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Ambulance delays could cost AMR $10K per month in Multnomah County, if not more

The county's contract with EMS provider AMR allows for fines of up to $500 for each time ambulances are extremely late in responding to emergency calls.

MULTNOMAH COUNTY, Ore. — Multnomah County says it will fine ambulance provider AMR for slow response times, a decision which could cost the company $10,000 per month — and potentially much more.

County Chair Jessica Vega Pederson shared her decision to enforce penalties on Wednesday, noting that AMR has been out of compliance with response time standards since March 2022.

“Frankly my patience is exhausted," Vega Pederson said. "AMR’s ambulance response times are unacceptable and they haven’t met performance metrics in months, and that requires that we take action."

In June, KGW asked Vega Pederson about the possibility of fining AMR. At that point, she said she was looking into it.

"The previous chair got briefed on that and made the decision not to fine because it was really detrimental and wouldn't do anything to improve outcomes," Vega Pederson said to KGW in June. "I just asked our team to re-brief me on that and look at the information and to really reopen the conversation about what we can do to address this crisis that we're in right now in terms of ambulance response."

Multnomah County's contract with AMR allows the county to fine AMR for poor performance, based on a variety of benchmarks.

As an example, AMR ambulance crews are supposed to arrive to Code 3 emergency calls within 8 minutes at least 90% of the time. AMR's response time compliance with those standards has fallen off over the last year, down to 60-70% of the time.

For anything under 88%, Multnomah County can fine AMR $10,000 per month, according to the contract.

Additionally, county leaders can levy fines for "outlier" responses — response times that are "excessive for the priority/response area category, such that it represents a potential threat to patient health and safety."

For the same Code 3 category, Multnomah County can fine AMR $50 per minute for any ambulance response that takes longer than 13 minutes. These "outlier" fines max out at $500 per incident.

That could be potentially significant, as AMR has failed to have any ambulances available to respond to an emergency call on thousands of occasions so far in 2023.

From January to June, AMR ambulances were unavailable for dispatchers on more than 6,300 calls, according to county and BOEC records. These instances, known as "Level Zero," were called "unacceptable" by Vega Pederson in June.

While Level Zero calls are not directly congruent to "outlier" response times, if Multnomah County elects to fine AMR for individual cases, the penalties could skyrocket.

In response to the county's decision to issue fines, AMR representatives shared a statement:

"American Medical Response takes the responsibility of staffing its Multnomah operation and meeting obligations very seriously. We have made extensive efforts to communicate the severity and external causes of paramedic staffing shortages nationwide to the County. However, we disagree with the County's current stance.

"AMR wants to assure members of the community that we are doing everything within our power to fulfill our responsibilities and address the staffing shortages. We remain open to working collaboratively with the County to find a resolution, including moving to a Paramedic and EMT staffing model like systems across the country."

Multnomah County maintains a standard that ambulance crews consist of two paramedics instead of one paramedic and one EMT, something that AMR has pushed against. The county has thus far refused to budge, beyond approving a pilot program where EMTs respond to lower-acuity calls.

AMR also operates in Clackamas County, Clark County and elsewhere, and response time issues have not been unique to Multnomah County. Starting August 1, the company expanded its services to Washington County, where it took over from Metro West Ambulance as the county's primary ambulance provider.

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