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Ambulance service scrutinized

Sat., Dec. 10, 2005

In an emergency, how long does it take for a private ambulance to arrive in Spokane?

It took more than 10 minutes in 11 percent of the calls during a three-month period this fall, a City Council panel was told Friday.

The city’s medical response system is like using concrete trucks to deliver pizza, Lt. Bill Jackman of the firefighters union told the panel.

City firefighters – paramedics and emergency medical technicians – use firetrucks to respond to emergency 911 calls under a citywide EMS levy rate of 50 cents per $1,000. In most emergencies, the department’s EMTs are the first on the scene.

But transporting of patients is only done by American Medical Response (AMR) ambulance crews, operating in a monopoly environment under a five-year contract with the city.

AMR, in turn, bills its patients for mileage and the type of medical care provided.

Now, two years into the contract between the city and AMR, a series of questions are surfacing from the firefighters union and citizens who have used the ambulance service.

The issues include:

• Response times. The contract requires AMR to respond within 10 minutes to 90 percent of the emergency calls, and within 20 minutes to 90 percent of the non-emergency calls. The City Council panel is attempting to determine if response times are too long.

• Services provided. The contract allows AMR to charge $480 for advance life support services, and $348 for simpler basic life support services. The city panel is questioning if too many patients are being charged for more-expensive advance life support, when only basic treatment is needed.

• Reimbursement of supplies. The city, using EMS levy money, re-supplies the ambulance company for any medical supplies, including narcotics, frequently at the emergency scene. The panel is asking if this procedure amounts to “gifting” of public resources to a private company. Other questions focus on inventory and control over the medical supplies and drugs.

• Mileage charges. The ambulance company currently charges the patient $16 per mile, up from $11 under the previous contract. If the patient is a city resident, they pay nothing for treatment provided by the Fire Department.

• Administration of the contract. The ambulance company is required to pay the city approximately $25,000 per month to “administer” the contract. Questions are being raised about where this money is going.

After the one-hour session, another was scheduled for next Friday at 9:30 a.m. at City Hall. City Council members Bob Apple, Al French and Mary Verner asked the Fire Department and AMR to provide more specific statistics and answer questions not addressed at Friday’s session.

“I have concerns about this contract, specifically the response times,” Verner said at the outset of the panel session.

Randy Strozyk, AMR regional vice president of operations, said it’s financially impossible for the for-profit company to meet the 10-minute deadline in 100 percent of the emergency calls. “But we try to be at the 93 or 94 percent level.”

Jackman, a Spokane fire lieutenant and member of Firefighters Local 29, told the panel about a recent emergency call where he and other EMTs waited 44 minutes for the AMR ambulance to arrive.

“From my view, our system is about as efficient as using concrete trucks to deliver pizza,” Jackman said.

In Seattle, taxpayers pay 25 cents per $1,000 of valuation – half the rate in Spokane – and the Fire Department provides free medical transport, Jackman said in an interview.

Under the Spokane contract, the ambulance company is fined $50 a minute after the 10-minute deadline for emergencies, to a maximum of $250, Fire Chief Bobby Williams told the panel.

The fines – called “liquidated damages” – are paid monthly by AMR to the city.

Between June 2004 and Oct. 31, the city collected $168,000 in late-response fines from the ambulance company, said Richard Kness, the Fire Department’s division chief who oversees emergency services.

“We are collecting a substantial amount of liquidated damages,” Verner said. “We must have an awful lot of late responses.”

Councilman French said paying $5,000 a month in fines may be cheaper for the ambulance company than spending $25,000 to put an ambulance on the street.

The fire chief responded that the city, while interested in keeping ambulance bills down for patients, can’t dictate how many ambulances AMR makes available for service.

The previous contract did not include fines if ambulances did not arrive within a specified amount of time, Williams said.

“It becomes somewhat concerning to the public,” said councilman Apple. The fine system should encourage the ambulance firm to meet the 10-minutes response deadline, he said.

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