State law requires the county to create a plan that will lead to a request for proposal, selection of an ambulance provider and development of a contract with that provider.
Commissioner Diane McKeel requested the week postponement and Commissioner Loretta Smith seconded.
“There are still questions the members of our commission have, so we’ll postpone,’’ said Chair Deborah Kafoury. “We do need to get a plan approved, this is a very important part of our health system.’
The current plan, adopted in 1994, coordinates multiple agencies to respond and provide high-quality pre-hospital care and ambulance transport across Multnomah County.
American Medical Response - AMR - has won the contracts to provide the service since 1994. During the uncertainty following state and federal health reform, in 2015, the Board voted to extend the AMR contract for three years. The county is required, after that extension, to put the contract out to competitive bid.
Plans are for a new contract to begin in July 2018.
Dr. Gary Oxman, former Health Officer, said prior to 1994, the county had three competing ambulance companies that served different geographic areas in a way that was disorganized and inefficient.
The 1994 ambulance service plan laid the groundwork for the current, one provider, one service area system. It also dramatically improved care, response time and decreased cost. Oxman said the challenge is to make improvements without degrading the system.
The proposed plan retains many of the previous pillars: having one provider in one service area, first response by fire agencies; a medical director, and transport that is supported by user fees without explicit financial subsidies by local government.
Dr. Paul Lewis, Multnomah County Health Officer and manager of EMS Services, said five areas that the county is considering changing would:
- Increase future flexibility with a new process that relies on a new EMS advisory council and medical director.
- Allow subcontracting that was previously prohibited.
- Allow fine-tuning of responses through a 911 triage plan update, reserving the full response for most serious medical response and lesser response for more minor conditions.
- Clarify the role of medical director.
Lewis said the county launched its plan development with a webinar in January 2016, held stakeholder interviews between January and October, a two-week public comment period and a public hearing on Oct. 19.
The meetings were with members of underserved communities, as well as the Portland Bureau of Emergency Communications, Legacy Health, Kaiser Permanente, AMR, Metro West ambulance, the mayors of Fairview, Troutdale and Wood Village and Portland City Commissioners Dan Saltzman and Steve Novick.
At the Board meeting, several stakehoders also testified. Ken Burns of the Portland Fire Bureau said 80 percent of the Ambulance Service Area lies within the city of Portland and that the city would like to expand its role and have more opportunity to tap revenue for the services.
Randy Lauer, regional director for AMR who has been in the business 35 years, thanked the the EMS office staff to update the plan “they did a very good job.’’ However, he asked that the plan reconsider response time for non-life-threatening calls, because the proposed one is costly with no benefit to patients.His largest concerns, however, were for his staff serving today and that they be given more wage, benefit and hiring protections in the event the contract was awarded to another ambulance provider.
“We are proud to have been your ambulance provider for 21 years.’’
Scott Lewis, Division Chief of Gresham Fire and Emergency Services, also called upon the plan to allow greater input from local fire departments on the delivery and transport of citizens.
Finally, dozens of AMR paramedics attended and a few testified to their commitment to serving the public and their worry about the future.
“The dedication and years of experience of our paramedics are irreplaceable,’’ Sayre said. “We do not get into this business to get rich, but we have fought hard for our family wages and excellent benefits and our elected officials should not be undermining that. Do the right thing in protecting our jobs by adopting strong language.’’ she said.
Chair Kafoury thanked everyone who attended to testify.
“I hope you all know how much we at Multnomah County value our partnership with the all various providers in this system. We know it is complex and it is crucial to the health, life and safety of our residents. We value the important role you play.’’