By Claire Harlin
Having emergency ambulance service is a standard of living that many may pay little attention to unless it’s not up to par, and in the case of County Service Area 17 (CSA 17), which includes Del Mar, Solana Beach, Rancho Santa Fe and Encinitas, 10-minute response time standards have been consistently met with shining colors over the years and residents have been content.
But just as you may not have been aware you were part of a special emergency medical service (EMS) district, you may not know that the county actually outsources EMS, just as is does with many other services, and counties nationwide are increasingly contracting with third-party providers to avoid high pension costs and other expenses. Rural Metro Corporation has provided EMS to both CSA 17 and the City of San Diego for 12 years, however, that could change next spring, as the county is currently re-contracting for EMS service — and a change in provider could greatly impact CSA 17, whose cities have very different demographics and needs.
“Right now we have great service,” said Barbara Cerny, who sits on the CSA 17 Advisory Committee as part of the Torrey Pines Community Planning Group. “What worries me, though, is that the county may go with the lowest bid and if that means contracting with a new EMS provider, it may compromise service.”
Cerny also said that a change in EMS provider means all the employees have to go from one company to another — that is, if they keep their jobs.
As a former, decades-long fire department employee, Cerny understands the workings of CSA 17, which was formed by the Board of Supervisors in 1969, and is watching the process closely — mainly because she has concerns ranging from mutual aid to a lack of public input on the process.
The competitive bid process provides an opportunity for the county to evaluate its EMS service and include any new guidelines in its request for proposal (RFP), a detailed “job description,” so to speak, that goes out to EMS providers wishing to bid on the some $5 million contract. Before the RFP goes out, the county is to hold a request for information (RFI) meeting to allow the public to voice any concerns, and officials may also order a third party to conduct a formal analysis of EMS performance in an effort to steer guidelines set forth in the RFP.
A special public meeting was held in late August and an RFI meeting was held on Sept. 6, however, members of the public were present at neither. Representatives from a handful of interested EMS companies were present at the RFI meeting, however, and Cerny said the county’s failure to inform the public about the so-called “community forum,” leads her to believe the meeting was geared more toward potential bidders than the public. American Medical Response (AMR), the company San Diego County contracted with prior to Rural Metro had a “big presence” at the meeting, said Cerny, and they are also winning new contracts in other parts of the state.
Marcy Metz, the county’s EMS director, said there were no local advertisements for the meeting, and the only prior outreach was via flyers passed out to advisory board members and a posting on the county’s BuyNet website — an online interface for purchasing, contracts and e-commerce that, although public, is not highly visible to the everyday local resident.
In addition to thinking there should have been more public input on the process, Cerny said the county should have done a formal study on CSA 17, analyzing response times and ambulance placement amid changes in population, traffic and other factors. Last time the county contracted for EMS in 2006, officials did two studies that cost more than $50,000, but no new study has been done since.
At the request of the advisory committee, however, officials at the two recent meetings still presented an in-house comparison between current conditions and those from the 2006 study, and some concerns were noted.
One major issue is that Del Mar Heights, which is technically part of San Diego but was annexed into CSA 17 in 1976, is nearly entirely reliant on mutual aid from the City of San Diego, which also uses Rural Metro but is re-contracting as well. Without response from San Diego’s ambulances, standard response times in Del Mar Heights were only met between zero and 50 percent of the time, according to county documents, however, they were met 90 to 100 percent of the time when mutual aid was factored in.
“CSA 17 has to be self-sufficient,” said Cerny, adding that residents of Del Mar Heights have been lucky that San Diego also uses Rural Metro and can provide mutual aid without additional costs. “If any other companies win the bid then San Diego is out of the picture.”
Despite the reliance on mutual aid, Metz said there is no connection between San Diego and CSA 17 in their contracting processes, however, “bidders can be innovative in how they propose to provide service.”
“We provide the framework, and they come up with a way to operate,” she said, adding that there could be higher transport fees if mutual aid is used between two different companies. “Our goal is that it’s fair, competitive and remains objective going through the process.”
Metz said the most important thing for the community to know is that the response time standard of 10 minutes, 90 percent of the time, will not change for CSA 17.
There’s a two-year review period that can end the contract, said Cerny, however, she said the advisory board also suggested implementing penalties if guidelines are not being met.
Winston McColl, San Diego County’s director of purchasing and contracting, said standards set forth in the RFP cannot be discussed before it opens for bidding, but the RFP will “probably be similar to the current contract.”
The RFP will most likely post this month, he said, and the entire process takes about six to seven months.
The county’s Health and Human Services Agency (HHSA) will choose members to be on the selection committee, which will choose which company will be awarded the contract. The committee is anonymous and usually consists of voting members and non-voting technical experts. He said a member of the public may sit on the selection committee, however, that’s up to HHSA.
“They may enter negotiations with the top one or two or they may go straight to No. 1,” he said, adding that price is not the driving factor. “Many things are considered, from staff resumes, to training to past performance.”
More information about CSA 17 can be found on the county’s HHSA website at www.sdcounty.ca.gov/hhsa. To contact someone on the CSA 17 Advisory Committee, call (619) 285-6429.