SBC Officials & Lawyers Consulting With Their Sonoma County Counterparts In Fighting Off AMR Suit

San Bernardino County officials and their attorneys are trading notes with their counterparts in Sonoma County in the aftermath of American Medical Response filing a suit in federal court alleging San Bernardino County, its board of supervisors and two of its interrelated or associated joint public safety agencies engaged in a violation of the Sherman Antitrust Act when the board in December awarded the franchise for emergency medical response throughout most of the county’s desert region to an amalgam of one of those public safety agencies and an Arizona-based ambulance company.
Colorado-based American Medical Response, known as AMR, operates as an ambulance service provider in 40 states as well as the District of Colombia. Some of its corporate predecessors were providing ambulance service in San Bernardino County in the early 1970s. On January 1, 1981 AMR was given an exclusive operating contract in a wide swathe of the desert by the Inland Counties Emergency Management Agency, which oversees emergency medical response in San Bernardino, Inyo and Mono counties and licenses emergency medical service providers – including hospitals and ambulance companies – in those regions. AMR maintained that exclusive contract for providing services ambulance service in San Bernardino County’s desert for more than four decades. Though the Inland Counties Emegrgency Management Agency, know by its acronmym ICEMA is a three-county joint powers authority, county oficials in Inyo and Mono counties have empowered the San Bernardino County Board of Supervisors to act as the ICEMA board.
Whereas in previous years, the AMR contract was merely “rolled over” in what the county referred to as “a grandfathered process,” in late 2022 county officials began to look toward what action it would take with regard to the expiration or continuation of the contract. On December 20, 2022, the county released a request for proposals – a solicitation of bids – inviting prospective providers to provide ground ambulance service in 11 of the county’s 26 exclusive operating areas.
Responding to the request were AMR and Consolidated Fire Agencies, known by its acronym CONFIRE, a joint powers authority which provides communications, dispatch, computer information systems support and geographic location information to its nine member agencies – the Apple Valley Fire Protection District, Chino Valley Independent Fire District, the Colton Fire Department, the Loma Linda Fire Department, the Rancho Cucamonga Fire Department, the Redlands Fire Department, the Rialto Fire Department, the San Bernardino County Fire District and the Victorville Fire Department – and four contract agencies – the Big Bear Fire Department, the Montclair Fire Department, the Running Springs Fire District and the San Manuel Fire Department.
In its response, AMR stated it could commit 12,889 weekly unit hours to respond to calls, had 111 ambulances available during peak system demand and stationed throughout the service area backed with 39 additional available ambulances available to meet surges. It emphasized that it was the current provider of the services with vehicle infrastructure in place and 10 managers and 18 field supervisors and a medical director familiar with the comprehensive needs of the service area. The company offered rates of $3,958 for both basic life support and advanced life support, $2,834 to carry out an interfacility transport, and $4,392 for critical care transport.
In its response, CONFIRE said it would subcontract with Priority Ambulance, which also serves Maricopa County in Arizona and therefore could devote 10,371 weekly unit hours to respond to calls, had 93 ambulances available at peak demand, with 45 additional ambulances available to meet surges throughout the service area, that it will establish ambulance staging locations, put on-board personnel in place and acquire vehicles upon receiving the contract. It offered an assurance that it has leadership and management to meet the demands of providing the service, including nine managers and 18 operations supervisors as well as a medical director and that it controls the regional emergency services communication system. Its proposed rates for its advance life support service were $3,547 for non-emergency and interfacility transfer, $4,053 for emergency transport, $2,533 for non-emergency basic life transport and $3,167 for emergency basic life transport and CCT $5,067 for critical care transport.
What the county referred to as an “independent review panel” made up of four evaluators individually scored each proposal on 14 key areas – system requirements, response time standards, clinical performance, deployment plans, vehicles, medical supplies and equipment, personnel, hospital and community requirements, disaster preparedness/response, quality management, electronic patient care reports, centralized emergency medical dispatch center, financial and administrative requirements qualifications, and future system enhancements – for the purpose of making a recommendation to the county for final negotiation of contract terms. The total cumulative scores, against a standard with 1,720 points maximum, favored AMR, which registered 1,519 total points against 1,515 points for CONFIRE.
Based on what the county characterized as the negligible difference between the scores, it provided AMR and CONFIRE with notice to enter into contract negotiations with the county and that the final contract approval rested with the board of supervisors.
After those negotiations concluded, the county purchasing division on October 27, 2023, emailed AMR a notice of intent to recommend that it be awarded a contract extension from the time its current contract expires on March 31 from April 1, 2024 through September 30, 2024 to allow CONFIRE to get prepared to take on the contract for an initial term from October 1, 2024 through September 30, 2029.
AMR lodged a protest, alleging the county had failed to follow the selection procedures, did not adhere to requirements specified in the request for proposal, had awarded the contract to the entity which had lost in the competition and that it had otherwise violated state and/or federal law. The county’s purchasing agent, Ariel Gill, who reviewed and considered the protest and notified AMR of its decision to deny the protest.
At the December 5 board of supervisors meeting, a motion by Supervisor Jesse Armendarez seconded by Supervisor Curt Hagman to deny the protest from American Medical Response and schedule a vote to consider awarding the contract to Consolidated Fire Agencies and its private subcontractor Priority Ambulance passed by a unanimous vote. During the December 5 meeting, AMR was represented by a spokesman who neglected to identify himself and Mike Rice, the company’s vice president of operations, who made no comments. The unidentified spokesperson said AMR offered “stability, performance and clinical excellence. AMR is in the best position to take this into the future. We’re fully integrated with the fire departments, public health, behavioral health, the communities we serve.” He emphasized that AMR had a “depth of resources, history of performance, experience and expertise, disaster response capability and represented a lower risk of liability to the cities and county than have public agencies providing ambulance service. He said that “AMR meets or exceeds all response [time] standards” and featured as part of its vehicle fleet “all-wheel-drive units in key areas that need that… and a disaster command vehicle.” He said the company had helicopter ambulances and was “financially strong” with an established sustainable model.”
CONFIRE was represented by Rancho Cucamonga City Councilwoman Lynn Kennedy, the chairwoman of the CONFIRE Board of Directors, as well as Rancho Cucamonga Fire Chief Mike McCliman and CONFIRE Chief Nathan Cook. Lynne Kennedy said what CONFIRE was offering something that “will result in increased resources, decreased response times and a delivery model that includes private/public partnership, a private partnership with Priority Ambulance that has the capacity to serve our county and the public partnership that crosses the continuum of care, making sure that every single resident receives the right care at the right time on time every time without exception. It is going to be transformational in three areas. It is going to improve our service delivery, establish an efficient system and invest both financial and human resources back into the system.”

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