Alameda's Emergency Care Is on the Line Tonight



You've just been in a major accident. Blood is running down your face, your lungs have collapsed and then your heart begins to fail — you need paramedics and you need them yesterday. If you've found yourself in the city of Alameda, you currently have no worry; you'll receive a level of care on par with an emergency room by the city's own fire department paramedics. Yet, this ER-level care is threatened because of an ongoing dispute between the city and the Alameda County Emergency Medical Services Agency.

Tonight, the Alameda City Council is scheduled to decide whether it can afford to continue its topnotch fire-department paramedic care system, or whether it will attempt to go with a cheaper, private paramedic service that could leave some emergency patients stranded. At the heart of the council's decision is a five-year impasse with the county over how much the city must pay to use county trauma centers and other services. If Alameda wants to keep using its own fire department paramedics, then the county says the city must pay $860,000 a year and sign a contract by January 3.

By allowing the fire department's paramedics to service the town, the city may be able to stave off firing nineteen paramedics, according to a report by interim Alameda Fire Chief Michael Fisher, and the city would still be able to recuperate revenue from insurance companies for transporting patients. Moreover, city residents would still get quick emergency response times. Fisher is recommending that the council approve the contract with the city and pay the $860,000.

But if the city refuses, then Alex Briscoe, the acting director with the Alameda County Health Care Services Agency, said the county will exercise its authority and prohibit Alameda Fire Department paramedics with advanced life support training to respond to emergencies. If that were to happen, the county would send out an exclusive operating area bid to privately licensed paramedic companies in hopes that one of them will agree to service the island. A company such as Paramedics Plus or American Medical Response would then respond to Alameda patients in lieu of the city's fire department. If the city takes this route, Alameda may have to buy $256,000 worth of equipment to be used by Paramedics Plus upon their request, according to a city report. Since the county EMS must certify paramedics that operate within the county, Alameda cannot subcontract its own paramedics. Instead the city would have to rely on the county's paramedic contractor.

However, two major private paramedic companies have voiced no interest in servicing Alameda because of high operating costs related to transporting patients to and from the island, according to Dale Fanning, county Emergency Medical Services director. In addition, the county won't require its paramedic contractor to service Alameda if the city refuses to sign the contract, said Fanning. That scenario could possibly leave Alameda residents without adequate emergency paramedic service. AMR's contract with the county ends next November as Paramedics Plus takes their place. Fanning said Paramedics Plus might show interest in Alameda's exclusive operating area just so it can compete with other companies, but she said, that's an unlikely scenario.

And even if Paramedics Plus shows interest, the company's response times will be slower than what the Alameda Fire Department has been recording, according to a November 3 report by Fisher. The reason is that Paramedics Plus will be servicing the entire county and Alameda is geographically challenging to get to. Fisher's report compared response times of the city's paramedics against estimations for Paramedics Plus and found that response times for certain life-threatening injuries increased from a prompt eight minutes to a sluggish fifteen minutes, which is too long when lives are at risk, Briscoe said. Furthermore, private paramedic companies probably won't be stationing ambulances on the island because of the low volume of calls, according to Briscoe. Instead, the company will have to position their services within the heart of the county's 911 area, he added. "There's literally a hundred square-miles of city and county," he said. Alameda will "be lumped in with the rest of the county."

Briscoe called the city's excellent response times and advanced life support services "examples for the rest of the county." Hiring a private paramedic service would be cheaper for Alameda, but at the cost of slower response times and a loss in insurance company revenue for the city's fire department. Fisher also submitted a report during the November 3 city council meeting detailing $256,000 for equipment the city would have to pay for out of pocket if Paramedic Plus were contracted to provide medical services. The city would own this equipment and allow the private paramedic group to use it, per their request, according to the report. Even though the city is eyeing private paramedics as a solution, Briscoe said he's almost sure the city will sign a contract with the county that will allow Alameda to keep using its fire department paramedics. "I've been given assurance by the city that the matter will be put to bed before the deadline," he said.

Fisher and Alameda interim City Manager Ann Marie Gallant also are urging the council to begin the process of setting up a benefit district so that future payments to the county can be made directly by taxpayers instead of having to come from the city's cash-strapped general fund. The $860,000 a year comes out to about $26.42 per benefit unit in Alameda. Three other cities in the county use their own fire department paramedics for emergency care and pay the county similar annual payments from their assessment districts — Albany, Berkeley, and Piedmont.

Alameda City Attorney Teresa Highsmith, however, argues that Alameda residents will not go without paramedic support if the city does not sign a contract with the county. Highsmith maintains that the county, by law, has to require its paramedic contractor to service the city if the county prohibits the city from using its own paramedics. However, Fanning and Briscoe said they disagree with Highsmith's argument because of an opinion by the California Attorney General's Office. Fanning said the opinion concluded that if the county Health Services Agency barred paramedic service to Alameda, it is not obligated to restore it.

The city has been operating without a contract with the county for the past five years. The two sides have not been able to come to agreement over how much the city should pay. It's a dispute whose origins actually go back roughly three decades.

In 1983, the Alameda County Emergency Services District was created to provide paramedic care as well as fund the county's three trauma centers. Alameda was the only city in the county back then that chose to be excluded from the district. At the time, the city was not transporting patients to the county's trauma centers. But four years later, Alameda began doing so, and the city signed its first contract with the county.

But it was a good deal for Alameda. The county charged the island a much lower price per resident than the other cities were paying. And the discounts continued for more than a decade.

In 1997, Alameda started offering advanced life support care using its fire department paramedics. Two years later, the county finally demanded Alameda start paying at a rate comparable to all other cities in the county. However, the county still offered the city a discount because it wanted to help foster Alameda's new advanced life support care and transport program, according to Fanning. The county charged the city $332,318 each year — roughly half of the Alameda's benefit assessment units or properties — and gave $255,000 back to help ensure growth within the city's program, she said. The county repeated its reimbursement practice with Alameda until 2004 when the county was charging $650,000 and giving back $530,000. After the county's last contract with the city expired in 2005, the county decided it could no longer afford to keep giving Alameda discounts.

Briscoe said Alameda will have to retroactively pay $5.1 million for using the county's trauma care centers for the past five years. "We really shouldn't have let things get this bad," he added. "Payment is second, getting back on contract is first."

However, Highsmith said she'll challenge the legality of Briscoe's claim. Seeing as there was no contract between the city and the county for the last five years, Highsmith said there's no legal authority for the county to charge the city for past dues. "I wouldn't make a threat I couldn't back up," she said.

Staff writer Robert Gammon contributed to this report.