By Tim Sheehan
Fresno Bee
Copyright 2007 The Fresno Bee
VISALIA, Calif. — Tulare County’s use of nine ambulance services could come to an end if officials determine a single provider would quell concerns over slow response times and loss of service in some areas.
“We’ve been looking very carefully at problems we’re currently experiencing and problems we see on the horizon ... as we become a more urbanized and heavily populated county,” Ray Bullick, the county’s director of health services, said during a recent Visalia City Council presentation.
Bullick and officials from the Central California Emergency Medical Services Agency — a consortium of Tulare, Kings, Fresno and Madera counties that provides regulatory oversight for ambulance services — are making the rounds of cities, hospitals and ambulance services to pitch the single-provider proposal before asking the county Board of Supervisors to formally seek bids.
The services currently operating in Tulare County, and their primary response areas, are:
American Ambulance of Visalia and American Medical Response: Visalia, Goshen and Farmersville.
LifeStar Ambulance: Tulare, Pixley and Tipton.
Dinuba Fire Department: Dinuba and Cutler-Orosi.
Imperial Ambulance and American Medical Response: Porterville and Springville.
Exeter District Ambulance: Exeter, Lindsay, Woodlake and Badger.
Three Rivers Ambulance: Three Rivers.
Camp Nelson Ambulance: Camp Nelson.
California Hot Springs Ambulance: California Hot Springs.
Daniel Lynch, administrator of the four-county EMS agency, said the contracts the county has now with individual ambulance services lack the teeth needed to enforce performance standards such as response times or levels of service available to communities.
“And I think the most important thing is there is no certainty that the closest ambulance responds to a medical emergency in Visalia and many parts of Tulare County,” Lynch said.
If it ultimately happens, a single-provider system would authorize only one ambulance service to operate in the county — with the exception of Dinuba, where the city Fire Department would continue to operate the community’s tax-supported ambulance service.
Lynch said Kings and Fresno counties have such a system that offers distinct advantages, chiefly restoring ambulance service to several communities.
“What we’ve seen in the last few years is a loss of ambulance service” in Woodlake, Farmersville and Lindsay, Lynch said. Providers can’t fund the service and pull out of those communities. And nothing can be done about it.
It also forces remaining services to stretch resources to cover the deficit.
In Lindsay, the pullout of Imperial Ambulance meant Exeter District Ambulance began responding to emergency calls to Lindsay, in addition to its expansive territory.
Lori Trowbridge, operations manager for Exeter District Ambulance, said the company responded to 247 calls for service last year; 82 were in Exeter.
Lynch said a single provider could be required to staff an ambulance in various communities and roll backup equipment into an area if the ambulance goes out on a call.
And the county could enforce penalties for failing to meet response time requirements, which the county could determine with resident input.
The industry standard for urban areas, he added, is eight minutes 90% of the time or 10 minutes 95% of the time.
“Imagine if we tell the provider that in Visalia, Tulare and Porterville, if you’re not there in eight minutes we’re going to charge you $15 for every minute you’re late,” he said. “And if you fall below 90%, we’re going to fine you $100 for every tenth of a percentage mark that you fall below the response requirement.”
In Kings County, Lynch said, the fines and penalties are returned to fire departments that provide “first-responder” medical services. In Fresno County, he added, the money is used to help pay for the county’s radio dispatching system.
Lynch said the system would provide better overall ambulance service at no cost to the county or its cities.
“It’s supported 100% by fee for services; it’s based on ambulance billings,” he said. “And because we would be giving a legal monopoly to a provider ... the Board of Supervisors would be the ones to approve any rate increases.”
Yet to be determined by the county is what would become of volunteer ambulance services in Three Rivers, Camp Nelson and California Hot Springs, or a taxpayer-supported service such as Exeter’s. Lynch said the winner of a single-provider franchise could subcontract with those agencies.
Bullick told Visalia leaders he hoped the county would be able to solicit proposals by September.
“I’m sold on this,” Bullick said. “It’s going to be much better for our ambulance system.”
But county supervisors may not be ready to pull the trigger just yet.
Board of Supervisors Chairman Allen Ishida of Lindsay said he and his fellow supervisors want to learn more. He said he expects supervisors later this month to allow the health department and the Emergency Services Agency to keep studying the issue.
Ishida said his concern is the unincorporated county territory and smaller cities that don’t have on-the-spot ambulance service. At a meeting Wednesday among the county, EMS officials and most ambulance services, Ishida said, “We said if they can all come together and service the unincorporated areas, we’ll keep the current system in place.”
“If they can’t, then we’ll look at a single provider,” he added. “I think we need to give the companies a better template of what we expect ... and we owe our local people a chance to continue providing this service.”
Representatives of American Ambulance of Visalia and American Medical Response, which share responsibility for the Visalia service area, said the concept has merit, but both want to know more details.
Jason Sorrick, a spokesman in Sacramento for American Medical Response, said single-provider coverage “is the new way of emergency medical service not only in California, but throughout the country.”
“It’s usually a good choice for a county to do something like that,” Sorrick said. “It means everybody has the same policies, same protocols and training, and it can mean better response times.”
Paul Main, president of American Ambulance of Visalia, said his main concern is the loss of local ambulance services.
“Some experienced providers that have been around here for a number of years would be put out of business,” he said. “None of us want to stop providing services to the communities we serve. We want to be able to continue providing services.
“But there’s also some good things; some of the communities that don’t have service might gain some.”