If you're going to have a heart attack, the Multnomah
County Board of Commissioners asks that you try not to
collapse in the West Hills or North Portland.
That's one interpretation of a contentious 3-2 vote in
which the board decided to renew the county's $18 million
annual contract with American Medical Response.
The Feb. 24 meeting was supposed to have been a day of
reckoning for the county's Emergency Medical Services
department following last summer's fracas over ambulance
response times.
You remember last summer: That's when the county was
either supposed to extend AMR's contract or put it out
for rebid. Gary Oxman, Bill Collins and Jon Jui--the county's
EMS troika--showed up to explain why AMR's response times
were increasing. Unfortunately, their data was so flawed
it was useless. Commissioners announced their intent to
extend AMR's contract but sent the EMS crew home with
a verbal spanking.
Now, Oxman, Collins and Jui were back. Their new data
were good, they said. County Auditor Suzanne Flynn gave
them a clean bill of health. The new numbers showed that
in some parts of the county--such as the Southwest Hills
and parts of North Portland--AMR wasn't up to snuff. But
instead of blasting the national ambulance company, the
three did everything but don the mantle of AMR's lobbyists
in explaining to commissioners that it wasn't the company's
fault.
Commissioners Sharron Kelley and Serena Cruz looked on
in veiled disbelief as Oxman, the county's chief health
officer, explained why, despite what AMR's contract said,
it was fine for ambulances to take longer to reach certain
neighborhoods.
County chairwoman Beverly Stein and Commissioners Diane
Linn and Lisa Naito, however, took the sales pitch and
swallowed a new contract allowing AMR to respond slower
to some parts of the county.
Oxman said it was "a tightening" of performance standards
(and The Oregonian described the move on Feb. 25
as "stiffening" the contract). But Kelley, the most senior
member of the board, didn't buy it. "We're lowering the
bar," she said. "It doesn't make any sense to me."
Under its contract, AMR is required to respond to 90
percent of its 911 calls in eight minutes or less; AMR
agreed to that standard in March 1995. Such "geographic
equalization" means that AMR will respond with the same
speed to calls across the county, whether you live in
Dunthorpe or St. Johns.
Soon after AMR set up shop in Multnomah County, the county
began to monitor response time in eight sub-zones. According
to the new EMS data, AMR was only hitting the eight-minute
standard 87 percent of the time in the Southwest Hills
and the Rivergate area of North Portland. That translates
to response times 35 seconds slower where wealthy people
live on switchback roads and where blue-collar families
live near marshland. In short, it's harder for AMR to
get to homes in Rivergate than in Laurelhurst. Interestingly,
Linn, whose district includes the Southwest Hills, admitted
that she can't find her way among the twists and turns
straddling the Sunset Highway.
Collins says none of it matters, even though there are
no exemptions for geographical peculiarities in AMR's
1995 contract. "Slower response time in these two zones
is not significant in degree," he said. "The contractor
has met the requirements of the contract."
The EMS trio first explained how AMR's contract did not
require it to hit the eight-minute standard 90 percent
of the time in each part of the county. Ninety percent
was only a county-wide average, they said. Besides, Oxman
added, "It would be financially stressful to our contractor"
to hold them to 90-percent performance.
Then Oxman and Jui went a step further. They argued that
response time has nothing to do with whether someone survives.
They urged the county to dump time as a measure altogether,
in favor of training citizens in how to perform on-the-spot
cardiopulmonary resuscitation.
They were talking about "outcomes," a nebulous EMS term
describing a host of factors--such as CPR training and
swift medical attention and transport--that play into
survival rates. Contacted by WW, Jarris Hedges,
OHSU's chair of emergency medicine, said that "outcomes"
are the way the medical-emergency world is going. He could
not, however, name a single American jurisdiction that
has abandoned response time as the measure of effectiveness.
Cruz, whose district includes Rivergate, says it's too
early to test the outcome theory with the public. "We're
jumping the gun," she says.
Moreover, during the heated ambulance wars of the early
'90s, all the bidders seeking the county's business, including
AMR, focused on response time. Since AMR knew what it
was getting into, why is the county softening its requirements
without getting any concessions from the company?
Stein, who describes herself as "the CEO of Multnomah
County," concedes that the county didn't get a rate reduction
from AMR, but she says she was certain that the company
wouldn't seek a rate increase before 2001--when the county
will rebid its ambulance contract.
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Willamette Week | originally
published March 1,
2000
