A new report from the Multnomah County Ombudsman found that county leadership failed to hold American Medical Response accountable for slow ambulance response times prior to March 2022. Despite adding an emergency medical services advisory council to county code in 2016, the county never created the committee.
In response to the report, Multnomah County Chair Jessica Vega Pederson said she would seek to remove the advisory council from county code, rather than complying with the ombudsman’s recommendation to finally form the council.
Multnomah County Auditor Jennifer McGuirk directed County Ombudsperson Cheryl Taylor to investigate the county’s contract with AMR last year, when a man died while waiting more than 30 minutes for an ambulance to arrive after a driver hit him and fled the scene.
The ombudsman also recommended providing the county commissioners with ambulance response time data at least monthly for urban areas and every six months for rural areas.
Vega Pederson said that data is protected but that “after consultation with the County Attorney’s Office, the Health Department could develop access to a confidential internal dashboard with response time performance for elected officials that meets the requirements for protection of the AMR-owned quality assurance response time data.”
Vega Pederson said the health department “could” develop a dashboard, but did not say she would direct the health department to do so.
The county has repeatedly cited data protection needs when denying requests for information, but has also selectively released response time data. The data is stored in AMR’s online compliance program but is accessed by county staff.
Under the contract with Multnomah County, AMR is required to respond to at least 90% of life-threatening calls in urban areas within eight minutes. Since March 2022, AMR has continually failed to comply with those standards.
But the auditor’s office found that AMR failed to comply with response times standards at times even as far back as 2018.
“The county had opportunities to hold American Medical Response accountable for ambulance response times before March 2022,” the ombudsman wrote.
The county received a corrective action plan from AMR, which it is required to provide if the county demands a plan to correct noncompliance, that ran from June 2022 through December 2022. The corrective action plan did not fix AMR’s performance. A review of response time statistics through the end of February 2024 showed AMR’s response times were still too slow, the ombudsman found.
“It is not clear when the County Chair or the full Board of County Commissioners became aware of AMR’s non-compliance. We also do not know the frequency with which the full Board is provided ambulance response time statistics,” the report stated. “County Emergency Medical Services staff did not answer the Ombudsperson’s questions about these topics.”
AMR and the county are currently in mediation over the county’s plans to levy more than $2 million in fines against AMR.
“In the future, ensuring that county leadership is regularly informed of AMR’s compliance or non-compliance could reduce the need for significant fines because it would enable the county to proactively manage the contract with AMR and resolve non-compliance timelier,” the report found.
Vega Pederson said not issuing fines earlier in AMR’s noncompliance was “an intentional policy decision based on our commitment to collaborative problem-solving, and assurances from AMR that they would cooperate in rectifying consistent problems with delayed response times.”
Instead, Vega Pederson wrote, AMR launched an intensive and ongoing political and public relations effort to change the long-standing Multnomah County EMS standard of care requiring two paramedics per Advanced Life Support ambulance, to a lower level of medical care with one paramedic per ambulance.”
