Scottsdale ambulance contract challenge claims deal not in compliance with state law

Third-party EMTs and paramedics are a regular part of any municipality’s emergency response system — and Scottsdale is no exception. (File photo)

A legal challenge has been filed against the city of Scottsdale regarding its recent approval of a citywide ambulance contract claiming certain tenets of the agreement don’t meet Arizona Department of Health standards.

Historically, the Rural/Metro ambulance service was the dominant provider in Scottsdale and in other parts of the Valley of the Sun, but in recent years the third-party emergency services provider has changed ownership a few times with American Medical Response Transport taking the reins in 2015.

American Medical is the corporate owner of PMT Ambulance, Life Line Ambulance and Rural/Metro. Records show on May 9, 2017, the city of Scottsdale entered into a no-bid agreement with American Medical Response Transport.

However, that contract never came to fruition as a new public bid was issued weeks later when the city manager’s office became aware a new third-party ambulance operator emerged in the Scottsdale marketplace: Maricopa Ambulance.

Scottsdale City Council Monday, Dec. 4, 2017, unanimously selected Maricopa Ambulance as its ambulance service partner. At the time of the approval the Independent reported pending final negotiations — the three-year contract will begin in February 2018 with the option for two additional three-year renewals.

“You are completely changing the service model — who has vetted that?” asked John Karolzak of American Medical Response Transport Government and Public Affairs Friday, Jan. 12 at the Scottsdale Independent offices. “Nobody has said ‘we are taking 33 paramedics out of the city.’ Who has vetted that? This was just the assistant chiefs. Based on the document, how it sits today, there are some serious problems.”

One of the questions raised, Ms. Karolzak says, is the use of emergency medical technicians — also known as an EMT — versus the use of a licensed paramedic.

On Jan. 4, Brett Johnson and Colin Ahler of the Law Offices of Snell & Wilmer filed a legal bid protest and formal request for reconsideration of its November 2017 bid protest request, which was ultimately denied by the city of Scottsdale.

The January 2018 request cites new information from the Department of Health Services that outlines certain provisions of the contract do not meet Arizona Revised Statute 36-2234, which states, among other things, that an ambulance service contract between a municipality and a third-party must be ratified by ADHS and in-tune with the already in-place Certificate of Necessity.

The Certificate of Necessity outlines the geographic service area, level of service, hours of operation, response times, effective date, expiration date and any limiting or special provisions for emergency medical services to be provided by the third-party ambulance effort, according to the Department of Health Services.

According to the Arizona Ground Ambulance Service Rate Schedule adopted in October 2015, the Certificate of Necessity for District 71, which is held by American Response until next month, covers the city of Scottsdale, charges a rate of $898 per advanced life support ambulance transport and $800 per basic life support ambulance transport.

The city of Scottsdale responds to thousands of calls for medical emergency transport annually, records show.

Bryan Gibson, Maricopa Ambulance CEO, says his company can meet the charge of the Scottsdale Fire Department.

“Maricopa Ambulance is investing significant resources in the community to begin operations, and we are focused on building a system that provides the best emergency medical care and is financially sustainable to ensure the community continues to be properly resourced,” he said in a Jan. 10 statement to the Independent.

“The city of Scottsdale is a progressive city with a fire department that deeply cares about emergency medical services and the health of its people, and we are excited to partner with them in the EMS system.”

John Karolzak of American Medical Response Transport outlines the proposed service model for ambulance transportation in the city of Scottsdale. (Independent Newsmedia/Terrance Thornton)

Advanced vs basic

American Medical Response Transport officials contend the current contract approved by Scottsdale City Council is in violation of state law.

“In particular, the ADHS letter explains that several provisions of the current contract contradicted ADHS guidelines and regulations, violate the ambulance service’s Certificate of Necessity and will adversely impact the fixed rate or charge to the general public rate,” said Mr. Johnson and Mr. Ahler in their Jan. 4 protest to the city of Scottsdale.

The Department of Health Services on Dec. 21, 2017, according to CON & Ambulance Rates Manager Aaron Sams, outlined eight provisions of the approved ambulance services contract that do not meet state standards including:

  • Specific language for standby and waiting fees to be assessed;
  • The financial impact of dedicated ambulances call volumes and associated costs;
  • How litigation disputes would be handled and financial policies in place to address them if they were to arise;
  • The lack of a formal mobile integrated health plan defined by the city of Scottsdale but not outlined in specific contract language; and
  • Financial reserve policies for existing and new positions, clinical upgrades and training efforts.

Furthermore, American Medical officials contend the new contract will provide for only basic life support as Maricopa Ambulance will carry EMTs on their ambulance in contrast to American Medical’s policy of carrying one paramedic on each of its ambulances.

Tom Shannon

However, Scottsdale Fire Chief Tom Shannon is steadfast in the assertion that in the event of a medical emergency a SFD paramedic will be riding with a patient in distress to the hospital.
“The Scottsdale Fire Department has and will continue to provide two paramedics and two EMTs on each fire truck,” he said in a Jan. 9 statement to the Independent.

“As the primary provider of direct patient care in the pre-hospital setting, the fire department relies on its paramedics to assure consistency and continuity of care to our patients. The presence of a paramedic on the private ambulance provided greater opportunity for the private ambulance to conduct inter-facility transports outside of their 9-1-1 system response obligations.”

Despite the claims made by American Medical officials, Chief Shannon assures that zero is changing with the Scottsdale Fire Department emergency response model.

“No, the Scottsdale Fire Department has always attended our patients,” he said. “There will be no change in the response model that is currently being utilized.”

Mr. Karolzak contends the issue for him is not sour grapes, but rather legitimate concern for the emergency service model being disrupted in Scottsdale — a place he calls home.

“They should rebid based on issues of compliance based on the Department of Health Services review,” he said.

“We have been careful and respectful of the city and we want to bring that level of service back to the community. The concern for me is the service level. I think this is a regressive system.”

Mr. Gibson says the SFD and Maricopa Ambulance contract is a partnership dedicated to delivering the best emergency medical care.

Bryan Gibson

“Maricopa Ambulance vehicles will be staffed with two licensed EMTs,” he said.

“Once the vehicle arrives on-scene, a Scottsdale firefighter paramedic will accompany the patient to the hospital on the Maricopa vehicle to ensure a continuity of care from first response to the emergency department.”

Mr. Gibson points out both EMTs and paramedics play a vital role during emergency calls for service.

“Both EMTs and paramedics are professional prehospital care providers licensed through State of Arizona and have the skills and knowledge to transport patients. EMTs can perform basic life support functions including CPR, oxygen administration, basic airway management, spinal immobilization, vital signs and bandaging/splinting,” he said.

“Paramedics have received additional training and are permitted to administer certain medications, ECG 12-lead administration and monitoring, as well as provide advance airway management, among other activities.”

Faith in the process

Scottsdale Vice Mayor Virginia Korte says she is aware of the bid protest on file at City Hall but confirms her faith in the municipal process and Scottsdale public safety officials.

Virginia Korte

“I am not an expert in public safety and I am not an expert in dealing with public safety contracts, but we were kept informed all along the way,” she said in a Jan. 9 phone interview.

“The overview that I was provided of the two contracts — I trusted the decisions made by our fire chief and our public safety officials.”

When asked if he was aware of the legal request on behalf of American Medical, Chief Shannon acknowledged tenets of the current contract are being finalized.

“Yes, I am aware that Life Line has asked the city procurement director to reconsider the RFP process and the contract award,” he said.

“From the city’s perspective, the RFP process is over and Maricopa was the preferred provider. The city council has approved the contract award to Maricopa Ambulance, and we are working with Maricopa and the Arizona Department of Health to get the contract finalized.”

Vice Mayor Korte echoes a similar sentiment.

“I do have confidence in the contract we are moving forward with,” she said. “They have followed all the regulations that are needed and I am confident we will bring closure to that contract and move forward with Maricopa Ambulance.”

Northeast Valley Managing Editor Terrance Thornton can be contacted at tthornton@newszap.com

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