40% Hike in Ambulance Fees Urged by County

Los Angeles County health officials are recommending that ambulance companies be allowed to raise their basic charge about 40%, boosting the fee for a typical daytime emergency run to $232.

The proposed rate hike is prompted by a fundamental restructuring of ambulance service in most cities and the unincorporated areas of Los Angeles County. Triggered by a 1986 court ruling, health officials devised a new plan to divide the county into service areas, with 16 private ambulance companies each given an area, with the exclusive right to respond, under contract with the county, to all 911 emergency telephone calls.

But even as county officials are negotiating with the Los Angeles County Ambulance Assn. to carve up the territory, a handful of small ambulance companies complain that they have been frozen out of the action. They are criticizing not only the county’s exclusive negotiations with the so-called “Sweet Sixteen” ambulance companies but also attacking the proposed rate hike as excessive.

The last rate hike approved by Los Angeles County supervisors eight months ago was less than 4%. In a few weeks, the supervisors are expected to act on the new increase.

Douglas Emslie, president of Lifeline Medical Transport in San Gabriel, accused the county of throwing lucrative business--without seeking competitive bids--to an “old boys club” of ambulance operators represented by the politically influential Los Angeles County Ambulance Assn. The association and its members have contributed more than $16,000 to the supervisors’ campaigns during a recent four-year period, records show.

Fran Dowling, head of the County Department of Health Service’s contracting and management office, said that while ambulance operators may well be campaign donors, this has no impact on his decisions regarding the ambulance franchise program.

“There have been questions, but no directions,” coming from the supervisors’ offices, he said.

Dowling acknowledged that a handful of smaller ambulance operators “are not too happy with us.” But he said that the county is simply trying “deal with the problem” created by a 2nd District Court of Appeal ruling 18 months ago that ordered the county to assume responsibility for all emergency ambulance service in the county.

Previously, a patchwork quilt of emergency transport service was provided by city-operated ambulance companies and by private companies, either under contract with cities or with the county. The court ruling does not disrupt ambulance service now provided by 23 cities, including Los Angeles, Long Beach, Beverly Hills, Pasadena and San Marino, Dowling said.

But it will require the county to significantly expand its coverage to encompass 30 more cities than it now covers and to assume responsibility for the cost of transporting all sick people throughout the county who cannot pay their ambulance bills. The two biggest of the 30 new cities are Torrance and Glendale, Dowling said.

Despite the looming expense, the county wants to hold the line on its costs. Raising the rates that ambulance operators can charge their paying customers is one way of doing so, county officials said.

A rate increase “makes sense” because without it, “the county will have to come up with more money from the general fund,” said Roderick Dorman, attorney for the ambulance association.

Dowling said that ambulance charges must be increased to entice ambulance companies to participate in the county’s new franchise program. He said the rates here have long lagged behind those in other counties.

The median baseline charge for ambulance operators in 30 California counties surveyed by health officials is $143, Dowling said.

In Los Angeles County, the baseline charge is now $109. It will rise to $151 under the proposed rate increase.

However, this charge excludes extras such as the fee for oxygen, mileage, waiting time and night service. These charges will also be boosted. The fee for using an ambulance’s red lights and siren, for example, will jump 250% from $16 to $56.

According to the proposed rate schedule, a typical daytime emergency run of three miles will cost $232, up from $148. Another $61 would have to be added for oxygen and night service, up 85% from the current rate.

“While I would agree to an increase, this seems excessive,” Emslie said in a letter to supervisor Mike Antonovich.

Emslie also criticized a proposal that would force ambulance operators to charge “no more, no less” than the prescribed amounts.

“Is this free enterprise?” he asked.

Paul Duran, general manager of United Ambulance in East Los Angeles, said that half a dozen small, relatively new ambulance companies are upset that the county is negotiating for service exclusively with “the Sweet Sixteen, who have been around many, many years.”

“It’s a tight little system, and they want to keep us out,” he said.

“It’s very simple,” Emslie said, “If these guys can lock up Los Angeles County, the value of their companies goes way up.”

Dorman, attorney for the ambulance association, acknowledged that some of the smaller ambulance companies are “screaming” because they fear that “they’ll be closed out.”

But it’s not only the small, local ambulance companies who are upset.

Several large ambulance operators, such as Jon Baker of PMTM Ambulance in Phoenix, said his firm had expected the county to open the process to nationwide competitive bidding.

Baker said he was looking forward to bidding in Los Angeles and was stunned to learn a few weeks ago that the county may not go to bid because of pressure from the so-called Sweet Sixteen.

“I was told that they had made campaign contributions to the supervisors and that the RFP (request for proposal) was being pulled,” he said.

Dowling said that seeking competitive bids from ambulance operators remains an option if negotiations with the ambulance association break down.

In either event, he said that ambulance rates will have to go up.

“There must be some reasonable increase in rates to entice other operators from across the country to come to Los Angeles,” Dowling said.

He said that when the department recently queried 500 operators nationwide, about 10% expressed interest.

Last summer, the supervisors instructed health officials to seek ambulance operators through competitive bidding, but Dowling said that when the supervisors were informed of the “monumental problems and possible uncertainties” in the competitive bidding process, they informally approved of health officials sitting down with the ambulance association and negotiating contracts.

He said the economic issues are extremely complex--and further complicated by the fact that the ambulance industry is very competitive.

As he put it, “They’re not all kissing cousins.”

Times staff writers Victor Merina and Cecilia Rasmussen contributed to this story.

THE COST OF CARE

Health officials are recommending that the Los Angeles County Board of Supervisors approve the following rate increases for ambulance operators.

Current Proposed Charge Charge Response to call $109.00 $151.00 Mileage rate $7.50 $8.40 Nighttime service $16.75 $33.60 Oxygen $16.25 $28.00 Red lights, siren $16.75 $56.00

CONTRIBUTIONS BY AMBULANCE COMPANIES

These are campaign contributions to Los Angeles County supervisors by private ambulance companies between 1984 and 1987.

Company Antonovich Dana Edelman Hahn Adams Ambulance Service Arcadia-Monrovia Amb. Svc. Bowers Ambulance Service $625 $ 700 $250 Crippen Ambulance Service 125 500 250 Goodhew Ambulance Service 125 500 Hall Ambulance Service Los Angeles County Amb.Assn. 1,375 500 $1,000 Maurer Ambulance Service Medic I Enterprises Newhall Ambulance Service Pruner Health Services 875 Risher Ambulance Service 250 Wilson Ambulance Service 600 Total $3,725 $2,200 $1,000 $750

Company Schabarum Total Adams Ambulance Service $ 750 $750 Arcadia-Monrovia Amb. Svc. 1,650 1,650 Bowers Ambulance Service 750 2,325 Crippen Ambulance Service 1,650 2,525 Goodhew Ambulance Service 750 1,375 Hall Ambulance Service 100 100 Los Angeles County Amb.Assn. 2,875 Maurer Ambulance Service 350 350 Medic I Enterprises 1,200 1,200 Newhall Ambulance Service 350 350 Pruner Health Services 350 1,225 Risher Ambulance Service 750 1,000 Wilson Ambulance Service 350 950 Total $9,000 $16,675

Researcher: Cecila Rasmussen, city hall researcher