American Medical Response may continue as Santa Barbara County’s ambulance services provider after a review panel ranked the company’s proposal higher than the one submitted by the county Fire Department, the only other applicant.
A contentious request-for-proposals process has pitted AMR, the existing provider, against the county Fire Department, the aspiring provider of countywide emergency medical care and ambulance transportation.
AMR has been the ambulance services provider in the county for more than 50 years, and this is the first time the county has held a public bidding process.
A contract is expected to go to the Board of Supervisors for approval early next year, and start in March 2024.
Santa Barbara County issued a notice of intent to award the exclusive ambulance services provider contract to AMR on Oct. 28.
County Fire Chief Mark Hartwig filed a protest letter several days later, and last week AMR attorney Pamela Johnston filed a response to the protest.
From here, the protest is reviewed by county Chief Procurement Officer Phung Loman, County Counsel Rachel Van Mullem, and the county’s ambulance services contract consultant, Fitch & Associates, according to Public Health Department spokeswoman Jackie Ruiz.
Santa Barbara County has 15 business days to respond to the protest. If the protest result is appealed, then it is heard by a Protest Resolution Committee whose members are not disclosed, Ruiz told Noozhawk.
“Once that process concludes, the Public Health Department will evaluate the results of the entire protest process to determine the next steps,” she said.
As the county prepared for the bidding process, representatives of local fire agencies and AMR personnel have filled public meetings with comment about why their respective sides would do a better job with the contract.
Under Hartwig’s leadership, the county Fire Department has implemented advanced life support response from all fire stations, from basic life support-level emergency medical response.
Since about 80% of fire department calls are medical calls, it makes sense for the Fire Department to provide ground ambulance services, local fire chiefs have argued during the bidding process.
AMR representatives said their employees focus on emergency medical services and provide good outcomes for patients.
In late October, a five-person panel reviewed each provider’s proposal.
All five panelists scored AMR’s proposal higher than County Fire’s proposal, with total scores of 2,077.75 points for AMR and 1,760 points for County Fire.
Panelists included Steve Fellows, a retired Cottage Health executive; Lawanda Lyons-Pruitt, director of the Santa Maria-Lompoc NAACP and a retired investigator for the Public Defender’s Office; and three emergency medical services subject matter experts from out of the area. Those three were Justin Fairless, an emergency medicine doctor and professor in Texas; Steven Smith, a retired Nevada fire chief and retired Marine; and Richard Schomp, chief operating officer of Sunstar Paramedics in Florida and a retired firefighter, according to county documents.
County Emergency Medical Services staff and procurement office staff attended the presentations as observers.
“The experts on the RFP panel clearly could see AMR was dedicated to improving the delivery of emergency medical services to this community, and we backed that commitment up with real enhancements to the system that will improve patient care and outcomes,” AMR regional director Mike Sanders told Noozhawk.
County Fire Protests Decision
Hartwig filed a protest letter on Nov. 4 alleging that AMR’s proposal had misleading claims and was unresponsive in some areas.
The responses in clinical performance management and clinical innovations sections were not detailed enough and “provided its winning margin,” Hartwig wrote.
Those two sections are flawed and ambiguous, and since they “fail to provide for full and fair competitive bidding upon a common standard, the competitive process must be thrown out and the county cannot award the contract to AMR,” the protest letter states.
AMR’s proposal was scored 317.75 points higher than County Fire’s proposal, including 138.5 points separating the two providers in the clinical standards section.
AMR’s proposal also ranked higher for disaster response, interfacility transport plan and mentally disordered transport plan.
Hartwig said his proposal detailed what the department is already doing, what the deployment plan would be, and what programs they’re working on.
“We thought it was a very compelling presentation and compelling bid, and it was created by a broad coalition within the county, so we stand by that and believe our protest has some very valid points to it,” Hartwig told Noozhawk.
He said his department worked with fire chiefs, hospital representatives and others in the emergency medical services system to develop the proposal.
“There are a lot of promises, a lot of ideas in their proposal,” he said of AMR, adding that the company talked about programs in other areas it could implement here, but hasn’t.
In the protest letter and an interview with Noozhawk, Hartwig also focused on the financial impact of giving the exclusive contract to County Fire.
Under the county plan, the profit from reimbursable ambulance transports — estimated at $8 million a year, according to his team — would be reinvested in the local emergency medical services system, he said.
Hartwig said the scoring process didn’t evaluate the content of the financial information in each proposal, only that it met minimum qualifications of the RFP process.
The organization that wins the contract will have to provide ambulance services countywide, including areas AMR does not currently serve and are instead served by the county Fire Department — UC Santa Barbara, Vandenberg Village and the Cuyama Valley.
AMR meets the minimum qualifications of the RFP, and County Fire’s protest arguments “lack merit,” AMR said in a response filed Nov. 10 by attorney Pamela Johnston.
AMR has been a provider in more than 20 California counties and provides thousands of ambulance transports a year in Santa Barbara County, while County Fire operates only three ambulances, Johnston wrote.
“The five independent evaluators here recognized the difference in experience, capabilities and the quality of the bids and awarded AMR 317.75 points more than County Fire received. AMR is the better-suited provider, and was awarded the contract. None of County Fire’s arguments in its protest is persuasive or legally valid,” she wrote.
Proposals From AMR and County Fire Describe Staffing, Response Strategies
Each proposal breaks down staffing and the use of advanced life support-level ambulances (staffed by paramedics and emergency medical technicians) and basic life support-level ambulances (staffed by EMTs).
AMR’s proposal has some changes from how the system operates now.
AMR wants to subcontract with Care Connection Transport Services to provide “non-medical and non-emergency support” transportation and behavioral health-related transports.
“New pre-hospital ultrasound devices will be introduced to our paramedics to better identify life-threatening medical conditions so that they may be treated earlier,” Sanders said. “Additionally, we have introduced a ‘nurse navigation’ concept in which a qualified nurse can evaluate certain patients with a non-life threatening health concern at the time they call 9-1-1 to discuss the condition, include treatments and advise if any follow-up care is needed.
“This will allow our paramedic resources to remain available for higher-acuity emergency responses, and it prevents the patient from making an unnecessary trip to the hospital, which in turn helps our crowded emergency departments.
“Further enhancements include video laryngoscopes on each ambulance, automatically loading gurney systems on each ambulance, placing AEDs in high traffic areas throughout the county, a mobile simulation lab to enhance training of all Santa Barbara County paramedics, expanded paramedic school scholarship opportunities for our local EMTs, and many more proposals that will benefit our county.”
County Fire proposes using ALS-level ambulances for emergency medical response, and using BLS-level ambulances for interfacility transfers. There would be “comfort stations” for paramedic and EMT crews to wash up, rest and get meals, Hartwig said.
County Fire’s proposal details 122 full-time people: 62 EMTs, 51 paramedics, six field supervisors and three registered nurses to help staff the critical care transport (CCT) unit.
Management and support staff would be hired to manage the system as well, including an EMS battalion chief.
AMR “currently employs more than 150 ground clinicians (paramedics, EMTs, CCT-RNs, etc.) as the necessary staff to fulfill our proposed deployment plan,” according to the proposal.
Both applicants noted their track records meeting response times in the county.
“AMR has consistently met our current response-time standards. As these are more stringent than required in the new 9-1-1 contract and we are adding more ambulances, we do not anticipate challenges meeting response time in the future,” AMR wrote in its proposal. “Each month in Santa Barbara County, we must achieve 90% reliability or greater with these response times to meet compliance or face financial penalties. For the year beginning April 1, 2021, and ending March 31, 2022, AMR responded to 34,744 emergency incidents in Santa Barbara County. Our all-zones average for Codes 2 and 3 combined was 92.9%.”
The County Fire Department also says it meets its response time obligations for ambulance response zones.
The County Fire proposed staffing plan “chooses to prioritize life-threatening calls for help” and says AMR is reporting slower response times for Priority 1 incidents than Priority 2 and Priority 3 incidents.