July 27, 2020

GUEST COMMENTARY: CV’s Decision on Ambulances Questioned

By La Prensa San Diego

By Pablo Quilantan

The Chula Vista City Council moved to transition ambulance services to the city’s fire department without significant public input, which could be costly for the city’s more than 270,000 residents. 

The decision, which was made on May 12 with little to no opportunity for public input or scrutiny, bucked a 40-year trend of contracting those services out to private contractors instead of fire department employees.

Now, city officials claim that the proposed $2,800 transport rate is $1,000 less than what the rate will be if there are no changes to the transport arrangement. The transport rate is what the patient is charged by the ambulance company to be taken to the hospital. 

But, what’s not clearly disclosed is that Chula Vista residents have already borne the cost of the city’s paramedic program from its inception via increases in the transport rate. Under the current situation, the public is unaware that they are charged $1,871 for the Fire Department’s portion of the paramedic response and $1,583 for the service provided by American Medical Response AMR, the current ambulance services contractor. Thus, it would appear that a better rate from a private contractor is possibly feasible than what is currently proposed.

One thing is certain: Chula Vista residents should not be burdened with paying a needlessly high ambulance transport rate. The city’s proposal should be further vetted to ensure that residents are getting the best possible service at a reasonable cost.  

The decision to transition ambulance services in house without a competitive bid process for the city’s ambulance transport contract contradicts the council’s previous actions. No competing proposals were considered or even allowed when it was decided. This transition is slated to go into effect on April 9, 2021.

During my 18-year tenure with the City of Chula Vista, I served as a central budget analyst and served five years as the administrative services manager for the fire department.

After five years at the fire department, I fully understand that part of the fire service gold standard is to have paramedic service delivered from a fire engine. 

But, as a government finance employee, I recognized early on that the city can’t afford the current paramedic program without financing it on the backs of its residents. 

Understanding emergency medical response services is a blur to most of us. When we see an accident or witness an emergency response, we typically assume the personnel and vehicles all come from the same source. This has notbeen the case for the last 40 years. 

One of the first things I learned on the job was how the emergency medical response system serves the south bay of our county.

Emergency medical services in the City of Chula Vista are provided as part of an Exclusive Operating Area (EOA) that includes the City of Imperial Beach and the unincorporated area of Bonita.  

Fire Departments serving each of these jurisdictions are the first responder for medical emergencies and work in concert with EOA ambulance services contractor AMR, which provides medical transport. This means any change to the ambulance services contract would apply to the entire contracted area.

When a citizen calls 911, public and private emergency resources are deployed. A Chula Vista Firefighter-Paramedic, dispatched in a fire engine, and a private Paramedic and EMT, in a privately operated ambulance, comprise the emergency medical response team. Once stabilized, the private ambulance crew is responsible for transporting patients to medical facilities who are in need of additional attention.”

Now, the fire department will do both jobs. 

In the early years of my career with the city, I served on the team that negotiated the transport rates with AMR on behalf of the city and the rest of the EOA.  

Although these negotiations were at times contentious, the EOA was usually successful in acquiring a competitive transport rate from AMR that ranked among the lowest in the county. We used to our advantage the fact that we are one of AMR’s largest contracts to help residents by negotiating low transport rates.

Response time performance standards to ensure AMR’s timely service delivery were also part of the contract in addition to the negotiated transport rate and other ancillary costs. 

During this time, the City of Chula Vista Fire Department did not provide paramedic services from its fire engines. AMR provided the paramedic service from its ambulances. This service model began to change when momentum from within the Chula Vista Fire Department convinced city management to pursue the development and deployment of its own paramedic services from its fire crews.

When the Chula Vista Fire Department was given approval to develop and deploy its own paramedic program, it was financed with an increase to the transport rate. The transport rate has been increasing in order to offset the cost of the added City paramedic personnel in order to not impact the city’s general fund.

Chula Vista residents already support the City’s general fund by paying one of the highest sales tax rates in the County. A portion of the sales tax is already designated for public safety. Unfortunately, with the proposed change, residents will get little relief, as they will bear the burden of paying a higher transport rate than is necessary. This is because the City has decided to include the cost of the firefighter/paramedics first responders into the transport rate.

Few if any realize that the cost of these firefighter/paramedics is already budgeted and paid from within the City’s general fund. There is no cost to the resident when the firefighter/medics respond to a fire related or other non-medical emergency. Few also realize that residents have been charged for the paramedic program since the program’s inception through increases in the transport rate. It is unfair that residents should have to pay additional costs for a service already funded by their tax dollars.

Nevertheless, Chula Vista officials are proceeding with the implementation of this service change without a clear understanding of the potential impact. They are gambling that the revenues for this enterprise will materialize as projected thus not affecting their coffers. They are gambling that the new liabilities associated with this service will also not bring adverse consequences. 

We can only hope for the best, as gambling with the well-being of the community is not an option.

Pablo Quilantan is a retired City of Chula Vista employee with more than 30 years of municipal government experience in the areas of financial management, budget and operations research. He holds master’s and bachelor’s degrees in economics from San Diego State University. He is a 30 year resident of the City of Chula Vista.