Mark Hartwig has been on the job as the county’s new fire chief just three months, and already he’s making big waves. Hartwig is now quietly leading the charge to allow the Fire Department to bid on the county’s ambulance contract, which has been held since 1992 by the private company AMR. That contract was extended when it expired in 2017. This Tuesday, the county supervisors voted unanimously to extend that service contract one more year, but it was clear that a majority of the board was interested in opening the contract up to new bids rather than renegotiating another contract with AMR. Most eager apparently were supervisors Das Williams and Peter Adam, ideological polar opposites on most matters. But according to sources on the fourth floor of the county’s administration building, it’s Hartwig who’s made the biggest difference.
In his previous incarnation as fire chief of San Bernardino County, Hartwig said his department ran 16 ambulances. A recent consultants’ report issued on AMR’s performance reportedly identified 35 gaps in service, Hartwig said. Perhaps the county can get better value, he suggested, if the fire department either took over the service directly or managed the service. Firefighters already show up at the scene of most ambulance calls — often providing the paramedic services necessary to stabilize the person. The fire department’s pay for this support has never satisfied departmental brass. Even though AMR — one of the largest private ambulance companies in the nation — charges $1,500 for basic life-support services (not counting $48 per mile of travel), the ambulance company collects just a small fraction of that. Government insurance providers such as Medicare pay only $510. MediCal is less. On paper, AMR charges about $82 million a year in services fees; in reality, it collects only $18.2 million.
The most striking thing about Tuesday’s meeting was who didn’t talk. No one from AMR went to the podium to tout the company’s stellar record when it came to cardiac arrest saves — one of the best in the nation. Or how AMR stepped up when the frightening Ebola virus struck and provided an ambulance rigged especially for the job. Or how its personnel served during the Thomas Fire and subsequent debris flow. For that matter, Hartwig wasn’t even in the room. A group of AMR employees were present, however, sitting on one side of the supervisors’ chambers, while a cluster of county fire officials sat on the other, arms crossed. No one said anything.
Of all the contracts the county issues, ambulance service is one of the most vital. No one is saying AMR hasn’t done a good job. Emergency Medical Services chief Nick Clay noted that since the last contract was negotiated, the world has changed substantially. The county needs something more “flexible and nimble,” Clay said. “The demands of the mental-health and substance-abuse patients are crushing all aspects of the Santa Barbara emergency system,” wrote the consulting firm Fitch. The average mental health call takes AMR four and a half hours. “Often patients are transported to facilities located far outside of Santa Barbara County that will involve a six-to-ten hour round trip.” In this context, Clay and the consultants have suggested there might be ways other than an ambulance ride to get such patients from Point A to B. Likewise, they have suggested that social service workers might be made part of the mix where homeless people are concerned. As the population ages, the demand for ambulance service will only grow.
At issue is not just whether AMR can shift accordingly, but how willing the county supervisors are to give the company that chance. Dr. Angelo Salvucci, medical director for the county’s Emergency Medical Services, warned that opening up the contract might be akin to opening a can of worms. Others have questioned how county firefighters — paid significantly more than AMR employees — could provide the same range of services for anywhere near the same cost.
County emergency response planners have until this summer to issue yet another report before the supervisors want to get serious about opening up the contract. Other municipalities have tried to take over such services; some have succeeded, others have failed. If the ambulance services are up for grabs, what ingredients should be in the request for bids? And if the fire department is interested in submitting a bid, what role can it play in those preliminary discussions without opening the county to a lawsuit by AMR? County Counsel Mike Ghizzoni warned that the county’s “procurement integrity record” must be maintained. Exactly when the matter comes back to the board remains uncertain. But Supervisor Steve Lavagnino was abundantly clear: “We want it done,” he said, “as soon as humanly possible.”