Woodside, Menlo fire districts losing millions on ambulance service Woodside, Menlo fire districts losing millions on ambulance service (December 10, 2003)

** As Menlo quits ambulance service, Woodside says funding changes must be made.

By Renee Batti

Almanac News Editor

The Woodside and Menlo Park fire districts have lost millions of dollars since 1998 by operating their own ambulances, and are unfairly subsidizing ambulance service countywide, a frustrated Woodside Fire Protection District board member declared at a public meeting last week.

Although the Menlo Park Fire Protection District will cut its losses by backing out of its ambulance-operation agreement next June, the Woodside district will continue staffing an ambulance. But Woodside may have to follow Menlo Park's example in the foreseeable future if changes in funding aren't made, said the board member, Peter Berger.

Mr. Berger made his remarks at the December 3 meeting of the joint powers authority (JPA) that oversees and funds county fire departments' "first-response" emergency medical services.

The JPA, made up of fire districts and cities in the county, and the for-profit company American Medical Response (AMR) form a public/private partnership that provides emergency medical care and ambulance transport in San Mateo County. Under that partnership, a fire truck with a paramedic on board is almost always the first on the scene of an emergency medical call. When an AMR ambulance arrives on the scene, its staff takes over medical care and, if needed, transports the patient to a nearby hospital.
Losing money

While most of the county's fire districts and city-run fire departments participate in the partnership with AMR through the JPA, the Menlo Park and Woodside districts also operate ambulances, as do the city-run fire departments in Pacifica and Half Moon Bay.

The Menlo Park fire district, which loses about $550,000-plus each year by operating the ambulance, has reached an agreement with AMR and the JPA allowing it to end its contract June 30, although the agreement needs to be finalized, said district Chief Paul Wilson.

The district will have to pay an $81,700 penalty next year for ending the contract, and $166,000-plus for each of the following two years if the county extends its contract with AMR through 2006. The extension of the six-year contract, which expires at the end of 2004, is a near-certainty.

Mr. Berger said that the Woodside and Menlo Park districts realized when they signed their ambulance-service agreements in 1998 that they might not break even financially. But, he said, "we sat down and made a conscious decision that we would ... suck it up for the six years of the contract to make this thing work." Both districts had healthier budgets at the time, and both already had trained paramedics on their staffs, unlike most fire departments in the county.

But, Mr. Berger said, there was an oral agreement among JPA members in 1998 that after the new medical emergency service program was stable, with enough trained paramedics in all fire agencies, the JPA would take another look at funding for those fire agencies operating their own ambulances. Now, he added, that agreement has been "conveniently forgotten" or has faded from the agenda as JPA membership has changed.

The losses to the two districts over the six-year contract period will be well over $5 million, Mr. Berger told the Almanac after last week's meeting.

"It's just outrageous that no one (in the JPA) recognizes the sacrifices we made to get this thing going," he said. But his district can't afford to continue subsidizing the county's ambulance service, and will have to look at alternatives if it can't get more funding from the JPA, he said.
Complications

Ambulance service in San Mateo County is considered a model across the country, in large part because of the fire agencies' participation as "first responders." But it is a complex arrangement.

The county contracts directly with AMR, and monitors its performance through a number of measures, including response time. AMR has met its response-time commitments through the years, according to county records.

AMR subcontracts with the JPA for "first response" service provided by fire departments throughout the county. It also subcontracts with the four fire agencies that operate their own ambulances. But the JPA is in charge of dispersing the money to the fire departments for their participation in the program.

Both the Menlo Park and Woodside districts wanted to operate their own ambulances for several reasons. Menlo Park had long wanted to incorporate ambulance service into its operations, and saw the 1998 agreement as a first step in that direction.

The remoteness of the Woodside district, which covers Woodside, Portola Valley and surrounding rural areas, led to concerns by district officials that the area would not receive the level of service the private ambulance company would provide more urban areas.

Five years after the agreement, Menlo Park district staff and officials say they believe they could run ambulances successfully, and are lobbying the JPA to come up with a plan for a fire agency-based ambulance program to propose to the county for 2007, said Menlo Park district board member Bart Spencer.

Mr. Spencer and other board members have criticized the private ambulance service for its high patient transport fees, which is one of the highest -- if not the highest -- in the country, they say.

They and district paramedics also maintain that AMR doesn't put enough ambulances on the streets. That puts an unfair burden on fire departments, whose trucks must stay on the scene of a medical call until an ambulance arrives, they say. It also means the Menlo Park ambulance far too often gets sent out of the district to cover other areas -- sometimes in the far north of the county, they say.

Mr. Berger said he supports Menlo Park's decision to get out of the ambulance contract, but he is concerned that the change could adversely affect his district's ambulance service. That's because East Palo Alto and Menlo Park have the highest number of medical emergency calls in the county, and Mr. Berger fears that, without the Menlo Park ambulance, the Woodside ambulance will be sent to those calls more often.

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