Multnomah County health officials have notified American Medical Response, Inc., the county’s ambulance provider, that they are prepared to issue fines if the company doesn’t start responding to 911 calls faster. But a company executive says the county needs to budge on its insistence that two paramedics staff every ambulance.
In a county press release announcing the warning, Board Chair Jessica Vega Pederson said it was her decision to begin levying fines on the company starting in September if it does not meet its contractually required response times for August.
The county announcement signals a change in policy from the county’s practice for years of either disregarding slow response times by AMR or carving out exceptions that amounted to loopholes in the contractual requirements.
In recent months, the county launched two pilot programs that essentially met AMR halfway, one lowering a county standard requiring advanced life-saving equipment on all calls, and the other substituting an emergency medical technician for one of the paramedics for lower-acuity calls. But according to the county, AMR did not properly staff the pilot programs.
“My patience is exhausted,” Vega Pederson said in a statement. “AMR’s ambulance response times are unacceptable and they have not met performance metrics in months, requiring that we take action.”
Randy Lauer, vice president of operations with American Medical Response Northwest, told The Lund Report that the company is exploring its options.
Lauer blamed hiring difficulties for the company’s contract violations. He said that county leaders have rebuffed the company’s request to allow ambulances to be staffed with a paramedic and an emergency medical technician, instead of having two scarce paramedics on each call. The company has argued that relaxing the dual paramedic standard would put more ambulances on the street.
“It’s frustrating that they won’t let us apply the only solution,” said Lauer.
Vega Pederson, in a letter she sent Wednesday to Gresham city leaders, wrote that a forthcoming “penalty could be the first of many, as our contract stipulates monthly performance metrics, which the company has not met in months. We’re also reserving our right to levy penalties for prior non-compliance.”
Multnomah County’s two-paramedic ambulance standard has been in place since 1995. Although AMR staffs ambulances in neighboring counties with a paramedic and an emergency medical technician, Multnomah County has resisted adopting that standard, citing patient care as well as a different response system in Multnomah.
“Those counties deploy two paramedics to medical responses fundamentally differently compared to Multnomah County,” Sarah Dean told The Lund Report in an email. “Our County neighbors deploy a paramedic staffed fire unit and a Paramedic/EMT ambulance to almost every call in their Counties. Multnomah County does not send a fire unit to almost 40% of all calls.”
Paramedics have more training than emergency medical technicians and having two of them in each ambulance reduces fatigue and burnout, she added. While Multnomah County is the only county in the state with a two-paramedic standard, cities including Denver, Seattle, Minneapolis, Boston and others have the same requirement, Dean said.
But Lauer said there is a national shortage of paramedics and easing the county’s requirement is the only way to improve response times.
“I don’t know what's going on with Multnomah County,” he said. “It confounds me.”
An AMR spokesperson followed up with a statement to The Lund Report stressing that it “takes the responsibility of staffing its Multnomah operation and meeting obligations very seriously.”
“AMR wants to assure members of the community that we are doing everything within our power to fulfill our responsibilities and address the staffing shortages,” reads the statement.
The time AMR ambulances can take to respond to emergencies varies depending on the severity of the emergency and if it’s in a more remote area, according to the county contract. For instance, AMR is required to respond to life-threatening emergencies in urban areas within eight minutes 90% of the time. For non-life-threatening emergencies in rural areas, ambulances have 30 minutes to respond.
Dean didn’t specify how much the county intends to fine AMR. But the contract states that the county can fine AMR up to $10,000 for late responses.
If Multnomah County moves forward with the fine it won’t be the first time AMR has faced fines from an Oregon county. Clackamas County fined AMR $456,000 for response times. But in June the county Board of Commissioners voted to forgive the fine but require AMR to invest $228,000 in workforce support and retention.
Last year, the city of Seattle fined AMR $1.4 million for failing to meet timeliness standards on 20% of calls.
AMR is a subsidiary of a Colorado-based multinational corporation called Global Medical Response.
Dean didn’t provide response time data for AMR in Multnomah County. But in March, records obtained by The Lund Report showed that Multnomah County documented significant contract noncompliance both during the pandemic and before it, dating back to 2018.
Rather than fine AMR, the county approved new policies that, for instance, excused contract violations when hospitals are on “divert” and not accepting ambulances.
According to the county, AMR has been out of compliance with response times since March 2022. The company submitted a staffing improvement plan to the county in June 2022 to resolve their lagging response times, but the slow responses have continued.
The contractor’s tardiness has made headlines at times
A man in a wheelchair died in April while waiting for an ambulance to arrive after being struck by a hit and run driver in Northeast Portland, according to reporting by KGW.
In her letter to Gresham city leaders, Vega Pederson said she shared their concerns.
“The distressing situations you describe are gut wrenching and unacceptable,” she wrote. “You should know that Multnomah County has in good faith tried to work with AMR – particularly on increasing recruitment and retention – so that they can meet their contractual obligations, but to no avail.”
Austin DePaolo — business agent for Teamsters Local 223, which represents AMR's paramedics and emergency medical technicians — told The Lund Report that the union supports the two paramedic system. He said it may contribute to slower response times, there are other contributing factors.
DePaolo said those include fire crews not responding to about 40% of calls. He also said the county’s emergency response system could do a better job triaging calls and not send an ambulance with two paramedics to a situation where someone has broken their arm. He also said that hospital emergency departments are frequently backed up because of their own staffing issues, further slowing AMR ambulances.
“The health care system’s a mess,” he said.
AMR hiring 50 paramedics in Washington County
AMR recently won the Washington County ambulance contract after claiming in its bid package that it was “consistently compliant with all contractual requirements and response-time criteria” across the hundreds of EMS systems it serves.
In contrast, the county’s previous provider, Metro West, had been called out for noncompliance by a Washington County audit.
Metro West ambulance appealed the decision, calling AMR’s claim false. But it was not successful.
While AMR has faulted hiring difficulties for its issues in Multnomah County, it has sounded a more optimistic note in Washington County as it gears up operations there.
On June 12, Lauer wrote Washington County expressing confidence that hiring and and fully staffing there would not be a problem. AMR intends to hire 50 paramedics and 75 EMTs in that county.
“We have been adding 5 paramedics and 5 EMTs each week and are confident that we will be fully staffed by August 1st,” he wrote. “In the unlikely event we fall short, we can tap into our experience as FEMA’s national disaster ambulance contractor to bring in paramedics from around the region who are eligible for Oregon licensure.”