The San Bernardino County Board of Supervisors along with their predecessors have long done their level best to give a single ambulance company and its corporate successor a competitive advantage over other emergency transport providers as a reward for the generosity that consortium has demonstrated in endowing the supervisors’ political campaign coffers going back decades. Nevertheless, at the prompting of County Executive Officer Gary McBride, all five of the county’s current supervisors are on a trajectory to break down next week and enter into an agreement with an ambulance company that has not lined their pockets.
In the late 1970s, Terry Russ, Homer Aerts, Steve Dickmeyer and Don Reed, all of whom operated ambulance companies on the west and central portion of San Bernardino’s Inland Valley and had been competing against one another for years, consolidated into one entity, Mercy Ambulance, streamlining their dispatch service, and better coordinating with local fire and police departments. Through efficiencies, economies of scale and the sharing of resources, they were able to overwhelm the other ambulance operators they were in competition with, lower their prices, and induce most of those competitors to either go out of business, move elsewhere, merge with them or sell out to them. After pooling their money and initiating a program of making substantial political contributions to local politicians at both the city and county level, Russ, Aerts, Dickmeyer and Reed then used this newfound political clout and influence to have both the county board of supervisors and various city councils “regulate” the ambulance industry, which included essentially adopting as the minimum requisites for an ambulance operation within their jurisdictions the vehicle, equipment and employee training standards Mercy had in place. The politicians were able to do something so blatantly in the interest of their political donor by asserting that these actions enhanced public safety.
Thus, Mercy Ambulance established a political hammerlock on the region. Keeping up its pace of donations to the county’s top local elected officials, the consortium gobbled up ever more key franchises, making its operation yet more lucrative. In turn, the company would use a percentage of the profits it was generating to increase the scope of its political contributions. In return, the grateful politicians ensured that Mercy retained its competitive advantage over its rivals, giving Mercy plum franchises in the county’s most heavily populated areas. While what Mercy established fell slightly short of being an outright monopoly, it was at that point capable of controlling the local ambulance market at will. It then began raising its prices, making up for the rate cuts it had instituted to obtain market dominance and then raising its service rates to a point where customers were openly complaining about being gouged.
As Mercy grew, so did the scope of its operations and its power. The company added helicopters to its line of service and extended its reach all over 20,105-square mile San Bernardino County – a land area the size of four New England states. But as Russ, Aerts, Dickmeyer and Reed aged and grew wealthier, they began, slowly at first, to disengage from and then inevitably pulled out of the stressful emergency response business entirely. A first step in that direction was selling off – at considerable profit – the Mercy Air wing. Thereafter, they sold or let their heirs take on the ground ambulance fiefdom that Mercy represented, and they withdrew into a retirement of luxury and comfort.
It was at that point that American Medical Response came into San Bernardino County as the new kid on the block. As Mercy withdrew, American Medical Response filled the vacuum, simultaneously taking a leaf out of Mercy Ambulance’s playbook, and it too made hefty political contributions. Over time, favored status would be conferred upon American Medical Response in San Bernardino County that would rival that of Mercy Ambulance a generation before. American Medical Response ultimately bought out Mercy Ambulance, thereby inheriting Mercy’s ambulance service kingdom.
Along the way, the county’s corrupt political establishment was able to manipulate the entity formed to oversee emergency service provision issues in San Bernardino County and both Mono and Inyo counties, known by the acronym ICEMA, short for the Inland Counties Emergency Medical Agency. With the permission of the boards of supervisors in Mono and Inyo counties, the San Bernardino County Board of Supervisors acts as the governing body of the Inland Counties Emergency Medical Agency, which was chartered “to ensure an effective system of quality patient care and coordinated emergency medical response by planning, implementing and evaluating an effective emergency medical services system including pre-hospital providers, specialty care centers and acute care hospitals.”
Seamlessly, the board of supervisors capitalized on that authority to lock in the advantages that had already been extended to the ambulance company endowing its members with campaign cash, deriving for themselves an even more lucrative stream of kickbacks.
For decades the county’s supervisors shamelessly indulged in the arrangement. When challenged they would repeat the refrain that the provision of ambulance service is an expensive undertaking, and that a select company, the one giving them the money they needed to campaign with, needed to be protected from the vicissitudes of competition, or else it would go out of business, leaving the county’s residents without ambulance service.
Last year, the 2017–2018 San Bernardino County Civil Grand Jury in its final report recommended that the county undertake to solicit bids for the provision of emergency ambulance support in a wide range of so-called “exclusive service areas” for the first time in 37 years. According to the grand jury report, “The primary ambulance service provider has continued to be a contracted provider to the county for 34 years.” Obliquely and politely, without directly referencing the degree to which hefty campaign contributions from American Medical Response have bought influence on the board of supervisors, the grand jury report raised the issue of the favoritism shown toward American Medical Response over the years and the way in which the company has been allowed to adhere to older and lower standards that were in place when it obtained the ambulance service franchise it now has while the county is insisting that the companies that would compete with American Medical Response hew to higher and more expensive standards. Moreover the report further referenced the way in which American Medical Response has been allowed to monopolize all of the high population areas of the county where a high profit in operating is guaranteed, with no requirement that the company ensure coverage in the more remote and less populated areas. The low-profit or no-profit areas are serviced by American Medical Response’s competitors. In many cases, those competing companies are sustaining losses that are in danger of putting them out of business.
This has laid bare how the members of the board of supervisors have neglected those remote areas and disregarded the safety of their constituents who live and work there.
A case in point is the county’s extreme northwest end, where Liberty Ambulance is the franchised emergency transport and advanced life support provider.
County Chief Executive Officer Gary McBride in a report dated next Tuesday, January 29, is requesting that the board of supervisors “terminate the existing financial agreement with Progressive Ambulance, doing business as Liberty Ambulance, effective January 30, 2019, and approve a new financial agreement with Progressive Ambulance, doing business as Liberty Ambulance, for the delivery of advanced life support ambulance services in San Bernardino County Non-Exclusive Operating Areas 24 and 25, including the Trona area, for the period January 30, 2019 through January 29, 2020, with two additional one-year options to extend the agreement, in the amount of $500 per call, for a total amount not to exceed $125,000 per year.”
McBride explained, “On February 13, 1996, the board of supervisors approved a non-financial contract with Progressive Ambulance, Inc., doing business as Liberty Ambulance Services, Inc. Contract No. 96-115, to provide advanced life support services in the San Bernardino County Non-Exclusive Operating Areas 24 and 25, including the Trona area. The geographical area located in Areas 24 and 25, including the Trona area, is extensive, covering the northwest corner of the county. This area is a very low population density area, with the total number of calls totaling approximately 250 in 2018. This extremely low volume can be challenging for advanced life service providers who are required to provide 24/7 coverage, as is the case for Progressive Ambulance. As a result of the Areas 24 and 25 challenges, combined with more recent changes seen in the emergency medical services reimbursement that has resulted in decreased revenues, Progressive Ambulance has communicated to the county its concerns regarding its ability to continue to provide advanced life services in Areas 24 and 25, including the Trona area, under the non-financial agreement approved by the board on February 13, 1996. If Progressive Ambulance was to terminate service, Areas 24 and 25, including the Trona area, would be left with no public or private advanced life service ambulances in close proximity to respond to emergencies.”
The current population of Trona is around 1,900.
Rather than make arrangements to have American Medical Response extend its service into the northwest corner of the county as a condition of maintaining its preeminent position as the county’s dominant ambulance service provider and risk angering his political masters on the board of supervisors by cutting into the profit margin of one of the supervisors’ major campaign donors, McBride more politicly elected to usher the board of supervisors instead toward having the county’s taxpayers underwrite the guaranteed provision of ambulance service in Trona.
McBride said he recommended terminating the existing non-financial agreement with Progressive Ambulance and entering into a $150,000 per year arrangement with the company “in order to ensure that advanced life service continues uninterrupted in Areas 24 and 25 while the county explores a permanent solution to the problem.”
“This agreement can be terminated by either party, for any reason, with a 90-day notice,” McBride stated. “The county will continue to explore all options to ensure that the long-term safety of the public is maintained.”
-Mark Gutglueck