student who calls 911 because they were injured while intoxicated may receive treatment for the injury without being assessed for alcohol dependence. For this reason, study participants felt a holistic approach to treating this population is needed. Pedestrian/bicycle safety is another need that youth and young adults have expressed to community providers that serve them, as described in the quote below. “A lot of the kids in this area ride their bikes to school, so they talk about safety a lot. They also talk about . . . getting to school – and the high levels of traffic that there are in the mornings that impede them from getting to school on time.” – Focus Group Participant Equity and Cultural Competency One of the primary CHNA research questions related to equity: Are all residents of the Palo Alto/Stanford area benefiting equally from available health care services and other things that make residents healthy? Regarding equity, community members expressed concern that not PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 29 February 1, 2018 everyone has the same access to quality health care within the area and within the county because not all workers can afford to live in the area due to the high cost of living. Specific local populations identified by community members as lacking access to health care were those experiencing homelessness, those who are low-income, and undocumented immigrants who do not have access to subsidized health insurance under the Affordable Care Act. Cultural competence is the ability to interact effectively with people of different cultures, which is key to effective health care access and delivery. A lack of cultural competency contributes to health disparities, resulting in behaviors, attitudes, and policies that undermine the goal of providing quality health care and emergency response. PAFD asked key informants whether cultural competency was an issue in the Palo Alto/Stanford area. Health care professionals who were consulted explained that cultural competency is addressed adequately in health systems such as the VA Palo Alto Health Care System, Stanford Health Care, and Stanford University’s Vaden Health Center, and that there is a recent focus on building competencies to serve the LGBTQI population. For example, a key informant explained that while gynecologists are understandably trained to address pregnancy with patients, asking lesbian patients about their risk for pregnancy can cause these patients to feel misunderstood and/or disrespected. Professionals who participated in a focus group also said that cultural competency related to gender and sexual orientation is important so that everyone feels welcome by health care professionals. One key informant who represented the Muslim population also indicated that it is important for first responders to understand cultural norms, and that there are some misconceptions about treating Muslims. For example, she explained that while Muslims generally prefer a clinician of the same sex, in emergencies one should not hold back providing care if only a male EMT is available to treat a female patient. To Muslims and many others, maintaining modesty (with regards to exposing one’s body) is important; when clinicians cover patients or keep onlookers away, they preserve the dignity of their patients. In addition, this same key informant indicated that because many people in the Palo Alto/Stanford area are vegetarian, hospitals should take extra care to offer foods that are made without any animal products (e.g. gelatin, broth). While cultural competency regarding race/ethnicity was not mentioned by other study participants, additional information provided by the African Ancestry Report indicated that Africans/African Americans of different national origins, religions, and sexual orientations in the county commonly experience mistreatment and a lack of cultural competence among health care providers (SCCPHD, 2014b). For the veteran population, gender equity was discussed by the expert interviewed. While men are estimated to make up 91% of veterans in the U.S., the proportion of female veterans is rising over time (U.S. Department of Veterans Affairs, 2017). The Veterans Affairs (VA) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 30 February 1, 2018 representative interviewed said, “If you’re not thinking about women as veterans, then you may miss out on a host of issues that women may face.” The representative suggested that women combat veterans who choose to go to non-VA providers are particularly at risk in this regard, as non-VA providers may be less likely to know about or consider the health implications of their patient being a combat veteran. It is important for residents to be able to understand information, warnings, and directions given by health care and emergency medical personnel to their clients and those who are caring for their clients. Language capacity is also important for delivery of services because, as expressed by a study key informant, when professional interpretation is lacking, patients rely on family members to translate, and those family members may “introduce their own cultural sentiments.” This creates uncertainty for health care providers about whether everything they are saying is being shared with the patient. Such uncertainty is of particular concern in an emergency situation, when the impact of communication barriers or breakdowns could be especially dire (Pressman & Schneider, 2009). Study participants indicated that Spanish and Mandarin are common languages where interpretation and translation are needed for health care/emergency services in the Palo Alto/Stanford area. Additional Community Concerns In response to a question about what changes they predict are coming in the future, the key informants expressed concern about possible changes in health insurance, namely that changes to the Affordable Care Act could result in many Palo Alto/Stanford area residents losing health insurance. Key informants and residents alike also reported that they anticipate technology playing a larger role in health care. Examples include innovations in wearable technology, laboratory testing, and telemedicine. Community members cautioned, however, that telemedicine (such as video visits or communicating with doctors using messaging) is not a mode that is accessible for all older adults, and that technology cannot always take the place of face-to-face visits with health care professionals. Residents’ and experts’ feedback on how to improve the health of the community may be found in the Recommendations chapter of this report. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 31 February 1, 2018 PAFD Calls and Medical Emergency Patients: City of Palo Alto, 2015 and 2016 The data provided by PAFD contained all unique 2015 and 2016 calls from PAFD’s internal CAD and ESO Solutions medical emergency services data systems. The CAD dataset includes all of the various calls to PAFD for dispatch (e.g., fire, medical emergency, false alarm), which were restricted for the purposes of these analyses to the City of Palo Alto (and, in a later section of this report, Stanford). Note that CAD call types are the initial presumption of incident type, based on what dispatchers are told, not the incident type verified by PAFD personnel once they are at the scene. The ESO dataset contains only medical emergency patients for whom PAFD was dispatched, but includes incident ZIP Code, patient age, gender, and primary impression. A “primary impression” is the main problem, condition, or symptom that brought about the encounter between the patient and EMS personnel. This section briefly describes the current data, with a special focus on medical emergency calls/patients. PAFD CAD Calls Originating in the City of Palo Alto Current Call Volume and Type Of all calls for service to PAFD during 2015 and 2016, an average of approximately 85% per year originated in the City of Palo Alto (84.2% in 2015 and 85.7% in 2016). Based on the CAD data provided by PAFD for calls originating only in the City of Palo Alto, in 2015 and 2016 there were a total of 14,037 calls for service to PAFD (6,887 in 2015 and 7,150 in 2016).15 See Figure 10 for a chart of the percentage of calls by call type originating in the City of Palo Alto. Appendix 6 shows the number of unique calls of each type by year. 15 Note that these figures do not tie to PAFD’s total annual costs because they represent only calls from individuals in the City of Palo Alto, not in all cities. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 32 February 1, 2018 Figure 10, PAFD Calls for Service Originating in the City of Palo Alto, 2015/2016 Average Source: Amber Cameron, City of Palo Alto Public Safety Department, personal communication containing PAFD CAD unduplicated data (2015/2016), January 24, 2017 (“City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016”). Note: “Service” calls are, for example, assisting with lock-outs, water leaks, police assists. * “All Other” is comprised of all call types that by themselves represent less than 1.5% of calls from the City of Palo Alto to PAFD.16 16 The categories of call included in “All Other” are: Airplane Emergency, Auto Aid, Full First Alarm, Gas, Hazardous Materials, Mutual Aid, Second Alarm, 1056 (suicide), Suspicious Circumstances, Technical Rescue, Train, Utilities, Vegetation Fire, Welfare Check, and Wires. Taken all together, these represent less than 3% of calls from the City of Palo Alto to PAFD. Fire Smoke All Other * Accident Service False Alarm Medical Emergency 0% 10% 20% 30% 40% 50% 60% 70% 80% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 33 February 1, 2018 Current Medical Emergency Calls by Time of Day Approximately 70% of all calls for service in Palo Alto each year were classified as medical emergency (70.7% in 2015 and 69.7% in 2016). More calls came in during the day than at night. See Figure 11. Figure 11, PAFD Calls by Type and Time of Day, 2015/2016 Average, City of Palo Alto Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. PAFD Medical Emergency Patient Volume Originating in the City of Palo Alto Based on the ESO data provided by PAFD, there were a total of 8,837 medical emergency patients during 2015 and 2016 (4,446 in 2015 and 4,391 in 2016). Note that an individual may be a patient more than once in a given year, and each time a patient presents, s/he requires PAFD’s attention. Actionable Insights was asked to analyze the ESO data by age, gender, ZIP Code, and primary impression, and to provide PAFD with predictions about future medical emergency patients in the City of Palo Alto (and, in a later section of this report, in the Stanford area) based on these data. Current data are found in this section, while predictions may be found in the next section. 3,342 1,584 1,434 659 0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 5,000 Palo Alto Daytime Palo Alto Nighttime All Others Medical Emergency PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 34 February 1, 2018 Current Medical Emergency Patient Volume by Age Almost all (98.1%) cases had data on age. Based on a preliminary analysis of the ESO data,17 we found the relationship of the number of patients to patient age to be positive (1.033) and statistically significant (p < 0.001). That is, there are more older individuals represented in the ESO dataset than younger individuals, to a statistically significant degree. This indicates that older individuals are more likely than younger individuals to have a medical emergency in the combined Palo Alto/Stanford jurisdiction. We converted age into categories used by the U.S. Census Bureau’s American Community Survey (ACS) and the CA DOF, the better to compare statistics on current age of patients to predicted age of future patients. Note that certain ACS/DOF age groups contain fewer years (e.g., 60-64) than others (e.g., 65-74). For ease of viewing in the various charts below, the three lowest age categories have been merged; the 15-19 and 20-24 age categories have been merged, and the 55-59 and 60-64 age categories have been merged. (Data by original age categories are available upon request.) As shown in Figure 12, there tend to be more medical emergencies as individuals age. Figure 12, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Counts and Percentages, City of Palo Alto Source: Amber Cameron, City of Palo Alto Public Safety Department, personal communication containing PAFD ESO unduplicated data (2015/2016), July 24, 2017 (“City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016”). Notes: City was determined by ZIP Codes. Data for the City of Palo Alto are shown only for the 98% of cases where age of patient was available. Data for Stanford are shown in the chart in the Stanford section; data for other cities (2% of the cases used to generate the average counts and percentages) are not shown. 17 We used a simple linear regression in which we predicted number of medical emergency patients by patient age in combined years 2015 and 2016. 0% 5% 10% 15% 20% 25% 0 200 400 600 800 1,000 1,200 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ Av e r a g e N u m b e r o f P a t i e n t s ( P a t i e n t Vo l u m e ) Palo Alto # Palo Alto % PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 35 February 1, 2018 Comparatively, a much greater proportion of older adults are being served by PAFD for medical emergencies compared to the proportion of older adults in the resident population. In Figure 13, we compare the average current medical emergency patient volume in the City of Palo Alto to its residential population, by the proportion of individuals of each age group represented among patients and residents. Figure 13, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Percentages, Compared to Residential Population by Age Category, City of Palo Alto Sources: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016; U.S. Census Bureau, 2014. Notes: For purposes of medical emergency data, city was determined by ZIP Codes. Data for Stanford are shown in the chart in the Stanford section; data for other cities (216 of the 10,943 cases used to generate the percentages) are not shown. One can see that in Palo Alto, adults aged 55 and older are medical emergency patients at higher rates than they are present in the residential population, with medical emergency patients who are aged 85 and older representing more than seven times their proportion in the residential population. Current Medical Emergency Patient Volume by Gender Of the patients originating in the City of Palo Alto for whom gender was reported (97.1%), slightly more than half (52.3%) were female, on average. Current Medical Emergency Patient Volume by Incident Location (ZIP Code) Virtually all cases included data on incident ZIP Code. The vast majority of medical emergency patients (98%) identified in the ESO dataset were assisted in the cities of Palo Alto or Stanford (see Figure 14; map does not show the approximately 8% of cases associated with ZIP Codes 4% 7% 9%8% 10% 14% 12%13% 22% 19% 10% 13%14%15% 12% 9% 5% 3% 0% 5% 10% 15% 20% 25% 30% Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ Palo Alto Medical Emergency Patient Volume Palo Alto Resident Population PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 36 February 1, 2018 representing P.O. boxes). Most patients (an average of 43%) were found downtown, in the 94301 ZIP Code. A further breakdown of patient volume by ZIP Code, by year, may be found in Appendix 7. Figure 14, Map of Current Medical Emergency Patient Volume by Incident ZIP Code, 2015/2016 Average Sources: Map from DataSF.org, 2017; data from City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Map does not show P.O. box ZIP Codes 94302 (6.4%) and 94309 (1.5%). 2,360 (43%) 546 (10%) 696 (13%) 862 (16%) 467 (9%) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 37 February 1, 2018 Current Medical Emergency Patient Volume by Type of Illness/Issue Medical emergency patients called 911 with a wide variety of symptoms. Table 4 offers categories (higher-level groupings) of primary impressions by year. We remind the reader that some patients are represented more than once in the ESO data, since they may have called and been seen by PAFD more than once. The primary impressions associated with the greatest proportions of medical emergency patients in Palo Alto appear to be altered level of consciousness (ALOC)18, followed by injury and cardiac-related issues. Table 4, All Medical Emergency (ME) Patients, Categories of Primary Impressions, 2015/2016 Average, in Order of Frequency for the City of Palo Alto Primary Impression Category Annual Avg. % (#) of ME Patients in Palo Alto, 2015/2016 Altered Level of Consciousness 29.2% (1,290) Injury (Traumatic or Otherwise) or Hemorrhage 23.2% (1,026) Cardiac-Related 10.6% (469) Non-Specific Pain 8.8% (389) Abdominal Discomfort 7.4% (328) Respiratory-Related 6.6% (291) Behavioral Health 5.0% (220) All Other* 4.5% (198) No Complaints or Injury/Illness Noted 2.6% (116) Data Missing 2.2% (96) TOTAL 4,423 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Percentages may not add to exactly 100% due to rounding. *“All other” comprises other impression types that represented < 1% of calls both years. 18 Note that this last category is based on a patient’s actual level of wakefulness and/or disorientation (Tindall, 1990), and does not refer to drug-induced hallucinatory experience. However, based on a scan of the data, some small number (<5%) of cases identified as ALOC may be related to alcohol or drug use. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 38 February 1, 2018 Appendix 9 provides patient volume by primary impression, separately for day versus night. Based on Appendix 9, medical emergency patients are seen more often during the day than at night in the City of Palo Alto. More specifically, ALOC, injury/hemorrhage, and (to a lesser extent) cardiac-related issues occur significantly more often (p < 0.05, based on a one-way ANOVA analysis) during the daytime, while behavioral health issues, abdominal discomfort, and non-specific pain occur significantly more often at night, statistically speaking (p < 0.05). For reference, Appendix 3 lists the total number and percentage of patient cases by all primary impressions by year, and includes the category into which each primary impression was placed. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 39 February 1, 2018 Predictive Analysis Findings: City of Palo Alto, Year 2030 Based on our analysis of current call volume and calls by type, we have predicted year 2030 call volume and calls by type for the City of Palo Alto (and for Stanford, separately, in the next section).19 As described briefly in the Predictive Analysis Methods Summary section at the beginning of this report, we used a modified life table approach, which is generally used to describe a current population and predict future growth or decline. We assume that the 2030 cohort will be subject, proportionally, to the age-specific medical emergency call/patient volumes, other call type volumes, incident locations, and primary impressions that prevailed for the 2015/2016 cohort. We adjusted medical emergency call/patient volume predictions by age based on CA DOF (2017) projections. We predicted call/patient volume and calls by type for day and night separately, using population figures based on CA DOF figures, City of Palo Alto scenarios, and City of Palo Alto Transportation Survey results (2013). A full description of this process may be found in Appendix 4. We provide predictions for all call types that represented at least 1% of calls in the 2015 or 2016 CAD datasets. The remainder are grouped into a call type category labeled “Other.” We used ESO data (described in Predictive Analysis Methods Summary section of this report) to adjust predictions for the medical emergency call type based on medical emergency patient volume and expected age-related shifts in the demographics for the City of Palo Alto (and for Stanford, separately, in the next section) between now and 2030.20 This process is also further described in Appendix 5. The overall 2030 predictions for the City of Palo Alto for all call types and for patient volumes take into account projected daytime and nighttime visitors, as well as larger daytime populations based on net commuters, again based on CA DOF figures, City of Palo Alto scenarios, and City of Palo Alto Transportation Survey results.21 Further information on this process may be found in Appendix 5. Projected Population Overall and by Time of Day As shown earlier in Table 3, the City of Palo Alto has a current (2014) residential population of 65,685 people, which is projected to rise to between 72,285 and 79,765 by the year 2030 (see scenarios from Hilary Gitelman, Planning & Community Environment Department, City of Palo Alto, personal communication, December 21, 2016). Nighttime population is the same as what 19 Due to the lack of ZIP Codes in the CAD data, we were not able to estimate call volume by ZIP Code, PAFD district, or other sub-city-level areas (e.g., neighborhood). 20 Note that while there were no data projecting gender for sub-county-level areas, the projections of gender by county (CA DOF, 2017) suggest that the projected change in gender proportions between now and 2030 is not statistically significant in either San Mateo County or Santa Clara County (Chi-square = 2.00, p > 0.05). Therefore, we do not include gender as a factor in our predictions. 21 However, figures and tables in this report that show data by age group generally do not include visitors (see text associated with various figures/tables for explanation). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 40 February 1, 2018 the U.S. Census would consider the residential population. Daytime population is a net total of nighttime residents who stay, residents who “out-commute” to somewhere besides the City of Palo Alto, and individuals from other cities who “in-commute” to the City of Palo Alto. Based on Table 3, the City of Palo Alto’s year 2014 daytime population (not including visitors) was estimated to be 129,616 people, and projected to rise to between 142,841 and 150,587 by the year 2030. Figures 15 and 16 show the recent (2014) and projected 2030 population for the City of Palo Alto, comparing daytime (Figure 15) and nighttime (Figure 16) figures by age. The charts show the lowest and highest 2030 population projections based on the six scenarios provided by the City of Palo Alto (see Table 3); note that the lowest and highest scenarios are different for the daytime population (Scenarios 5 and 4) than for the nighttime population (Scenarios 2 and 6). Visitors were not included in Figures 15 and 16 because the data available for estimating visitors’ ages in 2030 grouped age into four broad categories rather than the 13 categories available for estimating residents’ and workers’ ages; however, visitors are very small proportions of the total populations. Figure 15, Current and Year 2030 Projected Populations by Age Category, Daytime, City of Palo Alto Sources: Hilary Gitelman, City of Palo Alto Planning & Community Environment department, personal communication, December 21, 2016; U.S. Census Bureau, 2014. Note: Excludes visitors to increase age category granularity (see text for further explanation). In both Scenario 4 (the highest 2030 daytime population projection) and Scenario 5 (the lowest 2030 daytime population projection) the projection is higher than its 2014 comparison for all age categories except age 0-14 and 65-74. - 5,000 10,000 15,000 20,000 25,000 30,000 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ 2014 Daytime (Residential & Commuter) Pop. 2030 Projected Daytime Pop. - Sc. 5 2030 Projected Daytime Pop. - Sc. 4 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 41 February 1, 2018 Figure 16, Current and Year 2030 Projected Populations by Age Category, Nighttime, City of Palo Alto Sources: Hilary Gitelman, City of Palo Alto Planning & Community Environment department, personal communication, December 21, 2016; U.S. Census Bureau, 2014. Note: Excludes visitors to increase age category granularity (see text for further explanation). Scenario 2 (the lowest year 2030 nighttime population projection) is higher than its year 2014 comparison for all age categories except ages 0-14, 25-34, and 35-44. Scenario 6 (the highest 2030 nighttime population projection) is higher than its 2014 comparison for all age categories except ages 0-14 and 25-34. Overall, based on these scenarios, it appears that the absolute numbers of residents in younger age categories (particularly ages 0-14, 25-34, and 35-44, but not age 15-2422) are generally projected to be similar or to decrease in 2030 compared to 2014, while the numbers of residents in older age categories (particularly ages 55 and older23) are generally projected to increase in 2030 compared to 2014. 22 It may be that the 15-24 age group is not predicted to decrease in part because some of Stanford University’s students live in Palo Alto and the university’s student population is expected to increase over time (Stanford University, 2016). 23 Since the workforce is overwhelmingly made up of individuals between ages 20-64 (Bureau of Labor Statistics, 2016), even though labor force participation among those aged 65 and older has been increasing due to longer life spans and financial obligations (Kromer & Howard, 2013), we remained conservative in our predictions and used age groups 20-64 to represent the working population in the City of Palo Alto. It may well be that there are more individuals aged 65-74 commuting into the City of Palo Alto than our predictions indicate. - 5,000 10,000 15,000 20,000 25,000 30,000 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ 2014 Nighttime (Residential) Pop. 2030 Projected Nighttime (Residential) Pop. - Sc. 2 2030 Projected Nighttime (Residential) Pop. - Sc. 6 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 42 February 1, 2018 Predicted Medical Emergency Call Volume and Other Call Types by Time of Day For the purposes of our predictions, daytime is considered to be 8:00 a.m. to 7:59 p.m., and nighttime is considered to be 8:00 p.m. to 7:59 a.m. (Amber Cameron, City of Palo Alto Public Safety Department, personal communication, March 18, 2017). The time indicator used was the time of dispatch. Table 9 in Appendix 6 shows the average annual 2015/2016 call volume and the age-adjusted 2030 predicted call volume, by call type and time of day, for the City of Palo Alto. Table 9 also takes into account the six different City of Palo Alto scenarios. See Table 3 earlier in this report for the six scenarios. It is clear from the tables generated by the data that the total number of calls will increase between now and 2030 for all call types, and the volume of patients will increase between now and 2030 for medical emergencies. Figure 17 below shows the predicted change from 2015/2016 to 2030 for medical emergency calls and other major call types, for the City of Palo Alto. The grey portion of the bars shows the current (2015/2016 average) number of calls by type, the light green portion of the bars illustrates the lowest predicted increase, and the dark green portion of the bars indicates the highest predicted increase based on the six City of Palo Alto scenarios. Proportionally, it is predicted that CAD medical emergency calls will increase between 25% and 34% (depending on the growth scenario), while other types of calls will increase between 10% and 16% each, depending on the scenario.24 Figure 17, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, City of Palo Alto Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: Medical emergency calls are age- adjusted. “All other” comprises calls that make up less than 1.5% each in the unduplicated 2015/2016 CAD dataset (Gas, HazMat, Mutual Aid, etc.). 24 Since ESO medical emergency patient volume predicted increases are within one percentage point of CAD medical emergency call volume predicted increases, we do not display them separately here. They may be found in Appendix 7. 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 Fire Smoke All Other* Accident Service False Alarm Medical Emergency Base (2015/2016 Average) Minimum Predicted Increase Maximum Predicted Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 43 February 1, 2018 Figure 18 below shows the predicted change from 2015/2016 to 2030 for Medical Emergency calls and other major call types, for the City of Palo Alto during the daytime hours. The grey portion of the bars shows the current (2015/2016 average) number of calls by type, the light orange portion of the bars illustrates the lowest predicted increase, and the dark orange portion of the bars indicates the highest predicted increase based on the six City of Palo Alto scenarios. It is predicted that medical emergency calls will increase between 24% and 32% during the daytime (depending on the growth scenario), while other types of calls will increase between 9% and 16% each during the daytime, depending on the scenario. Figure 18, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Daytime, City of Palo Alto Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016.Notes: Medical emergency calls are age- adjusted. “All other” comprises calls that make up less than 1.5% each in the unduplicated 2015/2016 CAD dataset (Gas, HazMat, Mutual Aid, etc.). 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 Fire Smoke All Other* Accident Service False Alarm Medical Emergency Base (2015/2016 Average) Minimum Predicted Increase Maximum Predicted Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 44 February 1, 2018 Figure 19 below shows the predicted change from 2015/2016 to 2030 for medical emergency calls and other major call types, for the City of Palo Alto during the nighttime hours. The grey portion of the bars shows the current (2015/2016 average) number of calls by type, the light blue portion of the bars illustrates the lowest predicted increase, and the darker blue portion of the bars indicates the highest predicted increase based on the six City of Palo Alto scenarios. For the nighttime, it is predicted that medical emergency calls will increase between 26% and 39% (depending on the growth scenario), while other types of calls will increase between 8% and 22% each at night, depending on the scenario. Figure 19, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Nighttime, City of Palo Alto Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016.Notes: Medical emergency calls are age- adjusted. “All other” comprises calls that make up less than 1.5% each in the unduplicated 2015/2016 CAD dataset (Gas, HazMat, Mutual Aid, etc.). Although the absolute numbers of increased calls are smaller for nighttime than for daytime, the maximum proportional increases of medical emergency and other calls at night (39% and 22%, respectively) will be somewhat greater than the maximum proportional increases of medical emergency and other calls during the day (32% and 16%, respectively). Predicted Medical Emergency Patient Volume Originating in the City of Palo Alto Predicted Medical Emergency Patient Volume Overall and by Age Again, we converted age into categories used by the ACS and DOF, the better to compare statistics on current age of patients to predicted age of patients. For the sake of simplicity, in Figure 20 we merged certain age categories and show current and projected data on the City of Palo Alto and the two scenarios that generated the lowest (Scenario 2) and highest (Scenario 6) predictions. Visitors were not included in Figure 20 because the data available for estimating visitors’ ages in 2030 grouped age into four broad categories rather than the 13 categories 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 Fire Smoke All Other* Accident Service False Alarm Medical Emergency Base (2015/2016 Average) Minimum Predicted Increase Maximum Predicted Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 45 February 1, 2018 available for estimating residents’ and workers’ ages; however, visitors are very small proportions of the total populations.25 Figure 20, Current and Year 2030 Predicted Age-Adjusted Medical Emergency Patient Volume by Age Category, City of Palo Alto Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Excludes visitors to increase age category granularity (see text for further explanation). The 2030 City of Palo Alto predictions show overall increases of 24% to 33% in medical emergency patient volume (depending on the scenario) compared to current medical emergency patient volume (see Appendix 6). Over two thirds (68%) of the City of Palo Alto’s predicted 2030 medical emergency patients will be aged 55+. The City of Palo Alto will experience a statistically significant change in age between current and 2030 medical emergency patients.26 The data suggest that the City of Palo Alto’s medical emergency patients in 2030 will skew significantly towards older adults, from a mean patient age of 55-64 to a slightly older demographic, with the modal, i.e., most common, patient age category in 2030 being those aged 85+ in all six scenarios. In other words, the City of Palo Alto will have more older medical emergency patients in 2030, both in terms of absolute numbers (Figure 20) and a skew towards older adult patients. This is the major issue for which the City of Palo Alto and PAFD will need to prepare. Predicted Medical Emergency Patient Volume by Time of Day Based on ESO data, there will be very little change in the City of Palo Alto’s proportion of medical emergency patients by time of day. In 2015/2016, the average proportion of daytime medical emergency patients was 68.6%, while in 2030 the proportion of daytime medical emergency patient volume originating in the City of Palo Alto is predicted to be between 67.3% (Scenario 6) – slightly lower than the current proportion – and 68.9% (Scenario 1) – slightly 25 Including daytime and overnight visitors would only increase the predicted numbers of patients by an average of 39 in total, across all age groups – a very small proportion of the total number of predicted interactions overall. 26 An increase of 0.30 in Scenario 2 and 0.34 in Scenario 6, approximately one third of an age category using the merged age categories in the chart above, p < 0.001 in both scenarios, F = 37.288 for Scenario 2 and 47.671 for Scenario 6. - 200 400 600 800 1,000 1,200 1,400 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ 2015/2016 Avg. # PA ME Patients 2030 Predicted # PA ME Patients-Sc. 2 2030 Predicted # PA ME Patients-Sc. 6 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 46 February 1, 2018 higher than the current proportion. In none of the scenarios is the proportional change from 2015/2016 to 2030 statistically significant. This means that PAFD will continue to see a much higher call volume from the City of Palo Alto during the daytime than at night. Predicted Medical Emergency Patient Volume by Type of Illness/Issue In 2015/2016, the primary impressions that were associated with the greatest proportions of medical emergency patients in the City of Palo Alto were altered level of consciousness,27 followed by injury and cardiac-related issues (see Table 4, earlier in this report). As shown in Table 5, the order of the top primary impressions remains the same in the predictions for year 2030. Table 5, Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, by City, in Order of Frequency, City of Palo Alto Primary Impression Category % (#) Scen. 2 (Lowest) PA, 2030 % (#) Scen. 6 (Highest) PA, 2030 Altered Level of Consciousness 30.4% (1,625) 30.5% (1,748) Injury/Hemorrhage 23.2% (1,239) 23.1% (1,328) Cardiac-Related 11.4% (607) 11.4% (654) Non-Specific Pain 8.9% (478) 8.9% (513) Abdominal Discomfort 7.6% (404) 7.5% (433) Respiratory-Related 6.9% (371) 7.0% (402) Behavioral Health 4.6% (246) 4.5% (259) All Other* 4.5% (238) 4.4% (255) No Complaints 2.6% (137) 2.6% (147) TOTAL 5,345 5,739 Source: Actionable Insights, LLC, 2017, unpublished data, based on City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Percentages may not add to exactly 100% due to rounding. *“All other” comprises other primary impression types that represented < 1% of calls in both years. 27 Altered level of consciousness is based on “a patient’s actual level of wakefulness and/or disorientation” (Tindall, 1990) and has a variety of causes, including dehydration, hypoglycemia, and shock, but is not intended to refer to symptoms that are directly related to drug or alcohol use. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 47 February 1, 2018 However, it is also important for PAFD’s future planning to review the primary impressions that will increase the most between 2015/2016 and the year 2030. In absolute numbers, predictions suggest that the greatest increase in the City of Palo Alto will be among ALOC patients (ranging from an increase of 335, or 26%, in Scenario 2 to an increase of 458, or 36%, in Scenario 6). However, proportionally, the greatest increases in the City of Palo Alto will be among cardiac patients28 and respiratory patients.29 See Figures 21 and 22 for a representation of City of Palo Alto increases in absolute numbers by primary impression, for daytime and nighttime separately.30 See Appendix 9 for total predicted changes in primary impression categories, by city and time of day. Figure 21, Comparison of Actual Average Annual Patient Volume versus Predicted Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, City of Palo Alto, Daytime Source: Actionable Insights, LLC, 2017, unpublished data, and City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. 28 Ranging from an increase of 30%, or 139 more patients, in Scenario 2 to an increase of 40%, or 186 more patients, in Scenario 6. 29 Ranging from an increase of 28%, or 81 more patients, in Scenario 2 to an increase of 39%, or 112 more patients, in Scenario 6. 30 Note that Scenario 4, not Scenario 6, has the highest increases for daytime in the City of Palo Alto. - 250 500 750 1,000 1,250 Abdominal Altered Level of Consciousness Behavioral Health Cardiac Injury/ Hemorrhage Non-Specific Pain Respiratory 2015/2016 Average 2030 Lowest # Increase (Sc. 2)2030 Highest # Increase (Sc. 4) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 48 February 1, 2018 Figure 22, Comparison of Actual Average Annual Patient Volume versus Predicted Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, City of Palo Alto, Nighttime Source: Actionable Insights, LLC, 2017, unpublished data, and City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. We conducted a binary logistic regression analysis to determine which variables, if any, were significant in determining the increase in patient volume between 2015/2016 and 2030 (note that we used Scenario 6 for the City of Palo Alto’s 2030 figures). Regression analysis is a statistical method to explain the relationship between a dependent variable (in this case, medical emergency patient volume in the year 2015/2016 compared to the year 2030) and various independent or “explanatory” variables (for this analysis, patient age categories, daytime versus nighttime dispatch, and what kind of primary impression the patient presents). Binary logistic regression is a special form of regression analysis used when the dependent variable has only two values (in this case, total patient volume for the year 2015/2016 and predicted total patient volume for the year 2030). We tried a variety of regression equations, changing how we represented primary impression as a variable in the models. No matter how we constructed the primary impression variable(s), only patient age was significant in the binary logistic regression analyses for the City of Palo Alto; primary impressions were not statistically significant indicators in any model. As described earlier in this section on 2030 predictions for PAFD, the main issue for which the City of Palo Alto and PAFD will need to prepare is the expected increase in older medical emergency patients in 2030. - 250 500 750 1,000 1,250 Abdominal Altered Level of Consciousness Behavioral Health Cardiac Injury/ Hemorrhage Non-Specific Pain Respiratory 2015/2016 Average 2030 Lowest # Increase (Sc. 2)2030 Highest # Increase (Sc. 6) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 49 February 1, 2018 PAFD Calls and Medical Emergency Patients: Stanford, 2015 and 2016 As described in the City of Palo Alto section, the PAFD data contained all unique 2015 and 2016 calls from PAFD’s internal CAD and ESO medical emergency services data systems. The CAD dataset includes all types of calls to PAFD for dispatch (e.g., fire, medical emergency, false alarm), which were restricted for the purposes of these analyses to Stanford (and, in the previous section, the City of Palo Alto). Note that CAD call types are the initial presumption of incident type, based on what dispatchers are told, not the incident type verified by PAFD personnel once they are at the scene. The ESO dataset contains only medical emergency patients for whom PAFD was dispatched, but includes incident ZIP Code, patient age, gender, and primary impression. A “primary impression” is the main problem, condition, or symptom that brought about the encounter between the patient and EMS personnel. This section briefly describes the current data for Stanford, with a special focus on medical emergency calls/patients. PAFD CAD Calls Originating in the Stanford Area Current Call Volume and Type Of all calls for service to PAFD during 2015 and 2016, an average of approximately 15% per year originated in Stanford (15.8% in 2015 and 14.3% in 2016). Based on the CAD data provided by PAFD for calls originating only from Stanford, in 2015 and 2016 there were a total of 2,482 calls for service to PAFD (1,289 in 2015 and 1,193 in 2016). See Figure 23 on the next page for a chart of the percentage of calls by call type originating from Stanford. Appendix 6 shows how many unique calls of each type by city, on average. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 50 February 1, 2018 Figure 23, PAFD Calls for Service Originating from Stanford, 2015/2016 Average Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Note: “Service” calls are, for example, assisting with lock-outs, water leaks, police assists. * “All Other” is comprised of all call types that by themselves represent less than 1.5% of calls from Stanford to PAFD.31 Current Medical Emergency Calls by Time of Day Approximately 50% of all calls for service in Stanford each year were classified as medical emergency (50.2% in 2015 and 50.1% in 2016). More calls came in during the day than at night. 31 The categories of call included in “All Other” for Stanford are: Auto Aid, Gas, Hazardous Materials, Mutual Aid, Second Alarm, Vegetation Fire, and Wires. Taken all together, these represent less than 3% of calls from Stanford to PAFD. Smoke remains a separate category so this chart can be comparable to Figure 10 (City of Palo Alto calls by type). Smoke Fire Accident All Other * Service False Alarm Medical Emergency 0% 10% 20% 30% 40% 50% 60% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 51 February 1, 2018 See Figure 24. It is important to note that the total difference in volume between daytime and nighttime calls on Stanford is much smaller than that of the City of Palo Alto. Figure 24, PAFD Calls by Type and Time of Day, 2015/2016 Average, Stanford Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. PAFD Medical Emergency Patient Volume Originating in the Stanford Area Based on the ESO data provided by PAFD for the Stanford area, there were a total of 1,890 medical emergency patients during 2015 and 2016 (916 in 2015 and 974 in 2016). Note that an individual may be a patient more than once in a given year, and each time a patient presents, s/he requires PAFD’s attention. Actionable Insights was asked to analyze the ESO data by age, gender, ZIP Code, and primary impression, and to provide PAFD with predictions about future medical emergency patients in the Stanford area based on these data. Current data are found in this section, while predictions may be found in the next section. 370 253 399 220 0 200 400 600 800 1,000 Stanford Daytime Stanford Nighttime All Others Medical Emergency PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 52 February 1, 2018 Current Medical Emergency Patient Volume by Age As described in the section on the City of Palo Alto, based on a preliminary analysis of the ESO data,32 we find that the relationship of the number of patients to patient age is positive (1.033) and statistically significant (p < 0.001). That is, there are more older individuals represented in the ESO dataset than younger individuals, to a statistically significant degree. This indicates that older individuals are more likely than younger individuals to have a medical emergency in the combined Palo Alto/Stanford jurisdiction. We converted age into categories used by the U.S. Census Bureau’s American Community Survey (ACS) and the CA DOF, the better to compare statistics on current age of patients to predicted age of future patients. Note that certain ACS/DOF age groups contain fewer years (e.g., 60-64) than others (e.g., 65-74). For ease of viewing in the various charts below, the three lowest age categories have been merged; the 15-19 and 20-24 age categories have been merged, and the 55-59 and 60-64 age categories have been merged. (Data by original age categories are available upon request.) As shown in Figure 25, aside from the spike for young adults ages 15-24 (which is appropriate given the demographics of the Stanford area), there tend to be more medical emergencies as individuals age. Figure 25, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Counts and Percentages, Stanford Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Notes: City was determined by ZIP Codes. Data for Stanford are shown only for the 99% of cases where age of patient was available. Data for the City of Palo Alto are shown in the chart in the Palo Alto section; data for other cities (2% of the cases used to generate the average counts and percentages) are not shown. 32 We used a simple linear regression in which we predicted number of medical emergency patients by patient age in combined years 2015 and 2016. 0% 5% 10% 15% 20% 25% 30% 0 50 100 150 200 250 300 350 400 450 500 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ Av e r a g e N u m b e r o f P a t i e n t s ( P a t i e n t Vo l u m e ) Stanford # Stanford % PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 53 February 1, 2018 Comparatively, a much greater proportion of older adults are being served by PAFD for medical emergencies compared to the proportion of older adults in the resident population. In Figure 26, we compare the average current medical emergency patient volume for Stanford to its residential population, by the proportion of individuals of each age group represented among patients and residents. Figure 26, Current Medical Emergency Patient Volume by Age Category, 2015/2016 Average Percentages, Compared to Residential Population by Age Category, Stanford Sources: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016; U.S. Census Bureau, 2014. Notes: For purposes of medical emergency data, city was determined by ZIP Codes. Data for the City of Palo Alto are shown in the chart in the Palo Alto section; data for other cities (216 of the 10,943 cases used to generate the percentages) are not shown. At Stanford, adults aged 35 and older are medical emergency patients at higher rates than they are present in the residential population, with medical emergency patients who are aged 85 and older being represented at 15 times their proportion in the residential population. Current Medical Emergency Patient Volume by Gender Of the patients originating in the Stanford area for whom gender was reported (98.4%), slightly more than half (52.1%) were female, on average. Current Medical Emergency Patient Volume by Incident Location (ZIP Code) Virtually all cases included data on incident ZIP Code. The vast majority of medical emergency patients (98%) identified in the ESO dataset were assisted in the cities of Palo Alto or Stanford 4% 28% 13% 7%8%10%7%8% 15% 6% 64% 15% 4%3%4%3%1%1% 0% 15% 30% 45% 60% 75% Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ Stanford Medical Emergency Patient Volume Stanford Resident Population PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 54 February 1, 2018 (see map in the City of Palo section, Figure 14; map does not show the approximately 8% of cases associated with ZIP Codes representing P.O. boxes). An average of 16% of all patients were found in the 94305 (Stanford) ZIP Code. A further breakdown of patient volume by ZIP Code, by year, may be found in Appendix 7. Current Medical Emergency Patient Volume by Type of Illness/Issue Medical emergency patients called 911 with a wide variety of symptoms. Table 6 offers categories (higher-level groupings) of primary impressions by year. We remind the reader that some patients are represented more than once in the ESO data, since they may have called and been seen by PAFD more than once. Table 6, All Medical Emergency (ME) Patients, Categories of Primary Impressions, 2015/2016 Average, in Order of Frequency for Stanford Primary Impression Category Annual Avg. % (#) of ME Patients in Stanford, 2015/2016 Altered Level of Consciousness 28.9% (273) Injury (Traumatic or Otherwise) or Hemorrhage 28.0% (265) Behavioral Health 9.4% (89) Non-Specific Pain 7.3% (69) Abdominal Discomfort 7.0% (66) Cardiac-Related 6.1% (58) Respiratory-Related 4.8% (45) All Other* 4.0% (38) No Complaints or Injury/Illness Noted 3.3% (31) Data Missing 1.2% (11) TOTAL 945 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Percentages may not add to exactly 100% due to rounding. *“All other” comprises other impression types that represented < 1% of calls both years. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 55 February 1, 2018 The primary impressions associated with the greatest proportions of medical emergency patients in the Stanford area appear to be ALOC33, followed by injury and behavioral health issues. Appendix 9 provides patient volume by primary impression, separately for day versus night. Based on Appendix 9, in the Stanford area all primary impressions except behavioral health issues occur more often during the day than at night. Behavioral health issues occur significantly more often at night than any other primary impression, statistically speaking.34 For reference, Appendix 3 lists the total number and percentage of patient cases by all primary impressions by year, and includes the category into which each primary impression was placed. 33 Note that this last category is based on a patient’s actual level of wakefulness and/or disorientation (Tindall, 1990), and does not refer to drug-induced hallucinatory experience. However, based on a scan of the data, some small number (<5%) of cases identified as ALOC may be related to alcohol or drug use. 34 Depending on the primary impression to which behavioral health is being compared, these differences range from 28% more often (compared to abdominal discomfort) to 39% more often (compared to injury/hemorrhage). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 56 February 1, 2018 Predictive Analysis Findings: Stanford, Year 2030 Based on our analysis of current call volume and calls by type, we have predicted year 2030 call volume and calls by type for Stanford (and for the City of Palo Alto, separately, in the previous section).35 As described briefly in the Predictive Analysis Methods Summary section at the beginning of this report, we used a modified life table approach, which is generally used to describe a current population and predict future growth or decline. Stanford’s daytime population could not be broken down by age, as data on age ranges of the Stanford workforce were not available to us at a granular-enough level. Therefore, we adjusted nighttime (but not daytime) medical emergency call/patient volume predictions by age based on CA DOF (2017) projections (see Appendix 5 for details).36 We predicted call/patient volume and calls by type for day and night separately, using population figures based on CA DOF figures, Stanford University (2016) GUP projections, and City of Palo Alto Transportation Survey results (2013). A full description of this process may be found in Appendix 4. We provide predictions for all call types that represented at least 1% of calls in the 2015 or 2016 CAD datasets. The remainder are grouped into a call type category labeled “Other.” We used ESO data (described in the Predictive Analysis Methods Summary section at the beginning of this report) to adjust predictions for the medical emergency call type based on medical emergency patient volume and (for the nighttime population only) expected age- related shifts in the demographics for Stanford between now and 2030. This process is also further described in Appendix 5. The 2030 predictions for Stanford for all call types and for patient volumes take into account projected daytime and nighttime visitors, as well as larger daytime populations based on net commuters, again based on CA DOF figures, Stanford University GUP projections, and City of Palo Alto Transportation Survey results. Further information on this process may be found in Appendix 5. Projected Population The Stanford area has a current (2014) residential population of 13,506 people (U.S. Census Bureau, 2014), which is projected to rise to 20,296 by the year 2030 (calculated based on the GUP, Stanford University, 2016). The “nighttime” population we discuss in this section is the same as what the U.S. Census would consider the residential population. 35 Due to the lack of ZIP Codes in the CAD data, we were not able to estimate call volume by ZIP Code, PAFD district, or other sub-city-level areas (e.g., neighborhood). 36 Note that while there were no data projecting gender for sub-county-level areas, the projections of gender by county (CA DOF, 2017) suggest that the projected change in gender proportions between now and 2030 is not statistically significant in either San Mateo County or Santa Clara County (Chi-square = 2.00, p > 0.05). Therefore, we do not include gender as a factor in our predictions. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 57 February 1, 2018 Daytime population is a net total of nighttime residents who stay, residents who “out- commute” to somewhere besides Stanford, and individuals from other cities who “in- commute” to Stanford. Stanford’s 2014 daytime population was estimated to be 38,327 people, and projected to rise to 49,695 (see Appendix 5 for further information on the calculation of projected populations). As mentioned previously, Stanford’s daytime population could not be broken down by age, as data on age ranges of the Stanford workforce were not available to us at a granular-enough level. Figure 27 shows the recent (2014) and projected 2030 residential (nighttime) population for Stanford, by age range. Note that visitors were not included in the chart because the data available for estimating visitors’ ages in 2030 grouped age into four broad categories rather than the 13 categories available for estimating residents’ ages; however, visitors are very small proportions of the total population. Figure 27, Current and Year 2030 Projected Residential Populations by Age Category, Stanford Source: Stanford University, 2016; U.S. Census Bureau, 2014. Note: Excludes visitors to increase age category granularity (see text for further explanation). Predicted Medical Emergency Call Volume and Other Call Types For the purposes of our predictions, daytime is considered to be 8:00 a.m. to 7:59 p.m., and nighttime is considered to be 8:00 p.m. to 7:59 a.m. (Amber Cameron, personal communication, March 18, 2017). The time indicator used was the time of dispatch. Appendix 6 contains tables showing the average annual 2015/2016 call volume and the age-adjusted 2030 predicted call volume, by call type and time of day (not age-adjusted for Stanford daytime predicted 2030 calls). As mentioned previously, Stanford’s daytime population could not be - 1,000 2,000 3,000 4,000 5,000 6,000 7,000 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ 2014 Nighttime (Residential) Pop. 2030 Projected Nighttime (Residential) Pop. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 58 February 1, 2018 broken down by age, as data on age ranges of the Stanford workforce were not available to us at a granular-enough level. This means that only nighttime, not daytime, CAD medical emergency call predictions for Stanford are age-adjusted. Total average nighttime Stanford call volume in 2015/2016 was 473, and predicted to be 710 (age-adjusted) in 2030. Total average daytime Stanford call volume in 2015/2016 was 769, and predicted to be 973 (not age-adjusted) in 2030. It is clear from these data that the total number of calls will increase between now and 2030 for all call types. Figure 28 below shows the predicted change from 2015/2016 to 2030 for medical emergency calls and other major call types, for Stanford. The grey portion of the bars shows the current (2015/2016 average) number of calls by type and the red portion of the bars shows the predicted increase. Proportionally, it is predicted that medical emergency calls will increase by 36%.37 Figure 28, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Stanford Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: Nighttime medical emergency calls are age-adjusted, daytime medical emergency calls are not (see text for explanation). “All other” comprises calls that make up less than 1.5% each in the unduplicated 2015/2016 CAD dataset (Gas, HazMat, Mutual Aid, etc.). 37 Since ESO medical emergency residential patient volume predicted increases are within one to two percentage points of CAD medical emergency residential call volume predicted increases, we do not display them separately here. They may be found in Appendix 7. 0 200 400 600 800 1,000 Smoke Fire Accident All Other* Service False Alarm Medical Emergency Base (2015/2016 Average) Predicted Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 59 February 1, 2018 Figure 29 below shows the predicted change from 2015/2016 to 2030 for medical emergency calls and other major call types, for Stanford during the daytime hours. Again, we note that these figures are not age-adjusted due to the lack of granularity in age-range information for Stanford employees. The grey portion of the bars shows the current (2015/2016 average) number of calls by type and the yellow portion of the bars indicates the predicted increase. It is predicted that medical emergency calls will increase by approximately 27% during the daytime. Figure 29, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Daytime, Stanford Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: Daytime medical emergency calls are not age-adjusted (see text for explanation). “All other” comprises calls that make up less than 1.5% each in the unduplicated 2015/2016 CAD dataset (Gas, HazMat, Mutual Aid, etc.). 0 200 400 600 800 1,000 Smoke Fire Accident All Other* Service False Alarm Medical Emergency Base (2015/2016 Average) Predicted Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 60 February 1, 2018 Figure 30 below shows the predicted change from 2015/2016 to 2030 for medical emergency calls and other major call types, for Stanford during the nighttime hours. The grey portion of the bars shows the current (2015/2016 average) number of calls by type and the dark blue portion of the bars indicates the predicted increase. It is predicted that medical emergency calls will increase by 50% during the nighttime. Figure 30, Predicted Change in Average Annual Call Volume from 2015/2016 to 2030, Major Call Types, Nighttime, Stanford Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: Nighttime medical emergency calls are age-adjusted, daytime medical emergency calls are not (see text for explanation). “All other” comprises calls that make up less than 1.5% each in the unduplicated 2015/2016 CAD dataset (Gas, HazMat, Mutual Aid, etc.). Although the absolute numbers of increased calls are smaller for Stanford during the nighttime than for the daytime, the proportional increases of medical emergency and other calls at night (50%) will be much greater than the proportional increases of medical emergency and other calls during the day (27%). These predictions, taken with the current baseline data, could suggest that nighttime call volume at Stanford may increase faster than daytime call volume over time, resulting in a closer balance between day and night call volume. That is, based on this analysis (which we remind the reader is limited by the fact that Stanford daytime medical emergency call predictions could not be age-adjusted), nighttime calls to PAFD from Stanford are predicted to drop from 62% to 58% of total Stanford call volume by 2030. 0 200 400 600 800 1,000 Smoke Fire Accident All Other* Service False Alarm Medical Emergency Base (2015/2016 Average) Predicted Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 61 February 1, 2018 Predicted Medical Emergency Patient Volume Originating in the Stanford Area Predicted Medical Emergency Patient Volume Overall and by Age Overall, there were an average of 933 medical emergency patients annually from Stanford in 2015/2016, with 600 during the daytime and 333 at night. It is predicted that there will be 1,213 medical emergency patients from Stanford in 2030, with 713 predicted during the daytime (not age-adjusted) and 500 predicted at night (age-adjusted). Below, we review the nighttime (residential) predictions by age. Again, we converted age into categories used by the ACS and DOF, the better to compare statistics on current age of patients to predicted age of patients. For the sake of simplicity, in Figure 31 we merged certain age categories. The figure shows current and projected data on Stanford’s residential (i.e., nighttime) population. As mentioned previously, granular-enough data are not available for Stanford’s daytime population by age range. Visitors were not included in the figure because the data available for estimating visitors’ ages in 2030 grouped age into four broad categories rather than the 13 categories available for estimating residents’ and workers’ ages; however, visitors are very small proportions of the total population.38 Figure 31, Current and Year 2030 Predicted Age-Adjusted Residential Medical Emergency Patient Volume by Age Category, Stanford Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Excludes visitors to increase age category granularity (see text for further explanation). 38 Including daytime and overnight visitors would only increase the predicted numbers of patients by an average of 39, across all age groups – a very small proportion of the total number of predicted interactions overall. - 20 40 60 80 100 120 140 160 180 200 Age 0-14 Age 15-24 Age 25-34 Age 35-44 Age 45-54 Age 55-64 Age 65-74 Age 75-84 Age 85+ 2015-16 Avg. # Stanford ME Patients 2030 Predicted # Stanford ME Patients PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 62 February 1, 2018 As with the 2030 Palo Alto predictions, the 2030 Stanford predictions show increases in medical emergency patient volume compared to current medical emergency patient volume at approximately 31% overall (see Appendix 6). However, less than a third (32%) of Stanford’s predicted 2030 residential medical emergency patients will be age 55+, while over 40% will be age 15-24. Predicted Medical Emergency Patient Volume by Type of Illness/Issue In 2015/2016, the primary impressions that were associated with the greatest proportions of medical emergency patients in Stanford were altered level of consciousness,39 followed by injury and behavioral health issues. The order of the top primary impressions for Stanford (see Table 7) remains the same in the predictions for year 2030, although we note that the portion of primary impression predictions that relate to the daytime population are not age-adjusted due, as discussed previously, to a lack of granular-enough data on Stanford’s employees’ age ranges. Table 7, Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, in Order of Frequency Primary Impression Category % (#) Stanford, 2030 Altered Level of Consciousness 29.2% (367) Injury/Hemorrhage 28.0% (352) Behavioral Health 10.1% (127) Non-Specific Pain 7.4% (93) Abdominal Discomfort 7.1% (90) Cardiac-Related 6.2% (78) Respiratory-Related 4.8% (61) All Other* 4.1% (51) No Complaints 3.2% (40) TOTAL 1,259 Source: Actionable Insights, LLC, 2017, unpublished data, based City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Notes: Not age-adjusted. Percentages may not add to exactly 100% due to rounding. *“All other” comprises other primary impression types that represented < 1% of calls in both years. 39 Altered level of consciousness is based on “a patient’s actual level of wakefulness and/or disorientation” (Tindall, 1990) and has a variety of causes, including dehydration, hypoglycemia, and shock, but is not intended to refer to symptoms that are directly related to drug or alcohol use. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 63 February 1, 2018 However, it is also important for PAFD’s future planning to review the primary impressions that will increase the most between 2015/2016 and the year 2030. Stanford predictions suggest that the greatest increase in absolute numbers will be among ALOC patients40 and injury patients.41 However, the greatest proportional increases will be among behavioral health patients (43%, or an increase of 38 more patients). See Figures 32 and 32 for a representation of Stanford increases in absolute numbers by primary impression, for daytime and nighttime separately. See Appendix 9 for total predicted changes in primary impression categories, by city and time of day. Figure 32, Comparison of Actual versus Predicted Absolute Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, Stanford, Daytime Source: Actionable Insights, LLC, 2017, unpublished data, and City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Not age-adjusted. 40 An increase of 94 more patients, or 34%. 41 An increase of 87 more patients, or 33%. - 100 200 300 Abdominal Altered Level of Consciousness Behavioral Health Cardiac Injury/ Hemorrhage Non-Specific Pain Respiratory 2015/2016 Average 2030 # Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 64 February 1, 2018 Figure 33, Comparison of Actual versus Predicted Absolute Change in Average Annual Patient Volume from 2015/2016 to 2030, by Primary Impression, Stanford, Nighttime Source: Actionable Insights, LLC, 2017, unpublished data, and City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. As described in the section predicting the City of Palo Alto’s primary impressions, age was the predominant factor in the increase in medical emergency patient volume between 2015/2016 and 2030. Because we did not have projections of age for Stanford’s daytime population, we did not conduct such an analysis for Stanford. - 100 200 300 Abdominal Altered Level of Consciousness Behavioral Health Cardiac Injury/ Hemorrhage Non-Specific Pain Respiratory 2015/2016 Average 2030 # Increase PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 65 February 1, 2018 Recommendations & Next Steps Addressing the Expected Increase in EMS Calls Increases in fire department EMS calls are a national issue. According to the National Fire Protection Association’s data, the proportion of total fire department calls nationwide that were for medical aid increased from 54% in 1986 to 64% in 2015 (National Fire Protection Association, 2016). Fire departments nationwide have reported this trend of increasing EMS calls (see, for example, Cooper, 2016; Keisling, 2015; Los Angeles Fire Department, 2015; Luthern 2014). Fire departments with ambulance services are also having to address non- emergency use of 911 dispatch. The National Conference of State Legislatures (NCSL) (n.d.) identified research that suggests non-emergencies account for between 10% and 40% of EMS responses, and other researchers have suggested that successful reduction of inappropriate ambulance use could consequently reduce the load on emergency departments (EDs) by 11% (Patton & Thakore, 2012). The traditional model to address expected increases in EMS calls would be to add more 24-hour ambulances. However, this is a costly method of addressing increases in call volume. Other jurisdictions have turned to alternate models, including various forms of community paramedicine and mobile integrated health care practice approaches (CP/MIHP). We review these approaches below, with reference to Actionable Insights’ literature review conducted on behalf of PAFD (unpublished, 2017). In 2015 there were over 100 CP/MIHP programs nationwide, and they are expanding rapidly. This presents PAFD with a timely opportunity to leverage the knowledge gains from these other programs. Successful Strategies to Reduce EMS Calls and/or Reliance on Emergency Transport The following are four primary evidence-based programs and strategies that are applicable to the situation facing the Palo Alto/Stanford community. 1. Community paramedicine and mobile integrated health care practice (CP/MIHP) approaches. The CP/MIHP approach is broadly characterized as a model in which a community has greater access to 24/7 non-emergency healthcare, including health education, outreach, monitoring, and prevention, brought to the patient by inter-professional teams42 who are integrated into and/or partnered with local or regional healthcare systems and under appropriate medical direction (HRSA, 2012, Myers et al., 2012, NCSL, n.d.). This could include any or all of the following (NCSL, n.d., Wang, 2011, WECAD, 2011): Conducting assessments and/or screenings (e.g., for congestive heart failure or 42 These may include paramedics, emergency medical technicians (EMTs), nurse practitioners (NPs), registered nurses (RNs), physician assistants (PAs), and other allied health professionals. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 66 February 1, 2018 diabetes) Providing treatment (such as wound care) Engaging in prevention (like health education, heat surveillance, vaccinations, fall assessment, helmet fitting, and car seat installation) Making referrals (that is, to other medical providers or social services) including addressing mental health, housing, and other needs (also known as “patient navigation”) Regularly checking in with high-risk patients – 911 or ED super-users – to assist with chronic disease management, medication compliance, and/or insurance enrollment. CP/MIHP programs look different in different communities because they are uniquely responsive to gaps in assessed community needs, and no two communities’ needs are the same (Myers et al., 2012) However, all CP/MIHP programs involve partnerships with existing healthcare organizations/infrastructure, address gaps in service, enable providers to exercise the full scope of their practice, and focus on patient outcomes to improve individual and community health. The focus on patient outcomes is particularly important. One reporter described CP/MIHP as “a redefining of what EMS is, emphasizing measuring patient outcomes over processes like response times” (Goodwin, 2013). Recently, certain researchers (Choi et al., 2016) noted that while there are relatively few studies assessing CP/MIHP program safety, efficacy, and cost- benefit ratios, data from existing programs suggest that these approaches may have impacts such as reduced health disparities; reduced Examples of EMS CP/ MIHP Program Results MedStar, Ft. Worth, TX (AHRQ, 2016): Frequent 911 users enrolled in program (incl. home visits and phone support). Total of 300 program “graduates.” ▪ 911 call volume from “graduates” down by 61% in the 12 months post-program ▪ Transport costs reduced from pre- to post-program by $4.98M ($16,600 per “graduate” in 1 year) ▪ Freed up 14,000 bed hours at local EDs over 5 years CARES, Colorado Springs, CO (Zavadsky et al., 2015): Frequent 911 users enrolled in program (incl. home visits, health ed, navigation to resources). Total of 500 patients. ▪ 911 call volume from two-thirds of patients down 50% in first 2 years ▪ Hospital readmissions down 75% in first 3 months post-program, led to $150K savings in Medicaid claims REMSA, Reno, NV (Gerber, 2015): Post-discharge congestive heart failure patients enrolled in program (incl. 1 hospital visit, follow-up home visits, screenings, assessments, services). Total of 444 patients. ▪ Avoided 28 readmissions and 97 ED visits ▪ First year total savings of $1.6M PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 67 February 1, 2018 hospital readmission rates for congestive heart failure, chronic obstructive pulmonary disease, and pneumonia; increased immunization rates; injury prevention; and reduced mortality rates (Choi et al., 2016, Myers et al., 2012, Wang, 2011, WECAD, 2011). Another important element of CP/MIHP is the reduction in healthcare costs, both directly and via reduction in ED transports and/or hospital readmissions. Krumperman (2010) has indicated that part of the value of CP/MIHP is its ability to provide cost- effective care to patients for whom services could be provided in a non-ED setting. Several writers have described the cost savings that may be found in reducing unnecessary ED transports and potential hospital readmissions (Coffman & LaFrance, 2016, Tadros et al., 2012, and Widiatmoko et al., 2008). 2. Use of nurses and/or physician assistants (PAs) in EMS and/or triage; can also be considered part of a CP/MIHP approach. Dr. Eric Beck, the medical director for the City of Chicago EMS System and the Chicago Fire Department, has been quoted as saying, “EMS needs to rethink its basic mission of being about transportation and instead be about providing care in the most effective way for the patient. …That could be community paramedicine. It could be by integrating nurse triage into dispatch, or using telemedicine to enable patients to be treated at home without having to transport” (Goodwin, 2013, emphasis ours). Walsh and Little’s (2001) small study of a nurse practitioner (NP) working in a paramedic role found that although the NP took more time at the scene to diagnose and treat a patient than a conventional EMS team would have, up to one third of calls attended to by the NP avoided ED transport. Widiatmoko et al. (2008), in describing a pilot study of nurse/paramedic partners dispatched to visit non-urgent emergency calls, suggested that the costs of such partnerships to the national Ambulance Services would be more than made up for by the savings in secondary care costs. There have been similar findings in studies on nurse telephone consultation (also known as telephone triage). A UK study found after-hours nurse telephone consultation was “at least as safe” as existing after-hours options and reduced both home visits by general practitioners and ED visits outside of normal business hours (Lattimer et al., 1998). The companion study found that there were moderate net annual cost savings of £13,185, the equivalent of about $33,000 in 2018 dollars (Lattimer et al., 2000).43 The researchers stated, “The greatest impact on the results of the cost analysis was generated by costs for emergency hospital admissions, a secondary analysis of admission data for this trial 43 Currency conversion from British pounds to U.S. dollars for historical period January 1997-January 1998 via fxtop.com. Calculation for inflation to 2018 dollars via www.in2013dollars.com. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 68 February 1, 2018 having shown that the intervention saved short stays (1-3 days) in hospital” (Lattimer et al., 2000:1056). They noted that this savings excludes the reduced costs of physicians not having to attend at the ED (Lattimer et al., 2000). There are a limited number of studies on the use of physician assistants (PAs) in EMS and/or triage (Bloemhoff et al., 2016, Callard, 2012, Nestler et al., 2012). ED-related studies found improvement in patient wait times, and one reported reduced stress on medical staff (Callard, 2012). A study of nearly 1,000 patients in the Netherlands, which compared results of the use of PAs versus nurses as solo EMS providers in ambulances, found that while PAs consulted twice as often with medical specialists than did nurses, PAs also referred a significantly smaller proportion of patients to general practitioners or the ED compared to nurses (50% versus 73%), with no apparent difference in 72-hour follow-up (Bloemhoff et al., 2016). This research suggests that use of PAs can reduce unnecessary hospital admissions and related costs (Bloemhoff et al., 2016). 3. Telemedicine and in-home visit preventive care models; can also be considered part of a CP/MIHP approach. Some studies have shown that home visits (face-to-face care at home) by community health workers, community paramedics, and/or personal support workers result in good patient outcomes and reduce the volume of 911 calls, ambulance transports, and ED visits (see, for example, Findley et al., 2014 and Ruest et al., 2012). Qualitative studies available on community paramedic home visits have described improved access to and use of healthcare services by patients, improved disease management, improved safety, and increased patient satisfaction and/or peace of mind (see, for example, Do et al., 2016 and Pennell et al., 2016). A meta-analysis of studies comparing in-home care to no home care found that in-home care delivered by nurses led to improved outcomes in patients with various levels of heart disease (Health Quality Ontario, 2013). This meta-analysis also found that home visits from physical or occupational therapists with the goal of modifying tasks and the home environment improved the ability of adults with chronic disease to engage in activities of daily living (Health Quality Ontario, 2013). With regard to end-of-life, researchers found that home visits by nurses or by community-based palliative care teams were effective in lowering levels of patient distress, reducing ED visits, and allowing more individuals to die at home rather than in the hospital (see, for example, McCorkle et al., 1989 and Seow et al., 2014). As mentioned briefly in the previous section, the use of telemedicine may be an effective way to provide patient care. There are several categories of telemedicine, including remote monitoring, “store-and-forward” technology (data transmission to a remote clinician followed by a later report or consultation), and real-time consultation (Flodgren PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 69 February 1, 2018 et al., 2015). A meta-analysis of 93 studies of interactive telemedicine concluded that face-to-face and telephone delivery of care in managing congestive heart failure and diabetes have similar outcomes, with perhaps greater decreases in high blood pressure and better control of blood glucose for telemedicine patients compared to those receiving face-to-face care (Flodgren et al., 2015). Research on the use of telemedicine for those who suffer chronic wounds found that advice-giving via telemedicine correlated with significantly increased healing of wounds in comparison to a best-practice conventional approach (Zarchi et al., 2015). A study of the implementation of a telemedicine service at a nursing home found fewer hospitalizations of nursing home residents (associated with reduced health complications and lower mortality), and consequent Medicare savings (Grabowski and O’Malley, 2014). Telemedicine was also used to good effect in palliative care for advanced cancer patients by improving healthcare access, reducing EMS use, and improving symptom assessment/control (Hennemann-Krause et al., 2015). 4. Outreach and education efforts also complement a prevention approach. A review of research shows that lay health educators (such as promotores) have been found to be effective in improving community members’ health status (Ayala, 2010). Reductions in hospital expenditures for diabetes and hypertension were identified in areas that had lay health educators (Boone, 2002). In a Denver community served by community health workers, economic savings were realized in health care costs, including urgent care (Whitley et al., 2006). The community consulted for this study suggested that the community lacks awareness of the appropriate use of the emergency departments and alternatives, including urgent care clinics. “Well, I think that a lot of people don’t know about urgent care and express care. I mean we deescalate so many things to express care clinics rather than the emergency room. I deescalated one just the other day for a gentleman. His sister couldn’t get into primary care. He had something going on with his neck. He was recently moved here from out of state just to be by Stanford. And they had a little bit of wait to go into primary care and they were gonna come back to the emergency room. And I told them about this express care clinic and it worked out great.” – Key Informant PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 70 February 1, 2018 Based on our research, community paramedicine and integrated health care practice models currently appear to be the most successful and innovative approaches available to fire departments with ambulance services. As described, these models can be implemented in a wide variety of ways, including telemedicine, home visits, arrangements for direct transport/diversion, community clinic extensions, nurse/PA triage, etc. Below, we describe some of the challenges to and best practices for implementing a CP/MIHP approach. Implementation Challenges and Best Practices in CP/MIHP The NCSL (n.d.) has identified several challenges to implementation of a CP/MIHP program, including financial, regulatory, and workforce-related issues. 1. Solutions to financial (i.e., reimbursement) challenges: It is suggested that financial issues (that is, reimbursement) can be worked out on the state or community level with public and/or private insurers (NCSL, n.d.). There are a variety of examples in the literature, including obtaining added funding via non-EMS work (HRSA, 2012), adapting the payment models of accountable care organizations (ACOs) to CP/MIHP programs (Kizer et al., 2013), and aligning CP/MIHP program financial interests with the financial interests of their partners by “linking sustainable program funding to savings accruing to system payers from reduced re-admission rates” (MIHP Resource Center, 2014). Goodwin (2013) observes that the latter requires the CP/MIHP program to share both the savings and the risk. With regard to other sustainable funding models, there are various subscription programs (City of Arcadia, 2015, City of Fountain Valley, 2010, City of Huntington Beach, 2017, Farkas, 2016), some of which include sliding scale fees for low- income households, and there are financial models based on property taxes or other municipal funds (Pearson & Shaler, 2015, Snohomish County Fire District 1, 2017, Zavadsky et al., 2015). 2. Solutions to regulatory challenges: With regard to regulatory barriers, the NCSL (n.d.) has noted that some states are working to define CPs as a class and to overcome regulatory barriers for CP programs. The Western Eagle County Ambulance District (WECAD) in Colorado has recommended that CP/MIHP program developers talk with their state’s EMS regulatory body to address any issues that may impact the operation of such a program. While WECAD began their program at the grassroots level by partnering with their area public health department, they have stated clearly that the program was “in cooperation with the state EMS Office” (WECAD, 2011:6). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 71 February 1, 2018 3. Solutions to workforce-related challenges: With regard to workforce concerns, the NCSL (n.d.) has indicated that health professionals (like nurses or home healthcare associations) have occasionally opposed CP/MIHP programs because of concerns about encroachment on their scope of practice. Wang (2011:10) stated, “Rapid implementation of CP without identification of expanded roles causes resistance from other health care professionals.” Wang (2011) also noted that past CP/MIHP program failure has occurred in part simply because of a lack of relationships with community residents, from whom program support might otherwise be found. The literature has suggested that continued engagement of providers and other community members throughout the development and introduction of CP/MIHP programs is essential for role clarity, to address various concerns among providers and the community, and to plan for optimal collaboration among all providers (NCSL, n.d.). EMS agencies that already have CP/MIHP programs in place have recommended that program developers involve stakeholders from the very start to assure them the program is intended for collaboration rather than competition (Zavadsky et al., 2015). It is noted that “[i]n well developed, mature CP programs, the community paramedic can be the eyes and ears of primary and emergency care physicians and an extension to their practices” (NOSORH, 2010). The literature has emphasized that CP/MIHP programs expand the role of EMS practitioners but do not change their scope of practice. The International Roundtable of Community Paramedicine (2011) stated that community paramedics work “in non-traditional roles using existing skills… [and] will provide services through unique models of delivery and enhanced protocols through an integrated collaborative network with other health care providers.” Goodwin (2013) described how EMTs and paramedics working in CP/MIHP have an expanded role rather than an expanded scope; they simply apply skills for which they are already licensed in order to help community members manage chronic disease, navigate through the healthcare system, and prevent ED visits via prevention campaigns and/or public education. 4. Best practices: Engage in external quality control (Wang, 2011) and address quality assurance via medical direction and program evaluation (WECAD, 2011); for the latter, integration with state or area electronic health information exchanges is crucial in order to measure patient outcomes, experience, and the program’s impact on patient costs (Zavadsky et al., 2015). Use WECAD (2011) handbook with recommended steps for a grassroots approach to implementing a CP/MIHP program: a. Plan to plan (learn about CP/MIHP) b. Assess program feasibility and engage key partners (like medical providers) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 72 February 1, 2018 c. Determine how to provide medical direction d. Assess community health needs e. Determine the scope of the program (services, staffing, budget/funding needs) f. Engage the community (approach key stakeholders with your community health needs assessment, program vision statement, and fact sheet with problem/ opportunity statement and FAQ) g. Develop policies and procedures h. Plan and implement training i. Develop an evaluation plan j. Begin operations k. Evaluate the pilot phase Follow broad principles developed by an MIHP working group to guide CP/MIHP program developers (Goodwin, 2013): a. Assess community needs, remain value-focused, and feature a competency- and evidence-based practice that ensures continual education, 24-hour community access, and ongoing performance improvement. b. Ensure community partnership with active medical direction. c. Deliver improved access to care and health equity for populations served through 24-hour care availability. d. Focus on patient-centered navigation and offer community-centered care by integrating existing infrastructures and resources and bringing care to patients through technology, communications, and health information exchange. e. Use evidence-based practice, incorporating multidisciplinary and inter- professional teams through which providers utilize their full scope of practice. Focus on integration with current health care and social services systems to develop a robust network of resources (Zavadsky et al., 2015). Addressing Community Health Needs Our primary research for this study indicates that the need for preventative services in the Palo Alto/Stanford area is supported by the community. For example, residents who participated in the neighborhood association focus group stressed that education is needed in the areas of emergency preparedness, especially for those who do not live in close proximity to a fire station. In response to a question about solutions to the overuse of emergency departments, some suggested that residents need to know what constitutes a medical emergency, and also where to call or go for non-emergencies. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 73 February 1, 2018 Some residents also indicated support for community integrated health care; in one focus group, the firehouse clinic operating in Hayward, CA, was suggested as a model (City of Hayward, 2015). The community envisioned it as “checking in” on those who otherwise would not go to a clinic. For example, seniors with whom we talked appreciated having access to a nurse practitioner at their senior housing facility several times per week. They observed that they checked their blood pressure and vision more often when this service was available. Also, the need to reach isolated and homebound community members was mentioned in more than one group. Health education was mentioned multiple times. Community key informants and residents suggested subjects such as youth mental health (for parents), adult caregiving, stroke risk and prevention, and falls prevention. Cultural competency and capacity of first responders were mentioned several times by community members. For example, one key informant recommended sending mental health specialists out with first responders (such as the Santa Clara County Behavioral Health pilot program). As mentioned earlier, training first responders on how to serve people of diverse cultures, gender identities, and languages is also important. In addition to the services that can be provided through an integrated community health care model, the community expressed the need for more services that are traditionally provided by other organizations such as nonprofit organizations or hospitals: Home health care for seniors, including those of the middle class who can’t afford it Phone buddy program for seniors Discharge planning Geriatric care managers Social workers to serve those with depression and handling life transitions (e.g., moving to senior housing) Telemedicine (e.g., using photographs to communicate with doctors) Sobering station with the capacity to screen for mental health problems and substance abuse Mental health services during non-traditional hours PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 74 February 1, 2018 Next Steps in Addressing Future Needs and Capacity To “engineer out” unplanned emergencies (i.e., EMS incidents) and understand what it will take to work together as a community to help address these risk factors and help prevent emergencies from occurring, Actionable Insights recommends a three-pronged approach: 1. PAFD conducts an internal resource assessment to assess its capacity to implement the recommended EMS strategies described above. Such an assessment, combined with this study of current needs, will serve as the foundation of a plan for a community integrated health model that best fits Palo Alto/Stanford. 2. PAFD convenes internal City of Palo Alto stakeholders and external stakeholders with a focus on prevention efforts in Palo Alto/Stanford. This includes discussion of those risk factors that have been identified through the work underlying this report. These discussions will include preliminary identification of community partnerships that might best help to minimize the need for emergency response by preventing emergencies from happening. Actionable Insights will meet with PAFD to review the results of the discussions. 3. Actionable Insights will then assist PAFD in developing a collective impact plan to prevent medical emergencies. A collective impact plan provides structure to collaborative efforts and recognizes the contribution of many different partners towards the same goals. This effort will bring stakeholders from the City of Palo Alto and other organizations together to plan how they will make collective impact in the years to come. Ideally, the collective impact group can also inform and even shape the integrated health model that PAFD plans to adopt. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 75 February 1, 2018 Appendix 1 Sources Agency for Healthcare Research and Quality (AHRQ). (2016). Trained paramedics provide ongoing support to frequent 911 callers, reducing use of ambulance and emergency department services. Service Delivery Innovation Profile, February 21, 2016. Accessed February 5, 2017: http://www.innovations.ahrq.gov/content.aspx?id=3343. Arias, E. (2012). United States life tables, 2008. National Vital Statistics Reports, 61(3), September 24, 2012. 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Mobile Integrated Healthcare and Community Paramedicine (MIH-CP). National Association of Emergency Medical Technicians. Accessed January 30, 2017: https://www.naemt.org/docs/default-source/community-paramedicine/naemt-mih-cp- report.pdf?sfvrsn=4. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 84 February 1, 2018 Appendix 2 Methods After consultation with several statistical experts (Kristi Kelly, Ph.D., personal communication, May 10, 2016; Professor Stefanie Bailey Möllborn, Ph.D., personal communication, November 28, 2016; Christina Branom, Ph.D., personal communication, February 17, 2017), Actionable Insights determined that the most appropriate method for predicting future unit call volume/type and proportion of emergency medical interactions by age group, gender, incident location, and/or primary impression was a modified life table approach. This is a population ecology approach used to describe a current population and predict future growth or decline (see, for example, Begon et al. 1990; Begon et al. 1996; Krebs, 1985). The U.S. Centers for Disease Control calls this a period life table approach (Arias, 2012). We use a snapshot of the years 2015/2016 and assume that the cohort of individuals alive at that time in the combined Palo Alto/Stanford jurisdiction, plus the expected increase in individuals in the jurisdiction over the next 15 years, will be subject (proportionally) to the age-specific call/patient volumes, call types, locations, and primary impressions that prevailed for the actual population in 2015/2016. The greatest factor that would affect construction of period life tables for 2030 is the expected increase in the older population in the City of Palo Alto. Based on a preliminary analysis of the ESO data, a simple linear regression in which we predict number of medical emergency patients by patient age in combined years 2015 and 2016 shows that the relationship of the number of patients by patient age is positive (1.033) and statistically significant (p < 0.001). That is, there are more older individuals represented in the ESO dataset than younger individuals, to a statistically significant degree. This supports the hypothesis that older individuals are more likely than younger individuals to have a medical emergency in the combined Palo Alto/Stanford jurisdiction. After predicting expected 2030 call volume by call type, medical emergency call/patient volume by age group, and patient volume by location and primary impression, we adjusted medical emergency predictions based on CA DOF (2017) age projections. More information about this process may be found in Appendices 5 and 6. We provide separate predictions for the City of Palo Alto and for Stanford.44 Another factor one would expect to affect construction of period life tables for 2030 is gender. While gender is associated with number of medical emergency (ME) patients overall (with females somewhat more likely to be an ME patient than males), the gender composition of the combined Palo Alto/Stanford jurisdiction is not expected to change significantly within the next 15 years (see footnote 9). Thus, we did not take gender into account in generating the period 44 Note that we do not apply these age adjustments to Stanford’s daytime population due to the lack of granularity in age-range data for Stanford employees. See Appendix 5 for more information. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 85 February 1, 2018 life tables predicting call type, call/patient volume, or call/patient volume by location or primary impression in 2030. Although it is possible that the proportions of the population of the various ZIP Code areas in the combined Palo Alto/Stanford jurisdiction may change within the next 15 years, no data were available to address population change in such a fine-grained way (i.e., by ZIP Code). Therefore, we did not develop period life tables predicting patient volume in 2030 by ZIP Code of interaction. Finally, we provide call/patient volume and call type projections both overall, and separately for daytime and nighttime. As suggested by Bhadur (2007), daytime and nighttime populations are fundamentally different, with daytime population including workers, tourists, and business travelers, as well as the residual nighttime resident population that does not leave the area during the day. For PAFD’s purposes, it is important to predict year 2030 call/patient volume and call type, as well as ME patient volume by location and primary impression, based on these two very different daytime and nighttime populations. Again, we provide separate predictions for the City of Palo Alto and for Stanford. Further information on how these populations were constructed is available in Appendix 6. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 86 February 1, 2018 Appendix 3 Mapping of Primary Impressions to Categories Table 8, Total Medical Emergency Patient Volume by Primary Impression by Year: Percentage and Number45 Primary Impression Category # of Patients in 2015 # of Patients in 2016 Abdominal Pain Abdominal Discomfort < 1% 1.1% (59) Abdominal Pain/Discomfort Abdominal Discomfort < 1% None Abdominal Pain/Problems Abdominal Discomfort 6.4% (342) 5.6% (301) Acute Appendicitis Abdominal Discomfort None < 1% Acute Bronchitis Respiratory- Related Issues None < 1% Acute Respiratory Distress Respiratory- Related Issues < 1% < 1% Acute Respiratory Distress (Dyspnea) Respiratory- Related Issues None < 1% Airway Obstruction Respiratory- Related Issues < 1% < 1% Alcohol Behavioral Health Issues < 1% None Alcohol Use Behavioral Health Issues < 1% < 1% Allergic Reaction All Other 1.7% (89) 1.8% (100) Altered Level of Consciousness Altered Level of Consciousness 8.3% (443) 6.8% (364) Altered Mental Status Altered Level of Consciousness < 1% < 1% Asthma Respiratory- Related Issues < 1% < 1% Back Pain Non-Specific Pain < 1% < 1% Behavioral/Psychiatric Disorder Behavioral Health Issues 1.9% (103) 2.5% (135) 45 City of Palo Alto and Stanford only. A total of 234 cases across the two years (<3%) are from other ZIP Codes. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 87 February 1, 2018 Bowel Obstruction Abdominal Discomfort < 1% < 1% Cardiac Arrest Cardiac-Related Issues < 1% < 1% Cardiac Arrhythmia/Dysrhythmia Cardiac-Related Issues < 1% < 1% Cardiac-Related Issues Cardiac-Related Issues < 1% < 1% Cardiac Rhythm Disturbance Cardiac-Related Issues 1.8% (99) 1.4% (74) Chest Pain/Discomfort Cardiac-Related Issues 5.7% (309) 5.6% (301) Chest Pain, Other (Non-Cardiac) Non-Specific Pain None < 1% CHF (Congestive Heart Failure) Cardiac-Related Issues < 1% < 1% Common Cold Respiratory- Related Issues < 1% < 1% Concussion Injury/ Hemorrhage None < 1% Confusion/Delirium Altered Level of Consciousness None < 1% Constipation Abdominal Discomfort None < 1% Contact with Venomous Animal All Other < 1% None Dehydration Altered Level of Consciousness < 1% < 1% Diabetic Hyperglycemia Altered Level of Consciousness < 1% < 1% Diabetic Hypoglycemia Altered Level of Consciousness < 1% < 1% Diabetic Symptoms Altered Level of Consciousness < 1% < 1% Diarrhea Abdominal Discomfort < 1% < 1% Electrocution All Other < 1% < 1% Epistaxis Injury/ Hemorrhage < 1% < 1% Esophageal Obstruction Respiratory- Related Issues None < 1% Eye Pain Non-Specific Pain None < 1% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 88 February 1, 2018 Fatigue Altered Level of Consciousness None < 1% Fever All Other < 1% < 1% Foreign Body in Alimentary Tract Abdominal Discomfort None < 1% Foreign Body in Ear All Other None < 1% Foreign Body in Respiratory Tract Respiratory- Related Issues None < 1% G.I. Bleed Injury/ Hemorrhage < 1% < 1% Gastro-esophageal Reflux Disease (GERD) Abdominal Discomfort None < 1% Gastrointestinal Hemorrhage Injury/ Hemorrhage < 1% < 1% Generalized Weakness Altered Level of Consciousness 7.3% (390) 8.5% (458) Hallucinogen-Related Disorders Behavioral Health Issues None < 1% Headache Non-Specific Pain 1.0% (53) 1.0% (51) Hemorrhage Injury/ Hemorrhage < 1% < 1% Hypertension Cardiac-Related Issues < 1% 1.2% (64) Hyperthermia Altered Level of Consciousness < 1% < 1% Hyperventilation Respiratory- Related Issues None < 1% Hypotension Cardiac-Related Issues < 1% < 1% Hypothermia Altered Level of Consciousness < 1% < 1% Hypovolemia Cardiac-Related Issues None < 1% Hypovolemia/Shock Cardiac-Related Issues < 1% < 1% Influenza Respiratory- Related Issues < 1% < 1% Inhalation Injury (Toxic Gas) Respiratory- Related Issues < 1% < 1% Injury Injury/ Hemorrhage 2.1% (112) 3.1% (169) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 89 February 1, 2018 Injury of Head Injury/ Hemorrhage None < 1% Injury of Lower Back Injury/ Hemorrhage < 1% < 1% Injury of Pelvis Injury/ Hemorrhage None < 1% Injury of Thorax (Upper Chest) Injury/ Hemorrhage None < 1% Malaise Altered Level of Consciousness < 1% < 1% Mental Disorder Behavioral Health Issues < 1% < 1% Migraine Non-Specific Pain < 1% < 1% Nausea Abdominal Discomfort < 1% < 1% Obvious Death All Other < 1% < 1% Opioid-Related Disorders Behavioral Health Issues None < 1% Other Stimulant-Related Disorders Behavioral Health Issues None < 1% Pain (Non-Traumatic) Non-Specific Pain 7.4% (392) 6.7% (360) Pelvic and Perineal Pain Non-Specific Pain < 1% < 1% Pneumothorax Respiratory- Related Issues None < 1% Poisoning/Drug Ingestion Behavioral Health Issues 1.3% (68) 1.2% (64) Pregnancy/OB Delivery All Other < 1% < 1% Pregnancy-Related Conditions All Other None < 1% Pulmonary Edema, Acute Respiratory- Related Issues None < 1% Pulmonary Embolism Respiratory- Related Issues None < 1% Renal Failure All Other < 1% < 1% Respiratory Arrest Respiratory- Related Issues < 1% < 1% Respiratory Distress Respiratory- Related Issues 4.6% (246) 4.3% (230) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 90 February 1, 2018 Respiratory Failure Respiratory- Related Issues None < 1% Respiratory-Related Issues Respiratory- Related Issues < 1% < 1% Seizure(s) Altered Level of Consciousness 2.3% (126) 2.6% (145) Seizures Without Status Epilepticus Altered Level of Consciousness None < 1% Sepsis/Septicemia Altered Level of Consciousness < 1% < 1% Sexual Assault/Rape All Other None < 1% Smoke Inhalation Respiratory- Related Issues None < 1% Stings/Venomous Bites All Other < 1% < 1% Stroke Altered Level of Consciousness < 1% < 1% Stroke/Cerebrovascular Accident (CVA) Altered Level of Consciousness 2.3% (126) 2.1% (110) Substance/Drug Abuse Behavioral Health Issues 1.2% (66) < 1% Syncope/Fainting Altered Level of Consciousness 6.1% (327) 5.9% (316) Transient Cerebral Ischemic Attack (TIA) Altered Level of Consciousness < 1% < 1% Trauma Injury/ Hemorrhage < 1% None Traumatic Circulatory Arrest Cardiac-Related Issues < 1% < 1% Traumatic Injury Injury/ Hemorrhage 21.4% (1,147) 17.9% (962) Vaginal Hemorrhage Injury/ Hemorrhage < 1% < 1% Vertigo Altered Level of Consciousness < 1% < 1% Visual Disturbance All Other < 1% < 1% Vomiting Abdominal Discomfort < 1% < 1% No Complaints or Injury/Illness Noted No Complaints 2.9% (154) 2.5% (140) “Everything Else” All Other 1.7% (89) 1.2% (67) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 91 February 1, 2018 Missing Missing 1.7% (92) 2.3% (123) TOTAL 5,362 5,365 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Notes: Primary impressions with more than zero but less than 50 patients are marked as “< 1%” to preserve patient confidentiality. Rounding of averages or predictions may cause minor differences in totals. Primary impression categories developed in consultation with Mary Vizzi, R.N. (ret.), personal communication, May 27, 2017, August 3, 2017). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 92 February 1, 2018 Appendix 4 Call Volume and Call Type Predictions Call volume and call type predictions for 2030 are based on calendar years 2015 and 2016 data from the computer aided dispatch records system (CAD). We averaged the call counts across years 2015 and 2016 to generate an annual average before making the prediction calculations, in order to base them on more stable figures. Data are broken into daytime and nighttime calls by city; based on discussions with PAFD’s Strategic Operations Manager, daytime is considered to be 8:00 a.m. to 7:59 p.m., and nighttime is considered to be 8:00 p.m. to 7:59 a.m. (Amber Cameron, personal communication, March 18, 2017). The time indicator used was the time of dispatch. Each call type/call volume prediction is based on the proportion of such calls in 2015/2016 to the total daytime or nighttime population in that city in 2014 (see Appendix 5 for a further description of the calculation of current daytime and nighttime city populations and the rationale for using 2014 population with 2015/2016 calls), and increased proportionate to the projected 2030 total daytime or nighttime population for each city. Call type/volume predictions for the City of Palo Alto are made for each of the six 2030 scenarios (see main text, Table 3), as well as for Stanford alone (not applying the six City of Palo Alto scenarios). In order to show the difference between the CAD data and the ESO data, medical emergency call type predictions for 2030 were generated for both datasets. Note that we used ESO data for City of Palo Alto and Stanford ZIP Codes only, in order to align more closely with CAD data (which were only provided for the two cities). The advantage of the ESO data was that patients’ ages were made available in the ESO dataset, and age is considered a primary factor in predicting future medical emergency patient volume. As with the CAD data, we averaged annual patient counts in the ESO dataset across years 2015 and 2016 to obtain more stable figures. As described elsewhere in this report, we assigned age to one of 13 groups, to align with U.S. Census Bureau ACS age categories. To generate the medical emergency patient volume predictions, we first generated from the ESO dataset average patient counts for each city by age group and by daytime versus nighttime. Then, for daytime and nighttime populations separately, these average medical emergency patient counts were then divided by the number of individuals in the population who were of that age group, to obtain a ratio of medical emergency patients for each age group. Having the average ESO medical emergency patient counts by age, we were able to apply these to the CAD data by dividing each average ESO medical emergency age group count by the total average ESO medical emergency count and then multiplying by the total average CAD medical emergency calls to obtain estimated average counts and ratios by age group for CAD medical emergency calls. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 93 February 1, 2018 These two sets of medical emergency ratios, ESO and CAD, were then applied to the projected 2030 populations, by city, age group, and time of day, to generate predicted counts of 2030 medical emergency patients and 2030 medical emergency calls. Note that for Stanford, the age adjustments described in this paragraph were applied only to the nighttime population, as the data for the daytime population were not granular enough to determine age ranges for Stanford employees. Information on how the 2030 populations were obtained, including more information on the lack of age-range granularity for Stanford’s data, may be found in Appendix 5. For example, there were an estimated 2,066 individuals age 25-34 in the Stanford nighttime population in 2014, and an average of 41 medical emergency patients in the 2015/2016 EMS dataset for individuals age 25-34 that were found in Stanford ZIP Codes 94305 or 94309 between the hours of 8:00 p.m. and 8:00 a.m. The medical emergency patient ratio for Stanford residents aged 25-34 during the nighttime was thus 0.02 (41 divided by 2,066). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 94 February 1, 2018 Appendix 5 Population Figures by Age – Current and Predicted Current Figures, Including Populations by Age City of Palo Alto In all cases, “current” figures are 2014 actuals or estimates, to align with the 2014 baseline figures used for the six City of Palo Alto 2030 scenarios.46 To obtain current City of Palo Alto resident figures, we began with the total 2014 base population for the City of Palo Alto (see main text, Table 3, City of Palo Alto Scenarios Table, note 3). We applied to this base number the U.S. Census Bureau American Community Survey (ACS) 2010-2014 percentages of the City of Palo Alto’s residents by age. To obtain current City of Palo Alto nightly (overnight) visitor figures (a conservative estimate of tourists and business travelers), we began with the dollar amount of Transient Occupancy Tax (i.e., hotel tax) reported in 2014 ($14 million), the 12% tax rate at the time, and the average room rate of $202 per night (Thorp, 2014). Dividing $14 million by 12% of $202, then dividing by 365, gave us an estimate of 1,582 occupied rooms per night. We used a conservative estimate of one person per room, giving us an estimated 1,582 overnight visitors in the City of Palo Alto during each 24-hour period.47 We applied to this base number the U.S. Census Bureau ACS 2010-14 percentages of U.S. residents by age.48 To obtain current City of Palo Alto daily visitor figures (i.e., shoppers and others making non- work-related day-trips to Palo Alto), we contacted the City of Palo Alto Chamber of Commerce, which estimated approximately 300,000 visitors in the year 2016 (Dawn Billman, personal conversation, March 26, 2017).49 We estimated the total population of the City of Palo Alto in 2016 based on the net increase between the 2014 and 2015 City of Palo Alto populations as provided by the U.S. Census Bureau (2014; 2015),50 then adjusted downward the estimated 46 PAFD’s CAD and ESO data systems were not implemented until March of 2014, and confidence by PAFD in the 2014 CAD and ESO data quality was not as strong as in the 2015 and 2016 data (Amber Cameron, Judy Maloney, & Kim Roderick, personal communication, December 6, 2016); thus, we received 2015/2016 data and employed averages from the 2015 and 2016 combined datasets to obtain more stable statistics related to call volume, call type, and medical emergency interactions in connection with the 2014 population figures. 47 We realize that there are informal options for overnight guests (e.g., staying with friends/relatives, using AirBnB or other services not formally subject to the hotel tax); again, this is a conservative estimate of overnight visitors to the City of Palo Alto. 48 While it is likely that some visitors are from outside the U.S., we could not estimate what proportion of total visitors these might be, and therefore applied only U.S. age percentages. Note that visitors are a very small proportion of total population numbers. 49 While we attempted to obtain shopper statistics from Stanford Shopping Center (located within the boundaries of the City of Palo Alto), the local mall management office claimed it did not track such figures and its Chicag0-based headquarters (Simon Property Group) did not respond to requests for information. 50 Note that 2016 population estimates were not yet available at the time of these analyses. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 95 February 1, 2018 2016 annual number of visitors using the total 2014 base population for the City of Palo Alto (see main text, Table 3, note 3). We applied to this base number the U.S. Census Bureau ACS 2010-14 percentages of U.S. residents by age.48 Stanford To obtain current Stanford resident figures, we employed the U.S. Census Bureau ACS 2010- 2014 estimates and applied percentages of Stanford residents by age from the same source. To obtain current Stanford daily visitor figures (i.e., tourists and others making non-work day- trips to Stanford), we contacted Stanford University’s Visitor Center, which estimated approximately 150,000 visitors in the year 2016 (D.J. Dull-MacKenzie, personal conversation, April 26, 2017). We estimated the total population of Stanford in 2016 based on one quarter of the difference between the 2015 and 2018 estimated Stanford resident populations as provided by the Stanford University 2018 General Use Permit Application (GUP) (Stanford University, 2016), then adjusted downward the estimated 2016 annual number of visitors using the U.S. Census Bureau ACS 2010-2014 population for Stanford. We applied to this base number the U.S. Census Bureau ACS 2010-14 percentages of U.S. residents by age.48,51 Year 2030 Predictions, Including Predictions by Age City of Palo Alto Nighttime Population To predict 2030 City of Palo Alto residents, we took the 2014 base population as provided in Table 3, note 3, and added to it, for each of the six scenarios, the predicted net change in population indicated in the City of Palo Alto Scenarios (Table 3). To predict 2030 City of Palo Alto overnight visitors, we took the 2014 overnight visitors estimate and adjusted it upward by applying, to the 2014 estimate, the ratios of the 2014 base population to the projected 2030 resident population figures associated with the six scenarios (2030 projected resident population figures calculated as described in the bullet above). We applied to the estimates of the six City of Palo Alto resident scenarios CA DOF projected 2030 percentages of San Mateo County residents by age (CA DOF, 2017). Although the City of Palo Alto is technically in Santa Clara County, it is just south of the San Mateo County line; we use San Mateo County 2030 projected age percentages because (a) neither the DOF nor any other agency provides age projections by city (Stephen Levy, personal communication, December 14, 2016), and (b) the latest available population age distribution of the City of Palo 51 There are no hotels within the city limits of Stanford, no record of the number of informal overnight guests on the campus/within the city limits, and no clear way to determine this number; thus, we did not estimate figures for overnight visitors to Stanford. Note that daytime visitors are a very small proportion of total population numbers, and it might be expected that nighttime visitors are similarly a small proportion compared to the total population. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 96 February 1, 2018 Alto was more like the population age distribution of San Mateo County than it was like the population age distribution of Santa Clara County (U.S. Census Bureau, 2015). For overnight visitors to the City of Palo Alto, we applied to the various 2030 estimates U.S. Census 2030 projections of percentages of U.S. residents by age (Colby & Ortman, 2015).48 City of Palo Alto nighttime population estimates by age thus comprise age-adjusted numbers of residents and overnight visitors for each of the six 2030 resident scenarios. City of Palo Alto Daytime Population To predict 2030 City of Palo Alto residents, we took the 2014 base population from Table 3, note 3, and added to it, for each of the six scenarios, the predicted net change in population indicated Table 3. To predict 2030 City of Palo Alto jobs, we took the 2014 base number of jobs as provided in Table 3, note 3, and added to it, for each of the six scenarios, the predicted net change in jobs indicated in Table 3. The figures for predicted 2030 Palo Alto employed residents in each scenario were derived by taking the predicted number of jobs and dividing them by the “Jobs/Employed Residents” ratio from Table 3. Finally, using the U.S. Census Bureau’s “Method #2” for calculating daytime population estimates (U.S. Census Bureau, 2013; see also McKenzie et al., 2013), for each 2030 City of Palo Alto scenario we then took the total predicted resident population, plus the total predicted workers working in the city52, minus the total predicted workers living in the city.53 This provided estimated daytime populations for the six 2030 scenarios but did not include visitors. To predict 2030 City of Palo Alto daytime visitors, we took the 2014 daytime visitors estimate and adjusted it upward by applying to the 2014 estimate the ratios of the base 2014 population to the projected resident population figures for the six 2030 scenarios (calculated as described above). We expect that overnight visitors to the City of Palo Alto also enjoy the City of Palo Alto during the day. Thus, the total estimated daytime populations for the six 2030 scenarios included both 52 McKenzie et al. state that “The total number of workers working in an area includes all workers who indicate a specified area as their place of work regardless of where they live” (2013:3). While we do not have the total number of predicted workers who work in the city (such projections are not available on the city level, per Stephen Levy, personal communication, December 14, 2016), we do have the total number of projected jobs in the city. For purposes of this analysis, we use total projected jobs in the city as a proxy for total predicted workers working in the city. 53 McKenzie et al. state that “The total workers living in a specified geography is defined as the number of workers who are also residents. This estimate does not reflect location of work” (2013:3); predicted workers living in the city thus equate to predicted employed residents as provided by the City of Palo Alto 2016 (see Table 3). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 97 February 1, 2018 daytime visitors and overnight visitors to the City of Palo Alto. For daytime and overnight visitors to the City of Palo Alto, we applied to the various 2030 estimates U.S. Census Bureau 2030 projections of percentages of U.S. residents by age (Colby & Ortman, 2015).48 To predict the City of Palo Alto’s daytime population by age: We retained 39% of the predicted City of Palo Alto employed residents aged 20-64,54 using the proportion of employed respondents who reported that they lived and worked locally, based on the City of Palo Alto Transportation Survey (City of Palo Alto, 2013).55 We treated the remaining proportion of employed residents as out-commuters. We calculated in-commuters to the City of Palo Alto based on the remaining predicted number of jobs, using the proportions of the working population (aged 20-64) in the top three counties identified as City of Palo Alto in-commuters in the Transportation Survey (City of Palo Alto, 2013): Santa Clara County (39%), San Mateo County (27%), and Alameda County (15%). We attributed the rest (“Other”) to California generally (19%). We then had four sets of in-commuters for each of the six 2030 City of Palo Alto scenarios (three counties and California generally). For each set of predicted in- commuters, we applied that county’s projected 2030 percentages of residents by age for the working population (aged 20-64) only, using California state projected percentages by age for the set not representing a specific county (CA DOF, 2017 for counties and state). Therefore, the overall City of Palo Alto 2030 daytime population estimates by age for each of the six scenarios include both remaining residents and expected in-commuters, as well as daytime and overnight visitors, all age-adjusted. Stanford Nighttime Population The GUP provides, in its Tab 5.5 (reproduced below in Table 9), projections of the Stanford resident population for the years 2015 and 2035 (Stanford University, 2016). We calculated the 2030 Stanford resident population by taking the average increase per year between 2018 and 2035, and subtracting 5 years’ worth of that average from the 2035 estimates. The estimated 2030 resident population is equal to the estimated 2030 nighttime population for Stanford.51 For Stanford, dramatic change was not expected by age category for residents, given that most of the residents are students, who are generally likely to be from certain age groups. For age 54 The vast majority of the U.S. labor force is aged 20-64 (Bureau of Labor Statistics, 2016). Even though labor force participation among those aged 65 and older has been increasing due to longer life spans and financial obligations (Kromer & Howard, 2013), we remain conservative in our predictions and use age groups 20-64 to represent the working population in the City of Palo Alto. 55 We note that 39% is consistent with prior reports of Palo Alto residents who work where they live (e.g., this figure was 36% in the 2000 U.S. Census; see Bay Area Census, 2010). PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 98 February 1, 2018 ranges in both current and 2030 Stanford nighttime population projections, we used the U.S. Census Bureau’s estimates of Stanford’s 2014 resident (nighttime) population proportions by age.56 Stanford nighttime population estimates by age are thus comprised of predicted, age-adjusted 2030 residents only. Stanford Daytime Population To obtain the predicted 2030 daytime population: Daytime Resident, Student, and Worker Population: o Overall: The GUP (Stanford University, 2016) provides in its Tab 8 estimates of the daytime population, including both workers and students, for the years 2018 and 2035. These estimates are reproduced below in Table 10. We calculated the 2030 Stanford daytime population by taking the average increase per year between 2018 and 2035, and subtracting 5 years’ worth of that average from the 2035 estimates. We added graduate students’ non-student spouses and faculty/staff “other family members” in the same proportions, and added in children of graduate students (a number that is not projected to change between 2018 and 2035, based on Tab 5.5 of the GUP; see Table 9). o By age: The GUP (Stanford University, 2016) data and estimates are not provided at a granular-enough level to determine commute (i.e., daytime) population ages, despite requests for the same.57 Use of age groups from other geographies (e.g., Santa Clara County, the City of Palo Alto) as proxies for Stanford’s daytime population is inappropriate because Stanford is not like these other areas; it has a much larger young-adult population due to its university. After considerable effort and discussions with PAFD, it was decided that Stanford’s daytime population would not be estimated by age group. Because we do not have granular-enough data on the current Stanford daytime population by age, we cannot predict how many working-age adults will stay on the campus and how many will out-commute, so we treat them all as staying. This means our analysis uses a slightly more liberal estimate of Stanford’s daytime population than might otherwise be generated. Daytime Visitors: To predict 2030 Stanford daytime visitors, we took the 2014 Stanford 56 We used 2014 rather than 2015 data for Stanford because all City of Palo Alto “current” data and the six 2030 scenarios are also based on 2014 figures; this allows for comparisons between Stanford and the City of Palo Alto if desired. 57 Note that a request for age-related information about the Stanford daytime population was made to the authors of the GUP. The request netted some additional information from Stanford University’s Human Resources department, but the information provided was still not enough to allow us to determine age groups for Stanford’s daytime population. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 99 February 1, 2018 daytime visitors estimate and adjusted it upward by applying to the 2014 estimate the ration of the 2014 resident population to the projected 2030 resident population figure. Together, these figures provided the estimated 2030 daytime population for Stanford. Table 9, Stanford Projected Growth in Academic Year Residential Population Through 2035 (from Stanford GUP Tab 5.5) Affiliation Fall 2015 On- Campus Residential Population Housing Units/ Student Beds Added by Fall 2018 and Resulting Residential Population in 2018 Housing Units/ Student Beds Added by Fall 2020 and Resulting Residential Population in 2020 Housing Units/ Student Beds Added under 2018 General Use Permit and Resulting Residential Population in 2035 Undergraduates 6,401 existing beds occupied 216 beds added at Lagunita 0 beds added 1,700 beds added 6,401 undergraduate students living on campus 6,617 undergraduate students living on campus 6,617 undergraduate students living on campus 8,317 undergraduate students living on campus Graduate Students, including Ph.D.s (see note below) 4,892 existing beds occupied 200 beds added at Highland Hall 2,020 beds added at EVGR 900 beds added 5,001 graduate students living on campus plus 644 non-student spouses and 420 children 5,205 graduate students living on campus plus 660 non-student spouses and 420 children 7,265 graduate students living on campus plus 822 non-student spouses and 420 children 8,183 graduate students plus 894 non-student spouses and 420 children Postdoctoral Scholars 28 existing beds occupied 0 units added 0 units added N/A – included with faculty/staff 28 postdocs living on campus 28 postdocs living on campus 28 postdocs living on campus Faculty/Staff 937 existing faculty/staff housing units built 0 units added 0 units added 550 units added 937 faculty/staff living on campus plus 1,471 other family members 937 faculty/staff living on campus plus 1,471 other family members 937 faculty/staff living on campus plus 1,471 other family members 1,515 faculty/staff/ postdocs living on campus plus 2,335 other family members Total 14,902 15,338 17,560 21,664 Source: Reproduced from Stanford University 2018 General Use Permit (Stanford University, 2016), Tab 5, Table 3. Original source: Stanford University Land Use and Environmental Planning Office, in consultation with Stanford University Residential and Dining Enterprises. Original note: Increases in units/beds are not one-to-one increases except with regard to undergraduates. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 100 February 1, 2018 Table 10, Stanford Projected Growth in Worker Population Through 2035 (from Stanford GUP Tab 8) Population Fall 2015 Fall 2015 to Fall 2018 Fall 2018 to Fall 20201 Fall 2018 to Fall 2035 Total Increase Total Increase Total Increase Total Students Undergraduate Students 6,994 91 7,085 0 7,085 1,700 8,785 Graduate Students 9,196 332 9,528 0 9,528 1,200 10,728 Total Students 16,190 423 16,613 0 16,613 2,900 19,513 Stanford Faculty & Staff Faculty 2,959 114 3,073 0 3,073 789 3,862 Staff 8,612 373 8,985 0 8,985 2,438 11,423 Postdoctoral Scholars 2,264 139 2,403 0 2,403 961 3,364 Total Faculty/Staff 13,835 626 14,461 0 14,461 4,188 18,649 Stanford Other Workers Casual 2,080 87 2,167 0 2,167 579 2,746 Contingent 980 41 1,021 0 1,021 273 1,294 Temporary 1,390 58 1,448 0 1,448 387 1,835 Non-Employee Affiliates (Including Non-Matriculated Students) 2,636 111 2,747 0 2,747 733 3,480 Total Stanford Other Workers 7,086 297 7,383 0 7,383 1,971ǂ 9,354 Non-Stanford Workers Third Party Contractors 300 24 324 0 324 72 396 Janitorial Shift Contractors 240 19 259 0 259 57 316 Construction Contractors 1,200 0 1,200 0 1,200 0 1,200 Total Non-Stanford Workers 1,740 43 1,783 0 1,783 129 1,912 Grand Total 38,851 1,389 40,240 0 40,240 9,188ǂ 49,428 Original source: Stanford LUEP & Fehr & Peers, 2016. Original note: (1) Fall 2018 to Fall 2020 Scenario evaluates the change in VMT with the new Escondido Village Graduate Residents (2020 beds). Source: Reproduced from Stanford General Use Plan, Tab 8, Table 3 (Stanford University, 2016). Note: ǂ Total is incorrect; figures copied from original source. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 101 February 1, 2018 Appendix 6 2030 Predicted ME Call/Patient Volume, Based on CAD Calls and ESO ME Patient Volume City of Palo Alto Table 11 below shows the average 2015/16 CAD call volume by call type (in alphabetical order) for the City of Palo Alto. Note that these are based on unique (unduplicated) CAD calls, not unit calls. Table 11, Current 2015/2016 Call Volume, City of Palo Alto CAD Call Type 2015 2016 2015/2016 Average 1056 0 1 0.5 2nd Alarm 1 6 3.5 Accident 245 299 272.0 Airplane Emergency 3 6 4.5 Auto Aid 3 3 3.0 False Alarm 922 985 953.5 Fire 105 105 105.0 Full First Alarm 1 6 3.5 Gas 47 41 44.0 Hazmat 73 72 72.5 Medical Emergency 4,866 4,986 4,926.0 Mutual Aid 2 5 3.5 Service 443 490 466.5 Smoke 148 110 129.0 Suspicious Circumstance 1 0 0.5 Technical Rescue 5 1 3.0 Train-FD 2 3 2.5 Utilities 0 1 0.5 Vegetation Fire 12 11 11.5 Welfare Check 0 3 1.5 Wires 8 16 12.0 CAD Total 6,887 7,150 7,018.5 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Table 12 below shows the average 2015/16 CAD call volume and the 2030 predicted call volume, by major call type for the City of Palo Alto, taking the six scenarios into account (see PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 102 February 1, 2018 main text, Table 3 for the scenarios). Medical Emergency call volume predictions are age- adjusted. Note that these are based on unique (unduplicated) CAD calls, not unit calls. Table 12, Current 2015/2016 and Predicted 2030 Call Volume, City of Palo Alto CAD Call Type 2015/2016 Average 2030 Predictions Scen. 1 Scen. 2 Scen. 3 Scen. 4 Scen. 5 Scen. 6 Accident 272 309 300 307 316 301 310 False Alarm 954 1,078 1,051 1,078 1,106 1,060 1,101 Fire 105 119 116 119 122 117 121 CAD-ME 4,926 6,230 6,148 6,305 6,476 6,250 6,605 Service 467 526 514 527 541 519 540 Smoke 129 146 142 146 150 143 150 All Other* 166 190 184 188 194 184 190 CAD Total 7,022ǂ 8,598 8,455 8,670 8,905 8,574 9,017 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: CAD ME call volume predictions are age-adjusted. *“All other” comprises call types that represented < 1% of unique calls in the unduplicated 2015/2016 CAD dataset. ǂRounding of averages may cause minor differences in totals. Table 13 below shows the average daytime 2015/2016 CAD call volume and the 2030 predicted daytime call volume, by major call type for the City of Palo Alto, taking the six scenarios into account. Again, Medical Emergency call volume predictions are age-adjusted. Table 13, Current 2015/2016 and Predicted 2030 Daytime Call Volume, City of Palo Alto CAD Call Type 2015/2016 Average 2030 Predictions Scen. 1 Scen. 2 Scen. 3 Scen. 4 Scen. 5 Scen. 6 Accident 223 255 246 252 259 246 251 False Alarm 637 729 702 720 739 702 716 Fire 70 80 77 79 81 77 78 CAD-ME 3,342 4,241 4,159 4,265 4,381 4,210 4,410 Service 296 338 326 334 343 326 332 Smoke 78 89 85 88 90 85 87 All Other* 132 151 145 149 153 145 148 CAD Total 4,778ǂ 5,883 5,740 5,887 6,046 5,791 6,022 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: CAD ME call volume predictions are age-adjusted. *“All other” comprises call types that represented < 1% of unique calls in the unduplicated 20152016 CAD dataset. ǂRounding of averages may cause minor differences in totals. Table 14 shows the average nighttime 2015/2016 CAD call volume and the 2030 predicted nighttime call volume, by major call type for the City of Palo Alto, taking the six scenarios into account. Once again, Medical Emergency call volume predictions are age-adjusted. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 103 February 1, 2018 Table 14, Current 2015/2016 and Predicted 2030 Nighttime Call Volume, City of Palo Alto CAD Call Type 2015/2016 Average 2030 Predictions Scen. 1 Scen. 2 Scen. 3 Scen. 4 Scen. 5 Scen. 6 Accident 49 54 54 55 57 55 59 False Alarm 317 349 349 358 367 358 385 Fire 36 39 39 40 41 40 43 CAD-ME 1,584 1,989 1,989 2,040 2,095 2,040 2,195 Service 171 188 188 193 198 193 208 Smoke 52 57 57 58 60 58 63 All Other* 35 39 39 39 41 39 42 CAD Total 2,244ǂ 2,715 2,715 2,783 2,859 2,783 2,995 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: CAD ME call volume predictions are age-adjusted. *“All other” comprises call types that represented < 1% of unique calls in the unduplicated 2015/2016 CAD dataset. ǂRounding of averages may cause minor differences in totals. Table 15 shows the average 2015/2016 ESO Medical Emergency patient volume and the 2030 predicted patient volume, for daytime compared to nighttime, for the City of Palo Alto, taking the six scenarios into account. Medical Emergency patient volume predictions are age-adjusted. Table 15, Current 2015/2016 and Predicted 2030 Medical Emergency (ME) Patient Volume, City of Palo Alto ESO Patients 2015/2016 Average 2030 Predictions Scen. 1 Scen. 2 Scen. 3 Scen. 4 Scen. 5 Scen. 6 ESO-ME - Daytime 2,971 3,736 3,663 3,757 3,859 3,707 3,883 ESO-ME - Nighttime 1,359 1,707 1,707 1,750 1,798 1,750 1,883 ESO Total 4,330 5,443 5,370 5,507 5,657 5,457 5,766 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: ESO ME patient volume predictions are age-adjusted. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 104 February 1, 2018 Stanford Table 16 below shows the average 2015/2016 CAD call volume by call type (in alphabetical order) for Stanford. Note that these are based on unique (unduplicated) CAD calls, not unit calls. Table 16, Current 2015/2016 Call Volume, Stanford CAD Call Type 2015 2016 2015/2016 Average 1056 None None None 2nd Alarm 0 1 0.5 Accident 30 33 31.5 Airplane Emergency None None None Auto Aid 1 0 0.5 False Alarm 450 409 429.5 Fire 25 22 23.5 Full First Alarm None None None Gas 18 15 16.5 Hazmat 7 8 7.5 Medical Emergency 647 598 622.5 Mutual Aid 2 1 1.5 Service 83 88 85.5 Smoke 20 11 15.5 Suspicious Circumstance None None None Technical Rescue None None None Train-FD None None None Utilities None None None Vegetation Fire 6 5 5.5 Welfare Check None None None Wires 0 2 1.0 CAD Total 1,289 1,193 1,241.0 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Table 17 below provides the average 2015/2016 CAD call volume and the 2030 predicted call volume, by major call type, for Stanford. Medical Emergency call volume predictions are age- adjusted for nighttime but not daytime, due to the lack of granularity of age-range data on Stanford employees. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 105 February 1, 2018 Table 17, Current 2015/2016 and Predicted 2030 Call Volume, Stanford CAD Call Type 2015/2016 Average 2030 Predictions Accident 32 41 False Alarm 430 582 Fire 24 31 CAD-ME 623 848 Service 86 115 Smoke 16 21 All Other* 33 44 CAD Total 1,244ǂ 1,682 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: Nighttime CAD ME call volume predictions are age-adjusted, daytime predictions are not. *“All other” comprises call types that represented < 1% of unique calls in the unduplicated 2015/2016 CAD dataset. ǂRounding of averages may cause minor differences in totals. Table 18 below provides the average daytime 2015/2016 CAD call volume and the 2030 predicted daytime call volume, by major call type, for Stanford. Again, Medical Emergency call volume predictions are age-adjusted for nighttime but not daytime, as described above. Table 18, Current 2015/2016 and Predicted 2030 Daytime Call Volume, Stanford CAD Call Type 2015/2016 Average 2030 Predictions Accident 26 32 False Alarm 269 340 Fire 18 23 CAD-ME 370 468 Service 56 71 Smoke 8 9 All Other* 23 30 CAD Total 770 973 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Notes: Daytime CAD ME call volume predictions are not age-adjusted. *“All other” comprises call types that represented < 1% of unique calls in the unduplicated 2015/2016 CAD dataset. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 106 February 1, 2018 Table 19 below provides the average nighttime 2015/16 CAD call volume and the 2030 predicted nighttime call volume, by major call type, for Stanford. Once again, Medical Emergency call volume predictions are age-adjusted for nighttime but not daytime, as described above. Table 19, Current 2015/2016 and Predicted 2030 Nighttime Call Volume, Stanford CAD Call Type 2015/2016 Average 2030 Predictions Accident 6 9 False Alarm 161 242 Fire 6 8 CAD-ME 253 380 Service 30 44 Smoke 8 12 All Other* 10 14 CAD Total 474 709 Source: City of Palo Alto PSD, 2017: CAD unduplicated data 2015/2016. Note: Nighttime CAD ME call volume predictions are age-adjusted. *“All other” comprises call types that represented < 1% of unique calls in the unduplicated 2015/2016 CAD dataset. Table 20 shows the average 2015/16 ESO Medical Emergency patient volume and the 2030 predicted patient volume, for daytime and nighttime separately, for Stanford. Medical Emergency patient volume predictions are age-adjusted for nighttime but not daytime, due to the lack of granularity of age-range data on Stanford employees. Table 20, Current 2015/2016 and Predicted 2030 Patient Volume, Day versus Night, Stanford ESO Patients 2015/2016 Average 2030 Predictions ESO-ME - Daytime 600 713 ESO-ME - Nighttime 333 500 ESO Total 933 1,213 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Nighttime ESO ME patient volume predictions are age-adjusted, daytime predictions are not. See report text for explanation. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 107 February 1, 2018 Appendix 7 Total Medical Emergency Patient Volume by Incident ZIP Code by Year: Percentage and Number Table 21, Total Medical Emergency Patient Volume by Incident ZIP Code by Year Incident ZIP Code # of Medical Emergency Patients in 2015 # of Medical Emergency Patients in 2016 72533 < 1% < 1% 93302 < 1% None 94022 < 1% < 1% 94028 < 1% < 1% 94030 None < 1% 94035 < 1% < 1% 94039 < 1% < 1% 94040 < 1% < 1% 94041 < 1% < 1% 94042 < 1% < 1% 94043 < 1% < 1% 94061 < 1% None 94065 None < 1% 94102 < 1% None 94204 None < 1% 94301 44.0% (2,405) 42.3% (2,315) 94302 7.3% (397) 5.5% (302) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 108 February 1, 2018 94303 11.4% (621) 8.6% (472) 94304 9.9% (539) 15.6% (852) 94305 15.5% (847) 16.0% (878) 94306 8.9% (484) 8.2% (450) 94307 < 1% < 1% 94308 None < 1% 94309 1.3% (69) 1.8% (96) 94310 < 1% < 1% 94930 None < 1% 95050 None < 1% 95301 < 1% None 95305 < 1% None Missing < 1% < 1% TOTAL 5,465 5,478 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Totals that are less than 1% are not represented, for the sake of individuals’ confidentiality. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 109 February 1, 2018 Appendix 8 Current 2015/2016 Average Patient Volume by Primary Impression and Age Note that the tables below contain only the categories of primary impression that are relatively specific; categories such as “Everything Else” and “No Complaints or Illness/Injury Noted” are not included in these tables. Table 22, Current 2015/2016 Average Patient Volume by Primary Impression and Age, City of Palo Alto Abdominal Pain/ Discomfort Altered Level of Consciousness Behavioral Health Issues Cardiac- Related Issues Injury/ Hemorrhage Non- Specific Pain Respiratory- Related Issues Age 0-4 <10* 16 <10 None 10 <10 14 Age 5-9 <10 <10 <10 <10 24 <10 <10 Age 10-14 <10 14 <10 <10 28 <10 <10 Age 15-19 <10 30 14 <10 50 <10 <10 Age 20-24 12 44 22 <10 62 11 <10 Age 25-34 38 89 52 17 120 31 19 Age 35-44 24 101 34 41 84 41 <10 Age 45-54 39 126 34 64 84 46 19 Age 55-59 35 92 20 33 50 50 23 Age 60-64 28 81 10 27 52 30 20 Age 65-74 34 151 18 93 96 58 40 Age 75-84 39 206 <10 78 122 40 50 Age 85+ 64 332 <10 102 244 66 80 Total 328 1,288 218 468 1,023 388 290 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Totals that represent fewer than 10 patients are not represented, for the sake of individuals’ confidentiality PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 110 February 1, 2018 Table 23, Current 2015/2016 Average Patient Volume by Primary Impression and Age, Stanford Abdominal Pain/ Discomfort Altered Level of Consciousness Behavioral Health Issues Cardiac- Related Issues Injury/ Hemorrhage Non- Specific Pain Respiratory- Related Issues Age 0-4 <10* <10 <10 <10 <10 <10 <10 Age 5-9 None <10 None None <10 <10 <10 Age 10- 14 <10 <10 <10 <10 <10 <10 <10 Age 15- 19 <10 31 27 <10 36 <10 <10 Age 20- 24 10 44 26 <10 40 <10 <10 Age 25- 34 10 32 16 <10 36 <10 <10 Age 35- 44 <10 16 <10 <10 18 <10 <10 Age 45- 54 10 20 <10 <10 18 <10 <10 Age 55- 59 <10 16 <10 <10 12 <10 <10 Age 60- 64 <10 13 <10 <10 13 <10 <10 Age 65- 74 <10 22 <10 <10 21 <10 <10 Age 75- 84 <10 24 <10 10 24 <10 <10 Age 85+ <10 48 <10 14 36 12 11 Total 66 273 89 58 264 69 45 Source: City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Totals that represent fewer than 10 patients are not represented, for the sake of individuals’ confidentiality. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 111 February 1, 2018 Appendix 9 Current 2015/2016 Average and Predicted 2030 Patient Volume by Primary Impression, by City and Time of Day Note that the tables below contain only the categories of Primary Impression that are relatively specific; categories such as “Everything Else” and “No Complaints or Illness/Injury Noted” are not included in these tables. Tables are ordered alphabetically by Primary Impression. Table 24, Current and Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, by Time of Day, City of Palo Alto Primary Impression Category City of Palo Alto (CoPA) 2015/2016 Average, Daytime Scen. 2 (Lowest) CoPA, 2030 Daytime (% incr.) Scen. 4 (Highest) CoPA, 2030 Daytime (% incr.) City of Palo Alto (CoPA) 2015/2016 Average, Nighttime Scen. 1 & 2 (Lowest) CoPA, 2030 Nighttime (% incr.) Scen. 6 (Highest) CoPA, 2030 Nighttime (% incr.) Abdominal Discomfort 201 244 (21%) 257 (28%) 127 159 (25%) 176 (39%) ALOC 940 1,181 (26%) 1,244 (32%) 350 445 (27%) 491 (40%) Behavioral Health 131 146 (11%) 154 (18%) 89 99 (11%) 110 (24%) Cardiac- Related 321 416 (30%) 438 (36%) 148 191 (29%) 211 (43%) Injury/ Hemorrhage 749 895 (19%) 943 (26%) 277 344 (24%) 379 (37%) Non-Specific Pain 238 289 (21%) 305 (28%) 151 189 (25%) 208 (38%) Respiratory- Related 185 232 (25%) 244 (32%) 106 139 (31%) 153 (44%) TOTAL 2,765 3,403 (23%) 3,585 (30%) 1,248 1,566 (25%) 1,728 (38%) Source: Actionable Insights, LLC, 2017, unpublished data, based on City of Palo Alto PSD, 2017: ESO unduplicated data 2015/201617. Note: All predictions are age-adjusted. Rounding of averages or predictions may cause minor differences in totals. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 112 February 1, 2018 Table 25, Current and Predicted Year 2030 Medical Emergency Patients, Categories of Primary Impressions, by Time of Day, Stanford Primary Impression Category Stanford 2015/2016 Average, Daytime Stanford, 2030 Daytime (% increase) Stanford 2015/2016 Average, Nighttime Stanford 2030 Nighttime (% increase) Abdominal Discomfort 41 52 (27%) 26 38 (46%) ALOC 181 228 (26%) 93 139 (49%) Behavioral Health 30 38 (27%) 60 89 (48%) Cardiac- Related 39 49 (26%) 19 29 (53%) Injury/ Hemorrhage 191 242 (27%) 74 110 (49%) Non-Specific Pain 43 54 (26%) 26 39 (50%) Respiratory- Related 31 39 (26%) 15 22 (47%) TOTAL 556 702 (26%) 313 466 (49%) Source: Actionable Insights, LLC, 2017, unpublished data, based on City of Palo Alto PSD, 2017: ESO unduplicated data 2015/2016. Note: Nighttime predictions are age-adjusted, daytime predictions are not. See report text for explanation. Rounding of averages or predictions may cause minor differences in totals. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 113 February 1, 2018 Appendix 10 Palo Alto/Stanford CHNA Data Dashboard Table 26, Data Employed for Community Health Needs Assessment: Combined Palo Alto/Stanford Area Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA DEMOGRAPHICS CC Change in Total Population 8% 6% 10% SCCPHD Ethnicity: African American 2% 2% SCCPHD Ethnicity: Asian/Pacific Islander 27% 32% CC Ethnicity: Hispanic Population 8% 27% 38% SCCPHD Ethnicity: Latino 6% 27% SCCPHD Ethnicity: White 61% 35% CC Female Population 49% 50% 50% SCCPHD Foreign Language Spoken 39% 52% 58 “CC” stands for Community Commons, 2017. “SCCPHD” stands for Santa Clara County Public Health Department, 2014. “NCS” stands for The 2016 National Citizen SurveyTM (City of Palo Alto, 2017b). “EPIC” stands for California Department of Public Health EpiCenter, 2013. PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 114 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA SCCPHD Foreign-Born 32% 37% SCCPHD Household Size 2.4 2.9 SCCPHD Households with Children 35% 39% CC Male Population 51% 50% 50% CC Population in Limited English Households 5% 11% 9% CC Population with Any Disability 6% 8% 10% CC Population with Limited English Proficiency 11% 21% 19% SCCPHD Single Parent Households 5% 7% CC Population Density 3,033.1 1,447.9 246.6 SCCPHD CalFresh Households 1% 5% CC Children Eligible for Free/Reduced Price Lunch 8% 38% 58% SOCIAL & ECONOMIC FACTORS SCCPHD College Graduate 80% 47% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 115 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Economic Security - Commute Over 60 Minutes 5% 8% 11% CC Economic Security - Households with No Vehicle 9% 5% 8% SCCPHD Economic Security - Unemployment Proportion 3% 4% CC Economic Security - Unemployment Rate 4.7 3.3 5.0 CC Education - Head Start Program Facilities no data 3.4 6.3 CC Education - Less than High School Diploma (or Equivalent) 3% 13% 18% CC Education - School Enrollment Age 3-4 81% 57% 49% CC Food Security - Food Desert Population 8% 10% 14% CC Food Security - Food Insecurity Rate 12% 12% 15% CC Food Security - Population Receiving SNAP 6% 6% 11% SCCPHD Highest Ed: High School Grad 6% 15% SCCPHD Highest Ed: Some College 11% 24% CC Income Inequality no data 0.47 0.49 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 116 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Insurance - Population Receiving Medicaid 5% 17% 26% CC Insurance - Uninsured Population 3% 9% 15% CC Lack of Social or Emotional Support county only 22% 25% SCCPHD Median Household Income $ 126,771 $ 93,854 CC Poverty - Children Below 100% FPL 4% 11% 23% SCCPHD Poverty - Children Below 175% FPL 8% 33% SCCPHD Poverty - Families Below 185% FPL 8% 29% CC Poverty - Population Below 100% FPL 7% 10% 16% CC Poverty - Population Below 200% FPL 14% 23% 36% SCCPHD Received Free Food 16%* 11% CC Housing - Cost Burdened Households (by Tract) 35% 38% 44% CC Housing - Substandard Housing (by Tract) 36% 41% 47% CC Housing - Vacant Housing (by Tract) 5% 4% 8% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 117 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA SCCPHD Lives in Multi-Unit Housing 38% 33% SCCPHD Overcrowded Households 3% 8% NATURAL ENVIRONMENT NCS Air Quality 81% 80% (PA 2006) CC Air Quality - Ozone (O3) 0.0% 0.0% 2.7% CC Air Quality - Particulate Matter 2.5 0.0% 0.0% 0.5% CC Climate and Health - Canopy Cover no data 10% 15% NCS Paths and Walking Trails 76% 74% (PA 2008) SCCPHD Proximity to Open Space (Miles) 0.24 0.29 TRANSIT NCS Carpooled 56% 53% (PA 2014) CC Commute to Work - Alone in Car 58% 76% 73% SCCPHD Commute to Work - Carpooled 7% 10% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 118 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA SCCPHD Commute to Work - Other 23% 10% SCCPHD Commute to Work - Public Transportation 6% 4% CC Commute to Work - Walking/Biking 23% 4% 4% NCS Drive for Daily Needs 77% NCS Ease of Public Transportation 28% 60% (2006) CC Transit - Public Transit within 0.5 Miles 20.9% 4.43% 15.5% CC Transit - Road Network Density no data 5.23 2.02 NCS Used Public Transportation to Work 53% 50% (PA 2014) NCS Walked or Biked to Work 87% 85% (PA 2014) CC Walking/Biking/Skating to School 48% 48% 43% NCS Walks/Bikes for Daily Needs 21% N/A NCS Health Rating 95% N/A GENERAL HEALTH OUTCOMES PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 119 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Years of Premature Death Rate suppressed 3,721 5,308 CC Poor General Health county only 14% 18% CC Preventable Hospital Events 42.9 58.5 83.2 HEALTH CARE ACCESS & DELIVERY CC Access to Primary Care 103.6 105.9 78.5 CC Federally Qualified Health Centers 1.3 1.6 2.4 NCS Health Care Availability 65% 57% (PA 2006) CC Lack of a Consistent Source of Primary Care county only 12% 14% NCS Preventive Health Services 74% 70% (PA 2008) BEHAVIORAL HEALTH CC Access to Mental Health Providers county only 272.4 280.6 SCCPHD Adult Smokers 3%* 10% CC Alcohol - Excessive Consumption county only 15% 17% CC Alcohol - Expenditures 18% suppressed 13% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 120 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Depression Among Medicare Beneficiaries 65+ county only 11% 14% CC Needing Mental Health Care county only 14% 16% CC Poor Mental Health Days county only 2.7 3.6 NCS Mental Health Care 46% 63% (PA 2014) CC Mortality - Suicide 10.7 7.9 9.8 CC Tobacco Expenditures 0.5% suppressed 1.0% CC Tobacco Usage county only 10% 13% CANCER CC Breast Cancer Incidence county only 121.5 122.1 CC Cervical Cancer Incidence* county only 5.9 7.7 CC Colon and Rectum Cancer Incidence* county only 38.7 40.0 CC Lung Cancer Incidence county only 41.3 48.0 CC Prostate Cancer Incidence county only 140.6 126.9 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 121 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Breast Cancer Screening (Mammogram) county only 62% 60% CC Cervical Cancer Screening (Pap) county only 79% 78% CC Colon and Rectum Cancer Screening (Sigmoid/Colonoscopy) county only 65% 58% CC Cancer Mortality 120.4 140.8 157.1 HEART DISEASE & STROKE CC Heart Disease Prevalence county only 5% 6% CC High Blood Pressure - Unmanaged county only 27% 30% CC Ischemic Heart Disease Mortality* county only 118.55 163.18 CC Mortality - Stroke 15.1 27.2 37.4 DIABETES & OBESITY CC Diabetes Hospitalizations 3.1 7.9 10.4 CC Diabetes Management (Hemoglobin A1c Test) 80% 85% 82% CC Diabetes Prevalence county only 8% 8% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 122 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Obesity (Adult) county only 19% 22% CC Obesity (Youth) no data 15% 19% CC Overweight (Adult) county only 33% 36% CC Overweight (Youth) no data 17% 19% HEALTHY EATING/ACTIVE LIVING SCCPHD Adult Aerobic Physical Activity 75% 58% NCS Affordable Food 59% 62% (PA 2006) SCCPHD Farmers' Markets 1.4 1.6 SCCPHD Fast Food Consumption - Adults 24% 38% SCCPHD Fast Food Proximity 1.5 2.8 NCS Fitness Opportunities 79% 78% (PA 2014) CC Food Environment - Fast Food Restaurants 80.5 78.7 74.5 CC Food Environment - Grocery Stores 17.0 19.0 21.5 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 123 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA SCCPHD Fruit Consumption - Adults 34% 27% NCS Fruit/Vegetable Consumption 64% N/A CC Fruit/Vegetable Expenditures 14.4% suppressed 14.1% SCCPHD Grocery Stores 0.57 0.56 CC Low Fruit/Vegetable Consumption (Adult) county only 69% 72% CC Low Fruit/Vegetable Consumption (Youth) county only 60% 47% NCS Moderate Physical Activity or Better 67% N/A CC Physical Inactivity (Adult) county only 15% 17% CC Physical Inactivity (Youth) county only 25% 36% NCS Recreational Opportunities 77% 83% (PA 2006) SCCPHD Shops for Fruits/Vegetables Locally 93% 92% CC Soft Drink Expenditures 3.2% suppressed 3.6% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 124 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA NCS Used Recreation Centers 63% 63% (PA 2006) SCCPHD Vegetable Consumption - Adults 19% 19% NCS Visit Park 93% 93% (PA 2006) INFECTIOUS DISEASE CC STD - Chlamydia county only 329.37 459.2 CC STD - HIV Hospitalizations county only 0.87 1.98 CC STD - HIV Prevalence county only 208.42 376.16 CC STD - No HIV Screening county only 64.0% 60.8% MATERNAL & INFANT HEALTH CC Breastfeeding (Any) county only 97% 93% CC Breastfeeding (Exclusive) county only 77% 65% CC Infant Mortality suppressed 3.5 5 CC Lack of Prenatal Care 0.94% no data 3.1% CC Low Birth Weight 5.7% 6.89% 6.8% PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 125 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA ORAL HEALTH CC Absence of Dental Insurance Coverage county only 36.0% 40.9% CC Dental Care - Lack of Affordability (Youth) county only 4.2% 6.3% CC Dental Care - No Recent Exam (Adult) county only 19% 31% CC Dental Care - No Recent Exam (Youth) county only 30% 19% CC Poor Dental Health county only 8% 11% RESPIRATORY HEALTH CC Asthma - Hospitalizations 4.12 6.57 8.9 CC Asthma - Prevalence county only 14% 14% CC Pneumonia Vaccinations (Age 65+) county only 67% 63% VIOLENCE & INJURY (SAFETY) SCCPHD Bicycle/Vehicle Injuries 83 636 NCS Downtown Safety 74% 67% (PA 2006) NCS Downtown Safety* 92% 91% (PA 2006) PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 126 February 1, 2018 Source58 Indicator Palo Alto/ Stanford Area SC County Trend CA CC Mortality - Homicide 3.50 2.8 5.2 CC Mortality - Motor Vehicle Accident 2.12 4.0 5.2 CC Mortality - Pedestrian Accident* 0.53 1.54 1.97 SCCPHD Motor Vehicle Collisions 459 6,669 NCS Perceived Neighborhood Safety at Night 87% 79% (2006) NCS Perceived Neighborhood Safety during Day 98% 94% (2006) SCCPHD Pedestrian/Vehicle Injuries 30 478 CC Violence - All Violent Crimes county only 262.1 425.0 CC Violence - Assault (Crime) county only 152.2 249.4 CC Violence - Rape (Crime) county only 21.1 21.0 CC Violence - Robbery (Crime) county only 86.3 149.5 EPIC Unintentional Senior Falls Hospitalizations (Crude Rate) county only 1,259.5 1,501.4 EPIC Senior Deaths due to Falls (Crude Rate) county only 55.4 36.1 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 127 February 1, 2018 Appendix 11 Palo Alto/Stanford Neighborhood Data Dashboard Table 27, Data Employed for Community Health Needs Assessment: Cities of Palo Alto and Stanford (Separately) Neighborhood Desired Direction ↑↓ Santa Clara County City of Palo Alto Stanford Barron Park / Green Acres Downtown North / Crescent Park Midtown North / Palo Verde / Charleston Gardens Midtown South / Ventura / Charleston Meadow Professorville / Old PA / Duveneck / St Francis Population Size N/A 1,781,642 64,403 10,902 14,647 12,094 11,692 14,527 12,755 Race/Ethnicity African American N/A 2% 2% 5% 2% 2% 2% 2% 1% Asian/Pacific Islander N/A 32% 27% 31% 23% 19% 38% 33% 21% Latino N/A 27% 6% 11% 8% 5% 6% 8% 5% White N/A 35% 61% 44% 63% 70% 50% 53% 69% Foreign-Born N/A 37% 32% 29% 32% 28% 34% 37% 25% Speaks Language Other than Eng. at Home N/A 52% 39% 41% 38% 30% 45% 46% 33% Single Parent Households N/A 7% 5% 1%* 5% 4% 4%* 5% 7% Households with Children N/A 39% 35% 12% 35% 24% 44% 37% 37% Average Household Size N/A 2.90 2.41 1.9 2.5 2.1 2.7 2.5 2.5 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 128 February 1, 2018 Neighborhood Desired Direction ↑↓ Santa Clara County City of Palo Alto Stanford Barron Park / Green Acres Downtown North / Crescent Park Midtown North / Palo Verde / Charleston Gardens Midtown South / Ventura / Charleston Meadow Professorville / Old PA / Duveneck / St Francis Income, Employment, Poverty Median Household Income ($) ↑ 93,854 126,771 33,994 121,332 119,781 156,210 119,932 156,530 Unemployed (Ages ≥ 16 Years) ↓ 4% 3% 6%* 4% 4% 7% 7% 5% Families below 185% FPL ↓ 16% 8% 29% 9% 7%* 4%* 10% 8% Children (Ages 0-17) below 185% FPL ↓ 25% 8% 33%* 12%* 3% 2%* 8%* 12%* Educational Attainment (Ages ≥25) Highest Ed Attained: Less than High School ↓ 13% 3% 2* 5 1* 2* 3* 1* Highest Ed Attained: High School Graduate Relative 15% 6% 2* 7% 6% 4% 6% 5% Highest Ed Attained: Some College/AA Relative 24% 11% 3* 10% 9% 11% 15% 11% Highest Ed Attainment: College Graduate ↑ 47% 80% 94% 79% 84% 82% 76% 84% Transportation N Vehicle-Pedestrian Injury Collisions, 10 Years ↓ 478 30 20 39 94 11 34 35 N Vehicle-Bicycle Injury Collisions, 10 Years ↓ 636 83 68 143 146 39 128 149 N Motor Vehicle Collisions, 1 Year ↓ 6669 459 15 82 83 41 55 86 Lives in Close Proximity to Public Transit ↑ 65 85 96 86 89 59 99 92 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 129 February 1, 2018 Neighborhood Desired Direction ↑↓ Santa Clara County City of Palo Alto Stanford Barron Park / Green Acres Downtown North / Crescent Park Midtown North / Palo Verde / Charleston Gardens Midtown South / Ventura / Charleston Meadow Professorville / Old PA / Duveneck / St Francis Percentage of Residents Who Commute to Work by Mode Drove Alone ↓ 76 65 11 54 55 73 68 70 Carpooled ↑ 10 7 3 7 6 6 8 6 Public Transportation ↑ 4 6 4 8 6 3 5 5 Other N/A 10 23 82 31 33 18 19 20 Nutrition & Food Households receiving CalFresh Benefits Relative 5% 1% 1* 0* 1* 2* 1* 2* Ave. Miles to Nearest Full-Service Grocery Store ↓ 0.56 0.57 0.75 0.61 0.61 0.61 0.62 0.44 Ave. Miles to Nearest Farmers’ Market ↓ 1.60 1.37 1.00 0.73 1.91 1.77 1.18 1.32 N of Fast Food Outlets per Square Mile ↓ 2.80 1.50 1.50 2.10 7.90 1.20 2.10 1.10 Housing Household Rent >=30% of Household Income ↓ 46 40 69 41 35 36 44 44 Overcrowded Households ↓ 8 3 2* 5* 3 2* 3* 1* Lives in Multi-Unit Housing ↓ 33 38 90 37 60 30 31 24 Average Miles to Nearest Park or Open Space ↓ 0.29 0.24 0.25 0.33 0.21 0.23 0.25 0.24 N of Tobacco Retail Outlets per Square Mile ↓ 3.50 1.20 0.0 1.6 3.4 3.1 2.6 0.5 Average N of Violent Crimes within 1 Mile ↓ 16.04 6.30 1.8 3.1 11.6 1.8 5.1 9.2 N of Alcohol Retail Outlets per Square Mile ↓ 2.7 1.00 0.0 0.7 5.1 3.7 2.1 1.1 PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 130 February 1, 2018 Neighborhood Desired Direction ↑↓ Santa Clara County City of Palo Alto Stanford Barron Park / Green Acres Downtown North / Crescent Park Midtown North / Palo Verde / Charleston Gardens Midtown South / Ventura / Charleston Meadow Professorville / Old PA / Duveneck / St Francis Maternal, Child, & Infant Health Births per 1,000 People N/A 13.50 9.70 7 8 12 9 10 7 Low Birth Weight Infants ↓ 7% 6% 5% 4% 7% 7% 7% 5% Preterm Births ↓ 9% 8% 6% 6% 10% 7% 7% 7% Overweight/Obese in 1st Trimester ↓ 38% 19% 12% 20% 15% 21% 21% 17% Prenatal Care ↑ 74% 85% 83% 85% 87% 85% 82% 88% Teen Live Births ↓ 19.2 2.3 0 2 2 2 3 1 Mortality Life Expectancy ↑ 83.4 87.0 -- 87.2 86.8 87.4 86.8 87.5 Cancer Mortality Rate ↓ 140.3 111.7 -- 109.9 118.0 111.9 116.8 104.1 Heart Disease Mortality Rate ↓ 118.8 82.7 -- 86.9 84.8 72.8 84.1 81.4 Alzheimer’s Disease Mortality Rate ↓ 34.6 32.4 -- 34.0 31.9 28.7 40.0 25.7 Stroke Mortality Rate ↓ 27.8 17.3 -- -- 13.5 -- -- 20.5 Chronic Lower Respiratory Mortality Rate ↓ 25.5 16.7 -- -- 20.6 -- -- -- Unintentional Injury Mortality Rate ↓ 23.4 15.1 -- -- -- -- -- -- Diabetes Mortality Rate ↓ 23.3 7.8 -- -- -- -- -- -- Influenza and Pneumonia Mortality Rate ↓ 14.3 10.2 -- -- -- -- -- -- Hypertension Mortality Rate ↓ 14.6 9.4 -- -- 10.7 -- -- -- PAFD 2017 Report Final Draft © Actionable Insights, LLC Page 131 February 1, 2018 Neighborhood Desired Direction ↑↓ Santa Clara County City of Palo Alto Stanford Barron Park / Green Acres Downtown North / Crescent Park Midtown North / Palo Verde / Charleston Gardens Midtown South / Ventura / Charleston Meadow Professorville / Old PA / Duveneck / St Francis Other Health-Related Currently Uninsured (18-64) ↓ -- -- 4% to 10% 13% to 15% 4% to 10% 4% to 10% 10% to 13% 4% to 10% Current Smoker (18+) ↑ -- -- 3% to 8% 8% to 10% 3% to 8% 3% to 8% 8% to 10% 3% to 8% Obese (18+) ↓ -- 11% 1% to 15% 1% to 15% 1% to 15% 1% to 15% 1% to 15% 1% to 15% Overweight or Obese (12-17) ↓ -- -- 0% to 11% 11% to 17% 0% to 11% 0% to 11% 11% to 17% 0% to 11% Overweight for Age (2-11) ↓ -- -- 0% to 6% 0% to 6% 0% to 6% 0% to 6% 0% to 6% 0% to 6% Received Flu Vaccine (65+) ↓ -- -- 75% to 76% 78% to 84% 75% to 76% 78% to 84% 78% to 84% 76% to 78% Received Flu Vaccine (6m-11) ↓ -- -- 52% to 71% 52% to 71% 52% to 71% 49% to 50% 50% to 52% 50% to 52% Source: Santa Clara County Public Health Department, 2016. CITY OF PALO ALTO OFFICE OF THE CITY AUDITOR November 13, 2018 The Honorable City Council Palo Alto, California Policy and Services Committee Recommends the City Council Accept the Code Enforcement Audit In accordance with the Fiscal Year 2017 Annual Audit Work Plan, the Office of the City Auditor has completed the Code Enforcement audit. The audit report presents three findings and seven recommendations. The Office of the City Auditor recommends that the Policy and Services Committee review and recommend to the City Council acceptance of the Code Enforcement audit. Respectfully submitted, Harriet Richardson City Auditor ATTACHMENTS: Attachment A: Code Enforcement Audit (PDF) Department Head: Harriet Richardson, City Auditor Page 2 Attachment A Code Enforcement Audit November 6, 2018 Office of the City Auditor Harriet Richardson, City Auditor Yuki Matsuura, Performance Auditor I Attachment A Page intentionally left blank for double-sided printing Attachment A th OFFICE OF THE CITY AUDITOR EXECUTIVE SUMMARY Code Enforcement Audit November 6, 2018 PURPOSE OF THE AUDIT inform them CONCLUSION The City code enforcement cases and in a timely manner due to factors such as unclear roles and responsibilities The City’s records on code enforcement complaints and cases are inconsistent and incomplete and useful information for management decisions The City’s has opportunities for further in regard to code enforcement processes It is essential for the City to guide and support its code enforcement functions to ensure that any barriers to useful data is collected and REPORT HIGHLIGHTS Finding 1: many code enforcement fragmented Municipal Code timely response and resolution (Page 9) been hampered by factors such as fragmented Municipal Code re enforcement efforts by addressing those factors and realigning its code Key Recommendations: Clarify and confirm the City’s code enforcement strategy and priorities is Attachment A Finding 2:The City does not code enforcement data to useful information for management decisions (Page 28) decentralized recordkeeping system produces incomplete or inconsistent The City can capture stakeholders and designing standardized code enforcement data tracking and reporting processes to mee Key Recommendations: terminology Reconfigure Accela Code Enforcement to enhance data collection and Finding 3: responsible for code communication on code enforcement efforts (Page 38) arding Municipal Some nearby City can adopt some o Key Recommendations: the enforcement functions across the City Attachment A TABLE OF CONTENTS Background Scope Methodology fragmented response and resolution Recommendations information for management decisions Recommendations compliance but Recommendations Code Enforcement Functions Across the City Code Enforcement Functions and Primary Enforcement Responsibility Appendix ABBREVIATIONS C&D Construction and Demolition CAD Computer Aided Dispatch FTE Full- PAMC Palo Alto Municipal Code TDM Transportation Demand Management Attachment A Page intentionally left blank for double-sided printing Attachment A Code Enforcement Audit 1 INTRODUCTION Objective Does the City useful information for management m about the Background Goal is to achieve compliance rather than to sanction violators The City’s code enforcement processes encompass efforts by responsible for certain sections of the guidance regarding code enforcement authority and other uidance regarding Appendices the code enforcement functions across the City and their The City’s goal is to rather than to impose sanctions through formal enforcement and penalties City staff r seri may also initiate a code enforcement process based on completing other duties or referrals The of the Planning and complaints by the public as the function generally responsible for enforcing code Exhibit Attachment A 2 Code Enforcement Audit EXHIBIT 1 Planning’s Code Enforcement High-Level Process SOURCE: Auditor’s analysis of Accela Code Enforcement data Code Enforcement Officers The Municipal Code defines ode enforcement officer as any of the Municipal Code title The City has four fulltime the title of code enforcement officer T position ’s Code Enforcement and report directly to the chief planning official O ’s deputy d Other City positions are designated in specific Municipal Code Appendix affected the code enforcement officer Attachment A Code Enforcement Audit 3 EXHIBIT 2 Municipal Code Titles That Code Enforcement Officers Are Authorized to Administratively Enforce Municipal Code Title Title Description Title Business Licenses and Regulations Title Title Animals Title Trees and Vegetation Title Public Title Public Works and Utilities Title Title Building Regulations Title Title Zoning Title Parks SOURCE:PAMC Sections and Enforcement Responsibilities Planning’s code enforcement officers are responsible for codes and and Building staff percent of each of Planning’s three code enforcement officer positions lead code enforcement officer in January some of the leaf bl and to The lead code Attachment A 4 Code Enforcement Audit The Police Department enforces the City’s noise ordinance including cons animal control regulation parking regulations and and solicitors The Fire Department code s related to fire safety and hazardous materials and identify and abate s that All t the Public Works Department enforcement responsibilities o properties and streets o items placed or performed in the City’s right-of- encroachment o al and for including container i such as Enforcement Options The Municipal Code remedies to as cost-initiating formal V notices to inform the alleged that a or that a Citations to encourage compliance through assessment of o itations issued by authorized City staff penalty schedule Attachment A Code Enforcement Audit 5 the listed penalty for a a - of the listed penalty for a a - The responsible party can appeal to the City’s hearing officer o Criminal citations can be Compliance orders for cases that and specific penalties comply attend a hearing before the City’s hearing o to The City Attorney’s Office supports the code enforcement functions Scope code enforcement processes and related complaint and case records for FY for six departmen Planning orks further focused on Planning’s code enforcement cases opened January and June Methodology s Attachment A 6 Code Enforcement Audit Information Technology Departments to understand the City’s code enforcement functions and processes and identify enhancement opportunities Municipal Code sections understand code enforcement organizational structure of the City’s code enforcement other budgets to identify their Conducted a risk assessment to identify and prioritize areas on code enforcement data and department records to understand the o o Planning’s FY code enforcement case data in Accela in detail all Accela code enforcement and June o A judgmental sample enforcement issues in detail to assess accuracy and o Building’s FY inspection data in Accela related to code enforcement o Police’s FY nonemergency call data in the Computer ystem for Municipal Code and noise s o or FYs o Public Works Watershed Protection’s FY Accela is the City’s permitting system for planning and Attachment A Code Enforcement Audit 7 o Public Works Refuse’s FY o Golf citations issued in FY the code enforcement functions Because highly depend on the nature and complexity of based on that context rather than a specific timeframe or outcome Sampling methodology code enforcement issues based on public interest identified on The sample case types We chose this sample design to address public concerns to identify the cause of any deficiencies to inform our conclusions cannot be projected to the total population of code Data reliability the Accela code enforcement data and cross-referenced it against supporting documents recorded in PaloAlto assess the accuracy and completeness of the code enforcement performance on code enforcement cases and timeliness of that different departments use to track complaints and enforcement We identified data reliability concerns that became a focus in our audit j We chose some of Attachment A 8 Code Enforcement Audit Code Enforcement Community Survey the National to conduct a statistically assessment of the Compliance with government auditing standards We conducted this audit of code enforcement our FY Annual Audit Work Plan and generally accepted ble basis for our findings and and conclusions based on our audit Planning Attachment A Code Enforcement Audit 9 Finding 1 The City resolves many code enforcement cases effectively; but unclear roles and responsibilities, fragmented Municipal Code requirements, and staffing limitations have hampered timely response and resolution Summary The City has many code enforcement functions Each function has its responsibilities departments many enforcement program is administered based on clear roles through numerous organizational changes that staffing and priorities causing roles and responsibilities to become unclear for some functions The City focuses its limited resources on situations that pose a serious risk Timeliness and such as fragmented that do not difficult cases that consume a significant amount of staff time its code enforcement efforts by addressing those factors and realigning its code enforcement prior staffing Timeliness or effectiveness of code enforcement varies by function, nature of violation, and workload factors primarily by complaints from residents issues that trouble residents City staff prioritize complaints based on the situations that pose a ser This is the rated prioritizing enforcement based on health and safety risks as enforcement function and the Attachment A 10 Code Enforcement Audit Planning’s Code Enforcement their in the second half of FY Building s but Police enforces the City’s noise ordinance but response times are affected by other public safety priorities Fire enforcement but Park rangers enforce park and open space regulations and Planning’s Code Enforcement resolved 81 percent of their cases within 60 days lead code enforcement o i its timeliness in closing cases Exhibit Planning opened code enforcement cases in FY and closed of December bit percent of the cases opened during the first half of FY closure percent cases opened in the second half of FY o better and more timely recordkeeping and may not necessarily reflect the timeliness of maintenance cases to their complexity Attachment A Code Enforcement Audit 11 EXHIBIT 3 Planning’s Code Enforcement Cases Opened During FY 2017 and Status as of 12/31/17 Case Type Number of Cases Opened Status as of 12/31/17 Jul-Dec 2016 Jan-Jun 2017 Total %Closed Open # Citations3 - % - 4 Encroachment % - Property Maintenance % % - - Zoning % Building % Fences % - - Short-Term Rental % Long Term CM % - - - - - - - Vehicles - - - Grand Total 435 331 766 100% 752 14 17 The home o leaf b short-term rental case types in z - We recategorized them to more accurately present the The larger in the first half of FY resulted from political the the fall The number of citations is based only on 4 Police issued four s SOURCE: Planning Department - Accela Code Enforcement data EXHIBIT 4 Planning’s Code Enforcement Cases - Number of Calendar Days from Case Opened to Closed Cases closed within: Number of Cases Opened During 1st half of FY 2017 (Jul - Dec 2016) 2nd half of FY 2017 (Jan-Jun 2017) # Cases %# Cases % Same %% Could not determine Total 435 100% 331 100% SOURCE: Planning Department – Accela Code Enforcement data Attachment A 12 Code Enforcement Audit s for code enforcement officers to open a case because of data reliability issues are discussed in Finding based on the case records it is likely that their timeliness has been affected by a large increase in the Enforcement Issue as complaints Most residents EXHIBIT 5 Number of PaloAlto311 Service Requests for “Code Enforcement Issue” Code Enforcement Issue Type Number of Service Requests FY 2016 FY 2017 - Property Maintenance - Zoning Compliance - Fences - Signs - Weeds Other Total 188 575 All Includes SOURCE: Planning Department – Planning has an internal guideline for priorities and response It took Planning Attachment A Code Enforcement Audit 13 Many minor encroachment or property maintenance cases are simple and the need to e items from the take longer for a code enforcement officer to get to these cases due to other higher priority cases that pose a risk to health or safety It may also take longer for Planning to respond if a com Planning staff generally do not respond to calls during those In FY Enforcement Issu hours After lead code enforcement officer led to Planning’s code enforcement Ensuring that all three officers are certified by the California Association of Code Enforcement Officers Enhancing Attorney’s Office and ing enforcement of gas-s through additional need to be made for actions taken Building Division works closely with Code Enforcement, but cases involving a building permit take a long time to resolve Building staff typically conduct an inspection one to three days after If Building staff confirm during a routine inspection or in time to than simpler cases and It Attachment A 14 Code Enforcement Audit confirmed Police response times to nonemergency complaints are affected by other public safety priorities Police o and enforce the City’s noise ordinance depending on the ue and impact on public Police also enforce certain business regulations such as taxicabs the Police Department’s FY other higher priorities often take olice officers from getting to the site in progress and correct the same police o and identify it as such may only be on site for a short period of ti only temporarily EXHIBIT 6 FY 2017 Police Nonemergency Calls for Service - Selected Event Type and Event Subtypes Event Type Event Subtype Number of Calls Municipal Code Violation Construction Noise Solicitors Other Disturbance Noise SOURCE: Police Computer-Aided Dispatch System Data Fire contracts with Santa Clara County to identify and abate fire hazards from weeds The Fire Department contracts Santa Clara County to focus addresses The County has the expertise and a -established to identify potential fire hazards from The City Council adopts a resolution each fall to declare those properties a public nuisance and holds a public hearing each spring to hear any objections to Attachment A Code Enforcement Audit 15 To ensure continued compliance must meet the Minimum Fire Safety Standards for three e property fails plus an are Public Works forwards some code violations to Planning for enforcement but also has its own enforcement programs Public Works’ arded to Planning for incidents incidents the permitting and plan check processes It also responds to property complaints but does not keep a record of them because they are not considered a code enforcement case until al enforcement program for each of its functions Watershed Protection staff Attachment A 16 Code Enforcement Audit Park rangers enforce park and open space regulations and issue citations on the spot for public protecting the natural resources of the City’s parks and open a -the-spot citations in FY An effective resolution should be cost-effective, which may sometimes be more important than timeliness The Cit rather than to impose sanctions such as tations on gaining compliance by guiding the responsible party to obtain a rather than immediately issuing a citation code enforcement officers assess each case and its responsible party lty does not create an immediate danger to health or safety s ind -faith effort to abate the This strategy may frustrate complainants may urge the City to to immediately issue a citation unless certain criteria are met n could also result in costly and time- A repeat offense may not be sanctioned depending on the severity and circumstances The City’s strategy also influences City staff’s approach to a creates an immediate danger to health or safety a repeat offense Although states that the schedule of See Joint Report from City Attorney and City Manager to Confirm City Code Enforcement and City Attorney’s Office Code Attachment A Code Enforcement Audit 17 accordingly - month period Planning staff typically s that do not pose an immediate danger s if the osed generally apply the only to s Timeliness and effectiveness of code enforcement have been hampered by unclear roles and responsibilities and fragmented Municipal Code requirements some code enforcement roles and responsibilities for certain functions became unclear the ability for staff to respond to code enforcement Municipal Code do not or are interpreted and applied code enforcement responsibilities puts an additional burden on enforce the Municipal Code and is enforced A series of organizational and staffing changes resulted in higher expectations for Planning code enforcement efforts under the Police Department in FY ensure compatibility and consistency in code enforcement po through cross- training and coordinat ue to budget constraints in FY the City three full-time positions for code enforcement in Police and Public W code enforcement o reduced the Police code enforcement officer position FTE en Attachment A 18 Code Enforcement Audit With establishment of the in FY code enforcement o a planning manager but continued to support Building for Planning reorganized its code enforcement function under the chief planning official in FY The City’s code enforcement structure remains decentralized today lead code enforcement officer position in FY specifically to Municipal Code taking from Police Although Planning it no longer does and staff cited increased case as the reason Municipal Code sections not always aligned with current practices cedures in compliance orders The organizational and regulatory changes since then and departments enforcement practices that best suit The City has not amended the procedures since Municipal Code do not reflect the organizational and regulatory changes thus do not For example Municipal Code code enforcement officers to for the responsible party to correct a if the structural or zoning matters that do not create an immediate When to the lead code enforcement officer Attachment A Code Enforcement Audit 19 the City is restricted from issuing a citation a prior Police can issue a criminal citation the - Some Municipal Code chapters define enforcement procedures or designate specific positions to enforce a chapter’s While it makes sense to maintain separate procedures Use ome Fo PAMC Noncompliance a Public Nuisance Enforcement – Citation Authority to address zoning d administr procedures at the time on the City Attorney’s legal proceedings and the designated employees’ ’s code enforcement officers address most using the and the City Attorney’s Office and the designated employees mainly play a supporting role in hearing and lien are difficult to understand facts California Penal Code Section Attachment A 20 Code Enforcement Audit S es appear in front of the enforcement officer at a stated time and place for a hearing are no longer because of the more courteous in – Streamlining and updating these enforcement City staff These chapters also designate nonexistent positions for enforcement such as plan check engineer and ordinance compliance inspector A better practice update the position titles in the Municipal Code if they change or the responsibilities are reassigned to another position may be to designate the department responsible for enforcement but not Advanced coordination clarifies roles and responsibility and prevents redundancy Planning has arrangements functions in other departments staff to process based on preestablished enforcement roles and responsibilities Planning’s Construction and D oordinator gain c lead code enforcement officer Without such an Various other efforts are Planning’s code e their maintenance responsibilities in these areas to regularly In expand the Attachment A Code Enforcement Audit 21 inconsistencies and modernizing the ordinance to prepare for an automated tracking and penalty collection program City staff must prove a violation by a preponderance of the evidence before issuing a citation Some complainants expressed their frustration that City staff do not issue citations code -ained he Municipal Code Because the City has on a preponderance of the City staff cannot rely solely on a photo submitted and generally do not issue a citation unless they Some regulations are difficult to enforce and consume a disproportionate share of staff time D e a technical understanding of multiple Municipal Code other City staff consume a significant amount of staff time by adopting practices - complaints in FY most not substantiated primarily because Police officers often cannot respond immediately to due to other priorities s unconfirmed cases to Planning Planning also complaints by opening a code enforcement case in Accela sending a courtesy letter to notify of the complaint conducting one inspection on a later date before closing the case the it is difficult to catch a often and change their schedules operators a hired gardener Based on that ordinance Police issue a citation only to operators and upon Attachment A 22 Code Enforcement Audit es courtesy another Municipal Code section that applies to aiding and Some cities strengthened both operators and accountable for leaf the City of Santa Monica amended its ordinance to assign f When they issue they also attach informational door hangers to the front door of the property to alert the resident of the Santa Monica also These complaints om - The number of citations also increased The Placing responsibility more effecti insufficient to deter professional gardeners from committing Construction noise – officers often cannot get to the construction Building staff respon and make the s construction sites a future occurrences ilding does not record the Attachment A Code Enforcement Audit 23 complaints or obtain Police call data to track and identify Some jurisdictions contractor’s contact departments the City only ires the Police nonemergency number to be posted isting the City to address the problem sooner and Complex property maintenance cases – Complex property properties or h multiple departments and interpretation of multiple Municipal Code sections f there are any health or safety hazards the City abate the conditions to protect the public the City Attorney’s Office to ensure other To streamline San Jose and San Francisco adopted anti-blight ordinance Municipal Code to address properties under Zoning cases – enforcement officers rely on the planners’ expertise to inter reach an unbiased conclusion due to Planning’s role in the Attachment A 24 Code Enforcement Audit s to identify any jurisdictions that offer an appeal process to a s Some regulations lack an enforcement process or resources a defined process or Council made a conscientious decision to implement regulations based on their contributes to frustrations among residents regarding the City’s code Public benefits – The City has adopted istricts Municipal Code for not specifically Although Planning staff stated that many PC districts lack he Municipal Code inspections of each PC district at least regulations and the conditions of the ordinance under s that the City dedicated sufficient resources for reasses -specific PC enforcement officer position in FY Planning monitors certain projects closely but has not established a process to meet the three-year inspection cycle and takes enforcement action primarily on a complaint basis Attachment A Code Enforcement Audit 25 Multi-family smoking ban – City did not budget resources to perform outreach or to c of tracking i – The City routinely attaches numerous typic enforcement officer positio projects to self-monitor certain conditions and report annually - Improving the enforceability of regulations can free up resources for other enforcement priorities s and from the City The City can support staff by setting code enforcement priorities and making resource and policy decisions to ensure that the Resources could also be freed up f other enforcement priorities if code enforcement officers stopped - up for continued Attachment A 26 Code Enforcement Audit Recommendations We recommend that the City Manager Attorney’s Office and functions to Clarify and confirm the City’s code enforcement strategy and priorities an updated enforcement procedure strategy for each area of the City’s code enforcement priorities This includes assessment of the regulations that lack an enforcement process or sufficient PC district regulations leaf conditions the applicant to self-Post the updated strate Update the Municipal Code enforcement including Combining into a single chapter larifying and streamlining in PAMC practices and Council’s intent for code enforcement a A a as needed and streamlining for consistency across City departments Clarifying code enforcement roles and responsibilities to that permit information and contact information for contractors and responsible City annual Municipal Code clean up Attachment A Code Enforcement Audit 27 old regular meetings code enforcement responsibilities to share allocation and consistent enforcement action plan responsibility Attachment A 28 Code Enforcement Audit Finding 2 The City does not have complete and reliable code enforcement data to provide useful information for management decisions Summary record code enforcement complaints and cases using different its Computer-CAD Some functions do not record all or system produces incomplete or inconsistent data that is difficult to aggregate into a c M performance measures and use the information for their annual reliable data by identifying and designing code enforcement data tracking and reporting processes to meet the identified needs The City does not have a centralized tracking system for complaints and code enforcement cases through multiple channels and each code enforcement function may classify and record the complaints and cases using different systems This decentralized recordkeeping makes it difficult to aggregate data in a manner City’s code enforcement acti some functions do not record all complaints they re informally address some issues considering the issue as a graffiti on public property may be treated as a maintenance task rather than a code code enforcement functions Inconsistent and incomplete data limit the City’s ability to identify trends for strategic policy discussion and resource allocation Planning re an enforcement action Attachment A Code Enforcement Audit 29 to create and track cases do not enter any information in the code enforcement cases and instead track inspections they conduct in support of code enforcement in the Building module of Accela complaints related to construction sites in the City but does not record them as code enforcement issues Planning’s P construction and Systems’ debris tracking oncompliance in FY The C&D coordinator reports noncompliance to the lead code enforcement officer for citation but no code ach citation to the corresponding building permit record in Accela’s Building module We could there is not a field in Accela dedicated to tracking citations All calls are recorded in the CAD system classify the complaints based on the type of issue A police days on its the permitting and inspection processes Fire does not record complaints or track abatement cases that it reports to Santa Clara County to address phone or email and a Watershed Protection staff use Microsoft spread Attachment A 30 Code Enforcement Audit City’s refuse contractor y monitor the log to identify issues The City reports only a limited number of performance measures, which does not reflect the timeliness and effectivenessof citywide code enforcement efforts Planning reports the days in the annual Performance Report and rated code enforcement as good or excellent in the annual Operating Budget Other City departments do not regularly report understand the extent Center for Performance Measurement es a list of core measures for code enforcement umber of calendar days from case inspection to oluntary or forced compliance compliance Accela code enforcement case data is not reliable for analysis P To determine if the City’s code enforcement data is complete and Planning’s code enforcement case data in Accela dataset specific to code enforcement cases only ing the second half of FY opportunities Although the code enforcement officers documented detailed informati data and the system configured to capture and produce reliable and useful data for management Attachment A Code Enforcement Audit 31 EXHIBIT 7 Code Enforcement Cases Opened Between 1/1/17 and 6/30/17 and Status as of 12/31/17 Case Type Total Void1 Forwarded to Other City Dept2 No Violation Violation # Citations Abated Open --- Property Maintenance - Encroachment - - Zoning -- Building -- - - Fences -- - - Short-Term Rental - Long Term CM - - - - - - - - - Vehicles -- - - - Grand Total 331 18 2 160 140 14 9 1 Includes duplicate cases 2 Source:Auditor’s analysis of the code enforcement cases in Accela Useful information cannot be extracted in a reliable manner is entered in the Description or Comments fields and cannot be extracted to produce accurate For example Accela does code enforcement officers enter a Cases for a specific type of olation because the options are not standardized and data is entered for the same type of and case type are the same and just say Building or The case types are code enforcement officers create one case and choose a case changed once entered an inspection finds that it is incorrect or that there is are no data fields specifically for the source or date of the Attachment A 32 Code Enforcement Audit complaint or its resolution compliance Code enforcement officers describe these in the Comment field but not in a Workflow status is not entered consistently and completely Code enforcement officers update case status by choosing a the date and comments for the status Exhibit EXHIBIT 8 Example of Changes in Code Enforcement Case Workflow Status SOURCE:Auditor’s analysis of Accela Code Enforcement data W data to assess the code enforcement officers’ or performance because the data not entered consistently and completely Each inspection should be recorded by choosing the We counted the Comments field had an Our dataset had or triggering the automatic generation of a Code Enforcement distinguishes a courtesy notice from a oth notices are recorded in Acce be distinguished for reporting purposes Some of these issues may staff not fully understanding the code enforcement officers use an iPad to document their cases in the field but the Attachment A Code Enforcement Audit 33 fully explained to staff to ensure consistent and complete data entries in Accela through an iPad Case description and status are sometimes incomplete or not detailed enough for the public to understand the issue or resolution in BuildingEye As explained in Finding the c status are BuildingEye displays selected Accela code enforcement case data through an complete or detailed enough it limits the public’s ability to understand the issue code enforcement cases and may contribute to residents reporting additional complaints for an issue that has already been or is Accela case data also tend to be incomplete or not updated timely function other than Planning or high-profile zoning issues that are primarily handled by a planner complex property maintenance issues that e the City to perform the Exhibit the descriptions Exhibit information regarding the status of a code enforcement and displayed on BuildingEye could reduce the number of -s transparency to the public regarding the cases Attachment A 34 Code Enforcement Audit EXHIBIT 9 Extract of City of San Diego Code Enforcement Records SOURCE:City of San Diego Citizen Portal at EXHIBIT 10 Example – City of Pittsburgh BuildingEye/Enforcement SOURCE:City of Pittsburgh BuildingEye at Attachment A Code Enforcement Audit 35 Code enforcement documents are not labeled consistently and can be difficult to identify Code enforcement officers upload related case documents in Accela s of s find a specific attachment because they are all under the same tab not labeled clearly and consistently For to Planning has a project in place to integrate Accela and PaloAlto311 but has not been able to move forward Planning’s three--per- year contract to implement Accela enhancements in June The contract includes integrating code enforcement such as changes to gramming and Transportation Demand Management I ill City competing priorities Planning has only one business analyst to support its including PaloAlto Geographic Information System Accela data e a thoughtful design process to define data points The lead code enforcement officer made various improvements, but more is needed Planning code enforcement cases since the lead code enforcement officer joined the City code enforcement officers did not consistently use Accela to record their cases in Accela all cases action cases in Accela e increase partly due to enhanced an increase in political sign an Created -term rental cases to separately ously included in Zoning Attachment A 36 Code Enforcement Audit ed ed and standardized the process for notifying the party responsible for an Automated and standardized the recording and notification processes s Standardized iz The lead code enforcement officer stated that Code Enforcement did not ha due to Recommendations Upon confirming the City’s code enforcement strategy and that the City’s code internally and internally and D s to use and enforcement data for each function including design reporting processes capable of aggregating the data into a measures for the annual If it is determined under that Planning continue to use Accela Planning should reconfigure Accela Code Enforcement to enhance data collection and reporting p e ay adopt Accela by Attachment A Code Enforcement Audit 37 Defining each type of and identifying additional status or other data points to be captured the Accela consultant to ensure needed data and documents are captured accurately consistently in a manner that can be extracted for reporting additional data fields Adding or modifying drop-s after initial data entry templates in Accela for periodic reporting of code enforcement performance measures in Establishing data entry procedures to Establishing s Ensuring that information displayed on BuildingEye s sufficient detail for the public to understand and resolution of each case Attachment A 38 Code Enforcement Audit Finding 3 The City actively engages with individuals responsible for code violations to gain compliance but should improve its public communication on code requirements and enforcement efforts Summary Municipal Code ce Although City staff typically bringing s into may find it difficult to get information use Pa but BuildingEye for code enforcement linked to and looking for code enforcement case information may not easily find it additional information compliance such as their code enforcement strategy and a neighborhood resources l Citywide information on code enforcement is not easily accessible from a central location Most and makes it difficult for residents or City staff to find the responsible City staff or the For many planning and zoning handouts such as guidelines and pr Attachment A Code Enforcement Audit 39 ge GreenWaste of Palo Alto an PaloAlto311 capabilities not fully leveraged The Public Works- Exhibit the City expanded the use of the platform to other public-facing departments EXHIBIT 11 Number of PaloAlto311 Service Requests by Department Department FY 2013 FY 2014 FY 2015 FY 2016 FY 2017 Public Works - Planning - - Utilities - - Other Total Maintenance issues such as open space and parks s s SOURCE: Planning Department – coordinated interdepartmental efforts or monitored Attachment A 40 Code Enforcement Audit S issue types are not clearly defined or causes certain complaints to be routed to the then the right person to the issue has been so it may remain in an open status Some users stated that they did ed making communication difficult among departments The City Open Data Portal but the data is incomplete and the dashboard does not current not been addressed because each PaloAlto311 application is not as user friendly as it could be The City’s code enforcement The application lists primary issue types subcategories and brief descriptions that may not be sufficient for residents to type to choose reporting a code Attachment A Code Enforcement Audit 41 description for the Enforcement Issue option and does not list other types of code enforcement issues until the option and a location is selected subcategories V Weed and no clear description of the difference option The also includes subcategories other options for reporting other types of obstructions restaurant tables and chairs or or direct their more clearer descriptions of represents could S submit a complaint or sp their issue of interest and find information Attachment A 42 Code Enforcement Audit EXHIBIT 12 Extract of SF311 List of Online Services SOURCE: Communicating the City’s Code enforcement strategy and priorities can improve expectations It also may be helpful to communicate clearly the City’s code types of complaints and address Exhibit jurisdictions clearly communicate their code Attachment A Code Enforcement Audit 43 EXHIBIT 13 Redwood City Code Enforcement Principles SOURCE: -- -inspection-code--enforcement The City can leverage its community partners and provide online resources for achieving compliance ir code that can help address code enforcement issues or neighborhood -going and persistent disputes Palo Alto has a number of community partners and City programs that residents can reach out to neighborhood issues resources are not linked to the code enforcement information on compliance Example The City’s Safe Routes to School staff can assist in clearing a bike path Attachment A 44 Code Enforcement Audit -market rates to abate property maintenance issues City staff actively engage with individuals responsible for code violations to gain compliance responsible parties to gain differ depending on the code enforcement function and nature and issue a citation if not corrected Planning’s code enforcement officers issue a courtesy notice or respons Multiple methods used to communicate complaint and case status, but information available to the public is not always complete or easily accessible Planning uses three methods to collect and communicate – Residents can report code enforcement report back to the complainant through but Planning uses this primarily as a Accela - through email or Planning’s lead code enforcement enforcement officer only if the complaint is determined to an enforcement action igned Planning does not create a case Attachment A Code Enforcement Audit 45 around the for cases in of in BuildingEye – e res Accela building permit data Planning adopted BuildingEye for planning applications soon after and began using it for code enforcement in July Other departments use methods other than Accela and their cases Planning’s Code Enforcement uses PaloAlto311 as a reporting tool and Accela to manage cases When a complainant uses notification S R y When Planning simultaneously notifies the complainant that it has opened a case file and that the complaint is C in includes a link to BuildingEye so the complainant can U C cause complainants to think that Planning kept the PaloAlto for a four-month trial period to maintain communication the complainants it discontinued the practice because Accela are not interfaced and for Planning an d multiple complainants or one complainant filed multiple complaints on the same T the Accela case record nor is the Accela case number recorded in Attachment A 46 Code Enforcement Audit to track the ongoing status of cases that they reported through BuildingEye data not always complete or detailed enough to understand the issue or resolution Complainants must either BuildingEye’s Enforcement exists to search for the status of a case because there is not a direct link from Planning’s Code BuildingEye A search for result in a documents that announced the launch of BuildingEye and access BuildingEye through links in those documents case information ’s Enforcement is not complete or detailed enough for planning application data through BuildingEye’s and building permit data through the Building T link to the more detailed information accessible through City of Palo Alto Citizen Portal it is not apparent in BuildingEye’s E an permit code enforcement officers typically note the permit or application number in the Comments field of Accela for a related ould onfigure and display the number in BuildingEye could also enhance dissemination of data that are already The City of Palo Attachment A Code Enforcement Audit 47 Recommendations responsibility for ensuring that the information is kept up to Examples of information that the should include are The City’s code e function code enforcement case status and resolution including links to BuildingEye City of Palo or the complainant can expect and examples of information that the complainant is not ne Redefining PaloAlto reconfiguring s to minimize incorrect routing of Managing user access and making training materials Updating and maintaining the and Attachment A Code Enforcement Audit 48 APPENDIX 1 – Code Enforcement Functions Across the City Attachment A Code Enforcement Audit 49 APPENDIX 2 – Code Enforcement Functions and Primary Enforcement Responsibility Primary Enforcement Functions Primary Enforcement Responsibilities Department Function Palo Alto Municipal Code Primary Focus City Attorney Legal Support All Legal advice and support on code enforcement matters referred to the City Attorney’s Office. Community Services Open Space, Parks & Golf 6.16.100, 6.20.010, 6.20.045 Unleashed dogs, animals at large, dog defecation to be removed by owner. Title 22 Parks Unleashed dogs, unauthorized activities, alcohol in City parks. Development Services Building Services Title 16 Building Regulations1 See Code Enforcement. 9.10.060(b)(c)(d) Construction noise related to activities permitted by Building Services. Fire Fire Prevention 8.08 Weed Abatement Abatement of weeds posing a fire hazard (outsourced to the Santa Clara County). 9.56 Abatement of Nuisances Public nuisance involving a fire or life safety hazard (including impairment of access by emergency personnel). Title 15 Fire Prevention Fire hazard. Title 17 Hazardous Materials and Storage Hazardous materials, toxic gases, underground storage tanks. Planning Code Enforcement 8.08 Weed Abatement Abatement of weeds as a nuisance. 9.56 Abatement of Nuisances Public nuisance involving property maintenance (including weed, junk, debris, or solid waste) or encroachment. Parking of a Recreational Vehicle or inoperable vehicle on private property. 16.14 California Green Building Standards Code Diversion of construction and demolition (C&D) debris, conditions of approval for private development projects. Takes enforcement actions on behalf of Planning/Development Services. 16.20 Signs Permanent or temporary signs. 16.24 Fences Fence height. Attachment A Code Enforcement Audit 50 Primary Enforcement Functions Primary Enforcement Responsibilities Department Function Palo Alto Municipal Code Primary Focus Title 16 Building Regulations1 Illegal construction and demolition, substandard building condition, expired building permit and temporary certificate of occupancy. Takes enforcement actions on behalf of Development Services Department’s Building Services. Title 18 Zoning Zoning regulations, land uses, long-term monitoring of conditions, short-term rental. Takes enforcement actions on behalf of Current Planning. Current Planning Title 18 Zoning See Code Enforcement. Planning/Development Services 16.14 California Green Building Standards Code See Code Enforcement. Police Technical Services – Code Enforcement Title 4 Business Licenses and Regulations Solicitations, intrusion alarms, taxicabs, bingo games, massage establishments and therapists, push cart vendors, helicopter landing. Field Services –Police Officers & Community Services Officers Title 9 Public Peace, Morals, and Safety Public nuisance impacting peace and safety, noise (including gas- powered leaf blowers), alcoholic beverages, guns and explosives. Title 10 Vehicles and Traffic On street parking, abandoned vehicles. Animal Services Title 6 Animals Care and keeping of animals, dangerous and wild animals, diseased and crippled animals. Public Works Public Services – Urban Forestry 8.04 Street Trees, Shrubs and Plants Unpermitted tree work. 8.10 Tree Preservation and Management Regulations Protected trees. Public Services – Traffic Control/Street Sweeping 9.48 Obstructing Streets and Sidewalks Illegal dumping (furniture or other items obstructing roadway), dirt, debris, or litter on sidewalks, public parking lots or garages. 9.50 Graffiti Graffiti on public buildings. Public Services – Storm Drain/Street Maintenance 16.36.050 Curb painting without a permit. Attachment A Code Enforcement Audit 51 Primary Enforcement Functions Primary Enforcement Responsibilities Department Function Palo Alto Municipal Code Primary Focus Engineering Services 9.10.060(b)(c)(d) Construction noise related to activities permitted by Engineering Services. 9.79 Newsracks Newsracks on public property. 12.08 Maintenance and Construction of Streets, Sidewalks, Driveways, and Driveway Approaches Unpermitted work in the public right-of-way. 12.12 Encroachments Accessary structure in public utility easement, tables and chairs on sidewalk, fences without setback. 16.28 Grading and Erosion and Sediment Control Unpermitted excavation or grading, dewatering. 16.52 Flood Hazard Regulations Construction flood hazards. Environment Services – Watershed Protection 16.09 Sewer Use Ordinance Discharge of pollutant or industrial, commercial, or domestic waste into the sanitary sewer system, storm drain system, local creeks, or the San Francisco Bay. 16.10 Private Sewage Disposal Systems Discharge from private sewage systems. Environment Services – Zero Waste/Refuse 5.20 Collection, removal, and disposal of refuse Refuse carts, bins, or debris boxes, excess refuse materials, garbage area not being maintained or smells. 1 Except for the sections that belong to other code enforcement functions (16.09, 16.10, 16.14, 16.20, 16.24, 16.28, 16.36.050, 16.45, 16.46, 16.47, 16.49, 16.52, 16.59, 16.60). SOURCE: Auditor’s compilation based on the Palo Alto Municipal Code, FY 2018 Adopted Operating Budget, and interviews of City staff. Attachment A Code Enforcement Audit 52 APPENDIX 3 – Code Enforcement Staffing Timeline Attachment A Code Enforcement Audit 53 APPENDIX 4 – City Manager’s Response The City Manager has agreed to take the following actions in response to the audit recommendations in this report. The City Manager will report progress on implementation six months after the Council accepts the audit report, and every six months thereafter until all recommendations have been implemented. Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date Finding 1: The City resolves many code enforcement cases effectively; but unclear roles and responsibilities, fragmented Municipal Code requirements, and staffing limitations have hampered timely response and resolution We recommend that the City Manager coordinate with the City Attorney’s Office and other departments with code enforcement functions to: 1.1. Clarify and confirm the City’s code enforcement strategy and priorities with the City Council. Develop an updated enforcement procedure that is aligned with the confirmed strategy for each area of the City’s code enforcement priorities, including case intake, tracking, and reporting. This includes assessment of the regulations that lack an enforcement process or sufficient resources, such as PC district regulations, leaf blower regulations, and conditions of approval requiring the applicant to self-report. Post the updated strategy on the City’s code enforcement web page. CMO Agree Corrective Action Plan: The CMO will work through Planning and other responsible departments to update and align enforcement strategies as described. Target Date: 12 months from Council acceptance of audit report. 1.2 Update the Municipal Code sections governing code enforcement, including: CMO Agree Corrective Action Plan: The CMO will first coordinate the work of Attachment A Code Enforcement Audit 54 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date a. Combining into a single chapter, clarifying, and streamlining the administrative procedures in PAMC Chapters 1.12 and 1.16 to ensure they support current practices and Council’s intent for code enforcement activities. b. Aligning administrative procedures in other PAMC chapters with the revised administrative procedures developed in 1.2.a above as needed and streamlining enforcement activities for consistency across City departments, to the extent possible. c. Clarifying code enforcement roles and responsibilities to ensure they are aligned with the current organizational structure. d. Requiring that permit information and contact information for contractors and responsible City departments be posted at each construction site. e. Removing ambiguities or inconsistencies as part of the annual Municipal Code clean up, responsible departments on item 1.1 above, and on item 1.2.c to clarify roles and responsibilities in alignment with a revised structure. Once improved practices are clarified, the CMO will work through the CAO and other responsible departments on items 1.2.a, 1.2.b, 1.2.d, and 1.2.e to amend the municipal code as appropriate to improve the administration of code enforcement activities and to align enforcement strategies with organizational responsibilities. Target Date: 12 months after item 1.1 and related process redesign is completed. Attachment A Code Enforcement Audit 55 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date including specific position titles, which can change over time. 1.3. Hold regular meetings (e.g., quarterly) with staff citywide who have code enforcement responsibilities to share information, discuss resource allocation, and develop collective and consistent enforcement action plans, particularly for where there is overlapping or unclear responsibility. CMO Agree Corrective Action Plan: The CMO will convene regular meetings of responsible departments throughout the duration of this corrective action and thereafter routinely convene an interdepartmental working group to monitor and manage the success of the ongoing program. Target Date: Starting 3 months following Council acceptance of audit report. Finding 2: The City does not have complete and reliable code enforcement data to provide useful information for management decisions We recommend: 2.1. Upon confirming the City’s code enforcement strategy and priorities with the City Council in Recommendation 1.1, that the City Manager coordinate with the City’s code enforcement functions to: a. Identify what complaint data to capture, track, and share internally and externally. b. Define what constitutes a code enforcement case and identify CMO Agree Corrective Action Plan: The CMO will coordinate the work of responsible departments to strengthen citywide data management, including the protection of private and confidential information, related to code enforcement. While performance measures related to code enforcement already exist, considerably improved metrics will be developed (per item 2.1.d) concurrent Attachment A Code Enforcement Audit 56 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date what case data to capture, track, and share internally and externally. c. Determine which system(s) to use and how to track code enforcement data for each function, including standardizing code enforcement terminology citywide, and design reporting processes capable of aggregating the data into a citywide view. d. Develop performance measures for code enforcement as part of the citywide initiative to improve measures for the annual Performance Report. with the improvement of code enforcement practices throughout this corrective action. Items 2.1.b and 2.1.a are consistent with the priorities of the city’s IT Strategic Plan and may be refined iteratively in coordination with item 2.1.c. Estimates may be required for anticipated resource commitments to support new tasks and/or software investments. Target Date: 12-24 months following Council’s acceptance of Recommendation 1.1 2.2 If it is determined under Recommendation 2.1 that Planning will continue to use Accela, Planning should reconfigure Accela Code Enforcement to enhance data collection and reporting, to pave the way for other functions that may adopt Accela, by:10 a. Defining each type of code enforcement workflow status and identifying additional status CMO Agree Corrective Action Plan: The CMO will coordinate the work of Planning and other responsible departments to integrate data collection and reporting functions into the appropriate data management system. Target Date: 10 This recommendation will not apply if the City adopts a different code enforcement software under the new Enterprise Resource Planning (ERP) system. However, some of the concepts would need to be considered if different code enforcement software is adopted. Attachment A Code Enforcement Audit 57 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date or other data points to be captured. b. Working with the Accela consultant to ensure needed data and documents are captured accurately, consistently, and in a manner that can be extracted for reporting. This may include: • Adding new workflow status and creating additional data fields to capture new data points. • Adding or modifying drop- down lists. • Allowing certain data fields to be modified after initial data entry. c. Developing report templates in Accela for periodic reporting of code enforcement performance measures developed in Recommendation 2.1.d. d. Establishing data entry procedures to prevent errors and improve consistency. This may include: • Establishing naming conventions for attachments. Concurrent with item 2.1; 12-24 months following Council’s acceptance of Recommendation 1.1 Attachment A Code Enforcement Audit 58 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date • Ensuring that information displayed on BuildingEye provides sufficient detail for the public to understand the issue, status, and resolution of each case. Finding 3: The City actively engages with individuals responsible for code violations to gain compliance but should improve its public communication on code requirements and enforcement efforts We recommend that the City Manager: 3.1 Provide general, citywide information on code enforcement in a central location on the City’s website and assign responsibility for ensuring that the information is kept up to date. Examples of information that the website should include are: a. The City’s code enforcement strategy and priorities (see Recommendation 1.1). b. Enforcement process, administrative procedures, and penalties (see Recommendations 1.2.a and 1.2.b). c. A list of common code enforcement issue types with a brief description of code requirements, how to report a violation, and contact information CMO Agree Corrective Action Plan: The CMO will coordinate the work of responsible departments to implement code enforcement strategies and priorities. Target Date: 3 months following implementation of Recommendation 2.2 Attachment A Code Enforcement Audit 59 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date for the responsible City function and/or link to additional information on the function’s website (see Recommendation 1.2.c). d. How to track code enforcement case status and resolution, including links to BuildingEye, the City of Palo Alto Citizen Portal, or PaloAlto311. e. General information on how a complaint is managed, including what level of communications and information the complainant can expect and examples of information that the complainant is not entitled to receive, if any. f. City programs, community partners, and other neighborhood resources available to provide assistance. 3.2. Assign staff to be responsible for citywide administration of PaloAlto311 to provide ongoing maintenance and support in coordination with code enforcement functions across the City, including: • Redefining PaloAlto311 issue types and reconfiguring CMO Agree Corrective Action Plan: The CMO will coordinate the work of responsible departments on administration of citywide code enforcement efforts. Target Date: Attachment A Code Enforcement Audit 60 Recommendation Responsible Department(s) Agree, Partially Agree, or Do Not Agree and Target Date and Corrective Action Plan To be completed 6 months after Council acceptance and every 6 months thereafter until all recommendations are implemented Current Status Implementation Update and Expected Completion Date workflows to provide clearer options for complainants who are reporting issues and to minimize incorrect routing of service requests. • Managing user access and making training materials available for new users. • Updating and maintaining the PaloAlto311 data and dashboard on the City’s Open Data Portal. Concurrent with recommendation 2.2 (12- 24 months following Council’s acceptance of Recommendation 1.1) City of Palo Alto (ID # 9808) Policy and Services Committee Staff Report Report Type: Action Items Meeting Date: 11/13/2018 City of Palo Alto Page 1 Summary Title: Review Council Procedures and Protocols Title: Review Council Procedures and Protocols From: City Manager Lead Department: City Manager Recommended Staff recommends that the Policy and Services Committee review the Council Procedures and Protocols (Attachment A) and recommend revisions for staff to incorporate and return to the Committee for further review. Background The Council handbook on Procedures and Protocols (Attachment A) describes the way the Palo Alto City Council does its business and is a directional guide. It is intended to accomplish two goals. First, the handbook is an informational guide for anyone doing business or appearing before the City Council. Second, the handbook is a compilation of Procedures and Protocols that have been formally adopted by Council Resolution. Municipal Code 2.04.100 states the following related to the handbook: Municipal Code 2.04.100 - Handbook of procedural rules The council shall adopt by resolution a handbook of procedural rules governing any aspect of the conduct of meetings and hearings for the council and its standing committees, including but not limited to agenda requirements, the order of business, rules of order, rules of evidence, closed session procedures and rules for public participation in meetings. The handbook of procedural rules shall be deemed guidelines and failure to comply with any procedural rule shall not be the basis for challenge to or invalidation of any action of the council, nor shall they be construed to create any independent remedy or right of action of any kind. City of Palo Alto Page 2 Moreover, the Council Procedures and Protocols (CPP) includes a provision for the Policy and Services Committee to annually review the Council Procedures and Protocols (CPP) as stated below from Section 5 – Enforcement: Section 5 - Enforcement Council Members have the primary responsibility to assure that these protocols are understood and followed, so that the public can continue to have full confidence in the integrity of government. As an expression of the standards of conduct expected by the City for Council Members, the protocols are intended to be self-enforcing. They therefore become most effective when members are thoroughly familiar with them and embrace their provisions. For this reason, Council Members entering office shall sign a statement affirming they have read and understood the Council protocols. In addition, the protocols shall be annually reviewed by the Policy and Services Committee and updated as necessary. City Council discussed the CPP at their October 29th, 2018 meeting. At this meeting Council approved an ordinance (Attachment B) amending Municipal Code section 2.04.190 to reduce number of Council Members on Finance and Policy & Services from four to three, and section 12.10.060 to change the votes required to resolve a certain type of appeal from five to a majority A (Attachment B). Council also referred the review of additional discretionary changes to Council Procedures and Protocols to the Policy and Services Committee. Discussion Various changes to the Council Procedures and Protocols were previously recommended by Policy & Services in Fiscal Year 2015, however the recommended changes were not finally approved by Council. As the 2015 CPP version includes recommendations from previous Committee work and staff work, and also reflects the current Council practice in procedures and protocols, staff recommends the Policy and Services Committee work from the attached 2015 version in reviewing the CPP. The most recent Council adopted version is available on the City Council Webpage: City Council Staff’s initial high-level review of the CPP includes a few areas for possible discussion. The first is the overall purpose and structure of the CPP. As with any document amended over time the structure and cohesiveness can become fragmented. While much of the content of the CPP remains relevant, staff would like to consider how the document might be more readable and accessible for the public and Council. City of Palo Alto Page 3 As mentioned by incoming City Manager Ed Shikada at the October 29 Council meeting, a good starting place in reviewing the CPP is to consider the purpose of the document. The CPP has two parts, and the first is Procedures. The intent of the Procedures appears to primarily be to inform the public how they can interact with the City Council. If this is the intent of the Procedures staff encourages a discussion about the content and structure in context of this purpose, with an eye toward further clarity for the public on how to most effectively interact with the Council. Part two of the CPP is called Protocols. The intent of the Protocols appears to primarily be to inform Council members how they will interact with one another. Again, if this is the intended purpose of the Protocols staff encourages a discussion with an eye toward further clarity in how Council members can most efficiently and effectively interact with one another. Prior to the November 13, 2018 Policy and Services discussion on the CPP staff asked Council to share with staff their thoughts on how the CPP could be improved (Attachment C). While we did not hear from every Council Member, the feedback we did receive provides some insight into how the CPP might be improved for discussion. For example, a specific area of discussion related to the CPP is managing the volume and capacity of work for a seven-member Council versus a nine-member Council. Currently there are 37 boards and commissions that the Mayor annually assigns Council liaison roles to. This is a very large number of commitments to cover and may be practically challenging going forward. Resources Impact There is no resource impact identified at this time. Attachments: • Att A - 2015 Council Protocols • Att B - 10-29-18 Item 9785 Council Procedures • Att C - 11-2018 Council Member Feedback on P&P City of Palo Alto Page 1 City of Palo Alto (ID # 6170) Policy and Services Committee Staff Report Report Type: Agenda Items Meeting Date: 10/6/2015 Summary Title: Updates to Policies and Protocols Handbook Title: Discussion and Recommendation to Council Regarding City Council Procedural Matters, Including Updates to Procedures and Protocols Handbook From: City Manager Lead Department: City Manager Background On April 8, 2015 and May 21, 2015 the Policy & Services Committee discussed the Procedures and Protocols Handbook and ideas about enhancing meeting management. These items were referred to the Committee from City Council’s meeting on January 31, 2015. On February 17, 2015 the City Council held a Committee as a Whole meeting and also discussed the following items: procedures and protocols, meeting management, committees and staff relations. At this meeting additional ideas about the Procedures and Protocols Handbook as well as the subject of meeting management were also referred to the Policy & Services Committee. Ideas about the subjects of committees and staff relations were deferred to the next Committee as a Whole meeting. On April 8, 2015 the Committee had its first discussion about the referrals and directed staff to draft certain changes to the Procedures and Protocols Handbook. On May 21, 2015, the Committee completed discussions related to the Handbook and meeting management. Staff indicated that the edited draft of the Handbook would return to the Committee for review. Discussion Attached is the updated version of the Procedures and Protocols Handbook. Staff has edited the document using the “track changes” tool in Microsoft Word. Staff recommends that the Committee review the document and provide any clarifications or revisions as needed. The goal of the meeting will be to complete the revisions and forward the updated document to City Council for approval. City of Palo Alto Page 2 The Committee also asked staff to update the Handbook to include language about alternative recommendations or ranges of options in staff reports. Additionally, the Committee recommended that staff presentations be made available in advance of the meeting and also posted online. In updating the Procedures and Protocols Handbook staff concluded that these items are not within the scope of this document. The City Manager can work with staff to incorporate alternative recommendations or ranges of possibilities, where possible, in staff reports. Additionally, the City Manager can work with the City Clerk to post staff presentations in advance of the meetings, where feasible. Finally, the Committee asked staff to review whether a new timing system can be installed in the City Council Chambers to help Council Members with time management. Staff will bring the Committee’s recommendations on this topic, together with technical options, to the City Council for action. If approved, staff will work within existing Capital Improvement Projects or create a new project to accomplish the task. Resources Impact Potential increase in staff time, facility and technology costs. Staff will bring costs increase, if any, to City Council along with Committee recommendations. Attachments: • Attachment A: Revised Procedure and Protocols Handbook(DOC) • Attachment B: 5-21-15 Staff Report (PDF) • Attachment C: 4-8-15 Staff Report (PDF) • Attachment D: Referral Items from 2-17-15 (PDF) • Attachment E: 4-08-15 PS Minutes (DOCX) • Attachment F: 5-21-15 PS Minutes (DOCX) CITY OF PALO ALTO CITY COUNCIL PROCEDURES AND PROTOCOLS HANDBOOK Procedures and Protocols Approved 2/11/13XX/XX/2015 If you have any questions about this handbook, please feel free to contact the City Clerk by phone at (650) 329-2571 and e-mail at city.clerk@cityofpaloalto.org or the City Attorney by phone at (650) 329-2171 and e-mail at city.attorney@cityofpaloalto.org. TABLE OF CONTENTS CITY COUNCIL PROCEDURES ___________________________________________1 INTRODUCTION & CONTENTS 1 SECTION 1 - PUBLIC PARTICIPATION IN COUNCIL MEETINGS 2 1.1 - Policy 2 1.2 – Purpose 2 1.3 - Summary of Rules 2 1.4 - General Requirements 2 A. Accessibility 2 B. Presiding Officer's Permission Required 3 C. Recording and Identification 3 D. Specific Requirements and Time Limits 3 SECTION 2 – COUNCIL MEETING & AGENDA GUIDELINES 5 2.1 - Policy 5 2.2 – Purpose 5 2.3 - Summary of Guidelines 5 A. Regular Meetings 5 B. Special Meetings 65 C. Study Sessions 6 D. Closed Sessions 6 2.4 - General Requirements 6 A. Regular Meetings 6 B. Telephonic Attendance Of Council Members At Council Meetings 6 C. Items Considered After 10:30 p.m. 8 D. Late Submittal of Correspondence or Other Information Related to Planning Applications. 8 E. Agenda Order 9 F. Council Comment 9 G. Public Comment 9 H. Council Requests to Remove Item 109 I. Hearing of Removed Items 109 J. Consent Calendar Categories 109 K. Co llea gue s Me mo ’s Council Matters 1211 L. Council Member Questions, Comments and Announcements 1312 M. Closed Sessions 1312 N. Adjournment 1312 O. Rescheduling Agenda Items 1312 P. Adding New Items to the Agenda 13 Q. Special Meetings 1413 R. Study Sessions 1413 S. Closed Sessions 14 T. Motions, Debate & Voting 15 U. Motions 1615 V. Debate and Voting 2120 W. Quasi-Judicial/Planned Community Hearings _ 2322 X. Standing Committees 2625 Y. Ad Hoc Committees & Committee as a Whole 2726 2.5 - Election of Mayor 2827 CITY COUNCIL PROTOCOLS ________________________________________ 2928 SECTION 1 - CORE RESPONSIBILITIES 3029 SECTION 2 - COUNCIL CONDUCT 3130 2.1 – Public Meetings 3130 2.2 - Private Encounters 3130 2.3 – Council Conduct with City Staff 3231 2.4 - Conduct with Palo Alto Boards and Commissions 3433 2.5 - Staff Conduct with City Council 3534 SECTION 3 - OTHER PROCEDURAL ISSUES 3635 3.1 – Commit to Annual Review of Important Procedural Issues 3635 3.2 – Don’t Politicize Procedural Issues (e.g. Minutes Approval or Agenda 3635 Order) for Strategic Purposes 3635 3.3 – Submit Questions on Council Agenda Items Ahead of the Meeting 3635 3.4 - Submittal of Materials Directly to Council 3635 3.5 - Late Submittal of Correspondence or Other Information Related to 3635 Planning Applications 3635 3.6 – Respect the Work of the Council Standing Committees 3736 3.7 – The Mayor and Vice Mayor Should Work With Staff to Plan the Council 3736 Meetings 3736 SECTION 4 - POLICY & SERVICES COMMITTEE – ROLE, PURPOSE, & WORK PLANNING 3837 SECTION 5 - ENFORCEMENT 3837 SECTION 6 - CITY COUNCIL E-MAILS FOR AGENDA-RELATED ITEMS 3938 6.1 - Policy 3938 6.2 - Procedure 3938 SECTION 7 - CITY COUNCIL AND BOARDS AND COMMISSSIONS POLICY FOR TRAVEL AND MISCELLANEOUS EXPENSE REIMBURSEMENT, March 2006 4140 7.1 - Eligible Activities 4140 7.2 - Out-of-Town Conferences or Meetings 4140 A. Reimbursement 4140 B. Meals and Incidentals 4241 C. Lodging Expense 4241 D. Transportation 4241 7.3 - Local or Bay Area Activities 4342 7.4 - Other Expenses 4342 7.5 - Activities Not Considered Reimbursable 4342 7.6 - Reports to Council 4443 7.7 - Violation of This Policy 4443 7.8 - Mayor and Vice Mayor Additional Compensation 4443 7.10 - Support Services 4443 CITY OF PALO ALTO COUNCIL PROTOCOLS ETHICS ADDENDUM 4544 A. Comply with Law 4544 B. Conduct of Members 4544 C. Respect for Process 4544 D. Decisions Based on Merit 4544 E. Conflict of Interest 4544 F. Gifts and Favors 4544 G. Confidential Information 4746 H. Use of Public Resources 4746 I. Representation of Private Interests 4746 J. Advocacy 4746 K. Positive Work Place Environment 4746 1 CITY COUNCIL PROCEDURES INTRODUCTION & CONTENTS This handbook describes the way the Palo Alto City Council does its business and is a directional guide. It is intended to accomplish two goals. First, the handbook is an informational guide for anyone doing business or appearing before the City Council. Second, the handbook is a compilation of Procedures and Protocols that have been formally adopted by Council Resolution. The handbook City Council Procedures is organized into two sections: 1) Public Participation in Council Meetings This section explains the basic rules for speaking to the City Council. It covers things like when to speak, time limits, and how groups of speakers are handled. 2) Council Meeting & Agenda Guidelines This section explains the different kinds of meetings the City Council holds, what they are for, and how the meeting agenda is prepared. 2 SECTION 1 - PUBLIC PARTICIPATION IN COUNCIL MEETINGS 1.1 - Policy It is the policy of the City Council to assure that members of the public have the opportunity to speak to any regular or special meeting agenda item before final action. These rules establish the rights and obligations of persons who wish to speak during City Council meetings. 1.2 – Purpose These rules are intended to enhance public participation and Council debate so that the best possible decisions can be made for Palo Alto. Palo Alto has a long and proud tradition of open government and civil, intelligent public discourse. Open government meetings must allow everyone to be heard without fear of cheers or jeers. For these reasons, the City Council takes these rules seriously. Disruptive or unruly behavior in violation of the law can result in removal from the Council meeting and/or arrest and prosecution. 1.3 - Summary of Rules Every regular City Council agenda has two different kinds of opportunities for the public to speak. The first is during Oral Communications. This part of the meeting is provided so that the public can speak to anything that is in the City’s jurisdiction, even ifwhen there is no action listed on the agenda. The Council allows up to three minutes per speaker, but limits the total time to 30 minutes per meeting. State law does not permit the Council to respond to oral communications, but City staff may be asked to follow up on any concerns that are raised. The second opportunity to speak is during the public comment or public hearing portion of Each Agenda Item. Public comments or testimony must be related to the matter under consideration. The Council allows three minutes per speaker for most matters. During “quasi-judicial” hearings (where the City Council is legally required to take evidence and make impartial decisions based upon that evidence), the applicant or appellant may have up to ten minutes at the outset and three minutes for rebuttal at the end. These hearings are specially marked on the Council agenda. A person who wants to speak to the Council must should fill out a speaker card and hand it in to the City Clerk. The Clerk will give the cards to the Mayor or Vice Mayor so that the speakers can be identified and organized in an orderly way. 1.4 - General Requirements A. Accessibility Palo Alto makes every reasonable effort to accommodate the needs of the disabled. Any provision of these rules may be modified if needed to provide reasonable accommodation. Persons needing assistance should contact: Larry Perlin, ADA Director, City of Palo Alto, 650/329-2496 (voice) or 650/328-1199 (TDD). *For all purposes, applicant also refers to applicant agent. 3 B. Presiding Officer's Permission Required The presiding officer at Council meetings (usually the Mayor or Vice-Mayor) is legally required to “preserve strict order and decorum.”i This is important in order to assure a fair opportunity for everyone to participate in an open and civil setting. • Any person desiring to address the Council must first get the permission of the presiding Presiding officer Officer by completing a speaker card and handing the card to the City Clerk. • The presiding Presiding officer Officer shall recognize any person who has given a completed card to the City Clerk. • No person, other than a Council Member and the person having the floor, shall be permitted to enter into any discussion without the permission of the presiding Presiding officerOfficer. • No person shall enter the staff area of the Council dais without the permission of the Presiding Officer or appropriate Council Appointed Officer. C. Recording and Identification Persons wishing to address the Council shall comply with the following: • Use the microphone provided for the public and speak in a recordable tone, either personally or with assistance, if necessary. • State their name and address if presenting evidence in a hearing required by law. • Other speakers should state their name and address, but cannot be compelled to register their name or other information as a condition to attendance at the meeting. D. Specific Requirements and Time Limits 1) Oral Communications Oral communications shall be limited to up to three minutes per speaker and will be limited to a total of thirty minutes for all speakers combined. • Oral communications may be used only to address items that are within the Council’s subject matter jurisdiction, but not listed on the agenda. • Oral communications may not be used to address matters where the receipt of new information would threaten the due process rights of any person. • All remarks shall be addressed to the Council as a body and not to any individual member. Formatted: Indent: Left: 0" Formatted: Strikethrough 4 • Council members shall not enter into debate or discussion with speakers during oral communications. • The presiding Presiding officer Officer may direct that the City Manager will respond to the person speaking and/or the Council at a later date. 2) Other Agenda Items Public comments or testimony on agenda items other than Oral Communications shall be limited to a maximum of three minutes per speaker unless additional time is granted by the presiding Presiding officerOfficer. The presiding Presiding officer Officer may reduce the allowed time to less than two minutes if necessary to accommodate a larger number of speakers. 3) Spokesperson for a Group When any group of people wishes to address the Council on the same subject matter, the presiding Presiding officer Officer will request that a spokesperson be chosen by the group to address the Council. Spokespersons who are representing a group of five or more people who are present in the Council chambers will be allowed ten minutes and will to the extent practical be called upon ahead of individual speakers. 4) Quasi-Judicial/ Planned Community Hearings In the case of a quasi-judicial/planned community hearing, single applicants and appellants shall be given ten minutes for their opening presentation and three minutes for rebuttal before the hearing is closed. In the case of a quasi-judicial/planned community hearing for which there are two or more appellants, the time allowed for presentation and rebuttal shall be divided among all appellants, and the total time allowed for all appellants shall be a total of twenty minutes for the opening presentation and six minutes for rebuttal before the hearing is closed; however, under no circumstances shall an individual appellant be given less than five minutes for presentation and three minutes for rebuttal. In the event a request is made and the need for additional time is clearly established, the presiding officer shall independently, or may upon advice of the city attorney, grant sufficient additional time to allow an adequate presentation by the applicant or appellant in a hearing required by law. 5) Addressing the Council after a Motion Following the time for public input and once the matter is returned to the Council no person shall address the Council without first securing the permission of the Council Presiding Officer so to doto do so, subject to approval of the City Attorney with respect to any hearing required by law. 5 *For all purposes, applicant also refers to applicant agent. 6) Decorum The Palo Alto Municipal Code makes it unlawful for any person to: • Disrupt the conduct of a meeting • Make threats against any person or against public order and security while in the Council chamber. • Use the Council Chambers during meetings for any purpose other than participation in or observation of City Council Meetings. Any Council Member may appeal the presiding Presiding off icer’s Off icer’s decision on a decorum violation to the full Council. Decorum violations are punishable as a misdemeanor and may lead to a person being removed from the Council meeting.ii SECTION 2 – COUNCIL MEETING & AGENDA GUIDELINES 2.1 - Policy It is the policy of the Council to establish and follow a regular format for meeting agendas. 2.2 – Purpose The purpose of these guidelines is to facilitate the orderly and efficient conduct of Council business. This purpose recognizes the value of establishing a community understanding of meeting procedures so that broad public participation is encouraged. This purpose also recognizes that Council Members must have a common approach to the discussion and debate of City business so that meetings are both streamlined and thorough. 2.3 - Summary of Guidelines The City Council generally conducts four different kinds of meetings. These are Regular Meetings, Special Meetings, Study Sessions, and Closed Sessions. A. Regular Meetings are conducted at City Hall on the first three Monday nights of each month, except during the Council’s annual vacation. The meetings will are scheduled to begin at 76:00 p.m. Regular meeting agendas must be posted in the City Plaza by the elevators no later than 7:00 p.m. on the preceding Friday on the preceding Fridayng as required by the Brown Act. It is City policy to make every effort to complete and distribute the agenda and related reports by the preceding WednesdayThursday, eleven days prior to the meeting. For major complex projects and policies, the City will make every effort to distribute these reports two weeks prior to the meeting when the item will be considered. Once the agenda is posted, it shall also be uploaded to the City Council web page for use by the public. It is City policy to make every effort to complete and distribute the agenda and related reports by the preceding WednesdayThursday, eleven days prior to the meeting. For major, complex projects and policies, the 6 City will make every effort to distribute these reports two weeks prior to the meeting when the item will be considered. B. Special Meetings are “special” because the mayor Mayor or Council can call them on a minimum of 24 hours notice, or are held on a different day of the week, at a different time or different location. Special meetings need not be held at City Hall, as long as the alternate location is within the City. The Council makes every effort to provide notice well in advance of 24 hours, especially when the special meeting is for the purpose of conducting a Study Session. C. Study Sessions are meetings during which the Council receives information about City business in an informal setting. The informal study session setting is intended to encourage in-depth discussion and detailed questioning and brainstorming by Council on issues of significant interest, including City policy matters, zoning applications, and major public works projects. The Council may discuss the material freely without following formal rules of parliamentary procedure. Staff may be directed to bring matters back for future Council consideration as no action can be taken at a study session. Public comments on study session items may be received together with oral communications immediately following the session or may be heard during discussion of the item as determined by the Mayor. The Decorum rules still apply to the behavior of the Council and public. D. Closed Sessions can be part of regular or special meetings. Closed sessions are the only kind of Council meeting that the public cannot attend. State law allows closed sessions to discuss pending litigation, employment issues, real estate negotiations and certain other matters. Members of the public are permitted to make public comments on closed session matters. The Council must make a public report after the session when certain kinds of actions are taken. These are guidelines, not rules. The Council intends that City staff and Council Members will follow these guidelines. However, these guidelines should not be used in a way that leads to inefficiency, unfairness, or the promotion of form over substance. State law establishes a variety of mandatory meeting rules the City must follow in order to assure open and public government, regardless of unusual situations and consequences. 2.4 - General Requirements A. Regular Meetings Attendance Required. Council Members, the City Clerk, City Attorney, and City Manager, along with any other city officers and department heads that have been requested to be present, shall take their regular stations in the Council chamber at 76:00 p.m. on the first, second and third Mondays of each month, except during the established Council vacation.iii The Mayor will ensure that during each regular meeting there will be one 5 minute break.The Council expects its members to attend regularly and notify the City Clerk of any planned absences. The Council may levy fines of up to $250.00 against Council members who willfully or negligently fail to attend meetings.iv B. Telephonic Attendance Of Council Members At Council Meetings 7 The City Council Procedures provisions concerning Telephonic Attendance shall apply to all Boards and Commissions as well as the City Council members. Requests by Council Members to attend a Council meeting via telephonic appearance are actively discouraged. Telephonic attendance shall only be permitted not more than 3 times a year in in the event of extraordinary events such as a medical, family or similar event emergency requiring a Council Member’s absence. In addition, at least a quorum of the Council must participate from a location within the City (Government Code Section 54953(b)(3)). If these two threshold requirements are met, the Council Member who will be appearing telephonically must ensure that: • The meeting agenda identifies the teleconference location and is posted at that location in an area that is accessible and visible 24 hours a day for at least 5 days 72 hours prior to the meeting. • The teleconference location is open and fully accessible to the public, and fully accessible under the Americans with Disabilities Act, throughout the entire meeting. These requirements apply to private residences, hotel rooms, and similar facilities, all of which must remain fully open and accessible throughout the meeting, without requiring identification or registration. • The teleconference technology used is open and fully accessible to all members of the public, including those with disabilities. • Members of the public who attend the meeting at the teleconference location have the same opportunity to address the Council from the remote location that they would if they were present in Council Chambers. • The teleconference location must not require an admission fee or any payment for attendance. If the Council Member determines that any or all of these requirements cannot be met, he or she shall not participate in the meeting via teleconference. Approved Teleconference Guidelines for Council Members: • One week advance 5 days written notice must be given by the Council Member to the City Clerk’s office; the notice must include the address at which the teleconferenced meeting will occur, the address the Council packet should be mailed to, who is to initiate the phone call to establish the teleconference connection, and the phone number of the teleconference location. If Ccellular telephones shall not beare used to participate in teleconferenced meetings then Council members needs to ensure speaker phone option is functioning. • The Council Member is responsible for posting the Council agenda in the remote location, or having the agenda posted by somebody at the location and confirming that posting has occurred. The City Clerk will assist, if necessary, by emailing, faxing or mailing the agenda to 8 whatever address or fax number the Council Member requests; however, it is the Council Member’s responsibility to ensure that the agenda arrives and is posted. If the Council Member will need the assistance of the City Clerk in delivery of the agenda, the fax number or address must be included in the one-week advance written notice above. • The Council Member must ensure that the location will be publicly accessible while the meeting is in progress. • The Council Member must state at the beginning of the Council meeting that the 72-hour posting requirement was met at the location and that the location is publicly accessible, and must describe the location. Furthermore, the City Clerk will provide Council with a quarterly report detailing the telephone charges associated with teleconferenced meetings. C. Items Considered After 10:30 p.m. The City Council makes every effort to end its meetings before 11:00 p.m. The Council also generally does not take up new matters after 10:30 p.m. Before 10:00 p.m. the Council will decide and announce whether it will begin consideration of any agenda items after 10:30 and, if so, which specific items will be taken up. D. Late Submittal of Correspondence or Other Information Related to Planning Applications. In order to allow for adequate Staff review and analysis, and to ensure public access to information, all plans, correspondence, and other documents supporting planning applications being heard by the City Council must be submitted to staff not later than noon five working days prior to the release of the Council Agenda Packet. If any correspondence or other information is submitted after this deadline to Council Members or staff, and Staff determines additional review is needed Staff will reschedule the item for a future Council meeting. If a Council member receives planning application materials from a project applicant he or she shall notify the City Clerk and the City Manager as soon as possible. There are no restrictions on the rights of applicants or others to comment or respond to information contained within the Staff Report. At the meeting the City Council may determine whether to continue or refer the item to the appropriate Board and/or Commission if significant changes to a project or significant new information become known. Nothing in this statement is intended to restrict the rights of applicants or other interested parties to respond to information contained in or attached to a Staff Report.. 9 *For all purposes, applicant also refers to applicant agent. E. Agenda Order City Council agendas will be prepared by the City Clerk and presented to the City Council in the order described below. It is the Council’s policy to hear the major items of business first at each meeting, to the extent possible. The City Manager, with prior approval of the Mayor, is authorized to designate upon the agenda of the Council, and the City Clerk shall publish in the agenda digest, items that shall be taken up first or at a specific time during the course of the meeting.v The City Council may take matters up out of order upon approval by a majority vote of those present: 1) Roll Call 2) Study Session/Closed Session 2)3) Special orders of the day 3)4) City Manager Comments 4)5) Oral communications, including oral communications related to any study session that began immediately before the regular meeting 5)6) Approval of minutes 7) Agenda Changes, Additions and Deletions 6)8) Consent calendar Items may be placed upon the consent calendar by any council-appointed officer whenever, in such officer's judgment, such items are expected to be routinely approved without discussion or debate. The consent calendar shall be voted upon as one item. 9) Action Items 7)10) Inter-Governmental Legislative Affairs F. Council Questions & Comment Consent Calendar: No discussion or debate shall be permitted upon items upon the consent calendar; however, any Council Member may request that his or her vote be recorded as a "no" or "not participating" due to a specified conflict of interest on any individual item. Council Members may also explain their "no" votes at the end of the Consent Calendar, with a 3 minute time limit for non-appeal items and 5 minutes for appeal item for each Council Member. Council Members may also submit statements in writing to the City Clerk before action is taken. The City Clerk shall preserve and make available such written statements in a manner consistent with the Brown Act and shall assure that the minutes of the meeting make reference to the existence and location of such written statements. G. Public Comment Formatted: Font: Arial, 11 pt 10 If members Members of the public wishing to speak to items on the Consent Calendar, the Mayor will have the option of allowing the testimony prior to adoption of the Consent Calendar., or removing the item from the consent calendar and hearing the public comment at a later time, prior to the vote on the item. H. Council Requests to Remove Item Three Council Members may request that an item be removed from the consent calendar prior to and following the public comment period on the agenda. The City Manager’s office should be advised whenever possible, in writing, of a request for removal no later than noon the day of the meetingSunday before the meeting. I. Hearing of Removed Items Removed items will be heard either later in the meeting or agendized for a discussion at a subsequent meeting, depending upon the number of speakers and the anticipated length of the items that have been officially scheduled for discussion on a particular evening. The Mayor will decide when during the meeting any removed items will be heard. J. Consent Calendar Categories The consent calendar portion is the section where administrative and non- controversial shall be presented. Mayor and City Manager should be sensitive to high dollar value items and consider placing those items in the action agenda section. The consent section is presented in 5 categories in the following order: 1) Ordinances and Resolutions The following ordinances and resolutions may appear on a consent calendar: • Second Reading (passage and adoption) of Ordinances. • a resolution which are ceremonial in nature. • Ordinances or resolutions that implement a prior Council policy direction in the manner contemplated by the Council's previous actions, in the Adopted Budget (including the Capital Improvement Program and especially in the department key plans); and the Council Top Priority Workplan, among other sources.. • Budget amendment ordinances that accept funding such as grants or gifts, provided Council has previously approved the activity or program. • Resolutions approving funding applications, such as grants or loans, provided that the program or activity has been previously approved by Council. 2) Administrative Matters Including Contracts, Appointments, Approval of Applications, and Any Other Matter. The titles of administrative matters need not be read. An administrative matter may be placed on the consent calendar if it is: • An action that is merely the administrative execution of previous Council direction. The Council direction and vote will be quoted in the staff report accompanying the item. Comment [MB1]: City Clerk recommends that section not be changed as we may or may not hear an item on night that it gets pulled. Commented [HT1]: The City Attorney notes that the Municipal Code requires re-noticing of certain planning items removed from consent. The Procedures should acknowledge and align with these requirements. Commented [HT2]: The City Attorney notes that the proposed changes would likely result in some items currently heard on consent being moved to action. Council is encouraged to consider how it would accommodate additional action items. Commented [HT3R2]: In addition, the City Attorney recommends updating the categories of consent items to align with current practice. Staff will provide committee members with proposed revisions at places. 11 • Contracts for which the subject or scope of work has been previously reviewed by the City Council. • A contract for goods, general services, professional services, public works projects, dark fiber licensing contracts or wholesale commodities, purchases, as outlined in the Purchasing Ordinance, provided such contracts represent the customary and usual business of the department as included in the Adopted Budget. Examples include: routine maintenance contracts, annual audit agreement; software and hardware support agreements, janitorial services, copier agreements or postage machine agreements. • Rejection of bids. • Designation of heritage trees. • Designation of historic building at the request of the property owner if there are no unusual policy ramifications. • Approval of funding applications, such as grants or loans, provided that Council has previously approved the general program or activity. • Formal initiation, for consideration at a later date, of a zoning code amendment or review process, such as preliminary review. • Status report required by law for fee administration. • Cancellation of meetings or scheduling of special meeting. 3) Request to Refer Items to Any Council Standing Committee, Committee, Board, Commission or Council Appointed Officer. The consent calendar includes matters for which staff is merely seeking Council approval of a referral to a Council standing committee or other City official, advisory board or commission. This does not preclude staff from making referrals to the standing committees. Staff uses such referrals in order to expedite the business of the full Council, since its agenda is so full. Discussion of a complex issue by another body, provides an opportunity for public input and extended discussion by the members of the body. The full Council is then able to benefit from the minutes of that discussion when the item comes back to the Council for final approval. This practice also allows the City/School Liaison Committee to consider items of interest to both agencies without having to go through the formality of a Council agenda referral. 4) Items Recommended for Approval if the Committee Unanimously Recommends Placement on the Consent Calendar, Unless Otherwise Recommended by the Committee, Mayor, City Attorney or City Manager. or Staff. 12 5) Items Recommended for Approval, and for Placement on the Consent Calendar, by any Council-Appointed Boards and Commissions, Provided that Other Public Hearing Requirements are Not in Effect. 6) Agenda Changes, Additions, and Deletions 7) Action Items: • Unfinished Business • Public Hearings • Reports of committees/commissions • Ordinances and Resolutions • Reports of officials K. Council MattersColleagues Memo’s Any two three Council Members may bring forward a colleague memo on any topic to be considered by the entire Council. Two ThreeCouncil Members are required to place such a memo on the agenda, reflective of the Council procedure requiring a motion and a second for consideration of a motion by the Council. Up to four Council Members may sign a colleague memo. The City Attorney recommends that the colleague memo be limited to three Council Members in order to avoid the potential of a Brown Act issue. Prior to preparing a colleague memo, Council Members will consult with the City Manager to determine whether he/shethe City Manager is or is not willing and able to address the issues as part of his/her his/her operational authority and within current budgeted resources. Colleague’s memos should have a section that identifies any potential staffing or fiscal impacts of the contemplated action. This section will be drafted by the City Manager. Council Members shall provide a copy of the proposed memo with to the City Manager or appropriate senior staff prior to finalization. Completed Council colleagues memos shall be provided to the City Clerk’s staff by noon on the Tuesday 11 days prior to the Council meeting that the memo is intended to be agendized, to provide time for the City Clerk to process for the Council packet. The City Council will not take action on the night that a colleague memo is introduced if it has any implications for staff resources or current work priorities which are not addressed in the memo. The Council will discuss the colleague memo and then direct the City Manager to agendize the matter for Council action within two meetings, allowing City staff time to prepare a summary of staffing and resource impacts. Action may be taken immediately by the Council on colleague memos where there are no resource or staffing implications or where these are fully outlined in the colleagues memo. The Brown Act requires that the public be fully informed of the potential action by the Council via the Agenda 72 hours before a scheduled Council meeting. In order to satisfy the Brown Act requirements, the Council should consult with the City Attorney to ensure that the Formatted: Indent: Left: 0.5" Formatted: Indent: Left: 0" Comment [AK2]: Section needs further revision. Due to early publication date and staff work load, staff will provide Committee members with revision at places. As mentioned in staff report, revisions will be made, real time, during the meeting and Committee members can comment on changes. 13 proposed title to the colleague memo contains all actions that the Council Members want completed on the night of the Council review. L. Council Member Questions, Comments and Announcements The purpose of this agenda item is to allow Council to question staff briefly on matters upon which Council has taken action or given direction, make general comments as a reference to staff on factual matters of community concern, or make brief announcements in a manner consistent with Government Code section 54952.2. New assignments will not be given nor will major policy issues be discussed or considered. To the extent possible, Council will confer with staff before raising matters of nature under this agenda item. This agenda item will generally be limited to 15 minutes in length and the public may not speak to matters discussed; M. Closed Sessions Special closed sessions will be scheduled before or after regular or special Council meetings to the extent possible and appropriate. Closed sessions may be scheduled during a regular or special Council meeting, but this is discouraged by Council; N. Adjournment O. Rescheduling Agenda Items When the Council is unable to complete its agenda the remaining business will generally be rescheduled as follows. Nothing in this section shall be deemed to supersede or conflict with state law. 1) Meeting Adjourned Sine Die When a regular meeting is adjourned sine die (without a day), all unfinished items will be listed under unfinished business on the next regular Council meeting agenda; except, that where deemed necessary, the City Clerk, with the City Manager's concurrence, may place those business items in a different order on the agenda. 2) Meeting Adjourned to Date Certain When a regular meeting is adjourned to another regular meeting night, all unfinished items will be listed in their original order after roll call on the agenda of such designated regular meeting. 3) Continued Items When an item on the agenda is continued to a subsequent meeting, such item will be listed under unfinished business on such agenda unless the Council by majority vote chooses to place such item in a different location on such agenda or unless the City Clerk, with the City Manager's concurrence, deems it necessary to place such item at a different location on such agenda. P. Adding New Items to the Agenda No matters other than those on the agenda shall be finally acted upon by the Council. However, emergency actions (as defined in Government Code section 54956.5) and matters upon which there is a lawful need to take immediate action (as defined in Government Code section 54954.2) may, with the consent of two- Comment [AK3]: Section needs further revision. Due to early publication date and staff work load, staff will provide Committee members with revision at places. As mentioned in staff report, revisions will be made, real time, during the meeting and Committee members can comment on changes. 14 thirds, or all members present if less than two-thirds are present, be considered and acted upon by the Council. Q. Special Meetings Special meetings may be called by the Mayor or City Council by providing a minimum of 24-hours posted notice in the manner required by state law. To the greatest extent possible, special meetings called for other than regular meeting days should be scheduled by a majority of the Council present and voting at a regular meeting.vi Unlike regular meetings, there are no circumstances that permit the City Council to add new items to a special meeting agenda or notice. R. Study Sessions Study sessions are meetings during which the Council receives information about City business in an informal setting. 1) Time Special study sessions will be held as needed. 2) No Formal Rules Study sessions are intended to be conducive to in-depth factual presentations by City staff and detailed questioning and brainstorming by Council. The Council may discuss the material freely without following formal rules of parliamentary procedure, and the Mayor shall have discretion to determine the appropriate process for conducting the study session, including when public comment and oral communications will be heard. 3) Public Participation. The general rules of decorum apply. 4) No Final Action Staff may be directed to bring matters back for Council consideration at future meetings, as no action can be taken. S. Closed Sessions Closed sessions are the only kind of Council meeting that the public cannot observe. State law allows closed sessions to discuss pending litigation, employment issues, real estate negotiations and certain other matters. To the greatest extent possible, the City Attorney and City Clerk shall use standardized agenda descriptions that are consistent with Government Code section 54954.5. Special closed sessions will be scheduled before or after regular or special Council meetings to the extent possible and appropriate. Closed sessions may be scheduled during a regular or special Council meeting, but this is discouraged by Council; The City Council will take a vote to go into Closed Session prior to closed session beginning. 1) Announcements Before Closed Sessions The mayorMayor/City Clerk shall announce the item or items to be considered in closed session by reference to the appropriate agenda number or letter, or in an alternate form that shall be provided by the City Attorney. 15 2) Public Comments Members of the public are permitted to make public comments on closed session matters. The City Clerk shall be present in the open session to record Council attendance and any statements made during oral communications or by the Council. 3) Attendance The City Manager and City Attorney, or their designees, shall attend closed sessions unless it is necessary to excuse them. Only such additional staff shall attend as are necessary and then only if the legal privileges of confidentiality obtained in an executive session are not waived. 4) Public Reports State Law and a Palo Alto initiative require the Council to make a public report after a closed session when certain kinds of actions are taken.vii Reports from closed sessions shall be made by the Mayor, the Vice Mayor in the Mayor's absence, or such other City representative as designated by the Council or its committees. Such designated person is the only individual authorized to make public statements concerning the closed session. It is the policy of the City Council to inform the public of action taken in closed session to the greatest extent possible. It is recognized, however, that the need for confidentiality is inherent in closed sessions and that certain matters if revealed may be a detriment to the results desired. The Council shall publicly report: (a) any decision to appoint, employ, or dismiss a public employee and the roll call vote thereon at its next public meeting, (b) actions related to litigation and the roll call vote on such actions, unless the report would, in the written opinion of the City Attorney for specifically stated reasons, clearly jeopardize the city’s ability to effectuate service of process on one or more unserved parties or impair the city’s ability to resolve the matter through negotiation, mediation or other form of settlement. Notwithstanding the City Attorney's written opinion, the Council may under any circumstance, by majority vote, determine that it is in the City's best interests to disclose actions taken in closed session related to litigation. The public report shall be given as soon as possible, but no later than the next regular meeting, and shall include the vote or abstention of every member present. The City Attorney’s written opinion shall be made public, along with any action taken and any vote thereon, as soon as any litigation is concluded. The City Attorney shall record any action and vote upon such forms as the City Attorney may deem desirable. 5) No Minutes No minutes of closed sessions shall be kept. The City Attorney shall record the information necessary to comply with state law and the Palo Alto initiative. 6) Confidentiality No person in attendance at a closed session may disclose the substance or effect of any matter discussed during the session.viii T. Motions, Debate & Voting 16 1) Policy It is the policy of the Council to follow simplified rules of parliamentary procedure for motions, debate and voting. These rules focus on the types of motions the Council can debate and when those motions are properly used. 2) Purpose The purpose of these rules to facilitate orderly and thorough discussion and debate of Council business. These rules shall not be applied or used to create strategic advantage or unjust results. 3) Summary of Rules Palo Alto does not follow Roberts Rules of Order. See the Summary Table below. U. Motions A motion is a formal proposal by a Council Member asking that the Council take a specified action. A motion must receive a second before the Council can consider a matter. Matters returning to the Council with unanimous approval from a standing committee will be introduced without a motion if directed by the committee. Motions may be provided to the City Clerk in advance of the City Council meeting so that the Clerk can post the motion on the screen for community and Council members thus saving transcription time. 1) Types of Motions There are two kinds of motions. These are the “main” motion and any secondary motions. Only one main motion can be considered at a time. 2) Procedure: • Get the Floor A Council Member must receive the permission of the Mayor (or other presiding officer) before making a motion. • State the Motion A motion is made by a Council Member (the “maker”) stating his or her proposal. Longer proposals can be written and may be in the form of a resolution. • Second Required Any other Council Member (including the presiding officer) who supports the proposal (or who simply wishes it to be considered) may “second” the motion without first being recognized. A motion to raise a question of personal privilege does not require a second. • Motion Restated The Mayor should restate the motion for the record, particularly if it is long or complex. • Lack of a Second 17 If there is no second stated immediately, the Mayor should ask whether there is a second. If no Council Member seconds the motion the matter will not be considered. • Discussion The maker shall be the first Council Member recognized to speak on the motion if it receives a second. Generally Council Members will speak only once with respect to a motion. If the Mayor or Council permits any Council Member to speak more than once on a motion, all Council Members shall receive the same privilege. • Secondary Motions Secondary motions may be made by a Council Member upon getting the floor. • Action After discussion is complete the Council will vote on the motion under consideration. 3) Precedence of Motions When a motion is before the Council, no new main motion shall be entertained. The Council recognizes the following secondary motions which may be considered while a main motion is pending. These motions shall have precedence in the order listed below. This means that a secondary motion that is higher on the list will be considered ahead of a pending secondary motion that is lower on the list: • Fix the time to which to adjourn; • Adjourn; • Take a recess; • Raise a question of privilege; • Lay on the table; • Previous question (close debate); • Limit or extend limits of debate; • Motion to continue to a certain time; • Refer to committee; • Amend or substitute; 4) Secondary Motions Defined The purpose of the allowed secondary motions is summarized in the following text and table. • Fix the time to which to adjourn This motion sets a time for continuation of the meeting. It requires a second, is amendable and is debatable only as to the time to which the meeting is adjourned. • Adjourn This motion ends the meeting or adjourns it to another time. It requires a second and is not debatable except to set the time to which the meeting is adjourned, if applicable. A motion to adjourn shall be in order at any time, except as follows: (a) when repeated 18 without intervening business or discussion; (b) when made as an interruption of a member while speaking; (c) when the previous question has been ordered; and (d) while a vote is being taken. • Take a recess This motion interrupts the meeting temporarily. It is amendable, but is not debatable. • Raise a question of personal privilege This motion allows a Council Member to address the Council on a question of personal privilege and shall be limited to cases in which the Council Member's integrity, character or motives are questioned, or when the welfare of the Council is concerned. The maker of the motion may interrupt another speaker if the presiding officer recognizes the "privilege." The motion does not require a second, is not amendable and is not debatable. • Lay on the table This motion is used to interrupt business for more urgent business. A motion to lay on the table requires a second, is not amendable and is not debatable. It shall preclude all amendments or debate of the subject under consideration. If the motion prevails, and the subject is tabled, the matter must be reagendized in the future if further consideration is to be given to the matter. • Previous question This motion “calls the question” by closing debate on the pending motion. A motion for previous question requires a second, is not debatable and is not amendable. It applies to all previous motions on the subject unless otherwise specified by the maker of the motion. If motion for previous question fails, debate is reopened; if motion for previous question passes, then vote on the pending motion. A motion for previous question requires a two-thirds vote of those Council Members present and voting. • Limit or extend debate This motion limits or extends the time for the Council or any Council Member to debate a motion. It requires a second, is amendable and is not debatable. The motion requires a two-thirds vote of those Council Members present and voting. • Continue to a certain time This motion continues a matter to another, specified time. It requires a second, is amendable and is debatable as to propriety of postponement and time set. • Refer to a city agency, body, committee, board, commission or officer This motion sends a subject to another city agency, body, committee, board, commission or officer for further study and report back to Council, at which time subject is fully debated. It requires a second, is amendable, and is debatable only as to the propriety of 19 referring. The substance of the subject being referred shall not be discussed at the time the motion to refer is made. • Amend or substitute This motion changes or reverses the main motion. It requires a second, is amendable, and is debatable only when the motion to which it applies is debatable. A motion to amend an amendment is in order, but one to amend an amendment to an amendment is not. An amendment modifying a motion is in order but an amendment raising an independent question or one that is not germane to the main motion shall not be in order. Amendments take precedence over the main motion and the motion to postpone indefinitely. Motion Description 2nd Required Debatable Amendable 2/3 Vote Fix the time to which to adjourn Sets a next date and time for continuation of the meeting X Only as to time to which the meeting is adjourned X Adjourn Sets time to adjourn. Not in order if (a) repeated without intervening business (b) made as an interruption of a member while speaking; (c) the previous question has been ordered; and (d) while a vote is being taken X Only to set the time to which the meeting is adjourned Take a recess Purpose is to interrupt the meeting X X Raise a question of privilege Lay on the table Interrupts business for more urgent business X Previous question (close debate or “call the question”) Closes debate on pending motion X X Limit or extend limits of debate Purpose is to limit or extend debate X X X Motion to continue to a certain time Continues the matter to another, specified time X X X Refer to committee Sends subject to another city agency, body, committee, board, commission or officer for further study and report back to council, at which time subject is fully debated X Only as to propriety of referring, not substance of referral X Amend or substitute Modifies (or reverses course of) proposed action. Cannot raise independent question. Can amend an amendment, but no further X Only if underlying motion is debatable X 20 21 V. Debate and Voting 1) Presiding officer to state motion The presiding officer shall assure that all motions are clearly stated before allowing debate to begin. The presiding officer may restate the motion or may direct the City Clerk to restate the motion before allowing debate to begin. The presiding officer shall restate the motion or direct the City Clerk to restate the motion prior to voting. 2) Presiding officer may debate and vote The presiding officer may move, second and debate from the chair, subject only to such limitations of debate as are by these rules imposed on all Council Members. The presiding officer shall not be deprived of any of the rights and privileges of a Council Member. 3) Division of question If the question contains two or more divisible propositions, each of which is capable of standing as a complete proposition if the others are removed, the presiding officer may, and upon request of a member shall, divide the same. The presiding officer's determination shall be appealable by any Council Member. 4) Withdrawal of motion A motion may not be withdrawn by the maker without the consent of the Council Member seconding it. 5) Change of vote Council Members may change their votes before the next item on the agenda is called. 6) Voting On the passage of every motion, the vote shall be taken by voice or roll call or electronic voting device and entered in full upon the record. 7) Silence constitutes affirmative vote Council Members who are silent during a voice vote shall have their vote recorded as an affirmative vote, except when individual Council Members have stated in advance that they will not be voting. 8) Failure to vote It is the responsibility of every Council Member to vote unless disqualified for cause accepted by the Council or by opinion of the City Attorney. No Council Member can be compelled to vote. 9) Abstaining from vote Council Members should only abstain if they are not sufficiently informed about an item, e.g. when there was a prior hearing and they were unable to view the prior meeting before the current meeting. In the event of an abstention the abstainer in effect, "consents" that a majority of the quorum of the Council Members present may act for him or her. 22 _______ City Council Protocols and Procedures Handbook 10) Not participating A Council Member who disqualifies him or herself pursuant to the Political Reform Act of 1974 because of any financial interest shall disclose the nature of the conflict and may not participate in the discussion or the vote. A Council Member may otherwise disqualify him or herself due to personal bias or the appearance of impropriety. 11) Tie votes Tie votes may be reconsidered during the time permitted by these rules on motion by any member of the Council voting aye or nay during the original vote. Before a motion is made on the next item on the agenda, any member of the Council may make a motion to continue the matter to another date. Any continuance hereunder shall suspend the running of any time in which action of the City Council is required by law. Nothing herein shall be construed to prevent any Council Member from agendizing a matter that resulted in a tie vote for a subsequent meeting. 12) Motion to reconsider A motion to reconsider any action taken by the Council may be made only during the meeting or adjourned meeting thereof when the action was taken. A motion to reconsider requires a second, is debatable and is not amendable. The motion must be made by one of the prevailing side, but may be seconded by any Council Member. A motion to reconsider may be made at any time and shall have precedence over all other motions, or while a Council Member has the floor, providing that no vested rights are impaired. The purpose of reconsideration is to bring back the matter for review. If a motion to reconsider fails, it may not itself be reconsidered. Reconsideration may not be moved more than once on the same motion. Nothing herein shall be construed to prevent any Council Member from making a motion to rescind such action at a subsequent meeting of the Council. 13) Appeal from the decision of presiding officer When the rules are silent, the presiding officer shall decide all questions of order, subject to appeal by a Council Member. When in doubt, the presiding officer may submit the question to the Council, in which case a majority vote shall prevail. Any decision or ruling of the presiding officer may be appealed by request of any member. The presiding officer shall call for a roll call or electronic voting device vote to determine if the presiding officer's ruling shall be upheld. If said vote passes or results in a tie vote, the presiding officer's ruling shall stand. If said vote fails, the decision or ruling of the presiding officer is reversed. 14) Getting the floor; improper references to be avoided Every Council Member desiring to speak shall address the chair and, upon recognition by the presiding officer, every Council Member shall be confined to the question under debate, avoiding all indecorous language and personal attacks. 23 _______ City Council Protocols and Procedures Handbook 15) Interruptions Except for being called to order, a Council Member once recognized, shall not be interrupted when speaking, except as otherwise provided for in these rules. A Council Member called to order while speaking shall cease speaking until the question or order is determined, and, if in order, said Council Member shall be permitted to proceed. W. Quasi-Judicial/Planned Community Hearings Policy It is the policy of the Council to assure that the due process rights of all persons are protected during City hearings. A “quasi-judicial” hearing is a hearing that requires a higher level of procedural due process because of the potential impact on life, liberty or property. Usually, quasi-judicial/planned community hearings involve a single parcel of land and apply facts and evidence in the context of existing law. Findings must be stated to explain the evidentiary basis for the Council’s decision. Purpose These rules are intended to assure that City Council decision making on quasi- judicial/planned community matters is based upon facts and evidence known to all parties and to support the role of Boards and Commissions in making independent recommendations to Council. General Requirements For purposes of this Section IV, a Quasi-Judicial or Planned Community Development Project subject to these rules is a formulated plan to go forward with a particular project or development. 1) Quasi-Judicial/Planned Community Proceedings Defined Quasi-judicial/planned community proceedings subject to these procedural rules include hearings involving the following matters: • Conditional Use Permits • Variances • Home Improvement Exceptions • Design Enhancement Exceptions • Subdivisions, other than final map approvals • Architectural Review • Assessment protest hearings • Other matters as determined by the City Attorney • Appeals related to any of the above • Environmental Review relating to any of the above 24 _______ City Council Protocols and Procedures Handbook 2) Restrictions on Council Communications Outside of Quasi-Judicial and Planned Community Zone Hearings It is the policy of the Council to discourage the gathering and submission of information by Council Members outside of any noticed public meeting, prior to final recommendations by the Architectural Review Board or Planning & Transportation Commission. The following procedural guidelines are intended to implement this policy, but shall not be construed to create any remedy or right of action. 3) Identification of Quasi-Judicial/Planned Community Matters The City Attorney, in conjunction with the City Clerk and City Manager, will identify agenda items involving quasi-judicial/planned community decisions on both the tentative and regular Council agendas. This identification is intended to inform the Council, interested parties, and the public that this policy will apply to the item. 4) Council to Track Contacts Council Members will use their best efforts to track contacts pertaining to such identified quasi-judicial/planned community decision items. Contacts include conversations, meetings, site visits, mailings, or presentations during which substantial factual information about the item is gathered by or submitted to the Council Member. 5) Disclosure When the item is presented to the Council for hearing, Council Members will disclose any contacts which have significantly influenced their preliminary views or opinions about the item. The disclosure may be oral or written, and should explain the substance of the contact so that other Council Members, interested parties, and the public will have an opportunity to become apprised of the factors influencing the Council's decision and to attempt to controvert or rebut any such factor during the hearing. Disclosure alone will not be deemed sufficient basis for a request to continue the item. A contact or the disclosure of a contact shall not be deemed grounds for disqualification of a Council Member from participation in a quasi-judicial/planned community decision unless the Council Member determines that the nature of the contact is such that it is not possible for the Council Member to reach an impartial decision on the item. 6) No Contacts after Hearings Following closure of the hearing, and prior to a final decision, Council Members will refrain from any contacts pertaining to the item, other than clarifying questions directed to City staff. 7) Written Findings Required On any matter for which state law or City ordinance requires the preparation of written findings, the staff report and other materials submitted on the matter will contain findings proposed for adoption by the Council. Any motion directly or impliedly rejecting the proposed findings must include a statement of alternative or modified findings or a direction that the matter under 25 _______ City Council Protocols and Procedures Handbook consideration be continued for a reasonable period of time in order for staff to prepare a new set of proposed findings consistent with the evidence which has been presented and the decision which is anticipated. 8) Rules of Evidence Council hearings need not be conducted according to formal rules of evidence. Any relevant evidence may be considered if it is the sort of evidence upon which responsible persons rely in the conduct of serious affairs. The presiding officer may exclude irrelevant or redundant testimony and may make such other rulings as may be necessary for the orderly conduct of the proceedings while ensuring basic fairness and full consideration of the issues involved. Evidentiary objections shall be deemed waived unless made in a timely fashion before the Council. 9) Burden of Proof The applicant and appellant shall bear the burden of proof on all aspects of the action or relief they seek. The person with the burden of proof must offer evidence to the Council to support his or her position. 10) Council Members Who are Absent During Part of a Hearing A Council Member who is absent from any portion of a hearing conducted by the Council may vote on the matter provided that he or she has watched or listened to a video or radio broadcast, or video or audio recording, of the entire portion of the hearing from which he or she was absent and if she or he has examined all of the exhibits presented during the portion of the hearing from which he or she was absent and states for the record before voting that the Council Member deems himself or herself to be as familiar with the record and with the evidence presented at the hearing as he or she would have been had he or she personally attended the entire hearing. 11) Appeals Appeals to the Council shall be conducted de novo, meaning that new evidence and arguments may be presented and considered. All matters in the record before any other City board, commission or official shall be part of the record before the Council. *For all purposes, applicant also refers to applicant agent. 26 _______ X. Standing Committees City Council Protocols and Procedures Handbook Policy It is the policy of the Council to use standing committees in open and public meetings to study City business in greater depth than what is possible in the time allotted for Council meetings. Purpose These rules are intended to enhance public participation and committee meetings so that the best possible decisions can be made for Palo Alto. General Requirements Council standing committees shall be subject to the following procedural rules: 1) Quorum A majority of the committee membership shall constitute a quorum. 2) Referrals Only the Council or City Manager shall make referrals to the standing committees. Referrals will generally be directed to only one of the standing committees. Items may be withdrawn from the committee and taken up for consideration by the Council at any Council meeting with the consent of a majority of the Council, and subject to any applicable noticing or agenda posting requirements. Council members who submit matters to the Council which are referred to a standing committee may appear before the standing committee to which the referral has been made in order to speak as proponents of the matter. Standing committee meetings during which such referrals may be considered shall be noticed as Council meetings for the purpose of enabling the standing committee to discuss and consider the matter with a quorum of the Council present. 3) Function of committees The purpose and intent of committee meetings is to provide for more thorough and detailed discussion and study of prospective or current Council agenda items with a full and complete airing of all sentiments and expressions of opinion on city problems by both the Council and the public, to the end that Council action will be expedited. Actions of the committee shall be advisory recommendations only. 4) Minutes The City Clerk shall be responsible for the preparation and distribution to the Council of the minutes of standing committee meetings. The minutes for these meetings shall be sense Action minutes which reflect the motions made during these meetings. The minutes shall be delivered to all Council Members before the Council meeting at which the committee's recommendations are to be discussed. 27 _______ City Council Protocols and Procedures Handbook 5) Report of committee The minutes of each committee meeting shall serve as the report to the Council. Any member may write a separate report. 6) Agenda The chairperson of each standing committee shall work with staff to prepare the agenda for committee meetings, the sequence of study being, within reasonable limits of practicality, the same as the sequence of referral. 7) Public Participation Public comment on agenda items will be limited to a maximum of five minutes per speaker, or any alternate time limit specified by the presiding officer. 8) Conduct of standing committee meetings The chairperson of each committee may conduct meetings with as much informality as is consistent with Council procedural rules, which shall also be in effect during committee meetings. The views of interested private citizens may be heard in committee meetings, but in no case shall a committee meeting be used as a substitute for public hearings required by law. 9) Oral Communications Opportunities for oral communications shall be provided in the same manner as Council meetings. Y. Ad Hoc Committees and Committee as a Whole Policy The Council may use Ad Hoc Committees or the Committee as a Whole on a limited basis where necessary to study City business in greater depth than what is possible in the time allotted for Council and Standing Committee meetings. Purpose These rules are intended to clarify the distinctions between Standing, and Ad Hoc Committees, and the Committee as a Whole and to set up guidelines for creation of Ad Hoc Committees and the Committee as a Whole.. General Requirements Council Ad Hoc Committees and the Committee as a Whole shall be subject to the following procedural rules: 1) Definition of Ad Hoc Committee An Ad Hoc Committee is an advisory committee composed solely of less than a quorum of members of the Council. The work of an Ad Hoc Committee is limited to a single finite purpose. By contrast, a Standing Committee has continuing subject matter jurisdiction extending for a lengthy time period and/or a meeting schedule fixed by charter, ordinance, resolution, or formal action of the Council. Commented [HT4]: The City Attorney notes that Council is not currently utilizing committee as a whole. Council may do so without specific language to the procedures. Under these circumstances, Council is encouraged to discuss whether committee as a whole language should be added at this time. 28 _______ City Council Protocols and Procedures Handbook 2) Definition of Committee as a Whole A Committee as a Whole is a committee composed of the entire City Council. The work of the Committee as a Whole is limited to a single finite purpose. 2)3) Brown Act Ad Hoc Committees do not constitute legislative bodies and are not subject to the requirements of the Brown Act. The Committee as a Whole is subject to the Brown Act. 3)4) Appointment The Mayor or the City Council may appoint four or less members of the Council to serve on an Ad Hoc Committee. In contrast, only the Council and not the Mayor alone can create a Standing Committee. The Mayor will publicly announce any Ad Hoc Committee created by him or her, its membership and stated purpose and posted on the City Council website. The City Manager shall prepare a report to Council about the anticipated time commitment required for staff to assist the Ad Hoc Committee. 4)5) Duration Ad Hoc Committees are created for a finite period of time. If an Ad Hoc Committee does not complete its task by the end of the calendar year, it shall not continue unless reappointed by the new Mayor in the following year. 5)6) Members Ad Hoc Committees shall consist of less than a quorum of Council members only, and shall not include any other persons such as members of other legislative bodies. 6)7) Reporting Ad Hoc Committees shall report their recommendations to the Council no less than once per quarter in writing or orally. Any Council Member may during the COUNCIL MEMBER QUESTIONS, COMMENTS AND ANNOUNCEMENTS request that an updated Ad Hoc Committee report be placed on the next meeting’s agenda. 7)8) Termination of Ad Hoc Committee by Majority of Council A majority of the Council may vote to terminate any Ad Hoc Committee following placement of the issue on an agenda. 8)9) Conclusion A public announcement shall be made any time the Ad Hoc Committee has concluded its work and/or upon dissolution. 2.5 - Election of Mayor Formatted: Indent: Left: 0.88", No bullets or numbering 29 _______ City Council Protocols and Procedures Handbook Palo Alto Municipal Code Section 2.04.060 governs the election of the Mayor. Nominations for Mayor may be made by any individual Council Member and do not require a second. CITY COUNCIL PROTOCOLS The handbook is organized into eight sections to serve as guidelines: 1) Core Responsibilities 2) Council Conduct 3) Other Procedural Issues 4) Policy & Services Committee – Role, Purpose & Work Planning 5) Enforcement 6) City Council Emails for Agenda-Related Items 7) City Council and Board and Commissions Policy for Travel and Miscellaneous Expense Reimbursement, March 2006 City of Palo Alto Council Protocols Ethics Addendum 30 _______ City Council Protocols and Procedures Handbook SECTION 1 - CORE RESPONSIBILITIES All members of the City Council, including those serving as Mayor and Vice Mayor, have equal votes. No Council Member has more power than any other Council Member, and all should be treated with equal respect. All Council Members: A. Demonstrate honesty and integrity in every action and statement B. Comply with both the letter and spirit of the laws and policies affecting the operation operations of government. C. Serve as a model of leadership and civility to the community D. Inspire public confidence in Palo Alto government E. Work for the common good, not personal interest F. Prepare in advance of Council meetings and be familiar with issues on the agenda G. Fully participate in City Council meetings and other public forums while demonstrating respect, kindness, consideration, and courtesy to others H. Participate in scheduled activities to increase Council effectiveness I. Review Council procedures, such as these Council Protocols, at least annually J. Represent the City at ceremonial functions at the request of the Mayor K. Be responsible for the highest standards of respect, civility and honesty in ensuring the effective maintenance of intergovernmental relations L. Respect the proper roles of elected officials and City staff in ensuring open and effective government M. Provide contact information to the City Clerk in case an emergency or urgent situation arises while the Council Member is out of town 31 _______ City Council Protocols and Procedures Handbook SECTION 2 - COUNCIL CONDUCT Councils are composed of individuals with a wide variety of backgrounds, personalities, values, opinions, and goals. Despite this diversity, all have chosen to serve in public office in order to improve the quality of life in the community. In all cases, this common goal should be acknowledged even as Council may "agree to disagree" on contentious issues. 2.1 – Public Meetings A. Use Formal Titles The Council should refer to one another formally during Council meetings as Mayor, Vice Mayor or Council Member followed by the individual’s last name. B. Practice Civility and Decorum in Discussions and Debate. Difficult questions, tough challenges to a particular point of view, and criticism of ideas and information are legitimate elements of a free democracy in action. Be respectful of diverse opinions. C. Honor the Role of the Presiding Officer in Maintaining Order and Equity. Respect the Chair's efforts to focus discussion on current agenda items. Objections to the Chair's actions should be voiced politely and with reason, following the parliamentary procedures outlined in the City Council Procedural Rules. D. Demonstrate Effective Problem-Solving Approaches. Council Members have a public stage to show how individuals with disparate points of view can find common ground and seek a compromise that benefits the community as a whole. Council Members are role models for residents, business people and other stakeholders involved in public debate. E. Be Respectful of Other People's Time. Stay focused and act efficiently during public meetings. 2.2 - Private Encounters A. Treat Others as You Would Like to be Treated. Ask yourself how you would like to be treated in similar circumstances, and then treat the other person that way. 32 _______ City Council Protocols and Procedures Handbook 2.3 – Council Conduct with City Staff The key provisions on Council-staff relations found in section 2.04.170 of the Palo Alto Municipal Code: “Neither the council nor any of its committees or members shall direct, request or attempt to influence, either directly or indirectly, the appointment of any person to office or employment by the city manager or in any manner interfere with the city manager or prevent the city manager from exercising individual judgment in the appointment of officers and employees in the administrative service. Except for the purpose of inquiry, the council and its members shall deal with the administrative service solely through the city manager, and neither the council nor any member thereof shall give orders to any of the subordinates of the city manager, either publicly or privately.” Governance of a City relies on the cooperative efforts of elected officials, who set policy, and City Staff, which analyze problems and issues, make recommendations, and implement and administer the Council’s policies. Therefore, every effort should be made to be cooperative and show mutual respect for the contributions made by each individual for the good of the community. A. Treat All Staff as Professionals. Clear, honest communication that respects the abilities, experience, and dignity of each individual is expected. As with your Council colleagues, practice civility and decorum in all interactions with City staff. B. Channel Communications through the Appropriate Senior City Staff. Questions of City staff should be directed only to the City Manager, Assistant City Manager, City Attorney, City Clerk, Assistant City Clerk, City Auditor, Senior Assistant City Attorneys, or Department Heads. The Office of the City Manager should be copied on any request to Department Heads. Council Members should not set up meetings with department staff directly, but work through Department Heads, who will attend any meetings with Council Members. When in doubt about what staff contact is appropriate, Council Members should ask the City Manager for direction. However, nothing in these protocols is intended to hinder the access Council-appointed liaisons (e.g. to the San Francisquito JPA or NCPA) may require in order to fulfill their unique responsibilities. C. In Order to Facilitate Open Government, All Council Members Should Make Decisions with the Same Information from Staff On Agendized or Soon-To-Be Agendized Items (i.e. Items on The Tentative Agenda or in a Council Committee). D. Never Publicly Criticize an Individual Employee, Including Council-Appointed Officers. Criticism is Differentiated From Questioning Facts or the Opinion of Staff. All critical comments about staff performance should only be made to the City Manager through private correspondence or conversation. Comments about staff in the office of the City Attorney, City Auditor or City Clerk should be 33 _______ City Council Protocols and Procedures Handbook made directly to these CAOs through private correspondence or conversation. E. Do Not Get Involved in Administrative Functions. Avoid any staff interactions that may be construed as trying to shape staff recommendations. Council Members shall refrain from coercing staff in making recommendations to the Council as a whole. F. Be Cautious in Representing City Positions on Issues. Before sending correspondence related to a legislative position, check with City staff to see if a position has already been determined. When corresponding with representatives of other governments or constituents remember to indicate if appropriate that the views you state are your own and may not represent those of the full Council. G. Do Not Attend Staff Meetings Unless Requested by Staff. Even if the Council Member does not say anything, the Council Member’s presence may imply support, show partiality, intimidate staff, or hampers staff’s ability to do its job objectively. H. Respect the “One Hou r” Rule f or Staff W ork . Requests for staff support should be made to the appropriate senior staff member, according to the protocol for channeling communications. Any request, which would require more than one hour of staff time to research a problem or prepare a response, will need to be approved by the full council to ensure that staff resources are allocated in accordance with overall council priorities. Once notified that a request for information or staff support would require more than one hour, the Council Member may request that the City Manager place the request on an upcoming Council agenda. I. Depend upon the Staff to Respond to Citizen Concerns and Complaints. It is the role of Council Members to pass on concerns and complaints on behalf of their constituents. It is not, however, appropriate to pressure staff to solve a problem in a particular way. Refer citizen complaints to the appropriate senior staff member, according to the protocol on channeling communications. The senior staff member should respond according to the Policy and Procedure for Responding to Customer Complaints. Senior staff is responsible for making sure the Council Member knows how the complaint was resolved. J. Do Not Solicit Political Support from Staff. The City Charter states that “Neither the city manager or any other person in the employ of the city shall take part in securing or shall contribute any money toward the nomination or election of any candidate for a municipal office.” In addition, some professionals (e.g., City Manager and the Assistant City Manager) have professional codes of ethics, which preclude politically partisan activities or activities that give the appearance of political partisanship. 34 _______ City Council Protocols and Procedures Handbook 2.4 - Conduct with Palo Alto Boards and Commissions The City has established several Boards and Commissions as a means of gathering more community input. Citizens who serve on Boards and Commissions become more involved in government and serve as advisors to the City Council. They are a valuable resource to the City’s leadership and should be treated with appreciation and respect. Council Members serve as liaisons to Boards and Commissions, according to appointments made by the Mayor, and in this role are expected to represent the full Council in providing guidance on Council processes or actions to the Board or Commission. Refrain from speaking for the full Council on matters for which the full council has not yet taken a policy position. In other instances, Council Members may attend Board or Commission meetings as individuals, and should follow these protocols: A. If Attending a Board or Commission Meeting, Identify Your Comments as Personal Views or Opinions. Council Members may attend any Board or Commission meeting, which are always open to any member of the public. Any public comments by a Council Member at a Board or Commission meeting, when that Council Member is not the liaison to the Board or Commission should make a point to clearly state it is an individual opinion and not a representation of the feelings of the entire City Council. B. Refrain from Lobbying Board and Commission Members. It is inappropriate for a Council Member to contact a Board or Commission member to lobby on behalf of an individual, business, or developer, or to advocate a particular policy perspective. It is acceptable for Council Members to contact Board or Commission members in order to clarify a position taken by the Board or Commission. C. Remember that Boards and Commissions are Advisory to the Council as a Whole, not as Individual Council Members. The City Council appoints individuals to serve on Boards and Commissions, and it is the responsibility of Boards and Commissions to follow policy established by the Council. Council Members should not feel they have the power or right to unduly influence Board and Commission members. A Board and Commission appointment should not be used as a political reward. D. Concerns about an Individual Board or Commission Member Should be Pursued with Tact. If a Council Member has concerns with a particular Board or Commission member fulfilling his or her roles and responsibilities and is comfortable in talking with that individual privately, the Council Member should do so. Alternatively, or if the problem is not resolved, the Council Member should consult with the Mayor, who may address the issue to the Council as appropriate. E. Be Respectful of Diverse Opinions. A primary role of Boards and Commissions is to represent many points of view in the community and to provide the Council with advice based on a full spectrum of concerns and perspectives. Council Members may have a closer 35 _______ City Council Protocols and Procedures Handbook working relationship with some individuals serving on Boards and Commissions, but must be fair to and respectful of all citizens serving on Boards and Commissions. F. Keep Political Support Away from Public Forums. Board and Commission members may offer political support to a Council Member, but not in a public forum while conducting official duties. Conversely, Council Members may support Board and Commission members who are running for office, but not in an official forum in their capacity as a Council Member. G. Maintain an Active Liaison Relationship. Appointed Council liaisons or alternates are encouraged to attend all regularly scheduled meetings of their assigned Board or Commission. 2.5 - Staff Conduct with City Council A. Respond to Council Questions as Fully and as Expeditiously as is Practical. The protocol for staff time devoted to research and response is in application here. If a Council Member forwards a complaint or service request to a department head or a Council Appointed Officer, there will be follow-through with the Council Member as to the outcome. B. Respect the Role of Council Members as Policy Makers for the City. Staff is expected to provide its best professional recommendations on issues. Staff should not try to determine Council support for particular positions or recommendations in order to craft recommendations. The Council must be able to depend upon the staff to make independent recommendations. Staff should provide information about alternatives to staff recommendations as appropriate, as well as pros and cons for staff recommendations and alternatives C. Demonstrate Professionalism and Non-Partisanship in all Interactions with the Community and in Public Meetings. D. It is Important for the Staff to Demonstrate Respect for the Council at all Times. All Council Members Should be Treated Equally. 36 _______ City Council Protocols and Procedures Handbook SECTION 3 - OTHER PROCEDURAL ISSUES 3.1 – Commit to Annual Review of Important Procedural Issues At the beginning of each legislative year, the Council will hold a special meeting to review the Council protocols, adopted procedures for meetings, the Brown Act, conflict of interest, and other important procedural issues. 3.2 – Don’t Politicize Procedural Issues (e.g. Minutes Approval or Agenda Order) for Strategic Purposes 3.3 – Submit Questions on Council Agenda Items Ahead of the Meeting In order to focus the Council meetings on consideration of policy issues and to maintain an open forum for public discussion, questions which focus on the policy aspects of agenda items should be discussed at the Council meeting rather than in one-on-one communications with staff prior to the meetings. Any clarifications or technical questions that can be readily answered can be handled before the meeting. Council Members are encouraged to submit their questions on agenda items to the appropriate Council Appointed Officer or City Manager by 5:00 p.m. the Wednesday prior to the meeting. as far in advance of the meeting as possible so that staff can be prepared to respond at the Council meeting. More detailed procedures relating to agenda questions can be found in the addendum to these protocols titled “Policy and Procedures for Council E- mails for Agenda Related Items.” 3.4 - Submittal of Materials Directly to Council If Council receives planning application materials related to agenda item matters they will notify the City Clerk and the City Manager as soon as possible. 3.5 - Late Submittal of Correspondence or Other Information Related to Planning Applications In order to allow for adequate Staff review and analysis, and to ensure public access to information, all plans, correspondence, and other documents supporting planning applications being heard by the City Council must be submitted to staff not later than noon five working days prior to the release of the Council Agenda Packet. If any correspondence or other information is submitted after this deadline to Council Members or staff, and Staff determines additional review is needed Staff will reschedule the item for a future Council meeting. If a Council member receives planning application materials from a project applicant he or she shall notify the City Clerk and the City Manager as soon as possible. There are no restrictions on the rights of applicants or others to comment or respond to information contained within the Staff Report. At the meeting the City Council may determine whether to continue or refer the item to the appropriate Board and/or Commission if significant changes to a project or significant new information become known. Nothing in this statement is intended to restrict the rights of applicants or other interested parties to respond to information contained in or attached to a Staff Report. 37 _______ City Council Protocols and Procedures Handbook *For all purposes, applicant also refers to applicant agent. 3.6 – Respect the Work of the Council Standing Committees The purpose of the Council standing committees is to provide focused, in-depth discussion of issues. Council should respect the work of the committees. If a matter is taken forward to the full Council for approval and it receives a unanimous vote at Committee, the item will be placed on the Consent Calendar unless otherwise recommended by the Committee, Mayor or staffCity Attorney or City Manager if any of these entities believe the item is of significant public interest.. discuss future meetings. Consideration in building the agenda should be given to the potential length of the meeting and at what point items of significant public concern may be heard. The purpose of the meeting is not to work on policy issues. Normally, only the Mayor and Vice Mayor are expected to attend the pre-Council meetings with the City Manager and other CAOs, and Department Managers. The Mayor and Vice Ma yor’s role is to represent the interest of the entire Council. Consideration in building the agenda should be given to the potential length of the meeting and at what point items of significant public concern may be heard. Comment [AK4]: Section needs further revision. Due to early publication date and staff work load, staff will provide Committee members with revision at places. As mentioned in staff report, revisions will be made, real time, during the meeting and Committee members can comment on changes. 3.7 – The Mayor and Vice Mayor Should Work With Staff to Plan the Council Meetings There are three purposes to the pre-Council planning meeting: 1) to plan how the meeting will be conducted; including review of approximate time allocation of staff report presentations and to ensure adequate time for large complex items 2) to identify any issues or questions that may need greater staff preparation for the meeting; and 3) to 38 _______ City Council Protocols and Procedures Handbook SECTION 4 - POLICY & SERVICES COMMITTEE – ROLE, PURPOSE, & WORK PLANNING The Municipal Code states that the role of the Council Policy & Services Committee is to: …consider and make recommendations on matters referred to it by the council relating to parliamentary and administrative procedures and policy matters pertaining to intergovernmental relations, personnel policies, planning and zoning, traffic and parking, public work, and community and human services. (§2.04.220) In 2009 and 2010, the Council reviewed the purpose and structure of the Committee and adopted recommendations on several items related to this. This section documents these agreements related to the Committee. Purpose Statement: The purpose of the Policy & Services Committee is to review and identify important community issues and City policies and practices to ensure good public policy. The Committee shall consider and make recommendations to Council on matters relating to parliamentary, and administrative protocols, procedures and policy matters. SECTION 5 - ENFORCEMENT Council Members have the primary responsibility to assure that these protocols are understood and followed, so that the public can continue to have full confidence in the integrity of government. As an expression of the standards of conduct expected by the City for Council Members, the protocols are intended to be self-enforcing. They therefore become most effective when members are thoroughly familiar with them and embrace their provisions. For this reason, Council Members entering office shall sign a statement affirming they have read and understood the Council protocols. In addition, the protocols shall be annually reviewed by the Policy and Services Committee and updated as necessary. 39 _______ City Council Protocols and Procedures Handbook SECTION 6 - CITY COUNCIL E-MAILS FOR AGENDA-RELATED ITEMS 6.1 - Policy The Council adopted protocols provide a framework for the policy on e-mail communications between Council Members and Staff on agenda-related items, including the following: A. In order to facilitate open government, all Council Members should make decisions with the same information from Staff on agendized or soon-to-be agendized items (i.e. items on the tentative agenda or in a Council Committee) B. Submit questions on Council agenda items ahead of the meeting, In order to focus the Council meetings on consideration of policy issues and to maintain an open forum for public discussion, questions which focus on the policy aspects of agenda items should be discussed at the Council meeting rather than in one-on-one communications with Staff prior to the meetings. Any clarifications or technical questions that can be readily answered can be handled before the meeting. Council Members are encouraged to submit their questions on agenda items to the appropriate Council Appointed Officer or City Manager as far in advance of the meeting as possible so that Staff can be prepared to respond at the Council meeting. In its settlement agreement with the San Jose Mercury News of February 2003, the City Council agreed to consider a policy under which the Council would waive any deliberative or other privilege, other than attorney-client privilege, that it might assert with regards to e-mails on agendized items. This policy and procedure implements that agreement. The Council, in adopting this policy, does not waive attorney-client-privilege or any other privilege associated with a closed session authorized under the Brown Act. 6.2 - Procedure A. Council Members should direct any questions on staff reports to the City Manager or designee. Questions on reports from the City Auditor, City Attorney, or City Clerk should be directed to the appropriate Council Appointed Officer. Council Members should not direct any questions on agenda items to other members of the City Manager’s Staff or the Staff of the other Council Appointed Officers. B. Council Members will submit questions on agenda items no later than 9 a.m5:00 p.m. . on the Monday Wednesday prior to of the Council meeting at which the item will be discussed. Any questions received after that time may be responded to via e-mail, or alternatively, will be responded to at the Council meeting. 40 _______ City Council Protocols and Procedures Handbook C. Staff will not engage in “dialogues” with individual Council Members regarding questions, i.e. follow-up questions to initial questions will be responded to at the Council Meeting. D. Staff will give highest priority to responding prior to the Council meeting via e- mail only on items on the Consent Calendar. Questions which address the policy aspects of the item on the Council agenda will not be responded to prior to the meeting, although Staff welcomes such questions in advance of the meeting in order to prepare for the Council and public discussion. Technical and clarifying questions on non-Consent Calendar items will be responded to as time permits. E. If the Staff will be responding to a Council Members Consent Calendar question at the meeting rather responding to the question via e-mail, Staff will inform the Council Member as early as possible after receipt of the question(s). F. Questions and all Staff-prepared responses will be forwarded to all Council Members as well as put up on the special web page created for public review of Council agenda questions and Staff responses. Staff will include the name of the Council Member posing the questions in the “subject” field of the e-mail response. G. Written copies of all Council Member agenda questions and Staff responses will be at Council places at the meeting; additionally copies will be made available in the Council Chambers for members of the public. 41 _______ City Council Protocols and Procedures Handbook SECTION 7 - CITY COUNCIL AND BOARDS AND COMMISSSIONS POLICY FOR TRAVEL AND MISCELLANEOUS EXPENSE REIMBURSEMENT, March 2006 GENERAL CONSIDERATIONS This policy is set by the City Council and applies to Council Members and to Board and Commissions members, who will be referred to as “Officials” in the policy. In reimbursing travel and miscellaneous expenses, a municipal purpose requiring the expenditure of public funds must be in evidence; also, in accord with the Charter and Municipal Code, such expenditures must be from authorized appropriations. 7.1 - Eligible Activities The following activities (“Eligible Activities”) are recognized by the Council as advancing municipal purposes and are eligible for expense reimbursement, subject to limitations on activities and specific and total expenditures described elsewhere in this policy: A. Communicating with representatives of regional, state and national government on adopted city policy positions; B. Attending educational seminars designed to improve officials’ skill and information levels; C. Participating in regional, state and national organizations whose activities affect the city’s interest; D. In collaboration with city staff, implementing a city-approved strategy for attracting or retaining businesses to the city. All other expenditures require prior approval by the City Council at a regular or special meeting. 7.2 - Out-of-Town Conferences or Meetings A. Reimbursement All payments for travel and meetings shall be on the basis of either reimbursement of expenses advanced by the Council Member/Official or payments made directly to travel agencies/websites, hotels, airlines or the organization sponsoring the meeting. All requests for payments or reimbursements must be accompanied by supporting vouchers, invoices or paid detailed receipts and a copy of descriptive literature about the conference or meeting. The Mayor or Chair for Officials must approve, in advance, individual travel requests for out-of-town meetings and conferences, e.g., Annual League of California Cities Conference, National League of Cities Conference, etc., including Eligible Activates. Allowable expenses for local or Bay Area Eligible Activates do not require prior approval by the Mayor or Chair. The total reimbursement shall not exceed the budget adopted by the Council for this purpose. 42 _______ City Council Protocols and Procedures Handbook All reimbursements shall comply with the limits of Policy and Procedures 1-02 (Citywide Travel Policy). Expense reports should be submitted within 30 days of end of trip. Inability to provide such documentation in a timely fashion may result in expense being borne by the Council Member or Official. B. Meals and Incidentals Notwithstanding the preceding general policy regarding reimbursement, a Council Member or Official may submit a payment request (supported by conference literature) for advance payment of meals and incidentals allowance according to the Internal Revenue Service authorized mileage reimbursement rate and payment for meals and incidentals consistent with City Policy and Procedures 1-02. If the amount advanced is exceeded, additional reimbursement may be requested upon return from the meeting. Requests for additional reimbursement must be supported by a detailed report and receipts for all meals and incidentals. The Mayor shall pre-approve additional reimbursements, and if the expenses are determined to be excessive, they may not be approved. C. Lodging Expense Reimbursements or payment of hotel bills will be limited to the highest group or governmental rate available and will cover room charges, applicable taxes and any other item listed in this policy for the Council Member or Official. Telephone calls to Palo Alto City Hall may be made collect. Other charges on the bill such as extra guests and the like are not reimbursable. D. Transportation • Air Transportation Reimbursement or payment will be limited to economy class commercial air carrier, or an available group travel rate if lower. • Private Automobiles Private automobiles may be used for personal or group transportation on extended trips. Reimbursement shall be made at the rate established by the Internal Revenue Service authorized mileage reimbursement rate consistent with the City Policy and Procedures 1-02. Mileage reimbursement for private automobiles shall not exceed the cost of round trip air transportation (economy class) and rental car, if applicable, or an available group travel rate if lower. • Rental Car Economy level only when Council Member or Official has traveled by airplane out of the Bay Area. • Shuttle/Taxi When traveling out of the area. 43 _______ City Council Protocols and Procedures Handbook 7.3 - Local or Bay Area Activities Council Members or Officials who have been requested or designated to represent the City may receive the actual cost of: A. Meals, if they are a scheduled feature of the activity, e.g., SCCCA dinner meetings. B. Registration fees where applicable. C. Mileage if activity is outside the City (mileage claims should be submitted monthly, with details: date and type of meeting, number of miles traveled to be indicated), consistent with City Policy and Procedures 1-02. D. Council Members and Officials may be reimbursed by the City for use of a private bicycle to attend local or Bay Area activities outside the City of Palo Alto consistent with City Policy and Procedures 2-9. 7.4 - Other Expenses A. Airport parking fees, but Council Members and Officials must use long-term parking for travel exceeding 24 hours. B. Meal expenses and associated gratuities must be within the limits set in City Policy and Procedures 1-02. C. Telephone/Fax/Cellular expenses will be reimbursed for actual expense incurred on City business. D. Internet Fee up to $15 per day, if a Council Member or Official is traveling on official business and needs access for City-related business. E. Baggage Handling Fee up to $3 per bag will be reimbursed. F. Ethics Training Expenses – AB1234 requires ethics training every two years and such fee and related expenses are eligible for reimbursement. 7.5 - Activities Not Considered Reimbursable A. Voluntary attendance at any conference or meeting, not representing the City. B. Meetings of social or service organizations. C. Meetings of voter groups or with individual citizens concerned with agenda items. D. Election campaign activities. E. Alcohol and entertainment expenses. 44 _______ City Council Protocols and Procedures Handbook F. Personal portion of the trip and other non-mileage automobile expenses. 7.6 - Reports to Council Council Members and Officials shall provide brief verbal reports on meetings attended at the City’s expense at the next regular Council/Board/Commission meeting. If multiple Officials attended, a joint report may be made. All related documents are subject to the Public Records Act and can be periodically reviewed by auditors. 7.7 - Violation of This Policy Use of public resources or falsifying expense reports is in violation of this policy and may result in any or all of the following: A. Loss of reimbursement privileges B. A demand for restitution to the City C. The City reporting the expenses as income to the elected or appointed Official to state and federal tax authorities D. Civil penalties of up to $1000 per day and three times the value of the resources used E. Prosecution for misuse of public resources 7.8 - Mayor and Vice Mayor Additional Compensation The Mayor shall receive $150 monthly and the Vice Mayor $100 monthly to defray additional expenses of these offices. 7.10 - Support Services The City Clerk’s Office makes travel arrangements for Council Members. This service includes conference registration, hotel reservations, per diem advances and reimbursement of unforeseen expenses. The department liaison for each board and commission will be responsible for arrangements for Officials. 45 _______ City Council Protocols and Procedures Handbook CITY OF PALO ALTO COUNCIL PROTOCOLS ETHICS ADDENDUM The citizens, businesses and organizations of the city are entitled to have fair, ethical and accountable local government, which has earned the public’s full confidence for integrity. To this end, the City Council has adopted Council Protocols and this Code of Ethics for members of the City Council to assure public confidence in the integrity of local government and its effective and fair operation. A. Comply with Law Members shall comply with the laws of the nation, the State of California and the City in the performance of their public duties. These laws include but are not limited to: the United States and California constitutions, the city Charter, laws pertaining to conflicts of interest, election campaigns, financial disclosures, employer responsibilities and open processes of governments and City ordinances and policies. B. Conduct of Members The professional and personal conduct of members must be above reproach and avoid even the appearance of impropriety. Members shall refrain from abusive conduct, personal charges or verbal attacks upon the character or motives of other members of the Council, boards and commissions, the staff or the public. C. Respect for Process Members shall perform their duties in accordance with the processes and rules of order established by the City Council governing the deliberation of public policy issues, meaningful involvement of the public and implementation of policy decisions of the City Council by City staff. D. Decisions Based on Merit Members shall base their decisions on the merits and substance of the matter at hand, rather than on unrelated considerations. E. Conflict of Interest In order to assure their independence and impartiality on behalf of the common good, members shall not use their official positions to influence decisions in which they have a material financial interest or where they have an organizational responsibility or personal relationship, which may give the appearance of a conflict of interest. F. Gifts and Favors It is contrary to the city of Palo Alto’s ethical standards for any council member to accept gifts or gratuities from an individual, business, or organization doing business, or seeking to do business, with the City or who is seeking permits or other entitlements from the City. Commented [HT5]: The City Attorney comments that this section should be reviewed and amended as needed to conform with current state law requirements. Staff will provide proposed versions at places. 46 _______ City Council Protocols and Procedures Handbook The acceptance of gifts can convey an appearance of favoritism and conflict of interest. Gifts can be perceived as attempts to influence City operations or as compensation for services rendered and can erode the public confidence in the impartiality of decisions made by Council Members. Council Members exercise good faith in carrying out this Protocol. It is impossible to list every situation and fact pattern, so it anticipates that Council Members will exercise their good judgment in determining whether the item is a gift or not. This policy is supplemental to the gift limitations of the Fair Political Practices Commission’s Limitations and Restrictions on Gifts, Honoraria, Travel and Loans. The following are not considered gifts under this Protocol: • Gifts which the Council member returns (unused) to the donor, or for which the Council Member reimburses the donor, within 30 days of receipt. • Gifts from a Council Member’s spouse, child, parent, grandparent, grandchild, brother, sister, parent-in-law, brother-in-law, sister-in-law, aunt, uncle, niece, nephew, or first cousin or the spouse of any such person, unless he or she is acting as an agent or intermediary for another person who is the true source of the gift. • Minor gifts of hospitality involving food or drink, that the Council Member receives in an individual’s home or at another location of business. • Gifts approximately equal in value exchanged between the Council Member and another individual on holidays, birthdays, or similar occasions. • Informational material provided to assist the Council member in the performance of their official duties, including books, reports, pamphlets, calendars, periodicals, videotapes, or free or discounted admission to informational conferences or seminars. • A bequest or inheritance. • Campaign contributions. • Personalized plaques and trophies with an individual value of less than $250. • Tickets to attend fundraisers for campaign committees or other candidates, and tickets to fundraisers for organizations exempt from taxation under Section 501(c)(3) of the Internal Revenue Code. 47 _______ City Council Protocols and Procedures Handbook • Free admission, refreshments, and similar non-cash nominal benefits provided to the Council Member at an event at which the Council Member gives a speech, participates in a panel or seminar, or provides a similar service. Transportation within California, and any necessary lodging and subsistence provided directly in connection with the speech, panel, seminar, or similar service, are also not considered gifts. • Passes or Tickets which provide admission or access to facilities, goods, services, or other benefits (either on onetime or repeat basis) that the Council Member does not use and does not give to another person. • Wedding gifts • A prize or award received in a bona fide competition not related to official status. (These exceptions are paraphrased from FPPC publications.) • Gifts from Sister Cities or other entities, other municipalities, if forwarded to the City. G. Confidential Information Members shall respect the confidentiality of information concerning the property, personnel or affairs of the City. They shall neither disclose confidential information without proper legal authorization, nor use such information to advance their personal, financial or other private interests. H. Use of Public Resources Members shall not use public resources, such as City staff time, equipment, supplies or facilities, for private gain or personal purposes. I. Representation of Private Interests In keeping with their role as stewards of the public interest, members of Council shall not appear on behalf of the private interests of third parties before the Council or any other board, commission or proceeding of the City, nor shall members of boards and commissions appear before their own bodies or before the Council on behalf of the private interests of third parties on matters related to the areas of service of their bodies. J. Advocacy Members shall represent the official policies or positions of the City Council, board or commission to the best of their ability when designated as delegates for this purpose. When presenting their individual opinions and positions, members shall explicitly state they do not represent their body or the City, nor will they allow the inference that they do. K. Positive Work Place Environment Members shall support the maintenance of a positive and constructive work place environment for City employees and for citizens and businesses dealing 48 _______ City Council Protocols and Procedures Handbook with the City. Members shall recognize their special role in dealings with City employees to in no way create the perception of inappropriate direction to staff. i Palo Alto Municipal Code, § 2.04.080(b). ii Palo Alto Municipal Code, § 2.04.120(c); 2.04.150(b) iii Palo Alto Municipal Code, § 2.04.010(b). iv Palo Alto Municipal Code, § 2.04.050(a). v Palo Alto Municipal Code, § 2.04.070(c) vi Palo Alto Municipal Code, § 2.04.020. vii Palo Alto Municipal Code, § 2.04.030. viii Palo Alto Municipal Code, § 2.04.040. City of Palo Alto Page 1 City of Palo Alto (ID # 5804) Policy and Services Committee Staff Report Report Type: Agenda Items Meeting Date: 5/21/2015 Summary Title: Updates to Policies and Protocals Handbook Title: Continued Discussion Regarding City Council Procedural Matters, Including Updates to Procedures and Protocols Handbook (Continued from April 8, 2015) From: City Manager Lead Department: City Manager On April 8, 2014 the Policy & Services Committee discussed the City Council’s Procedures and Protocols Manual. The committee did not complete the discussion and referred the item to a future meeting. Attached is the staff report from April 8, 2015 which includes background, the manual and other relevant materials. The goal of the meeting will be to continue discussions based on the categories of protocols and procedures, meeting management, committees and staff relations. Attachments: • Attachment A: April 8, 2015 - Staff Report #5676 (PDF) • Attachment B: 04-08-15 P&S DRAFT Minutes (DOC) City of Palo Alto Page 1 City of Palo Alto (ID # 5676) Policy and Services Committee Staff Report Report Type: Agenda Items Meeting Date: 4/8/2015 Summary Title: Updates to Policies and Protocols Handbook Title: Referrals from January 31, 2015 City Council Retreat and February 17, 2015 City Council Meeting Regarding Procedural Matters, Including Updates to Procedures and Protocols Handbook From: City Manager Lead Department: City Manager Recommendation As directed by the Council, discuss referred procedural matters and recommend updates to the City Council Procedures and Protocols Handbook and other possible procedural modifications. Background On January 31, 2015, the City Council discussed updates to the Council’s procedures and protocols and referred certain elements to the Policy & Services Committee. On February 17, 2015 the City Council held another meeting focused specifically on procedures and protocols, meeting management, committees and staff relations. At this meeting certain ideas about procedures and protocols as well as meeting management were referred to the Policy & Services Committee. Ideas about committees and staff relations were deferred to the next committee as a whole meeting. Discussion The current Procedures and Protocols Handbook (Handbook) is attached to this report. During the meeting staff will provide language reflecting possible changes, focusing first on updates that have been agreed-upon, substantially discussed, or are recommended by staff to meet legal process requirements. At the meeting, the Committee may recommend these or other language changes. In addition, the Committee may recommend changes to Council procedures not contained in the Handbook. Resource Impact Depending on the direction given, there could implications to staff time, facility and technology costs. City of Palo Alto Page 2 Policy Implications Review of the existing Procedures and Protocols Handbook is consistent with policies and programs in the Comprehensive Plan’s Governance Chapter. Environmental Review A review of the Procedures and Protocols Handbook does not constitute a project for purposes of the California Environmental Quality Act (CEQA). Attachments: • Attachment A: Notes from 2-17-15 (DOCX) • Attachment B: Council Protocols and Procedures Manual (PDF) • Attachment C: 1-31-2015 City Council Retreat Agenda (PDF) • Attachment D: 2-17-15 City Council Meeting Agenda (PDF) 1 Referral Items Items going to Policy & Services 1. Discussion of Procedures and Protocols a. Telephone participation b. Consent calendar i. Brief comments ii. Changing back to 2 votes to remove item iii. Specify dollar amount for what goes on consent iv. Consider that brief comments related to opposition to a Consent Item may be made by CC member prior to vote taken on Consent Calendar. This is already true for reason for “no votes”. v. Consider what items are appropriate for the Consent calendar. For example, should they be non-controversial items, items that are of no greater than x dollars. c. Agenda setting i. Clarifying role of Mayor, Vice Mayor and City Manager 2. Meeting management a. Meeting efficiency: In the event that a Council Member intends a motion other than the staff recommendation, provide the motion to the City Clerk via digital means. This will alleviate the staff having to transcribe in real time and save time in deciphering and editing by the author. Holman b. Meeting efficiency, transparency, balanced information: Staff reports to offer options that are available to the Council (Board/Commission). This will save time exploring and crafting motions by Council members. Holman c. Meeting efficiency, public participation: Make every effort to keep us on schedule, commit to hearing the public who have come to speak to an item in the timeframe that the item was noticed. If this cannot be accomplished due to an especially complex item on the same agenda, make best effort to inform the public their item will not be heard. The mayor will remind Council of this during the meeting. Holman d. Set a hard ending time for Council sessions at 11pm and plan accordingly. Exceptions only under extreme circumstances. Schmid e. When Council time estimates call for it, limit Council times for questions (pre-Council written questions should cover most of key issues) Schmid f. Give Chair more discretion to limit Council comment time Schmid g. Give Council periodic agenda item to make comments on Council agenda priorities Schmid h. Greater use of “committee as a whole” meetings of the CC to have less formal and deeper discussions of given high level topics. These would be similar to Study Sessions, but involve more informal dialogue among CC members, similar to how the annual CC retreat functions. Burt 2 Referral Items i. Consider adding language that defines use of/gives clarity to use of “committee of the whole” such as procedures, study sessions, policy direction, dissemination of a wide range of topics not otherwise agendized, etc. Holman j. We should challenge ourselves to a Council meeting "moonshot" with the goal of keeping council meetings to 3 hours. This will require saving time on nearly all aspects of meetings; DuBois i. Staff reports - limit to 15% of allocated time, be concise and focus on new info not in report, ii. Public comment - recognize people that make a point, poll the audience for agreement, and then ask that only NEW points be made iii. Consider a "chess clock" style of time keeping - all council members have a suggested 40 minutes for Q&A/Motions per meeting to be split among items as they desire. Start as a recommendation, allowing people to exceed time limit it, but track and report it to encourage self-regulation. iv. Try to change culture so that everyone doesn't feel need to speak on every item. v. Use electronic devices to send motion to clerk to save time dictating/editing. vi. Specify sub-times in large agenda items and study sessions, x% for presentation, y% for Q&A k. Time and topic management Kniss l. Breaks…to take or not to take. Kniss m. Public Comment - Better time to take, than at the start of the meeting? Kniss n. I have three suggestions with the goals of improving efficiency of City Council meetings, saving time; saving money (for staff and consultant time); and encouraging civic participation. Wohbach i. Schedule of Council meetings Change regular Council meetings to the first and third Mondays of each month, with the second and fourth Mondays reserved as "overflow" in case of unfinished business from the regular meetings. This adds an incentive to be concise and keep meetings on schedule (to avoid extra meetings), and saves time for all involved. Also, unfinished items would be picked up again in a week at a short meeting, rather than disappearing into the ether. ii. Digital timers Add two digital timers to the presentation wall (facing Hamilton Ave) in Council Chambers. Start the first timer (at zero, counting up) at the start of each agenda item. Start the second timer (at zero, counting up) when each person begins a comment. Apply to council members, staff, and public, whether or not there is a time limit to their comments. This would serve as a subtle, constant, and public reminder to be concise. iii. Utilizing written record and technology; avoiding reading aloud at meetings Staff reports, updates, slide presentations, and resolutions should be made available digitally and in print in advance of (and following) meetings and 3 Referral Items entered into the official record without generally needing to be read aloud during a meeting. Where possible, this should apply to other city meetings (committee, commission, and public outreach) as well. Verbal comments should add valuable content, rather than simply voicing an already written document. Items going to Committee as a Whole 1. Committees Discussion a. Discuss formation of Comprehensive Plan Committee and Health City, Health Community Committee b. Increasing authority of existing City-School Committee 2. Discussion of Core Values 3. Staff Relations a. Holman - Council to set policy by prioritizing projects/directives for the staff based on a work plan provided by the various CAO's. Prioritization to be based on timeliness, urgency, desire, nearing completion, staffing, etc. i. Reason: It should not be a pressure on staff to decide/guess what they should be working on among a long list of projects especially as prioritization is a policy decision. b. Holman - Direct staff to bring to Council those issues/trends emerging and otherwise that present policy questions that are best discussed and decided after public vetting of the issue. Issues should be brought forward in a timely manner and as soon as is practicable, individually or collectively whichever is the more timely. There might also be issues that staff wants to/should make Council aware of such as the lot combinations that currently appear to be taking place on California Avenue. Examples include: i. loss of retail/services uses converting to general office ii. basement space converting from traditional retail support use to general office (leads to changed office population, parking/traffic concerns, etc) iii. increased office occupancy density beyond what is considered in code (4 per thousand) iv. parking considerations that may need reconsideration from a policy perspective (mixed use) v. demolition of historic homes whereby the owner has circumvented Individual Review (CEQA) by proposing a single story home and then sells to another owner who then proposed a two story home. c. Burt - Proactive senior staff level participation in identification of community trends that may need CC policy reconsideration prior to accumulated severe impacts and consequent crisis management. Page 1 April 08, 2015 Policy and Services Committee DRAFT MINUTES Special Meeting Wednesday, April 8, 2015 Chairperson Burt called the meeting to order at 7:03 P.M. in the Council Chambers, 250 Hamilton Avenue, Palo Alto, California. Present: Berman, Burt (Chair) DuBois, Wolbach Absent: Oral Communications None Agenda Items 1. Referrals from January 31, 2015 City Council Retreat and February 17, 2015 City Council Meeting Regarding Procedural Matters, Including Updates to Procedures and Protocols Handbook. Khashayar Alaee, Senior Management Analyst, reported Attachment A of the report was a list of items that the Council referred to the Policy and Services Committee (Committee). The information contained in the at-places memorandum was included in the Staff Report, because it did not pertain to the Procedures and Protocols Handbook (Handbook). James Keene, City Manager, noted the background information of the Staff Report summarized information discussed by the Council. The Committee could discuss other issues within those areas. Chair Burt suggested the Committee's meeting would be informal. In past meetings to revise the Handbook, the Committee provided its input through consensus. The City Clerk captured the Committee's actions for a formal referral of items to the Council. Beth Minor, Acting City Clerk, concurred. She would provide a draft for approval. Chair Burt was struggling with a method to act on meeting management items if they were not part of procedures and protocols. He viewed meeting management as a major subsection of procedures and protocols. He questioned whether the Committee should discuss items referred to the Page 2 April 08, 2015 Committee of a Whole in order to assist the future meeting of the Committee of a Whole. Topics contained in the at-places memorandum were not necessarily aspects of procedures or protocols. He suggested the Committee begin with comments regarding major areas. The Committee could then discuss items in the order they were listed in Attachment A. He wanted to review the Handbook for items not referred to the Committee, because many topics in the Handbook were not clear or did not reflect current practice. Council Member DuBois preferred to review the Handbook page-by-page so that Committee Members did not repeat themselves. Council Member Berman agreed with utilizing either format. Council Member Wolbach suggested the Committee review the at-places memorandum and the Staff Report, followed by review of Handbook items that Committee Members identified as needing work. Chair Burt indicated that was similar to the high level discussion he suggested. As the Committee reached consensus on topics, then it could review the Handbook page-by-page, discussing where items could be placed in the Handbook and identifying other items for discussion. Mr. Keene did not believe the Committee had sufficient time to cover all topics it wished to discuss. If there was not a context problem, the Committee could make recommendations to the Council in groups. Staff could incorporate formal changes into the document and present that to the Committee for review, at which time the Committee could identify other topics from the Handbook for discussion. Chair Burt historically construed procedures as similar to rules and protocols as similar to guidelines. Some Council Members did not agree with his interpretation. He requested the City Attorney comment on similarities and differences between procedures and protocols. Molly Stump, City Attorney, explained that the document described itself as a handbook. Those terms did not suggest legally binding, detailed requirements. The first document tended to be more rule-based and specific. The second was issues of tone and expectation and more aspirational with respect to behavior. Chair Burt indicated that was a description. Mr. Keene questioned whether the evolution of the documents was linear. The order of policies and procedures was inverted. Page 3 April 08, 2015 Chair Burt noted the first section was named procedures, and the second protocols. The Council had been interchanging the terms, when they were originally intended to have different meanings. Ms. Stump advised that the Council making rules for conducting its business could be useful in terms of organizing expectations and communicating with the public. The Council was the supreme authority for governing the City of Palo Alto, and it was in charge of the way it conducted business. At any given point, the Council retained the authority to modify the policies, procedures, or protocols by a majority vote. Mr. Keene added that the Council could make modifications on the spot. Ms. Stump clarified that one exception was the involvement of third-party rights. Most of the rules pertained to the Council conducting its business and working with Staff. Chair Burt did not believe the Council could modify its rules when the procedure was also contained within the Municipal Code. Ms. Stump agreed that the Council did not have discretion to change its rules as a matter of Resolution or Motion. Chair Burt suggested Committee Members consider modifications as a self- imposed rule or a guideline. He began the discussion with regards to telephone participation. He related his recollection of the reason for the Council implementing the policy for telephone participation. He questioned whether the rule was too restrictive and whether Committee Members wished to change it. Council Member Wolbach requested the City Attorney frame the discussion in the context of the Brown Act. Ms. Stump reported the series of bullet points at the top of Page 7 described legal requirements. The Council could not reduce those items. The Council had to be in an area accessible to the public; post notice of a meeting in advance; and allow admittance without a fee. Council Member Berman believed a Council Member should be allowed to participate in meetings via telephone on a limited basis. Perhaps Council Members could be restricted to participating by telephone in only three meetings per year. The current wording of the policy did not allow a Council Member to fulfill the requirements of the policy and the Brown Act. The procedure allowed Council Members to participate by telephone only in cases of emergency; yet, the Brown Act required notice be posted 72 hours in Page 4 April 08, 2015 advance. Emergencies typically were not known 72 hours prior to their occurrence. Chair Burt read Procedure 2.4B. Council Member Berman inquired about rules for telephone participation in other cities. Council Member Wolbach emphasized a contradiction between Procedure 2.4B, participation only in the case of an emergency, and Approved Teleconference Guidelines for Council Members, participation with a week's notice. Again, emergencies typically were not known in advance. He suggested one of the statements be deleted. Chair Burt suggested Committee Members determine the terms of any requirements for telephonic participation prior to determining the wording of any language. Council Member DuBois concurred with allowing telephonic participation but limiting the number of times it could occur. He asked if posting a notice at the remote location 72 hours in advance was a requirement. Ms. Stump believed it was, but she would confirm that. Council Member DuBois suggested limiting telephonic participation to one time per quarter with notice as required. He understood another issue was whether the rule should be different for Closed and Open Sessions. Ms. Stump did not believe the one week notice was required by the Brown Act. However, the City Clerk needed to ensure notice was properly sent to and posted at the remote location and that phones were available in both locations. The one week notice allowed Staff to support a Council Member's telephonic participation. Council Member DuBois inquired about the use of Skype or other means of videoconference. Perhaps that section should clarify the technologies that could be utilized. Mr. Keene noted the Teleconference Guidelines precluded the use of cellular telephones. Ms. Stump advised that the use of cellular telephones was lawful; however, the cellular telephones had to provide a speaker function. The Brown Act required public access to and public comment at the Council meeting and the remote location. Page 5 April 08, 2015 Chair Burt referred to the Brown Act requirement to post a notice at the remote location 72 hours in advance, and inquired about the length of time the City Clerk would need to accommodate telephonic participation. Ms. Minor would need one to two days to post notice on the website and to provide notice to the remote location. Chair Burt calculated the notice would need to be posted Thursday for a Monday meeting in order to meet the Brown Act requirement. Mr. Keene clarified notice would have to be posted Friday evening for a Monday meeting. Chair Burt asked if five calendar days would allow the City Clerk sufficient time. Ms. Minor answered yes. She would have to prepare and notice a revised Agenda for telephonic participation. Mr. Keene suggested the City Clerk could include information in the packet released on Thursday if she received notice on Wednesday. Chair Burt suggested Committee Members consider the different aspects of Closed and Open Sessions. Telephonic participation was less disruptive in a Closed Session. He questioned whether the rule should allow a Council Member to participate telephonically only in a matter of critical importance to the Council Member. Council Member DuBois referred to Skype's chat function whereby a Council Member could signal the City Clerk that he wished to speak. That ability could be less disruptive for Open Sessions. Chair Burt asked if Council Member DuBois was referring to the audio only function of Skype. Council Member DuBois indicated either the audio or the video function of Skype. The chat function would allow the Council Member to indicate his wish to speak. Chair Burt felt the video would be more disruptive; whereas, the chat function could be less disruptive. That would not have to be addressed in protocols. Council Member DuBois concurred. Page 6 April 08, 2015 Council Member Wolbach clarified that the chat function provided a text notification rather than a verbal notification. He asked if the City Clerk was legally required to fax or mail notification to the remote location. Ms. Stump replied no. Notice had to be provided to and posted at the location. Council Member Wolbach suggested Committee Members also consider telephonic participation and notification thereof for Council Committee meetings and Special Meetings. Council Member Berman requested Staff review and update all policies and procedures for the ability to use new technologies. Mr. Keene remarked that allowing Council Members to participate by phone three times a year would result in 27 absences. Potentially the full Council would not be present for two meetings per month. Telephonic participation was disruptive. The Committee could consider the role or outcome for which the Committee would allow telephonic participation. One, a Council Member could want to vote on a particular issue. Two, a Council Member could want to speak on and influence a particular issue. Third, a Council Member wished to ensure his comments were made in the meeting. Currently, a Council Member could provide his comments in writing to the Council for public information. The Committee could determine the objective in order to structure other limitations. Perhaps the Committee wished to restrict the number of Council Members who could participate telephonically in a meeting. Chair Burt felt the number of Council Members wishing to participate telephonically in order to influence outcomes through their vote would escalate. That would quickly become problematic. He cautioned against loosening restrictions too much. He inquired whether Committee Members agreed to a Council Member providing notice of telephonic participation five calendar days in advance of the meeting. He inquired whether Committee Members wished to consider more liberal language allowing telephonic participation in Closed Sessions. Council Member DuBois advised that the remote location would need to be closed and private for participation in a Closed Session. Chair Burt indicated the language could state that requirement. Council Member DuBois did not see a need to distinguish between Closed and Open Sessions. Page 7 April 08, 2015 Council Member Wolbach asked if the 72-hour notice required by the Brown Act applied to a Closed Session. Ms. Stump explained that the remote location would have to convene in the open, allow public attendance and comment, and then move to a Closed Session. The remote location would then need to be secure and private, as required by law. Council Member DuBois inquired whether the remote location would have to convene with the Council in open session for the vote to move to a closed session and then move to a closed session. Ms. Stump responded yes. A Closed Session for the remote location would be handled in the same manner as the Council meeting. Council Member Wolbach suggested any language for telephonic participation in a Closed Session require and enforce security of a remote location. Chair Burt stated the Handbook was not an enforcement tool. He inquired whether the Committee wanted the same or different guidelines for Closed and Open Sessions. Council Member Berman preferred to determine guidelines for telephonic participation in an Open Session first. Telephonic participation in Closed Sessions should not be unlimited. Council Member DuBois suggested retaining language to discourage Council Members from participating telephonically. Procedure 2.4B could be revised to "emergencies once every three months." Council Member Wolbach wanted to allow a Council Member who was cogent but hospitalized for an extended period to participate telephonically, even if the Council Member exceeded a limit of once every three months. He asked if the Committee could discourage without prohibiting actions. Chair Burt suggested the Committee could weaken or retain "actively discourage." "Shall only" was prescriptive. "Extraordinary events" without "emergency" would mean events that were not routine. Council Member DuBois wanted to allow one telephonic appearance per quarter even though the circumstances were not extraordinary. Chair Burt understood the question then became whether infrequent remote participation should be based upon the circumstance or the frequency. Page 8 April 08, 2015 Council Member Wolbach offered language of "once a quarter except in extraordinary events such as medical, family, or emergencies requiring an absence." If a Council Member was out of the City for good reason, he could participate telephonically. Chair Burt asked if the Committee would agree to language of "not more than once a quarter except in these extraordinary circumstances." Council Member DuBois wished to retain the requirement for the presence of a quorum in the Council Chambers. Chair Burt agreed. Council Member DuBois was concerned that Chair Burt did not discuss the first sentence. Chair Burt attempted to frame a high-level question of whether the Committee would agree to a proposal of "not more than once a quarter except in these extraordinary family or medical emergencies." Council Member Berman accepted that language. Council Member Wolbach concurred as well. He reiterated his concern of actively discouraging without prohibiting telephonic participation. Chair Burt advised the Committee could retain the language of "actively discourage." Council Member Wolbach was attempting to imagine ways to implement that. Discouraging an action without prohibiting it was tricky. Chair Burt stated that applied to almost all Council policies and procedures. The procedures were largely self-enforced with the Mayor having lead responsibility to inquire about significant breaches of procedures and protocols. Mr. Keene understood the Committee wished to allow Council Members one telephonic appearance per quarter or four per year. The Committee was attempting to craft language that provided extraordinary situations under which Council Members could exceed four telephonic appearances per year. The Committee was attempting to accommodate the Council and continue Council cohesion. The Committee could suggest a provision that allowed a Council Member facing an extraordinary family situation to petition the Council for an exception to the policy. If the family situation was extraordinary, it would be unusual for a Council Member to consider attending a Council meeting as more important than being with the family Page 9 April 08, 2015 member. If a Council Member was hospitalized for an extended period, the Council could allow an exception. Chair Burt advised that Council Members could participate telephonically 36 times per year plus an unspecified number of times for emergency situations in that scenario. That could be quite a few telephonic appearances per year. The Committee should consider the ramifications of any proposed language. Council Member Berman would support allowing one telephonic appearance every six months along with appearances under extraordinary circumstances. Chair Burt felt that would be a cautious change. Council Member Wolbach was not opposed to remote attendance at meetings through a teleconferencing service, provided the participant utilized a chat function to request an opportunity to speak. He would support telephonic participation either two or four times per year. Council Member DuBois preferred an allowance of one telephone appearance per quarter with an exception for an emergency situation. He did not believe Council Members would utilize the maximum number of telephonic appearances given the language of "actively discourage." Chair Burt noted the proposals were one telephonic appearance per quarter plus emergency situations; one telephonic appearance per quarter with Council Members petitioning for telephonic appearance in emergency situations; and one telephonic appearance every six months with Council Members petitioning for telephonic appearance in emergency situations. He recommended a modest rather than significant liberalization of the provision. Council Member DuBois suggested liberalizing telephone appearances for the Council before doing the same for Boards and Commissions. Chair Burt agreed. The Committee had not requested input from Boards and Commissions. He did not believe the Committee had reached consensus. He recalled that Council Members had participated telephonically, but not according to Procedure 2.4B. He did not recall Council Members appearing telephonically due to a family health emergency. He did not believe Council Members would utilize Procedure 2.4B often. He would agree to either two or four telephonic appearances per year for situations other than an emergency; an allowance for emergency situations; and a provision to ensure Council Members did not breach the exception for emergency situations. He did not wish to exclude a Council Member who was physically incapacitated and unable to sit on the dais. Page 10 April 08, 2015 Council Member DuBois asked if the hospitalized Council Member would need to move to a public place to hold the teleconference. Chair Burt reported the hospitalized Council Member would need to have the door open. He inquired whether the Committee would agree to whatever number of occurrences in non-emergency situations and retain the emergency provision. Council Member Wolbach suggested striking "similar" from ”a medical, family or similar emergency." Chair Burt wanted to retain "similar" as it provided some latitude. Mr. Keene inquired whether the Committee wished to strike "emergency" as it conflicted with the five-day rule. Perhaps the language could be "similar event." Chair Burt concurred with "similar event" rather than "similar emergency". He asked if the Committee wished to retain the remainder of the sentence. Council Member Wolbach replied yes. Chair Burt requested preferences for two or four telephonic appearances per year. Council Member Wolbach suggested three per year. Council Member Berman agreed. Council Member DuBois asked if three telephonic appearances meant three times per year or one time every four months. Chair Burt responded three times per year at the Council Members discretion. Council Member DuBois asked if the City Attorney would review the five Brown Act clauses. Chair Burt advised that the City Attorney would review appropriate legal questions. He asked if the Committee wished to treat Open and Closed Sessions differently. Council Member Berman felt the provision for three telephonic appearances should pertain to both Open and Closed Sessions. Page 11 April 08, 2015 Chair Burt agreed. The provision did not allow three telephonic appearances for Closed Sessions and three more for Open Sessions. He inquired about an existing policy for telephonic appearances by Boards and Commissions. Ms. Stump reported most City Boards and Commissions had internal guidelines or rules. She did not know if those guidelines addressed telephonic participation, but they could. Council Member DuBois suggested the language for telephonic participation three times per year apply to Council Members only such that the remaining language would be retained. Council Member Wolbach concurred. Chair Burt reiterated that all provisions, except three telephonic appearances, would apply to Boards and Commissions. Mr. Keene asked if the Committee wished to revise the language regarding cellular telephones to allow use of cellular telephones in speaker mode only. Council Member Burt responded yes. Council Member Wolbach reiterated the request for Staff to recommend revisions to include modern technologies as well as legal questions. Chair Burt noted a number of possible changes to the Consent Calendar. Some of those changes individually had some merit. In the aggregate, they could compound issues of meeting management. Council Member Wolbach believed removal of Individual Review (IR) items required four votes as stated in Ordinances. Procedure 2.4H lacked clarity. Chair Burt would add those topics to the list for discussion. Council Member DuBois suggested two items were essentially duplicates. Perhaps the Committee could choose one as the highest priority and discuss it first. Chair Burt inquired whether Consent Calendar procedures could be found elsewhere in the Handbook. Ms. Stump felt the rules could be better organized. She would review the Handbook for other references to the Consent Calendar. Chair Burt suggested the Committee organize topics in the Handbook at a future time. He requested comments regarding Consent Calendar items prior to consideration of the impact on meeting management. The existing Page 12 April 08, 2015 policy allowed Council Members to speak briefly to no votes only. Council Members could not ask clarifying questions. The alternative was the Council debating each item placed on the Consent Calendar, which defeated the purpose of placing items on the Consent Calendar. Council Member Berman would not support allowing Council Members to address Consent Calendar items orally. Council Members could ask questions, receive responses, and submit comments in writing prior to the meeting. Council Member DuBois agreed. Council Members could ask questions regarding Consent Calendar items prior to the meeting. Council Member Wolbach felt Council Members should be allowed to address items briefly. At times, Council Members voted no or abstained simply to address items. He suggested the language include "actively discourage." Chair Burt noticed Council Members recently had taken to voting no in order to address an item on the Consent Calendar. The "actively discourage" language could be included. He suggested delaying further discussion of Consent Calendar items. Council Member Berman suggested limiting the number of items Council Members could address and the length of Council Member comments. Council Members could speak for 30 or 60 seconds. Mr. Keene wanted to provide potential implications when the discussion of Consent Calendar items continued. Perhaps the Committee wished to state explicitly the problem it was attempting to solve or the improvement it hoped to achieve. Chair Burt recommended the Committee contemplate whether allowing an occasional comment of limited duration would result in fewer items removed from the Consent Calendar. Mr. Keene commented that brief comments could be advantageous or disadvantageous. Chair Burt noted the previous Council policy required only two votes to remove an item from the Consent Calendar, which was recently changed to three votes. Council Member DuBois referred to the five categories of Consent Calendar items, which did not contain appeals. The Committee could consider whether to allow a hearing of appeals. He asked under which category an appeal would fall. Page 13 April 08, 2015 Ms. Stump reported the rules could be found in different sections of the Zoning Code depending upon the type of appeal. The Committee could consider changes to those procedures; however, some of those changes might require Ordinances. Council Member DuBois suggested the Committee consider applying changes to certain categories of Consent Calendar items. Chair Burt requested initial comments regarding requiring two votes to remove an item from the Consent Calendar. Council Member Berman would possibly support two votes for certain categories. Overall, he preferred to retain three votes. Currently three Council Members could discuss items outside a meeting without violating the Brown Act in order to obtain a sense of the support for removing an item. Council Member Wolbach was inclined to require three votes universally. No item should require more than three votes for removal. There was no need to reduce the number votes to two, if the Council allowed brief comments from Council Members. Chair Burt inquired whether an IR would fall under Category 4. Ms. Stump answered yes. To the best of her recollection, it was the only Consent Calendar item that required four votes for removal. An IR was adopted as part of the carefully calibrated system that allowed some outlet for IR but set a high threshold for small projects of single family homes. Any change would follow the process for adoption of an Ordinance. Chair Burt advised that a Committee recommendation to change the vote for IR would need to be handled separately from policies and procedures. He requested comments regarding changing the threshold vote to three. Council Member Berman needed to understand reasons for initially setting the vote at four prior to discussing changing the number. Council Member DuBois referred to the concept of reducing the threshold to three if the appellant demonstrated a certain amount of support from people other than co-appellants. Council Member Wolbach felt the combination of requiring four votes and notification to the City Manager encouraged Council Members to communicate. Requiring four votes increased the chance of Council Members violating the Brown Act. He would support changing the notification process, allowing Council Member comment, changing the vote threshold, or a combination of those. Page 14 April 08, 2015 Chair Burt noted the Committee would discuss changes to the notification provided to the City Manager. Changing the notification to the City Manager had a broader impact than just the IR. Council Member DuBois would support changing the vote threshold to three; however, he had no strong feelings either way. Chair Burt advised the Committee would review a draft of changes at a future meeting, and suggested the vote threshold for an IR be continued to that meeting. Council Member Berman asked if the Committee reached consensus on lowering the removal threshold from three to two votes. Chair Burt answered no. He wanted one round of comment to gauge the Committee's consensus. Next, he would review the topics in aggregate. Currently the procedures allowed Council Members to comment after a no vote on a Consent Calendar item, but not before the vote. Council Members were given three minutes to comment on a no vote. He asked if the Committee wanted to allow comments before a vote or retain the current procedure. Mr. Keene explained that the current procedure allowed Council Members to clarify their no vote. If Council Members commented beforehand, they could influence the vote. Council Member Berman wanted to retain the current procedure. Mr. Keene believed the reason for the Consent Calendar was to allow the Council to read information and to vote on items quickly. If Council Members expressed concern about an Item, then they could remove an item from the Consent Calendar rather than influencing other Council Members prior to voting. Allowing a Council Member to comment prior to the vote was a de facto removal of the item. Chair Burt could be influenced by the Committee's response to Item 1, Section B Sub-section V: Consider what items are appropriate for the Consent calendar. For example, should they be non-controversial items, items that are of no greater than x dollars. He suggested setting aside Council Member comments before or after a vote to discuss items to be placed on the Consent Calendar. He seemed to recall additional information about the types of items to be placed on the Consent Calendar. Some items were removed from the Consent Calendar, because the City Manager or the Mayor recognized that those items were contentious. If a Council Committee vote was unanimous, the Council Committee's recommendation was placed on the Consent Calendar to aid the efficiency of Council Page 15 April 08, 2015 meetings. In a recent Finance Committee meeting, one Council Member advocated strongly for a unanimous vote in order to avoid a Council discussion. The Committee could consider language regarding unanimous votes from Council Committees being placed on the Consent Calendar but not for political purposes. Council Member Berman asked if the intent was to place items on the Consent Calendar or the motivation to place items on the Consent Calendar. Chair Burt stated it was the motivation to place an item on the Consent Calendar in order to achieve a political purpose. Council Member Berman felt that was appropriate. In 2014, the Finance Committee recommended an item with a unanimous vote be placed on the Action Agenda in order to obtain Council input. Chair Burt indicated that was the appropriate deference to the Council. Council Member DuBois noted that each member of a Council Committee should realize the purpose and not vote for political reasons. Chair Burt advised that the lack of a protocol prevented a Council Member from protesting. He inquired whether the Committee could agree to include that language. Council Member Wolbach replied yes. He suggested placing the language at the end. Council Member DuBois was interested in the concept of a dollar amount threshold for Consent Calendar items. He asked if the Council had a fiduciary responsibility to discuss an item involving funding over a specific amount. Ms. Stump responded not currently. Many very large items were routine. Council Member DuBois remarked that the public could become upset when the Council did not discuss large funding amounts such that the item became controversial. Chair Burt explained that some large amounts did not involve discretionary decisions, while some smaller amounts reflected discretionary or value decisions. That was the distinction for utilizing a threshold dollar amount. The dollar amount was not an effective trigger. Page 16 April 08, 2015 Council Member Berman agreed. Perhaps some trigger other than a dollar amount would be appropriate. Using a dollar amount would capture too many items that were not appropriate for Council discussion. Council Member Wolbach advised that placing an item on the Consent Calendar did not avoid public scrutiny or disclosure. Removing an item from the Consent Calendar was more important. He did not believe there was a need to restrict items placed on the Consent Calendar. Chair Burt suggested the Committee might want to review guidance for noncontroversial Consent Calendar items. Mr. Keene reported the largest expenditures often were the simplest. Smaller expenditures could have policy implications. Items were placed on the Consent Calendar, because other drivers determined they should be placed there. Other tests were utilized to manage Consent Calendar Items. More often than not, the largest expenditures occurred in Capital Improvement Program (CIP) projects that had been vetted and approved. Staff could better articulate that items had been subjected to different levels of Council review. Matters that signified policy change or the need for policy change were difficult to administer. Chair Burt referred to the requirement to notify the City Manager of interest in removing an item from the Consent Calendar. Council Member Wolbach noted the requirement was contained in Procedure 2.4H. Mr. Keene advised that Procedure 2.4H was the existing language. In practice, Staff requested Council Members notify the City Manager the Sunday evening prior to a Monday meeting. Chair Burt indicated the practice was good and should be followed whenever possible. Use of "should" was strong language. At times, public comment during the meeting raised legitimate reasons for removing an item. Other times, Council Members did not appreciate the need to remove an item in advance of the meeting. He preferred the language be revised to "Council Members would provide advance notice whenever possible." Mr. Keene would support language that clearly signaled the intention without being prescriptive. If items were removed without prior notice, then he would have to reschedule the item to a future meeting because Staff would not be present. Removal of Consent Calendar items that were time- sensitive were relatively rare. Page 17 April 08, 2015 Chair Burt suggested adding language to provide notice to the City Manager as early as possible. He felt Procedure 2.4G was ambiguous. He had forgotten that the Mayor as Chair could remove an item from the Consent Calendar. Ms. Stump did not believe the procedure meant the Mayor could remove an item. The sentence was confusing. In practice, it could mean many things. It was not logical to take public comment regarding removal of an item after a vote approving the Consent Calendar had occurred. The Committee should clarify the two types of relevant public comment. Chair Burt inquired about the intent of the other clause. Ms. Stump would not read that to authorize the Mayor on his/her own initiative to remove an item from the Consent Calendar. Rather if a sufficient number of Council Members had indicated a desire to remove an item, then the Mayor could allow public comment when the Consent Calendar was called or defer public comment to the time the Council heard the item. Chair Burt indicated that was consistent with Council practice. He inquired whether the Committee could agree to authorize Staff to provide language reflecting the City Attorney's explanation. Council Member Wolbach requested Ms. Stump repeat her explanation. Ms. Stump advised that Staff and Council favored a generous interpretation of the rules. The Council allowed the public to comment on removal of an item. If the Council voted to remove an item, the Council allowed additional public comment when the item was rescheduled before the Council. If the item was heard the same night it was removed, then Staff would discourage additional public comment. The public had the opportunity to address the Council on the removal itself. Staff could provide language. Council Member DuBois suggested allowing an appellant who had paid the required fee be allowed to speak for ten minutes regarding the Consent Calendar item before the vote. If an item was not removed from the Consent Calendar, then the appellant was not allowed to address the item. Chair Burt reported the appellant could speak for three minutes under public comment regarding the Consent Calendar. Perhaps the appellant could have additional time to speak. Council Member Berman would support that; however, he preferred the appellant be given ten minutes to speak on behalf of a group of people, as was the current practice. Page 18 April 08, 2015 Chair Burt agreed with allowing the appellant to speak, but felt ten minutes was too much time. The appellant would address the issue of removal rather than the merits of the case. The Committee would revisit the issue slightly later in the discussion. The Committee did not revise the requirement for three votes to remove routine items from the Consent Calendar; did not institute a dollar amount for Consent Calendar items; and did not prescribe items to be placed on the Consent Calendar. He returned to the topic of allowing Council Member comments prior to the vote on the Consent Calendar. Council Member Wolbach remarked that Council Members should be allowed to express their wish to remove an item prior to the vote. Before the vote was the correct time for such comments. Restricting comments to 30 or 60 seconds and to one item was appropriate. Chair Burt reiterated that undecided topics could be discussed when Staff returned with proposed Handbook revisions. He wished to consider Council Member Wolbach's proposal further. Council Member DuBois felt some of the topics were interrelated. He could support the proposal. He asked if Council Members could speak only prior to the vote. Chair Burt replied yes. Council Member DuBois would support requiring four votes to remove an appeal from the Consent Calendar if the appellant was allowed additional time to speak. Ms. Stump reported Staff would write a clear rule that complied with current practice for public comment. A member of the public would be allowed to speak for three minutes regarding the Consent Calendar, unless the Mayor reduced the time allowed for public comment. Council Member DuBois wished to allow the appellant additional time to speak. Chair Burt added if the appellant had paid for the appeal. Mr. Keene reiterated that revisions to the Handbook would be presented to the Committee for discussion. The IR and appeal questions had other aspects of change that were under consideration in various ways. The Committee's recommendation should be when the Council discussed the issue of amendments or changes to the process, then the Committee recommended thus and such, unless the Committee felt it could be done out of context. Page 19 April 08, 2015 Chair Burt felt the number of minutes provided an appellant could be out of context. Mr. Keene meant that the process was different to amend the Zoning Ordinance. Ms. Stump advised the Committee could not change the Zoning Ordinance by adopting a Resolution changing the procedures, if the Zoning Ordinance required four votes. Chair Burt concurred. The Committee was discussing the length of time an appellant could speak if he had paid the appeal fee and the appeal was on the Consent Calendar. Ms. Stump was almost certain the Zoning Ordinance did not specify speaking time limits. Council Member Wolbach asked if an appeal being placed on the Consent Calendar meant the Planning Director had found against the appellant and in favor of the applicant. Ms. Stump explained that the Planning Director made a decision on a recommendation, and the decision was final unless an appeal was filed. The Planning Director did not make a decision on the appeal. Council Member Wolbach suggested the Committee recommend additional time for the applicant to speak if the appellant was granted additional time. Chair Burt disagreed in that the proposal was to allow the appellant additional time to speak for removal of an appeal from the Consent Calendar. Council Member Wolbach withdrew his suggestion. Chair Burt asked if Committee Members agreed to allow the appellant to speak for five minutes regarding a Consent Calendar item. He noted the remaining topic for the Consent Calendar was allowing Council Members to speak briefly to a single item prior to voting on the Consent Calendar. Council Members would not be allowed to speak both before and after the vote. Council Member Wolbach suggested continuing the topic to the next meeting. Chair Burt would continue to the topic if the Committee could not reach consensus. Page 20 April 08, 2015 Council Member DuBois favored Council Members speaking to one item for 60 seconds. Council Member Berman could support a trial period for the proposal. Chair Burt requested additional time to consider the topic and suggested the topic be continued. Ms. Stump requested clarification that for all land use appeals the appellant would be allowed five minutes to speak while the applicant would be allowed the customary three minutes. She asked if the Committee wished to revisit the voting threshold for removing an IR. Chair Burt advised the voting threshold for an IR was continued. The topic of Council Members addressing Consent Calendar items prior to the vote was continued. Council Member DuBois inquired about the Committee's recommendation for noncontroversial items being placed on the Consent Calendar. Chair Burt asked if the Committee wanted language reflecting that Consent Calendar items not have significant controversy. Mr. Keene offered language of "every attempt should be made not to place controversial items on the Consent Calendar." Chair Burt added that the Mayor and City Manager at their discretion should attempt not to place controversial items on the Consent Calendar." Council Member DuBois asked if the language should be qualified with the idea that it was related to policy. Chair Burt believed that language was a bit narrow. Council Member DuBois noted the Committee had not considered agenda setting. Chair Burt asked if the guidance for agenda setting could be found in the Municipal Code or in the Handbook. Ms. Stump would check. Council Member Berman indicated guidance could be found in Protocol 3.7. Ms. Stump explained that Protocol 3.7 did not pertain to placement of items on the agenda, but the order of items. Page 21 April 08, 2015 Chair Burt noted Protocol 3.7 provided three purposes of the pre-Council meeting. He construed future meetings to mean future agendas. In his experience, the City Manager would determine agenda items that would accomplish efficient working of the government or fulfill prior Council direction. The Mayor or Vice Mayor would occasionally offer input or recommendations or request an item be scheduled at a certain time. Ms. Stump reported the City Manager's role was slightly broader than described by Chair Burt. The City Manager was responsible for presenting agenda items to which the operations of the City called the Council's attention. Chair Burt clarified that he referred to the operations in the first category. Ms. Stump added the operations were slightly broader than routine. The City Manager identified items that warranted and called for the Council's guidance. Most agenda items were initiated by the City Manager through his Staff. Mr. Keene advised that many items had other proscriptions from the Council or in the City Charter. He did not have discretion for bringing forward many operation items. He presented items to the Council that the Council may not have known about, but he believed they were important or a policy decision was needed. Chair Burt heard a description of how the City functioned and the dynamic of the Council running the City's business. He did not hear a question of whether change was needed, but whether the Council wanted language that more clearly described the reality. Council Member Wolbach was interested in hearing the Vice Mayor's role in the process. Chair Burt was surprised that the Protocol did not distinguish the role of the Mayor and Vice Mayor. The Council gave the Mayor authorities. The Vice Mayor was present in case the Mayor was not. A second question was whether the Protocol adequately described the dynamic between the City Manager and the Council's representative(s) and correctly described the roles of the Mayor and Vice Mayor. Mr. Keene believed that, in practice, the Mayor was clearly the lead. The Vice Mayor did not and should not share the Mayor's role of making decisions. The Protocol adequately described the purposes. The Mayor was a single member of the Council. Other procedures indicated Staff did not take individual direction from an individual Council Member. The Protocol should be reconciled with current practice. Page 22 April 08, 2015 Chair Burt asked if the Committee wanted to clarify the Mayor's obligation to reflect the interests of the Council as a whole in the agenda setting. That language was broad and discretionary, but it provided a context for the expectation. Council Member Berman indicated the Mayor's role was similar to a Council liaison role. Mr. Keene suggested language that referenced the fact that Staff worked on behalf of the full Council, not on behalf of the City Manager. Chair Burt offered language clarifying the fact that the Mayor represented the Council and the Vice Mayor could confer but did not have the Mayor's authority. Second, the Mayor should make his best efforts to reflect the interests of the Council as a whole. Council Member Wolbach asked what would happen if the City Manager felt an item needed to be on the agenda soon and the Mayor and Vice Mayor disagreed. That was the type of clarification the Committee was considering. Mr. Keene advised that many issues required conversation. Specific language made it easier for the City Manager to insist on setting an item on the agenda. Chair Burt added that Council Members could agendize items. Council Member Wolbach suggested clarifying the roles such as "either the City Manager or the Mayor had the power to place an item on the agenda. The role of the Vice Mayor was advisor." Chair Burt inquired whether that language would be problematic. Mr. Keene believed the language did not coincide with the City Charter. The Mayor as a single Council Member could not place items directly on the agenda. In practice, the Mayor attempted to influence the City Manager to place items on the agenda. Council Member Wolbach asked if the Mayor guided while the Vice Mayor advised. Chair Burt recalled that two Council Members could agendize items through Council Comments and a Colleague's Memorandum. The current City Manager worked to respect and accommodate the interests of the Council as reflected through the Mayor. Council Member DuBois requested clarification of the Vice Mayor's role. Page 23 April 08, 2015 Ms. Stump reported the Vice Mayor's role, according to the City Charter, was to attend meetings in the absence of the Mayor. The Vice Mayor attended the pre-Council meeting as training. Council Member DuBois asked if any Vice Mayor had dominated the pre- Council meeting. Mr. Keene responded no. Vice Mayors usually deferred to the Mayor. Ms. Stump remarked that the Mayor often requested the Vice Mayor's assistance with tasks during the pre-Council meeting. Chair Burt stated Protocol 3.7 did not reflect that activity. Mr. Keene did not recall an overt disagreement between the Mayor and the Vice Mayor at a pre-Council meeting. Chair Burt restated the three questions before the Committee. He did not believe additional language was needed to clarify the relationship between the Mayor and City Manager. Council Member Wolbach felt the purposes of the Handbook were public facing and education for new Council Members. Chair Burt asked if Council Member Wolbach wished to propose language. Council Member Wolbach suggested Staff prepare draft language for the roles of City Manager, Mayor, and Vice Mayor during agenda setting. Language could be similar to "the City Manager made decisions with the advice and guidance of the Mayor and additional input from the Vice Mayor with all three considering the needs of the City and the full Council." Chair Burt understood the Committee wanted language that reflected the respective roles of the City Manager and the Mayor, and the limited role of the Vice Mayor clarified in the agenda setting process. The Mayor's role was to reflect the interests of the full Council. He noted the Council had begun providing the City Clerk with Motions via electronic means, but he did not want the language to be prescriptive. He recommended "encouraging to the extent feasible" Council Members to provide Motions via electronic means. The language presumed the Council Member had drafted language in advance of the meeting or early in the meeting. Council Member DuBois suggested new technologies could transmit proposed Motions more quickly. Page 24 April 08, 2015 Chair Burt noted some people were more comfortable verbalizing language rather than writing it. Mr. Keene felt the mechanics of providing Motions was worthy of discussion. Dumb terminals were provided on the dais in order to manage the concern and public perception regarding Council Member communications that was not part of the public record. If Council Members were typing during the meeting, the public could question whether Council Members were communicating privately. Chair Burt did not believe Council policies prohibited electronic and handwritten communications. Ms. Stump reported many cities did have such a prohibition. It was not illegal to have substantive communications addressing the item and policy, except if the communication created a Brown Act violation within the meeting. Many, many people felt private communications during a meeting were fundamentally inappropriate. Many cities adopted rules that banned the practice. Chair Burt remarked that no language would circumvent the public perception that use of electronic devices implied private communications; however, the City Attorney just stated that was legal. He inquired whether the Committee wanted to draft a guideline prohibiting electronic communications amongst Council Members during a meeting. Council Member Berman suggested the Committee continue the topic to the next meeting. Council Member Wolbach understood Council Members' use of electronic devices during a meeting was subject to a public records request. Ms. Stump reported a case on that issue was before the California Supreme Court. The Superior Court ruled those communications were public records; however, the Court of Appeal disagreed. That issue was broader than simply conduct during a Council meeting. The case arose from Council Members communicating with the public during a meeting. Chair Burt took up the topic of Staff Reports providing options along with a recommendation. This was a policy question that had arisen a number of times. He requested Staff comment regarding alternatives being presented in Staff Reports and compliance with the Comprehensive Plan. Ms. Stump distinguished between legislative matters, where the Council could draft any procedure, and land use items, where the Municipal Code required a decision. In the latter case, existing laws directed Staff to apply Page 25 April 08, 2015 those laws to an application. The Staff Report provided Staff's actions and methods to comply with laws. Council Member DuBois asked if Staff could offer options once an appeal of a decision had been filed and placed on an agenda as an Action Item. Ms. Stump answered yes. Staff could assist the Council in the ways it needed. Whether Staff did that through confidential legal advice or proscribing the content of Staff Reports required careful thought. Mr. Keene recognized that Staff had a professional responsibility to make recommendations in reports. The City Charter anticipated that the City Manager had the right and responsibility to participate in Council discussions but not to vote; therefore, a recommendation was acceptable. To the extent that Staff built a rationale to support a conclusion, people questioned the lack of alternatives. Within the body of the work, the Committee should recognize conflicts and the need to adequately represent those conflicts. Drafting alternatives to the Staff recommendation asked Staff to put themselves in the perspectives of other people. More language was needed to clarify that Staff would do its best to identify and present the range of issues. Chair Burt felt codifying the language would allow the public to see that Staff was following Council direction. He questioned where that language could be placed as it was not a Council procedure. Ms. Stump advised that a set of policies and procedures was issued at the manager level. Perhaps that would be the appropriate place to describe generally Staff Reports. Chair Burt suggested the Handbook refer to the Manager level policies and process. Council Member Wolbach suggested the language be placed in Protocol 2.5, Staff Conduct with City Council, especially if the language referred to other documents. Chair Burt believed the title for Protocol 2.5 would need to be changed or a section added to it. Council Member Berman asked if the requirement for Council packets to be issued five days in advance of the meeting was contained in a document. Mr. Keene was not sure if that provision was contained in the Handbook. The Handbook had not been amended to reflect the new timeframe for Council packets. Page 26 April 08, 2015 Council Member Wolbach requested Staff update the Handbook to include changes made in the past few years. Chair Burt advised that that was part of his suggestion for the Committee to review the Handbook page-by-page. Council Member DuBois was interested in continuing the topic to the next meeting in order to review meeting management items. Chair Burt requested Staff provide draft language for Staff Report content. He did not believe Item 2c of Attachment A should be contained in the Handbook. Guidance to Mayors could reflect information on the topic. It was helpful to have common sense written down in a non-prescriptive manner. Council Member DuBois agreed Item 2c was common sense. However, including every possible topic would make the Handbook too lengthy. Chair Burt suggested Item 2c be included in the section for the Mayor conducting the meeting. Council Member Wolbach emphasized the need to inform the public if an item on the agenda would not be heard. Chair Burt agreed. "Making every effort to keep us on schedule" did not add value to the procedures. Council Member Wolbach advised that hearing the public during the noticed timeframe was the same as keeping on schedule. Chair Burt felt it was more nuanced. The timeframes for agenda items was an informal notice. Ms. Stump reported language was placed at the top of each agenda to inform the public that the timeframes were guidelines. Chair Burt believed the language should be "make an effort to allow the public to speak within the timeframe that was contained in the guidelines." Ms. Stump offered language of "inform the public of the progress of the night's agenda and whether items were anticipated to be removed or continued." Council Member Berman wanted to remove "commit to." Page 27 April 08, 2015 Council Member DuBois interpreted that clause as the Council would commit to hearing public comment even if the item was not taken up until much later in the meeting. Chair Burt concurred. "Commit to" should be softened such that it was an effort rather than an obligation. Ms. Stump recalled that the Council had contemplated that in the past and had declined to do it, because it was disruptive and created inefficiencies. Chair Burt offered language of "make efforts to hear the public who have come to speak to an item." Ms. Stump would provide language. Council Member DuBois advised that the Mayor in another city polled the audience regarding a point made in public comment and requested public speakers not make the same point. Chair Burt noted that related to Item 2.j.ii of Attachment A. Council Member DuBois felt the Mayor's style would determine whether that management technique was feasible. Chair Burt suggested a trial period. Council Member DuBois added that the public should still be allowed to speak. Chair Burt suggested the language be "encourage" or "suggest" rather than "ask that only new points be made." He did not want to place it in the Handbook. Council Member DuBois felt the Council needed a friendly method to shorten public comment. Council Member DuBois disagreed with setting a hard ending time for Council meetings. Chair Burt noted the Council had rules for taking up new items. He suggested the Committee review rules from other jurisdictions. The tradeoff was creating a new debate on whether to continue debate. Council Member DuBois asked if the Council policy was not to take up a new item after 10:30 P.M. Page 28 April 08, 2015 Chair Burt replied yes. The question was whether that procedure was sufficient or whether additional procedures were needed. Ms. Stump clarified that the rule did not ban the Council from taking up a new item after 10:30 P.M. Chair Burt suggested the Committee consider that topic further at the next meeting. Council Member Wolbach suggested the Council vote on taking up items after 10:30 P.M. or extending the meeting beyond 11:00 P.M. or 11:30 P.M. Chair Burt asked if the Committee concurred with continuing further discussion of meeting management. Council Member Berman answered yes. Future Meetings and Agendas Chair Burt reported a draft schedule was provided to the Policy and Services Committee. Staff listed a series of different topics. He requested the Committee discuss priority and sequence of topics along with the capacity to cover topics in a meeting. The Committee could consider holding three meetings in a month. For the next meeting, he expected the Auditor's Quarterly Report to move quickly. The work plan could require a deep discussion. The minimum wage topic could draw a great deal of public comment as well as a deep discussion. Agenda items for the following meeting would likely move more quickly. He asked if the substantive agenda items for the following two meetings were appropriate or if other items were more urgent. Council Member DuBois inquired about a date for completing discussion of protocols and procedures. Chair Burt asked about the urgency of the Smoking Ordinance. Khashayar Alaee, Senior Management Analyst, advised Staff was on track to complete it. James Keene, City Manager, advised that Staff was rolling out the first part of the ban and would be working through enforcement issues. Those issues could inform a discussion of the Smoking Ordinance. He preferred the Committee complete protocols and procedures prior to the Smoking Ordinance. Page 29 April 08, 2015 Chair Burt noted the Council referred several items to a future Committee of the Whole meeting. A number of those items could be referred to the Committee. He did not find Colleague's Memorandums listed in the draft schedule. Mr. Alaee did not have a list of Colleague's Memorandums. The Colleague's Memorandum regarding neighborhoods was removed from the agenda. Chair Burt reported Mayor Holman was drafting a Colleague's Memorandum regarding the Architectural Review Board (ARB). He inquired about Colleague's Memorandums that had been presented to the Council. Mr. Keene would review those with the City Clerk. Chair Burt asked if there were Colleague's Memorandums other than the Minimum Wage Ordinance. Mr. Keene advised the Smoking Ordinance was originally a Colleague's Memorandum. Council Member Berman suggested the Minimum Wage Ordinance and the City's legislative program be scheduled for April 28, 2015; the City Auditor's reports be scheduled for May 12, 2015; and the Smoking Ordinance and policies and protocols be scheduled for the following meeting. Chair Burt wanted to maintain the momentum to accomplish as many items as possible. A number of other items would be referred to the Committee. He inquired about a possible date for the Committee as a Whole meeting. Beth Minor, Acting City Clerk, indicated a date had not been set. Chair Burt suggested the Committee hold a special meeting in April. Molly Stump, City Attorney, noted the Tall Tree Award Ceremony was scheduled for April 21, 2015. Chair Burt suggested a special meeting on May 5, 19, or 26. Mr. Keene noted the Finance Committee was holding budget meetings throughout May. Staff could better support a Committee meeting on May 26. Council Member Berman was available May 26. Council Member DuBois indicated a Council meeting was scheduled for May 27. Page 30 April 08, 2015 Chair Burt asked if the City Clerk had confirmed a Council meeting on May 27. Ms. Minor requested Council Members hold May 6 and May 27 for Council meetings. Mr. Keene was not sure the Council meeting on May 6 would be held. Ms. Minor advised that Board and Commission Study Sessions were scheduled for May 6. Council Member DuBois could attend Committee meetings on May 26 or 19. Council Member Berman was available on both dates. Chair Burt would schedule a Committee meeting on May 26. Council Member Wolbach was available on May 26. Council Member DuBois asked if any aspect of the Residential Parking Permit (RPP) Program would be presented to the Committee. Mr. Keene did not believe the first phase would be presented to the Committee. Council Member DuBois inquired about aircraft noise. Mr. Alaee indicated the Committee referred air traffic noise to the Council. Mr. Keene reported if the historical data study and analysis was below the threshold, then it would proceed to the Council. Council Member Berman inquired about the overall timing and implementation of topics. Chair Burt did not believe any of the revisions to policies and procedures were urgent. The continued discussion could fill a meeting on its own. Perhaps the Committee could tentatively schedule an item for a portion of an upcoming meeting. The Minimum Wage Ordinance and work plan would fill one meeting. The earliest possible date was May 12, 2015. He suggested procedures and protocols be added to the May 12 Agenda with the understanding that it could be continued to May 26. Mr. Alaee advised that the Auditor's Quarterly Report, work plan, and the Minimum Wage Ordinance would be on the Agenda for April 28. Page 31 April 08, 2015 Council Member Wolbach recalled a concern regarding scheduling the Minimum Wage Ordinance and the work plan in the same meeting. Chair Burt indicated the Committee might not complete discussion of the work plan and could continue it to a subsequent date. Adjournment: The meeting adjourned at 10:05 P.M. Policy and Services Committee Final Minutes Special Meeting Thursday, May 21, 2015 Chairperson Burt called the meeting to order at 7:06 P.M. in the Council Chambers at 250 Hamilton Avenue, Palo Alto, California. Present: Berman, Burt (Chair) DuBois, Wolbach Absent: Oral Communications None. Agenda Items 1. Continued Discussion Regarding City Council Procedural Matters, Including Updates to Procedures and Protocols Handbook (Continued from April 8, 2015) Khashayar Alaee, Senior Management Analyst: Good evening, Chair Burt and Committee Members. Khash Alaee, Senior Management Analyst with the City Manager's Office. Just to quickly reorient us and place tonight's conversation in context, the City Council on January 31 at its Retreat discussed updates to the City Council's Procedures and Protocols and referred certain elements to the Policy and Services Committee. Again on February 17, the City Council held a Committee as a Whole meeting and focused on the Procedures and Protocols, meeting management, Committees and Staff relations. At this meeting, certain items about the Procedures and Protocols as well as meeting management were referred again to the Policy and Services Committee. Some ideas about the Committees and Staff relations were deferred to the next Committee as a Whole meeting. As we talked about at our April 8 meeting, the Committee has discretion to talk about any of those items and make recommendations to the Council or to the Committee as a Whole. On April 8, the Committee began to take the referrals and items and made recommendations to Staff about changes to the actual Handbook and Manual. The Committee discussed the referral items. If I could ask you to look at packet Page 5, if you guys all have your packet. 1 2 May 21, 2015 Chair Burt: Tonight's packet? Mr. Alaee: Yeah, tonight's packet. Everyone there? If you look at Number 1, the discussion of Procedures and Protocols. At our meeting on the 8th, we were able to have substantive conversations about Number 1 and all the sub-elements; the telephone participation, the Consent Calendar as well as the agenda setting. We began to have conversations about the meeting management items. There were a lot of different ideas put out there, but it was not as substantive as the first three items. The City Clerk has put a set of the Minutes in front of you. Just to orient you on a little bit of what we talked about. Beginning on Page 3 of the meeting Minutes is where the telephone conversation began. That conversation goes through Page 21. At the top of Page 21, you'll notice the first sentence in there says agenda setting. That's where we begin to start talking about that. That conversation carries through to Page 24. At the top of Page 24, right below consensus, in that first sentence you see the word Motions. That's where we started to discuss Motions. That then carried through and the conversation started to move into meeting management. That gives you a little bit of a sense of what we got through. It seems to me that to focus on packet Page 5, 6 and 7 and continue the conversations about meeting management is where the Committee had left off. Certainly on Page 7, the items going to the Committee as a Whole, we could continue conversations about that. If I could also refresh your memory that on April 8 we put an at-places memo. There was some items left off the Staff Report. We've placed another at- places memo tonight. It's double-sided. On the back of the first Page, Page 2, is the at-places memo from April 8. Hopefully that reorients us a little bit to where we had left off. Staff did start taking some of your comments and putting them in the Handbook. Truthfully, it's a difficult process to take the feedback and put it in the Manual. Due to time constraints and workload constraints, we weren't in a position to feel comfortable providing you or the public with what we have done so far. Our preference is we finish the conversation, update the whole Manual, certainly have the Attorney's Office review it, and then bring the final package to you and the public. With that, I turn it to you, Chair, for any direction and next steps. Chair Burt: Let me just get recalibrated. I'm trying to recall whether we were using the referral items as our sequence or just the sequence as it exists in the Policy and Procedures. Mr. Alaee: Correct. From reading the Minutes and my recollection, you were using the referral items to start to go through the Handbook. We had done pretty well with finishing Number 1. It seemed to me you had given us enough direction on those items. If you look at the set of Minutes, towards the end a lot of popcorn ideas were being popped for all the items in Number 2. There was no clear direction. We had gone pretty clearly through 1a, b 3 May 21, 2015 and c. The meeting was getting towards the end, and the ideas were just flowing. Chair Burt: I have some miscellaneous notes that we went through the existing Procedures and Protocols that aren't necessarily listed here. Whether I or others have those, we can look at whether we do a final run- through at the end that tries to capture what we didn't capture in this format. Colleagues, if we go to packet Page 5 from this evening's Council packet, the second section Meeting Management, 2a talks about trying to provide Staff with digital versions of draft Motions. We've actually been experimenting with that this year and seen more of that. Just one level of question, do we think it's a good idea? The second one is how would we capture that in our Procedures or Protocols. Anyone have any initial comments? Marc. Council Member Berman: From my standpoint, it's been very helpful for those who have been using it. I don't think it should be mandatory. I think it should definitely be utilized by those who want to, to get ahead of the game and be able to provide that to the Clerk. It saves time during the meetings for those who are able to. Chair Burt: To try to take that and capture it. As we look at 2a, the way this was put out, it's directional. We might want to consider language that City Council Members are encouraged, if we go the direction that you just ... Council Member Berman: That's my preference. Chair Burt: Others? Cory. Council Member Wolbach: I'd agree. Chair Burt: Tom. Council Member DuBois: I'm good with that. Chair Burt: All right. We're moving a lot faster tonight than last time. Council Member DuBois: If we could talk through some of these last items. Chair Burt: I'm looking at the second sentence of 2a and asking myself whether, in addition to the Policy, we should give a context. That is helpful for future Councils. They look at a Procedure and say, "Why is this here?" There probably would be a good way to re-frame that just to give a little more context. The next one is—we got into a little bit of discussion of this last time; the City Manager was here—Staff Reports offering options that are 4 May 21, 2015 available to the Council. I saw in review of our Minutes last time that the City Attorney had weighed in a little bit on that. The City Manager had. I don't know if there were any follow-up thoughts. Molly, do you have anything? Molly Stump, City Attorney: The spirit of this suggestion in many cases is helpful and a useful one. I do think that it has to be applied in the particularized case that's before the Council. If I recall correctly, my particular concern was that subset of issues that the Council is sometimes involved in, where you're adjudicating a particular project. The Staff is really called upon in that case to give you their best view of how the current rules apply to the facts before them in the project. In that kind of case, it may be that there's less ability to provide alternatives that stand on equal footing or are of equal weight. There are areas of course, as you know from your recent work on a couple of projects, where there is a fair amount of Council discretion. In those cases, the Staff is able to say that the Planning Director or the ARB reached this conclusion, that these findings can be made. Council has discretion to judge this and may come to a different conclusion. Sometimes I think that can be done. In other cases, there's less ability. I guess I would want this also perhaps to be put in language that recognizes that the particular item and the elements of the item may provide for lots of room to do that or less room to do it. Chair Burt: Cory. Council Member Wolbach: Would it be appropriate in the language to that effect to specifically refer to the distinction between quasi-judicial agenda items and others? Chair Burt: Yeah. One way that we might do that is have it as a preface. To the effect that we're not limited by quasi-judicial hearing Protocols or however we want to describe it, and then go on to put it that way. We could simply say ... Council Member Wolbach: Where appropriate? Chair Burt: Yeah. Within the quasi-judicial, it doesn't mean that they can't provide any alternatives. It's just that they're more constrained. We basically want to acknowledge those constraints and encourage Staff, especially in legislative matters but where permitted in quasi-judicial, to provide alternatives to the Staff recommendation. One of the things that's historically been an issue is in particular when there's reference to Comprehensive Plan policies and programs, to put a balance between those policies and programs that support a given recommendation and also to list some that are pertinent where the recommendation may be in conflict. My 5 May 21, 2015 recollection is that that's been one of the issues. Molly, did you want to wade in on that? Ms. Stump: Yes. I think the Committee's going in a good direction. If we could be given the direction to draft some specific language that would encourage that, but recognize there may be cases where there might be limits on that process of providing alternatives. We've talked about the quasi-judicial. There may be others. For example, where you are setting municipal utility rates based on Cost of Service Studies. Again, you need to be basing those rates on the evidentiary record before you. There sometimes is an ability to ask for more information, return the item, sometimes less so. Again, I think it's the same general direction that you'd like to see where possible alternatives are provided. Chair Burt: Ed, did you want to add something? Ed Shikada, Assistant City Manager: Sure. To pick up on comments the City Manager made last time. In addition to the potentially legal boundaries and the context in which Staff Reports are done, from a policy development perspective and in advising the Council in bringing forward recommendations, the City Manager pointed out Staff's obligation to develop recommendations and effectively defend or justify those recommendations. That said, it is appropriate to expect that Staff would be able to explain some of the dimensions of discretion that exist within developing those recommendations. The language that Molly pointed out works. By encouraging the discussion and the consideration and explanation of the variations that are brought forward to the Council. Chair Burt: I might put it slightly differently. While recognizing the role and responsibility of the Staff to put forward their best professional recommendations, we're looking for the reports to acknowledge the alternative interpretations of the Comp Plan or relevant portions of the Comp Plan that may be considered. That doesn't constrain Staff from saying, "However, in the net our recommendation is such and such for the reasons we stated." My question for colleagues would be does that seem to capture the intent and do we feel that we've given Staff enough direction to allow them to come back with specific language to reflect that. Tom. Council Member DuBois: This discussion is coming back to me. I think what we're saying is we want to see the range of possibilities along with the recommendation. As long as that point is clear. Ed, what I heard you to be saying was more detail on justifying the point of view, but also more about the range of options. Mr. Shikada: Understood. 6 May 21, 2015 Chair Burt: Are we okay? Great. The next item has to do with meeting efficiency and public participation. This is really just about trying to anticipate, either before a meeting or during a meeting, if things are drifting off of an initial schedule to inform the public as best we can. That doesn't seem very contentious to me. Yes, we could have it as a Policy to do so. I'd put it in this category that one of the functions of the Policies and Procedures is just to remind us of good practices when we go through. Even if it's not stipulating what shall be done, it's very helpful to not have to have every Mayor reinvent the wheel and think of what are best practices, but just to give recommended guidelines. Molly, was there something you wanted to add? No. Anybody have anything in particular on that? Other than that, maybe we just include it as essentially a note of a practice. Marc. Council Member Berman: I agree completely, but I just want to make sure. Maybe I’m reading it wrong. It seems to have a preference for committing to hearing the public who have come to speak to an item in the timeframe that the item was noticed. Then it says if this can't be accomplished ... In our Policy and Procedures, I wouldn't say that it's a hard and fast rule that the public will have the opportunity to speak during the time that was advised in the agenda. There's always terminology on the agenda that says the timeframes are just guesses or whatever the phraseology is that we use. I think that would be very disruptive, if we were to stop a conversation and then hear public comment on a different topic and then go back. I wouldn't recommend that. What you were recommending earlier is the right idea. Chair Burt: That's a good point. Let's look at that first sentence there. That's a little different from what I was alluding to. If the public comes to speak to an item, we have one question. Do we want to make sure that we make every effort to allow them to speak even if we're not going to be able to take that item up in full that night? We've been doing that. Sometimes saying, "We're going to continue the item, but let's allow the members of the public who came tonight to speak to it." Then we have another question of to what extent would we feel obligated to allow them to speak in the timeframe that's on the tentative timeline on the agenda, which is clearly just an advisory reference point. I would agree that we don't want to have the meeting be disjointed to achieve that, even though we do want to make efforts to allow them to speak in approximately the timeframe that we and they are anticipating. Tom, did you have suggestions? Council Member DuBois: I'm just looking through my notes. In my notes, we completed through Section d last time. Looking through the Minutes on Page 26-27, it captures what we're saying right now pretty well. 7 May 21, 2015 Chair Burt: Good. I have to say that for whatever reason the Minutes in the packet were not the intended Minutes, and so we didn't get them until an hour ago. Council Member DuBois: I know. I'm just looking at them right now. Chair Burt: I got through about half of the Minutes. What do you find there? Council Member DuBois: On Page 26 and 27, we talked about the intent to stay on schedule. Let people speak at the right time. Rather than committing, we softened the language. It seems to be in line with what we're saying right now. Council Member Berman: We affirm that one. Chair Burt: At least we're thinking consistently. Council Member DuBois: So far this seems to hold together pretty well. It doesn't seem like random items popping up. If you guys have enough here, we covered this one. Chair Burt: Good. I'm sorry. Go ahead. Council Member Wolbach: I'm sorry. It looks like we continued maybe during item 2d. Council Member DuBois: I think we stopped right after d. Council Member Wolbach: Did we really conclude that discussion or were we just starting to share thoughts on that with no consensus? Council Member DuBois: That's right about where we stopped. We could probably pick it up there. Council Member Wolbach: I'd be okay with jumping back to 2d. Chair Burt: That was the next thing. We were on c, and the next thing I was going to ask about was d. From your reading of the Minutes, did we get through a recommendation for d or just part way into discussion? Council Member DuBois: I think we agreed that we didn't want a hard ending time, at least I didn't want a hard ending time. Then we were talking about current Policy around looking at the schedule at 10:30 and deciding what to do. 8 May 21, 2015 Mr. Alaee: On Page 28 of the Minutes, it states that Council Member Wolbach suggested that the Council vote on taking up items after 10:30 or extending the meeting beyond 11:00 or 11:30. Chair Burt: At that time, our meeting was pretty late, and I suggested we continue that item. That's where we apparently left off, which was Cory suggesting that the Council vote on taking up items that begin after 10:30. Our existing Procedure, let's just refresh ourselves on that. Ms. Stump: It's on Page 8 of your Procedures. It says that the Council makes every effort to end meetings before 11:00, also generally does not take up new matters after 10:30. Before 10:00, the Council will decide and announce whether it will begin consideration of any agenda items after 10:30. Chair Burt: Cory, does that differ from what you were suggesting? Council Member Wolbach: Give me just one moment please. I don't think that we've been following that current Procedure very closely. That's a good refresher. (crosstalk) Chair Burt: This is on taking up items. I think we actually have. Council Member Wolbach: Okay. The idea of having the decision before 10:00, about whether we're going to take something up later, that gives good guidance if there's a situation where for some reason it's after 10:00 and we do make a decision that we want to press through with something. I don't want to feel constrained. If the current language allows for that flexibility, then I'm fine with retaining it as is. Council Member DuBois: I agree it's pretty good the way it is in this regard. Chair Burt: Okay. Marc. Council Member Berman: I agree that it's good the way it is. Should we— whether just through advice to Staff or actually putting it in the Policies and Procedures—have some mechanism in there that says—this past Monday we didn't necessarily follow it. I think we took up an item after 10:30 without having a discussion about it before 10:00. Maybe the City Manager at 10:00 or the most opportune time stops the discussion to remind the Council it's 10:00 and it has another item or two more items. That might spur us to either be more concise or decide at that point that we're not going to take up the following items. 9 May 21, 2015 Chair Burt: I don't know whether that's something the Clerk might be able to track as a reminder. Beth Minor, City Clerk: (inaudible) Chair Burt: Good. Should we then put language in here that says that the Clerk will make efforts to remind the Council? I don't know if that starts getting a little ... Council Member Berman: That could work. Remind the Council of this Policy. Chair Burt: Or to raise the need for Council to consider taking up an item. Molly, do you want to wade in? Ms. Stump: My suggestion would be at that level, it's really more direction to the current Staff and a reminder. Your Procedures now don't include that level of instruction to support Staff. Chair Burt: Good. The other thing that was in this recommendation from Vice Mayor Schmid was a hard ending time at 11:00 P.M. I can't remember whether we specifically addressed that in any way or what the consensus is of the Committee on that. Cory. Council Member Wolbach: The key question here on Council Member Schmid's recommendation is what qualifies for an extreme circumstance. He allows for the qualification that there can be exceptions under extreme circumstances. Chair Burt: That's only key if we think that extreme circumstances are the only time that we would continue an item past 11:00. If we don't go past that threshold, we don't have to worry about extreme circumstances. Council Member Wolbach: Good point. I'm not terribly excited about this idea. Chair Burt: We guessed that. Maybe this is a good opportunity. I know a number of times you've pushed to have us barrel through. One of the overriding considerations in why we attempt to do this is not whether the Council can endure—although there is a question of whether we make the best Policy at that time—but whether we do the public's business when the public is awake. That is a transparency and public participation issue aside from the question of the quality and endurance of the Council. 10 May 21, 2015 Council Member Berman: I agree 100 percent. Maybe one thing we could say is no new items will be taken up after 11:00 P.M. other than the Council comments which is always the last item. If it's so substantive that we feel like we need to take it up, we probably shouldn't be taking it up after 11:00 P.M. anyhow. Chair Burt: The only exception that I've recalled to that and the only one that seems to make sense is something that truly is urgent and, for whatever reason, it was agendized toward the end of the meeting. That's where maybe this extreme circumstances or ... Council Member Berman: Extenuating. Chair Burt: Yeah. Extenuating or urgencies. It's implicit in that if we're going to start an item after 10:30, it has to have a vote. That doesn't give guidance that says we shouldn't be starting anything after 11:00 unless it's a real urgency. Maybe we want to add that? Tom. Council Member DuBois: I don't. We're nine adults. I don't know if we need to be that specific. We can make the judgment call. I like the language that's in there, that we do the check at 10:00. Chair Burt: Okay. Anybody else? All right. E is when the Council time estimates call for it, limit Council times for questions. Then it says pre- Council written questions should cover most key issues. Council Member DuBois: There's a whole bunch of separate points about time management. I'm wondering if going through these in the order that they're here is the best way to do it. Chair Burt: I'm not sure it is, but I haven't organized them in a different order. If you have suggestions, I'm open to it. Council Member DuBois: Should we look through this and the next Page and pull out all the meeting time? Chair Burt: I see. It does jump around there. Council Member Wolbach: They're organized by Council Member who submitted them, I think. Chair Burt: No. (crosstalk) Meeting Management section. Council Member DuBois: In this Meeting Management section, maybe pull out from each Council Member the issues that have to do with time. 11 May 21, 2015 Chair Burt: Yeah. There is some repetition. Like Council Member Kniss says just the topic of time and topic management. That's not specific. Council Member Wolbach: J iii, which is Tom's chess clock, certainly applies. Two was mine, similar to that, also talking about having a clock or timer. Chair Burt: How about this? We see a number of items that are—3 appears to be time management also. 2e and f. We could open discussion on any of the time management issues or we could proceed sequentially as they're before us, even though that may not be the most efficient way to do it. We also have an obligation to take up whatever was referred to us, even if we don't need to have a whole bunch of discussion before determining whether we're going to accept it or not. Council Member DuBois: I'd suggest we look at 2e and f, j iii and iv and ii, which are all the ones specifically about timing. Council Member Wolbach: Those ones in particular refer specifically to constraining or encouraging Council comments to be brief. The others refer to Staff or Staff Reports. We could take those up maybe as a separate group. Chair Burt: Let's go through 2e and then 2f, and we'll just jump over there. Limit Council time for questions. That's something that the Mayor has discretion with the consent of the Council to do and has been getting done as a request more than a binding limitation. One question is do we think that works and something we want to continue to allow. If so, then we want to have some language that would reflect that. I don't see anybody jumping in. Tom. Council Member DuBois: Having done this for several months now, I'm starting to lean towards harder limits particularly around question periods, because we usually follow it with a more open-ended comment period. Sometimes we'll say we're going to do a three-minute question round, but the timing and enforcement of that round is inconsistent. When the public speaks, they get the green, yellow, red lights, but we don't get that. Even if we say we're going to do a three-minute question round and we had a three- minute countdown clock that we could see. I feel like that's the first step. If people ignore it, then maybe we have to come back and talk about something else. A lot of times we'll say it's a three-minute question round and several people will stick to three minutes, a couple of people won't. It's not really equitable. 12 May 21, 2015 Chair Burt: Let me add a couple of other considerations. One is that these are questions. If a Council Member asks a question in 10 seconds and Staff takes 2 minutes and 50 seconds to answer it, that's problematic. If a Council Member uses the question for rhetorical questions that are really their own advocacy of policy positions, that also is problematic. The third thing is it's important that the public participation be adequate, but the Council and the public are not equal participants in creating legislation. Council Member DuBois: I was using three minutes as an example, not to say we should only have three minutes. When the Mayor says, "Let's do a two-minute question round or a five-minute question round," it doesn't usually happen that way. That was my point. Chair Burt: One of the problems is that we don't have visible to Council Members the amount of time. A countdown clock being visible would be useful. We've talked about this, and that doesn't require being in the Procedures. I wonder if that's something we might be able to get out here. It could even be below the table here and just reset, or maybe below Beth. I don't know if it'd have to be wired so the Vice Mayor would start it. It's really disruptive when the buzzer goes off and a Council Member is in the middle of a question. I find that offensive and disruptive to clear thinking. It would be helpful for us to have that visibility of how much time is going on. Between a guidance from the Mayor with the consent of the Council and an awareness, I think that goes quite a ways. Council Member DuBois: Your point about asking a question and getting a ten-minute answer, I don't know how we manage that. Maybe another approach is to do a round based on number of questions. Council Members could ask three questions each or something. I don't know. It's a tough issue. Like you said, if you ... Chair Burt: It is. We also have items where a Council Member may have no familiarity or didn't do any homework on an item. Another Council Member may have familiarity and a set of questions that are valued by the rest of the Council. We do have times where we have gratuitous questions. We're not going to solve all those problems. Those are just some of the vagaries of how this is going to go on. The more rigid we are, the more we don't allow for flexibility that may be valuable. It's a balance. We also don't want to have no constraints. From my experience, what we've been doing this year in suggesting time limits on those has been helpful. If we aren't looking for it to be a perfect cure, then it's in the right direction. I would like to see a countdown clock. That would be additionally helpful. Cory. Council Member Wolbach: That actually is very similar to what Tom was suggesting in j iii and what I was calling for in 2. We'll probably have a lot 13 May 21, 2015 of consensus that that wouldn't be a bad idea. One question there is do we want to put it somewhere where it's public or just for our reference, facing us. I'm open to either of those. One other thing we might want to consider, whether it's in written Procedures or just as practice, is if a Council Member asks a question that has a necessarily long explanation from Staff that uses up that Council Member's time and that Council Member has some other questions, just to ask at the pleasure of the Mayor and the rest of the Council if they can continue with their questions in that situation. Chair Burt: It's a question of whether that's required, given that these are not binding as it is. In response to one of your questions, the clock should be visible to the Council and not to the general public. Tom. Council Member DuBois: It's a good step. What I was proposing went a step beyond that, which was a budget of time for each Council Member for the evening that they would manage between questions. The idea is that I would set the chess clock, but you would have 40 minutes or 50 minutes. If you use zero minutes on Item 3, you'd have more time for Item 4. That was the idea, but in the concept it would be almost a tally of how much time each Council Member was speaking. I have a feeling we don't want to go that far, but it was beyond just a countdown per question. Chair Burt: I wouldn't support that. I don't know how others feel. Council Member DuBois: Not to argue this point, but what we're trying to get to is a way to force Council Members to prioritize their comments, be more succinct, but also don't ask spurious questions. If we had something like everybody gets five questions or three questions, it'd really make you think about if you're asking the three most important questions. Again, a countdown clock is a good first step, but if we have other ideas to get more to forcing people to prioritize a little bit, it would be a good step. Chair Burt: I'll give you an example of where I personally would run into this problem. There are areas where—in part because this Council has fewer people with land-use experience and some of these other areas—nobody would go until I would on those items. My preference would be to go later and allow colleagues to ask as many of the questions as I might want to ask. I might have ten questions that I know need to be asked, and I don't want to be the one who asks all of them. It creates that kind of dilemma. Where I felt pressured by colleagues to ask as many of the important questions as possible, and it wasn't my choice. Council Member DuBois: It raises a different issue, but it's tied to this, which is instead of on each item seeing who wants to go first, should we have a rotation? You go first on an item, and then Cory goes first and then I 14 May 21, 2015 go first. It just rotates. That way it's not a waiting game for who's going to ask questions last or who's going to ask questions first. There would be a set order. Chair Burt: If I might, Marc? There are tradeoffs to that. That works in this regimenting mindset, but that's not the best way to make legislation and the best way to conduct the arguments. Yeah, it parcels things, but it doesn't necessarily result in the best discourse. Marc. Council Member Berman: In an ideal world, some of these things might work. When you think about it logistically, how would it work? You'd end up with arguments on Council about that second thing wasn't a question; it was a follow-up to the first question. I worry about what we're talking about creating, nobody would be able to manage it. Plus who would do it? The Mayor and the Vice Mayor normally serve that role, but they're also trying to follow the dialog and have their own thoughts in their head. The City Clerk's not going to be keeping track of that stuff, I don't think. You all seem pretty busy enough during the meetings as is. We just need to be cognizant of some of these logistical hurdles as well. This is something we talk about every year. Maybe this year we take some steps forward to see if maybe they are having a positive impact. If they're not, we can reevaluate next year. Council Member DuBois: I like the idea. We have one idea that I haven't heard anybody disagree with. Can we come up with one or two others that we do as experiments? Chair Burt: We've already done them. Let me give some context. As I said about ten minutes ago, the practice of the Mayor with the consent of the Council saying, "I'd like colleagues to try to limit their questions to X number of minutes," hasn't historically been common. It's been helpful this year. As a result, it's moderately improved the questioning period by colleagues. We seem to have consensus on the value of us having visibility for a chess clock or something. That's two right there. I would argue that those aren't very constraining, but they're constructive. If you start going in the other direction, there are clear tradeoffs to every one of the things that you're advocating. Just as we discussed in our last meeting, let's be cautious about overshooting in our corrections. We can always come back and calibrate it a little bit more. If you go from one swing of the pendulum to another, you probably haven't got it right, because these really are circumstances that have pros and cons to every one of these alternatives. Cory. Council Member Wolbach: Beyond what we've been doing with the practice of the Mayor saying we're going to use this round for questions and do a later round for comments and Motions and a clock that we can see—the idea 15 May 21, 2015 of having a clock that tracks overall speaking time—I would exclude the time that it takes for Staff to respond. Through the course of the meeting, it might be useful if it's not too much burden on Staff. I'd be open to that as long as there's not the constriction accompanying it, just as constructive information for Council Members to be aware. Chair Burt: You said as long as it's not too much burden. Logistically how are you going to do that in the middle of a meeting, track each Council Member's time and then subtract the Staff response times? Council Member DuBois: If there was a timer on the on/off at your mike, then it would be up to each Council Member. Again, as an experiment to see. Chair Burt: You guys are trying too hard on this. Marc. Council Member Berman: I'm with Pat. Just logistically speaking, I don't see how we accomplish that. I like the ideas, but a lot of people leave their mikes on probably for too long or they talk without having them on, if you're Greg Scharff. We've got two pretty good ideas; let's move forward on those and see if that helps our meeting management. Council Member DuBois: Before we move on, I'm not really advocating for any position. I was trying to throw out ideas to spur other ideas. It feels like very small steps, and I don't have a lot of confidence it's going to make a big improvement. I would just ask you guys if you have any other ideas, even if it's something we just try for a meeting or two in a way the public doesn't see. If we just want to try some things, I'd be up for that. Chair Burt: We've already tried one with moderate success this year. Having the visibility of a clock is another one. Those are my two. Council Member Berman: Pat, I don't know if you remember it. I think it was last year or the year before where we tried the Vice Mayor keeping track of the time that people were talking. It didn't work. The Vice Mayor just forgets and gets caught up in the meeting. Frankly we shouldn't be placing that burden on the Vice Mayor. I'm open to other ideas so long as they're logistically feasible and will have more benefits than tradeoffs. Chair Burt: I'll add one other thing that in 3 1/2 years we'll have a smaller Council, and that probably will have some benefit in some of these regards. Cory. Council Member Wolbach: I'm fine with moving forward with just having one change for now. A question is if, as Tom's suggesting, we try something 16 May 21, 2015 on an experimental basis, then we could do that without it being in the Policies and Procedures, especially if it's not something that's constraining. If we want to establish a timekeeping system that's connected to our on/off switch on our microphones just for our information, I don't think that needs to go into this document. We could probably try that if we wanted to. I would actually be okay with that. That would be a simple logistical way to do it. Chair Burt: It's not simple electronically. Council Member Wolbach: It would be logistically simple during the meeting and would not require a lot of extra Staff or the Vice Mayor's attention, but it requires the electronic setup. Chair Burt: This is not a smart mike. Tom. Council Member DuBois: We talked about questions. Vice Mayor Schmid also had an item on comments. We really haven't talked about comment time separately from question time. Chair Burt: Let's see if we're done with the question time part. We have a consensus that this would not be in part of the Procedures, but we want to try to get a clock visible that could be ... Council Member Berman: You might need two. Me on the edge over there, I can't see anything that's ... Council Member Wolbach: Get one there and over there. Chair Burt: Whatever. One or more countdown clocks would be visible to the Council. Ms. Minor: I can look into different options that there are. If they're in two different locations, it might be difficult for Staff to stop and start them. Chair Burt: No, they can be wired together. There's no problem there. They'd be showing the same thing. You wouldn't be running them with two different toggles; you'd have one toggle. Ms. Minor: Right. We'd have to figure how we could do it so that all of it fits in here, to be able to have one there and one here and be able to do it. Chair Burt: That's easy. It's just cantered slightly from here for the person at the far end and vice versa. That's physically not much of an issue. 17 May 21, 2015 Council Member DuBois: Let's just get the scoreboard clocks from the Paly gym before they tear it down, and then we'll have the air horn that goes off. Chair Burt: That's your new one that you wanted to add? Spoken like a basketball player. Cory. Council Member Wolbach: My guess is the answer is probably not easy. Is there a way that's not too difficult that it could be displayed on our screens? Chair Burt: Our time? Mr. Alaee: We get the sense where you guys are going with the countdown clocks. Let us research the technology available and how we can integrate that into the existing system and not make it too complicated and have to go through the RFP process. Chair Burt: That's right. Council Member Wolbach: That takes care of my whole issue under 2. Chair Burt: Tom, the next thing you were bringing up was the discussion. Council Member DuBois: I don't think we've really limited that at all. Chair Burt: One limitation. There are some things in the Procedures that place certain limits. One is we're limited to one round on each item that we're going to vote on. If somebody else speaks, then everybody else has a right to the second round. We've been having that not followed rigidly. Under existing Procedures, that's under the discretion of the Mayor. It's not the need for a new Procedure. Some of these things have always been a question of how the Chair exercises the existing rules as well. Council Member DuBois: I don't have a specific proposal right now. I made a comment about trying to change the culture so that everyone doesn't feel like they have to speak on every issue. We've been talking about sticks; are there incentives we could consider? If somebody doesn't speak on an item, they get extra time on another item. I don't know. Council Member Berman: The incentive is we get to go home early. Sorry, I didn't mean to interrupt. Council Member DuBois: I was done. If you guys don't think there's anything to be done in addition, we can move on. 18 May 21, 2015 Chair Burt: I'll just make one comment. This year we've had late meetings, but in comparison to other years we are having more substantive agenda items that we have actually been working through. My overall sense is that we're having moderately good efficiency per substantive agenda item, but we have more substantive agenda items this year. We are having long meetings. I actually perceive some improvement in the efficiency of the meetings despite their length, because (crosstalk). Council Member DuBois: Yeah, I'd agree with that. We've taken on some really big issues. Changing course takes a lot of time and discussion. If we were just on a roll and not making substantial changes, it would go a lot quicker. Chair Burt: Any other discussion on limiting discussion time? No recommendation to do so, then? Okay. Let's see. Anything else under Meeting Management that we haven't covered through the discussion we just had? Cory. Council Member Wolbach: There's a couple of things we might put under that category. Tom's suggestions, under j ii, public comment. Also Suggestion l about breaks. Chair Burt: Let's go to j ii. Council Member DuBois: Could we go to j i first? Chair Burt: Okay. Council Member DuBois: If we look at the meeting from beginning to end, the idea is where could we save time. A lot of times we'll have an hour for an agenda item with no real assignment for how much each component of that hour is used. This wasn't necessarily that Staff was taking too much time. It was the idea that whatever time we have for an agenda item, allocate so much time for Staff, for questions and try to manage items so that we don't get behind schedule. Chair Burt: Good comments. One of the things we're doing tonight is looking at changes to Policies and Procedures. We're going to want to separate where we're talking about good practices versus any specific recommended changes to Policies and Procedures. Council Member DuBois: This point would be emphasizing that Council Members should have read the reports and that the time for presentation or overview should be kept to a certain percentage as a recommendation or guideline. 19 May 21, 2015 Chair Burt: Marc. Council Member Berman: I'm intrigued by the idea of having a percentage of the allocated time be for Staff Reports. Staff Reports are always very informative, but sometimes—one time recently that comes to mind—the Staff Report was twice as long as it needed to be for the item. Staff Reports hold a dual purpose. One is for the Council and one is for the public. I don't expect the public to read the Staff Reports. I'd still want to encourage the presentations to be thorough, but I want to encourage them to be more concise. Chair Burt: Let me add here this is akin to Council Members speaking. We don't want Council Members to speak and waste time. We don't want Staff Reports to waste time. We have times where we have Staff Reports that basically Staff says, "No. We don't need to make any written presentation." We have other times where there's a need to be more than this 15 percent. Council Member DuBois: Again, that was a number. If we have an hour, is 45 minutes too long for the Staff Report? Probably. Chair Burt: You're saying if we have an hour. What I was trying to say was I don't see a way to have a rule that covers all circumstances. Council Member DuBois: Again, I was saying encourage or suggest, not a hard limit. Like we were talking about our own time, give a guideline. Chair Burt: That's not the way this is written nor was it stated. Cory. Council Member Wolbach: It looks like the City Attorney has a comment here. I'd (crosstalk) as well. Ms. Stump: Just an observation. I agree this really varies depending on the item. Sometimes no report is needed. Sometimes there is time that's needed. The amount of time that's needed may change between the time that the packet is published, ten days before, and when the meeting actually occurs. It can be influenced by questions that have come up in the community and questions that the Council has asked. Perhaps this is really a suggestion to the Chair. At the pre-Council, the City Manager gets a chance to talk with the Chair about what is the current situation. The Chair can jot down some guidelines, perhaps even share them with his or her colleagues, about how they foresee managing that item that night, rather than trying to publish it or trying to make a rule about it. Chair Burt: Marc. 20 May 21, 2015 Council Member Berman: That sounds like a good suggestion. I don't even know if it's the City Council's role to make limits on Staff Report or if it's the City Manager's role. I don't know that dynamic and how that would work. We can provide good guidance and suggestions tonight, but I don't know how it would fit in our actual Policies and Procedures. Chair Burt: Cory. Council Member Berman: We're actually right now talking about both j i and also j vi, combined. I'm more interested in j vi than in j i because, as we've discussed, it's hard to have a general rule when things vary so much. The City Attorney's comments are very interesting and a good reminder that things can change between the time of publication of an agenda and the night of the meeting, as far as how substantive the Staff presentation might have to be. I do like the idea of having something, even if it's just as an estimate. I don't know if there's a way to do that that's either part of the agenda or supplemental to the agenda, so that it's not bound by the rules of the agenda publication. I'm trying to think if there is a way to do that as a guideline that could be updated on the day of the meeting and available in the back of the room. I'm open to ideas about that. Chair Burt: One potential is along the lines of what the City Attorney alluded to, which is there can be a reference to the pre-Council meeting. They go over the agenda and a sub-issue within that can be anticipated allocation of time for the Staff Report. That might make it a more deliberate process, so it doesn't just happen. I can't see how something more restrictive than that works in the range of circumstances that we actually have. For you guys who are new to the Council, it's all nice in theory to say, "We'll do it this number of minutes across the board." It doesn't reflect the reality of the range of issues and the complexity, from things that are perfunctory to things that are very complex, things that require much more Staff input and things that require much less. This effort at rulemaking just doesn't reflect the reality of how meetings not just do function but how they need to function. There has to be latitude. Hopefully we'll have good meeting leadership. I'm perfectly fine with putting some suggestions and guidelines that will help that, but it's naïve to be too prescriptive and try to find a prescriptive solution in most of these circumstances. There may be some where we can, and we've done a few things. Council DuBois: I don't see anything in the guidelines about the pre- meeting. Can we suggest that for large agenda items ... Chair Burt: You don't see anything about the pre-meeting or ... 21 May 21, 2015 Council Member DuBois: In the guidelines (crosstalk). Chair Burt: We have it; we do. We may want to expand upon it. Council Member DuBois: What section is that? Ms. Stump: It's towards the end. Chair Burt: Of Procedures, right? Ms. Stump: It's on Page ... Council Member Berman: (inaudible) Ms. Stump: Yes, Page 36. Thank you. Chair Burt: 3.7, this is where we could provide some additional suggestions. I wouldn't support things that are prescriptive, but it's useful to include, for instance, that they will review the approximate time for Staff Reports versus other portions of an item. Mr. Shikada: If I could add also, Chair and Members of the Committee? Based on my experience, I would also share that this varies greatly by the, quite frankly, the temperament and the interaction and the tenor of interaction between Staff and the Council. In some cases there can be times at which the Chair can make it very clear to the City Manager that presentations have been going long. That word is very easy for the City Manager to pass along to Staff, tighten them up. That can reflect the comfort level that the Council has at any given moment in time. Again, that varies greatly based on what's happening in the community overall and the Council's impression of the matter on which the Staff is presenting the information. Chair Burt: I'd add that there may be a time where we say, "In the next month, we've got this really full agenda that we've got to get done. At a different time, we might have a different amount of time we'd allocate for an agenda item, but we're going to truncate it." That becomes a guiding principle for a month or two. That's part of the dynamics of the circumstance. I don't think you can try to prescribe this as a set rule. Cory. Council Member Wolbach: I very much agree. What I'm interested in are those things that provide better information for all Members of the Council and potentially for the public going to the meeting to have an expectation, even if it's only an estimate. If we're going to suggest any changes to 3.7— I'm open to whether we do or don't—it might be to expand Item 1 within 22 May 21, 2015 that to mention something about estimated length of time for Staff presentations. Council Member DuBois: I would make it more general, more of Number vi. Instead of just saying Staff time ... Chair Burt: You said Number vi? Council Member Wolbach: He's referring to his vi. Council Member DuBois: I'm sorry, we're jumping between different lists. Discuss interim times for large meetings including things like Staff time, questions, comments, Motions. I didn't want to just focus on Staff time. It was really the idea of the whole thing. Chair Burt: I would say that for large, complex items, that might be useful. Trying to do that on every agenda item gets ... Council Member DuBois: (inaudible) large items. Chair Burt: Yeah. How do we feel about a combination of what Cory and Tom alluded to, which is under 3.7, Number 1, including review of approximate time for Staff Reports and for large, complex items approximate time allocations for different aspects of the agenda item. I wouldn't say that those get published. This is between the Mayor and the City Manager. Is that good enough guidance? Mr. Shikada: Yes. Council Member Wolbach: Just a question there. Would they then provide that, as had been discussed earlier, to other Council Members? So we all have a sense of what to expect walking into the meeting. I'm open to arguments either way. I'm trying to move back to that question that had been raised earlier. Chair Burt: Marc. Council Member Berman: The length of presentation time, no. We don't need to know that. I don't need to know that. This year the Mayor has been doing a good job of letting us know at the beginning of items that we're going to have three-minute rounds for questions and that kind of thing. It can be done at that point. I don't know that I need an at-places memo giving me a heads up on it. 23 May 21, 2015 Chair Burt: It's really a question of how far we want to go in terms of putting these good practices into our Procedures and Protocols. For instance, what Marc just described is a good practice for the Mayor, under her discretion, to say, "This is a significant item and here's how we have this set up," versus us saying, "Thou shalt do so." Council Member DuBois: I'm in agreement with that. I'm looking at Cory's n iii which is related to this. Specifically, you're getting to things like presentations that aren't available until the night of the meeting. Chair Burt: Can you clarify what you're saying here? What you're recommending? Council Member DuBois: Avoiding reading aloud at meetings. That gets to part of the time of a Staff presentation if they're just reading something out loud. Then making sure that presentations are available digitally, ideally in advance of the meeting. For people following at home, it can be difficult. There are often items that weren't in the packet. I don't know if you want to speak to what you meant. Chair Burt: Go ahead, Cory. Council Member Wolbach: When I was providing these, these weren't necessarily things that I thought needed to go into Policies and Procedures. Some of these were definitely just recommendations for best practices for Staff and Council to consider. That's how I felt about that item. Chair Burt: It's important to bear in mind that there may be practices that are Staff practices that fall outside of the Council Policies and Procedures. Mr. Shikada: If I might do a postscript on that as well. At the risk of speaking out of turn, I believe the City Manager would welcome that type of feedback informally at any time. It's often that those can be conveyed on a one-on-one basis and, presuming no conflict typically among the feedback that's coming from Council, then once again the City Manager can immediately act on that with Staff. As a means of maintaining some alignment in feedback on how the presentations are being received and any issues whether they be concerns or perhaps guidance in providing that back to Staff making the presentations. Chair Burt: Great. Have we covered all the time management stuff? Cory. Council Member Wolbach: Also within that is the question of whether or not to take breaks, whether or not to prescribe breaks. Kniss mentioned it in Item l. 24 May 21, 2015 Council Member Berman: I find that to be a case-by-case basis. I don't know how we'd write that into our Policies and Procedures. That's just my thought. Chair Burt: Tom. Council Member DuBois: Just thinking on the fly. If we did know a break was coming up, we might have less people leaving during actual meeting time. That would be the only thing. Chair Burt: Let me ask this question. Do we think it is appropriate over the course of a Council meeting to routinely have at least one break? Council Member Wolbach: Yes, I do think that is appropriate. Whether it's in Policies and Procedures or not, I would encourage a five-minute break every two hours. Chair Burt: We get tempted when we're feeling the pressure of a meeting to cut it out, skip the break. If we as a Committee want to recommend that as part of these changes, there be at least one five-minute break per Council meeting. Council Member DuBois: I'm not trying to be overly prescriptive, but there'd be value to knowing it was a particular time. Chair Burt: It would be valuable, but I don't know how you would know that unless you are willing to break up items. Council Member DuBois: If it became a tradition that there was a 9:00 break for five minutes, people would not get up and walk out during a discussion. Chair Burt: The tradeoff is if we always have a 9:00 break at that time, then we'd have to be willing to break in the middle of an important item, to split it for that purpose. Council Member DuBois: I'm just throwing out there that I see the value of the break in not having people get up. When a break's a surprise, then I'm not sure we're going to get as much benefit from it. Chair Burt: It doesn't have to be one of those two extremes. The Mayor can say, "Let's plan for a break at the end of this item." That may not be a precise time, but it gives us an estimate. 25 May 21, 2015 Council Member DuBois: Maybe the suggestion would be to put it on the agenda between items. Chair Burt: Except we don't necessarily know how long an item is going to go. Those are only estimates, and they often are far off. This goes back to in a perfect world we could be all prescriptive. That's just not the legislative environment. That's not where we actually do function. Cory. Council Member Wolbach: I agree with the point about if it's on the agenda, that makes it tough. Items can run long. Having something written in our general Procedures or Policies about recommending a break every two hours would not be a bad thing to include with flexibility given to the Council and Mayor as the meeting progresses. On the question of whether we want to have a break in the middle of an item, that's something where it depends on the circumstances. I want to leave it up to us or the Mayor to decide at that time. I can actually see potentially an advantage to having a break sometimes. If you have a long and very contentious and complex item, sometimes stretching your legs, clearing your head for a minute can actually help you focus when we come back. (crosstalk) Chair Burt: I'm not saying you would never have one in an item. I'm saying that what you don't want to do is have a rigidly prescribed time, so that you're in the middle of an important discussion and the buzzer goes off and we have to take a break. Council Member Wolbach: I completely agree. Chair Burt: Let me just try to move this forward by seeing whether there's support for simply an addition to the Procedures that each Council meeting will have a minimum of one five-minute break. That doesn't limit it that we can't have more breaks or longer breaks or any of those things. It just puts a minimum threshold and a reminder in there. Council Member Wolbach: Do we have anything right now? Chair Burt: No, we don't have anything right now. Council Member Berman: I'm fine with that. This is up to the Chair of the meeting, but maybe you put the timer on for five minutes. I don't think I've ever seen us take a five-minute break. We always take five-minute breaks, but they never go just five minutes. That's something to keep in mind. I've seen us have breaks run to 15 minutes. That's excessive. Chair Burt: Having the buzzer on the break is a good practice. I don't think we have to put it in Protocols, but it's a good practice. 26 May 21, 2015 Council Member Wolbach: Sounds good to me. Chair Burt: You're okay with saying we're going to have one break per meeting. We can even say one break per meeting; we don't have to say how long. All right. Let's see. Are there any other things under Meeting Management or we've covered that well enough? It's listed under Meeting Management, but one of the substantive things is Committee as a Whole. We don't have that in our Procedures and Protocols. That's one thing we'll want to discuss. Shall we take that up at this time? Council Member Wolbach: One item that I'd suggested is less about management within the meeting, but how we schedule and plan meetings. That's what I have under n i. I'm okay with taking it up now or later. Chair Burt: Let's see if we can dispose of that one quickly. Council Member Berman: That has some support. Chair Burt: I see what's there. I thought we had a prior discussion of this maybe at the Committee as a Whole. I don't see how doing this has any relation to reality. Cory. Council Member Wolbach: As I mentioned, we talked about this briefly at the Retreat several months ago. My expectation is that this wouldn't necessarily result in fewer meetings, in that we would almost always end up with the second or fourth meetings. Even if this was just a guideline where we have to break it occasionally based on the number of things on the monthly or the annual agenda for the Council. My major reason for suggesting this was to provide clarity and expectations for members of the public, especially about when a continued item would be picked up. Let's spend the first half of the month on this chunk of issues and get through them hopefully in the first meeting. Anything we don't finish we can be put on the second. In the second half of the month, take up another set of issues. In that way when items are continued, they're brought up the following week rather than at some point often undetermined in the future. There might be other ways to achieve the same goal that's less prescriptive. Chair Burt: It's founded on a premise that we might have second Mondays that we don't need meetings for. That's just not there. What we actually have in our procedures is our regular meetings are only the first three Mondays of the month. It seems like that doesn't exist because we invariable need four. This states it as if we only have a need for two. That's why I'm going, "This is a nonstarter." You said we might occasionally break 27 May 21, 2015 this. That's not what we'd be doing; we'd be always breaking our rule. I don't believe in rules that are always going to be broken. What's the point? Council Member Wolbach: Certainly I will acknowledge that the reality, at least over the last several months, has been that we've ... Chair Burt: It's not the last several months. It's the last several decades, Cory. You've been on the Council the last several months. I don't want to get in a long debate on something that's a nonstarter to me. Council Member Wolbach: I'm not trying to debate it. We have an obligation to take up the issues, and I figured I'd explain where I was coming from. My goal was to find ways that items that get continued don't get continued indefinitely with a lot of confusion for the public. That's my number one objective with this. If there are other ways that we could achieve that goal, I'm completely open to those ideas. Chair Burt: We can ask Staff and colleagues, if that's the stated objective, how that might be done. Marc. Council Member Berman: In an ideal world, at some point hopefully in the not too distant future, we get back to having meetings only the first three Mondays of the month. That fourth Monday can be used for that purpose. Pat's right that there's just a boatload going on right now. I haven't been Mayor or Vice Mayor—I've sat in on a couple of pre-Council sessions—so I haven't totally seen behind the scenes. I know it's a juggling act trying to keep all the trains moving on time. I don't think we can set up a system that's that clear cut as to guaranteeing when things will be rescheduled if they're pulled or that kind of thing. Council Member DuBois: The Mayor's been trying to do that to a degree, by having some extra meetings or more Study Sessions or moving non-Action Items to other times, which is getting to what you're thinking about, freeing up the actual meeting to try to get through items. I don't think we've continued that many items. We've had discussion sessions that have continued. Chair Burt: When we have continued items and when it has a need to continue promptly, that's what we've done. The City Manager and the Mayor look at what flexibility there is or prioritization there needs to be in the subsequent meeting's agenda. A typical discussion is which of these things are not time sensitive on next week's agenda. They move it about. That's how you go about doing business that recognizes the circumstances of each situation and goes about that thoughtfully. Ed, did you have something? 28 May 21, 2015 Mr. Shikada: I appreciate the discussion. I'm not sure this will necessarily help. I would call to the Committee's attention one similar discussion that happened in the Finance Committee over the last couple of weeks, which was to suggest moving portions of the meeting during the business day. As a result, there were some juggling of meetings, and they started earlier on a few of the meetings related to the Budget. Once again, I'm not exactly sure how that would work. Talking about the trains being scheduled, how Staff might organize agenda items if it were of interest to the Council to potentially have some items that were conducive to conducting during the business day to happen at that point in time. Just something for your consideration. Chair Burt: Ed, I'll just add as a Council that is not by definition full-time positions, the times historically when that's been done is when on a Committee we had the four Committee Members who either had enough discretion in their work or didn't have a conflict. It was by that consent. As the Council as a whole, it'd be a problem. The other factor that goes into that is the public availability for that is less. If it's something that there's a significant public input, then we're less inclined to make that adjustment, even though there are some practical advantages to doing so. I haven't seen a real problem in how we're dealing with unfinished items. It's not very common. When it does occur, we have a deliberate process by which we either schedule it for the next meeting or, for reasons that are pretty transparent and rational, schedule it for a different meeting. I'm trying to figure out the problem we're trying to solve. Council Member Wolbach: I'm fine with moving on. I was fine ten minutes ago. Chair Burt: Tom. Council Member DuBois: The next section here where things have been referred to the Council as a whole ... Chair Burt: Where are you referring to? Council Member Berman: 2h. Council Member Wolbach: I don't think we're done with this list yet. Council Member DuBois: Aren't we? I'm sorry. Council Member Wolbach: There's the public comment stuff under j ii and m also. 29 May 21, 2015 Council Member DuBois: Which section are you? Council Member Wolbach: Still looking at the (crosstalk). Council Member Berman: 2j ii. Council Member Wolbach: Yeah, 2j ii and 2jm—sorry, 2m—are also kind of meeting management. They're both about public comment. Chair Burt: Let's break those up. They're both about public comment. Council Member DuBois: I think we already spoke about mine. Previously in the Minutes, it was a suggestion to the Mayor if she wanted to try that basically. Chair Burt: This issue of whether to take public comment at a time other than the beginning of a meeting. There are some elected bodies that do that. Palo Alto's spirit has been one where—this is reflected elsewhere in our Procedures and Policies—it's to make the greatest opportunity for public participation. Moving it to the end would meet legal requirements and be less open to the public for their participation. It goes back to the inefficiency of democracy. The more we're an open democracy and the greater the public process, the more conflict there is with efficiency. We have to decide what our values are. Council Member Berman: I agree. Council Member DuBois: Yep. Chair Burt: Does that cover it? Can we go to committee of the whole? Council Member DuBois: I was going to suggest we look at these items that didn't make the list next, because they seem to be more for us than the Committee as a Whole. Chair Burt: You're talking about the backside of the at-places item? Council Member DuBois: Yeah. Council Member Wolbach: Just to clarify, what Chair Burt was suggesting is before getting to the items on Page 3 that are assigned to the Committee as a Whole, there are a couple of things relating to Policies and Procedures on Page 2, Item h and Item i, that refer to Committee as a Whole. 30 May 21, 2015 Chair Burt: Yeah. We haven't historically used Committee as a Whole. This is something that the City Manager had raised as a way for us to be able to address things where we want the less formal setting and conduct of a meeting that we have as a Study Session, but be able to take action. We've used it essentially in our second Retreat, but it's not in our Procedures and Protocols. We don't have such a critter that's identified there. The first question is do we think this is something we want to adopt as a form of a meeting. Then we can go into the particulars about it. What do we think about having a third category of meetings other than regular scheduled meetings and Study Sessions? Cory. Council Member Wolbach: As you've stated, one of the primary objectives of it would be to have a more informal discussion, where you have more back and forth for the Council as a whole. That's a question of whether we like having (crosstalk). Chair Burt: Right. That's the question. What's your opinion? Council Member Wolbach: I'll be honest with you. Going back to our earlier discussion about the sequence of people speaking in regular Council meetings, there have been times in a regular Council meeting when for myself and noticing it for others, I would have liked a little bit more informality and a chance to go back around. Have a couple of rounds of questions. By the time I've heard other Council Members ask their questions, I realized there was something important I'd never thought of before that came to mind. Whether it's in a separate meeting or allowing for a little bit more informality in the regular Council meetings, I would like that. Chair Burt: It's a separate subject. Council Member Wolbach: If the regular Council meetings were able to achieve that, then I don't think it's necessary. That's why (crosstalk). Chair Burt: Let me just say then if it's done in regular Council meetings, we have to revisit the whole conversation we had earlier about restricting time and all of that. This is part of the tradeoff problem. I agree with you. This is part of why I was arguing for flexibility in how regular Council meetings are conducted. We're a deliberative process which hopefully means we're listening to the public and listening to each other. Over the course of a meeting, it may either prompt thoughts or change our minds. That's a good thing. Let's focus for the moment on the concept of the committee of the whole. Let me put it out there so we can move forward. It's a good idea, and we should at least allow for that as a form of meeting that allows the City Manager and the Mayor to use that form where it seems to be the most effective way for the Council to proceed on business. 31 May 21, 2015 Council Member Berman: I agree. My concern about all this isn't with the form of the meeting. It's a good form of meeting; it can be helpful with certain topics. I can't decide whether or not it falls under this topic of discussion or not, the frequency of them and the frequency of the non-first third Monday of the month meetings. I'm happy to just throw that out as a general concern. If it comes up later, I'll not bring it up. I don't know if we meant to talk about the frequency of these as well as the benefits of the form of the meeting. I want to make sure that we don't use this as a fifth and sixth and seventh Council meeting of the month. Chair Burt: Tom. Council Member DuBois: We had a meeting of the whole, and we're saying it was not defined essentially. Council Member Berman: Yeah, which is odd. Council Member DuBois: I'm looking at the rules on Committees, and the ad hoc committee specifically says it's less than a quorum of members. Was it really just a special Council meeting that we had? Chair Burt: It was, yes. Ms. Stump: Legally, yes, it's a Council meeting. Council Member DuBois: Where it makes sense is for topics where an ad hoc committee may not work because so many Council Members want to participate. The Comp Plan may be a good example where we may not want to appoint a committee of four of us. If a Comp Plan issue came up, we may want to have a committee of the whole meeting. That flexibility is good. The question is how much do we need to define. If we do define it—I'll echo Marc—that we should have a little bit of an indication of how often it should be used or when it should be used. Chair Burt: I would agree. I'm trying to think about how we would give guidance to not overuse it. Just like a Study Session, it can be on the same evening as a regular Council meeting. We've had a lot of times where we have Study Sessions. We call it a Study Session, because we wanted to be able to dig deeper and have the informality of probing into a topic, but we can't take action. If we could foresee that that may happen, that we may want to take action after a Study Session, then we schedule in succession an agenda item on the topic that was in the Study Session. It gets broken up. If you take what we did at the one Committee as a Whole meeting, we were able to go through and as the meeting progressed say, "Is this a specific 32 May 21, 2015 proposal? Let's have a motion and vote on it." It was a series of Motions within a broad agenda item. In fact, it was how we got referred a bunch of these. It worked well. I can tell you over the years there's a lot of times where we got done with a Study Session and it got referred to—let me give you an example. We had a joint meeting with the UAC, and we gave five directions that we wanted to see the UAC pursue this coming year. It was a Study Session, so we didn't take any votes on them. If you look at the meeting and review it, there was strong consensus on the Council on all the items. There was almost no dissent. It went back and the UAC thought they had guidance from the Council to proceed. Staff said, "No, there was no vote taken. There's no such guidance." It might be a little more awkward when we have a joint meeting, but it does give an example of how we have Study Session-like meetings where we want to be able to take actions. Council Member DuBois: There's a lot of good language in the language around ad hoc committees that we could use. Chair Burt: Give us the Page and stuff. Council Member DuBois: Make sure I have the right packet. I'm looking at (crosstalk). It's Page 26 of the Protocols and Procedures. It's a limited basis where necessary to study City business in greater depth than possible in time allocated for a Council meeting. The Mayor would decide when there is a committee of the whole. The difference here is that it's all members instead of less than a quorum. If we just directed Staff to model it on this, change it where it needs to be change. That would accomplish it. Chair Burt: Does that sound good? Council Member Berman: Sure. Chair Burt: Thank you. Pardon me? Council Member Wolbach: Sounds okay to me. Obviously the Brown Act would apply, so that would be one of those things that Staff would remove, that language. Chair Burt: Molly, does that sound good? Okay, great. Before we go to the at-places memo, do we have any other things that we haven't gotten through on these referrals? We're going to have the whole discussion on what goes into the Committee as a Whole. We have a whole Page of that, Page 7 of the packet and Page 3 of the referral items. 33 May 21, 2015 Council Member Wolbach: I've been trying to check these off as we've been going through them. I don't know if we've addressed Schmid's Item 2g, give Council periodic agenda item to make comments on Council agenda priorities. That's on Page 5 of the packet. Chair Burt: We do receive from the Clerk the upcoming agenda and then those things that are a list of future agenda items that no meeting date has been set for. Correct? Ms. Minor: That's correct. There's also another one that I'm sending out that now lists the Action Items and Study Sessions. Chair Burt: I don't see what prevents Council Members from doing exactly what Vice Mayor Schmid is asking for. Council Member Wolbach: Yeah. I'm just trying to put myself in his shoes, which is very difficult. I wonder if maybe he's referring to our annual Priorities, a periodic chance to have a Study Session or a committee of the whole or some agendized item to discuss how we're making progress towards those annual Priorities. I wonder if that's what he means. Chair Burt: Which letter again are you referring to right now? Council Member Wolbach: G. I could be wrong. I'm just trying to read it. It's give Council periodic agenda items to make comments on Council agenda priorities. I'm trying to think why would we want to have a periodic discussion of our Priorities, except maybe just to see how we're making progress on it. I don't know if that's ... Chair Burt: I'm trying to think through that. Council Member Wolbach: I could be mistaken or reading into it. Council Member DuBois: The question is if we individually mail in questions or comments from the upcoming agendas the Clerk sends out, is that the same thing as having a periodic discussion of are we spending our time on the right things. I think that's what he's trying to get to. Council Member Wolbach: Like a midyear review. Maybe after the break, check in and say, "How are we doing on our Priorities that we set during the Retreat." I'm not sold on it, but that's what (crosstalk). Chair Burt: It's a separate question whether that might be a good practice. Is that something that a Council Member raises at Council Comments and says, "I'd like to ask this to be agendized." Do we put it into our regular 34 May 21, 2015 Procedures and Protocols? Holy smokes. (inaudible) one-by-one. What are the thoughts? I'm not yet convinced that it should be in Procedures and Protocols. Council Member Wolbach: That's where I am. Chair Burt: Not a bad idea, but leave it out of Procedures. Do we want to go into the Committee as a Whole in greater depth? Council Member Wolbach: Maybe Tom is right that we should address these first, because they ... Chair Burt: Okay. I can do it either way. The suggestion has been made that we go to the at-places memo. Most of these are not Council Policies and Procedures. These are not changes. We're going to go off topic here if we do that. I'm okay. This is informal enough, but these are things that are specifically not in the Procedures and Protocols. Mr. Alaee: Chair Burt, that is correct. That's why they weren't in the original Staff Report. In conferring with the City Manager before we brought the item on the 8th, he said that we better bring them because they were brought up at the Retreat. Chair Burt: Let's put those off until the end, because they're out of sequence. Council Member DuBois: Where is something like the revolving door policy captured? Chair Burt: Wait. We're going to talk about that later. Council Member DuBois: Where is it, if it's not in here? Ms. Stump: It's in the Municipal Code. Chair Burt: We'll talk about where it is when we bring up that item. Committee as a Whole. Here are some of the sub-subjects. We've already asked Staff to frame it around the way we do ad hoc committees and things, but let's see whether there is anything else here that we would add to that direction as a result of considering what's before us. 1a sounds specific to a one-time event and outside of what we're discussing here. We've already addressed in the Committee as a Whole 1b. That does need to come back to the Council. I guess it would come back when we have these changes to Procedures. 35 May 21, 2015 Mr. Alaee: Correct. Presumably we'll get through everything tonight. If we don't, then we'll have another meeting. We'll bring all the changes back in the Manual to you, and then we can review it again. Chair Burt: In the interests of proceeding, interrupt me if you disagree. I'll say 1a is not applicable to Procedures. 1b was already covered by the Council as a whole. We do have the discussion of Core Values, but that should be over on this other sheet. It's not part of the Policies and Procedures. Council Member Berman: Are they trying to ask here what types of things should be sent to a committee of the whole? Mr. Alaee: Yes. Just to frame this for the Council again. At the Retreat, these items were already referred to the committee as the whole. Council Member Berman: We already did that. Mr. Alaee: (crosstalk) Committee as a Whole. We've just identified them here for you in case you wanted to have a more substantive conversation. Chair Burt: This is not about the nature of the committee as the whole. This is about potential agendas of the Committee as a Whole. Mr. Alaee: Topics that will be discussed. Council Member DuBois: At the committee of the whole meeting, we said that we may discuss these at Policy and Services but they'll (crosstalk). Chair Burt: Sorry. That's different from what I understood. My apology. Mr. Alaee: Correct. This is just in case you want to add any more substance or give us more direction to do homework before we bring them back. Chair Burt: As we go through this meeting, this like the things at-places is outside of our Policies and Procedures. At the beginning of the meeting, if you recall, I said, "There are some other things in our Policies and Procedures that were not identified by colleagues going into the start of the year." We have our annual review of Policies and Procedures. I had some notes and other colleagues may have notes about issues that need to be cleaned up in Policies and Procedures. At this time, I'd like to go into any other recommended changes to Policies and Procedures. If possible, do it sequentially as we have them in the existing Policies and Procedures. I have some notes, but others can proceed first if they have any. 36 May 21, 2015 Council Member DuBois: Can we just go through the Pages and then you speak up (inaudible)? Chair Burt: I'm trying to remember at the last meeting whether we did proceed that way sequentially or no. Council Member Berman: I don't think we'd gotten to that point, because ... Chair Burt: If we can do it expeditiously and only pause where we actually have recommendations. Page 1, 2 or 3, anything? Council Member Wolbach: I don't have any. Chair Burt: I have something small on Page 5. Maybe I mentioned this last time. It's this directive that says meetings will begin at 7:00 P.M. I'd say more language of "are to begin" or "are scheduled to begin." Council Member Berman: Frankly they all begin at 6:00 now anyhow. Chair Burt: That's a good point. We should say that the regularly scheduled meeting time is 7:00 P.M. Is that a more accurate way to put it? Council Member DuBois: Should we talk about changing the regular time to 6:00? Ms. Stump: That was done last year. The Municipal Code now reflects that the Council meeting starts at 6:00. This just needs to be trued up. Chair Burt: It does say that it does start at 6:00 or it may start at 6:00? Ms. Stump: No. It provides for a regular start time at 6:00. When the Clerk notices a meeting for 6:00, it's a Regular Meeting. When she notices it for 5:30 or 5:00, it's a Special Meeting. It's an Ordinance that Council passed. Chair Burt: What if we don't start it at 6:00? What if we start at 7:00? Ms. Stump: That would be a Special Meeting also. Chair Burt: That's a Special Meeting at 7:00. Ms. Stump: The Council passed an Ordinance last year. For more than a year, every meeting was a Special Meeting starting at 6:00, so the Council passed an Ordinance providing the regular start time would be 6:00. 37 May 21, 2015 Council Member Wolbach: You said this just needs to get cleaned up to reflect that. Ms. Stump: The Municipal Code trumps the Procedures, but Procedures should be aligned. Chair Burt: We'd need to just reflect that, say the regularly scheduled meeting time is 6:00 P.M. Mr. Alaee: Just to add onto that. When the Municipal Code was updated, the Clerk did update the Procedures with some minor edits. We haven't brought that forward pending this conversation. If you look in the next paragraph, it's been changed to the sentence that begins with it is City Policy to make every effort to complete and distribute an agenda and related reports by the proceeding Wednesday. It's now been converted to Thursday, 11 days prior to the meeting. That's been updated as well. Chair Burt: It might be useful to not only say that the regularly scheduled meeting start time is 6:00 P.M. Other start times will be listed as Special Meetings. Maybe it's clear enough elsewhere, but this might be the appropriate location, so that in one place it says what Molly just described. Council Member Wolbach: Would that go under a or would it go under b, which is Special Meetings. Just to say any meeting starting at a different time. Chair Burt: Either way. Ms. Stump: You certainly could say that. That is what State law requires, but you could repeat that here if you'd like. Council Member Wolbach: That clarity might be useful. Chair Burt: Just a note under c which is our Study Sessions. It says it's intended to encourage in-depth discussion. What we do have sometimes is direction and moderately frequently because they're typically one hour, you'll have one round of questions. My point is that seems to be in conflict with the stated intention of Study Sessions. We lose that ability to have discourse and follow-up questions. It doesn't mean that we have to change this. It's one of those where we need to reflect on abiding by it. It says it's in an informal setting. Some are on the dais, and the setting is not any less formal. That probably needs to be changed to something that says it's conducted informally or less formally. Does it ... 38 May 21, 2015 Council Member Berman: Unless us being crammed together is informal. That's right. Chair Burt: I like the idea of having them in other settings. Council Member Berman: We just don't always do that. Chair Burt: Those are my comments on that. A new e would be where we'd put in Committee as a Whole. On 2.4A, it says attendance required. Maybe that's okay. I don't know what the consequence is of not doing what's required. Council Member Berman: Levy fines. This is so vague it's fine. Chair Burt: Maybe it's fine the way it is. We've already got through the telephonic discussions at our prior meeting. That, I think, takes us all the way over to ... Council Member Wolbach: Can I just ask a quick question? Chair Burt: Yeah, sorry. Council Member Wolbach: You mentioned under 2.3E add a section on Committee as a Whole. When we were talking about committees of the whole earlier, we were looking at maybe adding it on Page 27. Do we want to do that in both places? Chair Burt: Potentially yeah. Council Member Wolbach: That's fine. I just wanted to clarify. Chair Burt: This is a much larger project, which is part of what I brought up at the outset of the meeting. We still haven't defined what a Policy is versus a Procedure or a Protocol. That is something we should yet take up. What we have is a hodgepodge of things. As I stated at the beginning of the prior meeting, I have always interpreted the first section as the Procedures as being more directive, and the second section of the Protocols as being more guidelines. Even the directive one is not legally binding in any way. We have no introduction that even attempts to describe the difference between a Procedure and Protocol, even if those descriptions are not legally binding in some way. That's one question. Do we mean for the Procedures to be more prescriptive? If so, do we want to have Staff come back with suggested language that we can weigh at our wrap-up meeting on this? Tom. Council Member DuBois: Were you going to say anything? 39 May 21, 2015 Chair Burt: Marc. Council Member Berman: No. Council Member DuBois: I think we had this discussion last time. I was happy with our City Attorney's description. Just looking at the Minutes, the terms themselves aren't legally binding. There was an intention in the document, but it doesn't bother me the way it is. Chair Burt: Why do we have two things then? Why do we have Procedures and separately Protocols, if they aren't different? Council Member DuBois: We use the terms interchangeably. I know there's the two sections. Chair Burt: They really are different. Without the distinction we start using them interchangeably, and that wasn't the original intent. There are differences. If there is no difference and we're using them interchangeably, they should be one, not two. Cory. Council Member Wolbach: I don't know if you want to take up the task of trying to define them this evening or not. Perhaps each of these, the section on Procedures and the section on Protocols, could begin with a short preamble or something explaining in this section we will explain either the City's Procedures or the City's Protocols for the purpose of X, Y, Z. I don't know if we want to get into the definitions tonight or at a future meeting. Chair Burt: What I was suggesting is that Staff come back; we give them a framework for them to come back with language that we can review at the wrap-up meeting. The framework that I would suggest is that Procedures are more directive, and Protocols are more guidelines. Not that simple of a description. They'll probably have several sentences, but along those lines. If you look at the content, it aligns roughly with that kind of .... The other thing is that I have a recollection from a decade or more ago, maybe 15 years ago, listening in to Council discussions around their updates. They were along the lines of what I'm describing. Because it was never codified, we've lost sight of it, and we start saying they're interchangeable. That wasn't why there were two different sets of guidelines. They weren't interchangeable historically. We don't have to make the decision tonight, other than perhaps to ask Staff to come back with prospective language, and then we can decide whether we do want to go forward with such a recommendation or not. In the interests of moving it forward, I'd recommend that we ask Staff to at least give us some draft language, and then we can (crosstalk). 40 May 21, 2015 Council Member DuBois: Sounds great. Council Member Wolbach: Sounds okay to me. Council Member Berman: I'm fine with that. Council Member Wolbach: Would we want to suggest that Staff do that as a preamble to each section? Chair Burt: Mm-hmm. Council Member Berman: That would be the right place. Great. Chair Burt: Let's see, where did we leave off? We had gone through telephonic conversations as well as on Page 8 discussions about meeting closure time. I had a note under Council comment. I'm sorry. Council Comment, at the end. Council Member Berman: No Council comments. Chair Burt: This is F on Page 9. This is under Consent Calendar. I'm just trying to find whether this is all under Consent. No. This is always a little confusing to me. Council Member Berman: L on Page 12, no. Chair Burt: This is 2.4F. I don't know, Beth, if you have any guidance here. Ms. Minor: (inaudible) Chair Burt: It pops up as Council comment, but it's actually a description of what to do with the Consent Calendar. We have other places that we have Consent Calendar. If this is under the agenda, we want to keep that there. We should simply re-title it. It's about Council comments on Consent Calendar items or something to that effect. Cory. Council Member Wolbach: What's missing here is a section heading to say that this is addressing Council comment. It looks like this several-Page section of the Protocols ... Chair Burt: This is under Section 2, which is Council meeting and agenda guidelines. Then 2.4 is general requirements of Council meetings and agenda guidelines. That's what we're in. 41 May 21, 2015 Council Member Wolbach: Right. It looks like it goes through meetings and the sections of the meeting in roughly the sequential order that they typically are agendized. That's why it goes from Consent Calendar. We're under E6. It's listing the first few items that are usually at the start of a meeting. Under agenda order, which is E, and then it goes to a discussion about Consent Calendar. Council Member Berman: You're saying it could be under (crosstalk). Council Member Wolbach: Actually what I think the ... Chair Burt: I'm sorry. Let me just jump in here. It's not really following a good flow, but F is about Consent Calendar. The point I was trying to make is that if Subsection F is about Consent Calendar, we should title it that way. Beth. Ms. Minor: It appears that both Section F and G refer to the Consent Calendar, whether it's Council comment or public. We could put a subsection under the 6 above, where it shows Consent Calendar, and make those as a part of it or include it in that above. Chair Burt: That's just about agenda order. That's why 1 through 6 fall under E. They're about order. F and G are about how to conduct the item. They need their own subsections. F and G could be combined to Consent Calendar item, and one part of that is Council comments. The other part is public comment. Council Member Wolbach: If I might add ... Chair Burt: I'm sorry. H is Council request to remove an item. Council Member Wolbach: The whole next Page is Consent also. Chair Burt: I'm sorry. As I'm going through it, we need a whole section on Consent, and then these become subsections. Council Member Wolbach: That's why I was (inaudible) earlier. Now the way it's currently formatted, it looks like it was inserted in the midst of the agenda order, and that's why the agenda order ends with Consent Calendar. It doesn't include Action Items or Council Member Comments. Those get picked up as Item 7 on Page 11. (crosstalk) Chair Burt: Let's just take what you said. It does seem that under E the balance of the agenda order should be included there. Then we have a whole section on Consent Calendar items. I do have a couple of comments. 42 May 21, 2015 Before we leave Consent Calendar items, if it's okay I'd like to hit that. One thing is that we already say the Mayor has the option of allowing testimony prior to adoption of the Consent Calendar. Do we simply want to change that? Are there circumstances where we don't want to allow the public to speak until after we've removed items or voted on them? The Mayor has been doing that, and it's a good practice. If the public's going to speak, it should be before we take action rather than after we take action. I'm seeing the City Attorney give agreement. Ms. Stump: Yes. The rule is awkward the way it's written. The way the Council's practice has developed recently is pretty sound. If you're going to approve an item on Consent, legally you want to have given the public a chance to speak to that item before you approve it. Where you know you're going to remove it, it's fine to delay the public comment until the item is heard. You wouldn't want to do it the other way around. It almost presupposes the result. Or you take the public comment regardless and then take your vote. Chair Burt: I'm not quite clear how to reflect what the City Attorney just stated. There is this other circumstance where if we know we're going to remove it, the public may have different comments if they've been told we're going to remove it. Their comments are generally please remove it. We aren't going to go into the substance usually that evening; although, sometimes the public came for that purpose and they want to speak to that substance. Do we simply want to ask Staff to come back with language that reflects these two circumstances? How do we know we're going to remove until we've heard from the public? Marc. Council Member Berman: One thing we could try is before public comment on the Consent Calendar items, the Mayor asks Council if anybody wants to remove an item. If so, then great. If not, then we go to public comment, and maybe public comment sways Council Members' opinion and has that effect. At least that gives that opportunity. Chair Burt: That's probably the reality. Do we want Staff to come back with language that reflects what Marc just described? That the Mayor would give the Council Members an opportunity to remove items from Consent. If they do at that time, public comment on that item would follow the removal from Consent. If items were not removed from Consent, the public would be allowed to speak, and the Council would have an opportunity to remove it from Consent at that time. Cory and then Tom. Council Member Wolbach: You'd have two opportunities to pull something, before and following public comment. 43 May 21, 2015 Council Member Berman: (inaudible) Ms. Stump: Essentially the Council has that now. Until you approve the Calendar, you can ... Council Member DuBois: How is that different? Ms. Stump: It's not that formal about exactly when you have to take it off. Chair Burt: I'd say the difference is it's never been clear, and it's been done a whole bunch of different ways at the discretion of the Mayor, including not letting the public speak until after the Council has decided not to remove something from Consent and not giving the Council another opportunity. The lack of clarity has been problematic over the years. Council Member DuBois: Where would this change be, and could you say it again? Chair Burt: It would need to be reflected in Council request to remove the item as well as under the public comment. We just have to look at how to fit these concepts into those two sections, I would think. Council Member DuBois: It sounds like you want to change G and not give the Mayor the discretion. Chair Burt: Oh, correct. That's what Molly just said. It is probably not lawful to have that discretion. Council Member DuBois: Just to be clear, we're just editing G. Am I missing something? I want to make sure I understand what you're saying. Chair Burt: The H edit is that we would have a second opportunity to remove it from Consent after hearing from the public. Council Member Berman: To formalize the process. Chair Burt: That would have to be in H, because it talks about when the Council can request to remove an item. Both changes would have to be there. Council Member Wolbach: Just to clarify for everybody's benefit. One change to G would be to remove from the Mayor the discretion to refuse public comment. Secondly, the change to H would be an opportunity to remove an item from Consent both prior to and following any public comment. 44 May 21, 2015 Chair Burt: Correct. Are we okay? Council Member DuBois: Yeah. There's no timing in H right now at all. Chair Burt: We've asked them to come back with language that will reflect what we just described. Council Member DuBois: All right. Chair Burt: I don't know why I have some other note here about appeals and Individual Review. I guess that was a placeholder to remind me about whether we want to have any discussion on changing any threshold for Individual Review. There was some discussion—maybe this was at the Retreat or the Committee as a Whole—about changing thresholds, how many Council Members would need to concur with pulling an IR item from Consent. We didn't change anything, did we? Ms. Stump: I don't believe so, no, Council Member. Just to inform folks, there are various requirements in this regard that are in our Municipal Code, in the Zoning Code, and in other places. The Procedures and Protocols are not complete. The Code is the last word on these particular types of appeals. That's where the IR requirement is. Chair Burt: You gave that guidance at the beginning of the last meeting, that some of these things would be most of all a recommendation to the Council to change the Municipal Code. If that occurred, then we'd track it here. I don't know whether we want any consideration at this time. It maybe belongs more in that other bucket list that we're going to hit later. There's no point in talking about a Protocol change if it's a Muni Code change. Cory. Council Member Wolbach: I've got something to say, but I'll let Khash go first. Mr. Alaee: It's Item Number 2 on the at-places memo. Chair Burt: Thank you. That was fast. Council Member Wolbach: I was just going to ask that we do give direction now to Staff to provide clarity in this document that we're editing for whatever the thresholds are, whether they get changed or not. They should be very clear here. 45 May 21, 2015 Chair Burt: A good point, that the Procedures and Protocols reflect what's in the Muni Code. This is still the guideline and the reminder for the Mayor and the Council of what it is, and we don't have to fumble through the Muni Code to figure out what the threshold is. Ms. Stump: Yes. Just to be clear, the Procedures have a backstop or a standard rule. For example, the number of votes to remove a contract item, there isn't a different Procedure in the Muni Code. It's whatever you have in your Procedures. It used to be two; now it's three. Council Member Berman: Can I ask—sorry to interrupt—the Chair? Do you have a sense for how late you intend on tonight's meeting going? It's 9:20. Chair Burt: Yeah. Not past 10:00. Twelve, near the top—I'm sorry. Council Member Wolbach: I was just going to highlight for Staff that of those items that we want to maybe relocate under—as we try to consolidate and complete the agenda order on Page 9, E, it looks like Item 7 on Page 11 is one of those. Actually it looks like all of these are. Several of them are items that really go under agenda order. Council Member DuBois: Six (inaudible). Chair Burt: They may be placed both locations. One to simply talk about the order. The other to speak about the substance of ... Council Member Dubois: It's just a formatting error. Six and 7 on Page 11 really belong under E. Is that going to (crosstalk) Chair Burt: My point is they also belong under E, but there are two purposes. One is to simply list the agenda. Council Member DuBois: They're not Consent Calendar categories, which the other items in that list are. Council Member Berman: They definitely don't belong (crosstalk). Council Member DuBois: The list is ... Council Member Wolbach: It's this list. Council Member DuBois: No, I'm talking about here. Council Member Wolbach: What I'm saying is there's a formatting error that leads to this list being here. 46 May 21, 2015 Council Member DuBois: Right. Six here (crosstalk) Chair Burt: E is the agenda order. Council Member Berman: (inaudible) 6 and 7 aren't here and here. Don't (inaudible). Chair Burt: I see. At the top of Page 10, J i, see. It's all under J. Council Member Berman: Which is Consent Calendar. Council Member DuBois: Six and 7J don't belong there. Chair Burt: Yeah. Six and 7 are K and L, right? Council Member DuBois: No. I think they're actually ... Chair Burt: I mean a new ... reordered in ... Council Member Wolbach: That's what I'm saying. They're actually 6 and 7 from List E. Council Member DuBois: Actually they're 7 and 8. Council Member Wolbach: They would be 7 and 8 for ... Council Member Berman: There's no substance (crosstalk). Council Member Wolbach: ... lists under E on Page 9. This is the formatting complexity. Chair Burt: Is there somewhere else—I assume there is—under Action Items where we go into all the details? Council Member Berman: You hope so. Chair Burt: That may be that the way they're listed there. Council Member Wolbach: The same thing is true of Items L and N on Page 12. Council Member Berman: Those have substance under them. That's more than just a list. 47 May 21, 2015 Chair Burt: Action Items have a whole section about how we conduct ourselves under Action Items. I'm just trying to relocate it where we go into the discussion of Action Items. That's much of what we're doing. Council Member Wolbach: I'm fine with just asking Staff to clean up the formatting. Just let you guys figure it out. Mr. Alaee: If I could throw a suggestion to the Committee. When we do this, we'll probably benchmark other agencies' Policies and Procedures, look at best practices, look at some more professional associations. We may provide some Staff revisions to the whole document to align with that. Maybe if the Committee wants to focus on some of the broader Policies, substantive stuff, we'll deal with those. Chair Burt: It does seem that J6 and 7 actually belong to part of E. Elsewhere, at least Action Items needs to have its own section. I don't know whether Agenda, Changes, Additions and Deletions, whether we have substance, maybe we'll find that as we go through it. I'm at the top of Page 12 which is about Council matters. I tend to think it should have its own header about Colleague's Memos. This is actually all about Colleague's Memos, that first paragraph. Actually two paragraphs. We call it K, Council matters, but it's Colleague's Memos as I dug into it. That's just a re-titling issue. Council Member Berman: The entire thing. Chair Burt: Yeah, three paragraphs. Council Member Berman: You're right. Chair Burt: Or two paragraphs. Council Member Berman: It is technically (crosstalk). Chair Burt: As I looked at it, there are a number of things. First, if you look at the third line. It says prior to preparing a Colleague's Memo, Council Members will consult with the City Manager to determine whether he/she is or is willing—I think there's some wording error there—whether he/she is or is willing and able—weird—to address the issues as part of his/her operational authority. The his/her or he/she, we should say the City Manager. This sounds like an error when we were struggling with gender. Within current budgeted resources. First the process is generally that Council Members draft a Colleague's Memo amongst each other and refine it somewhat, and then submit it to the City Manager and the City Attorney for their comments, with the City Attorney being a more defined role to give 48 May 21, 2015 feedback on whether there are any aspects to it that are legally problematic. The City Manager will at his discretion raise a suggestion or otherwise that can be accepted or rejected by the makers of the Memo. Then we have another aspect which is an obligation to have the City Manager provide any comments on fiscal impact. We have a prescribed section of the Memo that does that. These paragraphs get convoluted. They don't necessarily reflect that practice nor the sequence. I saw a number of things that needed to be—I don't know what that one sentence means. Council Member Wolbach: I think I figured that one out. Chair Burt: You look down at the last sentence in that first paragraph. We need to update it. It says it's by noon on the Tuesday, so that's changed. It's got to go to the Clerk on the Tuesday before the meeting that the Memo is intended to be agendized. The makers of the Memo often don't know when they're going to be agendized, and that ends up being between the Mayor and the City Manager. I thought elsewhere in here—no, it isn't. There's no clarity on how soon a Colleague's Memo should be agendized. Even if we don't have clarity, there should be guidance. We wouldn't want a City Manager to be able to essentially pocket veto a Memo. There should be some guidance that it will be as soon as it can be practically scheduled in the agenda. Something to that effect. It doesn't say X weeks. Tom. Council Member DuBois: It says within two weeks. Chair Burt: That's after we first get it. That goes into the next area, which is what we do when it comes to the Council and whether we refer it to a Standing Committee or go into a deeper discussion. That doesn't reflect the way we do Colleague's Memos either. Somehow the practice has drifted away from what's in this Procedure by quite a bit. Council Member Berman: The first question is, is current practice better than this. I'd probably argue yeah. Chair Burt: I would too. We've morphed into the right current practice, and we never had the Procedure track the practice. Council Member Berman: Should we give general guidance to Staff right now of draft a new section that reflects current practice with the caveat of there being some mechanism to make sure that there's a general timeframe within which it'll be initially agendized? Chair Burt: Mm-hmm. Council Member Berman: Does that cover it? 49 May 21, 2015 Chair Burt: I think so. Council Member Berman: You might have other good points that you wanted to ... Chair Burt: That covers it well enough for me. Is that okay? Cory. Council Member Wolbach: I was just going to say I agree with that direction to Staff. As far as that one sentence, the idea was that prior to bringing the Colleague's Memo to the full Council, that you'd find out is this going to require additional budgetary assignments, as you referenced as fiscal. Chair Burt: There's operational authority and current budgeted resources. Council Member Wolbach: That way Staff would be prepared to tell the Council when the Council considers it how substantial a change would be required. Chair Burt: That's in our current practices. This actually says prior to preparing. Our current practice is prior to submitting. Council Member Berman: Yeah, during preparation of. Chair Burt: The preparation process involves the colleagues going through their few drafts. When they think it's close enough, they ask the City Manager and the City Attorney for their input. If the City Manager says, "You can't ask me to do that. I don't have operational authority to do this," and it's not a question of whether it's in current budgeted resources, it's asking what would be the budget impact. Council Member Wolbach: There actually might be a good question here. Do we want to encourage or direct Council Members to come very early on to the City Manager, so that they have a sense of whether—maybe what they're asking for, maybe they weren't aware, didn't realize it's already being addressed or is already covered. That way as they go through iterations of putting a draft together, they have early (crosstalk). Chair Burt: I don't think we want to prescribe it. We typically have at least three Council Members drafting. Hopefully among those three at least one has a sense of the operational authority. We don't have an issue of whether it's within the current budgeted resources. It's really what would be the financial impact of it. The Policy can drive budget decisions. This, as it's written, is saying if it's not within the current budgetary discretion, you can't bring it up as legislators. 50 May 21, 2015 Council Member Wolbach: I'm not sure necessarily it does say that. It might just be so that when it does come up for discussion, that's one of the things that everybody will be prepared to discuss and understand. Council Member Berman: Let's just make sure the new one reflects ... Chair Burt: Let's see. The second to last sentence says to the extent possible, Council will confer with Staff before raising matters under this agenda item. That's saying that if we're going to ask a question or make a comment ... Mr. Alaee: I'm sorry, Chair Burt. Where are you? Chair Burt: L, Page 12, Council Member Questions, Comments and Announcements. If I read this correctly, it's saying that we're being told— and this is not something I've observed in practice at all—that in advance of a Council Member question or comment, we're supposed to confer with Staff in advance, before we raise anything at Council Questions or Comments. I've never seen that in practice. Molly. Ms. Stump: Thank you, Chair Burt. When I read that, I thought that that might refer to a dynamic that doesn't typically happen with this Council under this agenda item, which is a very specific question of an operational nature or a concern about something that's going on where maybe the City Manager would have needed to be prepared to address the item. This Council tends to use Council Questions, Comments and Announcements more to announce activities that are fully within your control, that you've been doing in the community and you want to share with the public and your colleagues. Chair Burt: If we have that potential contingency that you just described, maybe we should say if a Council Member has a question of this nature, they should do the following. Does that seem reasonable? Cory. Council Member Wolbach: That seems reasonable. I would also suggest that the issue of oral Colleague's Memos or raising an issue shouldn't be lost here. We might want to provide a little bit more clarity, not that I necessarily want to encourage the practice of oral Colleague's Memos (crosstalk). Chair Burt: Let me just pause here, because your point's well taken, except that maybe elsewhere we may have reference to the ability to agendize items by two Council Members under Council Member Questions, Comments and Announcements. I'm pretty sure it's somewhere else in our Procedures 51 May 21, 2015 and Protocols. Let's put that as a placeholder, and maybe we need to consolidate those. I believe that it is elsewhere, and I can't recall where. Council Member Wolbach: I might have missed it. Chair Burt: Under Closed Sessions, we now have to take a vote. That's not reflected there under M. Under O2, I don't think that reflects how we do it. When a Regular Meeting is adjourned to another Regular Meeting night, all unfinished items will be listed in their original order after roll call. We don't do that. I'd suggest, once again, that we ask Staff to come back with language that reflects current practices. Cory. Council Member Wolbach: That brings up one of the issues I was talking about much earlier in the meeting, one of my ever general suggestions about having items that get continued pushed to the very next meeting. Apparently that was, at least implied here, to be our previous role. Ms. Stump: I think that this was drafted to track the Brown Act, but it doesn't reflect this Council's practice. I think this Council has the practice that it wants, which is that when agenda items are continued, there is a prioritization and the Chair, the City Manager and the Clerk work together to juggle and get it right as opposed to do it in a rote way which might not reflect the priorities. Chair Burt: Where did I have the Closed Sessions? I see that we have Closed Sessions under M and then we have it under S. I'm not clear, no real reason. That needs to be cleaned up so that we have one section for Closed Sessions. I don't have anything until I get over to Page 23 or maybe further. I don't think I have anything for quite a ways. Anybody else have any in the subsequent Pages? Council Member Berman: I don't. Chair Burt: Just check one thing, because I made notes in a prior iteration of this. I don't want to skip anything. I'm all the way over to Page 36 before I have anything else. I don't want to run past it if anybody else has anything. Council Member Berman: Packet Page 36 or Protocol Page 36? Chair Burt: Protocol Page 36. The work of Standing Committees. One of the things that is already in the Protocols but has been somehow misunderstood is this notion that if something comes from a Standing Committee unanimously, it will necessarily be on the Consent Calendar. In both 3.6, maybe it's just 3.6. It says that unless otherwise recommended 52 May 21, 2015 by the Committee, Mayor or Staff. We had talked about that we've done that as a Committee, but the Mayor or the Staff—I don't know whether Staff ought to be City Manager. I think it should. Molly agreed there. Council Member Wolbach: Maybe City Manager or City Attorney. Not with our current executive team that that would ever be a conflict. Chair Burt: Are there times where something might, at your discretion, want to come off of Consent that was unanimous? Ms. Stump: It seems like a very remote possibility. Chair Burt: I throw it in there, because we wouldn't want to preclude that if you thought it was appropriate. Ms. Stump: Right. I wouldn't be precluded from speaking up, if I thought it was appropriate. I guess it's fine to add it. Chair Burt: There was a question—Tom. Council Member DuBois: If we're going to change that, Page 11 captures what you want, Item 4 on Page 11. Chair Burt: It does. This is one of those places where we have some replication between Procedures and Protocols. Let's put that as a future broader clean-up. We're doing a lot this year just to correct a bunch of errors. This can be ... Council Member DuBois: I'm just saying Page 36 captured what 4 says. Unless otherwise recommended by the Committee, then it may (crosstalk). Chair Burt: It says the same thing both places. Council Member Berman: I might be speculating, but maybe what I'm getting at is should there be something in there that says if a Committee believes that an issue would be controversial ... Chair Burt: Some guideline. Council Member Berman: Yeah. Chair Burt: That sounds good. Council Member Berman: The Committee's advised to place it on Action. 53 May 21, 2015 Chair Burt: If it is of significant public interest or controversial, the Committee should consider placing it under—really that's a guidance for the Mayor, the Committee or the City Manager. Right? Council Member Berman: Correct, yes. Three different bites at the apple. Hopefully the Committee picks up on that and makes that recommendation. If not, then the Mayor ... Chair Burt: If it's of significant public interest or controversial ... Council Member Berman: Controversial in nature. Chair Burt: ... that they should consider. We don't want to stipulate it. It's just a reminder. Now under 3.7, under the title, it talks about the Mayor and Vice Mayor ... Council Member Wolbach: What page? Chair Burt: Page 36. The Mayor and Vice Mayor working with Staff to plan the Council meetings. It's really the Mayor and the City Manager. Mr. Alaee: Real quick on this section. You guys had somewhat of a substantive conversation, from what my notes show, last time that we already have some notes for. Those describe the adequate relationship between the City Manager and the Mayor; add more specific language about what is the role of the Vice Mayor; do we want the language to reflect the views of the City Council as a whole, not just the Mayor; the Mayor is the representative of the Council at these meetings as the liaison role. These are some of the comments that you guys had mentioned. Intent of representing the best intent of the Council; again clarify the roles between all three in the agenda setting process. Chair Burt: That's great that you brought that up. That was part of that first chunk that we addressed, and it applies here. You're already going to attempt to capture that. That's great. That's more than I had just going through. Page 37 in Section 4, there's an underlined section that says the Committee shall consider and make recommendations to Council on matters relating to parliamentary and administrative procedures and policy matters. I was taking this to mean the administrative procedures were City Council procedures. Are we talking here about other administrative procedures in how the City Manager runs the organization? Do you follow what I'm asking here? Whose administrative procedures are being referred to here? There are a whole bunch of administrative procedures internal to the organization that we as a Council—I can't remember when and how we ever weighed into those. Is that part of our purview? 54 May 21, 2015 Mr. Alaee: I don't want to speak for the City Attorney. It's a good point, and probably we'd need to look at it. When we bring it back, we could bring back further context. Chair Burt: There are a lot of HR Procedures and all that. I don't know where the boundaries are on that. Whether there is a point in time where the Council does adopt those Procedures, and we just don't look at them frequently or we don't have a role in that. Ms. Stump: This is a Council/Manager form of government. Certainly there are many, many, many procedures and practices that are handled out of the Manager's Office, and don't come to Council and probably shouldn't. Certain ones that rise to the level of being of broader community concern or community attention, the Manager will typically bring them or the Council can invite them to come here. There's not a bright line. Chair Burt: I'm not even sure whether administrative procedures is referring to this document, because it follows parliamentary. It says that the Committee makes recommendation to the Council on matters relating to parliamentary and administrative procedures. I suspect that intention is referring to these documents, and we should say, in that case, Protocols and Procedures Handbook or whatever. You'll look hard at that and come back. That covers everything I had. Cory. Council Member Wolbach: The issue of when a Council Member wants to raise an issue but either has not had an opportunity or is unable because of Brown Act restrictions to gather the necessary forces to produce a written Colleague's Memo, how they present it during oral comments at the end of a meeting. You suggested earlier that you thought it was reflected somewhere else. The (crosstalk) on Page 12 ... Chair Burt: I have it in the back of my head. Beth, do you have any recollection on ... Council Member Wolbach: Maybe in an Ordinance or something. Chair Burt: Maybe you do, Molly. This ability of Council Members to agendize items through Council Member Comments, I thought is somewhere in here. Council Member Berman: You'd figure it would be. 55 May 21, 2015 Council Member Wolbach: I've spoken with some people in Mountain View. Apparently their Procedure there is quite different. It's interesting. If you did a written Colleague's Memo there, you'd be criticized for it. Chair Burt: Either way, can Staff look at whether there is another location where that practice or Protocol is actually referenced in writing? Ms. Stump: We certainly can research that. It's my recollection that it actually isn't, and the written Colleague's Memo is the form that this Council has historically used for Council Members to initiate an item onto the agenda. Chair Burt: I've got it in the back of my head differently. There is a place where it says you can agendize, and it's actually pretty specific. I don't think I'm making this up. It requires that it actually come on the next Council meeting. It's something that we may want to clean up, but I'm pretty sure it's in there. I'll look for it. I don't think I dreamed that one. Council Member Wolbach: As much as we would probably want to have language specifically saying that it's strongly, strongly recommended that Council Members use the written Colleague's Memo procedure in order to bring matters to start getting it agendized, because of Brown Act violations, I would want to make sure that there is an opportunity for items to be raised during Council Member Comments. Chair Burt: Let's find out what our existing Procedure is. If my recollection is correct, it's more liberal than we may want, not less so. I've got to find it, and I'll try and go back and look for it myself. Council Member Wolbach: My concern is that, as you were warning earlier, we will in updating the Procedures swing too far towards constraining it. I want to make sure we find a nice middle ground. Chair Burt: Anybody else, anything else on Policies and Procedures and Protocols? It's Policies and Procedures, but the Staff Report calls it Policies and Protocols. That's our nomenclature thing. We had this other at-places. It's 9:50; we don't, in all likelihood, have time to go through either this or the balance of the discussion around the particular items that we want to have go before the Committee as a Whole. Briefly, if anyone wants to provide any brief comments that will tee us up for our next meeting on these, you're welcome to do it at this time. Cory. Council Member Wolbach: Just a clarification. The items on Page 7 of the packet, items going to the Committee as a Whole, those are going to the Committee as a Whole anyway. As Staff was saying, maybe the next ten 56 May 21, 2015 minutes would be an opportunity if we do have any last minute additions that we want to add to this. They're already on their way to the Committee as a Whole. Chair Burt: Do we have a Committee as a Whole agendized? Mr. Alaee: You don't have a Committee as a Whole agendized. If I may make a suggestion. What we can do, since we are done with the Handbook, is bring a smaller Staff Report that just highlights the items on Page 7 and the items on the at-places. Then the Committee can have a conversation just about those. Then we can ... Chair Burt: You can take a little more time to come back with the draft changes. Mr. Alaee: With the Handbook, correct. Chair Burt: That sounds great. Mr. Alaee: If that leads to a natural discussion of looking at our schedule ahead, that would be fine unless there's other items the Council wants to talk about. Future Meetings and Agendas Chair Burt: We have before us our upcoming schedules. Khashayar Alaee, Senior Management Analyst: On the 9th, we are teed up to talk about Project Safety Net and the Colleague's Memo regarding strengthening the engagement with the neighborhoods. It's pretty much a copy and paste to bring the remaining items from tonight to any future meeting. I don't know if PSN and the Colleague's Memo are substantive and you'd want to wait to bring these items back. I'm pretty sure we could turn the remaining items of tonight around pretty quickly and bring them on the 9th as well. If you want to do that. Council Member Berman: It doesn't hurt to agendize it. If we don't get to it, we don't get to it. Mr. Alaee: We'll bring that back right away. From my standpoint (crosstalk). Chair Burt: I'm sorry. You're thinking of bringing it back when? Council Member Berman: 6/9. 57 May 21, 2015 Mr. Alaee: 6/9. Council Member Berman: Putting it on the agenda. Council Member DuBois: At the end. Chair Burt: The Project Safety Net is going to be a pretty full discussion. Council Member Wolbach: Both of those will be. Mr. Alaee: I was just throwing that out there for you. Chair Burt: I'm skeptical that it can fit in there. Council Member DuBois: Can we put it on the end? If we get to it, we get to it. Chair Burt: I don't mind doing what Tom just said. Go ahead and agendize it. If we have time, we can bring it up in that meeting. Council Member Berman: That was my idea. Council Member Wolbach: At the end of the meeting. Chair Burt: For the moment, I'm assuming we won't have time. Our next meeting is on September 8th. Although there are four items, those four are not ones that are going to take a lot of time for each item. We don't have a P&S meeting in the second half of August, and we get back in mid-August from our vacation. I'm concerned that if we don't get to the Committee as a Whole items until after vacation or worse yet September, our year is running out. There was supposed to be another Committee as a Whole that we'd be having this year. We ought to try and drive it sooner. Council Member Berman: Can any of this stuff that's scheduled for September 8th come in late August? Chair Burt: I'm questioning whether to have a meeting in late August that addresses this Committee as a Whole as being more time sensitive. Council Member Berman: Yeah. Chair Burt: Do it in August, the P&S meeting in August. 58 May 21, 2015 Council Member Berman: Do a P&S in late August, and do this stuff that we're pushing off. I don't think it'll take three hours. Chair Burt: We'll just keep these in September is what I’m saying. Council Member Berman: Okay. Sure. I'm fine with that. I just didn't know if what we're pushing off needs a full meeting. Chair Burt: We wouldn't be pushing it off. Council Member Berman: I wasn't sure if the meeting as a whole stuff needs a full meeting or if we can add other stuff to that. Chair Burt: If we have an August meeting ... Council Member Wolbach: (crosstalk) items up. Chair Burt: If you're ready to come back with a draft of Procedures and Protocols in August, then that would be the natural meeting. If not, then maybe we would move some of the September items to the August meeting. Mr. Alaee: Correct. Chair Burt: Do we want to look at calendars right now on this August meeting? Mr. Alaee: The standing date and time for the Committee is the second Tuesday of every month. Chair Burt: The second Tuesday. I'm sorry. Council Member Berman: I don't even know when break ends. Beth Minor, City Clerk: (inaudible) August. That's before they come back (crosstalk). Mr. Alaee: Oh, is it? Chair Burt: The second Tuesday, right. That's the problem. Council Member Wolbach: I'm pretty open in August currently. Council Member Berman: I've got to figure (inaudible). Chair Burt: We should do it after the Council is scheduled to return. 59 May 21, 2015 Council Member Berman: Which is the 17th, right? That's the third Monday. Chair Burt: Yeah. If we have the following Tuesday, which would be the 22nd. How is that? I'm sorry. I got that wrong. We get back the 17th. We're on Thursday. Thursday is what we do, right? Mr. Alaee: No. The regular meeting is the second Tuesday. Chair Burt: It's regularly Tuesday. I have other Council meetings on the 27th. I'm sorry, that's a Thursday again. The 25th or the 18th? Council Member Berman: I could do either. Council Member Wolbach: Same. Council Member DuBois: I think that's okay. I'm taking my son to college sometime in there. I don't know when yet. Council Member Berman: You can play it by ear. Mr. Alaee: Tuesday, the 18th. Chair Burt: Can you let Khash know? Because the rest of us are flexible for either of those dates, we'll let your schedule determine it. Mr. Alaee: Just before we conclude, I want to clarify. For the next meeting on the 9th of June, all I'm going do is ... Council Member Wolbach: You mean the 9th of June. Mr. Alaee: I'm sorry, the 9th of June. All I'm going to do is copy and paste the items from the at-places memo and the items on that Page 7, and just put them in a Staff Report, bring them here if we have time to continue the conversation. Then we're targeting to bring the Handbook back in August. Chair Burt: Correct. Council Member Berman: Yep. Adjournment: Meeting was adjourned at 9:57 P.M. CITY OF PALO ALTO OFFICE OF THE CITY ATTORNEY October 29, 2018 The Honorable City Council Palo Alto, California Adoption of an Ordinance Amending the Municipal Code and Adoption of Amendments to Council Procedures and Protocols to Conform to a Seven-Member Council; Discussion and Direction to Staff or Referral to Policy & Services of Additional Discretionary Changes to the Code and/or Council Procedures and Protocols Recommendation 1. Amend the Municipal Code and Council Procedures and Protocols to conform to a seven- member Council: a. Adopt on first reading an ordinance (Attachment A) amending Municipal Code section 2.04.190 to reduce number of Council Members on Finance and Policy & Services from four to three and section 12.10.060 to change the votes required to resolve a certain type of appeal from five to a majority; and b. Amend the Council Procedures and Protocols to reduce four to three the number of Council Members who may sign a Colleagues’ Memo and who may serve on an Ad Hoc Committee. 2. Discuss and Provide Direction to Staff or Refer to Policy & Services additional discretionary changes to the Municipal Code and/or Procedures and Protocols Background and Discussion On November 4, 2014, Palo Alto voters amended the Palo Alto Charter to reduce the number of Council seats from nine to seven, effective January 1, 2019. Many provisions of the Municipal Code and Procedures and Protocols Handbook provide for Council action by “a majority” of Council. When Council had nine members, a majority was five; when it has seven members, a majority will be four. This will occur seamlessly and requires no action to implement. In a few places, however, the Code and the Procedures and Protocols refer to a specific number of Council Members. In several situations, the number must be reduced to comply with state law. In others, Council has discretion to maintain or change the number specified. First, the Municipal Code and Procedures and Protocols provide for four-member Council committees. This must be changed to comply with the Ralph M. Brown Act. The Brown Act, which sets procedural requirements local governmental bodies, states that subcommittees are limited to less than a majority of the primary body. When the number of seats on Council is reduced to seven, Council committees (both regular “standing” committees, and temporary “ad hoc” committees) will be limited to a maximum of three Council Members. The attached Page 2 changes to the Municipal Code and Procedures and Protocols adjust the size of standing and ad hoc committees to three Council Members. In addition, and also to comply with the Brown Act, the Procedures and Protocols should be amended to provide that no more than three Council Members may participate in a Colleagues Memo. Staff identified one additional section of the Municipal Code that should be changed to align with a seven-member Council. Section 2.10.060 states that five votes are required to resolve a type of permit appeal. In context, it is clear that section 2.10.060 intends to refer to a simple majority of Council. The attached ordinance updates the language to provide for a simple majority. In addition to these changes, there are a number of changes that are not legally-mandated, but that Council may wish to consider. Staff recommends that Council refer these to Policy & Services for discussion and recommendation, or, in the alternative Council could provide direction to staff. These include: 1. Current procedure requires three votes to remove an item from Consent. (Procedures and Protocols, section 2.4(H).) Council could retain the three vote procedure or modify it. 2. The Zoning Code specifies the number of Council votes required to remove appeals from the Consent calendar. (For example, Municipal Code section 18.78.040(a)(2) provides that three votes are required to remove appeals from Consent.) Council could retain current requirements or modify them. 3. Various changes to the Procedures and Protocols were previously recommended by Policy & Services but have not been finally approved by Council. If the matter is referred to Policy & Services, staff will refresh those items with the Committee and forward the resulting recommendations to Council. In addition, Council Members may wish to propose additional modifications, as part of a regular review and updating process. Environmental Review The proposed procedural changes to the Code and Procedures and Protocols are not a project for the purposes of the California Environmental Quality Act. Environmental review is not required. ATTACHMENTS: • Attachment A: ORD Amending to Conform to 7 Member Council (10-12) (PDF) • Amendment to Council Handbook (PDF) Department Head: Molly Stump, City Attorney Page 3 Attachment A *NOT YET ADOPTED* th TS/ORD Amending 2.04 Ordinance No. _____ Ordinance of the Council of the City of Palo Alto Amending Section 2.04.190 (Standing Committees – Special Committees) of Chapter 2.04 (Council Organization and Procedure) of Title 2 (Administrative Code); and Amending Section 12.10.060 (Coordination with City) of Chapter 12.10 (Street Cut Fees) of Title 12 (Public Works and Utilities) of the Palo Alto Municipal Code to Conform to a Seven-Member City Council. The Council of the City of Palo Alto does ORDAIN as follows: SECTION 1: The Council of the City of Palo Alto finds and declares as follows: A. In November, 2014, the Charter of the City of Palo Alto was amended by the electorate to reduce the City Council to seven members (from the current nine member council) effective January 1, 2019. B. In order to prevent conflicts with the California Brown Act, relevant sections of the Palo Alto Municipal Code must also be amended to reflect the seven-member Council. SECTION 2. Section 2.04.190 of the Palo Alto Municipal Code is hereby amended as follows (deleted text is in strikethrough, new text is underlined): 2.04.190 Standing committees - Special committees. (a) Not later than the second regular council meeting in January, the mayor shall appoint two standing committees, consisting of four three members each from the members of the council. The mayor shall appoint each council member to only one standing committee and shall appoint the chairperson of each committee. The mayor, or the vice-mayor at the request of the mayor, may act as an ex officio, voting member of each committee when one or more regular committee members are absent. (b) The standing committees shall be designated, respectively, committee on finance and committee on policy and services, and shall meet at 7:00 p.m. in the city hall on the day established by Section 2.04.200. (c) Council members may attend meetings of committees of which they are not members, without participating in any manner, but only committee members or ex officio committee members shall vote in committee in accordance with subsection (a) of this section. (d) Council members who submit matters to the council which are referred to a standing committee may appear before the standing committee to which the referral has been made in order to speak as proponents of the matter. Standing committee meetings during which such referrals may be considered shall be noticed as council meetings for the purpose of enabling the standing committee to discuss and consider the matter with a quorum of the council present. Attachment A *NOT YET ADOPTED* th TS/ORD Amending 2.04 (e) In addition to standing committees the mayor may, subject to approval of the council, appoint such other special committees of council members, private citizens or both as deemed desirable and necessary to assist and advise the council in its work. SECTION 3. Section 12.10.060 of the Palo Alto Municipal Code is hereby amended as follows (deleted text is in strikethrough, new text is underlined): 12.10.060 Coordination with city. (a) Before a person, utility or public utility applies for an "Application and Permit for Construction in the Public Street" to construct in the public rights-of-way or any street, alley, sidewalk or other public place, the applicant shall notify the director of public works-city engineer, and the city engineer, or designee, shall review on behalf of the applicant the utility master plans and the city's five-year repaving plan on file with the department of public works. The applicant shall coordinate, to the fullest extent practicable, with the utility and street work shown on such plans to minimize damage to, and avoid undue disruption and interference with the public use of such public rights-of-way, streets, alleys, sidewalks or other public places. Such coordination shall include: (1) Whenever two or more parties have concurrently proposed a major excavation in the same block during a five-year period, they shall meet and confer with the director of utilities, or designee, regarding whether it is feasible to conduct a joint operation. If the director, or designee, determines that it is feasible to conduct a joint operation, a single contractor shall be selected and a single application fee charged. (2) Any person, utility or public utility aggrieved by the director's decision to require a joint operation may, within thirty days of receipt of the director's written notice, file an appeal with the city manager in written form in a manner prescribed by the director. Within thirty days of the filing of a timely appeal from the director's determination, the city manager shall review the appeal and issue a recommendation to the council to uphold or overturn the action or determination of the director. The recommendation of the city manager shall be placed on the consent calendar of the council within thirty days of the filing of the appeal. In determining such appeal, the council shall consider the impact of the proposed excavation on the neighborhood, the applicant's need to provide services to a property or area, facilitating the deployment of new technology as directed pursuant to official city policy, and the public health, safety, welfare and convenience. The council may adopt the recommendation of the city manager, or remove the appeal from the consent calendar, which shall require five votes a majority vote, and take action to uphold or overturn the recommendation of the city manager. The decision of the council is final. (b) To avoid future excavations and to reduce the number of street excavations, any person, utility or public utility providing utility or communications service shall be requested, when practicable, to install sufficient conduit to accommodate the reasonably foreseeable future business growth needs of that person, utility or public utility. Attachment A *NOT YET ADOPTED* th TS/ORD Amending 2.04 SECTION 4. Severability. If any provision, clause, sentence or paragraph of this ordinance, or the application to any person or circumstances, shall be held invalid, such invalidity shall not affect the other provisions of this ordinance which can be given effect without the invalid provision or application and, to this end, the provisions of this ordinance are hereby declared to be severable. SECTION 5. CEQA. The City Council finds and determines that this Ordinance is not a “project” within the meaning of section 15378 of the California Environmental Quality Act (CEQA) Guidelines because it has no potential for resulting in physical change in the environment, either directly or ultimately. SECTION 6. Effective Date. This ordinance shall be effective on the thirty-first date after the date of its adoption. INTRODUCED: PASSED: AYES: NOES: ABSTENTIONS: ABSENT: ATTEST: APPROVED: ______________________________ ____________________________ City Clerk Mayor APPROVED AS TO FORM: ____________________________ City Manager ______________________________ Deputy City Attorney In November, 2014, the Charter of the City of Palo Alto was amended by the electorate to reduce the City Council to seven members (from the current nine member council) effective January 1, 2019. In order to prevent conflicts with the California Brown Act, relevant sections of the Palo Alto City Council Procedures and Protocols Handbook must also be amended to reflect the seven-member Council. Subsection (K) (Council Matters) of Subsection 2.4 (General Requirements) of Section 2 (Council Meeting & Agenda Guidelines) of the City Council Procedures and Protocols Handbook is hereby amended as follows (deleted text is in strikethrough, new text is underlined): K. Council Matters Any two Council Members may bring forward a colleague memo on any topic to be considered by the entire Council. Two Council Members are required to place such a memo on the agenda, reflective of the Council procedure requiring a motion and a second for consideration of a motion by the Council. Up to four three Council Members may sign a colleague memo. The City Attorney recommends that the colleague memo be limited to three two Council Members in order to avoid the potential of a Brown Act issue. Prior to preparing a colleague memo, Council Members will consult with the City Manager to determine whether he/she is or is willing and able to address the issues as part of his/her operational authority and within current budgeted resources. Colleague’s memos should have a section that identifies any potential staffing or fiscal impacts of the contemplated action. This section will be drafted by the City Manager. Council Members shall provide a copy of the proposed memo with the City Manager or appropriate senior staff prior to finalization. Completed Council colleagues memos shall be provided to the City Clerk’s staff by noon on the Tuesday prior to the Council meeting that the memo is intended to be agendized, to provide time for the City Clerk to process for the Council packet. The City Council will not take action on the night that a colleague memo is introduced if it has any implications for staff resources or current work priorities which are not addressed in the memo. The Council will discuss the colleague memo and then direct the City Manager to agendize the matter for Council action within two meetings, allowing City staff time to prepare a summary of staffing and resource impacts. Action may be taken immediately by the Council on colleague memos where there are no resource or staffing implications or where these are fully outlined in the colleagues memo. The Brown Act requires that the public be fully informed of the potential action by the Council via the Agenda 72 hours before a scheduled Council meeting. In order to satisfy the Brown Act requirements, the Council should consult with the City Attorney to ensure that the proposed title to the colleague memo contains all actions that the Council Members want completed on the night of the Council review. Subsection (3) (Appointment) of Subsection (Y) (Ad Hoc Committees) of Subsection 2.4 (General Requirements) of Section 2 (Council Meeting & Agenda Guidelines) of the City Council Procedures and Protocols Handbook is hereby amended as follows (deleted text is in strikethrough, new text is underlined): 3) Appointment The Mayor or the City Council may appoint four three or less members of the Council to serve on an Ad Hoc Committee. In contrast, only the Council and not the Mayor alone can create a Standing Committee. The Mayor will publicly announce any Ad Hoc Committee created by him or her, its membership and stated purpose and posted on the City Council website. The City Manager shall prepare a report to Council about the anticipated time commitment required for staff to assist the Ad Hoc Committee. Council Member feedback on how the Council Procedures and Protocols 11.8.18 Council Member Fine: 1. Maintaining the threshold to pull consent items/zoning approvals at 3 votes. 2. Potentially folding the rail committee into the full council (particularly if we have 2 recused) 3. Strengthening the rules around dialing into meetings - we've never really settled what is/isn't allowed. Potentially, maybe you can only dial in domestically? 4. Implementing timers for council comments 5. An idea from Fremont: public comment cards include language that says "1-10 speakers: 3 minutes each, 11-20 speakers: 2 minutes each, 20+ speakers: at council discretion" 6. Reviewing council assignments... do we want to stop any of them? Council Member Kou: 1. Include page numbers 2. 1-3 Summary of Rules - delete "but limits the total time to 30 minutes per meeting." 3. A. Specific Requirements and Time Limits 1) Oral Communication - delete "and will be limited to a total of thirty minutes for all speakers combined." 4. Consent Calendar H. Council Requests to Remove Item - Change three to two council members to remove consent item Council Member Holman 1. Oral Communications speakers should be allowed no less than 3 minutes unless 30 minutes of speakers in which case the time will be divided by the number of speakers. On no occasion should speaker time be reduced to less than 2 minutes. 2. 1.3 and 1.4 d 1 (repetitive) 3. NOTE: Not so very long ago, it was 5 minutes standard. On page 44 you will see that “meaningful” public involvement is referenced. 4. Last minute and significant proposals by either staff or council members are not considered on the night of submittal but are instead continued to a future Council meeting, sent to PTC, ARB or back to staff for analysis. 5. NOTE: This is consistent with the language about last-minute significant applicant proposals. This deprives everyone of understanding the implications if not the meaning of such proposals. 6. Change the number of CC members it takes to pull an Item from Consent from 3 to either 2 or 1. Look at other cities’ rules that require either 1 or none. 7. Companion with the above is establishing “standards/threshold” for what is appropriate candidate for Consent (without prior Finance, P&S, UAC etc. review) 8. NOTE: see current recommendation by a prior P&S 9. CC member who has indicated a NO vote on a Consent Calendar item is given opportunity to state the reasons prior to the vote on the Consent Calendar. 10. Consent Calendar items—CC member may ask a clarifying question prior to the vote 11. D 2 Page 3: See Oral Communications above 12. Clarify purpose of Study Sessions, for what purposes they should be used, and identify a method of collecting a consensus for staff guidance when a City consideration or project. 13. Establish clearer role and limitations of CAO Committee 14. Clarify how matters are agendized for P&S and Finance discussion and action 15. Election of Mayor and Vice-Mayor---clarify that the elections are subject to the Brown Act 16. Closed sessions – clarify that CAO evaluations are also subject to the confidentiality rules 17. Clarify, strengthen the role of the Mayor in conducting and participating in meetings to be pursuant to parliamentary procedures such as Robert’s Rules. 18. Clarify rules/meaning around reconsideration of a vote re “vested rights” 19. Quasi-judicial items will be indicated as such on agendas 20. 2.4 - Conduct with Palo Alto Boards and Commissions 21. 2.5 - Staff Conduct with City Council 22. Staff should provide responses to CC member questions to all CC members as appropriate, so all CC members are operating with the same information 23. Staff is expected to comply with the one-hour rule with Council members pursuant to Section 2.3 24. Role of P&S Committee was essentially broadened a few years ago to balance the work load with Finance and because Finance was reviewed matters that could have as rationally been considered Policy matters. This needs to be clarified in the Purpose of P&S.