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Ambulance service clash

For the past 25 years, the city of Colorado Springs’ emergency transport services have been privatized through an agreement with the El Paso County Emergency Services Agency, a quasi-governmental collaboration of fire districts, the city and the county. In 1997, American Medical Response won the contract through a competitive request for proposal process.AMR is in its ninth month of a renewed three-year contract. However, a few months ago, City Council members asked city fire department officials to develop their own ambulance transport proposal.The proposal is tentatively scheduled to be heard at the Nov. 8 City Council meeting, said Chief Rick Martinez, the battalion chief of special operations, which includes emergency medical services. Martinez would not discuss details about the plan because it hasn’t been presented to City Council, but he did say the proposal includes emergency transport services for the city and the county. AMR’s agreement with the El Paso County Emergency Services Agency includes ambulance service for the county.Trent Harwig, the chief of the Falcon Fire Protection District, is concerned that those services will be compromised if ambulance transport is provided by the city.Harwig said the county needs an independent transport company to provide good service and ensure appropriate response times. He also is concerned that a city-operated ambulance service might cost the county more money. Regardless of what the proposal includes for county emergency transport services, Harwig doesn’t want to lose AMR’s presence in his fire district. If the company loses its contractor for citywide ambulance services, he said it might not be cost effective for AMR to remain in the county.”We would have to change our configurations and run out our services differently,” said Mark Bruning, the vice-president of AMR Rocky Mountain region. Although AMR has contracts with other entities, such as Penrose/St. Francis and Memorial hospitals and the U.S. Air Force Academy, the loss of the city’s ambulance transport services would affect the company’s bottom line. “We are able to have ambulances based in the county because we can spread our costs throughout the whole area,” Bruning said. “If you start to fragment the services, it could become more expensive.”Under the contract with El Paso County Emergency Services, AMR is required to provide services for all the entities that signed on with the agency. If the city opted out of the contract, Bruning said Colorado Springs would have to dissolve the intergovernmental agreement, which would affect all of the agency’s entities.AMR has been able to provide services at low rates with no subsidies because of its all-inclusive contract. “We have one communications center, which offsets our costs,” Bruning said. “If the city takes over ambulance transport, you would have a duplication of that service. Our prices would have to go up if the system is fragmented. As it stands, we are a great economic model because we are able to spread our fixed costs over the number of services we provide.”AMR’s Springs-based regional communications center, which has 200 local employees, provides for a seven-state region. In addition to efficient and widespread services, Bruning said AMR has been a good corporate citizen in the Springs. “We’ve gained national attention for our programs, like providing transportation for the Make a Wish Foundation,” he said. And locally, AMR has supported the balloon festival, senior programs and Pikes Peak Hospice.”We’ve won a number of national awards, including the 2000 “Colorado Ambulance Service of the Year,” the 1999 “Philanthropic Corporation of the Year” and the 2001 “Kind Company of the Year” awards,” Bruning said. “And we were just awarded the industry gold standard of accreditation by the Commission on Accreditation of Ambulance Services.” AMR is one of 80 ambulance service companies in the United States and three in Colorado that have received the designation. With its dispatch center accreditation from the National Academy of Emergency Dispatch, Bruning said AMR is one of only six dual-accredited emergency transport services – public or private – in the nation.Given a 25-year track record and high-performance levels, including a 90 percent-reliability rate related to the company’s goal of a six-minute response time, Bruning is asking, “Why fix what isn’t broken?”And he wonders why the city would want to assume the start up costs and take on all the risks? And how would switching from a fee-for-service program to a government-operated program affect taxpayers?Some of the questions will not be answered until the City Council reviews the proposal. But Bruning said the controls that are in place with privatization of the services keep his company accountable to a high set of standards.”We operate under a stringent performance contract,” he said. “We post a $1 million performance bond and adhere to a $20 per minute late response time assessment. Would the city require the same standards from the CSFD? Would the city fine itself if those standards are not met? Would the CSFD manage its own operations?”I have a lot of respect for the fire department, and we have had a great working relationship. We work with them every day, so what is the impetus for change? Part of our mantra is to continue to explore ways we can work together more efficiently with the fire department.”The question of privatization or public providers is a philosophical one, Bruning said. “Is it business or government?” he asked. “It all depends on the community resources available and how the services will be provided. Every community needs to decide which model works best.”The Lincoln, Neb., community is still reeling from a decision that created a city budget deficit of about $1 million. Bruning said the fire chief convinced the Lincoln City Council that the fire department could provide emergency transport services faster, better and cheaper than the private contractor the city had been using for 20 years. The decision eliminated 75 jobs, and the $1 million the city loaned to the fire department has never been repaid. Three years later, the emergency transport program under the fire department continues to operate at a loss, he said. An editorial in the Lincoln-based Journal Star stated that Fire Chief Mike Spadt said the city’s financial picture might improve now because a portion of the ambulance operations had been returned to the private sector.Martinez said the local proposal under the fire department is not about AMR’s services. “And it’s not a union issue,” he said. It’s a community-wide health issue, Martinez said. “We have become the primary caregivers for people who cannot afford to go to a doctor, and it affects all of us,” he said. “The emergency room gets inundated and three quarters of our calls are medical. We have to find innovative ways to approach how we provide our services.”Bruning said at the same time the City Council asked the fire department to come up with its proposal, council members asked AMR to explore ways in which the private and public sector could enhance its collaborative efforts. “We are already doing some joint dispatching and exploring other opportunities to improve response times, including rolling out the technology to be even more efficient,” Bruning said. “Yet we have this thing in the corner that is distracting.”The distraction is the possibility the city will end its contract with AMR, which, Bruning said in a letter to his colleagues, is all about “bigger government.””I don’t know that replacing private sector contracts with the government is what this city has traditionally been about.”

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