Last
September, on the night before his 11th birthday, Matt
Shank died from an asthma attack at his Troutdale home.
In the world of modern medicine, that's not supposed to
happen. Then again, ambulances aren't supposed to get
lost and arrive 11 minutes and 20 seconds after being
dispatched--which is what happened in Shank's case.
Multnomah County officials are now asking whether Shank's
death was a fluke or part of a growing problem of slowing
response times by AMR, the company that in 1995 won
the exclusive rights to operate ambulances in Multnomah
County.
Answers are unclear: County medical officials have
written a report on the Shank incident, but they won't
release it, insisting it isn't a public record. Data
that assess AMR's response to 33,000 ambulance calls
last year is also inconclusive. What is clear, though,
is that the ambulance wars of the early 1990s--in which
AMR was pitted against competing companies and the Portland
Fire Bureau--are smoldering again.
The stakes are high: At issue is whether AMR's contract--worth
roughly $18 million a year--should be extended for three
more years or be opened for bids. The deadline
for a decision is Aug. 31, and county commissioners
will meet July 29 to start debating the matter.
The crux of the debate centers on whether AMR, the
country's largest ambulance company, has complied with
the terms of its contract with Multnomah County. In
the contract, AMR promised it would respond to at least
90 percent of the calls in less than eight minutes.
Raw data from the last year show that response time
has increased and that AMR is getting to calls in less
than 8 minutes about 85 percent of the time. "There's
no question the whole system has slowed down a bit,"
says Bill Collins, the county's ambulance administrator.
AMR counters with two arguments.
First, company Vice President Terry Marsh says AMR
does meet the 90 percent standard when adjustments are
made for dispatching mistakes or calls that are downgraded
from emergencies, which means ambulances slow down and
turn off their sirens.
Second, AMR officials say increases in response time
can be traced to May 13. "That day will live in infamy,"
says Randy Lauer, AMR's director of operations. That's
when the system of dispatching ambulances from the Bureau
of Emergency Communications changed.
Before the change, BOEC dispatchers were assigned to
either ambulances or fire engines. Ambulance dispatchers
kept track of ambulance locations and selected the closest
ambulance for each call. After the change dispatchers
have been doing double duty on fire engines and ambulances,
and AMR claims they're making more mistakes.
Collins doesn't quite agree. "They're probably overstating
the problem," he says.
So what's behind the slower response times? "If we
knew where the smoking gun was, we'd be able to deal
with it," says Collins.
Portland Fire Chief Bob Wall says it's no mystery.
Wall says AMR isn't dedicating enough ambulances to
911 service, instead shifting ambulances to more lucrative
non-emergency rides. "It's no secret. There's not enough
units. That's my simple analysis," says Wall.
If only it were so simple. Data shows that AMR has
been putting more ambulances on the streets for more
hours.
Of course, Wall has incentive to criticize AMR. Faced
with an ever-declining number of blazes to fight, the
Portland Fire Bureau competed fiercely for the ambulance
contract back in the early '90s and was rejected by
voters in a 1994 ballot measure. The Fire Bureau remains
interested in capturing some of the ambulance business--perhaps
in a collaborative deal with a new private ambulance
provider.
It's in this contentious, conspiracy-tinged environment
that county commissioners must decide whether to invite
a new bidder--namely Rural/Metro, the country's second-largest
ambulance company. Rural/Metro has been aggressively
lobbying county officials in recent weeks, feeding them
newspaper stories showing AMR's problems in other cities
such as Hartford, Conn., Fort Worth, Texas, and Aurora,
Colo.
But even though Rural/Metro came to Portland with its
political sirens wailing, the company faces an uphill
battle. Only one county commissioner, Sharron Kelley,
who represents Gresham and Troutdale, is willing to
publicly suggest that the county should go shopping
for a new 911-response company.
Matt Shank's father doesn't really care who has the
ambulance contract. Dave Shank, an engineer at the Bonneville
Dam, would like to see two constructive things emerge
from his son's death.
First, Shank wants people to realize that in the real
world, ambulances don't come as quickly as they do in
TV shows. So if people live within several minutes of
a hospital--as Shank does--he says they might be better
off rushing a family member to the hospital themselves.
Second, Shank thinks an independent audit of ambulance
services is a good idea.
"We've avoided legal action because it would be devastating
to us," says Shank. "An independent audit that looks
not just at response time but at the overall financial
and clinical picture of what service ambulance companies
are supposed to provide--well, that's something I'd
like to see."
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Willamette Week | originally
published July 21, 1999
