By Pam Zubeck
The Gazette
Copyright 2007 The Gazette
COLORADO SPRINGS, Colo. — American Medical Response has been the only game in town for emergency ambulance service for a decade, but who gets the monopoly in the future is up for grabs.
The Emergency Services Agency, a panel of government officials and health care providers, soon will issue a request for proposals as the current contract expires.
How much AMR earns wasn’t released, but it makes about 30,000 contract runs a year. Its advanced life support base rate is $562 per run.
One official vowed the bid request and selection process will change dramatically from a decade ago when some saw AMR as the shoo-in.
Sallie Clark, an El Paso County commissioner who chairs the agency, said the contract will give the ESA board and the public more oversight.
“It’s about having the best service for our community and making sure we provide the proper oversight,” Clark said.
The ESA recently got permission from the County Commission and City Council to pay Public Safety Research Group of Scottsdale, Ariz., $40,250 to compile bid documents and analyze proposals.
The ESA panel, formed in 1997, selects and oversees a sole emergency ambulance provider to avoid competition that could undermine patient care and safety.
It initially was made up of nonelected fire and health officials to minimize political influence.
But Clark thought elected officials belonged on the board for accountability, and she pushed to change it. Now, she, Colorado Springs Councilwoman Margaret Radford and Fountain Mayor Jeri Howells are members.
Since Clark became chairwoman in 2006, the board, whose only duty is awarding and overseeing the contract and ancillary functions, has increased the fines AMR is liable for if it fails to meet contract requirements.
The sole source of the agency’s funds, fines used to range from about $500 to $2,000 a month, but since Clark came on board, range from $800 to $12,000 a month. The money pays salaries of city and county workers who handle compliance and board paperwork.
“It (fine) goes up and down depending on compliance, response times and whether they have ambulances available or not,” Clark said.
Clark is a longtime AMR critic, dating to a plan in the mid-1990s to convert west-side Fire Station 3 to a paramedic outpost. She later objected when the AMR contract was withheld from the public before its approval. While serving on the City Council from 2001-03, Clark unsuccessfully promoted the Springs Fire Department as a contender for ambulance service.
Now Clark is intent on reshaping the new contract based on loopholes she sees in the existing one.
First, she wants the public to see the contract before El Paso County commissioners and the Colorado Springs council vote on it.
“As we’re enforcing the contract, we’re finding things that need tightening up with regards to compliance and oversight,” she said.
For example, the contract doesn’t contain a medical review committee to monitor performance, and it’s vague on the definition of “level zero” -- time when all on-duty ambulances are busy.
Radford, also an AMR critic, said she faults the ESA board for being too lax.
“I’ve come to realize a contractor can be only as good as the contract,” she said. While the contract called for creating a medical review board, the board didn’t create one until elected officials became members, she said.
Clark also questions the nature of the contract. Being penalty-based, it essentially allows AMR to pay a fine and continue failing to meet contract requirements, she said.
“Sometimes it’s cheaper to pay penalties than staff up,” she said. She said she hopes the consultant can come up with other models to consider.
Clark also challenged patient care, but didn’t cite proof. “There are probably clinical issues that physicians deal with on a regular basis but we don’t always hear about,” she said.
But Howells said as a county commissioner from 1989 to 2005 she heard very few complaints, all of which were resolved quickly. She gives AMR “the highest marks” and feedback from the health community reinforces that high opinion, she said.
AMR spokesman Mark Bruning defended his company’s performance and said the contract contains “some of the most stringent requirements you’ll find anywhere.”
“We’ve consistently met and exceeded the contract standard,” he said. “I think we’ve performed extremely well, and we are extraordinarily interested in continuing.”
He noted AMR, based in Greenwood Village, has operated in El Paso County for 25 years and recently was named the ambulance service of the year by the National Association of Emergency Technicians and Paramedics, a first for a Colorado firm. He said AMR is the only service in Colorado and one of only nine in the nation that’s nationally accredited for operations and dispatch.
Bruning said AMR’s contract rates are among the lowest in the state for services of its size and scope, and the company has sought only four rate increases: 2.6 percent in 2002; 1.26 percent in 2005; 7.4 percent in 2006, and 1.94 percent this year.
But Bruning isn’t opposed to new standards. “As we prepare to go into a new procurement, it’s an excellent time to look at the system and decide what things need to be changed,” he said. “We certainly are going to continue to work hard and do the very best we can. We want to earn the right to serve the community every day.”
AMR operates an office and maintenance facility on Powers Boulevard that includes dispatch for El Paso, Pueblo and Fremont counties. It also provides support for AMR’s service to local hospitals and military bases as well as a 12-state area in which AMR operates.
AMR’s contract will be extended for six months to allow time to draft and issue the RFP, evaluate proposals and hire a contractor.