The Santa Barbara County Board of Supervisors approved a new contract with American Medical Response for ambulance services in a 3-2 vote Tuesday, and expressed disappointment that this was how it turned out.
“We have contorted ourselves every which way to try and find a way through this,” Supervisor Joan Hartmann said. “This contract is the best that we can do for now.”
The four-year pact is part of a lawsuit settlement agreement with AMR.
The company sued the county in 2023 when the supervisors granted contracts to the county Fire Department, and denied them to AMR through a new permit system.
Under the agreement, AMR and County Fire will both continue as providers, and the Fire Department has the option of taking a subcontract to serve Lompoc, Montecito, Summerland and Carpinteria.
AMR currently serves most of the county except the Cuyama Valley, Vandenberg Village and UC Santa Barbara, which are covered by County Fire.
The supervisors voted to approve the contract with supervisors Hartmann, Laura Capps and Steve Lavagnino in favor. Roy Lee and Bob Nelson opposed it.
“This is the best we can do in a very disappointing outcome, but one where there is still room for improvement moving forward,” Capps said.
The Fire Department ordered 35 ambulances for $3.4 million to make its contract bid more competitive, and now it may end up selling them. Next steps for the vehicles won’t be decided until a decision is made on the subcontract, county spokeswoman Kelsey Gerckens Buttitta said.
“If there are surplus ambulances, the county intends to sell them,” she said.
No one from AMR spoke at Tuesday’s meeting, but the company issued a statement about the settlement agreement last week.
Response Times
The supervisors and fire officials have been concerned about ambulance response times, and those concerns were aired again at Tuesday’s meeting. Several fire chiefs spoke during public comment opposing the contract.
“How did we end up in this position?” Lompoc Fire Chief Brian Fallon asked Tuesday. “Promises of a better system have led to longer response times, inappropriate use of (basic life support) ambulances, and a lack of urgent care for Lompoc residents.”
Offering County Fire the subcontract for Lompoc, Montecito, Summerland and Carpinteria “is not an act of generosity,” he said, but one based on revenues.
Hartmann called those areas “the least profitable and hardest to serve.”
Peter van Duinwyk of the Montecito Fire Protection District board of directors left supervisors with two words: “Seconds count.”
The county should have more ambulances, more transparency in contract compliance, and reinvest profits locally, according to Carpinteria-Summerland Fire Chief Robert Kovach.
“My district is on the south end of the county, and it’s considered a cul de sac for ambulance service, with units coming in from only one direction,” he said, and they’re often fighting rush hour or weekend traffic. “We demand improved coverage for our area.”
“You’re giving AMR permission to be late for every emergency,” claimed Louis Farah, president of the Lompoc Firefighters Association.
He said ambulance delays are “on you” and “only you can decide if the threat of their lawyers is more threatening than the threat to human life.”
Public Health and Emergency Medical Services officials explained some details of the new contract, in response to questions from the supervisors.
This contract has a “narrowing of response times and exemptions,” and gives the county more authority to make sure response times are being met, Public Health Deputy Director Lars Seifert said in response to questions from the board.
The response time standard for Priority 1 calls in urban areas, 7 minutes and 59 seconds, is two minutes faster than it is in the current contract.
The contract adds tools to evaluate clinical care performance as well as response times.
“It’s getting people to the scene as quick as possible and also what is the care being provided, and is it the appropriate level of care,” Seifert said.
County Executive Officer Mona Miyasato said that to incentivize the clinical report card, there are financial offsets to possible penalties or delayed response times.
“This approach was in the original RFP and was responded to by the Fire Department in their response, saying they supported this approach. This was not anything new that came out of this agreement today,” she said.
Hartmann said she didn’t know much about LEMSA before the contract request-for-proposals process, and “I think that’s a mistake.”
She later said, “We all know a lot more now having gone through this process, and we’re going to be watching very carefully.”
Lavagnino said he was “baffled” by Lompoc and Carpinteria-Summerland fire officials objecting to the contract since it allows County Fire to take over ambulance services in their areas, for which they’ve advocated.
He was also “disappointed” by accusations leveled at the board members during public comment.
“I’ve been here 15 years, and I have stood with you guys every single freaking time,” he said. “I’m just … I’m at a loss, man. To point to this board and say, if somebody gets killed, if somebody gets hurt, it’s on us … I thought you were better than that.”
Noting that his father is 89, Lavagnino also said he has children and grandchildren.
“If I thought I was putting any of those people in danger, I would not be voting for this,” he said.
Nelson said he doesn’t agree with the decision to settle the lawsuit and approve this contract, but he respects his colleagues who do.
“The one pinch point in this whole thing was response times, not level of service; we’re doing a great job across the board once we’re there,” Nelson said.
He said he wants a multi-provider system and more ambulances to address response times, and “I think this contract moves us away from that.”
Lee, who joined the board in January, said, “I have been struggling with this more than anything that I have voted for so far.”
He said he could not support the settlement.