The Santa Barbara County Board of Supervisors on Tuesday approved a contract extension with American Medical Response through early 2024 and had a longer discussion about the request-for-proposals process for a new contract, possibly with a new provider.
The county is starting a competitive bid process for its emergency medical services ambulance contract, and the County Fire Department will be competing for the contract along with AMR and other potential applicants.
Most of the 9-1-1 calls for service for local fire departments are medical calls, and different departments have staff trained in basic life support or advanced life support. Staff at AMR, the ambulance services provider for most of the county, respond to medical calls, provide care and transport patients to local hospitals when necessary.
“At the end of the day when it comes to the RFP (request for proposals), our goal is really not who is providing the service, but how well they’re doing it. I think that’s really what we’re concerned with,” said Dr. Daniel Shepherd, medical director of the county’s Emergency Medical Services.
County supervisors wanted to make some changes to the draft RFP, which is why it’ll have to be reviewed again by the state before it can be issued to potential bidders.
They all agreed to keep the current standard for response times, not increase them as the RFP language did.
Shepherd said research shows that the difference of 7:59 minutes (the current standard for urban areas) and 9:59 minutes for an ambulance arriving is not a detriment to patient outcomes.
There are some situations that need the fastest possible response, and that’s where first responders — the fire agency personnel — come in, he said, to administer naloxone for an overdose, epinephren for an allergic reaction, start CPR for a cardiac arrest, or otherwise initiate care quickly in a situation where minutes count.
Supervisors saw a longer response time standard as a “degradation,” as Fourth District Supervisor Bob Nelson called it.
“I will not be supporting a RFP that takes a step backwards in response times,” he said.
“And for myself, I wouldn’t want to explain that to the public,” board chair Joan Hartmann added.
Supervisors also supported language to encourage the provider to hire from the incumbent work force, in the case of AMR not winning the new contract.
The Board of Supervisors doesn’t want people losing their jobs because of this process, Fifth District Supervisor Steve Lavagnino said.
After Tuesday’s discussion and supervisor action, county staff will make the directed changes to the RFP language, get it reviewed and approved by the state emergency medical services agency, and then issue the RFP. The timeline includes reviewing proposals from bidders, choosing one and negotiating a contract, and giving the provider “ramp up” time before the current AMR contract ends on March 1, 2024.
A new provider would need time to buy ambulances, which are custom made, among other things, according to the Public Health Department.
During public comment, AMR Operations Director Dave Schierman said the company has dedicated employees and good outcomes for patients. He also accused fire agencies of displaying a passion for emergency medical services that would be gone once the contract discussion was over.
“AMR does medicine very well,” longtime local AMR paramedic Mary Gauthier said. “Fire does fire very well as they should, and all the elements that go with it, but this is our focus.”
Santa Barbara City Fire Chief Chris Mailes said the city relies solely on AMR to provide paramedics since his department is a basic life support agency. The new contract should hold to the same response time standards as the current standards, he told the Board of Supervisors. He said longer response times equates to an ambulance services provider being able to provide fewer ambulances on the street. The reason to increase them is to increase the company’s bottom line, he said.
Santa Maria City Fire Chief Todd Tuggle said his department responds to thousands of medical calls, and the RFP should not negatively affect the first responder fees or it will hurt fire agency budgets.
Tuesday’s meeting had large groups of public speakers from public fire agencies and AMR, unlike the previous meeting on this issue when only fire-agency-associated people spoke to the board.
There was some animosity in the room and public comments, and Hartmann broke into the public comment session to tell the crowd that everyone in the room should have “too much integrity to take potshots at each other.”
Lavagnino went even further, saying he had never been more disappointed, and hearing each person “ripping the other side” made it a sad day for the public.
“Honestly, at this point, I don’t want to give it to either of you. That’s where I’m at right now. I’m not happy,” he said.
— Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.