County Ambulance Contracting to Move Full Steam Ahead

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Citing a state mandate, Orange County supervisors on Tuesday rebuffed efforts by cities to slow down the county’s large-scale ambulance contracting process, as concerns were raised about the dropping of certain experience requirements for ambulance firms.

Last week, cities were first given a copy of the draft contract requirements and process, also known as an RFP. The 19 cities covered in the current process have until the morning of April 8 to submit their thoughts to supervisors.

In comments to supervisors that echoed several cities’ sentiments, Aliso Viejo City Manager Dave Doyle said his city is worried about “the rapidness with which this process is evolving.”

Doyle added that he’s “very concerned about how this might negatively impact our residents.”

He joined other cities in asking supervisors to extend the current contracts, which expire on Sept. 1, by another year.

But county officials said that’s not an option, given that the state Emergency Medical Services Authority warned that any extensions would remove the county’s protection from antitrust lawsuits.

Spitzer said that burden “sounds like it’s potentially insurmountable,” suggesting that if cities want an extension they should talk to the state. “I really really want to hear from you, so tell us as quickly as possible,” he said.

Under the draft RFP, ambulance firms would no longer be required to have specified years of experience in Orange County or a comparable system, prompting concerns from some city officials like Mission Viejo Mayor Trish Kelley.

Cities could also lose the authority to control the number of ambulances on duty for their residents, according to Kelley.

Those two issues weren’t publicly addressed by supervisors on Tuesday.

Spitzer did underscore how critical the next few days are, given that supervisors are allowed only to approve or disapprove the recommendation of bid review panels.

“The stakes are very, very, very high, because if we don’t get the RFP right and we want to make any changes in the recommended actions when it comes back to the board after the selection process, we will be prohibited from doing that at that time,” Spitzer said.

“This is probably one of the only times in my political career where my discretion has been completely taken away,” he added.

He encouraged cities to send in their comments as soon as possible.

Just five or six of the 19 cities have sent in their comments so far, according to county staff.

During Tuesday’s discussion, it also emerged that lobbying by ambulance companies and firefighter unions has changed part of the contracting process.

Previously a given ambulance firm could only compete for three of the five zones. Now county staff are allowing firms to apply for all zones. But if a single firm gets more than three, it will be asked to pick three, with the rest going to the second-ranked bidder.

That change grew out of the state emergency authority being lobbied by four of the ambulance companies and two fire unions, according to Dr. Sam Stratton, the county’s medical director for emergency services.

The state agency then called county staff and recommended that it change its plan, Stratton added.

Spitzer questioned why the county would knock the highest bidder out of some of the coverage areas, calling it an “artificial mechanism” to affect the outcome.

Mark Refowitz, the county’s Health Care Agency director, replied that there’s good reason to have at least three ambulance firms operating.

“We believe we have a compelling interest not to have a monopoly here,” Refowitz said, in case the firm goes out of business or something else happens to it.

Given the restrictions on supervisors’ ultimate decision on the contracts, a huge amount of power will rest with the panels that review and rank the contracts as well as what metrics they use and how those metrics are weighed.

It was unclear from Tuesday’s discussion who will pick the panelists that score the firms. Five panels will evaluate the bids, one panel for each of the new operating zones.

Spitzer also critiqued how the draft request proposals don’t require ambulance firms to provide background information on their EMS staff nor mandate that seatbelts be worn, vehicles cleaned after transporting a patient or what a standard response time should be.

The draft RFP is scheduled to return to the board April 8 for any changes before being sent to the state for approval.

Please contact Nick Gerda directly at ngerda@gmail.com  and follow him on Twitter: @nicholasgerda.

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