The Hawaii Department of Health has cautioned Mayor Peter Carlisle against merging the city’s Fire and Emergency Services agencies at this time, telling him in a letter Thursday that consolidation “seems premature.”

“While the counties can periodically examine how they provide ambulance services in their contracts with the State, any major changes should not be undertaken unilaterally,” DOH Director Loretta Fuddy told Carlisle in the letter. “It is our conclusion that HFD has not yet demonstrated the suitability of taking on the EMS medical mission for the City and County of Honolulu.”

Civil Beat first reported on the letter earlier this week. Fuddy told Civil Beat Thursday after she sent the letter that her department has had concerns about the merger ever since a report espousing it was produced a year ago. But the issue has come back to the fore in recent weeks after mayoral hopeful Kirk Caldwell made a merger one of the planks of his campaign, saying it would save money and lives. Caldwell has suggested the merger needs to move forward more quickly.

“Recently it has surfaced again about possible movement toward a consolidation,” Fuddy said when asked why she felt compelled to send the letter. “It appears that there’s some action towards moving towards a possible merger.”

Basically, the Health Department doesn’t believe the report produced by Emergency Services Consulting International for $175,000 is enough to justify combining the two departments. The process by which that contract was awarded is already the subject of an Ethics Commission investigation.

The Fire Department says it followed procurement rules and instructions from the Budget and Fiscal Services Department’s Purchasing Division. Multiple messages left for that agency have gone unreturned.

Now, DOH is raising other concerns about the contents of the report.

“The report prepared by the HFD consultants promises improved service and lower costs but does not specify a model of service delivery, i.e. organizational structure with detailed descriptions of what the employees would be doing,” Fuddy wrote. “Without the model it’s impossible to substantiate the claims of financial savings and better service for the people of Hawaii.”

Fuddy put it this way in her interview with Civil Beat: “Let’s not rush into this. Let’s get more specifics. Let’s look at the positives, the negatives. Let’s talk about what the model would really look like. Let’s cost it out.”

The Health Department’s input is critical because it provides about $30 million that covers the city’s emergency medical services program. The state could contract a private entity to do the work instead, as it does on Maui and Kauai.

“Therefore, they need to work with us if they’re going to change the model, because we have contracted for a specific type of service,” Fuddy told Civil Beat. “Whether it would be necessary to go out and re-procure, we don’t know. Whether the model would meet the standards, we don’t know. There are just a lot of unknowns at this point.”

Linda Rosen, Chief of Emergency Medical Services and Injury Prevention System Branch for Honolulu, said state law specifies that the county governments get the first crack at the contract, so the odds of the city losing out to a private company would be “pretty remote.” But that would remain an option if the city can’t come up with a model that satisfies the Health Department.

“We did make it clear to the mayor that the Department of Health, because we are the ones that are funding EMS, that there cannot be a change in the scope of work without consulting us,” Fuddy said.

Carlisle’s office acknowledged receipt of the letter Thursday afternoon and said in a press release that it “reinforces my position that this issue must be approached with caution, and protecting public health and safety is still the top priority.”

Asked whether the letter would change Carlisle’s previous plan to convene a working group, spokeswoman Louise Kim McCoy said, “Mayor Carlisle is evaluating the information provided by the State Department of Health and will determine its impact on the creation of a working group.”

Carlisle said last month that the group was still two or three months away. Fuddy told Civil Beat she has no objection to the formation of a working group to come up with a more detailed plan for how a merger would be carried out.

Emergency Services Director Dr. James Ireland said the focus of the working group, if convened, should be to explore “small-scale efficiencies” that would allow the two departments to work together more seamlessly while remaining separate entities. He’s been critical of the proposed merger that could cost him his job.

“We already work together and we already go on a lot of the same calls together, but let’s take it up one level and look at how we can provide better service to the public, and if possible, be more efficient and save money,” Ireland told Civil Beat. “I think we should look at taking baby steps and see where that leads us, but taking the leap right now I don’t think is the right move.”

Civil Beat contacted the Fire Department and Caldwell’s campaign. Neither immediately provided comment.

Read Civil Beat’s previous coverage of the Fire-EMS merger:

Read the full Department of Health letter, provided by the mayor’s office:

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