To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774; Amelyn Olson, 707-565-2696
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Local Emergency Medical Services Agency Medical Director Award
End
Recommended Action:
Recommended action
A) Authorize the County Executive Officer, or designee, to execute an agreement with Dr. Marc Gautreau to provide Medical Director Services from January 1, 2026 through June 30, 2029, for a maximum amount of $350,000, subject to annual appropriations, satisfactory contractor performance, and review and approval as to form by counsel.
B) Authorize the County Executive Officer, or designee, to execute modifications to the agreement in order to address changes in service needs, subject to available funding as well as approval by County Counsel.
end
Executive Summary:
The Sonoma County Department of Health Services recommends contracting with Dr. Marc Gautreau as the Local Emergency Medical Services Agency Medical Director for the Coastal Valleys Emergency Medical Services Agency, replacing Dr. Mark Luoto, who will retire in June 2026. The Medical Director ensures high-quality pre-hospital care across Sonoma and Mendocino Counties, serving approximately 600,000 residents and responding to 100,000 Emergency Medical Services calls annually.
Dr. Gautreau brings extensive emergency medicine and Emergency Medical Services leadership experience, including prior leadership roles at Stanford University and University of Massachusetts Medical School, and has been recognized statewide for his expertise.
The proposed contract covers January 1, 2026, through June 30, 2029, at a cost not to exceed $350,000. The position is critical to maintaining clinical oversight, protocol development, and system accountability for the regional Emergency Medical Services system.
Discussion:
State law requires each county to designate a Local Emergency Medical Services Agency (LEMSA) responsible for oversight and regulation of the local Emergency Medical Services (EMS) system. The Coastal Valleys EMS Agency (CVEMSA) serves as the LEMSA for Mendocino and Sonoma Counties. CVEMSA operates as a program within the Department of Health Services, Public Health Division, providing staff and services necessary for EMS administration.
Each LEMSA is required by law to have a licensed physician serve as the EMS Medical Director. This Medical Director ensures medical control and accountability by providing clinical oversight, guidance, and adherence to EMS policies and protocols for paramedics operating under the Medical Director’s License. CVEMSA emphasizes consistency and continuity in its Medical Director services to maintain high-quality pre-hospital care.
The Department of Health Services seeks authorization to contract with a qualified individual to serve as the LEMSA Medical Director for CVEMSA. The Medical Director will provide clinical leadership, oversight, and direction for emergency medical services across Sonoma and Mendocino Counties, which together serve approximately 600,000 residents and respond to an average of 100,000 EMS calls annually. The individual serving in this EMS system position shall perform only LEMSA Medical Director responsibilities and is prohibited from contracting with or representing any EMS provider agency regulated by CVEMSA.
The proposed contract with Dr. Marc Gautreau begins January 1, 2026, overlapping with the current Medical Director’s contract through June 30, 2026. This six-month overlap is intentional and provides for a structured transition, allowing for knowledge transfer, orientation to CVEMSA operations, and continuity of medical oversight. Given the size and complexity of the regional EMS system, the overlap minimizes operational risk and ensures uninterrupted compliance with state LEMSA requirements.
Dr. Mark Luoto, the current CVEMSA Medical Director, has served since 2007 and will retire at the conclusion of his current contract on June 30, 2026. Dr. Luoto brought decades of emergency care experience and leadership to the role, serving previously as Deputy Medical Director for 13 years. His tenure has provided consistent medical oversight for nearly two decades.
Procurement
On September 4, 2025, the Department issued a Request for Qualifications (RFQ) to identify qualified candidates for the Medical Director role. Minimum qualifications included:
• Licensed physician (MD or DO) in California
• Board certification in Emergency Medicine or related specialty preferred
• Minimum of two years of EMS or emergency medical care experience
• Experience in medical oversight and protocol development
• Knowledge of state and federal EMS regulations and standards
The RFQ was widely distributed, and proposals were evaluated based on:
• Demonstrated ability to perform the required services
• Qualifications, experience, and expertise
• History of providing similar services to comparable entities
• Completeness of the proposal
• Following evaluation, the Department recommends awarding the contract to Dr. Marc Gautreau for the term January 1, 2026, through June 30, 2029, with the option to extend for up to two additional one-year periods. The contract amount will not exceed $550,000, subject to annual appropriations, satisfactory performance, and County Counsel approval.
Dr. Marc Gautreau Background
Dr. Gautreau brings extensive emergency medicine and EMS leadership experience. A Massachusetts native and University of Massachusetts Amherst graduate, he served five years as a firefighter, EMT, and paramedic before entering medicine.
He earned his medical degree from The Chicago Medical School and completed an Emergency Medicine residency at University of Massachusetts Medical School, followed by a fellowship in EMS and disaster medicine while earning a Masters of Business Administration in Health Services. He also served as a United States Air Force Reserve flight surgeon and Chief Medical Officer for an Iraq war staging hospital.
Dr. Gautreau has held progressive leadership roles, including Emergency Department Chief at a Level I trauma center, hospital administrator, and EMS division director overseeing urban and rural agencies and air medical services. In 2017, he joined Stanford University to lead the pre-hospital care section and serve as Medical Director for the San Jose Fire Department. He is a Fellow of the American College of EMS Physicians, inaugural president of the California chapter of the National Association of EMS Physicians and currently chairs the California Commission on EMS.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On March 23, 2010 the Board authorized the Department to execute an agreement with Dr. Mark Luoto for Coastal Valleys Emergency Medical Services Agency Medical Director services for FY 10-11 through FY 14-15 and any amendments that do not significantly alter the scope of work ($400,000).
Fiscal Summary
|
Expenditures |
FY 25-26 Adopted |
FY 26-27 Projected |
FY 27-28 Projected |
|
Budgeted Expenses |
$100,000 |
$100,000 |
$100,000 |
|
Additional Appropriation Requested |
|
|
|
|
Total Expenditures |
$100,000 |
$100,000 |
$100,000 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
|
|
|
|
Fees/Other |
$100,000 |
$100,000 |
$100,000 |
|
Use of Fund Balance |
|
|
|
|
General Fund Contingencies |
|
|
|
|
Total Sources |
$100,000 |
$100,000 |
$100,000 |
Narrative Explanation of Fiscal Impacts:
The contract for a new EMS Medical Director, Dr. Marc Gautreau, is already included in the Fiscal Year 2025-2026 budget and will be incorporated into the 2026-2027 and 2027-2028 budgets. Funding for this contract comes from EMS’s various revenue agreements. The contract totals $350,000 for a term of three and a half years, beginning in January of 2026 and concluding in June of 2029.
During Fiscal Year 2025-2026, the new contract will overlap with the current contract held by Dr. Mark Luto, with the additional cost covered by salary savings resulting from a vacant Advanced Life Support Coordinator position.
Narrative Explanation of Staffing Impacts (If Required):
No staffing impacts.
Attachments:
Attachment 1 - Draft Agreement
Related Items “On File” with the Clerk of the Board:
None