Poodle | Ambulance Wars Heating Up in Santa Barbara

HOLD ON TIGHT:  The fat lady hasn’t begun to sing. In fact, she’s only just warming up. But for those interested in cataclysmic showdowns in our own backyard, there’s a platoon of agitated Brünnehildes — those Visigoth-Germanic warrior queens with horns sticking out of their helmets — ready to let loose a collective aria that will knock the pigeons out of the sky.

The outcome is not merely of ornithological interest. It matters to pretty much anyone who’s ever taken an ambulance ride or may need to someday.

At issue is which of two clashing titans will win the county’s lucrative contract for ambulance and EMT services.

On one side, we have the incumbent, American Medical Response (AMR) — a tiny cog in a vast corporate chain run by hedge fund overlords. Although the company has been in the county only 27 years — not the 40 or 50 years it now claims — it has provided high-quality and often heroic service since it took over the contract in 1995.

On the other side, we have a newly formed confederation of every fire chief and fire department in the county, all asserting they can provide faster, better, and more reliable service for less money while paying their EMT workers better. Instead of AMR skimming profits off the top, they promise to plow any surplus revenues back into the paramedic system. This, they say, comes to about $8 million a year. That will cover the costs of expanded mental health care and co-response teams, putting mental health clinicians and EMT workers together.

AMR has been predictably dismissive. They and their 22 ambulances have a track record of transporting 29,000 people in medical distress each year to the county’s hospitals. The fire departments, they sniff, have only three to four ambulances at their disposal and transport fewer than 800 people a year. Everything else, they say, is just talk. 

A whole lot of money is involved in the proposed 10-year contract. Depending on who you believe, the franchise is worth somewhere between $200 million and $350 million in actual collectible dollars.

It’s also worth noting that in the entire history of Santa Barbara County, the ambulance contract has never once been put out to bid. Not once.

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As a practical matter, this all started in 1980, when the state decreed all ambulance contracts must be put out to bid except for those with contracts already in place. Since 1980, “existing contracts” with a succession of companies — mostly mom-and-pops — were continually extended until AMR came along in 1995. AMR has a history of swallowing up mom-and-pops throughout the country, not just in Santa Barbara, and was itself bought out twice — once for more than $2 billion — most recently by the three-letter hedge fund. Maybe none of this corporate backstory is relevant; after all, AMR’s Director of Operations Dave Schierman — a good guy — has spent the past 31 years living in Santa Barbara; that’s where he met his wife and where he raised his kids. It’s about people, he says, not far-off corporate headquarters. 

But here’s the thing. The seven fire chiefs see it otherwise. It’s worth noting that three of the seven started their careers working for private ambulance companies. It’s worth noting that all seven have been backed up by their respective city councils. It’s worth noting they’ve been endorsed by their respective city managers. And they all have the ardent blessing of every single firefighters’ union in the county.

How many times has that happened?

How many times has the contract been put out to bid?

It’s the same number. Zero.

Here’s the punch line. Over the strenuous objection of the county’s Public Health Department, its EMS Medical Director, and 11 key players in Santa Barbara’s health care establishment, the county supervisors opted three years ago to open the contract up for bids. They got two. One from AMR and one from the Fire District. Last week, the committee scoring the dueling proposals released their results. It wasn’t even close. AMR had amassed 317 points more than the Fire District. 

The district immediately filed a protest. How could the panel possibly have ranked AMR higher for “Disaster Response” than the firefighters, the chiefs demanded? “That’s all we do,” exclaimed County Fire Chief Mark Hartwig. “Fire response!” Good question.

They also charged that AMR has played hide-the-salami, failing to disclose serious compliance issues in counties such as Sonoma and Santa Clara. In Santa Clara, AMR is charged with failing to reliably meet response time requirements three months in a row. In Sonoma, AMR announced it would no longer abide by the response time reliability standard stipulated in its contract. Also not mentioned was that in Los Angeles, AMR just unilaterally decided not to provide the non-emergency transport of patients between hospitals. AMR’s beef — a legitimate one — is that the state’s reimbursement formulas for people on Medi-Cal are unsustainably low. But that doesn’t mean they can just walk away from their contract. But that’s just what they did. 

As a sign of what’s to come, the county supes voted this week to deny a $50,000 contract extension with the consulting firm hired to orchestrate this whole bidding process. The extra money would pay for professional advice during the protest and appeals process. North County Supervisor Bob Nelson repeatedly charged “conflict of interest.” How, he wondered, could the very outfit that created the bidding process now under attack be expected to provide anything but self-serving advice? 

How indeed? Four of the five supervisors wondered the same thing. 

It’s only just getting started. In the meantime, if you stumble onto any Visigoth queens, steer clear. You might be needing an ambulance yourself.

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