Clackamas County looks to extend AMR ambulance contract
Clackamas County is pivoting away from an effort to amend the agreement with its ambulance service provider American Medical Response that would bypass the procurement process and extend the company's contract indefinitely should they meet certain performance requirements.
Instead, the Clackamas Board of County Commissioners has instructed lead public health officials within the Health, Housing and Human Services (H3S) department to work with county counsel to refine a draft memorandum of understanding that would commit the county to negotiate with American Medical Response (AMR) to implement new performance standards recommended by the county's Emergency Medical Services Council. The board will also look at passing a resolution at its Dec. 17 business meeting reaffirming the county's commitment to negotiate contract amendments that would retain AMR as the county's ambulance provider beyond the end of its current contract and implementing performance standards.
The move to amend AMR's contract was spearheaded by County Chair Jim Bernard, who admitted to his colleagues during their policy meeting Tuesday, Dec. 8, that his intention was to avoid a messy process like that of six years ago when only one company submitted an on-time bid and the previous county board struggled to agree on a contract.
"I'm hoping that you guys can work out a professional agreement and not turn this into a battle," said Bernard, who exits his role as county chair Dec. 31. "People, by the way, are going to create a battle whether you want it or not. I've got (not physical) threats already, and we haven't done anything yet."
According to Bernard, he's hoping the county can lock in an agreement with AMR to negotiate in good faith at some undetermined point in the future before January 2022.
AMR's contract doesn't expire until May 2024 thanks to a five-year extension granted by the board back in April 2019.
Bernard said that his intention was to not put his colleagues in an awkward position once both Chair-elect Tootie Smith and Commissioner-elect Mark Shull take their seats. According to Bernard, he feels the agreement with AMR and resolution by the board will pretty much seal this issue until the county and AMR are ready to negotiate its next contract, as well as the performance standards and innovations both the county and EMS Council hope to implement in ambulance services.
H3S Director Richard Swift and Deputy County Counsel Andrew Naylor will work with their staff to refine the draft agreement between the county and AMR for the board to review at its Dec. 17 meeting. According to Naylor, the first draft of an agreement has already received a tentative thumbs-up from AMR.
Commissioner Paul Savas asked Swift and Naylor if they could include a firm timeline of when negotiations would take place between the county and AMR, to which they agreed and noted that they would need to take place before January 2022.
Naylor told the board that the agreement would include language outlining potential "on ramps" for implementation of improvements to the county's emergency medical systems and ambulance service, as well as potential "off ramps" for both the county and AMR to part ways should negotiations not go as planned — two points that Savas also highlighted as being important to the agreement.
The original proposal, which has been canned for the time being, would have extended AMR's contract by as much as another five years based on its performance. The move was intended not only to avoid repeating the mishaps of 2014, but also to ensure improvements to the county's emergency medical systems and potentially save taxpayers money.
The proposed amendment spurred objection from the union representing firefighters and paramedics in Clackamas County who believed that the effort would subvert the public bidding process to give AMR — a private, for-profit company — a lifetime contract. The International Association of Firefighters Local 1159, also known as the Professional Association of Firefighters of Clackamas County, said they believe that work being done by the county's EMS Council intended to enhance the local emergency medical system and develop a set of standards for ambulance providers was being rushed to fit a new contract model that doesn't allow for transparency in the process.
"We asked that they delay this process another year or two, or just wait until the request for proposal process when those performance standards are completely developed so that we can actually show the data and see which programs work or not," said Nate Hon, IAFF Local 1159 secretary.
The move to amend AMR's contrat began in October when the county 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 county commissioners instructed it to develop to ensure service quality would not plateau following the most recent ambulance service agreement extension in April 2019.
According to the union — which represents 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 ambulance services contract. Instead, the council was asked to submit their recommendations by Nov. 25 to be considered by county commissioners and included in amendments to AMR's contract effective Jan. 1, 2021.
A subcommittee of the council was able to rush and complete the work by their day-before-Thanksgiving deadline, but according to Chair Joshua Santos, medical services chief for Clackamas Fire District No. 1, the council still feels that work is incomplete and needs refinement.
According to Hon, the union's misgivings about the county's effort to amend AMR's contract had nothing to do with AMR's performance as an ambulance provider. In fact, Hon said that most, if not all, agencies in Clackamas County enjoy working with AMR and believe them to be a well-functioning outfit.
"This isn't us versus AMR. We just want to see the process followed as it's written," Hon said. "In the 11th hour, there was a proposal by Chair Jim Bernard to evergreen the contract with performance standards that are very loose. Our request is to delay this process and wait another year or two until the RFP process when those performance standards are completely developed so we can show data of which programs are working and which aren't."
According to Hon, the union was confused why the board would task the EMS Council with writing these recommendations only to hurry them along without allowing the full process to unfold. They also believe the way the current performance standards in the contract amendment are written won't provide any gauge for how AMR is actually doing in terms of performance.
The union is suggesting that the county's haste is partially inspired by Bernard's exit as county chair and his intention to not repeat the events of six years ago.
In 2014, 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 former commissioner Tootie Smith — who takes her new seat as county chair on Jan. 1 — both opposed the contract extension for different reasons. Ludlow advocated for the inclusion of a contractual requirement for an annual outside-audited financial statement, versus the annual county-reviewed financial statement that AMR has provided with no issues for more than 20 years. Smith argued that she wanted to reduce duplication of services with fire paramedics.
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