Carmel: Closest ambulance should
be sent to emergency calls
Published: January 25, 2012
BREAKING AWAY from a
decades-old practice, the ambulance company serving most of
Monterey County wants the right to respond first to medical
emergencies just outside the city limits of Carmel, even if
the city’s ambulance could get there more
quickly, according to Carmel Mayor Jason Burnett.
That would put profits before safety, Burnett said, and he
plans to take his arguments to the Monterey County Board of
Supervisors when it considers extending the county’s contract
with AMR ambulance company Tuesday.
AMR had indicated it would take all calls — “even the calls
where they would be significantly slower than Carmel’s ambulance
in providing a response,” Burnett said. However, the city has
been negotiating with AMR for the past six months “to avoid
their proposed action, which would have really undone over two
decades’ worth of a good working relationship.”
“If you’re having a medical emergency or life-threatening
injury, you want to have an ambulance there as soon as possible,
and it doesn’t matter to you who shows up,” he said. “And it
shouldn’t matter to us, either.”
During negotiations, the closest-ambulance rule has remained in
effect, but Burnett said that service is threatened.
“It’s not an exaggeration to say that’s a life-and-death situation,” he said. “It is simply unacceptable for us to do anything other than send the closest ambulance.”
AMR’s position is profit driven, since Carmel area residents
tend to be wealthy enough to have private insurance and will pay
the full price for an ambulance ride, Burnett alleged. The
ambulance companies have to write off significant amounts, due
to low government reimbursement rates, when carrying indigent
patients and others who can’t pay or are receiving public
“So they see this as an opportunity to increase their revenues,
to increase their profits,” he said. “I see it as they are
putting profits ahead of public safety.”
He also said he’d be happy to have AMR respond to emergencies
inside Carmel city limits if its ambulance could get to the call
more quickly than the city’s.
“It goes both ways,” Burnett said. “We shouldn’t allow the
rather arbitrary line on a map to affect who gets the best
service. Regardless of where you live, inside or outside of the
city limits, you should have the quickest service.”
To push further, Burnett said he plans to attend the Monterey
County Board of Supervisors meeting Tuesday morning, when
supervisors are slated to consider extending AMR’s five-year
contract by another year. If approved, it would be the third
such extension and would keep AMR in place through Jan. 31,
But Monterey County fire chiefs are also concerned and
submitted a letter last October encouraging the board to send
the county ambulance service out to bid after the current
contract with AMR expires in January 2016.
“We believe that healthy competition will serve to improve
service delivery, and more importantly, patient outcomes,” they
They also asked that in the interim, the contract be amended so
that Carmel’s ambulance, as well as Carmel Valley Fire Ambulance
and the ambulance in Fort Hunter-Liggett, be dispatched to
significant medical emergencies if they are closer than AMR’s
AMR defends contract
In his request for another contract extension, AMR general
manager Doug Petrick detailed four pages of accomplishments,
goals that were fulfilled and other reasons the county should
He said AMR’s ambulances maintained better than 90 percent
compliance with regards to response times and other performance
criteria, and the company has upgraded its equipment and
participated in public-education efforts.
But the number of ambulance rides in the county has steadily
decreased over the years, he said, from 19,902 in 2009, to
18,667 in 2011, making financial health more of a challenge.
While the contract stipulates an 8 percent cap on profit, and
ambulance rides cost several thousand dollars each, 2011 ended
with a pretax profit of $1,339,524, which came in 4.9 percent
under the cap, he said.
Petrick anticipated requesting rate increases after two years
of holding the prices steady. AMR’s rates, as of Feb. 1, start
at $2,327.84 for a basic ambulance ride, with additional charges
for the type of emergency response, medical equipment and drugs,
and a per-mile charge of $50.21.
“As we continue our relationship with the county, it is AMR’s
desire to continually review and assess the needs of the
communities we serve,” he concluded. “We remain open to
discussions on possible changes to the existing contract that
would improve the emergency medical services delivery system and
overall patient care.”
County EMS Agency directory Kirk Schmitt is recommending
supervisors approve the contract and new rates.
Burnett encouraged people to attend the supervisors meeting
Jan. 29 in Salinas. For more information, visit
http://monterey.legistar.com/Calendar.aspx and download the
agenda. The supervisors meet in the board chambers in the
government center at 168 West Alisal St. in Salinas.