Over recent months, San Diego Fire Department officials have increasingly become uncomfortable with ambulance service in the city. On at least two occasions, firefighters, who act as first responders on 911 emergency calls, took it upon themselves to transport patients to a hospital using department fire engines after ambulances failed to show up on time.
Concerns city ambulance provider Rural/Metro hasn't provided proper service to residents facing life-threatening emergencies proved warranted last week after the city released its latest quarterly response-time report card for the Scottsdale, Arizona-based company.
Between July and September, Rural/Metro failed to meet response-time standards under its contract with the city, triggering a $230,000 fine. Drawing the toughest penalty allowed under the agreement, the private company failed compliance in each of the city's four ambulance zones, as well as citywide.
"It is a big deal," said Fire Chief Javier Mainar. "It's an essential safety service. We want to make sure we're getting the level of service that the taxpayers are paying for and that we feel is necessary to protect their safety."
In an email, Michael Simonsen, Rural/Metro's regional market development director, blamed the company's noncompliance on an uptick in calls and staffing issues. Simonsen declined multiple requests by CityBeat for a phone interview.
"[W]e, along with other EMS providers in the county, have faced a decline in readily available paramedics to hire and put through the city's field training process," he wrote. "Although, we continue to hire as many available paramedics as possible, it still requires us to put them through a 45- to 60-day process to be cleared to work in the system."
This year, the ambulance provider experienced a call-volume increase of about 7 percent, compared to an average annual increase of roughly 2 percent, Simonsen said. As part of a contract extension last year, Rural/Metro pledged to add 300 ambulance unit hours a week and hire more personnel to meet demand. So far, the company has added 130 unit hours.
"The fire-rescue department is holding weekly meetings with Rural/Metro to ensure compliance," said Craig Gustafson, spokesperson for Mayor Kevin Faulconer. "The company has informed the city that additional ambulance unit hours are being added to meet the increased demand and correct the under-performance."
In its 18-year history with the city, Rural/Metro has never had a fine until now. Under the contract, the city requires the ambulance company to arrive at life threatening 911 emergency calls within 12 minutes 90 percent of the time.
For many years, Rural/Metro benefited from a contract loophole, known as "system busy." The contract provision exempted from response-time standards any ambulance dispatched after 12 were already on the road. During peak hours, the company can operate more than 40 ambulances at once.
After CityBeat exposed the system-busy loophole in 2013, the city nixed the provision from the contract last year. For years before that, the city's compliance reports proudly showed Rural/Metro met the response-time standards around 97 percent of the time. Last year, from October to December, the ambulance company's percentages slipped down to 93 percent and below, flirting with noncompliance in several zones.
Then things went black. For the first two quarterly reports this year, fire department officials said a technical glitch resulted in inaccuracies in tracking response times, causing them to toss six months of compliance data. Once the system came back online, Rural/Metro found itself badly out of compliance.
For several years, Ryan Jurgensmeier worked for Rural/Metro as an emergency medical technician and a scheduling administrator before leaving in January. He recently told CityBeat that the company has provided the city with questionable service for longer than many realize.
"Now that the get-out-of-jail-free card, the loophole in the contract is cut off, the real times are showing up," he said. "I think that's always been a problem. It's just never been reported because of that loophole."
Simonsen has routinely denied that the contract loophole affected Rural/Metro's level of performance or its staffing decisions. However, since the tightening of the contract, the company has not only seen its number decline, but it has steadily added ambulances to areas long speculated to be underserved, such as at the border.
The issue now, Jurgensmeier said, has been getting employees to fill those additional shifts. As a scheduling administrator, he said he saw firsthand how the company's thin staffing model has over-worked employees and "hurt morale."
"It's like, do I really want to go to work and be run into the ground all day long because thereís going to be 20 other people calling out sick," he said. "So they say, 'No, I don't want to pick up those extra shifts.'
"The employees know when there's going to be a mass call-off where people are so tired," he added. "If people get run into the ground in the beginning of the week, nobody's going to be showing up on Friday."
These labor issues have also grabbed the attention of City Councilmember Marti Emerald, whose Public Safety Committee will hear the issue on Wednesday, Oct. 28.
"We've been hearing anecdotally that they're having some labor problems, and all I can say is 'fix it' because lives are on the line in the city of San Diego," she said.
Emerald said she is concerned about "another loophole" that allows Rural/Metro to sidestep the city's living-wage ordinance. The law, which applies to about 2,300 workers, currently requires city contractors to pay their workers a little more than $14 an hour. Starting paramedics and emergency medical technicians at Rural/Metro make $13 and $11 an hour respectively.
"We're working on amending the living wage ordinance to include medical workers, so that going forward in any new contract with Rural/Metro, or anyone else, their employees would instantly get a raise," Emerald said.
Going forward, Rural/Metro will now face an even tougher challenge. Under a five-year contract extension approved in June, the city tightened its rules further. Starting in October, the ambulance provider has had to meet response-time standards for eight zones instead of four or face fines of to a $50,000 for each area. Outlier penalties will also be issued for calls that take longer than double the 12-minute response time.