Santa Clara County ambulance service scrutinized

Santa Clara County will soon solicit a new contract for ambulance services, and one local fire chief is pushing to change the model.

In a letter sent to the county’s Health and Hospital Committee last November, San Jose Fire Chief Robert Sapien lambasted the county’s current structure, where a private company is contracted for ambulance and paramedic services. The fire chief said the model is outdated and doesn’t incentivize the private provider to respond on time, pointing to the county’s current provider American Medical Response (AMR). The system also doesn’t give fire departments, who rely on AMR’s services during emergencies, any say over the company’s operation.

“The challenge here is a private company’s interest is on profit,” Sapien told San José Spotlight. “(AMR) is not focusing on providing services.”

AMR, a for-profit business that bought out ambulance company Rural Metro, has consistently failed  to respond on a timely basis to emergencies this past year, according to county reports. Sapien said the company’s shortcomings are adding work to his department.

In Santa Clara County, the ambulance provider works with fire departments to supply emergency response and ambulance services. Initially, Rural Metro entered into a $375 million contract with the county in 2011 before it was absorbed by AMR in 2013 due to bankruptcy. Prior to that, AMR had provided ambulance services to the region for more than 40 years.

“I was very disappointed to hear the administration recommend that the county pursue the status quo private provider model,” Sapien said in the letter. “At present, it is the 10 contracted fire service responder agencies in the county that are preventing ambulance service failure.”

According to Sapien, San Jose firefighters provided paramedic services 152 times and ambulance services 125 times last September and October because AMR ambulances didn’t show up. When a fire engine has to take over such services, it can’t respond to other emergencies and strains city operations, he said. The San Jose Fire Department has one of the busiest fire stations in the nation.

Under the current contract, AMR is required to respond to emergencies within 12 minutes at least 90% of the time. But the company failed to meet the threshold last year for at least six months, county reports show.

The company blames ongoing worker shortages—an issue plaguing both the nation and California. AMR representatives said the company has proposed a number of solutions, including working with training programs to graduate more workers.

“Our local team has been working hard to mitigate the impacts of the EMS staffing shortage locally to ensure the long-term sustainability of ambulance services,” Brian Henricksen, an AMR senior regional director, told San José Spotlight. “We will continue to work with our response partners to ensure that backup ambulance services are available as needed.”

Push for alternatives

Sapien is urging the county to involve fire departments in the contract process and to consider all available options. He said Contra Costa County has found success in a hybrid model between a private provider and a local, central fire department where the county has more control over the operation. Santa Clara County could also move into an all public model by creating a department for ambulance services or allowing a local fire department to take over the county service altogether like San Francisco, he said. These options, explored in a county-commissioned survey of stakeholders Sapien took part in, could help address concerns with emergency response time, he said.

“We have to do something better,” Sapien told San José Spotlight. “We can create one unified system and have the ambulance service fully integrated (into it).”

He also worries that the private provider model will limit the pool of bidders. The last time the county solicited for an ambulance contract, it received one bid from the current provider.

The fire chief’s letter and push for changes comes after County Executive Jeff Smith told county officials recently he believed the current model is the best option for the region. The other systems are impractical, if not impossible, and won’t be able to meet the needs of roughly 1.9 million people in the county, Smith said. The current model, which costs about $65 million annually, is the most cost-effective option for Santa Clara County, according to a 2022 county-commissioned financial analysis. The other options are all more expensive, the report says, and could cost up to $85 million a year.

County officials have spent years working on a new proposal for emergency ambulance services, and the state has to approve the county’s contract requirements and criteria, officials said.

Smith told San José Spotlight the comment to stay with a private provider is his personal opinion, and nothing has been decided.

“Sapien is trying to say that we already made up our minds, which is not true,” Smith said. “The (proposal) has not even been approved or formalized. His comment is less than accurate and certainly less than helpful.”

Smith said the county still has issues to work out before going out for bids, including developing a contract with Palo Alto’s own ambulance services—a recent order from the state. No other cities in the county have a separate ambulance department. County officials will update the Board of  Supervisors on the progress next month and request direction, Smith said.

Persistent issues with response time

Supervisor Joe Simitian, who chairs the county’s Health and Hospital Committee, said it’s not the first time the county has to address such issues. The San Jose Fire Department also failed to hit its response time benchmark for more than a year in 2013 until the county stepped in, he said.

“It was a challenge nine, 10 years ago, and now we’ve got a similar problem with our ambulance service,” Simitian told San José Spotlight. “It’s fixable, but it’s got to get fixed and it’s got to stay fixed.”

AMR has provided consistent and affordable services in Santa Clara County for years, Simitian added, but how the county should proceed with a new contract is up to the full board.

“This is a very big deal, and it will have long lasting implications,” he said. “We want to make sure people are safe, and that we hold costs down to the greatest degree possible consistent with public safety.”