Dr. James Ireland, whose renomination as head of the city Emergency Services Department faced vocal opposition in recent months, was formally reinstated last week.
The Honolulu City Council voted 8-0 on April 16, with Andria Tupola absent, to adopt a resolution confirming Ireland’s second four-year term as leader of a department that includes the city’s paramedics.
Val Okimoto, chair of
the Council’s Public Safety Committee and a skeptic
of Ireland’s ongoing directorship of Emergency Medical Services, voted to approve his nomination “with reservations.”
In February at a Public Safety Committee meeting, opponents to Ireland’s nomination — largely former EMS workers — leveled complaints and allegations about low morale, chronic understaffing, employee favoritism and frequent resignations that allegedly affected the timely response of ambulances to emergencies across Oahu.
But earlier this month the same committee heard a chorus of support for Ireland, including from Gov. Josh Green, who came to the defense of his fellow physician, following Mayor Rick Blangiardi’s push for Ireland’s confirmation as well.
At the Council’s meeting Wednesday, Ireland — who spoke ahead of those testifying for and against his return to EMS — told the panel his continued leadership would improve and advance the paramedic service well into the city’s future.
He indicated that work includes purchasing more ambulances to reduce lengthy response times to 911 calls.
“We received 13 new
ambulances on a boat
(April 15),” Ireland said. “We have five more coming within the next three months, and then within the next year we have 12 more coming, and that includes some that are in next year’s budget.”
“So, one year from now, we will have 30 ambulances in our fleet that are under 1 year old,” he said. “And that’s unprecedented in our history, and I would challenge anybody to find any EMS agency across the country with comparable volume and ambulances to have a fleet all under one year.”
Previously, Ireland said he also wants to see the number of ambulance trips reduced to one trip every three hours, versus the current one trip every hour he said are currently being made, especially in urban Honolulu.
Others at the meeting supported Ireland’s efforts.
“Having worked with
him on and off for the last
25 years, our department has had the most growth under his direction,” EMS District Chief Sonya Austin said. “The work is really hard, and he’s shown that he’s up for the challenge.”
But Eddie Fujioka, a
retired EMS district chief, testified in opposition to Ireland’s appointment. He’d also stated previously that most testifying in support
of Ireland are “coming from people who are administrators in the medical field, and very little personnel from within EMS.”
In 2024, allegations arose among the ranks of city paramedics regarding unit closures — when an ambulance is not available to respond to 911 calls for service.
To seek relief, paramedics backed recently adopted Council Resolution 24-272, which Okimoto introduced in November, urging the city administration to study whether EMS should be merged into the Honolulu Fire Department.
During the mayor’s State of the City address March 18, Blangiardi vowed he would form a task force to study EMS’ possible integration into HFD.
Before Wednesday’s Council vote, Okimoto said her focus was on the well-being of city paramedics and the public at large. “Their work saves lives daily and is vital to the health and safety of our communities,” she added.
However, she said, “As we consider Dr. Ireland’s reappointment, I must express serious concerns.”
“My vote ‘with reservations’ … reflects not opposition to the department’s mission, but a need to address persistent issues that have gone unresolved for too long,” she said. “Testimony from EMS professionals has consistently described a workplace culture marked by low morale, favoritism and even retaliation, indicating a serious breakdown in the trust between front line staff and department leadership.”
She’d also note “numerous unit closures” resulted in the “overreliance on
our private and federal partners as well as the Fire
Department.”
“Equally troubling are recurring billing failures,” she said. “In 2022 a vendor transition resulted in a nearly two-year delay in ambulance billing, costing the city millions (of dollars) in lost revenue.”
She claimed that “these are not isolated problems; they point to structural challenges that require more than piecemeal fixes.”
“That is why I believe the city must seriously consider merging the Honolulu Emergency Services Department with the Honolulu Fire Department,” she added. “Other municipalities have successively integrated EMS and fire services to reduce duplication, improve coordination and streamline operations.”
She said “a unified public safety model would address many of the operational and fiscal inefficiencies that have plagued Emergency Services for decades.”
“This vote ‘with reservations’ is not about any single individual; it is a call for structural reform,” Okimoto asserted. “Our first responders, and the public they serve, deserve a system that works better, meets smarter and delivers results.”
