Alameda County Fire Abandons Ambulance Partnership Plans

ALAMEDA COUNTY, CA — Contra Costa County hasn’t been alone in crossing swords with the California Emergency Medical Services Authority over how 911 ambulance service is provided. When proposals for a new contract to provide 911 emergency ambulance in Alameda County are opened today, the Alameda County Fire Department will not be among the bidders.

Despite a legal victory earlier this year allowing ACFD to submit a proposal for a public-private partnership – or alliance – in which the fire department would manage ambulance service and a private company would provide the actual vehicles and crews -- that plan was abandoned last month when the department's search for a partner was abruptly cancelled.

ACFD had hoped to mimic an alliance model being used successfully in neighboring Contra Costa County, but ran afoul of the California Emergency Medical Services Authority (CEMSA), an agency responsible for coordinating emergency medical and disaster services throughout the state including the review and approval of 911 ambulance services historically provided by county EMS Agencies.

Contra Costa County is currently embroiled in a legal dispute with CEMSA over its public-private method of providing ambulance service, ignited after CEMSA accused the county Fire Protection District of rigging bids for the ambulance contract and rescinding prior state approval of the alliance nearly three years after the fact.

That accusation was prompted by a complaint from an ambulance industry group. When ACFD was told by the county EMS Agency it could not submit an alliance bid for the new ambulance contract the issue ended up in Alameda County Superior Court where the fire department won a victory of sorts. Those proceedings brought into question CEMSA authority to meddle in local ambulance contracting.

Since 2011, Paramedics Plus, LLC (PMP) has contracted with Alameda County’s EMS Agency to provide exclusive 911 ambulance service in three of the county’s five Emergency Response Zones. PMP’s exclusive territory encompasses most of the county including ten cities – Oakland, Emeryville, San Leandro, Hayward, Fremont, Newark, Union City, Dublin, Pleasanton, Livermore and unincorporated Castro Valley. The cities of Alameda, Albany, Berkeley and Piedmont provide their own ambulance service.

Bureaucratic Inertia

A year before the PMP contract was set to expire county officials extended the agreement until 2020, giving its EMS Agency time to prepare a request for new contract proposals. That request was issued in Sept. 2016, but quickly withdrawn, while the county awaited CEMSA review of its bid documents which had been submitted for state review three months before.

Those documents contained two separate drafts of the county’s planned Request for Proposals (RFP) – one version permitting alliance bidding being considered by the Alameda Fire Department, the other prohibiting it.

Related: Contra Costa County Accused Of Rigging Ambulance Bids

Alameda’s draft bid solicitations were submitted two months after the California Ambulance Association, a private industry trade and lobbying organization, filed an April 2016 complaint with CEMSA over the award of the Contra Costa fire district’s ambulance contract with a private company, American Medical Response West (AMR).

CEMSA rejected Alameda’s RFP draft version permitting a fire department alliance bid, claiming it raised several issues that couldn’t immediately be determined by CEMSA and the agency was “researching” the matter.

A Judge Weighs In

In January the California Fire Chiefs Association, a nonprofit corporation representing more than 800 local, state and federal fire agencies, sued CEMSA and Alameda’s EMS Agency seeking a restraining order halting further action on the county’s bid solicitation. The Association claimed excluding ACFD from bidding was improper. Alameda Superior Court Judge Tara M. Desautels agreed, ruling in March that a clause
in the RFP prohibiting alliance bids was “void, illegal an unenforceable.”

She ordered the county to issue a new solicitation. Desautels dodged the necessity of deciding a companion request that she find CEMSA’s action was an abuse of discretion, ruling her order for a new RFP resolved
the matter.

In court arguments, CEMSA waffled, saying it didn’t actually reject the alliance model, it just hadn’t finished its analysis. But CEMSA still argued the subcontractor arrangement might have an anti-competitive effect, leading to antitrust violations such as bid-rigging and the potential for a sham selection process – virtually the same words used in the complaint filed by the ambulance association against Contra Costa County.

Ultimately, CEMSA conceded the alliance model was legal and admitted it had previously approved similar partnerships in other counties.

Hollow Victory

Although Alameda’s EMS Agency issued a revised RFP and extended the deadline for responses, the court ruling proved a hollow victory. In a virtual encore of the Contra Costa drama two years before, ACFD on May 2 issued its own request for companies interested in partnering on ambulance service. But the fire department’s plan to submit an alliance bid was abandoned when the county’s General Services Agency, which actually conducted the solicitation, abruptly cancelled the process last month after just two companies responded – AMR and Paramedics Plus.

Alameda County Fire Department Chief David A. Rocha said he was disappointed there wasn't more competition for the ACFD partnership. Only two ambulance providers submitted proposals and one of them was disqualified because it didn't meet minimum requirements.

"We've been at this for some time and our goal was to improve service in a cost-effective and more efficient manner to benefit Alameda County residents," the chief said. "But I couldn't in good conscience stand before the Board of Supervisors and recommend a respondent."

Rocha said an ACFD ambulance partnership would have provided the opportunity to produce revenues that could have been plowed back into the EMS system and guaranteed success for the long term.

A spokesman for the Alameda General Services Agency told Patch details of the fire department’s solicitation couldn’t be released because the EMS Agency’s RFP is still ongoing. John Glann, the county purchasing manager, said premature disclosure of the fire department responses would reveal specific, confidential details of the competing proposals.

“Because of the similarities, it is reasonably foreseeable that there may be substantial cross over in the services offered, pricing, potential ambulance system innovations, and other terms of the proposals submitted by bidders responding to each RFP,” Glann said.

However, Patch has learned that Paramedics Plus was determined to have been “non-compliant” with ACFD requirements and AMR’s proposed hourly rates about 43 percent higher than the company is charging in Contra Costa.

Responses to the EMS Agency’s solicitation for ambulance contractors are scheduled to be opened at 2:30 p.m. when it’s expected there likely will be just three companies submitting proposals – AMR, Paramedics Plus and Falck Northern California, an unsuccessful bidder for Contra Costa’s contract in 2015.

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