HomeMy WebLinkAbout2007/12/11 Item 12
CITY COUNCIL
AGENDA STATEMENT
December 11, 2007
SUBMITTED BY:
REVIEWED BY:
RESOLUTION OF THE CITY COUNCIL OF THE CITY
OF CHULA VISTA APPROVING A REVISED AND
RESTATED AGREEMENT FOR BASIC AND
ADVANCED LIFE SUPPORT SERVICE WITH
LAIDLAW MEDICAL TRANSPORTATION INC., DBA
AMERICAN MEDICAL RESPONSE, AND
AUTHORIZING THE MAYOR TO EXECUTE THE
AGREEMEN~ ^JJ
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FIRE CHIEF ,..., ,
CITY MANAGER fk;J::2.--
4/5THS VOTE: YES NO X
ITEM TITLE:
BACKGROUND:
On May 14,2002 the City Council approved the Amended and Restated Agreement with
American Medical Response (AMR) for Basic and Advanced Life Support Ambulance
Service (2002 Agreement). The 2002 Agreement became effective for the three-year
period June 1,2002 through May 31, 2005. The 2002 Agreement contained a provision
for two additional three-year extensions for AMR to continue providing ambulance
services subject to the City's discretion. The 2002 Agreement also contained a provision
for AMR to request rate adjustments for ambulance services.
ENVIRONMENTAL REVIEW:
The Environmental Review Coordinator has reviewed the proposed activity for
compliance with the California Environmental Quality Act [CEQA] and has determined
that the activity is not a "Project" as defined under Section 15378 of the State CEQA
Guidelines because it does not involve a physical change to the environment; therefore,
pursuant to Section 15060[c][3] of the State CEQA Guidelines the activity is not subject
to CEQA. Thus, no environmental review is necessary.
RECOMMENDATION:
That Council adopts the resolution approving a Revised and Restated Agreement with
AMR for Basic and Advanced Life Support Ambulance Service, which includes a revised
rate schedule for basic and advanced life support ambulance transport rates and related
services charges and a new agreement period.
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December 11, 2007 Item~
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BOARDS/COMMISSIONS RECOMMENDATION:
Not Applicable.
DISCUSSION:
The City is authorized by Government Codes Section 38794 and Municipal Code
sections 5.10.310-5 10.340 to contract for ambulance services. The City has contracted
with American Medical Response (formerly known as Hartson Medical Services) for the
provision of Basic and Advanced Life Support Ambulance services since 1989. The
current agreement with American Medical Response (AMR) permits AMR to provide
services to an Exclusive Operating Area (EOA) that was adopted by the County of San
Diego. This EOA consists of the City of Chula Vista, Bonita/Sunnyside Fire Protection
District, and the City of Imperial Beach. On May 14, 2002, the City Council adopted an
amended and restated agreement (2002 Agreement) with AMR that clarified and
reinforced the following key stipulations:
· Definition of service requirements and performance standards to optimize service
delivery
· Minimum resource requirements for the number of ambulances, staffing and
equipment to be deployed for the provision of service
· Provisions for termination that would provide the City with adequate notice in
order to avoid service interruptions
· Insurance requirements for motor vehicles operated by AMR in order to protect
the City from liability
· Hold harmless provisions that indemnified the City from liability arising from
negligence acts or omissions resulting from AMR's performance
· Renewal Provisions that provided the flexibility to extend the agreement at their
own discretion.
In addition to these stipulations, the 2002 Agreement provided the members of the EOA
with the lowest basic and advanced life support ambulance transport rates in the County.
AMR has subsequently been providing services under the terms of 2002 Agreement and
has been in compliance with its terms.
Extension of 2002 Agreement
Two additional three-year extensions were made available to the City under the terms of
the 2002 Agreement (see Section 17 of2002 Agreement) approved on May 14,2002. The
2002 Agreement is provided as Attachment A. The initial three-year period covered
under this Agreement with AMR expired on May 31, 2005. The City and AMR did not
enter into a subsequent formal extension for the following reasons:
1. The City of Imperial Beach (A member of the EOA) was in process of exploring
partnerships with other jurisdictions for the provision of ALS and ambulance
services that would have potentially altered the structure of the EOA.
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December 11, 2007 Item JL
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2. The emergence of a potential new service ALS delivery structure known as the
Regional Care Cooperative Program (RCCP) is being explored by various
jurisdictions in the region. Under the RCCP, AMR would be leading provider of
ALS and ambulance transport services and would provide economies of scale
opportunities to RCCP participants. The implementation of the RCCP would also
have implications for the structure of the EOA.
3. Both AMR and the City awaited the completion Advanced Life Support (ALS)
Study that was being undertaken by the Fire Department to determine if new
opportunities for service delivery benefiting both parties could be restructured
into a subsequent new agreement.
Unfortunately, the ALS Study has been delayed and those opportunities will be further
explored and presented in the future. In the meantime, both parties have continued to
operate under the terms of the 2002 Agreement as provided in Section 18 of the 2002
Agreement. As a result, AMR has continued to provide services to the EOA up to the
present time.
Staff will formulate recommendations based on the completion and the findings of the
ALS study for the long-term delivery of ALS services within the City. These findings and
recommendations will be returned to Council in addition to any issues that may affect the
contract agreement with AMR.
In the meantime, staff is requesting approval of extensions allowed under provision of the
2002 Agreement with AMR. If approved, a Revised and Restated Agreement will be in
effect from December 11, 2007 through May 31, 2011 with two additional three-year
extension options available thereafter.
Request for Increase in the Basic and Advanced Life Support Ambulance Transport
Rates
Pursuant to section 5.7 of the amended restated agreement, AMR has the reserved right to
request a fee increase in the event of extraordinary cost increases occurring in any of the
contract years. Extraordinary costs are defined as an increase of 20% or more from the
previous contract year in any of the following categories:
. Vehicle physical damage insurance
. Professional liability insurance
. Worker's compensation insurance
. General Liability Insurance
. Gasoline, diesel, propane, oil and petroleum products
. Pharmaceuticals or medical supplies
Accordingly, the City Council reserves the right to approve or disapprove such a request
at its sole discretion.
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December II, 2007 Item~
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In an effort to address impacts to their business model sustained due to not increasing
ambulance transport fees since June 2004, AMR is requesting an increase in the amount
of $137.34 to the current ALS emergency ambulance transport fee. The new ALS
emergency ambulance transport fee would increase to $650.00 from the current fee of
$512.66 if this fee increase were approved. Under the terms of the 2002 Agreement, the
ALS emergency ambulance transport fees were increased at an annual rate of 5% from
2002 through 2004 by AMR to the current $512.66 fee level. In the absence of an
approved extension of the 2002 Agreement, the ALS emergency ambulance transport
fees were not increased further by AMR after June of 2004. However, the current 2007
ALS emergency transport fee would have increased to $593.47 if the annual 5%
adjustments had been applied to the current $512.66 fee from 2005 through 2007.
In addition to the proposed fee increase, AMR is also requesting that the revised fee be
allowed to increase by 7.0% each year as consideration for this Revised and Restated
Agreement. This increase is being requested in order for the fee to keep pace with costs
of service delivery. The proposed rate schedule is summarized as follows:
City of Chula Vista AMR Proposed ALS Rate Schedule:
Requested Rate Annual
Contract Year Base Rate Year 1 Rate Increase Ad'ustment
Current $ 512.66 650.00 $ 137.34
Ma ,2008 $ 695.50 $ 45.50 7%
Ma , 2009 $ 744.19 $ 48.69 7%
Ma ,2010 $ 796.28 $ 52.09 7%
The justification for increasing the ALS emergency ambulance transport fee to $650.00
and allowing this rate to increase by 7.0% throughout the contract extension period
ending May 31, 2011 is contained in an issue paper prepared by AMR titled:
"SUSTAINING EXCELLENCE: The Case of Ambulance Rate Increases - 2007. This
issue paper is provided as Attachment B and contains the pertinent information for
Council's consideration ofthe requested AMR fee increase.
DECISION MAKER CONFLICT:
Staff has reviewed the decision contemplated by this action and has determined that it is
not site specific and consequently the 500-foot rule found in California Code of
Regulations section I 8704.2(a)(1) is not applicable to this decision.
FISCAL IMPACT:
There is no fiscal impact to the General Fund as a result of adopting this
recommendation. All costs associated with this recommendation will be borne by the
users of AMR services.
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December 11, 2007 Item~
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ATTACHMENTS:
Attachment A - AMR Revised and Restated Agreement
Attachment B - SUSTAINING EXCELLENCE: The Case for Ambulance Rate Increases - 2007
J:\AnomeyIJDAWSQN\Agenda Sta/:emenu\AMR Contract ExteIl$ioll,doc
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THE ATTACHED AGREEMENT HAS BEEN REVIEWED
AND APPROVED AS TO FORM BY THE CITY
ATTORNEY'S OFFICE AND WILL BE
FORMALLY SIGNED UPON APPROVAL BY
THE CITY COUNCIL
.tfiUL I
Ann Moore
City Attorney
Dated: / z /~ /2-06 7
I I
Revised and Restated
Ambulance Service Agreement
by and between
American Medical Response Ambulance Service, Inc.
and
The City of Chula Vista
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Attachment A
REVISED AND REST A TED AGREEMENT FOR BASIC AND
ADVANCED LIFE SUPPORT AMBULANCE SERVICES
This REVISED AND RESTATED AGREEMENT FOR BASIC AND ADVANCED
LIFE SUPPORT AMBULANCE SERVICE ("Agreement") is entered into effective as of
December 11, 2007 ("Effective Date"), by and between the CITY OF CHULA VISTA, a
municipal corporation, herein called "CITY," together with Imperial Beach Fire Department and
Bonita/Sunnyside Fire Protection District (collectively "Participating Agencies"), and
LAIDLAW MEDICAL TRANSPORTATION, INC., a Delaware corporation, dba AMERICAN
MEDICAL RESPONSE, herein called "AMR."
WITNESSETH
A. WHEREAS, within the City of Chula Vista, there is a public health and safety need
for effective and efficient basic and advanced life support emergency and non-
emergency ambulance services; and
B. WHEREAS, various studies and actual practical experience have clearly
demonstrated that communities of the approximate size and population ofChula Vista
are best assured of receiving the highest level of emergency and non-emergency
ambulance transportation services at the lowest cost to the consumer where service
calls are originated through the 911 system if said services are delivered by a single,
competent provider on an exclusive basis; and
C. WHEREAS, CITY is authorized by Government Code Section 38794 and Municipal
Code Sections 5.10.310-5.10.340 to contract for ambulance services as public
convenience requires; and
D. WHEREAS, pursuant to Health and Safety Code Section 1797.224, the County of
San Diego has adopted a plan, in which it has designated an "exclusive operating area
(EOA)" defmed as that part of San Diego County generally known as the City of
Chula Vista, Bonita/Sunnyside Fire Protection District, and the City of Imperial
Beach, for which EOA the City is empowered to contract; and
E. WHEREAS, the City of Chula Vista Fire Department participates in the EOA's first
responder system responding to all emergencies originated in the 911 system; and
F. WHEREAS, on May 9, 1989, CITY and Med-Trans, dba Hartson Medical Services,
which has since been acquired by AMR, entered into an agreement for the provision
of basic and advanced life support and emergency and nonemergency service; such
agreement was amended on November. 26, 1996 (as amended, the "Original
Agreement"); and
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G. WHEREAS, on June 1, 2002, CITY, AMR, and PARTICIPATING AGENCIES
entered into an Amended and Restated Agreement for Basic and Advanced Life
Support Ambulance Services ("Amended Agreement"), with an option to extend the
Amended Agreement; and
H. WHEREAS, the parties' desire to extend the Amended Agreement, with revised and
restated terms and conditions, as set forth in this REVISED AND RESTATED
AGREEMENT FOR BASIC AND ADVANCED LIFE SUPPORT AMBULANCE
SERVICE.
NOW, THEREFORE, in consideration of the mutual promises herein contained and for
other good and valuable consideration, receipt of which is hereby acknowledged, the parties
agree as follows:
1. SERVICES
AMR shall, without cost to PARTICIPATING AGENCIES, perform the following services to
the satisfaction ofPARTICIAPATING AGENCIES:
1.1 Provide pre-hospital Advanced Life Support ("ALS") and Basic Life Support ("BLS")
emergency medical care and transport services in response to medical calls for service
received through 9-1-1 and/or public safety dispatch and communication centers for
calls within the EOA, twenty-four (24) hours each day, seven days a week without
interruption, without regard to the patient's financial status.
1.2 AMR shall meet a maximum response time of 10 minutes for 90% of all ALS
emergency calls dispatched for each Service Area.
1.3 AMR shall respond to all calls downgraded to BLS calls within 20 minutes for 90% of
the calls dispatched for each Service Area.
1.4 Response time shall be calculated from the time that a dispatch is received by AMR for
the first dispatched ambulance until the time that the first ambulance arrives on the
scene or at the designated staging area as designated by the incident commander. If an
ALS call is downgraded, the above maximum response time shall not apply; however,
AMR shall be responsible for responding to such a downgraded call as is required for a
BLS response.
1.5 At a minimum AMR shall provide 4 (four), Type III ALS capable ambulances,
operating 24-hours per day; and an additional Type III, ALS ambulance operating 12-
hours per day, normally posted within the EOA.
1.6 Only Advanced Life Support responses shall be rendered in direct response to calls for
medical emergencies originating from the 911 System or requests from public safety
dispatch and/or communications centers.
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1.7 Participate in disaster preparedness training with EOA personnel. This training shall be
in accordance with San Diego County and EOA disaster plans and consist of two
training sessions and participation in two exercises per year in order to ensure effective
coordination between AMR and EOA employees during disaster operations. AMR shall
make a reasonable effort to provide a supervisory level liaison to Service Emergency
Operations Center, when it is activated, for the purposes of coordinating emergency
medical operations for the EOA.
1.8 Provide a telephone "Hot Line" between AMR and the Fire Dispatch Center and the
installation of equipment in AMR vehicles to allow two-way radio communications
between AMR, ALS and BLS units and EOA Fire Departments on approved
frequencies.
All AMR dispatch data shall be captured electronically on a "real-time" with a
computer system capable of providing information to CITY in respect to address, times
of dispatch, response, arrival and unit identifier.
1.9 Participate in EMS system activities including development and operation of automatic
and mutual aid agreements, disaster drills, paramedic ride-alongs, paramedic intern
training, and continuing education programs. AMR also agrees to attend and participate
in meetings called at reasonable frequencies by CITY for the purpose of planning and
coordinating EMS service.
1.10 Provide a complaint procedure as outlined herein:
Whenever a complaint is received, regardless of whether from a health care agency,
public safety agency, a patient, or the general public, an Incident Report Form shall be
completed. The field supervisor shall conduct the initial investigation with emphasis
placed on identification of potential system failures and deficiencies, recommendations
for short and long range corrective actions, and the documentation of facts for future
review and reference.
Whenever possible, an immediate face-to-face response shall be made by a member of
AMR' s management team.
All documentation on complaints and criticisms shall be maintained for at least three
(3) years and a copy forwarded to appropriate PARTICIPATING AGENCY within 30
days of resolution or in a case where no resolution is reached, the City Manager of the
PARTICIPATING AGENCY or his or her designee shall be notified within two (2)
business days of determining that the matter is not resolvable.
1.11 AMR shall re-supply the Fire Departments of PARTICIPATING AGENCIES with
medical supplies and related emergency medical equipment, including Personal
Protective Equipment and disposable semi-automatic defibrillator supplies contained
within the list of equipment and supplies described in Exhibit "A," up to a maximum
cost ("Maximum Resupply Obligation") per fiscal year (July through June).
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a. Beginning December 11, 2007, through June 30, 2008, the Maximum Resupply
Obligation shall be $14,000. AMR's Maximum Resupply obligation shall be
increased each fiscal year thereafter by 10% per year, not to exceed $20,000 for any
fiscal year during the term of this Agreement or subsequent extensions.
b. The ratio of the resupply amount shall correspond, on a pro rata basis to the
percentage of calls for service for each P ARTICIP A TING AGENCY.
c. The cost of the items supplied by AMR shall be determined by the actual invoice
cost to AMR. CITY shall be provided with an appropriate statement on a monthly
basis from AMR detailing supplies PARTICIPATING AGENCIES have received
through this process and the cost assigned to same. In no event shall AMR's
obligation hereunder exceed the actual cost of PARTICIPATING AGENCIES'
reesupply needs.
d. AMR shall clearly label all items delivered to the PARTICIPATING AGENCIES
and to provide, with the initial order, "Material Safety Data Sheets" for any new
items added to the PARTICIPATING AGENCIES' use or inventory.
e. In the event that changes in federal, state or local regulations require additional
Personal Protective Equipment or other medical equipment or supplies in support of
emergency Medical Services operations, and/or if AMR and CITY, by mutual
consent agree to utilize new equipment in the field to enhance patient care, and the
Maximum Reesupply Obligation by AMR is thereby caused to be exceeded for a
given fiscal year, the parties agree to negotiate in good faith to adjust the maximum
limits of AMR's contribution.
1.12 Properly transport and dispose of all biological/medical waste material used in patient
care by P ARTICIP A TING AGENCIES pursuant to this Agreement.
1.13 Provide all ambulances, as well as other vehicles and equipment that are necessary for
the provision of services required under this Agreement (including all fuel, lubricants,
maintenance, insurance, and repairs/replacement).
1.14 Provide standby ambulance support to the Fire Department of PARTICIPATING
AGENCIES at major emergencies as determined appropriate and necessary by
PARTICIPATING AGENCY's incident commander. Exemptions shall be granted to
AMR for calls received within the response area for the unit assigned to such incidents
during the time that unit is committed. Additionally, calls that can be shown to be
exceptions because of the deployment of this resource may also be granted exempt
status from response time compliance.
1.15 To participate in disaster preparedness planning and training activities carried out by
the Agencies within the EOA and the County of San Diego. AMR is not responsible for
providing medical supplies or equipment for such activities.
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1.16 Comply with all training requirements established by the State of California, and all
applicable policies and provisions established by the San Diego County Emergency
Medical Services Division ("SDCEMSA"). .
1.17 Maintain neat, clean, and professional appearance of all personnel, equipment, and
facilities.
2. SYSTEM REQUIREMENTS
2.1 All ambulance units must be equipped and staffed at all times to meet all state and
county laws and regulations affecting service delivery. AMR shall operate and maintain
all ambulances and equipment in a manner that will not endanger life or property, and
in accordance with all existing and future federal, state, and local laws, ordinances,
regulations, resolutions, policies, procedures, and protocols applicable to AMR's
performance pursuant to this Agreement. AMR shall maintain Primary Type-III
Modular ALS units within the EOA in accordance with practices in effect as of the
Effective Date.
2.2 Staffing. For all requests for service received through the 9-1-1 system and/or public
safety dispatch and communication centers for calls within the Service Area, AMR
shall ensure that, at a minimum, the staffing requirements of SDCEMSD or other
appropriate successor in interest with appropriate authority, will be met at all times. In
furtherance of this requirement:
a. AMR shall guarantee minimum staffing levels on all units assigned to the EOA
24 hours/day, 365 days/year.
b. Such staffing levels shall be mandatory and employees needed for such staffmg
shall not be released until such time as minimum staffing levels can be maintained.
2.3 AMR agrees to employ Paramedics who meet and/or exceed all state and county
licensing and certification requirements. AMR will ensure that all emergency personnel
meet the continuing education requirements specified by San Diego County.
2.4 AMR shall notify PARTICIPATING AGENCIES immediately whenever any condition
exists which adversely affects delivery of satisfactory emergency medical services to
the EOA. For purposes of this paragraph, notification of Heartland Fire
Communications facility shall be deemed appropriate notification.
2.5 Other County-permitted providers' ambulances and personnel may be used for 9-1-1
pre-hospital emergency medical care and transport only in accordance with County
policy and with approval of AMR.
2.6 When it becomes necessary to use other providers to assist in responding to 9-1-1 calls,
AMR shall include such incidents in the monthly report.
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2.7 AMR is responsible for assuring that its ambulances are staffed and equipped III
accordance with County policy and the terms of this Agreement.
2.8 AMR shall participate in and cooperate with other EMS System entities in furthering
the development of and enhancing capabilities within the system.
2.9 CITY acknowledges AMR's responsibility to inform each Agency it contracts with of
the requirements contained in the Health Insurance & Portability Act of 1996 regarding
confidentiality of patient records. The PARTICIPATING AGENCIES agree to uphold
the law with regard to the confidentiality of patient records and bear the costs of any
violation of patient confidentiality by their respective employees.
2.10 A minimum of semi-annual operations meetings for this BOA shall take place. Those
present shall include representatives from AMR and representatives from each
PARTICIPATING AGENCY. These meetings will take place to review monthly
response time reports, and to discuss any other issues involving this contract or
operations.
3. RESPONSE TIME PERFORMANCE.
System response times are a key measurement of performance. This measurement is the
determining factor that drives the placement and redeployment of the system's resources
throughout the entire system.
3.1 Each incident will be counted as a single response regardless of the number of units that
respond.
3.2 AMR shall use its best efforts to minimize variations or fluctuations in response time
performance.
3.3 AMR shall not be held accountable for response time compliance for any request for
service outside the EOA. Responses to requests for service outside the EOA will not be
counted in the number of total calls used to determine response time compliance under
this Agreement.
3.4 Compliance Reporting: AMR shall file a report of response time compliance on the
following basis:
a. For the City ofChula Vista, reports of response time compliance shall be submitted
on a monthly basis.
b. For the City of Imperial Beach and the Bonita/Sunnyside Fire Protection District, a
report combining the City of Imperial Beach's and the Bonita/Sunnyside Fire
Protection District's response times shall be submitted on a monthly basis.
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c. The form and format of such reporting shall approximate the form attached hereto
as Exhibit "B," which from time to time may be amended with agreement of the
parties, and shall be filed within 10 days of the end of the previous month.
3.5 Response Time Exemptions - It is understood that unusual circumstances beyond
AMR's reasonable control can induce response times that exceed the aforementioned
standards. These unusual circumstances include only unusually severe weather
conditions, disaster, sudden and unexpected street closures or accidents that materially
alter traffic patterns, or unusual periods of very high demand upon the system.
Equipment failure, traffic collisions not involving the responding ambulance, or lack of
a nearby ambulance shall not furnish grounds for release from general response time
standards. If AMR feels that any run or group of runs should be exempt from response
time standards due to unusual circumstances beyond AMR's reasonable control, AMR
may request that these runs be excluded from response time performance calculations.
Each PARTICIPATING AGENCY shall determine the granting of exemptions within
its Service Area. If the PARTICIPATING AGENCY concurs that the circumstances do
fit the contract 1 s exemption criteria, it shall allow such exemptions in calculating
overall response time performance.
a. Each request for exemption will be accompanied by a completed "Exception
Inquiry Form" attached hereto as Exhibit "C," which from time to time may be
amended with the agreement of the parties, and shall be filed within 10 days of the
end of the previous month.
b. The Participating Agencies will have 10 days from the receipt of the requested
exemptions in which to notify AMR as to whether the requested exemptions have
been granted or denied.
3.6 Reassignment En Route. If a responding ambulance is reassigned en route from a first
call to second call prior to arrival at the incident location, the response time clock will
not stop on the first call until the arrival of an appropriately staffed ambulance on the
scene of the first call.
a. Separate code classifications and response time measurements will be kept on each
call.
b. AMR is expected to meet the applicable response times for the calls, even when
diverted.
3.7 Notwithstanding any other provision within this Agreement, the ALS Ambulance may
be canceled en route or down graded by dispatch, or anyon-duty paramedic, EMT, or
public safety officer at the scene consistent with San Diego County medical protocols.
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3.8 Cancellation of Calls. Calls cancelled prior to the arrival of an ambulance on scene,
shall not be included in determining monthly response time compliance, but will be
noted in the monthly report.
4. PENAL TIES FOR RESPONSE TIME NON-COMPLIANCE
4.1 In the event AMR fails to meet the Response Time requirements in any Service Area,
AMR shall be accessed penalties as follows:
a. If AMR fails to meet the Response Time Criteria, after exemptions (if any) have
been granted, AMR shall add an additional 6 ALS Type III unit-hours per day to the
EOA.
b. These additional unit-hours described in paragraph 4.1 shall remain in place until
such time and AMR has maintained response time compliance for two consecutive
months.
c. Notwithstanding paragraph 4.1, in the event that AMR has 9 or more ALS calls for
service in one calendar month with response times of 20 minutes or longer, the
following penalty shall apply: AMR shall add an additional 8 ALS Type III unit-
hours per day to the BOA for two months.
d. These additional unit-hours described in paragraphs 4.1 and 4.3 shall be
implemented within 7 days of the final determination of non-compliance.
5. FEE SCHEDULES
AMR shall operate a billing and accounts receivable system that is humane, well-documented,
easy to audit, and which minimizes the effort required of patients to recover funds from third
party sources for which they may be eligible. AMR shall be able to provide quarterly and annual
reports as specified by CITY.
5.1 AMR is authorized to bill patients transported on calls originating as medical calls for
service through 9-1-1 and/or public safety dispatch and communication centers
according to AMR's fee structure attached as Exhibit "D", which may be modified
from time to time as described in Subparagraphs below. Patients billed shall be
provided with varied payment options.
5.2 Rates charged for Base Rate, Oxygen, Mileage, Night Charges and Treatment only (No
Transport) ("Primary Rate Components") shall not be increased above those set forth
on Exhibit "D" for the period December II, 2007, until May 31, 2008.
5.3 For each of the three contract years, June 1,2008, to May 31, 2009 (Year 2); June I,
2009, to May 31, 2010 (Year 3); and June 1,2010, to May 31,2011 (Year 4), the
Primary Rate Components may be increased at AMR's discretion by an amount not to
exceed 7% per year. No CITY approval shall be required for such a rate increase.
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5.4 If CITY exercises its option to extend this Agreement for Years 5 through 7, or Years 8
through 10, AMR agrees to meet and confer with CITY for the purpose of negotiating
limitations on maximum rate increases in those years.
5.5 The meet and confer process shall begin six (6) months prior to the expiration of Year 5
and Year 8.
5.6 All other non Primary Rate Component charges, while not specifically assigned
maximum rates under this Agreement shall not exceed industry standard rates charged
by AMR and other ALS/BLS service providers within the County of San Diego.
5.7 AMR reserves the right to submit a request to the City Council for a fee increase, in
addition to that allowed above, for extraordinary expenses in any of the following
categories:
. Vehicle physical damage insurance
. Professional liability insurance
. Workers Compensation insurance
. General liability insurance
. Gasoline, diesel, propane, oil and petroleum products
. Pharmaceuticals or medical supplies.
Extraordinary expenses are defined as an increase in cost from the previous year of
twenty percent (20%) or more for a specific contract year in any of the above-stated
categories. The City Council reserves the right to approve or disapprove such a request
in its sole discretion.
5.8 Notwithstanding the above, AMR also reserves the right to submit a request for a fee
increase in the event of any extraordinary change in the payment or cost recovery
provisions in MediCal, MediCare, or their successor programs.
5.9 CITY shall notify AMR in writing of approval or disapproval of the increase within
thirty (30) calendar days of receipt of accurate and complete information satisfactorily
supporting any increase.
5.10 In the event that either Bonita/Sunnyside FPD or the. City of Imperial Beach withdraws
from this Agreement, the minimum ambulance requirements of the above subparagraph
shall be waived, and new minimum ambulance requirements established upon mutual
agreement between the parties. The withdrawing Agency must provide no less than 180
days notice to all parties of its withdrawal.
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6. INSURANCE
AMR shall obtain and maintain at all times a policy of insurance by an insurance carrier
acceptable to CITY against loss from public and automobile liability arising from any operation
or activity of AMR, its agents or employees. Types and amounts of such insurance to be
maintained shall be as defined in Exhibit "E" Insurance Requirements, which is hereby adopted
by reference and hereby made part of this Agreement.
7. HOLD HARMLESS
AMR shall indemnify, protect, defend and hold harmless the PARTICIPATING AGENCIES, its
officers, agents, elected officials, volunteers and employees from and against all claims,
damages, losses and expenses, including attorneys' fees and other costs of defense, arising out of
or resulting from the performance by AMR of the services specified in this Agreement caused, or
alleged by third parties to be caused, by any intentional or negligent act or omission of AMR,
any subcontractor of AMR or anyone directly or indirectly employed by AMR or its
subcontractors, except to the extent caused by the 80le negligence or sole willful misconduct of
the PARTICIPATING AGENCIES, any subcontractor of the PARTICIPATING AGENCIES, or
anyone directly or indirectly employed by the PARTICIPATING AGENCIES or its
subcontractors.
8. INDEPENDENT CONTRACTOR STATUS
8.1 Both parties hereto in the performance of this Agreement will be acting in an
independent capacity and not as agents, employees, partners or joint venturers with one
another. AMR is not an employee of CITY and is not entitled to any of the rights,
benefits, or privileges of CITY employees, including but not limited to medical,
unemployment, or workers' compensation insurance.
8.2 This Agreement contemplates the personal service of AMR and AMR' s employees or
independent contractors, and it is recognized by the parties that a substantial
inducement to CITY for entering into this Agreement was, and is, the professional
reputation and competence of AMR.
8.3 Neither CITY nor its officers, agents or employees shall have any control over the
conduct of AMR or any of AMR's employees or independent contractors, except as
herein set forth, and AMR expressly agrees not to represent that AMR, or any of
AMR's agents, servants, employees or independent contractors, are in any manner
agents, servants or employees of CITY, it being understood that AMR, its agents,
servants, employees and independent contractors are as to CITY wholly independent
contractors and that AMR's obligations to CITY are solely such as prescribed by this
Agreement.
10
12-16
9. ASSIGNMENT
AMR shall not assign any portion of this Agreement or the services to be rendered thereunder
without the written consent first obtained from CITY, which will not be unreasonably withheld.
10. PERMISSION TO SUBCONTRACT SERVICES
AMR may subcontract for ALS First Responder services with each PARTICIPATING
AGENCY within the service area. Each agency may enter into an agreement with AMR for the
provision of those services.
10.1 The parties agree that upon execution of such subcontracts for first responder services,
response time performance standards may be modified and applicable paragraphs of
this Agreement modified in conformance with these new standards.
11. RIGHT TO REQUIRE PERFORMANCE
The failure of CITY at any time to require performance by AMR of any provisions hereof, shall
in no way effect the right of CITY thereafter to enforce same. Nor shall waiver by CITY of any
breach of any of the provisions hereof be taken or held to be a waiver of any succeeding breach
of such provision or as a waiver of any provision itself.
12. SEVERABILITY
If any provision of this Agreement shall be declared to be illegal, void or unenforceable by a
court of competent jurisdiction, such provisions shall be deemed severable, and the other
provisions shall not be affected but shall remain in full force and effect.
13. AUDIT AND REPORTING ROCEDURES
AMR agrees to allow CITY officials complete access to all operational and financial records and
data (including computer generated reports) pertaining to the services provided pursuant to this
Agreement. All records and documents regarding this service shall be available in San Diego for
a period of not less than three (3) years. AMR further agrees to submit to CITY the following
reports:
13.1 San Diego County (pre-hospital patient records) EMS Report Forms (ALS and BLS) on
request.
13.2 Annual Financial Report: Revenues billed and collected by payment source for calls
originating within the EOA, which includes a list of all transports. (Note: CITY
reserves the right to conduct spot checks of patient billings).
13.3 Monthly Response Time Analysis Report: Which shows percentage of calls arrived
within minute parameters and shows all late responses for all classifications.
1 2111 7
13.4 Monthly Exception Report: Which lists all response performance exceptions requested.
AMR shall make every responsible effort to identifY the cause of such extended
response time and shall document efforts to eliminate repetitions of that cause of poor
response time performance, if requested by Participating Agencies. (Note: Time in the
system is counted in seconds, not in whole minutes.)
13.5 Annual Collection Percentage Report: Which shows a breakdown of collection
performance.
14. NOTICES
All notices to AMR shall be mailed to:
Vice President of Operations
American Medical Response
8808 Balboa Avenue
San Diego, California 92 123
and
CEO
American Medical Response
20101 Hamilton, Suite 300
Torrance, California
All notices to Participating Agencies shall be mailed to:
Fire Chief
City of Chula Vista
276 Fourth Avenue
Chula Vista, California 91910
and
City Manager
City of Chula Vista
276 Fourth Avenue
Chula Vista, California 91910
and
Fire Chief
City ofImperial Beach
865 Imperial Beach Boulevard
Imperial Beach, California 91932
12
12-18
Fire Chief
Bonita/Sunnyside F.P.D.
4900 Bonita Road
Bonita, CA 91902
15. CONSIDERATION
Consideration provided to AMR for the comprehensive services to be provided by AMR is that
CITY shall grant to AMR the exclusive rights to provide emergency and non-emergency basic
and advanced life support service within the EOA originated through the 911 system.
16. CONTRACT ADMINISTRATION
CITY designates the City Manager, City of Chula Vista, 276 Fourth Avenue, Chula Vista,
California 91910, or hislher designated representative, to administer this Agreement on behalf of
CITY. AMR designates Kurt Williams, VP Operations, 8808 Balboa Avenue, Suite 150, San
Diego, California 92123, to administer this Agreement on behalf of AMR. All reports, proposal,
letters, notices and/or other correspondence shall be sent to the attention of the designated
representatives at their respective addresses.
17. TERM OF AGREEMENT AND RENEWAL PROVISIONS
This Revised and Restated Agreement shall commence on December 11, 2007. This Agreement
shall terminate at midnight, May 31, 2011, unless extended as provided for herein.
This Agreement may be extended for two (2) additional periods of three years each at CITY's
option, in its sole discretion. CITY shall exercise its option to extend by sending written notice to
AMR of its intent by no later than six (6) months prior to the expiration of the then current term.
If CITY fails to notify AMR of its intent as provided above, then AMR shall notify CITY in
writing of its desire to extend or not to extend the term, and CITY shall have an additional 30
days from its receipt of such notice to make its election. Factors that will be considered by CITY
include AMR's response time performance, compliance with the terms and provisions of this
Agreement, AMR's responsiveness and cooperation in relationships with CITY, County
Emergency Medical Services and the Base Hospitals, and any other factors considered of
importance to CITY in its sale discretion.
18. RIGHT OF AMR TO TERMINATE AT BEGINNING OF YEARS 5 OR 8
18.1 Notwithstanding any other provisions of this Agreement, should the parties fail to come
to agreement on base rate charges at the beginning of the two extension periods (Year 5
or Year 8), AMR may terminate this Agreement by written notification to CITY
providing notice of the effective date of such termination which shall not be less than
365 days from the receipt of the notice. Service shall continue under the terms of this
Agreement for the time specified in the notice from AMR.
11~19
18.2 If after due diligence by CITY, CITY has not procured alternative ALSIBLS services,
CITY shall be entitled to order an extension of service for an additional period of up to
180 days after the termination by AMR. CITY shaH notify AMR in writing at least 60
days prior to the expiration of the one-year notice. Service shall continue under the
terms ofthis Agreement for the time specified in the notice from CITY.
19. TERMINATION FOR CCAUSE, LIQUIDATED DAMAGES
19.1 CITY may immediately terminate this Agreement if AMR's license to operate
ambulances by the state is revoked or suspended.
19.2 CITY may terminate this Agreement for cause, if the cause is not cured within thirty
(30) days after a written notice specifying the cause is delivered to Kurt Williams, VP
Operations, 8808 Balboa Avenue, Suite ISO, San Diego, CA 92123.
a. Cause shall include, but not be limited to:
(1) Failure to comply with the material terms and conditions of this Agreement,
after notice of the failure has been given to AMR;
(2) Gross misrepresentation or fraud;
(3) Failure to operate in compliance with the requirements of the applicable federal,
state and local laws, rules and regulations relating to the provision of ALS
paramedic and BLS ambulance service.
19.3 If, within the thirty (30) days after delivery of the written notice of termination for
cause, the material breach has not been cured to the reasonable satisfaction of CITY's
representative, then CITY may terminate this Agreement effective as of a date specified
in a written notice of termination delivered thereafter. During the thirty (30) day cure
period, if CITY determines that the public health and safety would be endangered by
the continued provision of service by AMR, in consultation with the County EMS
Medical Director or designee, CITY may nevertheless, inunediately suspend further
performance and give written notice of immediate termination of this Agreement.
19.4 If, after termination of this Agreement for cause by CITY pursuant to 19.1 and 19.2, it
is ultimately determined by an arbitrator that CITY's termination was not justified (that
AMR had not committed a material breach of this Agreement), CITY and AMR agree
that the injury AMR may suffer as the result of such conduct by CITY is, impossible to
ascertain or estimate and that the sum of $50,000, shall be paid by CITY to AMR and is
a reasonable estimate of the potential injuries suffered. Said amount is agreed upon as
liquidated damages and not as a penalty.
14
12-20
19.5 Any waiver, acceptance of services, or failure to require compliance as it relates to this
Agreement shall not be deemed to be a waiver of any other breach of or change to the
terms of, or operate to stop CITY from enforcing the provisions of this Agreement. A
consent to one assignment by CITY shall not be deemed to waive the right to consent to
any future assignments.
20. TERMINATION FOR CONVENIENCE.
Notwithstanding any provisions to the foregoing, CITY may terminate this Agreement at any
time and for any reason, by giving specific written notice to AMR of such termination and
specifying the effective date thereof, at least one hundred eighty (180) days before the effective
date of such termination. In the event this Agreement is terminated by CITY as provided in this
paragraph, AMR shall be entitled to receive compensation for services rendered prior to the
effective date of such termination. AMR hereby expressly waives any and all claims for damage
or compensation arising from termination as provided for herein.
21. EXTENSION
CITY shall be entitled to order extension of service for a period of sixty (60) days after
expiration of this Agreement by notifying AMR in writing at least thirty (30) days prior to
expiration of this Agreement. CITY shall be entitled to order two (2) additional sixty (60) days
periods of extension of service, for a maximum of 180 days of extension of service, providing
that AMR is notified in writing at least thirty (30) days prior to the expiration of each period of
extension and the parties agree on a reasonable interim compensation for said services. Service
shall continue under the terms of this Agreement for the time specified in the notice, or notices,
from CITY.
22. APPLICABILITY IN IMPERIAL BEACH
This Agreement shall apply throughout the EOA; provided, however, with regard to the
provision of services within the corporate limits of the City of Imperial Beach, the provisions of
paragraph 3 (response time commitments) and Exhibit "D" (base rates) shall be superseded by
the provisions, if any, in any agreement in effect between AMR and the City ofImperial Beach.
If AMR and the City of Imperial Beach do not have an agreement in effect at any time during the
term of this Agreement, then response times and the Fee Schedule for the Imperial Beach portion
of the EOA shall be as provided herein.
23. AGREEMENT TO REOPEN NEGOTIATIONS
At any time during the term of this Agreement, either party reserves the right to propose system
enhancement changes which will better meet the needs of the service area. The parties agree to
meet and confer and determined the appropriateness of any such change to the system and any
necessary or appropriate corresponding increase in AMR's rates. Any such change shall be by
mutual agreement with each party acting in its sole discretion.
1 t.?21
SIGNATURE PAGE TO AMENDED
AND RESTATED AGREEMENT FOR BASIC
AND ADVANCED LIFE SUPPORT AMBULANCE
SERVICE
THE CITY OF CHULA VISTA
LAIDLAW MEDICAL
TRANSPORTATION, INC.
A Delaware Corporation, dba
AMERICAN MEDICAL RESPONSE
Cheryl Cox
Mayor of the City ofChula Vista
ATTEST:
Approved as to form by:
Ann Moore
City Attorney
CITY OF IMPERIAL BEACH
City Manager
BONITNSUNNYSIDE FIRE
PROTECTION DISTRICT
Fire Chief
J:\AttorneyIJDA WSON\AGREEMENTSIBasic Advanc=d Ufe SUpport Svcs (wo exhibils).doc
1 Z!..6Z Z
Exhibit "A"
Equipment List
. 4x4 Non Slerile
, 0 4x4 Sterile
o ABD Pads
. Ace Wraps 3"
o Band Aids
. Chux
. Cold Packs
o Detib Pads
o Eye Pads
. Flashlight
. Hot Packs
o Kerfix
o Ocdusive Dressing
. Sam Splints
o Stethoscope
. Tape - 1 n Transpore
o Tape - 1" Waterproof
o Tape - 2" Bron
o Trauma Dressing
. Trauma Shears
o Triangular Bandage
. Toumiquet
o Bulb Syringe
. 02 Wrench, small
. KY Jelly Packets
. Nasal Airway 12-36 fr
. Oral Airway, o-a
o Nasal Cannula, Adult
o Nasal Cannula, Ped
. 02 Mask, NRB, Adult
. 02 Mask, NRB, Ped
. 02 Mask, Ped
. C-Collar each size
. NS, 500ce, Sterile
. Water, 500cc, Sterile
. Sharps Container
. Splint Arm & Leg each
. Sta-Bloks, Head Immobilizers
. Ambu-Bag, Adult set
. Ambu-Bag, Ped. Set
. Ambu-Bag, Infant set
. Mask, Resuscitator, ped
. Mask, Resuscitator, Infant
. Oxygen
. 02 Rings
. 02 Wrench
. 02 Humidifier
. 02 Nebulizer Set
. 02 Nebulizer Adult
. 02 Nebulizer Ped
. NaCI Bullet, 3ce
o Suction Cannister, 800ce wll,id
. Suction Cannister, 1200cc wI lid
. Suction Cath. Rigid Tip
. Suction Cath, Flexible, 6-18 fro Each
. Suction Connection Tubing
. Suction, Portable
. SIP Cuffs (Adult, Thigh, Ped, Infant)
. Gloves, Exam, Box each small, med, large
. Gloves, Sterile, pr Each 7,8
. Hydrogen Peroxide
. Mask, Surgical
. Mask, Hepa
. OB Kit
. Plastic Bags, Clear, Large
. Plastic, Bags, Clear, small
. Plastic, Bags, Red
. Plastic, Bags, Yellow, Large
12-23
Exhibit "S"
PARAMEDIC UNIT RESPONSE TIME SUMMARY
SOUTH SA Y EOA
Participating Agency
PERIOD: DODD, MMMM DO. 'fYYY Throogh DODO. MMMM DO, yyyY
I.. Finali%ed Monthly Response Time
Compliance Summary
Response TIm.. Total Adjusted
'_to On Scene) Runs Exempt RUi!s Percent Accumula1ive%
00:00 - 01 :00 MIN 0 0 0.00% 0.00%
01:01- 02:00 MIN 0 0 0.00% 0.00%
02:01 - 03:00 MIN 0 0 0.00% 0.00%
03:01 . 04:00 MIN 0 0 0.00% 0.00%
04:01 .05:00 MIN 0 0 0.00% 0.00%
05:01 - 06;00 MIN 0 0 0.00% 0.00%
06:01 . 07:00 MIN 0 0 0.00% 0.00%
07:01 - 08:00 MIN 0 0 0.00% 0.00%
08:01 . 09:00 MIN 0 0 0.00% 0.00%
09:01.10:00 MIN 0 0 0.00% 0.00%
10:01 -11:00 MIN 0 0 0 0.00% 0.00%
11:01-12:00 MIN 0 0 0 0.00% 0.00%
12:01. 13:00MIN 0 0 0 0.00% 0.00%
13:01 - 14;00 MIN 0 0 0 0.00'1'. 0.00%
14:01 - 15:00 MIN 0 0 0 0.00% 0.00%
15:01 - 16:00 MIN 0 0 0 0.00% 0.00%
16:01 -17:00 MIN 0 0 0 0.00% 0.00%
17:01 . 18:00 MIN 0 0 0 0.00% 0.00%
15:01 - 19:00 MIN 0 0 0 0.00% 0.00%
19:01 .20:00 MIN 0 0 0 0.00% 0.00%
20:01 - 21:00 MIN 0 0 0 0.00% 0.00%
21 :01 - 22:00 MIN 0 0 0 0.00% 0.00%
22:01 - 23:00 MIN 0 0 0 0.00% 0.00%
23:01 - 24:00 MIN 0 0 0 0.00% 0.00%
24:01 - 25:00 MIN 0 0 0 0.00% 0.00%
25:01 - 25:00 MIN 0 0 0 0.00% 0.00%
28:01 - 27:00 MIN 0 0 0 0.00% 0.00%
27:01 - 25:00 MIN 0 0 0 0.00% 0.00%
28:01 - 29:00 MIN 0 0 0 0.00% 0.00%
29:01 - 30:00 MIN 0 0 0 0.00% 0.00%
12-24
Response Times Total Adjusted
(Received to On Scene) Runs Exempt Runs Percent Accumulative %
30:01 - 31:00 MIN 0 0 0 0.00% 0.00%
31:01- 32:00 MIN 0 0 0 0.00% 0.00%
32:01 - 33:00 M1N 0 0 0 0.00% 0.00%
33:01 - 34:00 MIN 0 a 0 0.00% 0.00%
34:01 - 35:00 MIN 0 0 0 0.00% 0.00%
35:01 - 36:00 MIN a a 0 0.00% 0.00%
36:01 - 37:00 MIN 0 0 0 0.00% 0.00%
37:01 - 38:00 MIN 0 0 0 0.00% 0.00%
38:01 - 39:00 MIN 0 0 0 0.00% 0.00%
39:01 - 40:00 MIN 0 0 0 0.00% 0.00%
40:01 MIN OR OVER 0 0 0 0.00% 0.00%
TOTA~S a 0 0 0.00% 0.00%
Total TranspotlS 0
Average Paramedic Response Time: 0.00 Minutes
A. Total Mutual Aid provided: 0
B. Total Mutual Aid Received: 0
a) Annualized (Year to Date): Responses: 0
Responaeo Wllllln Criteria: 0
c. Annualized compliance %:
0.00%
This report shall be wed fer the compllaUon of annual response Ume con:'lpllance calculations.
12-25
EXHIBIT "cn
Exception Inquiry
Unit:
Incident Location:
Call Received:
Crewmembers:
Responded from:
Incident #:
Date of Incident:
Disp Time:
Resp Time:
ONS Time:
Communication Notes:
Crew Notes:
Comm Report By:
Crew Report By:
This response is to be submitted prior to EOS.
Fax to Communication Center 858-492-3634
Date:
Date:
12-26
Exhibit D
South Bay Exclusive Operating Area Rates
for ALS Base Rate, BLS Base Rate, Treatment Only
Rate, Mileage, Oxygen and Night Charges
NITA
$650.00
c
H
HAR E
ALS Emergency Base
Rate
BLS Base Rate
Mileage Rate/Mile or
ortion thereof
Ox en Char e
Ni ht Char e
Treatment Onl
497.30
497.30
497.30
20.02
72.35
71.66
150.00
Per ReviseiRestated Agreement effective December 11, 2007
12-27
EXHIBIT "E"
INSURANCE REQUIREMENTS FOR CONTRACTORS
AMR shall procure and maintain for the duration of the contract Insurance against
claims for injuries to persons or damages to property which may arise from or in
connection with the perfonTlance of the work hereunder and the results of that work
by the AMR, Its agents, representatives. employees or subcontractors.
II. Min~ Scope of Insurance
Coverage shall be at least as broad as:
1. Insurance Services Office Commercial General Liability coverage
(occurrence Form CG0001)
2. Ambulance Owners/Operators Malpractice Insurance and/or Errors and
Omissions Insurance appropriate to the contactors operations.
3. Insurance Services Office Form Number CA 0001 covering Automobile
Liability, Code1 (any auto).
4. Workers' Compensation insurance as required by the State of California
and Employer's Liability Insurance.
III. Minimum Limits of Insurance
AMR shall maintain limits no less than:
1.
Liability:
General $2,000,000
per occurrence for bodily injury,
personal injury and property
damage. If Commercial General
Liability insurance or other form
with a general aggregate limit is
used, either the general
aggregate limit is used. either
the general aggregate limit shall
apply separately to this
project/location or the general
aggregate limit shaH be twice
the required occurrence limit.
per accident for bodily injury and
property damage.
2. Automobile Liability: $2,000,000
12-28
3. Employer's Liability: $1,000,000
per accident for bodily injury or
disease.
4.Ambulance $ 2,000,000
Owners/Operators
Malpractice, Errors and
Omissions or
Professional Liability As
Appropriate
Deductibles and Self.lnsured Retentions
Any deductibles or self-insured retentions must be declared to and approved by the
City. At the option of the City, either: the insurer shall reduce or eliminate such
deductibles or self-insured retentions as respects the City, its officers, officials,
employees and volunteers; or the AMR shall provide a financial guarantee
satisfactory to the City guaranteeing payment of losses and related investigations,
claim administration, and defense expenses.
Other Insurance Provisions
The general liability and automobile liability pOlicies are to contain, or be endorsed
to contain, the following provisions:
1. The City, its officers, officials, employees, and volunteers are to be
covered as insureds with respect to liability arising out of automobiles
owned, leased, hired or borrowed by or on behalf of the AMR; and
with respect to liability arising out of work or operations performed by
or on behalf of the AMR including materials, parts or equipment
fumished in connection with such work or operations. General liability
coverage can be provided in the form of an endorsement to the AMR's
insurance, or as a separate owner's policy (CG20 1011 85).
2. For any claims related to this project, the AMR's insurance coverage
shall be primary insurance as respects the City, its officers, officials,
employees, and volunteers. Any insurance or self-insurance
maintained by the City, its officers, officials, employees, or volunteers
shall be excess of the AMR's insurance and shall not contribute with it.
3. Each insurance policy required by this clause shall be endorsed to
state that coverage shall not be canceled by either party, except after
thirty (30) days' prior written notice by certified mail, return receipt
requested, has been given to the City.
4. Coverage shall not extend to any indemnity coverage for the active
negligence of the additional insured in any case where an agreement
to indemnify the additional insured would be invalid under Subdivision
(b) of Section 2782 of the Civil Code.
12-29
A. AccePtability of Insurers
Insurance is to be placed with insurers with a current A.M. Best's rating of no less
than A:VII.
B. Verification of Coverage
AMR shall fumish the City with original certificates and amendatory endorsements
effecting coverage required by this clause. The endorsements should be on forms
provided by the City or on other than the City's forms, provided those endorsements
or policies conform to the requirements. All certificates and endorsements are to be
received and approved by the City before work commences. The City reserves the
right to require complete, certified copies of all required insurance policies, including
endorsements effecting the coverage required by these specifications at any time.
C. subcontractors
AMR shaJ/ include all subcontractors as insureds under its policies or shall fumish
separate certificates and endorsements for each subcontractor. All coverages for
subcontractors shall be subject to all of the requirements stated herein.
12-30
Exhibit "'P"
Definitions
The definitions included in California Code of Regulations, Title 22, Division 9,
Chapters! . 9; California Code of Regulations, Title 13, Division 2, Chapter 5,
Article 1; and Division 2.5, Chapters2 - 11 of the California Health and Safety Code,
shall apply to this Agreement unless the Agreement indicates otherwise. By way of
example such definitions shall include, but not be limited to EMT, EMT-IA, EM!.
Paramedic, Paramedic, Emergency Medical Services Agency andlor Medical
Director.
1) Ambulance is defined as any motor vehicle which meets current specifications and is
licensed as an ambulance by the State of California and is permitted in the County of
San Diego.
2) Arrival at Incident Location is defmed as the moment the EMS personnel notify an
appropriate Communications Center that an emergency response unit is at its parlcing
position at the scene of an incident (e.g., the entrance to a specific apartment building.
not merely the entrance to the apartment complex in general; or an actual collision
scene - not merely an approach location within sight of the collision). For purposes of
this paragraph, arrival at locked gates of a occupancy shall constitute arrival as shaU
arrival at an appropriate or designated staging area or "stand-back" location.
3) Back-uP is defined as assistance from another a unit not normally assigned to the
EOA from outside the EOA by responding into the Exclusive Operating Area at the
request of AMR.
4) Call(s) for Service shall mean requests for emergency medical ambulance service
received by Heartland Fire Communications Center or other Public Safety Answering
Point serving the Service Area.
5) CMS means Centers for Medicare and Medicaid Services. This agency of the United
States Department of Health and Human Services was formally known as the Health
Care Financing Administration (HCFA).
6) Computer-aided Dispatch (hereinafter referred to as "CAD'') is a system of computer
hardware and software that facilitates call taking, resource dispatch and deployment,
dispatch and unit times documentation, creation and real time maintenance of
incidents, data base and management information system.
7) Code 2 is a response to an emergency which has been designated in strict accordance
with approved protocols as non.life threatening at call reception by appropriate AMR
Communications personnel or other appropriate Public Safety Answering Point
(hereinafter referred to as "PSAP'') personnel. Vehicles responding Code 2 shall obey
all traffic signs and respond without the use of the siren.
12-31
8) Code 3 is a response to an emergency which has been designated in strict accordance
with approved protocols as life-threatening by appropriate AMR Communications
personnel or other appropriate PSAP personnel. Vehicles responding Code 3 shall
respond as quickly as possible using lights and siren and may move through traffic
against directional signs if it can be done safely.
9) AMR Communications Center is the central medical emergency dispatch center from
which all emergency ambulances operating in the BOA are dispatched and controlled.
10) Emergencv is defined as a perceived need for immediate medical attention or an
incident in which the potential for such need for immediate medical attention is
perceived by emergency medical personnel or public safety personnel, and in which a
delay in providing such services may aggravate the medical condition or cause the loss
of life.
11) Emergency Medical Dispatch (hereafter referred to as "EMD") is a protocol driven
system of caller interrogation that allows communications personnel trained as
Emergency Medical Dispatchers to provide medical care instructions, including
bleeding control, airway management, and CPR.
12) Exceotion is a late response as determined by response time criteria.
a) Exclusive Operatin~ Area (hereinafter referred to as "EOA") is defined as
the EMS area or sub-area defined in the EMS plan within which only the
designated emergency medical care and transport service may provide pre-
hospital emergency medical care and transport services in response to calls
received through the 9-1-1 system for a defined period of time. Forpurposes
of this Agreement, the EOA refers to the geographical boundaries of the City
of Chula Vista, Imperial Beach and Bonita/Sunnyside Fire Protection
District.
13) Exemotion is a determination to exclude an EMS event from the predetermined
response time criteria due to factors outside AMR's control.
14) First Resoonder Agency, for purposes of this Agreement, is defined as any public
agency that has a current agreement with AMR, approved by the County, to respond to
medical emergencies when dispatched in order to assess the scene, initiate emergency
medical treatment and document care prior to the arrival of the ALS Transport Team.
15) Medical Direction is direction given to EMS personnel, in accordance with EMS
agency policy, either by AMR Medical Director or by the County EMS Medical
Director, through standing orders, or through direct voice contact with a Base Station
Physician or with an approved mobile intensive care nurse (hereinafter referred to as
"MIeN") with or without vital sign telemetry.
12-32
16) Response Data is the measurement oHime lapsed on a continuum of response to a 9-1-
1 call. The components oHime measured for a response to a 9-1-1 call are defined as
follows:
a) Discovery - time of incident until dispatcher receives 9-1-1 call;
b) Disoatch - time from 9-1-1 call to dispatch of first responder and transport
ambulance;
c) First Response - time of unit notification until arrival of first response unit at I
incident location;
d) Response Time - time of unit notification until arrival of Transport Unit at incident
location;
e) Scene Time - time of arrival of First Response unit or Transport Unit at incident
location until they leave the scene. Scene time is calculated separately for First
Responders and Transport team;
f) Transoort time - time Transport Unit leaves the scene until arrival at hospital; and
g) Back in Service - Time Transport unit at hospital is clean and ready for another
call.
17) Service Area - Each PARTICIPATING AGENCY (City of Chula Vista, City of
Imperial Beach and the Bonita/Sunnyside Fire Protection District) is a separate and
distinct Service Area. The three Service Areas compose the EOA. .
18) Stand-by Service is defined as the dispatch of an ambulance unit by AMR
Communications Center at the specific request of a public safety agency to a position
of immediate availability. This does not include a pre-arranged stand-by request for
activity of any duration,. such as concerts, sporting events, etc.
19) SyStem Status ManaJl:ement Plan is an algorithm and written operating procedures for
on-line, real time management of system resources through system deployment,
posting patterns and redeployment of units and unit hours to meet the ongoing demand
of the system and to optimize system coverage consistent with real time needs of the
system.
12-33
BOND NO.: 5017389
PERFORMANCE BOND
BOND SAFEGUARD INSURANCE COMPANY
Know all Men by these Presents, that we, AMERICAN MEDICAL RESPONSE OF
SOUTHERN CALIFORNIA
(hereinafter called Principal"), as Principal, and the BOND SAFEGUARD
INSURANCE COMPANY, Lombard, II. a corporation duly organized under the laws of
the State 0 f Illinois, and authorized to transact business in the State of CA (hereinafter
called the Surety), as Surety, are held and firmly bound unto:
CITY OF CHULA VISTA
276 FOURTH AVENUE
CHULA VISTA, CALIFORNIA 91910
(hereinafter called "Obligee"), in the penal sum of THREE HUNDRED THOUSAND
AND OO/lOO----------------------------------DOLLARS ($300,000.00)
good and lawful money of the United States of America, for the payment of which, well
and truly to be made, we bind ourselves, our heirs, administrators, executors, successors
and assigns, jointly and severally, firmly by these presents.
SEALED with our seals and dated this 9th day of JUNE, 2006.
WHEREAS, the Principal entered into a certain Contract with the Obligee, dated the
I" day of NOVEMBER, 1998.
FOR: BASIC AND ADVANCED LIFE SUPPORT AMBULANCE SERVICES
in accordance with the terms and conditions of the said Contract, which is hereby referred
to and made a part thereof as if fully set forth herein.
Now, therefore, the condition of the above obligation is such, that if the above
bounden Principal shall well and truly keep, do and perform each and every, all and
singular, the matters and things in said Contract set forth and specified to be by the said
Principal kept, done and performed, at the time and in the manner in said contract
specified, or shall pay over, make good and reimburse to the above named Obligee, all
loss and damage which said obligee may sustain by reason of failure or default on the
part of said Principal so to do, then this obligation shall null and void; otherwise shall
remain in full force and effect, subject, however, to the following conditions:
12-34
Any suit under this bond may be instituted before the expiration of two (2) years from
the date on which final payment under the contract falls due.
No right of action shall accrue on this bond to or for the use of any person or
corporation other than the Obligee named herein or the heirs, executors, administrators,
or successors of the Obligee.
By:
By:
BO
COMPANY
12-35
POWER OF ATTORNEY AO 4 1 4 0 4
Bond Safeguard INSURANCE COMPANY
KNOW ALL MEN BY THESE PRESENTS, that BOND SAFEQUARD INSURANCE COMPANY, an illinois Corporation w~h its
prIncipal office in Lombard, Illinois, does hereby constitute and appoint: Richard C_ Gaff Marv rl:ai.,.p ronff' .....14...:" M Q..__....l "''''.......'''..'''...
................................~.................*....................................................**.**.**.**................
Its trua and lawful Attorney(s)-In-Facl to make, execute, seal and deliver for, and on its behalf as surely, any and all bonds, undertakings
or other writings obligatory in nature of a bond.
This authority is made under and by the authority of a resolution which was passed by the Board of Directors of BOND
SAFEGUARD INSURANCE COMPANY on the 7th day of November, 2001 as follows:
Resolved, that the President of the Company is hereby authorized to appoint and empower any representative of the Company
or other person or persons as Attorney-in-Facl to execute on behaif of the Company any bonds, undertakings, policies, contracts of
indemnity or other writings obligatory in nature of a bond not to exceed $1,000,000.00, One Million Dollars, which the Company might
execute through its duly elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an
Attorney-In-Fact shall be as binding upon the Company as n they had been duly executed and acknowledged by the regularly elected
officers of the Company, Any Attorney-In-Fact, so appointed. may be removed for good cause and the authority so granted may be
revoked as specified In the Power of Attorney.
Resolved, that the signature of the President and the seal of the Company may be affixed by facsimile on any power of
attorney granted, and the signature of the Vice Presiden~ and the seal of the Company may be affixed by facsimile to any certificate of
any such power and any such power or certificate bearing such facsimile signature and seal shail be valid and binding on the Company.
Any such power so executed and sealed and certificate so executed and sealed shall, with respect to any bond or undertaking to which
it is attached, continue to be valid and binding on the Company.
IN WITNESS THEREOF, BOND SAFEGUARD INSURANCE COMPANY has caused this instrument to be signed by its
President, and its Corporate seal to be affixed this 7th day of November, 2001.
BOND SAFEGUARD INSURANCE COMPANY
BY
r?/e~~
David E. Campbell
President
ACKNOWLEDGEMENT
On this 7th day of November, 2001, before me, personaliy came David E. Carnpbeillo me known, who being duly sworn, did
depose and say that he is the President of BOND SAFEGUARD INSURANCE COMPANY, the corporation described in and which
executed the above instrument; that he executed said instrument on behalf of the corporation by authority of his office under the By-laws
of said corporation. /J / :/ # 1..-/
"OFFICIAL SEAL" M.........~ ~
MICHELE KOLLER .
NoIary Public, Slate olllNnols
Mr Co_llSlon Expi... 08l28I07
Michele Keiler
Notary Publio
CERTIFICATE
I, the undersigned, Secretary of BOND SAFEGUARD INSURANCE COMPANY, Anlliinois Insurance Company, DO HEREBY
CERTIFY that the original Power of Attorney of which the foregoing is a true and correct copy, is in fuli force and effect and has not been
revoked and the resolutions as set forth are now in force.
Signed and Sealed at lombard, Illinois this
9th
Day of
June
.20 06
WJJ~
Donald D. Buchanan
Secretary
12-36
~,~
~~
~~~
CI1Y OF
OIUlA VISTA
COpy
Fire Department
June 28, 2006
MIMS INTERNATIONAL, lTD.
Atln: Ms. Felicia M. Buscemi
901 Dulaney Valley Road, Suite 610
Towson, Maryland 21204
RE: Bond Release - Western Insurance Company - #ABC50509
To Whom It May Concern:
Original bond #ABC50509 issued by Western Insurance Company, on behalf of
American Medical Response of Southern California, is hereby replaced with bond
#5017389 issued by Bond Safeguard Insurance Company.
~ )),~:;)
Douglas A. Perry,
Fire Chief
DAP:ah
447 F Street. MS F-200
Chula Vista, CA 91910
~~
PRIDE
AT w 0 II
Phone (619) 691.5055
Fax (619) 691-5057
12-37
www.chulavistaca.gov
:. PosI-Canwmer ~=cI hp:!
~{~
liiiMliii
~::.-~~
mY OF
CHUlA VISTA
Fire Deparbnent
December 18, 2003
MIMS INTERNATIONAL, LTD.
ATTN: Ms. Felicia M. Buscemi
901 Dulaney Valley Road, Suite 610
Towson, Maryland 21204
RE: BOND RELEASE - AMERICAN HOME ASSURANCE COMPANY
To Whom It May Concern:
Original Bond #29-25-51, issued by American Home Assurance Company, on
behalf of American Medical Response of Southern California is hereby replaced
with bond #ABC50509 issued by Western Insurance Company.
Sincerely,
U~~/dtrU3^~/
Alicia Hernandez {
Administrative Secretary
447 F Street. MS F-200
Chula Vista, CA 91910
- ~\lh,
PRIDE
A.T WaR k
'hone (619) 691-5055
r." '61'l1691-';057
www.chulavistaca.gov
12-38
1'.....I.H'..""...~".I.~I;>'I'oOf
Attachment B
SUSTAINING EXCELLENCE: The Case for Ambulance Rate
Increases - 2007
Background and Context of Ambulance Rates
AMR and its predecessor companies have been providing service continuously to this
area since 1980. In 2002 a contract defining our service terms and responsibilities was
implemented through a process involving the City of Chula Vista, the City of Imperial Beach and
the Bonita/Sunnyside Fire Protection District. This resulted in the creation of a service area
known as the Southbay Exclusive Operating Area (EOA).
During these negotiations both AMR and our partner cities recognized that EMS was
evolving in the South bay region and as such, fiexibility was paramount in considering system
parameters. As such AMR agreed to charge essentially the lowest base ambulance rates in
Southern California while allowing each jurisdiction the fiexlbility to add services and charges as
they deemed necessary to meet the needs of their unique community. A comparison of existing
ambulance base rates in Southern Califomia is found in the table below:
Rate TVDe Hiah Low Averaae Southbav
ALS Emergency $1,250.60 $551.25 (next $963.96 $512.66
lowest to
Southbav)
BLS Emeraencv $1,250.60 $422.00 $650.79 $447.62
AMR has not requested or implemented a rate increase in the Southbay EOA since June
of 2004. This has occurred in an environment of rapidly escalating fuel, insurance, labor, medical
supply and pharmaceutical costs. Additionally, there have been several innovations to EMS
delivery that have been implemented by AMR and our partners to enhance service levels and
encourage paramedic levels of service in our communities.
Contractual Rate Approvals
As part of this contract amendment, AMR is seeking an ALS Emergency adjustment.
This adjustment would bring the ALS Emergency Base Rate to $650.00. This rate is still in the
lower 30% of rates found in Southern California and remains substantially below the Average
Base Rate experienced in San Diego County.
The magnitude of the needed rate increase occurs because AMR has forgone its
contractually allowable rate increases for the past 3 years in order to allow the City and other
Agencies to conduct studies to help define the future vision of EMS in the South bay region. In
order to mitigate the scope of the first year increases, AMR in conjunction with staff have
developed a proposal that would provide a lower rate increase this year with 7% rate increases
through 2011. This will provide the revenue needed to provide a safe, efficient and sustainable
EMS system in Chula Vista and the South bay. This proposal would bring the initial base rate up
to $650 and would limit additional rate increases to 7%/year over 3 years (2008 - 2011). This
would bring the base rate to $796.28 or a fully compounded rate increase of 22.5% over these 4-
12-39
years. This would guarantee Chula Vista ambulance rates in 2011 substantially equal to the
average statewide ambulance rates available today.
This rate increase still does not provide adequate revenues consistent with the high
levels of service provided to the City of Chula Vista and South bay Communities. This inadequacy
stems from the following principle issues:
. Extraordinary costs enhanced by the fact that ambulance billing does not allow
for collection of 100% of the billed amount. Therefore, a 5% rate increase results
in only about 1.5% net In new revenue.
. AMR has invested resources in advance of the increase in transports necessary
to fund those additional resources. This has resulted in consistentiy high service
levels, but at a substantial financial penalty.
Impact of Insurance payments on ability to collect revenue
Part of the reason an additional rate increase is necessary is related to a reality of
healthcare finance called "marginal collection rate." Unfortunately, less than 30-cents of every
additional dollar billed will ultimately be collected within the South bay system
The reason for this is related to the realities of Medicare and the health insurance
industry. Revenue of any health care system is divided into various methods of payment.
Typically these categories include the following titles:
1. Medicare
2. Medicaid (MediCal)
3. Third Party Payers (Insurance Companies)
4. Private Pay
Each of these payers has a given "elasticity" of rate increases that they will recognize.
Medicare and Medicaid, for example, each set a given rate that they will pay for a service and will
not pay above that amount regardless of the amount charged. If 20% of the payer mix is paid by
Medicare, then any rate increase above the Medicare "profile" amount will go uncollected. The
same is true for Medicaid (Medical), except that the allowable rates for Medicaid are even lower
(in most instances) than Medicare.
Thus as can be seen by the figure below, the ability to recognize net revenue for each
dollar of rate increase becomes more and more difficult and the patient charge increases.
Therefore, it can be seen that many rate increases may seem large, but the actual ability of the
health care provider to see any net revenue can be as low as 5% on each additional dollar added
to a charge. This phenomenon partly explains the shocking reality of a $9.00 aspirin pill on many
itemized hospital charges.
12-40
Impact on Individual Payer
Rate Elasticity
$1.00
$0.90
: $0.80
..
e $0.70
..
.5 $0.60
~ $0.50
c:
.. $0.40
~ $0.30
~
.l! $0.20
$0.10
$0.00
$0
Increase Collected
Bill Amount
$1,000
One the unique aspects of healthcare economics in the United States is that it is the only
service that comes to mind where the consumer of the product in not the purchaser. This leads
to a variety of consequences, mostly negative, but it is the system that health care finance in the
United States has evolved to. Likewise, rate increases - although some may appear grand, have
a minimal effect on the actual consumer.
By way of example, the table that follows summarizes the hypothetical direct impact on a
variety of consumers of an increase in ambulance service fees.
Payer Type Old New New Consumer Rationale and Discussion
Rate Rate Revenue Impact
Medicare $512.66 $650.00 $0.00 $0.00 Consumer is obligated to
pay (or have supplemental
insurance pay) 20% of
Medicare Allowable Amount
Medicare Allowable is not
dependent upon rates
charaed.
Medicaid (Medical) $512.66 $650.00 $0.00 $0.00 Consumer is not obligated to
make co-payments.
Medicaid rate does not
change - not dependent
upon patient charaes.
Third Party $512.66 $650.00 $190.68 $38.64 Consumer cost is usually the
Indemnity delta in 20% co-pay of rates.
Insurance Most companies will
recognize increased rates if
they are generally consistent
with usual and customary
rates found in the
12-41
oeooraphic area.
Private Pay $512.66 $650.00 $0 - Varies As noted above, private pay
$189.68 within is a broad 'category.
Range However, the largest
percentage of cash
generated from this category
Is already reflected in the co-
pay categories above. The
remainder are either un-
Insured or self-insured/MSA
patients. The direct impact
on this population is
dependent upon where they
are in relation to deductible
cycles and the construction
of their unique plans.
While admitedly simplistic in detail, the table above illustrates that a theoretical increase
of $138.00 in a base ambulance rate will impact approximately 39.9% of the systems users by
increasing out-of-pocket expense by $38.64 per ambulance transport. The other 60% of the
population wili have vitrually no direct monetary impact.
It is important to note that our expansive history, and the history of local governments in
the South bay region, has continually proven that rate increases in ambulance services are bome
mostly by health insurance coverage. The majority of the citizenry is not directly affected by rate
increases and consistent with good policy practice, in ambulance services the users of the
service are the only ones impacted by the rates. Public concern and/or reactions to ambulance
rate increases are usually either minimal or non-existent.
The Further Impacts of Inflation
The Medical and Transportation components of the Consumer Price Index (CPI) are reflected in
the table below:
Year Medical TransDortation
2004 4.4% 3.5%
2005 4.2% 6.6%
2006 4.0% 4.0%
The combined CPI impact on costs averages 4.5% over the past 3-years. However,
when the above discussion on collection rates is considered, the ability to meet the impact of
inflation, let alone any system investments, is non-existent.
Consider the table that follows:
Rate and Marginal Net
Proposed % Rate Collection Collectable Net % Medical Realized
Adjustment Adiustment Rate Revenue Increase CPI Effect
2004 $ 512.00
2005 5.0% $ 25.63 30% $ 7.69 1.5% 4.4% -2.9%
2006 5.0% $ 26.91 28% $ 7.54 1.4% 4.2% -2.8%
12-42
-
--.-.-------
5.0% $
$
26.98
79.53
$ 7.55
$ 22.78
The table above reflects a rate increase granted on the assumption of a 5% annual rate
increase extending back to 2005 would result in an ALS base rate of $592.19.
However, because of the issues described above, AMR would only see a net increase
of $22.78/call. When the impact of inflation is considered, the end result of a 5% net
increase results net losses of over 1.5% every single year.
Another way of looking at the economic realities of the system would be to determine the
actual amount of cash that would actually be generated by the rates proposed by AMR. The
table below summarizes this:
Current Requested Rate Net Cash
Rate Rate Increase Received
$ 512.00 $ 650.00 $ 138.00 $ 38.64
The rate increase proposed by AMR will result in only $38.64 net cash actually received.
This represents an actual rate increase of only 7.42% over the three-year period in which no
rate increases were obtained.
Increases in ambulance resources prior to the transports generating revenue to support
an increased level of service.
Another primary cause of needed rate increases occurs because ambulance and system
resources needed to maintain or enhance service levels are needed prior to the ability of the
system to develop the actual transports which generate the revenue necessary for those
resources. In other words, the demand for resources increases more rapidly than the transports
necessary to pay for them.
It is often thought that ambulance rate increases are not necessary for reasons of system
growtih. The thought is, that a growing system generates additional transports which generate
more revenue. Unfortunately, growing systems require ambulances and other resources in
advance of the generation of additional transports.
The practical reality is that the need for the number of staffed and equipped
ambulances has escalated 37.4% over the past three years while the number of transports
available to pay for this level of service has increased only 28.5% over the same period.
The changes in the South bay EOA are summarized by the following data:
System Resource Change since
2004
Ambulance Service i 37.4%
Hours
Svstem Ambulances t 40.0%
Number of Transports t 28.5%
Ambulance Service i 6.94%
HourslTransport
12-43
This indicates that AMR has managed the system in a way that the total number of
hours that ambulances are staffed and equipped to respond has increased 7% over the
growth in the total number of transports available to generate the revenues necessary to
support those resources and thus, the community's service levels.
SUMMARY AND STA TEMENT OF FACT
AMR has submitted a request for a base rate adjustment to $650.00.
The $650.00 rate proposed is still below the average ALS Base Rates found in the current
market and is, in fact, in the lower 35% of rates in the County.
From the $138.00 rate increase proposed - AMR will net only $38.64. This represents a real rate
increase of only 7.4% over the entire previous 3-year period.
AMRs expenses are extra-ordinary in that Medical and Transportation CPI rates have averaged
4.2% and 4.7% respectively over the past 3-years while consumer CPI has averaged 2.6%. AMR
is particularly susceptible to increases in fuel which has brought the annualized transportation
inflation factor to close to 8% during several of the past 12 quarters.
Ambulances have been added to the system that have increased the total ambulance availability
40%, while the transports available to fund these additional resources have only increased
28.5%.
12-44
SUMMARY OF EXTRAORDINARY CONDITIONS JUSTIFYING
RATE INCREASES
CONDITION/EXPENSE JUSTIFICATION
Extraordinary Inflation Impact . Medical CPI Component averages
4.2%/year
. Transportation CPI Component
averages 4. 7%/year
. Standard consumer CPI increases
have averaged 2.4% over the same
period.
Impact of Collection Rates . 5% Rate increase results in only 1.5%
cash actually received.
. With inflation impact considered, AMR
has been losing 2.5%/year over the
past 3-years.
. Requested Rate increase
(approximately $138) results in only
$38.64 in cash received through
billings.
. Rate increases are primarily borne by
health insurance. Rate sensitivity to
citizens in minimal and rarely, if ever,
results in complaints or concerns.
Rate increases requested still leave rates well . Requested base rate is $248 less than
below average ambulance rates found current average of ambulance ALS
elsewhere. base rates.
Ambulance resources placed in service prior to . Number of ambulances have increased
new transports available to generate needed 40% over term of contract.
revenue.
. Number of transports needed to
generate revenues for new units has
increased only 28.5%
17-41';
RESOLUTION NO. 2007-
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CHULA VISTA APPROVING A REVISED AND RESTATED
AGREEMENT FOR BASIC AND ADVANCED LIFE SUPPORT
SERVICE WITH LAIDLAW MEDICAL TRANSPORTATION
INC., DBA AMERICAN MEDICAL RESPONSE, AND
AUTHORIZING THE MAYOR TO EXECUTE THE
AGREEMENT
WHEREAS, the City has had on ongoing relationship with Laidlaw Medical Transport
Inc., dba American Medical Response (AMR) and formerly known as Hartson Medical Services
since 1989 to provide basic and advanced life support ambulance services; and,
WHEREAS, an agreement entered into with AMR on November I, 1998 granted AMR
the authority to provide basic and advanced life support ambulance services to the Exclusive
Operating Area (EOA) that was adopted by the County of San Diego. This EOA consists of the
City of Chula Vista, Bonita/Sunnyside Fire Protection District, and the City of Imperial Beach;
and,
WHEREAS, this agreement was amended and was re-titled the Amended and Restated
Agreement and approved by Council on May 14,2002; and,
WHEREAS, the Amended and Restated Agreement commenced on June 1,2002 and was
in effect for the three-year period ending May 31, 2005; and,
WHEREAS, the Amended and Restated Agreement clarified and reinforced key
stipulations ensuring AMR's performance and service delivery throughout the EOA and thus
benefiting the members of the EOA; and,
WHEREAS, pursuant to Section 17 of the Amended and Restated Agreement, the City
has the option to extend the Amended and Restated Agreement for two additional three-year
periods at the City's option; and,
WHEREAS, the City wishes to exercise the option to extend the contractual relationship
with AMR on the terms and conditions set forth in a Revised and Restated Agreement; and,
WHEREAS, the authorized Primary Rate Components that AMR is permitted to charge
for services rendered in the EOA are stipulated; and,
WHEREAS, pursuant to Section 5 of the Revised and Restated Agreement, AMR
reserves the right to submit a request for increases to the Primary Rate Components; and,
WHEREAS, pursuant to Section 5 of the Revised and Restated Agreement, AMR is
requesting increases to the Primary Rate Components to be charged in the EOA as follows:
J:\Attomlly\RESO\FlRE\AMR Contract Extl105ion _12-11-07.doc
12-46
Resolution No. 2007-
Page 2
CHARGE BONITA CHULA VISTA IMPERIAL BEACH
ALS Emergency $650.00 $650.00 $1,060.69
Base Rate
BLS Base Rate $497.30 $497.30 $497.30
Mileage
Rate/mile or $20.02 $20.02 $20.02
!portion
Oxygen Charge $72.35 $72.35 $72.35
Night Charge $71.66 $71.66 $71.66
Treatment Only $150.00 $150.00 $150.00
WHEREAS, pursuant to Section 5 of the Revised and Restated Agreement, the City
Council has sole discretion to approve or disapprove increases to the Primary Rate Components;
and,
WHEREAS, if approved, the revised Primary Rate Components are set forth at Exhibit D
in the Revised and Restated Agreement and are incorporated therein; and,
WHEREAS, pursuant to Municipal Code 2.56.070, the City Council may waive any
competitive bidding requirements where there is a commodity or service available from only one
known source as the result of unique performance capabilities, compatibility requirements or
market conditions, or the competitive bidding requirements as applied to the contract are
impractical, impossible, or the city interests would be materially better served by applying a
different purchasing process; and,
WHEREAS, AMR has demonstrated through its past performance the ability to fulfill
previous contract requirements, provide competitive pricing for its services, sustain its
interoperability with the Chula Vista Fire Department and deliver longstanding quality services
to the community; and,
WHEREAS, the City's interests would be materially better served by continuing its long-
term contractual relationship with AMR because of its performance capabilities, compatibility
requirements, and market conditions, including cost and existing service relationship with all
members of the EOA; and
WHEREAS, it is the intent and desire of the City Council to waive any competition
bidding requirements and enter into the Revised and Restated Agreement with AMR for the
reasons set forth herein.
J:\Attomey\RESO\FIRBAMR Contract EXlellsioo_12-11-07.dOl:
12-47
Resolution No. 2007-
Page 3
NOW, THEREFORE, BE IT RESOLVED THAT the City Council of the City ofChula
Vista waives any competitive bidding requirements and exercises its option to extend its
contractual relationship with AMR for the provision of basic and advanced life support
ambulance services.
BE IT FURTHER RESOLVED THAT the City Council of the City of Chula Vista does
hereby approve the Revised and Restated Agreement with AMR to be effective December II,
2007 through May 31, 2011, with options to extend for two additional three-year periods
thereafter.
BE IT FURTHER RESOLVED THAT the City Council of the City ofChula Vista does
hereby approve the increases to the Primary Rate Components effective December 11,2007, as
set forth in Exhibit "D" of the Revised and Restated Agreement.
BE IT FURTHER RESOLVED THAT the City Council of the City of Chula Vista does
hereby authorize the Mayor to execute the Revised and Restated Agreement.
Presented by:
Approved as to form by:
Douglas A. Perry
Fire Chief
C)..WI Mdlid0- ffi1
. Moore (. .
City Attorney .
J:\Attomcy\RESO\FlRE\AMR Contracl Extcnsion_l2.t 1-07 .doc
1?_All