Palm Beach Post
Two private ambulance companies that have for the past 20 years enjoyed exclusive rights to transfer patients between hospitals, assisted living facilities and rehabilitation centers in Palm Beach County will continue to operate without competition for at least six more years.
After four hours of presentations, discussion and comment from the public, county commissioners on Tuesday unanimously decided to extend the certificates allowing American Medical Response, or AMR, and Medics Ambulance Service, to continue to provide emergency services. The two companies have been owned by the same parent company since 2011.
In a separate vote, commissioners denied All County Ambulance, which had been recommended to be offered a certificate, as well as three other applicants. The Health Care District of Palm Beach County was also approved for a renewed certificate, but it provides services only between its facilities, Lakeside Medical Center and JFK North’s addiction stabilization unit.
All County sought to supplement the work provided by AMR and Medics by supplying 12 ambulances to be available for interfacility transportation. These services are different from when a person calls 911 for emergency help, in which fire rescue personnel respond.
“We are extremely disappointed that the county commission sought to protect a 21-year monopoly instead of providing better patient care to residents,” said Neil Schiller, who represented All County. “When 15 hospitals say that they want choice over private ambulance services, I think that speaks louder than any amount of data they were looking for.”
County Public Safety Director Stephanie Sejnoha said she initially recommended maintaining the status quo with AMR and Medics but supported adding a third private provider after speaking with 15 hospitals in the county, which had expressed interest in having more options.
“All of them are wanting more (providers), and I think that that is something I cannot ignore,” she said.
At the same time, Sejnoha presented findings of a survey where a majority of the 60 respondents said they did not want more private providers, as well as reports from AMR and Medics that they showed up within 15 minutes of the agreed upon time 90% and 91%, respectively, of the time over the past two years.
Commissioners were concerned that adding a third provider without having a central dispatch system in place for all three providers would cause issues and felt they lacked sufficient data to deem it necessary to add another provider.
For example, Sejnoha requested data from hospitals on how long it took for these private providers to respond to a call for transport. But the data provided wasn’t within the same timeframes, making it difficult to compare. Plus, hospitals don’t have a system to accurately track this information and in some cases had to pore over patient records to cull this data.
“Before affixing my name to a particular certificate, I need to know the system is broken. And I don’t think it is,” Mayor Dave Kerner said.
The process was fraught with accusations, mostly against All County, in letters to county commissioners and in public. Representatives for AMR and Medics painted All County as an unreliable service provider that would cause more harm than good.
Henry Handler, an attorney representing AMR, said adding a third provider would “disrupt the coordination that the existing dispatch system provides.” He added that AMR’s compliance rate dipped below 90% for the first time during the pandemic, but said it was “inaccurate, unfair and short-sighted” to use that as a way to justify the need for a third private provider.
Medics’ director of operations, Isabel Rodriguez, said adding a third provider would “make a mockery of what we consider the best Palm Beach County transportation system.”
Charles Maymon, vice president of All County, said the claims were “patently false.”
“AMR and Medics have been in place for a lot of years, and they’ve done a wonderful job,” Maymon said. “The fact of the matter is, the county is growing significantly.”
Commissioners were shocked by the remarks of one emergency department medical director, who was in favor of adding more private ambulance providers. Dr. Steven Keehn, of JFK North, said on one occasion, he requested a transfer for a patient but was told the first available time the provider could arrive was three hours later. The patient became unstable, then died, Keehn said, noting that it was possible that the patient could have died regardless of how quickly the private ambulance arrived.
Keehn said he can rely on fire rescue personnel to respond immediately when called, but asking them to handle an interfacility transfer may mean taking them away from an emergency call. But when this happens, Keehn said fire rescue personnel often say that this is not their role, asking, “Where is the private provider?” and “Why are they having to perform this transport?”
“I do not want my comments to be misconstrued as an indictment on the current provider, as I’m truly grateful for their service,” he said. “I can tell you with certainty that competition breeds good service.”
After these comments, Commissioner Melissa McKinlay offered four things she wanted county staff to look at the protocols of when hospitals need to call 911 vs. private providers; require providers to process complaints; ask hospitals to collect data to learn the true need of private ambulance providers; and to revisit the certificates within three years to see if the population growth has necessitated a third provider.
This is the second time that the Board of County Commissioners declined to add a third private emergency services provider, despite recommendations by the county’s Emergency Medical Services Advisory Council.
The county began accepting proposals from other companies in 2014 after The Palm Beach Post reported that AMR and Medics held this monopoly since 2000. American Ambulance was the front-runner third company in 2014, also represented by Schiller. American Ambulance sold its assets to All County in January.
This article originally appeared on Palm Beach Post: County continues ’21-year monopoly’ for private ambulance providers
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