Supervisors to Consider Ambulance Contract Bid

The Riverside County Board of Supervisors will take a closer look at what extending a longstanding contract with American Medical Response entails, and what opening up a bid process could bring to the table.

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.

Money Drain

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.

Contributing Factors

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."

Deciding Factors

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."

Next Steps

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.

JohnQPublic October 18, 2011 at 02:34 PM
Once more the Fire Department is leading the charge to build their empire and increase their revenue by creating panic and hysteria and creating a problem where none exist. To imply that our county is 20 years behind others because of the contract with AMR is sheer lunacy. Many factors make up an EMS system and ambulance transport is but one of them. I also note reference to Alameda and Santa Clara who recently went out to bid. Ironically, both those contracts resulted in massive “payoffs” to the local Fire Departments that will be funded by increases in ambulance billing. More importantly, it is too soon to see if there was any benefit to the changes or if they will end up in disaster. Success should be measured in benefit to the end user, not in how much toys and money it can bring to the Fire Departments. The fact that Pete Wilson was against privatization in 1997 is so irrelevant it boggles my mind that it was brought up. Is that the best argument we get? It has been well proven that privatization in most every case is far superior to public, most notably is the oversight permitted to their operation and efficiencies. You put your requirements into a contract and fine them for failing to live up to those requirements. Can you do that with a Fire Department? If they fail to perform as expected, can you fine them? Of course not, just the opposite, they cry that they need more money and resources to do the job they promised.
MaryAnn Shushan Miller October 18, 2011 at 02:49 PM
Transparency in a bidding process is healthy and edifying. Thank you Murrieta City Council, Staff, and Fire Department representatives for responsible representation of the needs of over 100,000 residents in our city. Great job!
Rob October 18, 2011 at 04:31 PM
I agree with both comments. At day's end AMR has had a strangle hold on this county for fat too long. Put the contract out to bid and let the people decide if the firefigghters are, again increasing costs. NOTE: IF you took away the current OT in the fired dept, you could hire 30 FTE's... aka firefighters.
Concered about ems October 18, 2011 at 04:54 PM
The current County contract has been in place since the early 70's, Goodhew ambulance had a "special" relationship and agreement with County officials at that time. Because of the wording in the California EMS act, the current contract has been allowed under a grandfather clause. Nearly every other county in the country has been required to go out to competitive bid. There is no good reason not to explore new and potentially better alternatives. Every time a bid goes out, the private providers become more competitive and offer more not less to the cities or counties offering a new contract. Most of the larger ambulance companies operate with the same or similar standards as the current provider. It is time for Riverside County to open it's doors and explore all possible alternatives. A competitive bid can be accomplished in less than 6 months not 3 years. This process has been so refined that there is no need to re-invent the wheel. Riverside County officials need to remove the cloud of suspicion that hangs over them when they show a resistance to change a contract that was not agreed to using today's more transparent process.
Dean Hale October 18, 2011 at 07:18 PM
For JohnQpublic: It is sad that you use that as your cover name, because the public is a lot smarter than you. If you were able to follow the meeting at all; the discussion about 20 years behind the times; had nothing to do with AMR or the contract it was specifically talking about how the county is set up for handling the changes in EMS in the last twenty years, and the fact that they are just now dealing with information gathering and specialty resource centers when everywhere else in the nation and EMS industry has been at the fore front of this issue. If you think that for one moment that your local fire department is interested in toys than you need to visit and understand that our job and duties expected by the public have changed, and we keep up with the demands and what our end user expects. We also are in the business of understanding where we came from and where we are headed not how much money we make. We are a public (not for profit orgainzation) agency that does not bring in revenue, and we only act as a service to the end user. Privatization is relevent to the issue when you are talking about service. We do not have the luxury to turn down a call or consider it our best attempt to make it. Private companies are not about service they are only about contract and money/profit margins. When you give us a contract we meet it 100% of the time or we get fired. When Private organizations fail to meet contract they lose the bid...We do more with less everyday.
crash October 20, 2011 at 06:26 PM
If the county wants to save money they need to do the following: Open bids to other providers, cut fire ALS programs and keep them BLS, go third service response, and keep Riverside County EMS office control EMS in this county! Once you piece our EMS system out we will have a crappy EMS system just like LA and Orange County!


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