The Danes are Coming! (Who?)

Being fully retired after a 12-year stint as a volunteer EMT responder while consecutively serving most of that time as operations manager for the Anderson Valley Ambulance Service, I feel I can speak my piece about Mendocino County's emerging ambulance controversy.

In 2009, Mendocino County hired the consulting firm Fitch and Associates, LLC for assistance in evaluating the County's Emergency Medical Services (EMS) system. Fitch duly issued a report dated February 14th, 2011.

Many EMS providers in the County were not aware of this report.

Based on urban standards, most of the recommendations were not doable in our rural environment. The report did acknowledge in its conclusion that, “Mendocino County's EMS system is comprised of multiple providers responding to emergency medical events. The system is challenged by long distances, low population density, below average payer reimbursement and limited resources. It functions due to the dedication and commitment of the existing providers. Serious patient care issues are being avoided due to this ‘whatever it takes’ to care for the patients approach exhibited by the providers.”

Given that resolution of the many recommendations within the report would cost the County lots of money, the County tucked in its neck and sat on the issue. Wise move I suppose. Why fix something that isn't really broken?

In 2012 Leonard Winter, owner of Ukiah Ambulance, started letting it be known that he was creating a non-profit ambulance service, Medstar, to replace his Ukiah Ambulance so that he could apply for grants that would allow Medstar to provide ALS (Advanced Life Support) services to outlying areas like Anderson Valley. The all-volunteer Anderson Valley Ambulance Service operates BLS (Basic Life Support). Most of us wondered what would  happen when the grant money dries up that would pay for the expertise of Advanced Life Support. Live by grants, die by grants.

In 2013, Ukiah Ambulance was purchased by Medstar just about the same time as an interloper by the name of Verihealth showed up in Mendocino County and started taking 911 calls. Verihealth could move in because Mendocino has no EOA (Exclusive Operating Area) in place that would limit emergency response to a single provider.

Verihealth had no in-County headquarters. We would find them perched vulture-like along State Street both North and South, thus providing themselves maximum billboard visibility and in an advantaged position to respond to emergencies.

Stories started to circulate of local established Ukiah/Medstar and usurper Verihealth/Falck ambulances racing each other to 911 calls. Many of us in the responder community were baffled why anyone would want any part of such a low call volume and therefore low economic return. And most of us were worried about the hit that Ukiah Ambulance (now Medstar) would take from the predatory, outside-based newcomer.

The answer soon became known within Mendocino EMS circles. Verihealth had been purchased by an outfit named Falck and they wanted to become the official EMS provider for the Sonoma Raceway — probably for the high visibility and prestige. The hangup was that to do so required that Verihealth/Falck must be providing 911 emergency response within the Coastal Valley EMS Agency jurisdiction. Falck, a Danish Company and the largest ambulance service provider in the world, has the resources to do what it wants and it was doing just that.

On April 21, 2014 it was announced in Business News that "Verihealth has been named official emergency services provider of Sonoma Raceway. It will provide ambulances on a daily basis to cover track rentals, Simraceway Performance Driving School activities and major-event weekends. A Verihealth ambulance will also be on standby at the raceway around the clock in order to quickly respond to nearby emergencies and traffic accidents. The multiyear deal also includes naming entitlements to the raceway medical center, first-aid centers and first-aid stations, as well as the annual High-Speed Blood Drive. Combined with Falck Northern California’s new operation, Verihealth has a staff of more than 300 employees and a fleet of 50 ambulances.”

Here in Mendocino we have seen the backs of Verihealth ambulances in Ukiah turned into billboards now advertising their involvement with Sonoma Raceway.

Bouncing back to 2013. When the Mendocino Board of Supervisors realized that the lack of an exclusive operating area (EOA) was causing quite a disturbance, the Supes rehired Fitch and Associates, LLC to do a study to determine just what an EOA in Mendocino might look like.

Fitch again based their findings on an urban-based model. Their position as stated in a community meeting held in Boonville at the Senior Center was that ALS was the “Gold Standard” of EMS response and that an EOA should include a way of providing ALS response for Anderson Valley as well as other outlying areas, Covelo for instance.

With a call volume that hovers around 150 calls per year there is no way in Hades that ALS in Anderson Valley is economically viable. Fortunately there are emergency room docs as well as our own Dr. Ron Gester who feel the backbone of good EMS is a strong, well trained BLS response.

The Mendocino Board of Supervisors seemingly has abandoned the Fitch and Associates EOA model. Instead they have tasked the local agency under which Mendocino ambulances operate, Coastal Valley EMS Agency, along with another outfit named Abaris to develop a plan (and a Request for Proposals for the EOA) which they hope to have available for review by June. Coastal Valley made it clear to Abaris that they were not interested in a cookie cutter plan but one that addresses the real issues of Mendocino County.

The upshot: An exclusive operating area contract will be put out to bid. But who can outbid the largest, richest ambulance company in the world? The Danish conglomerate will win by lowballing the initial contract period and then on the second go around, with Medstar pushed totally out of the picture, come back with whatever they feel they can get out of Mendocino County's ambulance services. I'd call this Walmarting EMS except for the fact that Walmart at least gives lower prices and Verihealth/Falck will be free to charge whatever they can squeeze from our pockets because of a noncompetitive market.

Phase Two

Whenever it was hinted to them that Verihealth was an usurper, corporate picture painters would point out that Verihealth had actually been doing inter-facility transfers (IFTs) in Mendocino since 2010. The idea being, Hey, We've been around awhile, lighten up.

Most of us “in the trucks” — volunteers doing 911 responses — weren't that up to date on IFTs other than hearing occasionally that as non-emergency services they were the bread and butter of medical transport.

And if you thought the Medstar vs Verihealth/Falck issue would be napping until June you are wrong. On January 13th of this year a civil matter was placed before the Superior Court of California, County of Mendocino by Medstar Ambulance as Plaintiff vs VeriHealth; Falck; Adventist Health Systems West; Gary Tennyson (Verihealth), Sean Sullivan (Falck) and Does 1-100 as defendants.

The Plaintiff, Medstar, alleges that Adventist Healthcare Systems West (AHSW) operated or operates a transfer or dispatch business through which it dispatched ambulances and other non-emergency vehicles for inter-facility transfers and other transportation purposes. At some point Adventist contracted with Verihealth/Falck to operate the transfer center and dispatch ambulances and other non-emergency vehicles. Verihealth/Falck was authorized to use various names used by Adventist.

The gist of what happens in this situation, and these are my words not those of the suit itself, is that as a medical vehicle dispatching agent Verihealth/Falck was given what we emergency response people would call a “face sheet” which includes various important info on the transport including but not limited to nature and level of transport as well as the insurance status of the person being transported.

Higher levels of transport pay more money than others and certain methods of insurance pay more money than others. It is alleged by Medstar that by having this information Verihealth/Falck was able and did repeatedly guide the lucrative transports to its vehicles and the lower paying transfers to Medstar. Medstar further alleges that all of those named as defendants did either conspire to commit, participated in, approved and/or ratified the wrongful acts of Verihealth/Falck.

Ukiah Ambulance, now known as Medstar, like Anderson Valley Ambulance Service, has been a steady performer in Mendocino County EMS. Whenever a local call appeared to possibly need a higher level of care than we could provide, Ukiah Ambulance was paged and they responded. Not once in my 12 years was a patient outcome compromised because of our basic life support level service. Mendocino County deserves the steady and reliable service of locally owned and operated EMS not a corporate global giant with the same ethics of all the other One Percenters.