Private Ambulance Companies Have Served O.C. Taxpayers Well

To find the leadership of the Orange County Fire Authority (OCFA) brazenly demagoguing the debate over pending blueprints to retool the county’s Emergency Medical Services (EMS) system is unsurprising. That it’s occurring, however, is lamentable and injurious to the interests of county taxpayers, who are rightfully suspicious of public agency expansionism.

Of the proposals scheduled for scrutiny by OCFA, it should intrigue county taxpayers that a plan aggressively peddled by county firefighter unions has become the object of thinly veiled public cheerleading by OCFA’s leadership. This hardly encourages a dispassionate analysis of all the proposals before the agency, including the notion that the county’s EMS system might be just as well if left alone.

The scheme in question would find the county’s Fire Authority commandeering the provision of emergency transportation services from private ambulance companies. As it stands now, five ambulance firms serve the 19 cities and unincorporated corners of the county under the authority’s jurisdiction. Indeed, private ambulance service has been a fixture of Orange County’s EMS apparatus for more than 30 years.

Sherri M. Butterfield, OCFA chairwoman, and R. Craig Scott, agency vice chair, have accused private ambulance companies of profit raking at the expense of taxpayers. Worse, they’ve kicked dirt on the fine clinical skills of the dedicated medical professionals employed by private ambulance providers, as if they were high school physiology students when juxtaposed along side firefighter-paramedics.

“You see cases where [private firms] cut corners in terms of training and compensation of personnel,” Butterfield was quoted as saying in a Feb. 3 Times article. “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.”

If Butterfield has concrete evidence of corner-cutting, she should produce it. Private paramedics hold the same certifications as firefighter-paramedics. In fact, many private providers mandate their paramedics to be proficient in advanced clinical skills, and underwrite their training in these areas.

In Southern California cities where EMS services are contacted to outside providers, private paramedics don’t moonlight as hazardous materials specialists or firefighters. Rather, they perform with skill on a daily basis advanced clinical procedures that save lives. If these dedicated paramedics were the “minimum wage” hacks Butterfield suggests, there is not a county nor city that would continue to license their operation. Indeed, that 50% of this nation’s cities rely on outside providers for their EMS services lays bare the propaganda that private paramedics are humbling ambulance jockeys.

Scott has written that county taxpayers are subsidizing private ambulance company profits. That’s an absurd notion. The cost of transporting a patient to a hospital is borne by the patient’s health insurance carrier, and is paid to the private ambulance provider. That’s as it should be. They are the entities providing the transportation service.

It is not the fault of private ambulance companies that most major health plans do not reimburse medical care provided by paramedics. Nor is it the doing of private providers that under the county’s current EMS structure, OCFA firefighter-paramedics must ride along in private ambulances in order to continue medical care for which OCFA receives no reimbursement from third-party payers.

Nevertheless, to suggest OCFA is getting stiffed for the provision of paramedic services is a myth. We all pay taxes, don’t we? And what of the proliferation of municipal EMS subscription fees (a kind of insurance premium paid to cities for public agency paramedic service) that many citizens are paying? No one can credibly contend that these monies are finding their way to the pockets of private ambulance concerns.

But if it is the case that these monies are insufficient, then it should be that OCFA become more efficient instead of exterminating the important role the private sector plays in EMS delivery.

The OCFA is saddled with a multimillion-dollar budget deficit because it maintains a vastly expensive brigade of 1,500 firefighters (many of whom earn six-figure salaries that far exceed those of first-year residents in area hospitals) housed in 61 stations countywide. What justifies this massive platoon of firefighters when just 2,800 calls out of 62,000 in 1996 were responses to fires?

If within the complex dynamics of managed care and public sentiment for smaller government there needs to be an exploration of ways to more equitably share revenues between public and private EMS providers, that’s fine.

Still, it is troubling to witness OCFA’s bureaucracy campaigning for the wholesale elimination of an industry that has for 30 years made important and heroic contributions to the health and safety of Orange County.