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Rural/Metro: Slow response, no problem
http://www.sdcitybeat.com/sandiego/article-12072-rural_metro-slow-response-no-problem.html[8/12/2014 4:35:37 PM]
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Rural/Metro: Slow response, noproblemAmbulances in San Diego are arriving late more often and getting away with it
By Joshua Emerson Smith
In 2012, the city of San Diego excused Rural/Metro ambulances from arriving late to the most serious emergency callsmore than 11,000 times, more than a 100-percent increase over 2011.
When Ramon Soliz came home from work on a Monday afternoon in early June, he found his92-year-old mother Francisca unconscious in the living-room recliner. Soliz made severalattempts to wake her as his house quickly filled with relatives concerned that she could bedying. Soliz said he remembers his sister calling 911 while he tried to revive their mother.
“Honestly, I thought she was gone,” said the 62-year-old, who houses and takes care ofFrancisca. “We laid her down. I talked to her. I called her. I yelled at her.”
For more than half an hour, the Soliz family waited for an ambulance to show up to theirRidgeview-Webster neighborhood in southeastern San Diego and take Francisca to a hospital.At the scene, fire-department first responders communicated with the emergency vehicle,which was stuck in traffic.
The situation was extremely tense, Soliz said. “We sat here and the ambulance wouldn’tshow. She’s my mom. That situation would make anybody nervous.”
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Rural/Metro: Slow response, no problem
http://www.sdcitybeat.com/sandiego/article-12072-rural_metro-slow-response-no-problem.html[8/12/2014 4:35:37 PM]
When the ambulance arrived, emergency medical technicians (EMTs) apologized, Soliz said.“One of the guys said there was a major accident on [Highway] 805, and they were drivingfrom Chula Vista. They were trying to come this way because the people over here, thenearest [ambulance] was on another call.”
In the end, Francisca regained consciousness, was transported to the hospital as a precautionand returned home the next day.
“We’re fortunate that it was nothing serious, but she could have been in a worse situation,”Soliz said. “I know the day could come when she might not wake up.”
The city’s private ambulance provider, Rural/Metro, is required under its contract to arrivewithin 12 minutes 90 percent of the time or face up to a $50,000 fine. Each call that exceeds24 minutes is subject to a $5,000 fine.
However, the ambulance provider was never fined for taking more than 34 minutes to get tothe Soliz family’s home.
Since 2011, a loophole in its contract has allowed the ambulance company to arrive latewithout penalty to more than 20,000 of the city’s most serious emergency 911 calls,according to documents obtained from the San Diego City Emergency Medical ServicesDepartment.
Over the same time period, Rural/Metro was exempted from hundreds of 24-minute-response-time violations, in some cases taking more than 40 minutes to respond to an emergency call,according to city EMS documents.
That lost time can mean irreversible damage for someone suffering from a severe medicalcondition, said San Diego Medical Services Director Jim Dunford.
“For every 15 minutes that goes by, mortality rises,” he said of stroke and heart-attackvictims. “The long-term consequences of not getting an artery reopened in a timely manner isyou have a higher risk of not having a complete return to normal.”
So, why is the city allowing Rural/ Metro to get away with this? Under the company’scontract, response-time requirements are exempt for all ambulances dispatched after 12ambulances are on the road. In the contract, the exemption is called “unusual systemoverload.”
The Mayor’s office indicated a willingness to answer CityBeat’s questions about the city’scontract with its ambulance provider and what it means for the safety of citizens, but didn’tdo so by press time.
Rural/Metro spokesperson Michael Simonsen downplayed the company’s responsibility for theloophole. “It’s unfair to put it on Rural/Metro when the city agreed to and signed everythingthat’s there,” he said.
Limiting late arrivals would likely mean putting more ambulances on the road. However, it’snot clear if the Scottsdale, Ariz.-based ambulance company could afford that.
Rural/Metro recently filed for Chapter 11 bankruptcy reorganization after sealing a deal withlenders to significantly reduce its debt. As part of the deal, the company will receive $135million from lenders and bondholders to stabilize operations.
In San Diego, Rural/Metro staffs between 23 and 36 ambulances based on the city’s “peak”and “non-peak” needs, Simonsen said, adding that the company would never limit services tosave money.
“We don’t manage to the exemptions,” he said. “We manage the system how it is. We base iton the time of distance, all those things that go into managing an EMS system.”
In a 2011 report on Rural/Metro’s ambulance service, San Diego City Auditor Eduardo Lunawarned of abuse of the contract loophole. At that time, Rural/Metro was arriving within 12minutes more than 90 percent of the time, even without the advantage of exemptions.
That changed in the first quarter of 2012, when the ambulance company’s use of exemptionsfor the most serious emergency calls more than doubled, according to city EMS documents.
In 2011, Rural/Metro claimed an exemption 4,727 times. In 2012, the number of exemptedlate arrivals more than doubled to 11,432.
As a result, the company’s response-time rate before exemptions plummeted to 83.4percent. Without the loophole, the company would have faced a $50,000 fine. With theexemptions, the company got credit for meeting the deadline 96 percent of the time.
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Rural/Metro: Slow response, no problem
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Since then, the company’s actual 12-minute response time for the city’s most seriousemergency calls has not risen above 86 percent, according to the most recently available citydocuments. Officially, the company continues to enjoy a response-time rating that has beenas high as 97.4 percent when exemptions are factored in.
“They have met the city’s required contact terms,” San Diego Fire Chief Javier Mainer said.“Regretfully, when the city wrote the contract, the city didn’t write a very tight contract.”
While use of the exemptions has recently shot up, the loophole has been part of the city’sambulance contract since 1997, when Rural/Metro and the city of San Diego formed a public-private partnership called San Diego Medical Services Enterprise. The city lauded thepartnership as a national model for innovation. However, in 2011, the partnership dissolvedafter the ambulance provider was accused of embezzling more than $17 million from the city.In the end, the company paid $1.4 million to the city for legal fees, and the case wasdropped.
The city planned to start a competitive-bidding process, but then-Mayor Jerry Sanders delayedit, and Rural/Metro was given a temporary, two-year contract. During contract negotiations,the city unsuccessfully requested that Rural/Metro scrap the “unusual system overload”exemption.
“I was part of the meeting where they said, ‘We want to get rid of that,’” Mainar said.“Rural/Metro said they were not able to get rid of that because it would cost a lot moremoney.”
Rural/Metro never refused to get rid of the exemption, Simonsen said. “My take is thateverything was up for negotiation at that time. It takes two to come to an agreement, right?It was discussed. But we didn’t say, ‘No.’ We said, ‘Let’s talk about it.’”
Rather than battling over the exemption, the city agreed to a contract that would bring inabout $10 million a year from Rural/Metro and allow the company to charge patients morethan $1,800 for an ambulance ride, according to data from the city EMS department. Theregional average for a comparable ride is less than $1,500.
The city has since drafted a new request for proposals (RFP) with the help the Abaris Group,an industry consultant that recommended eliminating the exemption loophole.
However, Mayor Bob Filner has again put the RFP process on hold in an attempt to explorehaving the city’s fire department take over the most critical EMS transport services. This year,the City Council agreed to put $100,000 into the budget to explore the option and approvedanother year-long extension for the ambulance company with no changes to its contract.
The fire department wants to increase the number of ambulances on the road, providing onefor each of the city’s 47 fire stations, said Frank De Clercq, president of the city’s firefightersunion.
“It’s imperative that people get moved quickly when they’re critical,” he said. “When there’s alarge geographical area with a minimal amount of transport units available, there’s going to besome delays.
“On the private-sector side, they have a fiduciary responsibility to their stockholders toprovide a profit,” he added. “They want to get that done with less units. If they modify howmany are on the street, there’s more of a profit to be sent to their stockholders.”
At the same time, at least a few city officials have signaled the issue needs urgent attention.
“Every second counts in an emergency, which is why I’m advocating the city put theambulance contract out to bid without delay so we can ensure San Diegans receive the fastestand most effective response when they call 911,” said City Councilmember Kevin Faulconer.
Council President Todd Gloria recently requested that a comprehensive review of the EMSsystem be docketed for a meeting of the City Council’s Public Safety & Neighborhood ServicesCommittee.
“It has become clear that we cannot wait for a new contract or new system to more closelyexamine this critical service,” Gloria said.
While the city continues to study its ambulance services and flirt with the RFP process, peoplelike Soliz will have to take whatever he gets, whenever it comes.
Soliz said he has nothing against the EMTs that work for Rural/Metro, but his experience hasmade him wary of the profit-driven ambulance model.
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Rural/Metro: Slow response, no problem
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“If it’s a private company, they’re looking at money, their budget—and where they can cut thecosts, they will,” he said. “I’m not saying they have no regard for life, but that’s justbusiness, you know?”
Write to [email protected] or follow him on twitter at @jemersonsmith.
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Michael McKinley · Works at San Miguel Fire Department
If the City takes over the primary transport responsibility for it's citizens, the financial burdenwill fall to the tax payers in the form of a tax increase, or cuts to other services. Instead ofhaving Rural Metro pay $10 million dollars for the "privilege" of providing emergency transportservices, how about using those funds to increase the rigs on the road.Reply · Like · · Follow Post · August 10, 2013 at 2:55pm3
Jeff Clyons · Top Commenter · San Diego, California
Actually Mike, the 10 mil pays for the medics on the engines that allow RM to putone EMT and one medic on the transport units...I got a better idea...instead ofsending 10 mil or more to scottsdale how about putting more units on the road toget to the calls on time?? never happen when profit is the bottom line for thecorporate ambulance business. Unfortunately this is only about money for thesecompanies, not pt care anymore as I really believe it was in the past. Theseambulance companies are about serving the shareholders at the cost of low payfor the workers and poor service to the citizens...Reply · Like · August 19, 2013 at 3:54pm
Jeff Clyons · Top Commenter · San Diego, California
and you know I love ya brother!!Reply · Like · August 19, 2013 at 3:55pm
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Darren G. Sarvis · Following · Top Commenter · Grossmont
One of the major issues all the fire departments and medic/EMT services are they are
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