O.C. Ambulance Service May Be Facing Change

By SHELBY GRAD

Feb. 3, 1997 12 AM PT

TIMES STAFF WRITER

Paramedic and ambulance services for 1.1 million Orange County residents are undergoing a quiet but profound transformation that firefighters say will cut emergency response time by a minute and provide those in need with better care.

Already, the Orange County Fire Authority has revamped its emergency medical system, moving paramedics from vans to fire engines, where they can more quickly reach victims.

Over the next few months, the department will debate an even more radical change: Dropping the use of private ambulance companies and providing emergency transportation with its own fleet of vehicles.

“What we are doing will deliver paramedic service to your front door faster, and that’s critical to saving lives,” fire Capt. Scott Brown said. “With cardiac arrest and other emergency calls, every second counts.”

But opponents are lining up to fight the plan, led by a group of private ambulance companies who say their businesses would be devastated if the county takes over the service.

Critics question the logic of expanding the Fire Authority when the trend in government is toward privatization. They also doubt that the department can purchase new ambulances and run the system without significantly increasing the $300 transportation fees charged to victims.

“There’s going to be a cost of doing business no matter how you do it,” said Brian Ranger, director of government relations for MedTrans, one of five ambulance operators serving the Fire Authority. “The consumer is going to have to pay, one way or another.”

The stakes are especially high for smaller Orange County-based ambulance firms, because several city fire departments--including those of Newport Beach, Orange and Huntington Beach--have dropped private service in favor of operating their own ambulances.

The Orange County Fire Authority is the largest emergency services agency in the county, serving 19 cities and all the unincorporated area with 1,500 firefighters at 61 stations.

Medical emergencies account for more than 60% of the 62,000 calls taken by the county’s 911 operators each year, and officials have long complained that the Fire Authority recovers little of the cost of providing the paramedic assistance.

By taking over ambulance service, the authority would gain about $4 million in annual revenue, enough to close a budget deficit that might otherwise result in service cuts.

Fire officials said the ambulance proposal is a critical piece of a larger effort to improve efficiency and close the budget gap without raising fees or property tax assessments.

Earlier this year, the authority began implementing a “front loading” system in which paramedics ride on the first fire engine responding to a call rather than traveling by separate van.

Brown said the change allows the Fire Authority to place a paramedic with most fire companies and gets medical workers to the scene of emergencies more quickly. A 1993-94 pilot program found that “front loading” reduced paramedic response time from about 8 minutes to less than 6.

Currently, a private ambulance is radioed to transport victims to the hospital, often with a county paramedic riding inside to administer treatment. The company then charges the victim or his insurance company about $300 for the service.

“The public sector is actually subsidizing the private sector at taxpayer expense,” said Mission Viejo Councilwoman Sherri M. Butterfield, the Fire Authority’s chairwoman. “The ambulance companies are receiving full payment for services even though the Fire Authority is rendering part of that service.”

Under the county proposal, Fire Authority ambulances would transport victims--charging about $270 per ride, or 10% less than the private carrier fee. Each ambulance would be staffed with its own paramedic, allowing the medical worker who first arrived on the scene to stay with his engine company and respond to other calls rather than go to the hospital, Brown said.

But ambulance operators dispute this rosy scenario, saying the Fire Authority would have no choice but to increase transportation fees to cover the costs of purchasing new ambulances, retrofitting existing paramedic vans and hiring new personnel.

The Ambulance Assn. of Orange County recently proposed an alternative reorganization that calls for the private companies to pay the Fire Authority for the use of paramedics. The plan would provide the agency with $1.4 million per year but would also increase the transportation fees to $450.

“The private sector can accomplish exactly what the [Fire Authority] wants to do if they will only let us,” said Michael Dimas, with Medix ambulance company, which has served much of the South County for 19 years.

The conversion would wipe out many independent operators like Medix, Dimas said, leaving the Fire Authority with a shortage of available ambulances in case of a major disaster.

Ranger, with MedTrans, complained that the Fire Authority’s proposal is a “short-term solution to a long-term budget problem” and that officials should instead focus on cutting overtime payments, overhead costs and other expenses.

“They may gain revenues with this,” Ranger said. “But until they control costs, they are only putting off the problem.”

Ambulance companies have aggressively fought conversion efforts in other cities and actually sued Orange last year in an attempt to block a takeover by that city’s Fire Department. In a San Bernardino case now in the courts, private carriers argue that public agencies cannot take control of ambulance service without a competitive bidding process.

Other Orange County fire departments said the conversion to in-house ambulance service has proved successful.

In Huntington Beach, average ambulance response times dropped from 10 minutes to 6, and officials generated more revenue without raising emergency transportation fees, according to Fire Chief Michael P. Dolder.

The Orange County Fire Authority proposal will be submitted to a subcommittee later this month and likely go before the full governing board later this year.

Butterfield said she hasn’t decided how she will vote on the plan. But she said the agency needs to find a way to recover the costs of providing paramedic service without increasing fees.

The Fire Authority receives property tax revenue to cover only basic firefighting activities, even though the agency handles other tasks, including fire prevention education and swift-water rescue, she said.

“The scope of work has widened, but our source of funding has remained the same,” Butterfield said. “We need to find ways to recover these costs.”

She and other officials generally praised the quality of service the private ambulance services provide. But they expressed concern that locally owned, independent ambulance companies are rapidly being swallowed by a handful of national firms with a greater focus on the bottom line.

The private ambulance industry is undergoing a major consolidation that includes giant MedTrans, which recently bought out Careline Inc., another top Southern California operator. The big companies are going after public contracts like never before, sometimes putting them at odds with firefighters who want to perform the same work.

“You see cases where [private firms] cut corners in terms of training and compensation of personnel,” Butterfield said. “I’m not interested in a minimum-wage person arriving at the scene of an emergency if my family member’s life is involved. I want the best I can get.”

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Calls for Help

Emergency medical calls for 19 cities and the county’s unincorporated areas are handled by the Orange County Fire Authority. During 1996, the agency handled 35,663 such calls, with the most coming from Irvine and Westminster:

Buena Park: 2,793

Cypress: 1,191

Dana Point: 1,088

Irvine: 3,502

Laguna Hills: 953

Laguna Niguel: 1,252

Lake Forest: 1,603

La Palma: 290

Los Alamitos: 492

Mission Viejo: 2,415

Placentia: 1,159

San Clemente: 1,603