July 3 2013 09:46 AM

While Bob Filner delays choosing an ambulance provider, questions remain about current service

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Rural/Metro employees drop off a patient, whose face we’ve blurred, at Scripps Mercy Hospital in Hillcrest.
Photo by Joshua Emerson Smith

Two years have passed since San Diego's City Auditor exposed significant loopholes in ambulance provider Rural/Metro's contract with the city, and little has changed.

With the bidding process to determine the city's long-term ambulance provider in limbo, the City Council voted unanimously at a June 24 meeting to extend Rural/Metro's contract for a year. There was no mention of the performance concerns that the auditor outlined when the city dissolved a public-private partnership with Rural/Metro in 2011 amid allegations of embezzlement.

Recommendations to reform performance standards have yet to be fully addressed, said City Auditor Eduardo Luna in an email.

"Contract oversight to ensure performance standards are met is extremely important, especially for such a critical service like emergency medical transport," he said.

The Mayor's office did not respond to questions about the city's ambulance contract. City Councilmember Marti Emerald, who's been a vocal supporter of Rural/Metro, also did not respond to questions by press time.

"I'm confident, we're in very good hands," she said at the June 24 City Council meeting. "I want to thank Rural/ Metro for your great service to the city over the years, and [we] look forward to doing business with you—looks like for a couple of years."

Under contract terms dating back to 1997, the ambulance provider is required to arrive within 12 minutes 90 percent of the time or face up to a $50,000 fine. Calls that take longer than 24 minutes are subject to $5,000 fines.

However, there are a number of exemptions written into the contract, including one for calls received after 12 of the company's roughly 28 ambulances have already been dispatched. According to the auditor's report, about 37 percent of the most serious emergency ambulance calls in 2010 were exempt from fines and penalties. In 2010, it took the ambulance provider at least 24 minutes to respond to more than 60 emergency calls, according to the auditor's report. That's more than once a week that the ambulance provider took at least twice the official 12-minute standard to respond to a call.

However, because of contract exemptions, the provider avoided fines on about 60 violations, dodging $300,000 in penalties put in place to incentivize performance, according to the report.

CityBeat has submitted a state Public Records Act request for documents showing Rural/Metro's response-time performance and exemptions for all subsequent years. The city has yet to turn over the documents.

Asked about the exemptions, the company's California spokesperson, Michael Simonsen, said that wasn't for Rural/Metro to decide.

"It's a policy call for the city," he said. "We're the city's provider, and we perform to the letter of our contract."

The city auditor's report also pointed out that response times are not measured starting when a dispatcher receives an address from a 911 caller, as is the standard in many other ambulance districts around the state. Instead, the 12-minute response-time clock begins when a city dispatcher relays the call information to Rural/Metro.

As part of the report's analysis, the auditor's office added 45 seconds to all response times in 2010—an approximation of how long it takes a dispatcher to receive a caller's address and transmit the call to Rural/Metro.

Under these conditions, the ambulance provider failed to meet its 12-minute response deadline 90 percent of the time. In some areas, the report showed that the provider was showing up within 12 minutes less than 80 percent of the time.

Simonsen declined to comment about specific performance issues detailed in the audit.

"I'm not going to answer any more questions about an auditor's report that was done over two years ago," he said. "We're darn proud of the service we provide to the citizens of San Diego."

Besides the city and county of San Diego, Simonsen said the company provides service to one other ambulance district in the state: the 1.8-million-population Santa Clara County, including the metropolitan area of San Jose.

Since that contract started in 2011, Rural/Metro has racked up more than $4.7 million in fines for responding to calls too slowly and other violations. In response, local officials threatened to axe the ambulance provider.

After first denying the violations, Rural/Metro has since submitted a plan to the county for improving response times.

"The Santa Clara [Emergency Medical Services] Agency considers it critical to hold our 911 ambulance provider accountable for comply ing with all of the conditions of the contract, including strictly enforcing fines for response-time compliance," said the county's EMS director, Michael Petrie. "While we always want to maintain an exceptional working relationship with our contracted 911 provider, they are always and absolutely responsible for full contract compliance."

As in San Diego, throughout most of the high-density areas in Santa Clara County, Rural/Metro is required to respond to emergency calls within 12 minutes 90 percent of the time. However, if the ambulance company is one second late, a fine is levied that increases proportionally from $250 to $15,000.

At the same time, in Santa Clara County, in the first quarter of this year, Rural/Metro was exempt from about 2 percent of calls, according to county EMS documents.

Santa Clara County's tough contract is the result of a highly competitive-bidding  process, where Rural/Metro beat out the county's previous 40-year provider American Medical Response.

While the San Diego City Council hasn't recently discussed Rural/Metro's performance standards or how they match up to comparable regions, a few members have expressed concerns about moving forward with a request for proposals (RFP) in a timely manner.

"Keeping our citizens and visitors safe must always be a core priority," said City Council President Todd Gloria in an email. "I look forward to greater council participation in the development and oversight of our standards, especially as we move forward with a new contractor or modified system."

In 2011, Rural/Metro was given a two-year interim contract to give the city time to select a provider through a competitive-bidding process. Although the city spent time preparing the necessary documents, the request for proposals never went out. In an effort to study the viability of allowing the San Diego Fire Department to participate in the bid, Mayor Bob Filner has asked that the process be put on hold.

"The mayor, like us, like the firefighters, we believe that we want to provide the highest level of service to the citizens of San Diego and the people that visit here," said Frank De Clercq, president of the city firefighters union, during a hearing at the City Council's Budget Committee in May.

"Right now, I get many calls where we have delays in our ambulance transports," he added.

Putting off the bidding process under the pretense of including the Fire Department doesn't sit well with some, including City Councilmember Scott Sherman.

"My concern is that we're getting into [what] sounds like a perpetual-motion machine here," he said at the June 24 meeting. "We put it out for RFP. It gets delayed. It gets delayed. It gets to a point we need to extend the contract, get a new RFP. I don't want to get into a loop here."

If San Diego's competitive-bidding process for an ambulance provider is not completed within a year, another contract extension for Rural/Metro will likely be back before the City Council next summer.

Whether the 15-year-old contract terms will be addressed at that point is anybody's guess.



Write to joshuas@sdcitybeat.com or follow him on twitter at @jemersonsmith.

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