This figurative boxing match is contested in the ring of the Alameda County Board of Supervisors.
One company has under-bid a contract by more than $20 million in its zeal to gain a contract for ambulance services, setting the county up for fiscal crisis and disruption of ambulance coverage — according to an appeal by its competitor, the incumbent that has been operating the Alameda County system for more than four decades (including the company’s predecessor).
A vote may come as soon as April 27 to authorize county staffers to negotiate a contract with Paramedics Plus, based in Texas, the apparent low bidder.
Alameda County’s Request for Proposals for a new contract added “exponentially” more complexity to compliance requirements (response rates for 61 zones compared to the current three), necessitating a provider to make a substantial increase in unit hours (the hours an ambulance crew is covering a territory), the way American Medical Response staffers read it. So the incumbent provider was scratching its head when it read in one letter in the county records that PP, based in Texas, made a bid that is equal to or less than the current AMR contract.
“The net effect of PP’s proposal is that it underbid the RFP by approximately $25,000,000 per year,” wrote Mike Taigman, AMR’s general manager in Alameda County, in a letter to Alex Briscoe, the director of the county’s Health Care Services Agency.
Interviewed in mid-April, coming from a meeting of the board of the Ethnic Health Institute Board in Oakland, Taigman estimated the stricter levels of compliance inherent in the 61-zone plan would require a 65 percent increase in ambulances. This takes into account more ambulances staffed by more Emergency Medical Technicians and paramedics, guaranteeing prompt response times to Alameda County’s geographic spread — the urban streets of Oakland, rural stretches of the East Bay hills and wilderness surrounding Livermore’s ranchlands and ridges.
If the county turns its back on AMR and its decades of service to Alameda County, Taigman noted, it would lose a lot of the public health work company staffers do in the community with the company’s encouragement. AMR workers are active in community health causes, for instance, developing services that don’t exist now for asthmatic adults.
“We are involved in doing grass-roots health care reform in this community,” Taigman said. “We work with the health department, the hospitals and faith-based organizations. I’m not sure the county knows how to value that. It’s my bias that this work is as important a reason for us to be in this community as dealing with strokes, heart attacks and shootings.”
AMR protested the county’s March 5 notice of intent to award the contract to PP, citing drastic under-bidding and secrecy in the process. As to the latter, Taigman noted the lack of an independent validation study in Alameda County to ensure that a proposal is viable and fiscally sustainable. There was, for instance, such a validation study last year when San Mateo County reached a contract with AMR, said Taigman.
All around Alameda County, AMR also has contracts in Monterey, Santa Clara, Contra Costa, Solano, Sonoma counties and in the Sacramento Valley. The company has 6,000 employees in California.
Alameda County Supervisor Gail Steele said she would raise more questions for county staff about the contract issue — for instance, she planned to ask about reports she had heard of a more open process in San Mateo County.
The PP proposal has not yet been released. “It’s the citizens of Alameda County, technically, who are contracting with the provider,” said AMR spokesman Jason Sorrick. “They should be fully aware of who the provider is and what they propose.”
Steele said she felt the county’s process for making public RFPs and contract proposals should be consistent across the board and she looked forward to seeing a report by Alameda County Auditor Patrick O’Connell addressing AMR’s appeal of the county’s notice of intent to award the contract.
“AMR now has not had a whole lot of complaints,” said Steele. “In the past there were things wrong, management stuff and the county had some responsibility, too … Lately everything’s been cleaned up with different issues. They (AMR) have been around a long time and I think the community is fairly satisfied. I haven’t had any complaints.”
Dale Fanning, acting director of the Alameda County Emergency Medical Service Agency, said the county had decided with this round of contract negotiations to move to a tiered system based on a medical priority dispatch system. The added complexity, she said, combined geographic coverage with guarantees that sicker patients would get ambulances faster.
As to complaints about secrecy, “We’ll release the proposals and any other documents that are public records before the board’s final decision to execute a contract,” said Fanning. “We will complete the negotiations and then release the documents.”
The staff is following advice from the county counsel that it is unwise to make too many documents public before a contract is concluded, she added.
For AMR, the Alameda bidding was a bit of déjà vu. The company in 2006 lost its Monterey County contract to what it felt was an under-bid. The next year, the new provider was explaining contractual non-compliance and appealing to Monterey County for a subsidy to shore up the contract shortfall. The county eventually terminated that five-year contract and re-entering a contract with AMR.
Fanning said the situations are not parallel because PP is a much larger company, with greater capacity, than was the case with Westmed in Monterey County. PP, for instance, contracts for ambulance service in Pinellas County, Florida, which is larger than Alameda County, said Fanning.
“We feel we’ve done our due diligence and the proposal that our panel recommended is a reasonable proposal,” said Fanning. “We checked the references that they gave us and called the areas that they serve (including Florida, Texas, Oklahoma and Indiana). They are performing well.”
For PP, Alameda County would be its entry into the California market.
In his letter to the county, Taigman wrote, “We strongly believe the new system cannot survive, PP will breach the contract from day one, the health and safety of the citizens will be compromised and the County will incur significant costs to salvage the system when it fails.”
With the belief that the PP bid was grossly low to provide the coverage Alameda County sought, AMR wanted to know if there was realistic scoring in evaluating the bids and if county officials understood the dynamics of the RFP and bidding, or if it relied too much on advice from consultants.
The company sought a copy of the competing bid and the scoring decisions, pursuant to the California Public Records Act. The county refused, citing court precedents that point to the value of competition in multiple firms making bids without full knowledge of competitors’ pricing.
In a March 25 response, Briscoe defended the RFP process. He said the RFP forced bidders to consider alternative methods “to assist the County in obtaining the best value.” The agency, with the assistance of its consultant Fitch and Associates and the County Selection Committee, concluded that the PP proposal meets this goal, Briscoe stated.
“The County is not contemplating decreasing response time requirements or allowing a rate increase during contract negotiations,” Briscoe wrote.
Patrick Lickiss of Oakland, a paramedic and clinical field specialist working for AMR in Alameda County for five years, said he was a “little disappointed” at the lack of transparency in bidding.
“I’ve heard complaints from a lot of folks,” he said. “With most RFP processes, the way they’re run in other areas, the scoring is made available and the competing bids are made available to taxpayers.”
The 61-zone system might be the most complex in the world, Lickiss said. “It does seem like it’s one of a kind.”
Paramedics are trained to make evidence-based decisions — to avoid changing decision protocols without evidence to back up such a call. He doesn’t feel there’s evidence to back up the need for a change in ambulance service providers.
“We have response time criteria, and we consistently make those time criteria,” he said.
A lot of information is coming to paramedics and EMTs through the rumor mill, Lickiss said. The proposal supposedly guarantees that workers will be offered employment by the new provider, but not necessarily having the same union contract.
“Beyond that, no one knows,” Lickiss said.
That union, the National Emergency Medical Services Association, has endorsed the PP proposal. But, Lickiss said, he and other members believe that vote came from union stewards from all over Northern California, with little input from Alameda County.
Lickiss said he put out a survey question to Alameda County workers and found 223 supported continuing AMR as the provider, seven supported PP and 18 respondents said neither.
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