Ambulances pump brakes on move out of Woodlake

Ambulance companies will meet over the next two months to make recommendations on how to modify the contract with the county to improve service throughout the county

EXETER – Ambulance companies stationed in Woodlake are not moving out of town, at least for now.

A month ago, Exeter District Ambulance announced it and American Ambulance were shifting their ambulances posted in Woodlake to Lemon Cove to improve response times to the mountain community of Three Rivers. The move was set to take place on Dec. 1 and the Central California Emergency Medical Services Agency (CCEMSA), which oversees ambulance service in Tulare, Kings, Fresno and Madera counties, had confirmed the ambulances move to a previous post at the Tulare County Fire Station in Lemon Cove.

The shift never happened after the community of Woodlake called a meeting of all the parties involved less than 48 hours before the deadline. At the Nov. 29 meeting, Woodlake Mayor Rudy Mendoza, city manager Ramon Lara and fire chief Anthony Perez met with the ambulance companies, county supervisors Larry Micari and Eddie Valero, County CAO Jason Britt and Dale Dotson, EMS Coordinator for CCEMSA. Mendoza said ultimately all involved agreed to pause moving the ambulances out of Woodlake until the ambulance providers can work out a new plan to provide service to Three Rivers and Woodlake. The group tentatively set early February as the deadline to present proposals to decide how best to provide ambulance coverage for Tulare County.

“The good news is the decision was delayed,” Mendoza said. “But now we are waiting with baited breath. I am afraid that we will wait a few months and then nothing will change.”

Mendoza pointed out the community of Woodlake had made a significant investment in bringing the ambulance companies to town. In 2018, the public ambulance company began discussing a new post location in Woodlake area and in December of that year EDA signed an agreement with the city of Woodlake and Woodlake Fire District, also a special tax district, to post a 24-hour ambulance in the city in exchange for EMT and paramedic room and board. Mendoza said Woodlake residents were shocked last month when they were told by EDA it was moving its ambulance out of the community.

“We all have a role to play and we all need to figure out what our role is,” Mendoza said.

Representing Exeter District Ambulance was board member Bob Martinez and paramedic shift lead Tony Huckins. Three of the board members, including Martinez, did not respond to calls as of press time, but Huckins said he found out about EDA’s potential move to Lemon Cove by reading it in The Sun-Gazette. He said normally employees would have been informed by the district manager, but EDA is currently without a district manager for the foreseeable future after Peter Sodhy’s resignation on Nov. 5. EDA’s board has not meet since it held a special meeting on Nov. 4 due to a lack of quorum.

“There was never any official vote for that rig to move anywhere,” said Huckins, who is essentially running the district along with fellow lead shift Brian McCoy.

In an interview prior to the meeting, CCEMSA’s Dotson said EDA and American’s response times have improved in Woodlake since moving its post there 18 months ago, but Woodlake was never really a problem. During that same time frame, the network of five ambulance providers covering the district were inconsistent in maintaining compliance to the Three Rivers area, a problem which has persisted since Three Rivers dissolved its all-volunteer ambulance company in 2010 in light of more costly and more stringent training requirements for paramedics in California.

Each ambulance provider in Tulare County is required to have their crews arrive within 10 minutes of being dispatched to a life-threatening call in metro areas and within 20 minutes in rural areas at least 95% of the time. Under the contract with the county, ambulance providers are fined $15 for every minute past the 10-minute mark and $100 when an ambulance arrives at the 20-minute mark. Those fines are then collected and placed in a holding account for the Health and Human Services Agency of each county. Providers are also charged $1,000 for every percentile they are below the 95% mark on calls and $500 for breach of contract.

Typically, Exeter and American would be fined for late calls to Three Rivers, but CCEMSA has suspended penalties during the pandemic, as ambulance companies have had EMTs and paramedics leave the industry, get sick, or stay home on quarantine. Ambulances have also been stuck in a bottle neck at hospitals where they are not allowed to leave a patient until they are officially admitted into the Emergency Department. Known as wall time, ambulance companies have had to wait in the hallways of the emergency room for up to 90 minutes.

In 2018, when EDA was out of compliance with response time standards in February, March and April, the public ambulance company was fined $950 for late response times for the entire first quarter and another $12,000 for dropping below the 95% standards for response times in February and March. Failing to meet the performance standard in three straight months put EDA in major breach of its contract. If that were to happen again, EDA would be given a probationary period to continue operating as long as it was meeting the requirements on a month-to-month basis. Being out of compliance for a fourth straight month would trigger a hearing before the Board of Supervisors to determine if EDA should be dissolved.

Paul Main, CEO of American Ambulance, said Woodlake is in Zone 3 of the county and Three Rivers is in Zone 4 of the county, both of which are rural zones requiring a 20-minute response time. By comparison, Exeter and Farmersville are in Zone 5 of the county which is a metro zone requiring a 10-minute response time. Main said calls in Exeter, Farmersville and Woodlake average between two to three calls per day, while Three Rivers averages just 1 call per day. Main also said the zone maps have not been updated since 2009, so they have not been adjusted for the last two U.S. Censuses. There was discussion of designating Zone 3 as a metro zone, previously defined by the state as having at least 10,000 people, but Main was unsure if that threshold was still in existence or if it could be changed.

“It’s all a balancing act and it is difficult to find an appropriate location to meet the response time and compliance standard to serve the entire county in the best possible way,” Main said.

While ambulance providers decide where they post crews in order to stay in compliance with response times, the county and the Board of Supervisors decide the terms of the contract and CCEMSA is contracted to enforce the terms. The Board of Supervisors last amended the contract in 2017 to make changes to the response area for the all-volunteer California Hot Springs Ambulance Company.

Eddie Valero, who represents Woodlake in District 4, said the group agreed to come back to the table by early February to discuss if the zone boundaries need to change, what response times will be for those areas and discuss the possibility of EDA receiving federal relief funding through the American Rescue Plan Act (ARPA). Approved by the supervisors on Aug. 24, the county ’s ARPA spending plan only allots $1.5 million to special districts, including museums, memorial and community service districts, which have not received other sources of pandemic relief, and $3 million to hospitals. Despite being both a special district and hospital district, Exeter District Ambulance was not included in either bucket of funding. Unlike private ambulance companies, the public ambulance district did not qualify for the Paycheck Protection Program offered to businesses financially impacted by the pandemic last year.

“We are wanting to provide an opportunity in which all of the communities are involved,” Valero said.

Supervisor Larry Micari, who represents Exeter, Farmersville, Lindsay and Three Rivers, said why stop there. In addition to considering whether or not Woodlake should be designated as a metro area, Micari said the ambulance providers should come up with a list of issues they have with the current agreement. Once recommendations are made, the Board of Supervisors will decide which ideas should be incorporated into a new contract.

“They are the industry experts in our county,” Micari said. “They need to identify the problems and come up with solutions for them.”

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