Keep Mendo’s Ambulance Services Local
by Mark Scaramella, August 2, 2017
In 2013, the second of two expensive studies pointed out the obvious: Mendocino County’s emergency medical services were inadequately funded, uncoordinated, hard to staff and fragile.
At about that same time a huge Denmark-based medical services corporation named Verihealth showed up in Ukiah and started responding to 911 calls, creating a crazy race to emergencies to see who get to the patient first and get whatever reimbursements could be billed for.
Mendocino County soon announced that the solution to both problems was the establishment of something called an Exclusive Operating Area (EOA), contracting with one outfit, public or private, for exclusive ambulance coverage for a designated area of the County, primarily the Ukiah Valley.
Close observers saw parallels with the county’s trash hauling contract with Solid Waste of Willits and the still controversial mental health privatization contracts. In other words, the "solution" would probably depend heavily on who got the exclusive contract and what area was declared exclusive.
According to a 2013 question-and-answer collection on the County’s website, "An EOA is the only means by which the County would be able to limit ambulance operations in a given area to the entity (or entities) which best serve those communities. It is also the only legal means by which citizens, through their elected representatives, would be able to ensure that services meet their expectations. It also allows services competing for the same area the opportunity to compete through a transparent proposal process.”
But that “transparent proposal process” has been anything but transparent. In fact, nothing new has been added to the County’s EOA webpage since that initial flurry of activity in 2013.
Instead, Mendocino County turned the process over to a Sonoma County "contracted local EMS agency" named Coastal Valley EMS. Coastal Valley held meetings, County emergency services organizations and fire departments held meetings, input was taken, an authorizing ordinance was drafted and prepared, and, after several false starts, a Request for Proposals was drafted — but never released for bids.
The entire RFP drafting process was conducted in secret on grounds that doing it through a public process might give an unfair advantage to potential bidders.
Even though Mendo has unique emergency services problems, Official Mendocino County seemed satisfied to turn this important project over to the private Sonoma County agency with Mendo sort-of piggybacking on whatever Sonoma County did — even though most of Sonoma county is suburban while most of Mendo is rural.
The process has dragged out over the intervening years, as local emergency service agency personnel complained privately and became increasingly suspicious of the secrecy involved. Early on, the three ambulance services on the Mendocino Coast griped enough to get themselves excluded from any inland-based Exclusive Operating Area. But the Highway 101 corridor and Anderson Valley were left in limbo with the same fragile situation the two earlier studies had documented.
A 2013 Q&A about the Exclusive Operating Area on Mendo’s website offered this reply in answer to how an EOA would be funded: “Funding would be derived primarily from reimbursement by insurance companies, Medicare, and Medi-Cal for transporting patients.”
This answer shows that Mendo has no real understanding of how ambulance services are funded. If an ambulance operation depended on insurance reimbursements for 9-11 calls alone they’d be bankrupt in a year or have to charge a lot more than their already high costs. Medicare and Medi-Cal pay only pennies on the dollar and while private insurance companies pay more, it’s still not enough to cover the costs. In Anderson Valley — as with most rural ambulance services — if it weren’t for substantial revenue enhancements from memberships, donations, or other crossover services (such as ER supplementation during non-response times) there wouldn’t be an ambulance service, even one staffed by volunteers.
In Ukiah, Verihealth has figured out a way to cherry-pick most of the “interfacility transfers” by getting Adventist Health to turn over inter-hospital dispatch to Verihealth which then calls its own ambulances, taking away a major funding stream from Medstar the small non-profit that operated in Ukiah for years prior to Verihealth. Medstar sued, but that case is still open while Verihealth still gets that lucrative, cheap-to-provide non-emergency business.
In the intervening years since 2013 it came to light that the County needed to legally and formally enact a complicated, legalistic “enabling ordinance” before they could issue an RFP. This was also assigned to Coastal Valley EMS and was also conducted in secret. A few months ago that ordinance was finally complete.
When the status of the EOA ordinance and the RFP drafting process occasionally arose at supervisors meetings, representatives Coastal Valley EMS would grudgingly concede that the Board of Supervisors had the final authority to decide whether to authorize an Exclusive Operating Area and contract with a (probably private) service provider. But the reps from Coastal Valley made it sound like Mendo’s role was more of a rubber stamp after Coastal Valley handed them the paperwork to sign, not a partner or authority in an important decision.
Making matters even more dicey, somewhere along the way Coastal Valley decided that fire and ambulance dispatch services, currently handled through the Calfire’s Dispatch office at the top of the Willits Grade, should to be part of the bid package — a transparent attempt to privatize dispatch services, perhaps to a remote operation far from Mendocino County.
Coastal Valley presumably thought that including dispatch services in the RFP might make the package more attractive to potential bidders. But local emergency responders — including a unanimous vote of the Mendocino Fire Chiefs Association — complained, saying that the dispatch services should be dealt with separately, if at all. But if that happens, then why privatize dispatch at all? (Mendo pays Calfire several hundred thousand dollars a year for dispatch services.)
Remember, the Exclusive Operating Area idea only surfaced when Verihealth entered the picture butting in on ambulance calls, undermining the already fragile balance sheets of the inland ambulance services which were already in place.
It doesn’t take much of a conspiracist to think that the entire effort was really a way to turn the whole show over to Coastal Valley EMS and a big private ambulance company like Verihealth who as far as anyone could tell, could be orchestrating the entire secret process (which until recently included dispatch services) to turn over the most lucrative ambulance service areas to a private company (which could easily low-ball their bid to get their exclusive foot in the door) and leave the rest of the County’s small ambulance services with whatever’s left of the less profitable, low volume calls. Coastal Valley’s attempt to include dispatch services in the RFP was further indication of a tilt toward large outfit privatization because local ambulance service providers don’t have background or experience with dispatch services, and therefore couldn’t bid.
Enter Lynda Hopkins.
Lynda Hopkins is a young Stanford grad and small scale vegetable farmer in western Sonoma County who somehow beat Noreen Evans, the Democratic Party’s chosen replacement for Efren Carrillo as Sonoma County Fifth District Supervisor, in November of 2016.
Supervisor Hopkins’ Fifth District in Sonoma County is more rural than the other Sonoma County supervisorial districts and so she started hearing complaints from the rural fire departments in her district about Coastal Valley EMS and their plans to set up an Exclusive Operating Area in Sonoma County.
In June of this year Supervisor Hopkins wrote a scathing (by northcoast political standards) letter to the Sonoma County Department of Public Health finally saying in public and on the record what many emergency responders both in Mendo and Sonoma County had been grumbling about: that the entire process was being badly handled in closed rooms, that Coastal Valley was being high-handed, and that if left alone would seriously jeopardize rural fire departments and ambulance services.
In early July, Press Democrat reporter Martin Espinoza opened his account of Ms. Hopkins letter and its reaction in Sonoma County with, “Supervisor Lynda Hopkins has slammed the brakes on a move to rewrite the rules governing local ambulance service in Sonoma County, claiming the draft in its current form would financially harm local fire districts that provide ambulance services.”
A week later Gualala-based Independent Coast Observer reporter S.J. Black (whose readership includes a chunk of Ms. Hopkins northern Sonoma County constituency) wrote a similar article entitled, “Emergency medical ordinance gets fresh start.”
It took some digging but we finally found Supervisor Hopkins original letter. It’s four single-spaced typed pages (and can be found on our website in its entirety).
Here are some excerpts:
“The Fire/EMS providers in our district do not generate income from fighting fires. Although the EMS side is not profitable, the revenue generated from EMS supports the overall mission of the agency. Ifyou take away or compete with the ambulance service these agencies provide, you will take away the revenue that supports the firefighter/EMS personnel that provide it. Without them, the overall mission of the agency will be severely compromised.” …
“To be perfectly clear, I will oppose any attempt to create a system that places public agencies in competition with a private provider and/or requires that they assume a subservient position and have to contract with a private provider to remain in service. This position has been advocated by the current LEMSA [Coastal Valley EMS], both orally and on a distributed flow chart. It is not acceptable. As I studied the ordinance and spoke with the providers in my district, I became troubled by their reports of how they have been treated by CVEMS. They have been threatened, denigrated, demeaned and bullied. This treatment is not acceptable — especially not from a public agency subservient to DHS [Sonoma County Department of Health Services] and the Board of Supervisors.” …
“It is time to stop the endless rounds of negotiations that have resulted in the denial of exclusive operating areas to all of the public [my emphasis, not Hopkins] service providers. To date, the only current exclusive operating area, granted by LEMSA, has been given to a private provider. There is no reason to imagine that the LEMSA's stance will change, which is why the exclusive operating areas of public agencies must be clarified and codified by County ordinance.” …
“Therefore, I will oppose any ordinance that does not expressly recognize those exclusive operating area rights and will seek to pass an ordinance that places those agencies on a safe, sound foundation so that they may continue to serve their communities without threat or interference. Finally, I will firmly and publicly oppose any ordinance that grants a LEMSA the right to grant contracts that interfere with those public provider exclusive operating areas. For the reasons stated above, the draft ordinance and the governance structure it proposes are not acceptable to me. I plan to take a strong and vocal position against it. Furthermore, the current treatment of the public service providers, by the current LEMSA, is also unacceptable and I intend to take steps to make sure whatever agency we utilize works in a cooperative, respectful and professional manner.”
After reading Ms. Hopkins letter one local official who’s been following the situation told us that it looked like Coastal Valley was “intent on wiring things for their favored outside corporation. Why else take three runs at putting CV [Coastal Valley] in charge of the final decision on EOAs? And why else attempt to exclude CDF from dispatch, and Medstar [the private ambulance service in Ukiah that Verihealth started competing with in 2013] from ambulance service by attempting to issue a single RFP for both functions? … Bribery has to end up on the short list of potential explanations for CV's consistent approach to the issues at hand.”
In the weeks that followed Hopkins’ letter, Sonoma County’s Director of Department of Health Services, Barbie Robinson, quickly reversed course and announced that they were starting over in Sonoma County, telling Independent Coast Observer reporter S.J. Black, “We heard from our stakeholders and constituents, a lot of them, that they wanted to be more engaged in the process and have more information. Our goal is to hit the reset button and start from the beginning."
What does this mean for Mendocino County?
Nobody knows. Official Mendo is still in the dark, expecting the Sonoma-based Coastal Valley EMS to handle Mendo’s EOA in spite of everything, blithely unaware of Ms. Hopkins’ letter and Sonoma County’s subsequent restart.
Since we can’t expect anything from Hopkins’s Fifth District Supervisor counterpart in Mendocino County, someone like another Supervisor or CEO Carmel Angelo or Health and Human Services Director Tammy Moss-Chandler will have to raise the issue — and make sure that rural public ambulance providers like the Anderson Valley Fire Department are not undermined, dictated to or imposed upon by the likes of Coastal Valley or Verihealth.