Monday, Dec. 6, 1999 | 11:30 a.m.
Steve Corleone hasn't been behind the wheel of his ambulance five minutes before he receives his first call: A 79-year-old man Christmas shopping with his wife has collapsed at a local warehouse store.
Motorists ignore the flashing lights and siren on Corleone's American Medical Response (AMR) ambulance. They panic and stop in the middle of the street. Despite the obstacles, Corleone arrives by the ailing man's side in six minutes.
In another 10 minutes, the man is resting comfortably inside the ambulance and Corleone is awaiting word from the dispatch center on which hospital has an open bed.
It is "divert season," which means the county's six major hospitals don't have enough beds to accommodate the number of critical care patients. As a result, paramedics cannot transport patients until a hospital bed is available.
"The problem isn't the number of ambulances on the street, it's the number of hospitals," Corleone volunteers, rebutting claims of would-be competitor Southwest Ambulance that a second ambulance service would solve the diversion problem.
"AMR is putting the units on the street. It is growing with the demand, but the hospitals aren't. That's the biggest problem."
Divert season is only one area of AMR's operation that Southwest has criticized in the weeks leading up to Tuesday's Clark County Commission meeting.
Southwest has also knocked AMR for its increasing number of exceptions filed for exceeding the 8-minute, 59-second response time requirement on emergency calls.
The board is expected to decide whether a second ambulance provider is needed in the valley. If Southwest is permitted to compete with AMR, AMR will forfeit half of its business for the first time in the 45 years it or its former parent company Mercy has held the contract.
AMR and Southwest administrators have turned the debate into a political war, hiring big-time consultants with hopes they have enough clout to sway the commission's vote.
While the two companies have exchanged barbs, Corleone, irked by the scene, said paramedics on the street have continued with what they do best -- caring for patients.
"Politics need to stay out of this industry," Corleone said.
Corleone and his partner, Paris Bayardo, said they are well aware the issue is about money. They both agree that Las Vegas is their company's "cash cow" because it is a 24-hour town with an elderly population.
AMR charges about $500 each time it transports a patient. The company transports victims to the hospital an average of 130,000 times a year.
If anyone knows how lucrative the Las Vegas Valley is for an ambulance service, they said, it's John Wilson. Now the executive partner of Southwest Ambulance, Wilson was AMR's chief financial officer from 1993 to 1998.
Bayardo said he understands why Wilson, as a businessman, wants a piece of the market, but he is troubled by the accusations that have come from his former boss.
"He used to tell us we were No. 1; we were the best," said Bayardo, who has been with the company for five years. "Now he is bashing us and telling us we aren't good enough. It's not fair and that's what most of us are upset about."
Wilson said his frustrations are not with the paramedics but with AMR's administration, which he said blames the hospitals and changes response times rather than trying to work on solutions.
He also said contributing to the divert problem is AMR's slow response when it is requested to transport a patient from one hospital to another, which would free up beds.
"The franchise system as designed requires us to go through and show a need for a second ambulance provider," Wilson said. "It's understandable they would take it personally. There are great paramedics in the system. There just aren't enough of them."
AMR Executive Director Mike Williams said he is angered by the way in which his company's response time figures are being misinterpreted by Southwest.
A Southwest Ambulance press release says, for example, that between December 1997 and October 1999, the number of excuses for being late for calls has increased 148 percent.
Exceptions are permitted if the ambulance was stalled by conditions beyond the staff's control or, for example, if a cell phone user reported the wrong cross streets for a traffic accident. Paramedics might have arrived at the reported address within the required 9 minutes, but it took additional time to find the actual scene.
Williams doesn't dispute Southwest's figures, but he said the number of exceptions increased because, at the request of AMR, the rules on how to report response times were changed in January 1998.
Rather than stopping their response time clocks when paramedics arrive at an an address -- as the Clark County Fire Department operates -- AMR decided to wait until paramedics are at the patient's side.
AMR changed the rules because dispatchers had been telling the fire department, which also responds to every call, that AMR was at the scene when paramedics had yet to reach the patient.
"We were reporting ourselves at the scene, but we weren't visible," Williams said. "We were losing credibility with the fire department. We were saying we were there, they were saying we were not."
Under AMR's new guidelines, it is a legitimate excuse to exceed the response time limits to reach a patient's exact location as long as the paramedics arrive at the address within the nine-minute time frame.
For example, it might take paramedics two minutes to arrive at a major Las Vegas Strip resort, but it could easily take more than seven minutes to weave through the crowded casino floor and make it to the top floor.
"If we get a call on the 30th floor of Bellagio, it takes awhile to get to them," Corleone said. "There is nothing we can do about that. A second ambulance provider can't help that. It's a fact of life."
Whether the new rule is internal with AMR or a guideline implemented by the valley's Ambulance Oversight Committee -- which includes fire chiefs from Las Vegas, Clark County and North Las Vegas -- is a point of confusion.
While Williams said the rule was adopted by the oversight committee in January 1998, Jim Spinello, committee chairman and the county's franchise manager, said that rule is not official.
Under the franchise agreement, AMR is required to stop its clocks when it arrives at the address to which it is dispatched, Spinello said. He added that there has been confusion over the matter, but AMR's exceptions are reviewed monthly and they have been approved.
"The numbers are real high and real startling. You can't ignore it," Spinello said. "They are in compliance. I can't recall a single complaint about how they didn't get there in time." AMR has also defended its decision to fight Southwest's request for information regarding its grid map, which shows how many calls are made from each square mile of the valley.
The computer-generated information allows AMR to strategically place its ambulances based on the location of incidents that typically occur on a particular day during a certain time period.
AMR ambulances are staged at nine permanent posting areas throughout the valley every day. In addition to those locations, the company uses the computer information to predict where incidences will occur.
The company has a fleet of 95, which can easily be increased by borrowing ambulances from other AMR companies to handle events such as New Year's Eve.
"That computer information is our work and our intellectual property," Williams said. "I shouldn't have to provide it to our competitor."
AMR representatives will argue on Tuesday that it has invested millions in its Martin Luther King Boulevard headquarters because the company expected to handle all of the valley's calls for service until its contract expires in 2003.
Wilson, whose company is funded by Rural Metro Corp. and plans to staff 35 ambulances, said the county shouldn't wait to improve the ambulance service in the valley.
"AMR is good at excuses," Wilson said. "It's not so good at fixing problems."
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