Riverside County Grand Jury • 2002-2003

Advanced Life Support Ambulance Contract Riverside County

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Findings and Recommendations 16 findings

F1
Three options available prior to the expiration of the contract are: ¨ Activate the first of the two three-year extensions ¨ Renegotiate the terms of the contract with AMR ¨ Give notice of intent not to renew and publish a Request for Proposal (RFP) for a new contract.
No recommendations for this finding
F2
The Riverside County EMS Agency Protocol, Policy and Procedure Manual places the responsibility to “conduct disaster planning and coordination” upon EMS.
No recommendations for this finding
F3
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.
Related Recommendations (2)
R2
Riverside County Fire Chief or his designee be included in any ambulance contract renegotiation process.
R7
EMS delete the word “exclusive” from , paragraph 1.3 of the current contract regarding disaster planning and management.
F4
The Riverside County Fire Department, Emergency Service Division (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.
Related Recommendations (3)
R2
Riverside County Fire Chief or his designee be included in any ambulance contract renegotiation process.
R7
EMS delete the word “exclusive” from , paragraph 1.3 of the current contract regarding disaster planning and management.
R8
EMS include the Riverside County Fire Department, Emergency Services Division in their disaster coordination responsibilities. 4
F5
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.
Related Recommendations (2)
R1
Board of Supervisors renegotiate the existing AMR contract.
R5
EMS and Contractor review population changes annually and restructure response time areas appropriately.
F6
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 2
No recommendations for this finding
F7
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.
Related Recommendations (2)
R1
Board of Supervisors renegotiate the existing AMR contract.
R6
Increase ambulance response times based upon the effectiveness of the first responder firefighter/paramedic in an effort to minimize contractor performance fines.
F8
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.
Related Recommendations (1)
R1
Board of Supervisors renegotiate the existing AMR contract.
F9
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.
Related Recommendations (1)
R1
Board of Supervisors renegotiate the existing AMR contract.
F10
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.
Related Recommendations (1)
R4
Increases in reimbursement rates to EMS be based upon their justifiable increased cost of administering the contract. Contractor’s operating costs, fines, or reimbursement rate should not be factored in.
F11
The EMS Agency Director, as contract administrator, may approve any net increase up to 5% and has discretionary control of the contract elements. Net increases greater than 5% must be approved by the Board of Supervisors.
Related Recommendations (1)
R3
Board of Supervisors review all ambulance rate adjustments prior to approval.
F12
There have been no reported audits of the money transactions between the contractor and the EMS Agency over the term of the contract.
Related Recommendations (1)
R9
The EMS Agency report at least annually, to the Board of Supervisors, all recommendations made by the EMS Administrative Group and related actions proposed or taken. The annual report to include an independent CPA financial audit of ambulance contract transactions.
F13
Each Exclusive Operating Area has an EMS administrative group (contract, Schedule E, 1) to monitor contract performance and make
No recommendations for this finding
F14
In many cases the first responder to a 911 medical emergency is a fire 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. 3
Related Recommendations (1)
R6
Increase ambulance response times based upon the effectiveness of the first responder firefighter/paramedic in an effort to minimize contractor performance fines.
F15
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 §5150. These persons are referred to as “5150” patients.
Related Recommendations (1)
R10
The subject of prehospital management of “5150” patients be restudied in any renegotiation of the contract. The contractor be required to utilize a BLS ambulance or other cost-effective forms of transportation for those patients. 5
F16
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.
No recommendations for this finding