As Multnomah County publicly wrestles with penalties for delays and short-staffing by ambulance giant American Medical Response, Clackamas County commissioners quietly approved a new contract with the company while waiving hefty fines.
By a 4-1 vote on April 18, elected members of the Clackamas board granted AMR a one-year contract extension through May 1, 2025, despite the company racking up over $1 million in fines for failing to meet ambulance response times required by its county contract.
The vote came as AMR officials say that they have made “substantial investments in improving the EMS workforce” for the county and believe these steps have improved the ambulance service provider’s compliance rate. Clackamas County’s operation is now “just shy” of the contracted response time of 10 minutes or less 90% of the time, AMR leaders said.
Members of the Clackamas board said they lacked the negotiating power to make AMR pay fines as part of renewing the county’s ambulance services contract for a year starting May 1. But the new contract allows the waiver of fines to only happen if the company can hit its response-time goals for three consecutive months in the coming year.
In April 2023, AMR said that it was achieving a response time of 10 minutes or less 79-80% of the time and headed up to 88-89% during April 2024.
“May is looking good for compliance at this point, but if not May, likely June,” said AMR Vice President Randy Lauer.
In praising Clackamas, Lauer appeared to take a shot at Multnomah County’s decision to fine AMR for its short staffing and delays there in violation of that county’s contract. Those fines are currently in mediation.
“American Medical Response is pleased with the county’s decision and their willingness to work with us in our efforts to stabilize the EMS system for Clackamas County,” Lauer said of Clackamas. “Along with Washington County, they have proven to understand the pandemic-driven national paramedic shortage, escalating labor costs and poor health care reimbursement overall.”
AMR generates between $16 million and $17 million annually from its Clackamas County ambulance contract and has donated tens of thousands of dollars to reelection campaigns of sitting county commissioners.
“May is looking good for compliance at this point, but if not May, likely June,"
AMR lobbying, campaign contributions debated
In a meeting in January, Clackamas commissioners disagreed over when it was appropriate for them to accept contributions from AMR and meet privately with them to discuss the fines.
Commissioner Paul Savas, who received $15,000 from AMR between 2018 and 2022, stressed that he’d neither communicated with the firm or accepted a contribution since its contract compliance became an issue. A county attorney recommended against commissioners speaking with AMR officials.
Clackamas County Chair Tootie Smith has received $10,000 in campaign contributions from AMR since 2018, including as recently as Dec. 26. In January she said she’d been in conversations with Lauer, the AMR official, but said nothing improper had taken place. She voted in favor of the contract.
Other Clackamas County Commission members who accepted campaign contributions from AMR include Ben West ($3,500) and Martha Schrader ($7,500) who both voted for the one-year extension in the April meeting.
Smith blamed her county’s small size for giving neighboring counties an edge in negotiating with AMR. She said that AMR’s staffing woes stemmed from the ambulance contractor’s decision to take on a large contract with Washington County and provide two paramedics on each ambulance in Multnomah County.
“We cannot fine our way out of slow response times, but we have sought out solutions in this,” she said.
County commissioners didn’t just waive fines. Citing higher-than-average inflation, they agreed to allow AMR to increase patient service fees by 10% for about 1,200 self-pay transports annually. AMR transports more than 30,000 patients in Clackamas County each year, the vast majority of which are covered by health insurers.
Commissioner Paul Savas voted against the deal after noting that it appeared that the county was letting AMR off the hook for a record accrual of fines without tying the waiver to long-term ambulance performance improvements.
County staff determined that AMR had accrued $456,000 in fines from May 2022 through April 2023 for failing to meet required response times. County commissioners last year waived half of these fines and directed AMR to spend the other half of the fines, or $228,000, on a performance improvement plan.
In the next period of May 2023 through December 2023, county staff said that AMR accumulated an additional $840,000 in fines for failing to meet response times required by its contract.
County commissioners waived the fines contingent on AMR providing a nurse navigation program for Clackamas County. AMR’s program allows 911 dispatchers to forward low acuity, non-urgent 911 calls to a nurse line.
“We cannot fine our way out of slow response times, but we have sought out solutions in this,"
To reduce non-emergency ambulance calls, these nurses try to connect patients to clinics, schedule transportation to and from appointments, and assist patients with connecting to a primary care provider. Clackamas County commissioners expressed concern about extending AMR’s contract in January, when they said that AMR has a near-monopoly on ambulance service in the Portland area. They briefly considered going out for a bid, but decided that other ambulance providers would likely face the same performance problems.
Lauer said AMR started offering full-ride paramedic school scholarships nearly three years ago, with the first class graduating in December 2023. An additional 40 EMTs will graduate from this program in a few months.
“These scholarships, along with implementing our award-winning nurse navigation program, have made us optimistic that we will achieve response time compliance in the next few months,” he said.
AMR Region President Sean Russell signed an agreement with the county to provide a monthly financial statement documenting funds spent on a performance improvement plan with detailed explanation for each expenditure. The plan includes $228,000 to support workforce and recruitment efforts. AMR’s full-time recruiter is required to post a 1% increase in the number of recruiting events, show an improved interview-to-hire ratio, increase the number of candidates interviewed or increase the number of offers made.
Does Clackamas County still operate Clackamas fire and Rescue? It is a clear example of corruption for Commisioners to take money from organizations whose contracts are overseen by the Commisioners. If they were trustworthy they would have recused themselves or returned the money before voting on the contract.