County Not Required to Answer Murrieta's Call for Ambulance Bid

Murrieta city council members are set to vote Tuesday on a resolution urging the Riverside County Board of Supervisors to conduct a competitive bid process for emergency medical services.

If approved, the resolution would not be the first time Murrieta has stated its case in calling for the contract long-held by American Medical Response to be put out to bid.

"The original 1998 contract and the subsequent 2004 contract were not competitively bid, nor was the 2008 three-year extension," wrote city of Murrieta Senior Management Analyst, in an agenda report prepared for city council.

The city is one of a handful in Riverside County that has its own fire department, whose paramedics work hand in hand with AMR personnel on scene of emergency medical situations.

AMR is reimbursed through insurance and patient payments, while agencies such as the Murrieta Fire Department are publicly supported through taxes.

AMR's contract to provide emergency medical services to 95 percent of the county expires at the end of this month. It was unclear when the item was .

Ambrose wrote that in 2008, the Riverside County Fire Chiefs Association agreed to the contract extension with AMR with the "assumption that the County will go out to bid competitively in 2012."

Ambrose pointed out that neighboring counties such as San Bernardino and Los Angeles are moving forward with the intent to competitively bid their contracts. Like Riverside County, San Bernardino County has long contracted with AMR for much of its coverage.

The Situation in San Bernardino

Last month, city officials such as Murrieta fire Chief Matt Shobert closely observed when neighboring San Bernardino County made its decision.

The San Bernardino County Board of Supervisors on May 8 voted 3-0, with two board supervisors absent, to approve a two-year, performance-based contract extension with AMR while Inland Counties Emergency Medical Agency prepares to put its contract out to bid, according to board minutes.

"I am not sure what this means for Murrieta," Shobert said. "But I think for the citizens of San Bernardino County, it's a strong effort by their Board of Supervisors to show leadership in trying to improve their system up there, as well as a step forward for transparent government to work in synergy with improving the service.

"It is about competition, improving service, reducing cost and government being transparent. Hats off to San Bernardino County for following good government practices."

For San Bernardino County, it was "time to reassess," according to Virginia Hastings, who serves as executive director of Inland Counties Emergency Medical Agency.

ICEMA is the public agency that governs emergency medical services in San Bernardino, Inyo and Mono counties. However, Hastings told Patch the recent decision to "reassess" solely affected San Bernardino County.

"Our board feels it is time to look at this," Hastings said. "The economy is changing and how providers are paid is changing."

She said AMR along with several other ambulance companies were grandfathered in under the State Emergency Services Act of 1981. AMR proceeded to "buy up" several of the smaller providers, she said. 

San Bernardino County's vote will allow the county to hire a consultant to come in and study its emergency services operations, she said, noting that counties are required under state law to do a competitive bid as part of that process.

"With respect to whatever goes forward with our county or Riverside County or any other county, we are all bound by statutes," Hastings said. "It all has to be submitted to the board (of supervisors) and then to the state."

A representative for AMR said the company was willing to work with San Bernardino through the bid process.

"But you have to understand that San Bernardino and Riverside (counties) are distinctly different," AMR's Director of Government Affairs Jason Sorrick told Patch.

"In San Bernardino you have multiple providers that are exclusively operating... What the county has looked at is basically updating their plan; they are going to reassess their zones. This would be a fundamental change for them, so in order for for them to do that and not run afoul of the state EMS act, they have to develop an RFP (request for proposals). Then they have to prove it and then put it out to bid," Sorrick said.

Sorrick likened long-term paramedic contracts with those held by other service providers such as Waste Management.

"What we are seeking is nothing different than what Waste Management and others have—they have all have auto renewals... The reason why they do that is to ensure a provider will invest into the system. We really want to continue our investment."

Sorrick said its costs AMR $52 million a year to run its system in Riverside County.

"We also provide $49 million in uncompensated care. So when we want to invest in the system we certainly want to know the county is going to maintain our contract," Sorrick said, noting AMR is in negotiations for a five-year extension with Riverside County.

As part of the negotiations, which would have to go before the Board of Supervisors, AMR is offering a complete upgrade to the county's radio and dispatch system.

"But there is huge distinction with what is currently established for Riverside and what is happening in San Bernardino."

Riverside County Not Required to Bid Out

That distinction is much of Riverside County, including Murrieta—according to a state official—is already in a zone that AMR holds exclusive rights to under Riverside County's Emergency Medical Services Plan.

"According to our records, the zone which encompasses the city of Murrieta and surrounding areas meets the qualifications for exclusivity without a competitive process," said June Iljana, deputy director of policy, legislation and external affairs for Emergency Medical Services Authority of California.

Under Riverside County Emergency Medical Services Agency, that provider is AMR.

"It isn’t a right that AMR has, but rather a right that the county has to keep using the provider that has been there since 1981 if they choose. The local EMS agency has the ability to go out to bid at any time, but is not required to do so," Iljana continued, in an email to Patch.

"If a local EMS agency (designated by the county) wants an ambulance zone to be exclusive, they have two options. First, they can determine a zone has been operating in the same manner and scope since 1981 and submit it to the state Emergency Medical Services Authority as exclusive as part of their EMS Plan.

"The second option is to send the zone out for competitive bid. The local EMS agency has the sole ability to decide whether to do that or not.

"If the local EMS agency uses a competitive bid once, the zone will no longer qualify for exclusivity through the non-competitive process. If a competitive process is used to create an exclusive operating area, the competitive process must be conducted at periodic intervals.

"A LEMSA is never required to create an exclusive operating area or place an ambulance zone out for bid; the ambulance zone can be operated in a non-exclusive manner into perpetuity." 

For Sake of Residents, Murrieta Calls for Improvements

In addition to the resolution to be voted on Tuesday, Murrieta city officials submitted a letter to Riverside County Emergency Medical Services Agency in October, "citing concerns with a process that lacked competition and left little room for emergency services improvement," Ambrose pointed out.

"The city raised the specific issues of response times, continuity of care, familiarity with the city and staffing levels," Ambrose wrote.

The resolution urges the Riverside County Board of Supervisors to begin the competitive bid process this fiscal year to ensure that new proposal have been evaluated and are ready to be implemented by the end of the 2013-2014 fiscal year.

"A competitive bid process would help ensure that city residents are receiving the best service for the best possible price, and help protect the best interests of the tax payers by demonstrating transparency in vendor selection."