Submittal to the Board of Supervisors County of Riverside, State of California Executive Office From:*

Three options available prior to the expiration of the contract are:

The Riverside County EMS Agency Protocol, Policy and Procedure Manual places the responsibility to "conduct disaster planning and coordination" upon EMS. Respondent disagrees partially with the finding. To clarify: The Riverside County Fire Department, Emergency Services Division has the overall responsibility for disaster coordination, not the EMS Agency. The EMS Agency Policy Manual specifies that is the responsibility of the EMS Agency to conduct the medical aspects of disaster planning and coordination only. The EMS Agency is not responsible for all aspects of disaster planning.

The contract, , paragraph 1.3, requires the County to incorporate the operation of the Contractor as an exclusive emergency ambulance provider into the County's ALS, disaster planning programs, and trauma systems. The office of the Riverside County Fire Department was not included in the development of this contract. Respondent agrees with the finding. The Riverside County Fire Department, Emergency Service Division 4. (ESD), Office of Emergency Services is responsible for coordinating the emergency preparedness and disaster recovery plan. The exclusion of other ambulance providers and fire departments will adversely impact ESD's ability to meet its responsibilities. Response to Grand Jury Report Respondent disagrees partially with the finding. The County/AMR contract does not exclude other ambulance providers and fire departments from participating in response to or recovery from disasters. The contract specifies that AMR will be included in the response and recovery. Other ambulance providers (public and private) are included in disaster planning, response and recovery.

justifiable increase cost of administering the contract. Contractor's operating costs, fines, or reimbursement rate should not be factored in. The recommendation requires further analysis. When the original AMR contract was put into place, the contract required more staff and oversight by the EMS Agency than was in place at the time. The EMS Agency must analyze how to recoup its on-going costs in administering the AMR contract. The EMS Agency will complete its analysis by May 2003.

Response-time zones were established when the contract was first authorized. There continues to be population changes within certain Exclusive Operating Areas resulting in expanded urbanized areas. This impacts upon present response time requirements and the staging of ambulances within these zones. Respondent agrees with the finding.

Required response times are divided into three categories for code 3 requests ("Obligations of Contractor" - Schedules A and E): • 10-minute response-time zone: city and urban areas • 14-minute response-time zone: rural areas 20-minute response-time zone: more rural (remote) areas Respondent disagrees partially with the finding. The County/AMR contract also has "best effort" response-time zones where AMR is not required to meet a specific response time. Best effort zones are wilderness or extremely rural areas where it is not possible to have a set response time.

The contractor is required to meet all response-time criteria 90% of the time within each of the seven exclusive operating areas (zones) and overall for all the seven zones. The contractor is assessed a fine for each individual call where response time is not met, even though the average response time for the zone is met or exceeded. Respondent agrees with the finding. Response to Grand Jury Report

The contractor pays the EMS Agency response-time fines of approximately $500,000 annually, and are distributed as follows: 20% to EMS Agency for contract administration, 80% to Riverside County Fire Department and the cities where the fines occurred. Respondent agrees with the finding.

The contractor also reimburses the Riverside County EMS Agency approximately $495,000 annually for dispatch services and database management. The funds are managed by EMS and are adjusted annually commensurate with the contractor's net increase. Respondent agrees with the finding.

Ambulance service rate adjustments may be reviewed annually, or upon request from the contractor. Any increases awarded are calculated on the basis of the Consumer Price Index (CPI), the collection rate as reported by the contractor, and any extraordinary contractor expenses. The EMS Agency reimbursement is increased at the same percentage rate. Respondent disagrees partially with the finding. The EMS Agency "reimbursement" is increased based on the contractor's "net" increase in rates.

The EMS Agency Director, as contract administrator, may approve any net increase up to 5% within his discretionary control of the contract elements. Net increases greater than 5% must be approved by the Board of Supervisors. Respondent agrees with the finding.

There have been no reported audits of the money transactions between the contractor and the EMS Agency over the term of the contract. Respondent agrees with the finding.

Each Exclusive Operating Areas has an EMS administrative group (contract, Schedule E, 1) to monitor contract performance and make

department unit containing a firefighter/paramedic. The fire fighter/paramedic stabilizes the patient who is then released to the arriving ambulance for continued care and transport to a treatment/trauma facility. Respondent agrees with the finding.

The contract authorizes the use of a BLS ambulance to transport persons who, as a result of a mental disorder, are a danger to themselves or others, or are gravely disabled as defined in California Welfare and Institutions Code Section 5150. These persons are referred to as "5150" patients. Respondent agrees with the finding.

In their memorandum dated November 30, 2001, EMS authorized additional ALS service providers throughout the county from which mutual aid may be arranged and backup provided. Respondent disagrees wholly with the finding. The EMS Agency periodically distributes the list of approved ambulance providers in the County. This list includes approved "ALS (paramedic) Providers," "BLS (non- emergency) Providers" and "CCT (critical care transfer) Providers." The contractor is to arrange mutual aid and back-up from emergency ALS providers in contiguous zones or in neighboring counties. While the EMS Agency list may be helpful to the contractor in ascertaining entities authorized to operate in the county, it is not intended to limit the providers from whom the contractor should arrange mutual aid and/or back-up services.