Options In Ambulance Service Delivery
City Council Meeting
February 15, 2022
Scott Westrope
Fire Chief
1 OVERVIEW
• On November 30, 2021, the Fire Department
presented a Study Session examining:
• The current Request for Proposal (RFP) process being
managed by Sonoma County related to the contract
award of Exclusive Operating Area (EOA) ambulance
service.
• The anticipated options for ambulance service,
specifically a comparison of a private entity franchise and a public entity franchise.
2 OVERVIEW
• As a result of this Study Session, the Fire
Department received direction to examine:
• Feasibility of withdrawing from EOA-1 and establishing and EOA exclusive to the Santa Rosa city limits.
• Contracting ambulance service for the newly developed EOA.
• This Study Session will examine the following
information as it pertains to the aforementioned
direction:
• Legal risk/benefit analysis
• Available data sets related to current EMS system
performance and compliance
3 Legal Framework
• A request for legal analysis was presented to the
City Attorney’s Office with the following questions:
• Can a charter city withdraw itself from a county Exclusive Operating Area (EOA)?
• Can a new EOA be created to serve within the city limits? • What is the process for creating a new EOA and
contracting directly for ambulance service within the city limits?
• What would be the ‘scope of work’ and timeline for such an enterprise?
• What legal hurdles might the City face in such an
enterprise? 4
Legal Framework
• The EMS Act (1980) establishes statewide policies
for the provision of emergency medical services
in California (Health & Safety Code 1797.200 et
seq.).
• The EMS Act aims to achieve integration and
coordination among various governmental
agencies and EMS providers.
• EMS Act creates consistency in prehospital
emergency medical services via State EMSA and
Local LEMSAs.
5 Legal Framework
• The EMS Act grants counties the authority to
designate a local EMS agency to administer
emergency medical services countywide (H&S
Code 1797.200).
• The local EMS agency may be a county health
department, a county agency, a contracted entity
or a joint powers agency (H&S Code 1797.200).
• Each local EMS agency may create one or more
Exclusive Operating Areas (EOA) (H&S Code
1797.224).
6 Legal Framework
• Sonoma County:
• Coastal Valleys Emergency Medical Services Agency
(CVEMSA) under Sonoma County Department of
Public Health
• Single Exclusive Operating Area (EOA) – EOA-1
• RFP issued for ambulance services in EOA-1
7 EOA - 1
8 Legal Framework
• H&S Code Section 1797.201 grants “grandfather”
status to cities that were providing EMS services
on June 1, 1980 and that have continued to do so
without interruption (commonly known as
“Section 201 rights”).
• Santa Rosa’s entitlement to Section 201 rights is
subject to proof and would likely be challenged.
9 Legal Framework
• Beyond Section 201 rights, H&S Code is silent as to a cities’ right to withdraw from an existing EOA or to
create its own EOA.
• Prior Court decisions have indicated that cities’ rights are limited to the grandfather provisions of Section
201
• California Supreme Court:
• Valley Medical Transport, Inc. v. Apple Valley Fire Protection District (1998)
• County of San Bernardino v. City of San Bernardino (1997) • California Court of Appeal
• City of Oxnard v. County of Ventura (2021)
10 Legal Analysis
• However, avenues may be open:
• Santa Rosa is a Charter City
• Seminal cases did not distinguish between general law or charter city status
• The question for the courts will be whether charter cities have greater authority and autonomy under the EMS Act status given that police, fire and emergency services have historically been deemed matters of municipal affairs.
• Petition for review has been filed requesting California Supreme Court review of City of Oxnard v. County of Ventura • Supreme Court has not yet acted on the Petition 11
Legal Analysis
• Legal process, scope of work, timeline:
• Dictated by Sonoma County Code 28-8 – Response Zones:
• City Council would request a change to ambulance service provider to LEMSA;
• Matter would be heard at a regularly scheduled meeting; • LEMSA would consult with LAFCO;
• LEMSA shall take into account medical appropriateness and operational impact on the coordinated system;
• LEMSA may make recommended changes, deny the change or conduct a competitive bid process.
12 Legal Analysis
• Legal process, scope of work, timeline (con’t):
• If the City disagrees with the decision, it can request a hearing under section 28-21 of the County Code. (15 Days)
• Hearing Officer will render a final administrative decision. (5 days) • Final Administrative Decision subject to judicial review via Writ of Mandate. (several weeks to prepare)
• Judicial hearing would occur. (>180 days after Writ filing) • Judicial decision will strongly consider impact of surrounding communities' ability to contract for high quality EMS services. 13 Legal Analysis
• Legal analysis summary:
• The City could consider requesting the creation of a
second EOA.
• The time and cost of such an endeavor is unknown.
• Significant court proceedings are likely.
• Process likely to extend beyond award of ambulance
contract.
• Proposals Due – March 1, 2022
• Proposal Review and Selection – March 16, 2022
• Notice of Award – April 5, 2022
14 Data Request Update
• Requests for Data To:
• AMR
• REDCOM
• CVEMSA (Sonoma County Public Health)
• Focused on EOA Contact Compliance
15 Data Analysis
Level 0 Instances
16 0
100
200
300
400
500
600
700
800
2014 2015 2016 2017 2018 2019 2020 2021
Sum of Level 0
Sum of Level 0 > 5 Minutes
Sum of Penalty Level 0 Events
Data Analysis
Mutual Aid by AMR Out of EOA
17 0
200
400
600
800
1000
1200
1400
2019 2020 2021
SLSA - VeriHealth/OCD
SLSA - Verihealth South/LAKEVILLE
SLSA - Sonoma Valley Fire
SLSA - Russian River
SLSA - Petaluma Ambulance
SLSA - Forced Call
SLSA - Coast Life Support
SLSA - Cloverdale
SLSA - BODEGA BAY
SLSA - BELLS
SLSA - AMR Out of Franchise
Data Analysis
Mutual Aid to EOA
18 0
200
400
600
800
1000
1200
1400
1600
2019 2020 2021
VEHA
SON
SCY
RRF
PTL
FALK/LFWA
CLOV
BELL
BDB
Data Analysis
Response Times
19 Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov 2019 2020 2021
80.00%
82.00%
84.00%
86.00%
88.00%
90.00%
92.00%
94.00%
96.00%
98.00%
Average of Raw
Compliance
Average of
Adjusted
Compliance
Data Analysis
Response Times
20 0
5000
10000
15000
20000
25000
30000
2019 2020 2021
Sum of Late
Calls
Without
Exemptions
Sum of Late
Calls With
Exemptions
Sum of On
Time
Continued Data Analysis and
Requests
• Continued and on-going analysis is requisite:
• Response Times and Exemptions
• EOA Contract Compliance Reports
• Need for Additional Data
• Daily EOA System Staffing
• Conclusions
• The request for data has created opportunities to have conversations about the health of the EMS system in Sonoma County as a whole.
• Transparent monitoring of EOA compliance and guide the SRFD in the creation of a contact for FRALS or additional services during the next EOA contact cycle. • Continued data sharing opportunities. 21
Options for Moving Forward
• Use this time as an opportunity to negotiate a
contract with the new EOA-1 ambulance provider
which focuses on service delivery to the citizens of
Santa Rosa.
• Use this time as an opportunity to lobby for
changes to relevant local ordinances and H&S
Code 1797 et seq. to allow additional rights to
cities regarding emergency medical service
delivery in their community.
22 QUESTIONS?
23