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Multnomah County to forgive $7 million in fines if AMR improves response times

Officials will relax paramedic staffing requirements in return for the private equity—owned firm's agreement to deploy more ambulances and stop violating response-time requirements
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An AMR ambulance at Legacy Health Good Samaritan Medical Center in Northwest Portland, Ore., on July 30, 2023. | JAKE THOMAS/THE LUND REPORT
August 1, 2024

Multnomah County has settled a long-running dispute with its private equity—owned emergency services provider, American Medical Response.

AMR, a subsidiary of Colorado-based Global Medical Response, had for two years failed to meet the response-time requirements of a contract it renewed with the county in March 2022 — sparking official and public concerns.

Threatened with hefty fines, the ambulance giant blamed its contract’s staffing requirements as well as a nationwide shortage of paramedics that had crippled the emergency-response workforce starting in 2020.

Under the new agreement the ambulance company must actually comply with its terms and fully staff a certain number of ambulances to respond in a timely manner to health emergencies or else pay off $7 million in fines the county assessed for AMR’s extended period of response-time violations. The company also agrees that the county will make monthly reports on its response times. 

In addition to holding off on levying the fines, the county has agreed to a one-year hybrid response system with lower overall paramedic staffing requirements, which will then be  assessed to see if health outcomes suffered.

AMR representatives and allied local officials had attacked Multnomah County Chair Jessica Vega Pederson for refusing to go along with the company’s staffing goal. Specifically, the company was requesting a so-called “one-and-one” paramedic/EMT ambulance staffing model as opposed to two paramedics per ambulance.

While some cities do require a two-paramedic response to health emergencies, the majority do not require the ambulance company to provide both of them, sometimes relying on the fire department to contribute a paramedic. In Portland, fire engines do respond with a paramedic to some 911 calls but not to others, a fact cited by county officials.

Vega Pederson hailed the deal in a joint announcement.

“This agreement improves ambulance response times and holds AMR accountable for more ambulances to respond to 911 calls on time. When someone needs an ambulance, every second counts,” she was quoted as saying. “We’ve included a pilot staffing model that we’ll closely monitor. And AMR has agreed response time data will be shared with the public. I have high expectations for AMR over the next 12 months, and I believe they can be successful.”

AMR official Rob McDonald was quoted in the same joint press release as saying, "This announcement is a real win for the citizens of Multnomah County … AMR will now be able to invest in putting more ambulances on the road, supporting our goal to provide the right care at the right time. We look forward to working with the County and EMS Office to implement this solution and to continuously evaluating and improving it."

County Commissioner Sharon Meieran, who’d long pushed for lower staffing requirements on AMR as a way to get more ambulances on the street, said the county’s past handling of the situation amounted to “egregious incompetence” and erred in “treating a human health crisis like an ongoing contracts issue.” She said the county's position that two-paramedic ambulances  improved care was false.

Austin DePaolo, an official with Teamsters Local 223, the union representing AMR paramedics, had earlier called criticism of the county’s stance “grandstanding.” However, in the joint release, he called the new agreement a “responsible compromise”

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