Board of Supervisors — 2022-05-31

Emergency Ambulance Services Contract Policy Resolution and Ambulance Services Update

• The Board directed staff to separate "System Integration" and "Innovation" into distinct scoring categories with increased point values for innovation.
• The Board maintained the current response time standards and "stop-the-clock" provisions while requiring a transparent, restricted fund mechanism for financial security.
• RFP language was clarified to require all proposers to describe plans for recruiting or retaining the incumbent EMS workforce in alignment with civil service rules.
• The Board approved a fifth amendment to the AMR contract extending the termination date to March 1, 2024, and authorized the issuance of the revised RFP.

Review of Contract Document Revisions

• Staff presented specific textual modifications to the contract, including the removal of language stating that BLS arrival does not stop the response time clock.
• Language was added to require the final contract to include a detailed list of vehicle make, model, age, and maintenance records.
• Provisions regarding the incumbent workforce were revised to encourage recruitment from the existing paramedic and EMT pool while requiring proposers to outline retention or hiring plans.
• Response time requirements for urban, rural, and wilderness areas were adjusted to reflect extended stop-clock agreements, removing the previous two-minute requirement.

Closed Session

• The Board convened to consider public employee performance evaluations for directors of various county departments.
• The Board conferred with labor negotiators during the closed session.
• No reportable action was taken during the closed session.

Agenda Item: Administrative Agenda (A1–A14)

• Discussion: The Board reviewed the administrative agenda items.
• Motion: A motion was made to approve items A1 through A14.
• Second: The motion was seconded.
• Decision/Vote: The motion passed unanimously.

Agenda Item: Emergency Ambulance Services Contract Policy Resolution and Ambulance Services Update (Departmental Item No. 1)

Public Comment

• Incumbent Provider (AMR) Representatives: Speakers representing American Medical Response (AMR) and its union (IAEP Local 70) discussed the impact of the Request for Proposal (RFP) on inter-agency relations and patient care. They cited incident reports and hospital letters expressing disagreement with Fire taking over EMS, reported increased animosity at 911 scenes, and expressed support for the current EMTs and paramedics. Speakers stated that AMR has served the county for over 50 years, reinvests revenue into local equipment, training, and personnel benefits, and highlighted AMR’s $54 million contribution to the local EMS system, including $20 million to fire departments. They noted AMR’s countywide borderless response, partnerships with colleges, accredited paramedic training program, and technological advancements. Concerns were raised regarding the future of the EMS workforce, with arguments that fire-based EMS is an antiquated model and that Fire has indicated it does not want to retain the current workforce.
• Fire Department and Fire Chiefs Association Representatives: Speakers representing the Santa Maria Fire Chief, the Santa Barbara County Firefighters Union, and the California Fire Chiefs Association argued that the Fire Department’s mission includes medical response. They stated that the RFP endangers integrated care by increasing response times, delaying paramedic arrival, and eliminating first responder fees. One speaker noted that the RFP increases commit times by 20-25% and results in approximately $2 million in lost revenue for the City of Santa Maria. Another speaker suggested adding co-response or community paramedicine programs to the RFP to prevent emergencies and emphasized that the community trusts fire departments. A representative for the California Fire Chiefs Association responded to the LEMSA presentation, arguing that changing response time standards from 7:59 to 9:59 constitutes favoritism toward the incumbent and challenging the use of pass-fail minimum qualifications. They noted that public agencies can pledge receivables/assets in lieu of bonds and argued that the RFP’s enterprise fund requirement does not equate to private performance bonds. Another speaker reported that many private for-profit ambulance companies are failing to provide timely response, with wait times of 30–60 minutes in some areas, and argued that fire agencies are prepared to manage ambulance resources to fix the shortage.
• Other Public Commenters: A representative for AP Triton emphasized the need for a level playing field and transparency, urging the Board to ensure the RFP does not inadvertently bias against the public sector. A resident supported a fair, unbiased RFP process to ensure the best value and service, criticizing the delay in the process. A representative for Fitch and Associates explained the unique nature of the RFP in California, which allows for public entity bidders, and the intent to maintain current service levels and funding structures. A representative for Marborg Industries advocated for local participation in the bid, stating that locally rooted companies provide better coordination in disaster response. A representative for the Santa Barbara County Fire Chiefs Association described the public service model where public providers answer 911 calls and provide first response, while the incumbent provider collects payment for transport, and proposed a system where the public provider collects revenue per transport to reinvest in community programs.

Board Discussion and Direction on RFP Elements

• UCSB Operating Area: The Board discussed the status of the University of California, Santa Barbara (UCSB) within the Exclusive Operating Area (EOA). It was determined that UCSB would not be included in the current RFP and would remain status quo. The Board noted that creating a separate exclusive operating area for UCSB would require a separate competitive bid process and could be considered at a later date. The RFP was modified to include the UCSB portion in the service area map, with corresponding language changes in Section 1.4 B.
• Response Time and "Stop-the-Clock": The Board discussed the change in response time standards from 7:59 to 9:59. One Supervisor expressed concern that this represents a step backward and stated they would not support an RFP that extends response times without a "stop-the-clock" measure. Another Supervisor emphasized that the primary concern is response time, not the associated cost, and suggested that having more ambulances could achieve the desired response time. The Board agreed to preserve the current system regarding response times and the "stop-the-clock" provision, maintaining the status quo. Staff explained that the intent was to enshrine current funding levels and response time performance standards to prevent competitive advantages for public bidders who might not allocate specific dollars to this fund. The Board directed that the mechanism for receiving and distributing these funds must be transparent, accountable, and housed under the county umbrella (e.g., as a restricted fund) to ensure fire departments are not harmed.
• Workforce Protection: The Board discussed the protection of current EMS workers. One Supervisor expressed caution about granting civil service rights to AMR employees who are not currently civil service employees, while acknowledging the need to protect workers if AMR is not selected. The Board directed that the RFP language be clarified to require non-incumbent proposers to describe their plan to recruit and hire the incumbent workforce, and incumbent providers to describe their plan to retain workers. This language must align with applicable civil service rules and regulations for public entities.
• Integration and Innovation: The Board emphasized the importance of system integration, distinguishing it from innovation. One Supervisor stated that integration should be a distinct category within the RFP criteria, not diluted within the innovation section. The Board directed that "System Integration" and "Innovation" (currently combined under "Future System Enhancements" at 10 points) be separated into distinct scoring categories. The Board indicated that the point value for innovation should be increased, with staff to determine the appropriate allocation within the total points. Two new categories were added to the scoring matrix: 10.1 System Integration (assigned 25 points) and 10.2 System Innovation (assigned 35 points).
• Review Panel Composition: The Board discussed the composition of the review panel. Concerns were raised regarding the potential dilution of expertise if community members were placed in the same category as professional evaluators. The Board decided to maintain a five-member review panel. The composition was specified to include three members selected by the Board (likely from outside the county, with national expertise) and two community members. The Board directed staff to develop specific criteria for the community members, emphasizing geographic diversity (North and South County), academia, and major industry/service providers demonstrating innovation.
• Fleet Requirements: The Board accepted proposed language requiring the contractor to provide a list of all vehicles (make, model, age, maintenance records) as part of the final contract. It was clarified that this requirement applies to the intended fleet proposed by bidders, not necessarily existing vehicles, to avoid disadvantaging bidders without an existing fleet.
• Community Education and Health Assessment: The Board discussed the importance of community education, including the use of Narcan for fentanyl overdoses and general health assessments. The existing RFP structure for this element was reviewed.
• Board Authority and Discretion: The Board reviewed language regarding the Board’s right to cancel, accept, or reject proposals. It was clarified that the Board retains full discretion to reject all bids or reinitiate the process, similar to other public bid processes.
• Ordinance vs. Resolution: The Board discussed the difference between adopting an ordinance versus a resolution for the AB 389 policy. Staff recommended proceeding with a resolution for immediate action to comply with AB 389 before approving the contract extension, with the option to consider converting it to an ordinance or updating Chapter 5 of the County Code in the future.
• Financial Security and Bonds: The Board directed staff to establish a mechanism, working with the County Auditor-Controller and CEO’s office, to hold funds in a restricted fund. It was noted that governmental proposers may pledge receivables or assets to satisfy performance security.
• Contract Extension and Timeline: Staff reported that an extension was negotiated with AMR, moving the contract end date to March 1, 2024, to allow for a ramp-up period. The mileage cap for primary ambulances was aligned to 250,000 miles. Staff outlined two potential timelines: if approved today, the intent to award would occur in mid-September with a 15–17 month ramp-up; if returned for changes, a final RFP would be presented on June 28, with an intent to award in early December and an 11–13 month ramp-up.
• Service Area and Exclusions: It was clarified that Vandenberg and UCSB are excluded from the RFP service area.
• Consultant Presentation and Q&A: The consultant presented the RFP development process, noting the use of a structured method to allow public, private, or public-private entities to bid. They highlighted modifications to historical requirements to ensure inclusivity, including allowing proposers without specific transport experience to propose how they would meet service provisions, combining all Exclusive Service Areas (ESAs) into a single ESA, codifying current effective ambulance response times, discussing the financial implications for public entities regarding first-response agreements, allowing government proposers to pledge receivables and assets in a restricted fund in lieu of traditional performance security, and clarifying that the RFP intends to prevent draconian measures against incumbent personnel but does not assign a specific scoring value to this element. The consultant also explained the scoring methodology, noting that minimum qualifications are pass/fail and additional criteria are scored on a scale with assigned point values. They stated there is no hard position on specific point values, which can be adjusted, and explained that an independent CPA will assess the financial viability of proposed rates to prevent unreasonably low bids. They described the review panel as including an EMS physician, two individuals experienced in high-performance EMS system design, and two community leaders. They noted provisions allowing for vehicles with higher mileage due to current supply chain shortages and long lead times for new equipment, and clarified that community education and outreach are addressed through various criteria, including a 25-point category for "community health status improvement."

Closed Session

• The Board adjourned to closed session to consider public employee performance evaluations for directors of various county departments (including Fire, Public Health, and others) and to confer with labor negotiators. No reportable action was taken in closed session.

Reconvening and Final Review

• Upon reconvening, staff presented the revised RFP document reflecting the Board’s directions. Staff noted that while substantive changes were incorporated, a final quality assurance check was required to ensure consistency across all sections before release. Staff confirmed that the RFP would be submitted to the state for approval prior to issuance.

Motion and Vote

• A motion was made and seconded to: 1. Adopt the resolution setting forth the policy for emergency ambulance services contracts as required by AB 389. 2. Approve and authorize the Chair to execute a fifth amendment to the professional services agreement with American Medical Response (AMR), extending the termination date to March 1, 2024. 3. Approve and authorize the issuance of the RFP for an exclusive ambulance services provider, incorporating the changes directed by the Board. 4. Determine that the proposed actions do not constitute a project within the California Environmental Quality Act (CEQA).
• The motion passed unanimously.

Agenda Item: Review of Contract Document Revisions

• Discussion: The speaker presented a series of specific modifications to the contract document, organized by page number and section:
• Page 34 (Section 3.2): The final sentence was removed. This sentence previously stated that the arrival of a Basic Life Support (BLS) unit at an Advanced Life Support (ALS) assignment does not stop the response time clock. The removal was noted as consistent with earlier changes to extended response time language.
• Page 45 (Article A, Section R44.44): Language was added to the final contract requirements. The contract will now provide a list to the LMSA detailing the make, model, age, and maintenance records of all vehicles. The speaker clarified that this requirement applies at the time of contract award.
• Page 48 (Treatment of Incumbent Workforce): Paragraphs two and three were removed. The first paragraph was modified to state that the winning proposal will be encouraged to recruit from the incumbent paramedic and EMT workforce. Proposers are required to describe their plan to recruit and hire the incumbent workforce or, as applicable, their plan to retain and prevent attrition of incumbent workers.
• Pages 51–52 (Response Times): Response times for urban, rural, and wilderness areas were modified to reflect the extended response times from the stop clock agreements. Specifically, the two-minute requirement was removed.
• Page 80 (Sections 10.1 and 10.2): The speaker noted that this section details the specifics for system integration and innovation, outlining what proposers shall propose regarding these areas.
• Motion: No motions were moved, seconded, or voted upon during this segment of the transcript.