City to face decision on countywide ambulance pact

The city of Spokane, now in the middle of a legal battle over excessive ambulance rates, will have to decide in the next few weeks whether to cancel its current contract with American Medical Response.

Mayor Dennis Hession and likely the City Council must decide if the city should join the cities of Spokane Valley, Airway Heights, Cheney, Medical Lake and seven outlying fire districts in seeking a new master contract governing rates and response times for the majority of Spokane County.

Those outlying fire districts and cities joined together earlier this year and just completed a draft of an “inter-local cooperation agreement” allowing them to jointly seek bids for a single contract, governing rates and response times for ambulance services.

Spokane Valley Fire Chief Mike Thompson, who led the effort for the countywide ambulance contract, said last week he hopes to put out bid proposals next month and have a new contract in place by late March or early April.

Such a countywide contract, Thompson said, would cover two-thirds of the county’s geographic area and approximately 400,000 of its residents if the city of Spokane participates.

“It will be particularly significant for these fire districts and municipalities to come together for one contract for ambulance service,” Thompson said.

The city of Spokane’s decision to participate or stay on the sidelines likely will have an impact on the number of bids received and rates and response times.

Start-up costs would be particularly significant for an ambulance company that was restricted only to outlying areas and couldn’t service patients in the city of Spokane, Thompson said.

The city of Spokane, represented by Medical Service Chief Rich Kness of the Fire Department, has been involved in meetings over the past several months where the inter-local agreement and bid requirements were discussed and drafted, Thompson said.

The Spokane Valley fire chief said he has no idea if the city of Spokane will participate, but said the decision must be made soon.

Mary Verner, Bob Apple and Joe Shogan, members of the Spokane City Council Public Safety Committee, said Friday they knew outlying fire districts were drafting a combined contract, but they didn’t have the details and were unaware the negotiations were so well-advanced.

Fire Chief Bobby Williams said he briefed the Public Safety Committee about the issue in June and again last month.

“It would seem to be of some conceptual advantage to the citizens of Spokane to have a countywide ambulance contract, but that’s a decision for the mayor and City Council,” Kness said Friday when reached at the Spokane Fire Department, which monitors the AMR ambulance contract.

“I think the city should take an honest look at the advantages and disadvantages for our citizens if we participate in a countywide contract,” Kness said.

If the city of Spokane stays with AMR and exercises a five-year renewal option in October 2008, there could be contract implications if another ambulance company wins the bid to service the outlying areas, Kness said.

Of particular concern, he said, is the number of ambulances available for a “mass-casualty incident.”

Apple said he believes the city’s Public Safety Committee should have been more directly involved, possibly with public hearings about joining a countywide contract and a discussion to determine if that would benefit residents of the city of Spokane.

“I began hearing rumors about this a few weeks ago,” Apple said. “We at first were ignored by the administration and only told that ‘negotiations were under way.’

“At this point, it looks like the administration has gone well beyond what’s reasonable, and we’ve been left out of the loop,” Apple said, expressing disgust with the process.

Now, probably within the next month, the City Council will be faced with the “significant decision of whether to cancel its current AMR contract” and join the other cities and fire districts, Apple said.

Shogan, the City Council president, said he knew the city was participating in the drafting of the countywide contract but had not seen the inter-local agreement or bid proposal.

“We’re expecting it to come back before us at some point,” Shogan said.

Verner and Shogan, both attorneys, said they believe that the decision to terminate the current ambulance contract rests solely with the mayor, but both said it would take a City Council vote to approve any new contract.

Mayor Hession did not return a call Friday seeking a comment.

Other cities in Spokane County and most of its fire districts currently don’t have contracts for ambulance service, and many residents of those areas have complained about excessive bills for patient transport to medical centers. The new contract would spell out response times and regulate charges.

The level of complaints from residents of Spokane Valley and other more-rural areas of the county grew louder after a group of Spokane residents filed a lawsuit one year ago, alleging they were being over-billed by AMR. The ambulance company was unsuccessful in legal attempts to get the class-action suit dismissed, and it is now set for trial next year.

The city of Spokane is not a defendant in the suit, but its Fire Department’s spot audits of ambulance calls and emergency response records are part of the litigation. The suit was brought against AMR by two patients – city residents – who contend they were overcharged by the ambulance company.

In March, three months after the suit was filed, AMR voluntarily admitted it had overbilled city of Spokane residents $320,689 in the past two years. In June, Hession fined the company $80,172 – only a fraction of the potential fine allowed under the existing contract for overbilling.

AMR, the nation’s largest private ambulance company, has an exclusive contract, which lasts through October 2008, to provide ambulance service inside the city of Spokane.

Under the Spokane contract, AMR bills city residents $358 for “basic life support” (BLS) service and $494 for “advanced life support” (ALS) care. If a city firefighter accompanies a patient in the ambulance, AMR is only supposed to bill for the BLS rates, regardless of the type of care rendered, because city residents pay an emergency services tax, directed to the Fire Department.

AMR’s exclusive-service contract, which includes a $25,000 monthly kickback payment to the city of Spokane to “monitor” the contract, leaves it as the only major ambulance company to provide services in the other areas of the county where rates and response times aren’t controlled by contracts.

With the exception of Medicare reimbursements, AMR is largely able to charge whatever it wants to patients who live outside the city limits of Spokane.