By Royal Calkins
If you live in Carmel Valley or an unincorporated area near Carmel or other various pockets in the county, you might want to brush up on your first aid skills. Monterey County officials are seriously considering a plan that would slow ambulance responses to your neighborhood.
And, if that wasn’t enough to concern you, consider that the plan calls for staffing ambulances countywide with emergency medical technicians, people with significantly less training than the paramedics who now handle most of those calls throughout much of the county.
If you are well-versed in the field of emergency medical services — ambulances and paramedics and the like — and would like to express your concerns about this to the appropriate county officials, you may have to keep it to yourself. The county lawyers have ruled that because the county ambulance contract is up for bid, it is inappropriate for members of the Monterey County Board of Supervisors or other key county officials to discuss the matter except with one another.
It’s all part of a plan by Monterey County to award a new contract for emergency medical services starting in January — a process that has proved to be a political and logistical minefield for other counties up and down the state and elsewhere.
The chiefs of various fire departments in Monterey County and others involved in emergency medicine are requesting that the county call a time-out and start over. The county’s own Emergency Medical Services committee, made up of fire and health officials and others appointed by the supervisors, voted unanimously last week to ask that the current process be aborted. They want the county to consult with professionals in the field, and the taxpaying public, before making any additional effort to hire a new ambulance service and implementing a long list of new and, in some cases, untested procedures.
County officials insist they consulted everyone who needed to be heard during a consultant’s study last year followed by a series public hearings. But those public “listening sessions” were held last October, before anyone knew that the county was considering a major overhaul, and the announcements provided fairly cryptic information.
Here is what they said:
“The Monterey County Emergency Medical Services Agency will be holding a series of five community-based listening sessions designed to help the county assess the effectiveness of our EMS system. The sessions will be open to residents and community partners and will be structured to encourage feedback and ideas around how to provide all aspects of our EMS system.”
Attendance was sparse.
A fire official in a Peninsula city who asked not to be named said he attended one of the sessions “and all I heard anyone say was they wanted faster and cheaper service. What the county’s planning to do won’t help on either of those counts.”
The county now contracts with American Medical Response (AMR), one of the nation’s largest ambulance companies, to serve most of Monterey County with the exception of Carmel and the service area of the Monterey County Regional Fire District and a couple other pockets. AMR had held the contract for several years, racking up its share of controversy, before it was replaced in 2006 by an under-capitalized startup, Westmed, that lasted a little over two years. AMR then won a new contract but never won the full support of county officials who complain, among other things, that the company’s equipment is too old.
One advantage to sticking with AMR, its supporters say, is that it also holds contracts with three other counties nearby — Santa Cruz, Santa Clara and San Benito — which can provide some economies of scale and help with staffing issues. AMR, like other ambulance providers, has been having great difficulty holding on to paramedics, partly because prevailing wages are low and because fire departments, which pay better, regularly recruit paramedics from the ranks of ambulance companies.
With AMR stretched thin to cover a county larger than Delaware, the county has relied for years on a system in which well-staffed ambulances operated by Carmel Fire Department and Monterey County Regional are routinely sent to emergency calls outside their bureaucratic boundary when it is obvious that they could arrive more quickly than an AMR unit. In January alone, Carmel Fire handled 40 such calls.
Under the plan crafted by the county in its effort to lure another provider to replace AMR, Carmel Fire or Monterey County Regional units would not be dispatched even if it was obvious they could arrive long before an unit under country contract.
Carmel Mayor Dave Potter, a former member of the Board of Supervisors, has called that part of the plan “outrageous.”
The county put out a detailed request for proposals to solicit applications from various ambulance companies, AMR among them. As part of that scheme, specific mandated response times for some areas would be eliminated and replaced with language requiring only that the ambulance arrive “as soon as possible.”
Along with soliciting a new ambulance provider, county EMS director Mike Petrie also proposes to rewrite a large slice of the county’s rules on emergency medical services, but professionals in that field say that not enough time and attention has gone into that process.
In a letter to the county earlier this month, Monterey Fire Chief Gaudenz Panzholzer wrote, “We would like the EMS Agency to define the problem that is being solved and then to collectively work on a solution with us. This still feels like an attempt to push through a predetermined solution to an undefined problem.”
Panzholzer added that while the county had been engaged in the process for months, he and other stakeholders were being given only a few days to analyze and comment.
Under the proposed new arrangement, the county’s designated ambulance provider would be subject to significant fines for missing various deadlines and response time requirements, at least the response time requirements that remain in place. Critics of the plan say it appears the county hopes to use hefty fines to generate additional income for itself. Attempts by other counties to make money off their ambulance contracts have been ruled to amount to illegal kickbacks of sorts.
Critics are also concerned that the county, which now operates the dispatch system, wants to turn that process over to the designated ambulance company, which could lead to dispatch decisions based on profit-and-loss considerations rather than public safety needs. Already, area health care experts say the county has been pushing AMR to take patients with relatively minor injuries to the county-owned Natividad Medical Center in order to prop up the trauma center there.
Mike Urquides, longtime chief of Monterey County Regional, is among the leaders of the effort to end the current process and begin again.
“The main thing should be to provide the best service with the best response times,” he said. “That isn’t happening.”
Urquides has been attempting to meet with John Phillips, chairman of the Board of Supervisors, but has been told that the county lawyers have ruled that Phillips and other board members cannot receive outside input because a competitive bidding process is under way and outside contact could be deemed to amount to inappropriate lobbying.
Urquides argues that the county is ignoring the realities of county ordinances and a countywide EMS tax that requires better service than what is being proposed.
Because of Urquides’ inability to meet with Phillips, a number of “concerned citizens,” including several political supporters of Phillips and contributors to his Rancho Cielo youth ranch, signed a January letter to Phillips pointing out their concerns about the system that could emerge from the county’s processes.
“Currently the portions of the Monterey Regional Fire District that are not served by our own fire-based ambulance can expect ambulance service within 16 minutes of reporting a medical emergency,” the concerned citizens wrote. “Assuming the newly proposed ambulance contract is approved and implemented in February 2020, many of these areas will no longer have any response-time requirements. The contract ambulance will simply arrive ‘as soon as possible.”
“Given the number of elderly residents living in neighborhoods such as Corral De Tierra, San Benancio, Hidden Hills, Tehama and Chualar Canyon, we are deeply concerned that precious minutes will pass without an ambulance during life-threatening medical emergencies …”
It isn’t known publicly which ambulance companies have bid on the new contract but a persistent rumor in health care circles is that the favorite at the moment is a Danish company, Falck, that has in recent years become the second or third largest ambulance company in the United States, largely through acquisition of smaller companies. It enjoys close corporate ties to Denmark’s pharmaceutical industry and is one of its largest shareholders is the family that owns the Lego toy and amusement park empire.
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