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Multnomah County fines ambulance company for slow response times

The $513,650 penalty against American Medical Response follows earlier warnings
An AMR ambulance at Legacy Health Good Samaritan Medical Center in Northwest Portland, Ore., on July 30, 2023. | JAKE THOMAS/THE LUND REPORT
November 15, 2023

Multnomah County plans to fine its only ambulance service provider for slow response times.

County officials announced Tuesday the county will impose a $513,650 fine on American Medical Response, the sole company that provides ambulance services to county residents.

According to the county, AMR has failed to improve its lagging response times to critical 911 calls. The company is expected to respond to 90% of life-threatening calls within eight minutes in urban areas, according to its contract with Multnomah County. In August, AMR ambulances arrived late to those emergencies 14% of the time.

AMR has not met that 90% target since March 2022.

County officials said ambulance response times weren’t much better for less critical emergencies this summer, though they couldn’t immediately provide specific numbers. They said the total fine includes penalties for delayed responses to both life-threatening and “non-immediate” emergencies across the county in the month of August.

AMR argues that these delays are largely due to staffing shortages and that the issue could be resolved if Multnomah County relaxes its standard requiring ambulances each be staffed with two paramedics, instead of pairing a paramedic with a lower-cost emergency medical technician.

“AMR strongly believes allowing EMTs to work with paramedics is the only viable way to improve response time performance now and for the foreseeable future,” said AMR spokesperson Nicole Michel.

Michel said no other jurisdiction in the 49 states that AMR operates within requires ambulances to be staffed with two paramedics.

Multnomah County Chair Jessica Vega Pederson rejects this explanation.

She said other neighboring counties are able to rely on a single paramedic response because local fire agencies also respond to those calls, and are able to provide needed medical support. In Multnomah County, fire department staff respond to about 55% of all 911 calls.

“This problem was not created by a two-paramedic requirement,” Vega Pederson said in a press statement. “AMR has the power and responsibility to fix these unacceptable response times. They have the power to subcontract with other agencies to bring on more paramedics and more ambulances.”

The county is required to spend the fine proceeds on improvements to its emergency response system. Valdez Bravo, Multnomah County’s Interim Health Department Director, said his office hasn’t yet decided where to use those dollars.

“Potential investments include EMT and paramedic scholarships, regional collaboration on public service announcements on when to call 911, training funds and other projects,” Bravo said at a Tuesday press conference.

AMR has been the sole ambulance provider in Multnomah County since 1995. This is the first fine Multnomah County has issued against it since its contract was last updated in 2018.

Bravo said county officials are not interested in hiring a new provider or creating a publicly-run ambulance service.

“[This model] has been working for a long time, and it’s only up until recently that we’ve had these issues,” he said. “We have some of the highest clinical outcomes nationwide. I think it goes to show that this is a model that can and does work when appropriately staffed. But that’s on AMR to take care of.”

Multnomah County first warned AMR that it would be issuing monthly fines if the company failed to meet response times in early August. The county said it is still determining whether it will levy additional fines for September or October.

This article was originally published by Oregon Public Broadcasting.