The Riverside County Board of Supervisors took the first step Monday toward opening up the county's emergency medical services for a competitive bid process, or at the very least, toward considering it.
The move came at the end of a nearly three-hour workshop in which several Murrieta officials and residents urged the supervisors not to blindly renew a long-held contract with American Medical Response. The meeting was called to assess the county's admittedly aging emergency medical system along with an amended contract with AMR.
"There is an area of improvement here; it is going to take some time," said Supervisor Bob Buster, who is chairman and called for the agenda item.
"Right now we have a system that does not distinguish the real trauma calls from those that are less severe. We are glad to see our partners here, because it is going to take coordination.
"This system here has to work at its best when we have a major disaster such as an earthquake. We are going to begin talking about this today, talking about where we are."
Murrieta Pushes for Change
But Murrieta officials said that talk has been going on for too long, and said going out to bid would provide healthy competition and in turn improve the system. Riverside County is 20 years behind others in California, they said.
"It is better to give birth than to raise the dead," said Murrieta City Councilman Doug McAllister, when given the floor to speak during public comments.
"For 31 years, in Riverside County there has been no competitive bid," added Murrieta City Councilman Alan Long. "I would venture to say that because of that, the bar has remained very very low."
Long gave examples of three other California counties that have gone out to bid and gotten positive results: Santa Clara, Alameda and Los Angeles. In Alameda, he said, they hired a private party to oversee the bid process.
Murrieta City Councilman Rick Gibbs also spoke. Gibbs has been employed in the private sector for many years, and has dealt with government contracts--which always go out to bid, he said.
"I would call these normal best business practices. The Manhattan Project was done in less time than this," Gibbs said.
Other officials in attendance from Murrieta included Fire Chief Matt Shobert, City Manager Rick Dudley and Senior Management Analyst Brian Ambrose. About two dozen residents from The Colony retirement community also came to show support in their elected officials' quest to better emergency medical services in the city and county.
"Perhaps AMR isn’t the best service for us," said Mary Ann Plummer, a resident of The Colony. "I am asking that we eliminate the AMR monopoly and go out to bid. It may save my life...please give us a choice."
Murrieta is unique in that is among the few cities in the county to provide its own fire department, while other cities--including its neighbors in Southwest Riverside County--contract for county fire services. For some years, fire departments have had to train paramedics in order to ensure adequate response times. The problem, Murrieta says, is the services are redundant. Therefore, the city seeks to control its own, or at the very least, see the contract go out to bid.
An official from Canyon Lake, which contracts with Riverside County Fire Department, spoke of increasing costs.
"The cost of emergency response to our city has increased so very rapidly that it is no longer sustainable," said Canyon Lake Mayor Barry Gene Talbot. "The Fire Department does a wonderful job. We are happy with the Fire Department and we are happy with AMR; we flat can't afford it and we are looking for some help here and some cost-efficiency."
He too said the services are redundant.
"It is very cost wasteful; I think there is a lot better way to provide that service. We don’t need heavy fire trucks driving through our neighborhoods to transport someone to the hospital."
While seeking different outcomes, both cities are pushing for change--a second, hard look at the proposed contract extension.
Bruce Barton, director of Riverside County Emergency Medical Services Agency, admitted there was a hole in Southwest Riverside County; there is not yet a certified heart attack center.
Barton, who worked for AMR before becoming the county director in 2007, said AMR is committed to addressing those needs. The company has contributed to bringing the county's data collection system up to par in the next contract period, he said.
"There are all kinds of things that we don’t have data for...the ambulance provider has said they are going to step up and help with funding the system," Barton said.
Murrieta firefighter/paramedic Dean Hale spoke, however, of the concern of privatizing emergency medical care.
"...The one thing the Gov. Pete Wilson said [in 1997] was do not privatize.." Hale said.
"Now we are looking at a bid service for privatization. I am sorry, but privatization is far less service then you get with your fire service. We step up and do our job 100 percent of the time," Hale said, referring to AMR's contractual obligation to meet their performance measures 90 percent of the time.
Tom McEntee, general manager for AMR, said the company brings in a "modest profit."
All fire departments, including Murrieta, he said, are reimbursed for materials used during medical aids.
"Our contract with the county requires that we reimburse cities. Murrieta has always been a one-for-one exchange," McEntee said. "They do get medications back and sometimes we get an order for that medication."
McEntee also said that years ago, when the county was looking to bring more revenue in, AMR agreed to pay penalties when its response times were later than contracted for. The average has been about $500,000 a year. It has been a little lower this year, though, he said.
About the possibility that the contract may go out to bid, McEntee said: "This isn't AMR's contract. This is the county's contract. If someone wants to make a change, it's up to the county."
No official vote was taken at the workshop. Second District Supervisor John Tavaglione was absent. Fifth District Supervisor Marion Ashley excused himself early for a doctor's appointment, but did say he thought the system must be kept intact for the benefit of the economy.
"The potential savings, if any, are important in this economy," Ashley said. "We must clearly justify though any recommenation for (extending the contract)."
Buster was also leery of augmenting the longstanding system, saying it could potentially be a burden on taxpayers, with the county still suffering from shrinking property tax rolls.
Fourth District Supervisor John Benoit was afraid opening up the contract would create a set back in the county's negotiations with AMR to improve the system.
One supervisor said he saw the benefit of going out to bid.
"I don’t have any heartburn from putting this out to bid...to see what we can get," said Supervisor Jeff Stone, whose Third District includes Murrieta.
"So when you bring this back, I think you should bring back a number of options for the board," Stone said to Barton, referring to a time line for when the contract could go out to bid.
"Why not go through the public exercise, it hasn’t been done in a long time. And maybe something good will come out of it," Stone said. "The citizens will see a transparent system; this is one of the most important services the county has control over."
Staff will return to the Board within 60 days with a draft of an amended contract with AMR, according to county Spokesperson Ray Smith.
"This was the official Board direction from a previous meeting," Smith said.
"In addition to bringing back the amended contract, staff will examine the issues and questions raised today and also return with information and answers on those topics. The draft contract and the information will return for consideration at a regular meeting and at that time, it will be up to Board members to provide further direction, take action, etc.," Smith said.
Talks to Continue
Murrieta Fire Chief Matt Shobert, who also spoke, was confident their voices were heard.
"The concerns were heard from the elected officials to the residents to the fire department. They know we are united and organized. It is not just some rogue idea," Shobert said.
Barton said he was looking forward to following up with Murrieta officials.
If the contract were to be opened up to other providers, the process could take two to three years, according to Barton. He recommended at least a three-year extension to AMR's contract.
"Everybody involved here wants to do the right thing. The AMR contract has been extended a number of times and each time there has been a lively discussion in making sure we are getting the best things provided in the contract," Barton said.