The Board of Supervisors approved a major change to Santa Barbara County’s ambulance services system on Tuesday.
After pursuing and then abandoning an exclusive contract for services across the county, the supervisors approved a non-exclusive contract system, and gave themselves the authority to pick future providers.
American Medical Response’s contract is up next year, and the county wanted a new, exclusive contract with a provider required to cover all areas.
AMR doesn’t cover Vandenberg Village, the Cuyama Valley or UC Santa Barbara, so the county Fire Department has ambulances serving those areas.
AMR and the county Fire Department both submitted proposals for the countywide contract and AMR was scored higher by a review committee – a decision upheld even after Fire Chief Mark Hartwig filed every appeal and protest that he could.
However, the Board of Supervisors was clearly unsatisfied with how that process went – they even dismissed their consultant during the process.
They abandoned the request-for-proposals process for an exclusive contract, and in April asked staff to create a process for a non-exclusive ambulance services agreements.
Public Health Director Dr. Mouhanad Hammami presented the proposed new system at Tuesday’s meeting: The Board of Supervisors would have the final say in issuing three types of permits: responding to 9-1-1 emergency medical calls; inter-facility transfers and staffing for special events such as festivals; and critical-care transfers.
The inter-facility transfer and special event provider would also provide “surge capacity” when there is a high volume of emergency calls, Hammami said.
Each permit type will be issued to cover the entire county except Vandenberg Space Force Base and the Santa Ynez Band of Chumash Indians reservation.
“The Board of Supervisors is the ultimate authority in approving, approving with conditions, or denying the permit applications,” Hammami said.
It seems likely from the county’s permit structure that it would select one provider for emergency medical call response, but could have multiple ambulance services providers overall.
The new process is very different from the request-for-proposals process. It gives the supervisors authority to pick providers, rather than emergency medical services staff in Public Health and other departments picking a provider and negotiating a contract before bringing it to the supervisors for approval.
The supervisors voted unanimously on Tuesday to approve the new ambulance services ordinance, and will have a second reading and final approval on the June 20 meeting agenda.
The supervisors will not only have the final say in picking providers, but broad discretion in doing so.
Beyond the minimum qualifications, they can consider community benefits such as innovation, integration of services and local reinvestment – all examples that sound like they were pulled directly from the county Fire Department’s ambulance services proposal.
In questions about board discretion on permits, Fourth District Supervisor Bob Nelson asked if they could consider contract disputes that happened in other counties – referencing an issue County Fire brought up in one of its RFP protests of AMR.
County Counsel Rachel Van Mullem said the board can consider additional permit criteria and “the totality of circumstances, and the board has discretion on that criteria.”
Nelson also asked how ambulance system resources will be deployed, saying, “Really important to this board is making sure whatever we have is equitably distributed throughout this county.”
Assistant County Executive Officer Tanja Heitman said AMR and the county Fire Department are eligible (and likely) to apply for these permits since they were established as viable options during the request-for-proposals process.
First District Supervisor Das Williams invited Hartwig to speak during the meeting about the department’s likely application for at least one of these permits.
Hartwig said the department did extensive financial analysis for its proposal, and looked at how to distribute ambulances countywide to meet requirements.
California has about 325 ambulance service zones statewide, he said, and about two-thirds of them are exclusive and one third are non-exclusive with multiple providers.
All three permit types are set up as countywide services, Heitman said, “so if an applicant applies or any of the three permit types, they need to describe a deployment plan that encompasses the entire county.”
Emergency medical calls will be dispatched out of the county’s public safety communications center at the Sheriff’s Office headquarters until May 2024, when it will all go through the Regional Fire Communications Center being built at the Emergency Operations Center.
Hammami said the goal is to have the new permit holders start operating by March 1, 2024, the last day of the current AMR contract.
“We are so sometimes focused on who is providing what, meanwhile the answer should be who is showing up, and how are we serving the public,” Hammami said.
Local fire chiefs and civic leaders have openly supported giving the ambulance services contract to the county Fire Department over AMR, but none of them spoke at Tuesday’s meeting.
No representatives of AMR spoke at the meeting either.