Key San Diego committee OKs fundamental shift in city ambulance service
Falck is required to keep providing the average number of ALS ambulance hours or face fines
By David Garrick
The San Diego Union-Tribune
SAN DIEGO — The San Diego City Council's Public Safety Committee unanimously approved Friday a new deal with the city's ambulance provider that is expected to improve response times by putting more ambulances on the streets for more hours.
Committee members praised the long-term benefits of the deal, which will transfer control over staffing, ambulance deployment and patient billing from ambulance provider Falck USA to the city's Fire-Rescue Department.
Falck no longer faces steep fines for falling short on ambulance hours and response times, but it is required to subcontract with a second ambulance provider to boost service.
Councilmember Raul Campillo expressed frustration with the new deal, saying it lets Falck "off the hook" for overpromising and underdelivering in convincing city officials to switch from American Medical Response in 2021.
"It really bothers me to see bad faith on the part of applicants," Campillo said. "But we need these additional (ambulance) hours right now."
Campillo said he plans to be more skeptical and vigilant before approving similarly large and impactful city contracts.
"I'm going to be a hawk on every contract like this, and if I sense even a little bit of bad faith estimation of how many hours or how many housing units or how many vehicles someone can supply the city, I'm going to dig in, and I'm not going to let it be easy," he said. "I'm tired of this, and I know my constituents are tired of it, too."
Fire Chief Colin Stowell said the city agreed to absolve Falck of further fines, provided certain conditions are met, so that the company would have enough money to pay a second ambulance provider to increase hours of service.
The conditions require Falck to keep providing the average number of advanced life support ambulance hours — 780 hours per day — it has been providing since replacing AMR 17 months ago.
If Falck falls below that average over the course of a Monday-to-Monday week, it must pay a $50,000 fine. If it were to fail for two weeks within any month, the old fine structure would get reactivated.
On the subcontracting, Falck is required to pay another company to close the gap between the 780 daily hours from Falck and the 900 daily hours the city wants.
Stowell said Falck is in talks with AMR to be the subcontractor. He said AMR has told the city it doesn't yet have the staff or equipment to cover the entire 120-hour gap.
Falck has already paid the city several million dollars in fines, including a recent fine of $1.2 million for failing to meet response-time goals during October, November and December.
Troy Hagen, Falck's chief commercial officer, said the company regrets not fulfilling its promises in San Diego. He partly blamed broad workforce shortages in many areas, especially paramedics.
"It's not for lack of trying," said Hagen, noting that Falck gave $50,000 signing bonuses to new paramedics last winter. "Despite not meeting the contracted advanced life support hours to date, Falck has provided more ambulance hours than the city of San Diego has ever had before. But we realize that is not good enough."
The deal approved Friday, which must get approved by the full City Council next month, is the first part of a fundamental shift by San Diego toward a new trend in ambulance service called the alliance model.
Instead of the existing model, where Falck pays San Diego $9 million a year for the right to charge patients, the city will now pay Falck and other providers fees to operate ambulances and will have the right to charge patients itself.
While the model shifts financial risk from Falck to the city, proponents say a new state law that took effect in January gives public agencies better reimbursement rates from Medicare and Medi-Cal patients than private ambulance providers get.
Councilmember Jennifer Campbell praised the deal approved Friday and the city's shift to the alliance model.
"This will close the gap in service we've been facing, it will reaffirm our commitment as a city to hold accountable our partners we contract with, and — most importantly — our residents will finally have access to the emergency services they deserve," Campbell said.
This story originally appeared in San Diego Union-Tribune.
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