Central Sonoma County gets new ambulance service Tuesday. Here’s what it means for residents

The takeover by Sonoma County Fire District, which was awarded the $30 million yearly contract in May, ends three decades of service by AMR, the EMS giant.|

MARTIN ESPINOZA

THE PRESS DEMOCRAT

January 12, 2024

Legal disputes settled

The road to Tuesday’s ambulance service handoff has until recently been rough — riddled by dueling lawsuits between Sonoma County and AMR, its main EMS provider for three decades.

The county launched a competitive bidding process — a requirement under state rules for exclusive operating contracts — in November 2022. In late April last year, Sonoma County Health Services Director Tina Rivera announced that the Sonoma County Fire District had earned a higher score in the bidding process than AMR.

Days later, AMR issued a formal protest alleging that the bidding was tainted by favoritism and violated the competitive process. Even before AMR’s protest of the bidding process, the company had filed a lawsuit alleging that county actions leading up to the bidding process had essentially voided the exclusivity of AMR’s contract with the county.

The county later countersued AMR, accusing the ambulance provider of failing to meet response times and other performance metrics, and for refusing to pay penalties for poor performance.

All legal disputes between AMR and the county were settled in November.

For the fire district, Tuesday’s takeover marks another expansion in what’s been a remarkably fast growth period since the district’s 2019 founding. Chief Mark Heine, who has been at the helm that whole time, described the bid for ambulance service as one of the more fraught moves he’s made to grow the agency.

There were “emotions from time to time and drama from time to time,” he said. “It was very difficult.”

At a Jan. 5 ceremony marking the district’s ambulance takeover, attendees said little about the legal disputes.

For her part, Rivera, the county’s health services director, said the fire district and its subcontractor Medic Ambulance deserved the “right to celebrate” their achievements, as well as the praise they’ve earned for building a new ambulance response system.

“You've earned the right to enjoy all of the achievements that have brought us to this space,” Rivera said. “I encourage you to stay sharp, I’ll make sure you stay sharp, because the hard work begins.”

— Martin Espinoza

Starting Tuesday, calling 911 for ambulance service will bring a new player to the paved and not-so-paved streets of central Sonoma County.

That’s when Sonoma County Fire District takes over the county’s lucrative, exclusive, 5-year ambulance contract, previously held for three decades by American Medical Response, locally known as Sonoma Life Support.

AMR’s familiar white and blue-trim ambulance vans will be replaced by a new fleet of boxy red and white-trim transports operated by the fire district’s subcontractor, Medic Ambulance.

County health officials and fire district representatives said local residents should expect ambulance service that is as good or better than what’s been provided for the past 30 years.

“There are a number of different innovations that Sonoma County Fire District put together in their bid, which are potentially going to increase the level of service that people can expect,” said Gabriel Kaplan, director of Sonoma County’s public health division.

Kaplan said these enhancements include deploying more ambulance vehicles and shortening response times in more rural areas of west Sonoma County.

The new contract is worth about $30 million a year in revenue, according to the fire district’s bid proposal.

At a recent ceremony previewing the new service, Sonoma County Fire District Chief Mark Heine said he expects the partnership with Vallejo-based Medic Ambulance will meet and even exceed the current needs of the community with new services.

“I feel the organization is very much on the cutting edge of emergency services locally and statewide,” he said. “We’re forging new concepts, we’re turning them into enhanced services for all of the communities we serve.”

Matt Windrem, the fire district’s EMS division chief, said the district, in partnership with its ambulance subcontractor, hopes to expand the medical services it offers “beyond answering 911 calls and driving patients to the hospital.”

Fire district officials said the new fleet of EMS vehicles also includes:

* Off-road, all-terrain ambulances for serving remote areas such as parks and open space areas.

* A “medical ambulance bus” that’s capable of transporting up to 22 patients and can respond to mass-casualty incidents or disasters.

* An EMS mobile command vehicle that can be used during unique events in the county, such as bike and foot races and the Sonoma County Fair.

Plans in the works also include building “pre-hospital EMS programs” such as home care check-ins and community-based para-medicine, where transports expand their destinations beyond the hospital emergency department, such as a behavioral health facility.

Fire district’s meteoric growth

The ambulance contract for the county’s Exclusive Operating Area 1, or EOA 1, takes in the most populous part of Sonoma County, stretching from Kenwood in the east to Occidental in the west, and from Larkfield in the north to Cotati in the south.

Landing the contract was a major coup for a relatively new fire district, which was founded in 2019 through a series of consolidations of local fire agencies. The district’s firefighting territory currently includes Windsor, Rincon Valley, Bennett Valley, Bodega Bay, Guerneville and Forestville.

Ambulance service in Windsor, Healdsburg, Geyserville and surrounding areas in north Sonoma County is provided by Bell’s Ambulance Service. In south Sonoma County, the Petaluma Fire Department and the Sonoma Valley Fire District provide their own respective ambulance services.

The Sonoma County Fire District, through predecessor agencies like Bodega Bay and the Russian River fire districts, currently operates ambulance service in a large swath of west Sonoma County. That area also includes the Two Rock community west of Petaluma, Bodega, Jenner and Monte Rio along the lower Russian River.

An agreement with Marin County also sends district ambulances to Tomales.

But to provide ambulance services in the EOA 1, the Sonoma County Fire District had to partner with Medic Ambulance, a family-owned ambulance company that holds an exclusive operating contract in Solano County.

Medic, which also provides ambulance services in Sacramento County, currently responds to about 90,000 calls a year in its service areas. Sonoma County’s exclusive operating area would add 30,000 to 40,000 annual calls, growing the company by about 30%, said Jimmy Pierson, Medic’s president and chief operating officer.

To cover that many calls, the partnership had to acquire a new fleet of emergency response vehicles, a roughly $13 million investment. The fleet’s equipment alone, including heart monitors, LUCAS chest compressors and gurneys, made $8 million of that sum, while the vehicles, some of them re-purposed, cost $4 million, Pierson said.

The fleet includes 32 ambulances and 10 to 11 specialty support vehicles, including ATVs that will allow emergency responders to get to reach residents in some of the more remote parts of the county.

What residents will pay

Beginning Tuesday, local residents transported by fire Medic ambulances will see a change in the transport fee. The new base fee for “advanced life support“ service, under the EOA 1 contract, will be $3,100 per transport.

That’s about $400 more than what AMR had until very recently been charging for the service. However, county health officials said that on Jan. 9, AMR increased its base fee to $3,626. And fire district officials frequently point out that under AMR’s bid proposal for the new EOA 1 contract, their base rate would have been $3,900.

“In terms of what people can expect, the county definitely went with the more affordable service for county residents,” said Kaplan, the public health division director.

Kaplan said the increase over what residents have been previously been paying, before last week’s increase, is due to the rising cost of health care.

“We're working with Sonoma County Fire and all of the providers in the area to make sure that we're operating the system at the lowest possible cost,” he said. “That includes making use of a lower level of response for a lower level of emergency.”

Preview ceremony

On Friday, Jan. 5, the fire district and Medic invited local county and municipal officials and members of county’s wider EMS community to a ribbon-cutting ceremony at the district’s Santa Rosa office off Corporate Center Parkway.

In attendance were several members of the county Board of Supervisors, which awarded the new contract, as well as officials with the county Department of Health Services, which oversees the county’s ambulance contract.

All of the district’s new ambulance fleet, including support vehicles were on display, making the parking lot a sea of red Type III ambulances, with an integrated cab and large boxy body and more space than the familiar Type II van-style ambulances.

County officials applauded the dawn of a new EMS era, one they said would bring of enhanced service for Sonoma County’s urban core, as well as harder-to-reach rural areas.

Supervisor Lynda Hopkins, who represents much a large segment of west Sonoma County, said the previous ambulance contract created “sort of a process of profits over people.”

She said that was not wholly the fault of the outgoing provider, AMR. The county “created the play-box, the rules that they were playing in,” Hopkins said, handing over a franchise that generated tremendous amounts of revenue in the county’s urban core.

Meanwhile, she said, rural communities like the ones she represents were “literally flipping pancakes” and holding raffles in order to buy new ambulances.

Hopkins recalled an ambulance in Bodega Bay whose call sign was 811 but was known to local first responders as “a-lemon” because it was constantly breaking down and put local residents “one mechanic shop away from a disaster.”

Hopkins applauded the years of work that went into crafting a new request for proposals that sought to correct previous service deficiencies. She said the new contract with the fire district, a public agency, will yield transparency and accountability.

“It is people first, it is patients first, it is a high level of care,” she said. “It is the service that Sonoma County deserves.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.