Ambulance Company Asks Murrieta City Council to Apologize

They alleged misleading and "false" statements about AMR employees were made during a March 6 City Council workshop held to discuss the possibility of an annual paramedic fee for residents.

Representatives from American Medical Response, which provides ambulance services to Murrieta, asked City Council members for an apology Tuesday.

They alleged misleading and "false" statements about AMR employees were made during a March 6 City Council workshop for residents.

Murrieta Fire Chief Matt Shobert is recommending the optional fee to recoup costs he says are spent providing paramedic services. Shobert said the Fire Department is getting a return of about 30 percent of materials used during calls when Murrieta firefighter/paramedics arrive on scene prior to AMR.

AMR Operations Manager Jim Price said he watched a video playback of the City Council discussion and was disheartened by some of the statements made.

"It seems it is OK for us to participate in washing toilets but it is not OK to participate in Thanksgiving dinners," Price said, as ambulance crews rent space at Murrieta fire stations.

"It is OK if you guys want to attack AMR and it is OK to attack me but it is not OK to attack the fine men and women who do the same work you do to protect our community," Price said.

Supported by fellow uniformed workers who sat in the audience, AMR paramedic and Murrieta resident Shelly Hudelson approached the Council. Hudelson brought up a statement made by Councilman Randon Lane in which he said AMR was committing "fraud" by recouping fees for work provided by Murrieta firefighter/paramedics.

"How can AMR charge for services we are providing and it not be considered fraud?" Lane said during the March 6 workshop.

Hudelson said she took his statement to mean that AMR paramedics were inferior to Murrieta crews.

"Two weeks ago you made misleading and false allegations of fraud," Hudelson said. "...You talked about response times and an unacceptable level of care...You used words like 'our guys are experts and more trained.' The fact is some of your guys were trained by these guys. They went to the same schools and took the same training.

"I am glad my fire department strives for excellence, but if you need to state that (this fee) is for training and equipment and fuel, please do so but not by insulting professionals who run twice as many calls per day.

"We ask for an apology from the City Council."

Because the issue was not on the Council agenda, Council members said they could not immediately respond to AMR's concerns.

During a portion in which they can address the public, however, Lane clarified his allegation of "fraud."

"I made it very clear that my comments were not dealing with actual illegal things AMR was trying to do," Lane said. "My concern was and is the rules in which our system is being handled. It is more (because of) the county that we have a monopoly in our system. AMR operates under those rules. I disagree with those rules by the county. I do not believe AMR is doing anything intentionally illegal but I do have grave concern and I will continue to lobby..."

Lane was referring to the city of Murrieta's request that the Riverside County Board of Supervisors Under a long-held county contract, AMR must arrive to emergency medical response calls within nine minutes, 59 seconds—something Murrieta officials have said they are not satisfied with.

The issue was scheduled to be discussed again by the Board of Supervisors March 13, but was taken off the agenda.

Councilman Alan Long, who is a battalion chief for the Anaheim Fire Department, said he has never made comments directed at AMR employees.

"I am not going to back down on anything I've said about the system," Long said. "Our system is redundant; it is also 15-20 years behind other counties. That needs to be fixed...A contract that has not been bid out for over three decades need to go out to bid. No where in there is anything directed at the employees."

When asked about AMR's statements made to City Council, Fire Chief Matt Shobert said they "did not merit a response."

Murrieta Firefighter/Paramedic Dean Hale spoke of good relationships with AMR employees. He said he knows of former AMR employees who chose to leave because of the way the organization was ran.

"Those are their words not mine," Hale said. "I have cooked Thanksgiving dinner—where they don’t pay for food, it comes out of my pocket. We have meals waiting for them but they never return. We respect the paramedics we work with..."

Hale said a law that was passed in 1983 required fire departments to staff trained paramedics.

"Because ambulances weren't doing their job, firefighter/paramedics were required to step up and do the job," Hale said.

The city continues to further discuss starting the . Residents who pay a $48 annual fee would not be billed for paramedic calls, but those who do not could be charged $350 per occurrence. Businesses could enroll in the program based on the number of employees.

Murrieta resident Jacqueline Fenaroli told City Council she opposed the fee.

"...A fire engine is an expensive and a redundant service when an ambulance will show up shortly....there are other better and cheaper ways to accomplish this," Fenaroli said.

She encouraged an open bid process, or even allowing multiple ambulance companies to compete to get to emergencies quickest.

"With our high unemployment rate and our (living) expenses...the citizens of Murrieta can not bear this tax. I would urge the Council to put it to a vote and see it the citizens really want it because this citizen doesn’t," Fenaroli said.

Fauntleroy Murphy March 22, 2012 at 03:53 PM
We have term limits. . I've also experienced 1st hand the selective enforcement of code enforcement. I was told they work off complaints, complaints of a 30" high A-Frame made by a competitor 2 blocks away, who by the way has a 4'x6' banner in front of their business. When I pointed it out the code enforcement officer said I would have to file a formal complaint with the city. I guess the code enforcement officer could't determine if he was in violation of the same city ordinace as I was. "no temporary signs not permenately affixed to the building" Fair is fair, enforce the ordinance or don't! The city is setting itself up for a class action lawsuit by business owners.
Charles Wood March 22, 2012 at 05:44 PM
Mr. Clark, learn how to spell... You can't get rid of overtime. When a firefighter takes the day off you can't just say oh sorry no one could drive the engine or sorry we could not treat your spouse in cardiac arrest. This is why OT is needed when someone takes a day off or is on a strike team, you need to backfill. That requires OT and when you work OT you get paid OT. Yet OT does not increase your pension, that is based on base pay. Firefighters already work 56 hours per week...not 40. Does the front line firefighter have a base pay of 100k...no. Do they make that with OT...probably. Ambulance companies are for profit, so if they can get away from adding a unit in our city to save money they will or shut down a unit so they don't have to pay OT they can. MAC this is not LAFD, this is Murrieta.
Jeff March 23, 2012 at 01:59 AM
Alright Charles explain to me what is really going on here. Is Murrieta wanting a change in ambulances services or seeking extra revenue? The city council and fire chief stated numerous times in the workshop that AMR has lesser qualified employees and even referred to them as a taxi service. Then they back track during the last council meeting. Help me I am confused. Yes ambulance companies are for profit and in this county follow the counties response standards. Murrieta needs to stop the games and realize that everyone is suffering and stop playing games.
Charles Wood March 23, 2012 at 03:10 AM
Jeff, I don't speak for the fire chief but I as a citizen want the best deal for my city. So if that means competition amongst ambulance providers...so be it. And if the results of the competitive bid get our city 1-2 more ambulances then that only helps our city. When the MFD shows up, starts (ALS) Advanced Life Support Treatment then hands the call off to AMR, AMR sends you a bill for the ALS treatment that they did not perform, the MFD did. So why shouldn't the MFD be able to bill for that. Odds are that insurance will pick up the cost anyway. AMR should bill you for the transport plus mileage only. I was at a school today picking up my kid. Engine 5 showed up for a medical aid at the school and then 5-6 minutes later an ambulance arrived. So who really provided the assessment and treatment for that patient? Shouldn't the fire dept. be able to bill for a service that the ambulance claims they provided??? Why not have MFD ambulances so all of billing goes to the City of Murrieta to help pay for our fire dept. Plus at a house fire the dual role firefighter/paramedics can provide support at that incident as well. Additionally a firefighters career is around 20-30 years, which means that those employees know our city pretty well unlike a private ambulance that has different employees all the time. Seems like a win-win for the citizens of Murrieta if you ask me.
MAC March 23, 2012 at 07:09 AM
Charles... I'm well aware of geography and realize Murrieta is not Los Angeles. I was drawing a comparison only. The similarities are LAFD does not track their resources to identify and send the closest resource utilizing AVL/GPS technology. Neither does MFD. LAFD was unable to accurately calculate true response times. The assertions made that MFD has 90 percent compliance at 6 mins can only be proven by reviewing their records. Is it not prudent to properly analyze the data to verify the accuracy of of what city officials claim before such claims are made?
Jeff March 23, 2012 at 04:08 PM
So you really think another provider would put additional units in Murrieta? Let's go back to your comment 3/22 at 10:44 where you state ambualnce companies are "for profit". I would be willing to bet any for profit company is not going to add additional ambulances to Murrieta and dedicate them to the city without some sort of agreement. So I go back to my point in this entire argument, if Murrieta is not satisfied with the standards of contract that Riverside County has, then argue that and leave the provider out of it. AMR is contractually bound to performance standards set by the county not standards that they themselves just threw out there. In regards to treatment, all of AMR's 911 units are ALS staffed and regardless of who initiates treatment they are responsible for continued ALS or BLS care until the patient is handed off to an ER. AMR employees also have told me that they do provide restock to MFD after a call so where is the issue? This is nothing more than another FD looking for a way to create revenue.
KLH March 23, 2012 at 04:10 PM
Charles, I have to ask how MFD will plan to handle the all-to-often case of extended "Bed Delays" at the hospitals.? Bed Delays = No immediate bed for the incomming patient into the ER, resulting in the Ambulance crew spending extended time at the hospital with the patient on their gurney (Unavailable). If MFD does get their wish to have their own transporting units and staff the current compliance of two units, What happens when both units transport to an area hospital and spend up to the next 2 hours on a "Bed Delay" unavailable. Who will transport the patients from the following 911 requests? .... AMR! By "Mutual-aide" request! By County EMS Contract, AMR is fined for every event that they have to request Mutual-aide from another transporting-contracted agency. Will MFD get fined, or be able to afford those same fines with their 2 units? To try to accomodate the possibility of these fines, will MFD staff a 3rd Ambulance? Could their budget afford a 3rd? Would MFD continue to charge patients the Medical Response Charge/fee as well as bill for the transport? Does MFD understand and know the percentages they could expect to receive back from Billing from both the patient and their insurance (40-50%)? Are those figures going to support the viability of MFD having their own transporting Ambulance? .... I think there are many viable questions that need to be asked and then researched before calling on the community to make a huge decision.
Charles Wood March 25, 2012 at 05:14 AM
Wow did I open a can of worms. Let me start off by saying that I am not an accountant, insurance adjuster or work for Murrieta. First MAC..I believe you are incorrect about the ALV/GPS. Most major departments, LAFD being one, have this. They have over 200 units to track and run 1000+ calls a day. The problem there was the computer was plugged in with one set of data for response times and the people were reporting that data with a different set of times....human error. With MFD, I do not know if they have AVL, but they probably voice status changes which are time stamped and stored. So have someone verify it.
Charles Wood March 25, 2012 at 05:15 AM
KLH: bed delays happen. If all available ALS ambulances are tied up on calls or bed delays and another call comes in then a BLS ambulance can respond with a MFD ALS engine. If the patient needs ALS care then the firemedic can continue treatment in the BLS ambulance. The engine can pick up the firemedic at the hospital. I do not know if MFD can afford 1 let alone 3 ambulances, that is up to the bean counters. However they should look strongly at the feasability from staffing to training to billing to purchasing to see if they could be in the mix. Potentially more firefighters, even on an ambulance, can lower building insurance rates. Ultimately the city would have to decide what is the best bang for our dollars, private or MFD. If the MFD had the contract who would they pay fines to, the city? I am guessing the fine thing would go away, the county would just let them deal internally with their own issues. The fire chief would have to answer to the city council and mayor probably.
Charles Wood March 25, 2012 at 05:34 AM
Jeff: If a private or the MFD proposed 3 ambulances not 2 and could still make a profit and all other valiables in the contract were the same acorss the board, and everyone else bidding could only provide 2 units, which company, as a city leader, are you going to pick? I do not know AMR's profit line for the Murrieta contract but if they could put a third unit in the city and still make a profit...why haven't they? We will not find out until there is a competitive bid process will we. Murrieta has 104k people, 2 ambulances are not enough. If you go into cardiac assest. MFD shows up and the 2 AMR units are on other calls so now a unit responds from Temecula or Lake Elsinore, meanwhile MFD has defib'd you 3 times, started an IV and given you cardiac meds and put in a breathing tube, again WHO has provided the assessment and treatment until AMR shows up 10 minutes later. WHO is going to send you a bill that says we did all of that to you? While that is extreme I will say that any acute status patient that is getting treatment the firemedic is probably going in the ambulance to the hospital and continuing treatment even if AMR shows up 2-3 minutes later. Again who provided the treatment???
MAC March 25, 2012 at 07:04 AM
Hey Charles... It's already been confirmed that in fact LAFD does not track their units using AVL/GPS. A few simple searches will show articles confirming that. MFD also does not not track their resources. This too has been confirmed through a Public Records Request. In fact, most departments in Riverside County do not track their resources. It's not a can of worms, just fact. Outside of very simple technology, there are other cost saving measures like implementing EMD, and not responding multiple engines (also confirmed through a records request) to a single medical response.
MAC March 25, 2012 at 07:18 AM
A competitive bid process won't reveal or demonstrate profit margins Charles. In fact, profit margins are predicated on collection percentages, payor mix, etc. Why do you think healthcare costs are so expensive? As unemployment goes up, so does the number of uninsured. There is not an EMS system whether the primary deliverer of service is public or private that collects 100 percent. In fact, there are most likely none that collect 50 percent. As far as who provided treatment, the average response outlined in the recent PE article would suggest MFD doesn't do too much.
MAC March 25, 2012 at 07:25 AM
ISO ratings have little to do with the amount of personnel a department has. There is so much more. As far as bed delays are concerned, do you really have an idea how bad they can be? And if "fines" are a non issue if the city were to assume control, what's the incentive to make sure standards are met? Again, a little research is in order.
Jeff March 25, 2012 at 03:02 PM
Charles, you are making my point for me, thank you. This is nothing but a revenue issue with MFD and your argument of who gets to bill what states your opinion clearly.
Jeff March 25, 2012 at 04:48 PM
Charles, who's BLS ambulance are you making reference to?
EMS mom March 26, 2012 at 01:21 AM
So when MFD hands over the patient to AMR do you think the IV therapy, continued EKG monitoring, vitals and possible further medication treatment get done by there selves? The paramedic on the ambulance continues that treatment in route to the hospital. Depending on which hospital the patient chooses it could be the closest for critical care or kaiser Riverside for care. I don't think the patient is alone back there. Example: If the nurse in the hospital starts the care and then ends his/her shift and another takes over the hospital still charges for continued care right?
Charles Wood March 26, 2012 at 04:33 PM
KLH/Jeff, Murrieta can and should require any BLS company that operates in the city to be part of a backfill/overload program as a condition of operating within the city, and yes that has been done no research needed. MAC even the IRS can't collect 100% but AMR has to have some sort of projection of earnings based on collection. And I have to think that Murrieta/Temecula billing pays pretty good. All I want is a competitive bid process...I really don't care who wins public or private. If AMR wins but they have to guarantee constant staffing or put opticoms on units to help with traffic and decrease response times or add 1 ambulance dedicated to our city and implementing EMD like MAC says, then the people of Murrieta win. EMS MOM, the hospital does not bill a patient for a treatment you did in the back of your AMR ambulance so why should AMR bill for a treatment that MFD or CALFIRE or whatever agency did at scene waiting for you to show up. Or why can't MFD or CALFIRE bill insurance for what they did. KLH I have to think that bed delays in Southwest Riverside County have improved over the last year with Rancho Springs ER expansion and Loma Linda opening up. But yes they probably still happen sometimes. MAC I have worked for 19 years on ambulances so yes I understand bed delays. Nothing like getting paged for a 911 call with a patient still on your gurney and it's 2:30 and you have not had lunch yet. If MFD wins but underperforms then the Fire Chief would probably lose his job.
Charles Wood March 26, 2012 at 05:00 PM
Jeff your eyes are blurry because as you can CLEARLY read in the above post I don't care who wins a bid process, public or private. All I want is more bang for my buck. Heck the real crying shame is that we don't have a STEMI center/cath lab in Southwest Riverside County. Being on scene within 10 minutes 90% of the time won't save your heart muscle. You have to be taken to Escondido or Corona, 30+ minutes down the road. But that is a different topic all together. Like I told EMS MOM the hospital does not bill you for what AMR did at scene or during transport, so why can't MFD bill for what they did for the individual patient. What if the city can just raise our taxes, provide free ambulance service thru XYZ ambulance service to people that live in Murrieta and just bill out of towners. And the city can write a check to XYZ ambulance agency minus any fines or fees. Just another option to look at for feasibility that either a private or public agency could do, Yes this is done also, no research needed. just in case you thought I was leaning to the dark side, I mean MFD.
MAC March 27, 2012 at 02:20 AM
Again Charles, research before you speak. You're correct in the fact that there are no STEMI facilities in SW Riverside County. If you can find one in Corona, I'll retract my statement. With that said, let's assume Murrieta has a STEMI patient and MFD transports to a STEMI facility in Escondido or Riverside. How long is that unit gone? Let's now assume the preverbal you know what hits the fan and MFD runs out of units. Who would they (MFD) call? BTW... "Riverside" is a clue on your STEMI locations.
MAC March 27, 2012 at 02:31 AM
Charles... You're exposing yourself again bud. AMR has pre-emption on all of their ambulances. They've had them for years. They also have MDT's, and "Live Routing". Maybe MFD will too some day. As far your time in the industry, thanks for your service. It is appreciated.
Jeff March 27, 2012 at 02:11 PM
Alright MAC if you want to keep this going I am game. With all you have said you still have never explained how a competitive bid process will increase response times and patient outcome, yet you still hang your hat on that. The county dictates the max response time and if you think XYZ ambualnce is going to say hey, its Murrieta lets put an extra ambulance there or lets do a lesser county mandated response time just because, you are really foolish.
Joh Q March 27, 2012 at 02:22 PM
Interesting read here. It looks like the Chief is pulling a fast one on the City Council and Residents. The fact is that AMR has a faster response time than the Fire Department. Perhaps he should spend more time focusing on his own performance and less time on manufacturing a crisis to bilk more money from us. http://www.publicceo.com/2012/03/riverside-county-ems-debate-fact-check/
Joh Q March 27, 2012 at 02:40 PM
Something else I discovered, AMR bills for ambulance TRANSPORT. Medicare, Medi-cal, and insurance companies pay for ambulance TRANSPORT. If an AMR ambulance arrives at your house, renders care, and does not TRANSPORT, then they don’t bill and don’t collect any revenue. THAT is why the Chief wanted to get ambulances, so he can get revenue. When that failed, he created another crisis and is now trying to charge US for services that your insurance companies WILL NOT PAY. Another misnomer is using the phrase “For Profit” as a dirty word. A corporation like AMR saves millions of dollars in expense by paying their employees a competitive (not excessive) wage and in bulk buying power. Compared to the salaries and off the shelf purchases made by a small city and AMR can take their 5 or 10% profit and still operate far cheaper than any Fire Department.
chris March 27, 2012 at 10:51 PM
(1/2)We don't need firefighter paramedics. There, I said it. A vast majority of calls are bls for the first 5 minutes. A solid bls team is all that's needed until the als crew arrives a few minutes later. The only calls that would benefit from als first responders are diabetic emergencies, and cardiac arrests. And the latter is even debatable. There are studies going on and they're showing data that patients have a better survival rate with high quality compressions, defibrillation, and simple airway adjuncts. No iv's, no drugs, no intubation. Just solid bls work. I wouldn't be surprised that in the next aha update its going to change to the aforementioned. There was also another study done that (I don't have a link to it right now) showed patients fared better with a bls first response and an als ambulance with one paramedic on it with an 8 minute ETA. That also means that that one paramedic on scene will have a higher skill success rate. More paramedics on scene will result in skill
chris March 27, 2012 at 10:53 PM
(2/2) Degradation. Simple as that. And if you still want the fire department to respond, only have them respond to calls where their equipment and/or response time would be important. Such as traffic collisions, drownings, gsw's, cardiac arrests. Otherwise keep them in station and keep them as emt's, not paramedics. And this may force amr to staff more ambulances to help keep ETA's down. I guarantee you they will be happier. Because lets face it, how many firefighter paramedics put being a paramedic first? I've never seen a firefighter run to a full arrest like they run towards a structure fire.
MAC March 28, 2012 at 03:16 AM
Jeff... Maybe I didn't come across so clear. If not, I apologize. I am not saying a "competitive" bid process will, or will not, improve response times and/or patient outcomes. In a bidding process, the agency/city requesting bids will dictate what they want the response times to be. The bidder has to meet those defined/set standards. If they don't, usually a penalty (monetary fine) is assessed; and in some cases, material breach. That help?
MAC March 28, 2012 at 03:31 AM
Joh Q... Thanks for pointing out the link to PublicCEO. Pretty amazing that the chief actually admitted he includes cancelled calls where MFD units never arrived on scene. So a unit responds yet gets cancelled 10 seconds in. The second unit responds to the same location in 10 minutes. 10 mins + 9sec= 10 mins 9 secs divided by 2 = 5 mins 4.5 seconds. I finally get it! Shobert/LAFD math! "Real world math" looks like this... MFD T1 responds to Hunter and 79 area... T1 gets cancelled in 9 seconds. MFD E3 becomes available and responds in place of T1 and arrives on scene in 10 mins. Avg response time = 1 unit ACTUALLY arriving on scene in 10 mins = 10 divided by 1 which ='s? Chief? Anyone? Beuller?
Jeff March 28, 2012 at 03:48 AM
MAC, not sure where the disconnect here is but open bidding does not in anyway change anything you mentioned. The County of Riverside sets the response standards by zone not the provider in bid process. The current contract does provide a financial penalty for missed response times so I am still not sure what your point on competitive bid is. Sorry if I am missing the point but I cannot figure out where you are coming from. What would be different than what is currently in place? The system needs to change or the County needs to improve the response standards or nothing will change except the uniforms of the ambulance providers wear. Also there is this little thing called 201 rights that needs to be considered.
MAC March 28, 2012 at 03:54 AM
Joh Q... At least you get it! BTW... Billing rates are also county approved... BUT! Let's just say you can charge $3000 for ambulance transportation to a local hospital. All Medi-Cal will pay is around $150 (that figure may be high). That's it. It could be for a stubbed toe or a 12" butcher knife hanging out of someones chest. And by law, you CANNOT recover the balance. Medi-care pays a little more, and often times those on Medicare may have a secondary payer. Secondary payers rarely pay the entire balance. Then there's another whole different category of uncompensated care. I'm sure that is MILLIONS of dollars in lost revenue. And "For Profit"? So is the city. Code Enforcement ring a bell? Do you know that in the City of Murrieta you can get a $100 fine for leaving a portable basketball hoop on the sidewalk? True story... You know Joh... "That makes it hard for the trash truck to pick up your trash." When asked if I could park my car in the street legally without being fined, I was told "absolutely as long as it's registered". I said to the nice code enforcement officer... "Now wouldn't it be harder for the trash truck if my car was parked there? All I heard were crickets as she walked back to her cute little truck.
Kevin Clark March 28, 2012 at 02:00 PM
Go to www.//lgcr.sco.ca.gov/compensation. The State of California publishes this site which includes city salaries and multipliers( amounts needed out of current budget to provide for future obligations). Retiement pay for the MFD Employees is at a minimum 90% of their outgoing salary every month for life, and life time health benefits. The multiplier for every MFD employee is 3, so 3x thier "salary" is really what is needed out of the budget to fund these future obligations. $137,703.00, 129,578.00, $171,806.00 , $178,282, $177,631.00, $130,586.00 151,469.00, these are actual amounts paid to MFD employees for 2010. All tolled 44 Dept. employee were paid over 100,000.00 in 2010. To me this is an obscene abuse of tax funds. It is no wonder the fire dept. "councilman" and chief have to disparage the abulance co.? True compitition would kill the cash cow.


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