Amarillo’s ambulance decision: City-run or private

City staff and the Amarillo City Commission are weighing the pros and cons of an ambulance service operated either by a new private company or by the city’s own fire department. The choice is a situation commonly faced by local governments across the nation.

“Emergency Medical Services at the Crossroads,” a federally financed EMS analysis published in 2007, says the industry is “fragmented” because of an absence of federal and state standards.

“There is broad speculation about which systems perform best and why,” said the study by the Institute of Medicine of the National Academies of Sciences. “For the most part, systems are left to their own devices to develop the arrangement that appears to work best for them.”

American Medical Response, one of the largest private emergency medical transport companies in the nation, wants a permit to operate in Amarillo but has run into opposition from the Amarillo Professional Firefighters Union.

AMR is negotiating a purchase of Amarillo Medical Services, the ambulance arm of Northwest Texas Healthcare System.

But firefighters union President James Williams has lobbied the commission to reject AMR and instead put a publicly financed fire department-based system in place.

Williams and Ted Van Horne, AMR’s southern region CEO, both partially base their promises of better service on a system that would post ambulances at more locations across the city than Northwest currently uses.

The city has not completed cost projections for a publicly financed system because state licensing requirements and other logistics details will affect the estimates, City Manager Alan Taylor said.

“The state gets into the detail of actually prescribing what size ambulance, what it’s got to have on it,” he said. “We’re figuring costs in an area that we’ve never had to deal with before.

“We can’t jump everything up because there’s rhetoric and not do our due diligence.”

The city is guided in its permit negotiations with AMR by a contract that AMR works under in the city of Arlington, City Attorney Marcus Norris said.

The contract implements a number of performance measures that AMR must meet on a monthly basis, from call response time to vehicle replacement, Norris said.

No such benchmarks are in Northwest’s permit document, although the city set some standards after a city audit raised questions about Amarillo Medical Services’ aging fleet.

Eleven of 14 Amarillo Medical Services ambulances had at least 219,000 miles on them as of October 2007. And three to four ambulances required service or repairs on an average day.

“We see this (potential service change) as an opportunity to increase accountability,” Norris said.

AMR has served Arlington for eight years and last year won a competitive bidding process for a second contract, said Arlington Assistant Fire Chief Don Crowson.

“The only way these public-private partnerships work is you have a strong contract, and you have an entity that ensures contract elements are adhered to and followed,” he said. “Right now – and I always qualify that – right now, we’re satisfied with the level of service we’re receiving.”

AMR handles a volume of 25,000 to 30,000 calls per year in Arlington and must respond to life-threatening emergency calls in eight minutes, 29 seconds, Crowson said. AMR has suggested it will maintain a response time of eight minutes, 59 seconds for priority emergency calls in Amarillo, Van Horne said.

“Again, there’s no time now,” Van Horne said, referring to the lack of benchmarks Northwest has had under its permit with the city.

Arlington does not pay a subsidy to AMR for its service, Crowson said. AMR has not requested a subsidy from the city of Amarillo, Norris said.

AMR also expects a contract with the city to require the company to seek and win approval of any rate increases charged to patients – the procedure the company follows in Arlington, Van Horne said.

Williams conceded the Arlington contract has “strong teeth” and could be “an OK deal for the people of Amarillo. But I still think having a fire department-run EMS is a better solution.”

Wichita Falls renewed its contract with AMR about a year ago and is “pleased” with the service, which the city subsidizes, said Fire Battalion Chief Roger Ritchie.

AMR has met a Wichita Falls contract benchmark of 10-minute response times for 90 percent of emergency calls, Ritchie said, though he called the company’s response time “not always the best.”

“They run from one station here in Wichita Falls, which gives them a pretty long response time,” Ritchie said.

Williams has called into question practices he says AMR uses in other cities, citing reports of Medicare claims fraud settlements, withdrawals from communities and layoffs.

“They have pulled out of other cities because they’re not making the money that they thought they should be making,” Williams said. “I’m not saying they’re going to do that this time, but it has been done in the past.”

Crowson contends it would be difficult not to find bad press about a company that operates services in communities in 38 states.

“You can find bad stories about AMR, there’s no doubt about that,” he said. “They’re all across the country, every deal they have with different communities is different – and they’re run by people.”

Any contract Amarillo negotiates with a private provider will give the city the right to immediately take possession of ambulance equipment to operate the service “while we go to the courthouse” to settle disputes, Norris said.

Several Amarillo Medical Services employees have declined to comment on the record because they fear losing their jobs. They have registered concerns about salaries, work shifts and other employment matters.

AMR has required the employees to reapply for positions, take written exams and undergo background checks, drug tests and other screening. AMR distributed a five-page document to workers on Nov. 5 to answer employees’ questions, Van Horne said.

Shifts will change as AMR determines how to distribute its vehicles to cover Amarillo both geographically and in relation to busier call times, he said.

Norris said the employment questions are a labor matter between private companies.

“It’s up to these two companies to decide how to manage their people and how they transition,” he said. “The city does not get into private labor disputes.”
By Karen Smith Welch in The Amarillo Globe-News