By Jim Johnson
Monterey County Herald
Copyright 2007 Monterey County Herald
County doctor says system redesign may not be needed.
MONTEREY COUNTY, Calif. — Six weeks after county supervisors agreed to allow three more months for a redesign of the county’s ambulance system, there is some disagreement among key officials about whether the system needs to be revamped at all.
County Emergency Medical Services medical director Dr. Suzanne Johnson, who is working with the EMS task force leading the redesign effort, said an overhaul of the current system may not be necessary now that current provider Westmed has righted its finances.
“Everything is up in the air right now because Westmed is in the black,” Johnson said. The system redesign “is not a foregone conclusion.”
No to ongoing subsidy
But Supervisor Dave Potter, the board chairman, said that comes as a surprise to him because the county probably wouldn’t be willing to continue subsidizing Westmed over the long term. Supervisors agreed in May to subsidize the local ambulance provider with nearly $1 million for salaries and benefits, and to keep Big Sur’s fully staffed ambulance in place, through the end of February.
An ambulance system redesign and new provider was originally supposed to be in place by then, but if county officials decide to forgo or delay the redesign process, it would presumably mean the county would need to continue subsidizing Westmed for some time.
“That ongoing subsidy would be an issue to me,” Potter said.
Potter, who also serves on the board’s ambulance redesign subcommittee with Supervisor Simon Salinas, said he believes supervisors remain committed to a redesign of the system. He said he’s pleased with the work of the EMS task force that is working on the redesign and believes it is on schedule to produce a redesign and request for proposals by the end of September.
However, EMS director Tom Lynch said he can’t guarantee that the redesign and request for proposal will be finished by then. He said the task force may not even have a formal recommendation ready for the board by next month.
Lynch and Johnson continue to make presentations to area stakeholder groups, including city councils, about the task force’s progress and to ask for feedback.
Johnson said the task force is “really still in the discovery phase” and is continuing to investigate various ambulance system alternatives.
Salinas City Manager Dave Mora, who serves on the EMS task force, said its members have come to the realization that the county can’t sustain its current advanced life support ambulance system without some kind of additional funding. Mora said that might make a redesign, which could include service reductions, less important than identifying a funding source.
“From my perspective, the funding is the biggest thing (to resolve),” Mora said. “Ultimately, a redesign may not be chosen.”
Westmed makes turnaround
Potter said he has already had discussions with the county’s fire chiefs about pursuing a tax measure that could help pay for a new system, and they have pledged their support.
After taking over the county’s ambulance system in January 2006, Westmed reported losses of more than $2 million during its first year in Monterey County and threatened to leave its contract. Supervisors subsequently agreed to subsidize the local ambulance provider with a loan of up to $1 million from county coffers, as well as changes in response time targets.
Westmed officials have since announced that the company’s local operations have begun yielding a profit and they have promised to begin paying the county back.
Supervisors also ordered a redesign of the ambulance system and development of a new request for proposals to be completed by June. A new provider was supposed to have been signed by the end of October and ready to take over ambulance service within a few months.
However, in response to a recommendation from the EMS task force June, the board agreed to extend the deadline for a new system redesign by three months, until the end of September. Task force members told the board they wanted to avoid the kind of rush to get a new system and provider in place that many say doomed the current contract with Westmed.
At the time, Potter said getting the redesign right was so important that he would be willing to continue the Westmed subsidy for a “very short term” but not on a perpetual basis.
Meanwhile, the EMS medical advisory committee will discuss a basic life support pilot program for Salinas on Wednesday. The program would include staffing ambulances with emergency medical technicians to transport ill or injured patients after first responder fire paramedics treat them at the scene. The program is designed to free up paramedics from transport for emergency response.
Also Wednesday, North County fire Chief Chris Orman will report on the ambulance redesign task force’s progress before the EMS Council.