By David Garrick
The San Diego Union-Tribune
SAN DIEGO — San Diego leaders say they plan to bring ambulance service in-house, despite the notable success of a new partnership where private ambulances transport patients while the city handles deployment, staffing and billing.
The 19-month-old partnership has generated so much money in profits for the city that Mayor Todd Gloria plans to use $17.3 million of it to help solve the city’s budget crisis by covering shortfalls in other departments.
But Gloria and Fire Chief Robert Logan have also been discussing how to bring the service fully in-house, meaning ambulance workers would be city employees and no longer work for private operators.
“We’ve had quite a few conversations on that topic,” Logan told City Council members during a May 9 budget hearing. “We’re getting to a good place. We’ve just got to do some fine-tuning.”
Logan said the city plans to start off small and slow.
That likely means some sort of hybrid approach where city ambulance crews handle low-level emergencies, called basic life support, while private ambulances continue to handle more life-threatening emergencies, called advanced life support.
The city’s private ambulance contractors now provide 852 hours per day of advanced life support service and only 120 hours per day of basic life support service.
If the hybrid approach is successful, the city could move incrementally toward fully handling all ambulance service in-house.
“We need to do our due diligence to ensure we’re heading in the right direction,” Logan said. “That comes with a lot of conversations, learning from the mistakes of the past, learning from our current contract and ultimately sitting down with the mayor and making a decision.”
Los Angeles, San Francisco and Chula Vista have in-house ambulance service, but most other cities in California and across the nation contract out for the service.
In general, in-house service is considered better for response times but more costly. However, results vary by city.
Gloria’s already putting command staff in place for in-house ambulance service. The proposed budget for the new fiscal year adds an assistant fire chief position to oversee emergency medical service workers.
Because city officials plan to keep using private companies for at least some ambulance service, they plan to issue a formal request for proposals for ambulance service sometime soon, officials said.
“The city intends to conduct a formal request for proposal for emergency medical services in the future, but exact timing and scope of services have yet to be determined,” Fire-Rescue Department spokesperson Candace Hadley said last week. “All EMS service delivery options would be explored and carefully evaluated.”
San Diego’s plan to begin bringing ambulance service in-house comes just as city officials have revealed for the first time that the new partnership with private operators is generating greater profits than expected.
Former Fire Chief Colin Stowell, who Logan replaced last August, said one year ago that it was still too early to tell whether the new partnership, called the alliance model, would be profitable at all.
He told council members that profits had been slow to materialize because of delayed payments for ambulance transports and what he characterized as flawed projections.
Since that update, city taxpayers have been in the dark about the success or failure of the alliance model because fire officials have stopped giving regular updates to the City Council’s Public Safety Committee on ambulance issues.
Fire officials updated the committee at three of its monthly meetings in 2022, at six of its monthly meetings in 2023 and then in March 2024, when fire officials said they were unsure how profitable the alliance model would be.
But they’ve given no public updates since. The Public Safety Committee has met 11 times since then, but there have been no ambulance updates at any of those meetings.
The city’s independent budget analyst revealed April 29 that the alliance model had generated enough profit to give the mayor $6.1 million to help balance the city budget for the ongoing fiscal year and still have $9 million left over.
The IBA said that means the alliance model should easily be able to generate enough profit in the new fiscal year that begins July 1 to send Gloria $11.2 million he says he needs to balance that budget.
That’s more in profits than consultant AP Triton predicted before the city agreed in summer 2023 to a three-year deal with private providers Falck USA and American Medical Response to create the alliance model. AP Triton estimated $15 million in total profit over the entire three-year deal.
The shift to the alliance model was prompted by frustration with poor ambulance response times and a 2023 state law that boosts reimbursement rates on ambulance transports when government agencies handle deployment instead of private contractors.
Before the switch, Falck USA handled staffing, deployment and billing for the city. Under the alliance model, the city took over those roles — and the financial risks and potential benefits that come with them.
The budget analyst’s office said in 2023 that the alliance model appeared to be a smart financial move for the city. But they also urged vigilance.
“While we believe that financial risks to the city in the short-term are low, our office recommends that the Fire-Rescue Department continue to provide periodic updates to the Public Safety Committee which include financial updates with fiscal year-end projections,” the IBA said in a July 2023 report. “Our office suggests that these updates occur following the first status meeting between the city and Falck, and at least quarterly thereafter.”
No such updates have been given to the Public Safety Committee in more than a year.
However, Councilmember Marni von Wilpert, chair of the committee, revealed last week during budget hearings that she has been receiving private updates on the alliance model and the possibility of bringing ambulance service in-house from Assistant Fire Chief Becky Newell.
“Chief Newell has been fantastic in educating us about what’s been going on,” von Wilpert said.
When asked Monday by the Union-Tribune for copies of those updates, von Wilpert’s staff said they were trying to track down the information.
City officials provided data Friday showing they’ve met or exceeded their ambulance response time goals under the alliance model. That’s not just citywide, but also in each of four zones the city uses for response time analysis: central, coastal, inland and southern.
But the city hasn’t provided data comparing response times under the alliance model to response times before the city made the switch.
It’s unclear why city officials want to bring ambulance service in-house when the alliance model is generating such healthy profits.
“The city is still evaluating all the options and is not yet close to a decision on which course it will pursue,” said Rachel Laing, a spokesperson for the mayor.
Last month, the IBA stressed that the original intention of shifting to the alliance model was boosting the city’s emergency medical system — not providing the mayor millions to balance the budget.
When Stowell first introduced the concept of the alliance model, he said the profits could pay for new programs like nurse triage, telemedicine and street-based interventions.
Nurse triage is where a state-licensed nurse would determine which 9-1-1 calls need an ambulance response and which need less urgent attention.
Sending fewer ambulances to relatively minor calls where they aren’t necessary would free up more ambulances for crucial calls where a quick ambulance transport can make the difference between life and death.
Under a street triage program, health care workers focus on frequent 9-1-1 callers.
Matt Vespi, the city’s chief financial officer, said reprioritizing the money was unavoidable given the city’s projected deficit of more than $300 million.
“It’s unfortunately where we are with the general fund,” Vespi said. “The other option would have been additional reductions to services we provide.”
Von Wilpert noted that the city must pay $4.7 million more to Falck and AMR during the new fiscal year to cover more ambulance hours and to pay Falck and AMR higher hourly rates.
The city plans to cover that increase with higher fees charged to patients who need ambulance transports. The budget projects revenue from those fees, which were hiked by the City Council in February, to rise by nearly $6 million in the new fiscal year.
The city previously raised ambulance transport fees in August 2023, just before the alliance model began operating on Oct. 1 of that year.
The city’s contracts with Falck and AMR run through late 2026, so the city couldn’t bring ambulance service fully in-house before that.
“Falck values its continued collaboration with the city of San Diego,” company spokesperson Scott White said. “Our top priority is providing reliable, high-quality ambulance service to the city and supporting our more than 400 paramedics, EMTs and critical support staff.”
©2025 The San Diego Union-Tribune.
Visit sandiegouniontribune.com.
Distributed by Tribune Content Agency, LLC.