Clackamas County has reaffirmed its commitment to revamping ambulance service agreements with longtime provider American Medical Response, whose future performance will be evaluated through a set of requirements recommended by a countywide council of emergency service providers to determine the company's contractual standing.
Commissioners on Nov. 23 unanimously voted to extend the current ambulance service contract's second amendment, which obligates county staff and stakeholders from the county's Emergency Medical Services Council to negotiate in good faith with AMR regarding new performance standards.
The amendment allotted the county and AMR a one-year window, expiring Jan. 1, 2022, to determine whether or not they could negotiate upon terms in good faith before allowing them to cut ties if need be, after which the county would pursue alternate ambulance service procurement approaches.
With the approved timeline extension, staff and EMS Council members say they now anticipate completing the performance-based contract tor the board's final review in October 2022. The extra time will also be used to "modernize" the current ambulance-service plan, which was last updated in 2012, according to Chair Joshua Santos, medical services chief for Clackamas Fire District No. 1.
Clackamas County in October 2020 instructed the EMS Council, which includes fire and emergency medical professionals from agencies across the county, to expedite its work on a new set of performance standards that the commissioners at the time instructed it to develop to ensure service quality would not plateau following an ambulance service agreement extension in 2019.
The accelerated timeline spurred objection from the International Association of Firefighters Local 1159, the union representing firefighters and paramedics in Clackamas County, which said was being rushed to fit a new contract model that didn't allow for transparency in the process. The union also suggested that the county's haste was partially inspired by Bernard's exit as county chair in December 2020.
According to the union — which represented a few of the council's members — the council was frustrated with the timeline, thinking it would have until sometime in 2021 to finish formulating its recommendations on enhancements to the system and a list of performance standards to include in a potential new contract.
Instead, the council was asked to submit their recommendations by Nov. 25, 2020, to be considered by then-commissioners and included in amendments to AMR's contract effective Jan. 1, which would also begin the clock for all parties' good faith obligation of one year.
Santos at the time said he felt the work was incomplete and needed refinement, and told commissioners on Nov. 23 that the short-notice endeavor represented a major change of direction for the council following an already tumultuous year of navigating the COVID-19 pandemic, multiple weather disasters and social unrest.
Following the development of COVID-19 vaccines in January, local fire agencies partnered with the county's public health division to organize and facilitate vaccine clinics countywide — a byproduct of which was the further postponement of contract negotiations, according to Santos.
Santos said the county and EMS members will spend the coming months working with AMR staff to finalize a set of performance requirements, while EMS continues on its own workshopping its ambulance service plan to meet current population needs and utilize modern resources as effectively and efficiently as possible.
Council officials said modernizing the plan will include altering outdated 911 dispatch procedures, addressing health care inequity, updating performance metrics and formalizing public and private partnerships.
"We have an opportunity to create a system that's reflective of today, it's scalable to tomorrow, it creates sustainable business models for both public and private, it'll ensure healthy workforce throughout their career and into retirement and it will deliver the highest level of service to the citizens were sworn to protect," Santos said.
The move to amend AMR's contract was spearheaded by former County Chair Jim Bernard, who told his colleagues during a December 2020 policy meeting that his intention was to avoid a messy process like that of six years prior when only one company submitted an on-time bid and the previous county board struggled to agree on a contract.
In 2013, the ambulance services procurement process devolved into a sideshow when the county initially offered AMR — the only on-time bidder, after Metro West and Rural/Metro either didn't bid or failed to meet the deadline — a one-year extension. That led AMR to threaten a lawsuit before Bernard changed his mind and sided with Commissioners Martha Schrader and Paul Savas to approve offering the company a five-year extension. Then-County Chair John Ludlow and current Chair Tootie Smith — who took her seat as chair on Jan. 1 — both opposed.
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