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.”

Closest-ambulance rule

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 assistance.

“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, 2018.

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 said.

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 ambulance.

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 agree.

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.