HomeMy WebLinkAboutAgenda Report - November 15, 2005 B-01 SMAGENDA ITEM
CITY OF LODI
%W COUNCIL COMMUNICATION
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AGENDA TITLE: Discussion and potential action regarding the award of the San Joaquin County
ambulance bid to American Medical Response.
MEETING DATE: November 15, 2005
PREPARED BY: Michael E. Preto Fire Chief
RECOMMENDED ACTION: That Council discuss and give appropriate direction regarding the proposed
award of the San Joaquin County ambulance bid to American Medical
Response.
BACKGROUND INFORMATION:
FISCAL IMPACT: None
FUNDING AVAILABLE: NIA
MEP/1h
Attachment
The San Joaquin Board of Supervisors will be taking action on the
ambulance bids at the November 1 e meeting. Due to the
accelerated schedule of the RFP process and review of the
American Medical Response and Priority One proposals, a special
meeting is needed to receive Council direction. Attached you will
find a memo reviewing the ambulance bids.
Michael E. Pretz, Fire ief
APPROVED: ra" -
BlaiKYdfig, City Manager
CITY OF LODI
FIRE DEPARTMENT
MEMORANDUM
TO: Honorable Mayor and Members of the City Council
THROUGH: Blair King, City Manager
FROM: Michael E. Pretz, Fire Chief
DATE: November 10, 2005
SUBJECT: Ambulance Bid
As you are aware, the San Joaquin County Emergency Medical Agency (SJCEMSA) has
released their recommendation for ambulance service throughout the County including the City
of Lodi. Of the three proposals submitted, SJCEMSA has determined the AMR proposal should
be accepted. The Board of Supervisors is scheduled to vote on the recommendation November
15th
The recommendation to award AMR an exclusive operating contract is not without controversy.
In fact, the competing providers, Priority One and City of Stockton/Rural-Metro, have filed
protests. The nature of these protests range from incomplete/inadequate supporting
documentation, conflicts of interest between AMR and the raters, a flawed RFP process, to
financial data that simply does not add up. In addition, the City of Stockton is pursuing legal
remedies regarding the Joint Venture Agreement (JVA) that both the City of Stockton and the
City of Lodi are parties to.
After reviewing the RFP process, there are two areas with which the City of Lodi should be
concerned. In the course of developing the RFP, fire department staff met with the County's
consultants to help design the pre -hospital care system. In public meetings and in written
correspondence, the need for a fire department element for the provision of emergency medical
care was discussed. There is no denying, the fire departments throughout San Joaquin County
are an integral part of the EMS system, a statement agreed to by the consultants. However, when
the RFP was released, the fire departments role and contribution to the EMS system was
completely ignored. The RFP was written as if the San Joaquin County was a large rural county
with no urbanized areas. Every county surrounding San Joaquin County has grappled with this
issue and in every case, have developed a sophisticated program in which the citizens are well
served. This RFP does not serve the City of Lodi or its citizens well.
Ambulance Bid
Page 2
The second area of concern is the role of emergency dispatching. The City of Lodi is on record
objecting to outsourcing this vital role to a private provider with no County or public sector
oversight. Typically, the county maintains control over the radio system and dispatching
computers and may utilize a private vendor to perform dispatching tasks. Under the current bid
provided by AMR, there is no ability by the county to control costs, manage the system, or
perform other administrative duties.
In reviewing the AMR proposal, there have been significant changes from AMR's signed letter
of intent with the City of Lodi and what has been proposed to the County. For example, in an
April 20, 2005, memo from Lou Meyer AMR vice-president, AMR stated their willingness to
pay to the City $18,829 per first responder engine. This amount will offset EMS costs by
$94,145 per year. In addition, the fire department was to assure three scholarships for paramedic
training per year. The AMR proposal before the Board of Supervisors offers a reduction in
dispatch charges to be used toward EMS costs. The cost reduction can only be realized by
fragmenting the regional dispatch system and out sourcing our current agreements with the City
of Stockton. The paramedic scholarships are now offered county -wide rather than Lodi specific.
The City of Tracy is experiencing similar problems with the AMR bid.
The Priority One bid reimburses the fire department $117,150 for first response in the first year
of the contract and grows to $125,125 in year three. In addition, 6 ambulances will be stationed
in Lodi, 3 ambulances will be 24 hour vehicles, 2 ambulances will be 10 hour vehicles, 1
ambulance will operate an 8 hour day, and 1 supervisor vehicle. In discussions with Michael
Parker, he stated he is looking for a 40,000 square foot building to house his operations including
fleet maintenance.
It is my intention to address these two issues at the Board of Supervisors meeting on November
15th. I believe it is important that the City of Lodi be on record regarding these issues.
April 20, 2045
Michael Pretz, Chief
Lodi Eire Department
25 East Pine Street
Lodi, CA 95240
Dear Chief Pretz,
American Medical Response is in receipt of your email correspondence sent April 4,
2005 proposing a revised first responder fee level. AMR would agree to the amount of
$18,829 per strategically located first responder engine on an annual basis, contingent
upon execution of a revised Memorandum of Understanding (MOU) which would
supersede and replace the Joint Venture Agreement entered into by the Parties as of July
3, 2003.
AMR will be contacting you to set up a meeting time to further discuss details of the
MOU.
Thank you for your diligence in this matter.
Sincerely,
Lou Meyer
Chief Executive Officer
Northwest -Plains Region
American Medical Response West, Inc.
cc: Brad White, Vice President of Operations, AMR
Barry Elzig, Director of Operations, AMR
Michael Hakeem, Esq.,
Michael Scarano, Esq.
Blair King, Lodi City Manager
7575 Southfront Road, Livermore, Ca 94551
TRACY FIRE DEPARTMENT �
The Critical Role of Local Fire Departments in the Advanced Life Support Pre -hospital
Emergency Medical System Response System.
Seconds can be the Difference Between Life and Death!
When emergency medical professionals respond to a call for assistance, time becomes a
critical factor. Seconds can mean the difference between life and death for people
suffering a heart attack or stroke as well as those victims of vehicle and industrial
accidents who suffer serious trauma. Regardless of their location, community citizens,
visitors and business owners have a reasonable expectation they will receive emergency
response service in the timeliest manner possible.
This expectation places requirements on a local government to provide emergency
response service. Due to the nature and location, most fire department response protocols
are established to provide timely service regardless of the nature of the call for service.
Given these two factors it's easy to understand the critical role local fire departments play
in providing the initial emergency medical response to those incident scenes. Fire
stations, which are located throughout the community in an effort to maintain the shortest
possible response times, allow the agency to place emergency resources on an incident
scene within a matter of minutes.
FirefighterlParamedics Utilized to Reduce Response Times
Throughout the country the pattern was the same, the fire department arrived on the scene
of an emergency only to wait for the private ambulance to transport the patient to the
hospital. Many times this wait was at the expense of the patient's life. Approximately
forty years ago Los Angeles County Fire Department was one of the first areas in the
Country to implement a program of placing Advance Life Support (ALS) units, or
paramedics, in many of their fire stations. This program was so successful in saving lives
that today it's common practice throughout the country for cities and counties to staff
their fire apparatus with firefighter/paramedics.
There are few individuals who better understand the importance of a timely response than
the highly trained men and women in the fire service. These skilled professional are
highly trained to handle all types of emergencies, including emergency medical incidents.
With the understanding that time is of the essence when dealing With medical conditions,
fire fighters are prepared and equipped to deliver the most effective pre -hospital medical
care possible at an incident scene while working under the immediate supervision of an
emergency room physician. In essence these professionals are bringing emergency room
care to the scene of every incident.
Advanced Life Support pre -hospital care often means the difference between life and
death for those victims of heart attack, stroke and accidents. In an effort to administer
this care in an effective manner it's critical that skilled emergency responders receive
notification of the incident as quickly as possible. In order to be included in this
notification system, it's imperative local fire departments be considered as the first link in
TRACY FIRE DEPARTMENT
the life safety chain for emergency medical care, By recognizing local fire departments
in the emergency medical system, we can ensure the citizens of our jurisdiction are
receiving the highest level of care available at all times.
Public/Private Partnerships Prove to be an Effective Alternative
In order to provide the most effective level of care for those residents and visitors of the
county, it's imperative that all aspects of the response system be considered before
critical decisions are made regarding service delivery. As public officials we have a duty
to ensure the residents of San Joaquin County are receiving the most efficient and
effective service available in the timeliest manner possible. By recognizing each
agencies role in the emergency medical response system it enables us to prepare for, and
provide quality care to the patient. ,
In order to provide the most comprehensive service possible it's imperative that local fire
departments enter into ALS partnership with the ambulance service who is chosen to
provide transport service in San Joaquin County. These partnerships will allow for the
most comprehensive service possible by keeping ambulance transport providers and local
fire departments focused on the issue of patient care. Partnerships also allow agencies,
whether public or private, to establish collaborative training and quality assurance
programs. Most importantly, this partnership is essential in providing a method of
funding ALS Programs throughout the County.
Through this collaboration both agencies will develop and foster a relationship focused
on interagency cooperation, resource sharing and mutual respect, which in turn will
provide the best service possible for the citizens they serve. In order for these agencies to
develop this relationship they must be provided with a level platform from which to
work. This level platform requires that all agencies be considered as equal partners,
which will require the County's EMS governing body to recognize local fire
department's ability to stop the response clock when they arrive on an incident scene. If
these agencies are working in partnership then the fire department arriving on an incident
scene should be considered no different than an ambulance arriving at the incident scene.
Specifically if that fire unit is ALS service.
Counties Require Public/Private partnerships as Part of an Ambulance RFP
As an example, the Santa Cruz Board of Supervisors in April of 2002 approved an
ambulance RFP that included the language "Fire service is an integral part of Santa Cruz
County EMS..." The approved submitted bid was based upon a binding agreement
between the ambulance contractor and the County's fire service providing for an
integrated ALS program reducing on -scene times throughout the County. In Alameda
County the ambulance RFP contains the following language "COUNTY agrees to
facilitate the use of fire department ALS first response as a cost-effective mechanism. To
support such services, CONTRACTOR agrees to provide funding to the COUNTY in the
amount of one million nine hundred twenty thousand dollars ($1,920,004) annually. This
first responder subsidy is contingent on the availability of 64 paramedic engines
TRACY FIRE DEPARTMENT
companies/stations, twenty-four (24) hours per day, and three hundred sixty-five (365)
days per year." In Contra Costa County the successful ambulance bidder is providing six
transport -capable vehicles to be staffed by firefighter/paramedics and will be used in pre-
defined and urgent circumstances.
San Joaquin County Continues to Lag Behind
It's unfortunate that today most of the residents, businesses and visitors in San Joaquin
County do not have the same availability of Advanced Life Support units that currently
exists in the majority of the State as referenced in the above examples. The delay of
paramedics to the scene of an emergency, along with the lack of a countywide
coordinated fire based ALS program in San Joaquin County, has resulted and will
continue to result in the loss of life.. The current leadership at the County's EMS Agency
refuses to accept a program which has proven to be enormously successful in saving
lives. As the population of San Joaquin County continues to increase it is critical to the
safety of our residents that we begin to understand and embrace the important role local
fire departments play in ensuring the fast, initial pre -hospital care provider be recognized
as the first link in the Chain of Survival.
The question needs to be asked in San Joaquin County..."why do we continue accept a
lower level of service in this County? The County is about to enter into a five-year
agreement with the successful ambulance bidder that will only further fragment an
already fragile emergency pre -hospital response system.
2MER; CAN MED;CAE RESPONSE
November 15, 2005
The Honorable Mayor and Members of the City Council
221 West Pine Street
Lodi, CA 95240
Re: November 10, 2005 memorandum from Michael E. Pretz, Fire Chief
Dear Mayor and Members of the Council:
AMR wishes to clarify and provide further information to the Lodi City Council in
response to the November 10, 2005 memorandum written by Lodi Fire Chief, Michael
Pretz. AMR believes that the Chief has inadvertently omitted important facts.
American Medical Response respectfully requests that Chief Pretz, if he chooses to
address the Board of Supervisors include within his remarks the clarifying information
below.
Following submission of EMS proposals to the County on September 22, 2005, an
independent proposal review committee read proposals and later heard oral presentations.
On October 14, 2005, the proposal review committee recommended that San Joaquin
County negotiate a contract with American Medical Response -West (attachment 1). The
recommendation document among other comments states:
• "AMR rates were the lowest of the proposers "
• "They (AMR) guaranteed ambulance response times that were the fastest"
• "AMR also demonstrated the strongest financial strength and stability of the three
proposals. "
0 "The proposal (AMR's) offered a design that integrated services within the three
zones and offered significant regional resources, including ambulances and a full
back-up dispatch center. "
Following the above referenced announcement, the RFP process included the opportunity
for bidders not selected to submit protests. The City of Stockton and Priority One filed
protests following which County Health Services Director, Ken Cohen stated that the
County has found the protests to be without merit. On November 4, 2005, Mr. Cohen
responded in writing to the protesting agencies (attachment 2) stating: "In conclusion all
issues ofprotest submitted by (Stockton Medical Services and Priority One Medical
Transport) are determined to be without merit and the protest is subsequently denied. "
245 W. Charter Way, Stockton, CA 952061704
(209) 948-6730 • Fax (209) 948.6532
The memorandum to the Council states, "This RFP does not serve the City of Lodi or its
citizens well." However, it does not provide any examples to demonstrate his conclusion.
Among many positive outcomes of the RFP process, AMR's proposal offers:
• Fastest paramedic ambulance response time
• Lowest cost to the citizens served
• AMR Option A proposal $259.88 less per call than Priority One
• AMR Option B proposal $349.88 less per call than Priority One
• Public assist ambulance response (response without transport)
• AMR proposal — $0
• Priority One proposal - $95
• Treat and release ambulance response (response and treatment with no transport)
• AMR proposal — $0
• Priority One proposal - $125
• Reduced cost of EMS dispatching
• Today the City of Lodi pays $25.52 per EMS dispatch
• AMR's proposal the City of Lodi pays $9.75 per EMS dispatch
• Ambulances de
4kated to 911 system coverage
• Enhanced supervision and additional Field Training Officers
• Specialized geriatric training of our paramedics to enhance service to our seniors
The Chief appears to have obtained inaccurate information with regard to EMS dispatch.
His memorandum to the council states, "Typically, the county maintains control over the
radio system and dispatching computers and may utilize a private vendor to perform
dispatching tasks." None of the three RFP proposals offered county control over the radio
system and dispatching computers. AMR is not aware of a "typical" methodology and
offers the following examples of surrounding Northern California counties:
• Stanislaus County: EMS dispatch center radio system and computers are owned
and controlled by the private EMS provider.
• Alameda County: EMS dispatch center radio system and computers are owned
and controlled by the private EMS provider.
• Contra Costa County: EMS dispatch center radio system and computers are
owned and controlled by the private EMS provider.
• Yolo County: EMS dispatch center radio system and computers are owned and
controlled by the private EMS provider.
• Placer County: EMS dispatch center radio system and computers are owned and
controlled by the private EMS provider.
• Sonoma County: EMS dispatch center radio system and computers are owned and
controlled by the County EMS provider
With regard to dispatch, Chief Pretz also states: "The City of Lodi is on record objecting
to outsourcing the vital role to a private provider with no County or public sector
oversight." In fact, AMR's proposal states the following: "Independent oversight (AMR
ON
Dispatch) from a user group comprised of EMS Agency staff, North and South County
Fire Department user groups, private ambulance users, and a representative from the
County Board of Supervisors, ensuring true accountability and responsive service for the
dispatch system (attachment 3.) "
With regard to the Joint Venture Agreement (JVA) between the City of Lodi, City of
Stockton, and AMR, the Chief's memorandum to the Council raises the issue that AMR's
EMS proposal is different than the JVA. In early August of 2005,1 contacted the Chief
by telephone advising him of the impasse of negotiations with the City of Stockton. I
fiuther informed the Chief, followed up in writing (attachment 4) on August 16, 2005
that "We do not believe our impasse with Stockton constitutes an impediment to finalizing
a proposed arrangement with Lodi that meets the foregoing criteria, and would be
pleased to proceed with further discussions toward that goal. "
On September 7, 2005, the Chief sent a letter to AMR effectively stating that he would
not be proceeding with further discussions (attachment 5). The letter stated, "We will not
commit to any provider until the RFP process has been concluded At the conclusion of
the bid process, however, we are looking forward to discussing a future partnership. It is
our hope that such a partnership will be included in the final contract with the San
Joaquin County EMS Agency. " AMR is concerned that in his memorandum to the
Council the Chief now claims that we did not put his desires into our proposal when he
declined in writing to negotiate further with AMR until after the award on November 15,
2005.
The Chief also discusses monies Priority One offered in their proposal (not selected by
the review committee) to pay the Lodi Fire Department for first response services.
However, the Chief fails to advise the Council of the cost to the citizens of Lodi who use
ambulance services. Priority One's proposal (attachment 6) requires the citizens of Lodi
to pay an additional $349.88 each time they use an ambulance in order to provide their
Option B fees and services to Lodi Fire.
In conclusion, AMR again respectfully requests that, if Chief Pretz chooses to address the
Board of Supervisors that he include within his remarks the clarifying information
provided.
Respectfully submitted,
L uis K. Meyer, Chief xecutive Officer
American Medical Response, West Region
3
October 14, 2005
Mr. Ken B. Cohen. Director
San Joaquin Health Care Services Agency
500 West Hospitaf Road
French Camp, CA 95231
Dear Mr. Cohen:
The Ambulance Proposal Review Committee has reviewed the proposals
submitted by ambulance providers who have proposed service to San Joaquin County
This review consisted of review of the written documents and presentations by the
proposers which were followed by question and answer periods
Based on this process, the Committee recommends that San Joaquin County
negotiate a contract with American Medical Response -West to provide service within
the Zone A, B, and C exclusive operating areas, based on their Option A proposal.
C
James E Andrews, M.D.
EMS Medical Director
Central California EMS Agency 8
Merced County EMS Agency
Miips Jul -
EMS Administrator
/El Dorado County EMS Agency
Catherine Ley, R.N
EMS Nurse
Mercy kledical Center -Redding
Hosahalli P. Padmesh, M.D.
Citizen Representative and President,
San Joaquin County Medical Society
Cliff mer
Dire for ofPurcha
si siSupport Services
22;D
i
Allan . Lennox
General Manager
American Legion
/Ambulance
Andy Mc Murry
Division Chief
California Department of Forestry and Fire
Chris Rose
Senior Deputy County Administrator
San Joaquin County
The Committee recommends that San Joaquin County negotiate with American
Medicaf Response -West (AMR) to serve Zones A, B, and C. The Committee
unanimously agreed that this was the best option among those presented by the
proposers to serve these zones. The Committee further recommends that the contract
be based on AMR's "Option A.'
The committee recommends that the following be considered in the negotiation.
implementation, and monitoring of the contract:
• . The contract should carefully provide for monitoring of the Contractors quality
management program.
• if AMR and fire departments opt to enter into an arrangement for Fire dispatching, as
described in AMR's 'Option B-, it should not result in higher ambulance charges.
The Committee met October 12-14, 2045 in Stockton, Califomia. The Committee
reviewed the written proposals submitted by AMR, Priority One (PI), and the City of
Stockton/Rural-Metro (SIR -M). Each proposer was invited to make a 45 minute
presentation to the Committee. These were followed by a question and answer period.
Each Committee member read the proposals prior to the meeting and individually
ranked them within each of the areas identified in the request for proposals. At the
beginning of the meeting, Committee members' rankings were shared for comparison
and the differences were discussed. These evlautions were preliminary and were not
retained by the Committee.
Committee members discussed rankings within each evaluation area. The
evaluation areas were:
• Credentials; experience, financial strength
• System design and rural parity
Operations
• Personnel
• Qualitylperrormance
• Data and reporting
Financial and administrative
• Community service programs
San Joaquin County Ambulance Proposal Review Committee
Final Report
The following is the final report of the San Joaquin County Ambulance Proposal
Review Committee, appointed by the Health Care Services Agency Director. Members
of the committee are:
James E Andrews, M.D.
EMS Medical Director
Central Catifomia EMS Agency &
Merced County EMS Agency
Cliff Saurner
Director of Purchasing and Support Services
San Joaquin County
Wes Julihn
EMS Administrator
EI Dorado County EMS Agency
Allan C. Lennox
Genera( Manager
American Legion Ambulance
Catherine Ley, R.N.
EMS Nurse
Mercy Medica! Center -Redding
Andrew McMurry
Div}sion Chief
California Department of Forestry and Fire
Hosahalll P. Padmesh, M.D.
Citizen Representative and President,
San Joaquin County Medical Society
Chris Rose
Senior Deputy County Administrator
San Joaquin County
Robyn Truitt Drivon (Non-voting)
Assistant County Counsel
San Joaquin County
�r�
After all of the presentations, Committee members again discussed rankings.
Each member of the Committee again ranked the proposals and an average ranking
was computed. The rankings were as follows:
Committee member AMR PA 51R -M
1 1 3 2
2 1 3 2
3 1 3 i 2
i 4
1
3
2
5
1
3
2
6
1
3
2
7
2
3
1
a
2
3
1
Avera g a
1.25
3.00
1.75
AMR rates were the lowest of the proposers and they guaranteed ambulance
response times that were the fastest—these response times were more stringent than
those required in the RFP. AMR also demonstrated the strongest financial strength and
stat)flity of the three proposals. The proposal offered a design that integrated services
within the three zones and offered significant regional resources, including ambulances
and a full back-up dispatch center.
The Committee appreciated the effort that the three proposers put into the
process. The Committee also recognized the commitment to serve the community by
Stockton Fire Department and Priority One,
The Committee in its work, recognizes the commitment of the County of San
Joaquin to improve its EMS system and to ensure quality prehospital patient care. The
County must ensure that the EMS Agency has the appropriate resources and expertise
to implement and monitor the contract and to continue to improve the system. The
Committee strongly urges that all prehospital care providers in San Jcaquin County
work together to provide seamless patient care.
Nov 07 05 05:12P
San Joaquin County Health Care Services
P.O. ftx 1020 • Stockton, CA 95203 a (209) 468-66M
04 November 2005
Wchaol Parker, President and Chief Operations Officer
Ptioriky One Medical Transport, Inc.
740 South Rochester Avenue Suite E
Ontario, CA 91761
Re: Emergency Ambulance Service Request for Proposals (RFP)
Dear kk. Parker:
P.2
The San Joaquin County EMS Agency and I have thoroughly reviewed and considered
al of the areas of protest filed by Priority One Medical Transport (POMT) in protest of
the Emergency Ambulance Service Request for Proposals recommendation.
The following are the responses to the issues of protest submitted:
EgMT _Asse ft _ #1: If the EMS Agency did not receive the actual
proposal evaluation documentation forms from the proposal review panel,
how can the Agency be assured the panel followed the instructions of the
Agency? Without proof of written panel member review evaluation forms
having been completed, how can the Agency or the County ensure the
integrity of the review panel evaluation process?
Section 2.10 of the RFP states that: "The Proposal Review Committee will develop a
rating system that may or may not contain a point system. Each reviewer shall rank
each proposal according to the individual reviewer's judgment as to the relative merits
of the competing proposals. "
The integrity of the Proposal Review Committee is evidenced by its report which was
individuality signed by each committee member. While the instructions to the committee
provided individual ranking forms, the committee utilized its discretion to modify that
process and did not utilize the individual ranking forms. The documents evidencing
consensus of the reviewers' judgment as to the relative merits of the competing
proposals have been provided as the permanent record of the committee's decision.
PONT sa on 2: How could Priority One be rated 3`d in Zones A and
C when only two bidders submitted proposals? How could a fair
evaluation be applied to Priority One's bid in Zones A and C by being
compared to a bidder not competing in those two zones?
Sen Joaquin General Hospital • Mental Health Services e Office of Substance Abuse
Public Health Services • Emergency Medical Services
Nov 07 05 05:13p P 3
The Committee's review examined the overall quality of the proposals. The proposals
were ranked as to their overall quality and then applied to the zone configurations.
POMT Assertion #3: We assert bidder's financial strength should be
evaluated on a zone -by -zone basis since the RFP was issued for three
separate exclusive operating areas.
The report issued by Moss Adams addressed the bidder's credentials and financial
strength as defeated in Section 3 of the RFP and the proposed operating budgets
required in Section 4.6.
PgNT Assertion #4: In reviewing AMR's proposal, we confirmed that
AMR did not follow the RFP instructions for completing the 'Acceptance of
Minimum Requirements Form' in Attachment E of the RFP.
The use of a check mark instead of initials was determined to be a non -substantive
issue that did not impact the proposal.
PONT Assertion 05: In the Moss Adams RFP financial review report of
the proposals, they confirm our assertion that the operating budget AMR
submitted was flawed and contained mathematical errors.
Based on the presentation of the report by Moss Adams, these were determined to be
minor rounding errors that, in the scope of the total proposal, were non -substantive and
did not impact the proposal.
POMT Assertion #6: AMR also failed to include dispatch personnel
wages (sic) cost in their operating budget as required by the RFP.
Further, the AMR budget format submitted in their proposal fails to adhere
to the format set forth in the RFP.
Based on the Moss Adams report, the County found that AMR's budget submission was
in compliance with the form and the requirements of the RFP. Note that AMR
accounted for their dispatch costs under "dispatch fees" rather than under wages.
POMT Assertion #7: We don't believe the proposal review panel ranking
recommendation reflects the fact the employee compensation and
benefits package we proposed far surpasses the compensation and
benefits proposed by AMR.
The Proposal Review Committee had and considered all of the information submitted by
al bidders.
POIVIT Assertion #8: We object to the fact that they proposed reduced
rates at the expense of their workforce having the ability to retain a quality
living standard
Nov 07 05 05:13p p:4
The information submitted by American Medical Response -- West meets the
requirements of the RFP.
PONT �serVon #9: We assert the review panel ranking doesn't reflect
this ambulance system resource reduction plan AMR is proposing for San
Joaquin County.
The information submitted by American Medical Response — West meets the
requirements of the RFP,
PQK A&spaon#10: AMR failed to disclose in its proposal as required
by the regulatory actions taken by the federal Medicare program and the
Department of Justice regarding billing practices of AMR operating units.
At the mandatory Bidders Conference held on August 4. 2005, the following clarifying
answer on this subject was provided by the EMS Agency: "The bidder must submit all
litigation for the bidding entity."
American Medical Response — West is the bidding entity and as such was not required
to submit any litigation or regulatory information for other operating entities of American
Medical Response. All other regulatory actions and litigation related to American
Medical Response — West were disclosed in their proposal.
POMT Assertion #11: We are also concerned that our complete proposal
was not published on the EMS Agency website as other bidders (sic)
proposals were.
The EMS Agency posted the information submitted by bidders in electronic fonn. Upon
receiving POMT's attachments in an electronic form they were posted on the EMS
Agency webpage.
Note: The various reviewers (Proposal Review Committee members, EMS Agency
staff, Health Care Services Agency Director) all worked with hard copies of the
proposals submitted by each bidder, not the electronic versions.
POMT Msertion 012: We submit our proposed communication systems
greatly exceed those proposed by AMR and we do not support the review
committee ranking of this item as well_
The Proposal Review Committee had and considered all of the information submitted by
all bidders.
In conclusion all issues of protest submitted by Priority One Medical Transport are
determined to be without merit and the protest is subsequently denied.
Nov 07 05 '05:13p p..5
Priority One Medical Transport remains a valued participant in the San Joaquin County
EMS System and I look forward to working with you and your organization in the years
to come.
Sincerely,
eA�
Kenneth B. Cohen, Director
Health Care Services Agency
Nov 07 05 05:13p
San Joaquin County Health Care Services
r"N
1020 • Stockton, CA 95201 • (209) 468-6600
D4 November 2005
Mark Lewis, City Manger
Slockton Medical Services
CIO City of Stockton Fire Department
425 North EI Dorado Street
Sltockton, CA 95202-1997
P.6
RE: Emergency Ambulance Service Request for Proposals (RFP) Protest
Dear Mr. Lewis:
The San Joaquin County EMS Agency and I have thoroughly reviewed and considered.
aN of the areas of protest filed by Stockton Medical Services (SMS) in protest of the
RFP recommendation.
The following are the responses to the issues of protest submitted.
SMAS, Assertion #1: In the "Credentials" section of its RFP Proposal AMR
materially misrepresented its reputation and its history.
Soction 3 of the RFI' refers to the overall contractual and regulatory performance of the
bidder and not individual instances of operational or clinical deficiencies. The
information submitted by American Medical Response — West meets the requirements
of the RFP.
SMS Assertion #2. AMR's proposal does not respond to many of
the RFP communications requirements.
'The information submitted by American Medical Response — West meets the
requirements of the RFP.
§M§ Assertion #3: AMR's proposal does not include in its budget
AMR's full costs for communications and 0 omits important data.
The report issued by Mass Adams confirms that all costs were appropriately accounted.
for in ttte bid documents submitted by American Medical Response — West and that the
proposal complied with the requirements of the RFP.
San Joaquin General Hospigi • Mental Health Services a Office of Substance Abuse
Public Heahh Services • Emergency Medical Services
Nov 07 05 05:I3p p.7
SMS Assertion *4: AMR's RFP proposal materially misrepresents the
communications and dispatch center resources that AMR proposes to use
in San Joaquin County.
The information submitted by American Medical Response — West meets the
requirements of the RFP.
SMS Assertion #5: AMR's response time and unit hour per week
numbers misrepresent AMR's actual deployment plan.
The initial deployment plan submitted by American Medical Response — West meets the
requirements of the RFP and establishes a "minimum resource deployment for the life
of the contract.' Additional unit hours are addressed in Section 4.1.2 8 of the RFP
which states that: `The Contractor shall redeploy ambulances or add additional
ambulance hours if the response time performance standard is not met_ Failure by the
Contractor to redeploy or add ambulance units within two months of notice by the
County shall constitute a major breach of contract."
SMS Assertion #6: If AMR's RFP budget accurately had stated the
full costs for its deployment plan, AMR would have stated costs
comparable to or greater than, the costs included in the City-
Rural/Metro budget.
The report issued by Moss Adams confirms that all costs were appropriately accounted
For in the bid documents submitted by American Medical Response — West. In addition
American Medical Response -- West committed to the proposed rates for two years and
included a rixed percentage for adjusting rates after two years.
SMS Assertion #7: AMR's deceptive and misleading deployment
plan also raises serious issues of public policy.
The information submitted by American Medical Response — West meets the
requirements of the RFP.
SMS Assertion #8: The facts do not support the conclusions of the
review committee and the Health Services Director that AMR's RFP
proposal demonstrated financial strength and stability.
We respectfully disagree.
SMS Assertion #8: The County failed to discern any of the serious
errors, omissions, inaccuracies and deficiencies in AMR's RFP
response.
We respectfully disagree with this premise.
Nov 07 05 05:14p P. �
SMS Assertion *10: The County failed properly to anatyze the
value of the City-RurallMetro's sole and total commitment to
provide superior ambulance in Zone B,
All of the proposals submitted in response to the RFP were carefully and thoroughly
evaluated.
SMS Assertion Nil: The County and its agents failed to follow
proper procedures to determine whether prior, present or planned
future business dealings with AMR created conflicts of interest for
the persons appointed to the response review committee.
None of the information provided by Stockton Medical Services demonstrates a conflict
of interest on behalf of any of the Proposal Review Committee members. Verification of
this was provided to you with each Committee member's Conflict of Interest Statement.
In conclusion all issues of protest subrnitted by Stockton Medical Services are
determined to be without merit and the protest is subsequently denied.
The City of Stockton Fire Department remains a valued participant in the San Joaquin
County EMS System and I look forward to working with you and your organization in the
years to come.
Sincerely,
'✓ 6z—
Kenneth B. Cohen, Director
Health Care Services Agency
AMR Proposal to County of San Joaquin for
Emergency Ambulance Services
Benefits: Model III
Under Model 111, AMR is offering the County the infrastructure and experience
necessary to develop and implement a single, integrated EMS, Fire, First Responder,
and fire suppression dispatch network. This network will give the County a single
point of accountability for EMS and fire suppression dispatching and resource
management. Highlights of our fully integrated dispatch proposal include the
following:
• Provision of industry-leading EMS and Fire dispatch at considerable cost
savings as compared with the current system; AMR is proposing low user
fees and user -group oversight of rate escalation.
a A brand-new, fully accredited Communications Center, staffed with highly
skilled, nationally certified EMDs, as well as certified Emergency Fire
Dispatchers (EFDs)
• Independent oversight from a user group comprised of EMS Agency staff,
North and South County Fire Department user groups, private ambulance
users, and a representative from the County Board of Supervisors, ensuring
true accountability and responsive service for the dispatch system
• Performance standards based on nationally recognized accreditation
requirements and national standards as established by the County and the
LIFECOM user group
All models will feature experienced leadership to oversee implementation of the
system and ongoing service to the community.
4.2.2.A. Dispatch Operations
Minimum Requirements: Accept dispatch requirements as described.
AMR accepts all dispatch requirements described on pages 28-29 of the RFP.
We are proposing a brand-new, technologically advanced Communications Center to
provide dispatching services and meet all EMD / EFD requirements for San Joaquin
County. This center, which is being built to replace our Stanislaus County
Emergency Medical Communications Center (Stanislaus Center) is located at 4701
Stoddard Road, Modesto, California, and is scheduled to open in April 2006.
For the purposes of dispatching services for San .Joaquin County, this center will be
known as LIFECOM; AMR's existing Center is licensed as a secondary Public
AMERICAN MEDiGAL RESPONSE
suis K_ Meyer Phone: 425-454-6020
Chief Executive Officer Fax: 925-454.6008
NoRhwesi-Plains Region
Date: August 16, 2005
VIA FACSIMILE
Michael Pretz, Chief
Lodi Fire Department
25 East Pine Street
Lodi, CA 95240
RE: Proposed Subcontract
Dear Chief Pretz:
This letter will confirm our most recent telephone conversation in which I affirmed
AMR's willingness to enter into a subcontract arrangement with Lodi as set forth in my
letter of April 20, 2005. As you know, AMR's position has been that any arrangement
between the parties must be consistent with applicable laws and the terms of the request for
proposals issued by the County, We believe it would be possible to finalize the proposed
financial relationship between AMR and Lodi in a manner that meets both of these criteria,
and believe we were well on the road to finalizing such an arrangement when our separate
negotiations with Stockton reached an impasse. We do not believe our impasse with
Stockton constitutes an impediment to finalizing a proposed arrangement with Lodi that
meets the foregoing criteria, and would be pleased to proceed with further discussions
toward that goal.
We look forward to hearing from you if you would like to proceed as discussed
above.
Very truly yours.
Lou Meyer
Chief Executive Officer
Northwest -- Plains Region
American Medical Response West, Inc.
023.273963.1 7575 Southfront Road, Livermore, CA 94551
10/.31'2005 11:`26 FAX
49/12/2005 10:36 FAX Q001/001
CITY OF LORI
FIRE DEPARTMENT
25 PAST ME STREET .10
LOK CALIFORNIA 45240
ADUNSMATION (109) 333 -GM FIRE FREVET MW M9) 333-6734
FAX (309) M 15944
VWW PWSM MdwNt E Rett Kevin tlonnegy
Fire ivi.r" Rre Chief (oerat wo Chief
George Juelch Jeff Larson Ron PMIx Ron Heberia
Ilion Chief 8st4Alion Chief Satmion Chief Trafninq officer
September 7, 2005
Lou Meyer
Chief Executive Officer
Northwest -Plains Region
American Medical Response West, Inc
7575 Southfront Rd.
Livermore, CA 94551
Hear Lou:
As you know, the City of Lodi has been following the developments relating to the County's
Response for Proposal for exclusive operating areas, The City of Lodi, through the Lodi Fire
Department, -is interested in forming a partnership with the selected ALS ambulance provider is
order to preserve our ability to serve our c.4uununity at our present level of service. We would
also like to explore the ability to increase our level of service from Basic Life Support (BIS) to
Advanced Life Support (AIS).
We are sending this letter to all of the entities that submitted a Letter of Intent to submit a
proposal. We will not commit to any provider until the RFP process bas been concluded. At the
conclusion of the bid process, however, we are looking forward to discussing a future
partnership. It is our hope that such a partnership will be included in the final contract with the
San Joaquin County EMS Agency. Lf you have any questions or would like to discuss the
m atter, feel free to contact me.
Sinccnsly
Michael E. Pretz, Fire Chief
City of Lodi Fire Department
cc: SJC SMSA
San Joaquin County
Emergency Ambulance RFP
July 12, 2005
Attachment K: Proposed Ambulance Rates
Bidder Priority One Medical Transport, Inc.
Zone A� B C Based on ro _ ed rates under option (circlet' A B
The undersigned company, a prospective bidder to provide emergency and advanced life
support ambulance service for the County of San Joaquin, recognizes that public health
and safety requires assurance of safe, reliable, and cost-efficient ambulance service.
The bidder shall commit that rates in effect at the time of contract execution remain in
effect for two years.
Advar„ od Life S'unpQrt
Basic Liie Su000rt
Emergency Base Rate ALS1
(A0427)
$930.40
Emergency Base Rate (A0429)
$585.00
Emergency Base Rate ALS2
(A0433)
$1,090.00
Emergency Response with
patient contact with or without
transport
$95.00
Emergency Response with
patient contact with or without
transport
$95.00
Night Charge
$78.00
Night Charge
$78.00
I.V. Therapy (A0394)
$35.00
I.V. Therapy
Not in Scope
Universal Precautions
No Charge
Universal Precautions
No Charge
Other
$0.00
Other
$0.00
Wait Time (A0420) per 114 Hr. 1st 114hr.
NIC
$35.00
Wait Time (A0420) per 114 Hr. 1st 114hr,
NIC
$35.00
Additional Attendant (A0424)
$60.00
Additional Attendant (A0424)
$60.00
Determination of Death (A0429)
BLS Base
Rate '
Determination of Death (A0429)
BLS Base
Rate
Treat and Release
$125.00
Treat and Release
$165.00
Mileage (per mile)
$19.75
Mileage (per mile)
$19.75
3
Standard Treatment Charges
Bandages
$19.50
Intubation
$45.00
Cardiac Pacing
$0.00
Meds Administration
SJGH Rates
Cervical Collar
$32.25
Oxygen (A0422)
$69.00
CID/Sand Bags
No Charge
Pulse Oximetry
$62.25
CPR
No Charge
Service Charge/Dry Run No Pt_
Contact
No Charge
Easy 10 (at cost)
$90.00
Defibrillation Pads/Pacing Pads
$75.00
Backboard, ridgid splints, KED
$36.35
EKG- Standard 3 -Lead
Included in
Base
Suction
$25.00
EKG 12 -Lead with interpretation
$90.00
Traction Splints
$64.75
Extrication (Minor)
see wait time
rate
Obstetrical Kit
$35.25
Extrication (Major)
see wait time
rate
Burn Kits
$35.25
San Joaquin County
Emergency Ambulance RFP
July 12, 2005
Proposed ambulance rates (page 2)
Bidder Priority One Medical Transport, Inc.
Zone A B C I Based on proposed rates under option circle A B
The undersigned company, a prospective bidder to provide emergency and advanced life
support ambulance service for the County of San Joaquin, recognizes that public health
and safety requires assurance of safe, reliable, and cost-efficient ambulance service.
The bidder shall commit that rates in effect at the time of contract execution remain in
effect for two years.
Emergency Base Rate ALS1
(A0427)
$1,040.00
Emergency Base Rate (A0429)
$685.00
Emergency Base Rate ALS2
(A0433)
$1,200.00
Additional Attendant (A0424)
$60.00
Emergency Response with
patient contact with or wothout
transport
$95.00
_.patient
Emergency Response with
contact with or without
trans rt
$95.00
Night Charge
$78.00
Night Charge
$78.00
I.V. Therapy (A0394)
$35.00
I.V. Therapy
Not in Scope
Universal Precautions
No Charge
Universal Precautions
No Charge
Other
$0.00
Other
$0.00
Wail Time (AD420) per 114 Hr. 1st 1I4hr.
NIC
$35.00
Wait Time (AD420) per 1!4 Hr. 1st 114hr.
NIC
$35.00
Additional Attendant (A0424)
$60.00
Additional Attendant (A0424)
$60.00
uetermination of ueath
6L5 base
Rate
ueterminatlon of ueatn
uLb t5ase
Rate
Treat and Release
$125.00
Treat and Release
$165.00
Mileage (per mile)
$21.75
Mileage (per mile)
$21.75
Standard Treatment Charges
Bandages
$19.50
Intubation
$45,00
Cardiac Pacing
$0.00
Meds Administration
SJGH Rates
Cervical Collar
$32.25
Oxygen (A0422)
$woo
CID/Sand Bags
No Charge
Pulse Oximetry
$62.25
CPR
No Charge
Service Charge/Dry Run No Pt.
Contact/ Cancelled by Fire PTA
No Charge
Easy 10 (at cost)
$90.00
Defibrillation Pads/ Pacing Pads
$75.00
Backboard, ridgid splints, KED
$36.35
EKG- Standard 3 -Lead
Included in
ALS Base
Rate
Suction
$25:00
EKG 12 -Lead with interpretation
$90.00
Traction Splints/ Air Splints
$64.75
Extrication (Minor)
See wait time
rate
Obstetrical Kit
$35.25
Extrication (Major)
See waft time
rate
Burn Kits
$35.25
San Joaquin County
Emergency Ambulance RFP
July 12, 2005
Attachment L: Charge scenarios
Bidder Priority One Medical Transport, Inc.
Zone A B C Based on proposed rates under option (circle) I A B
Charges are to be based on the rate schedule submitted in this proposal. If an item is included
in the base rate, or if there is no charge for an item, indicate this on the form. Identify additional
specific charges (e.g., charges to perform any of the identified skills) or routine charges (e.g.,
infection control charge) in the blanks provided. The total shall reflect all specific and routine
charges that a patient in this type of scenario would be billed.
SCENARIO #1: A 56 year-old male is complaining of chest pain. This call occurs at
2:00 a.m. and the patient's home is 12 miles from the closest hospital.
Total
$1,474.88
Base rate
930.40
Emergency response
95.00
N' ht charge
78,00
12 miles transport
237.00
O en
69.00
Oxygen administration equipment
Included in Oxygen erg Char e
I.V. administration equoment
35.00
Cardiac monitor
3- Lead No Char e
Nitroglycerin 9r, 11150 s.l.
15.64
Mo hive Sulfate 4 mg. I.V.
13.24
Aspirin
1.60
San Joaquin County
Emergency Ambulance RFP
July 12, 2005
Charge scenarios (Page 2)
Bidder Priority One Medical Transport, Inc.
Zone A B C Based on pTposed rates under option (circieLl A B
SCENARIO #2: A 25 year-old unconscious diabetic is treated with glucose and refuses
treatment signing out AMA. Field personnel spend .45 minutes on this call prior to
clearing.
Total 95-00 Flat Rate
Base rate
Emergency response 95.00 —Flat Rte
Oxygen
I.V. administration equipment
I.V. solution
Glucose
Narcan
Cardiac monitor
Note: No ether charges.
San Joaquin County
Emergency Ambulanoe RFP
Juiy 12, 2005
Charge scenarios (Page 3)
EUdder Priority One Medical Transport, Inc.
Zone1 B C I Based on proppsed rates under option (circle ) --FA— 8
Charges are to be based on the rate schedule submitted in this proposal. If an item is included
in the base rate, or if there is no charge for an item, indicate this on the form. Identify additional
specific charges (e.g., charges to perform any of the identified skills) or routine charges (e.g.,
infection control charge) in the blanks provided. The total shall reflect all specific and routine
charges that a patient in this type of scenario would be billed.
SCENARIO #1: A 56 year-old male is complaining of chest pain. This call occurs at
2:00 a.m. and the patient's home is 12 miles from the closest hospital.
Total
$1,608.48
Base rate
1 040.OD
Emergency response
95.00
Night charge
78.00
12 miles transport
261;0.0
ORgen
69:00
ORgen administration equipment
included in O en Char e
I.V. administration equipment
35.00
Cardiac monitor
3 -Lead No Char 'e
Nitroglycerin 9r. 11150 s.l.
16.64
Morphine Sulfate 4 mg. LV.
13.24
Aspirin
1.60
San Joaquin County
Emergency Ambulance RFP
July 12, 2005
Charge scenarios (Page 4)
Bidder Priority One Medical Transport, Inc.
Zone A B C t rased on proposed rates under option (circleF A B
SCENARIO #2: A 25 year-old unconscious diabetic is treated with glucose and refuses
treatment signing out AMA. Field personnel spend 45 minutes on this call prior to
clearing.
Total 9'6 00 —_ Flat Rate
Base rate
Emergency response :95.00 — Flat Rate
0 en
I.V. administrationequipment
I.V. solution
Glucose
Narcan
Cardiac monitor
Note: No other char e