County Asks State to Delay Ambulance Selection Process

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Top Orange County officials have asked the state to delay for a year a major ambulance selection process for 911 service as the troubled effort has hit political shoals and can’t be completed by a September deadline.

The last-minute request by the Board of Supervisors and the county Health Care Agency comes as the ambulance firm selection process for 19 cities is to start Friday. The process will determine what companies would assist the independent Orange County Fire Authority paramedics in transporting patients to hospitals.

With the current ambulance contracts for those cities running out on Sept. 1, county officials asked the state Emergency Medical Services Agency, which must approve ambulance selection processes statewide, to postpone selecting new firms for a year from that date.

“The current deadline does not provide sufficient time for our board and the public we serve to fully consider the broad changes represented by the [selection process],” wrote supervisors’ Chairman Shawn Nelson and the Health Agency’s director, Mark A. Refowitz, in an April 15 letter to state officials.

But in the latest miscue in the process over the past seven months, state officials say they didn’t see and review that letter until late last Monday, when it was provided by the Voice of OC.

The original county letter had been dispatched to Dr. Howard Backer, the head of the state emergency authority, but he was out of the office.

Apparently the county didn’t follow up, so critical days for review and consultation were lost. County health agency officials were unavailable for comment Wednesday.

On Tuesday, Jennifer Lim, the emergency authority’s deputy director of policy, legislative and external affairs, said her agency was “working diligently on its review.” She anticipated a state response to the county “won’t take long.”

Word couldn’t come soon enough to city officials and emergency providers, who’ve been dismayed by the lack of progress as well as the politics surrounding the ambulance selection process.

The county’s letter to the state contends the extension is needed to “allow for a thoughtful and deliberative process for selecting ambulance providers and will thwart any claims that the process was hasty and ill-conceived.”

Such “claims” are exactly what some municipal officials and elected leaders have been making for weeks after the county health agency was forced in February to take over the process.

In letters earlier this month, Mission Viejo and La Palma leaders wrote the state seeking the one-year delay.

“Without an extension, the current time frame will quell public input and transparency, and likely create a disruptive process,” wrote Dennis Wilberg, Mission Viejo’s city manager, on April 7.

Wilberg added that there has been “limited opportunity for review and public input” on the proposal, that county staff were “forced” to analyze and make decisions in “a matter of days” and that there are “significant issues” that remain unresolved.

In a letter on April 16, La Palma Mayor Steve Shanahan wrote that it is “unrealistic and impractical” for the county to complete the selection process by Sept. 1.

Shanahan noted that the county’s plan for the ambulance selection process wasn’t publicly released until March 27 — “after” the county held three public forums on the concept.

These cities and others are particularly concerned because the county’s proposed plan calls for creating five zones in which a firm would exclusively provide ambulances to assist paramedics. The 19 municipalities would be divided among those five zones.

Historically, the 19 cities have had a role in selecting their individual ambulance providers in partnership with the Orange County Fire Authority, whose paramedics provide advanced life support for patients transported in the private ambulances.

But in February, the state emergency authority forced the county Health Care Agency to take over the ambulance selection process, because the county had delegated too much responsibility to the Fire Authority, thereby violating state laws.

That decision came after months of conflict between and among county supervisors and the Fire Authority, with political and administrative criticisms flying in all directions.

In the latest such chapter, the Fire Authority issued a notice late Wednesday for a “special meeting” for a closed personnel session to discuss “public employee discipline/dismissal/release” at 6:30 p.m. that day. But it coincides with the regularly scheduled board meeting.

The special notice, required for a dismissal, is being interpreted by various officials in the emergency field as a possible attempt to call a vote to oust Fire Authority Chief Keith Richter.

This comes after two other publicly noticed closed sessions of the Fire Authority board’s executive committee in the last two weeks to review Richter’s performance, which followed a six-month period of added oversight.

Sources said political forces engaging in such behind-the-scenes tinkering with emergency service administration like the intrigue involving the fire chief have severely affected the launching of the ambulance selection process, which some saw previously as doomed not to meet the state deadline.

That state deadline is important, because it helps protect the exclusive rights an ambulance company has to transport 911 patients in a particular designated zone.

The state has said the county would not have its support in legally protecting those exclusive rights if the new ambulance selection process isn’t completed by Sept. 1.

Without that protection, other ambulance firms could legally challenge the exclusive contract rights for a zone. This could lead to a certain level of chaos as competing ambulances responded to 911 calls in a zone, authorities noted.

Already in the county’s proposed new ambulance deployment, there are “a number of critical steps” for cities, ambulances, paramedics and dispatchers to coordinate extensive changes for the new five-zone system, Shanahan stated. There is “not adequate time” to plan for such activities by Sept. 1, he added.

Meanwhile, ambulance firms are at the point where they don’t know whether they will be required to jump into the bidding process Friday.

On Wednesday, Bob Barry, director of business development for Care Ambulance Service, a firm based in Orange with a number of municipal contracts, said:

“We are aware of the extension request and are waiting to see what the state will do. In the meantime, we are moving forward with our [proposal] preparation on the chance the [county process starts] on Friday as planned. We have not received any information as to the status of the process.”

And that is the sentiment of many in the emergency field who are watching and waiting.

Rex Dalton is a San Diego-based journalist who has worked for the San Diego Union-Tribune and the journal Nature. You can reach him directly at rexdalton@aol.com.

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