Audit finds ambulance response time lagging

Erin Neff

Tuesday, Jan. 11, 2000 | 11:12 a.m.

The warring sides in the debate over who should provide ambulance service in Southern Nevada renewed their conflict Monday after the release of a city audit that claims American Medical Response is failing to respond to calls in a timely manner.

AMR meets the required 8:59-minute response time for emergency life-threatening calls fewer than 90 percent of the time and has not been penalized, the audit says.

The report, which will be discussed at Wednesday's Audit Oversight Committee meeting, is already being discredited by AMR at the same time competitor Southwest Ambulance is claiming, "We told you so."

The two ambulance providers have been locked in bitter debate for months over Southwest's attempts to wrest a piece of the lucrative medical transport pie from AMR -- currently the county's lone ambulance provider.

The audit suggests AMR's failure to meet response time requirements could have resulted in $126,240 in penalties over a three-year period if such fines were assessed, and even lead to termination of the city's contract.

"A city representative does not closely review and monitor the performance reports and payments on a regular basis," the audit says.

Auditors found that although AMR claims its performance remains above 90 percent for emergency life-threatening calls, its actual performance dropped below that mark and is continuing to sink due to the number of exemptions claimed.

For example, in April 1996 when the franchise began, 135 of the 1,802 emergency life-threatening calls exceeded the contractual 8:59-minute response time. AMR claimed 21 exemptions, or 16 percent valid delays.

In August 1999, 300 of the 2,010 emergency life-threatening calls exceeded the contractual 8:59-minute response time. In that month, AMR claimed 126 exemptions, or 42 percent valid delays.

"This is what we've been saying all along," said Southwest Ambulance executive partner John Wilson. "AMR has been abusing the exceptions that they are allowed to take."

AMR disagrees, saying that the raw data used by auditors doesn't reflect changing reporting requirements.

"We've turned in response times to the Audit Oversight Committee since the beginning of the franchise's inception, and we've never been challenged," said Brian Rogers, AMR's director of operations.

"(The auditors) take raw data, and they turn it into whatever it shows," Rogers said. "They don't take changes in franchise agreements into consideration."

AMR claims two major factors have led to its increased use of exemptions -- a change in the way ambulances report when they are "on scene" and an increasing number of times hospitals divert ambulances to other facilities.

For example, Rogers said, when an ambulance gets to the gate of a multiple-unit complex like the Miracle Mile mobile park home, it does not claim to be on scene until it actually gets to the individual home.

Ken Riddle, Las Vegas Deputy Fire Chief, said "it can take five minutes to get to the back of the place."

Rogers said AMR used to report "on scene" when it got to the main gate.

"I would love to know when the reporting requirements changes," Wilson said. "AMR is putting up these red herrings left and right trying to validate poor performance."

The other major cause of exemptions result from hospital diversions, Rogers said. He said when an ambulance must take emergency patients to Summerlin or Valley hospitals because one of the more centrally located facilities is on diversion, it takes that ambulance longer to make it to its next call.

Wilson said the "unusual system to man" exemption that AMR claims when hospitals are on diversion should apply only to major incidents like a plane crash or a storm like last July's flood.

"Hospital diversion goes on from November to April," Wilson said. "So they're saying that from November to April they have no incentive to make response times."

Riddle said he doesn't think either side should be able to use the audit as ammunition in the pending battles before the Las Vegas and North Las Vegas city councils.

Those councils must still decide whether Southwest Ambulance can proceed with a franchise application in those cities. County commissioners already granted Southwest the right to begin that process in the unincorporated areas of the Clark County.

"I don't think it gives anybody a better argument," Riddle said.

Riddle also said his department does not have the staff to monitor exemptions AMR claims on a monthly basis.

"It's just impossible at the end of the month to go over all of those late cases," Riddle said.