To: Sonoma County Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera 707-565-4774
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
Ground Emergency Ambulance Service Agreement Amendment
End
Recommended Action:
Recommended action
Authorize the Director of Health Services, or designee, to execute the first amended and restated agreement with Bell’s Healdsburg Ambulance Service, Inc. to clarify response time standards and compliance requirements within the Bell’s Ambulance historic service area and to mutually release claims between Bell’s Healdsburg Ambulance Service, Inc., and the County.
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Executive Summary:
Bell’s Healdsburg Ambulance Service (Bell’s), a private, family-owned ambulance company with a history of operating within the communities of Healdsburg and Windsor since 1956, has operated under contract with the County in their historic operating area since June 30, 2022. The requested action will allow the County to amend the existing agreement with Bell’s to clarify response time standards and compliance requirements, to utilize first responder advanced life support services to meet response time requirements, and to mutually release claims between Bell’s and the County.
Discussion:
On November 16, 2021 the Board authorized the Director of Health Services, or designee, to execute an agreement with Bell’s Healdsburg Ambulance Service, Inc. (Bell's), for the exclusive provision of ground emergency ambulance service within the Bell’s Ambulance historic service area for a term through November 30, 2026, with one option to extend the agreement term through November 30, 2031. Bell’s is a private, family-owned ambulance company with a history of operating within the communities of Healdsburg and Windsor since 1956 and has operated under contract with the County in their historic operating area since June 30, 2022.
Division 2.5 of the California Health and Safety Code (HSC) “the EMS Act” § 1797.224 allows Local Emergency Medical Services (EMS) Agencies (LEMSAs) to enter into formal agreements for provision of ambulance service in defined geographic areas through the creation of Exclusive Operating Areas (EOAs).
In 2021, the Sonoma County Board of Supervisors established an EMS Ad Hoc committee to guide the Department of Health Services (DHS) leadership and their LEMSA staff through the EMS Ordinance development and ambulance services request for proposals (RFP) process.
On March 23, 2021, DHS brought the first draft of the RFP for EOA 1 to the Board. The draft RFP included the existing Bell’s service area as part of an expanded EOA 1. The Board was also presented with an option to direct staff to remove the Bell’s service area from the competitive process, and to continue to negotiate a noncompetitive award of Bell’s current service zone as allowed by HSC §1797.224. The Board directed staff to move forward with the EOA 1 RFP development without incorporating Bell’s service area, and to return to the Board at a later date with a proposed agreement between Bell’s and the County for the Board’s approval.
On November 16, 2021 the Board authorized the Director of Health Services, to execute an agreement with Bell’s Healdsburg Ambulance Service, Inc., for the exclusive provision of ground emergency ambulance service within the Bell’s Ambulance historic service area and the agreement was executed on June 30, 2022. The agreement contains provisions for increased quality improvement process, response time mandates and the ability for Bell’s to work with partners through subcontracting if such an arrangement is approved by the County. The County will also recover the cost of oversight activity needed to monitor Bell’s compliance with the contract and all Local EMS Agency policies and patient treatment guidelines. Costs include Bell’s anticipated share of ImageTrend and FirstWatch data reporting and compliance utilities used to track patient care and provider agency performance.
On June 6, 2023, the Board of Supervisors authorized the Director of Health Services to execute a 5-year contract for emergency ground ambulance service in Sonoma County EOA 1 with Sonoma County fire District. In anticipation of the change of service provider in EOA 1 to Sonoma County Fire District (SCFD), DHS met with Bell’s Ambulance and SCFD, to discuss the coordinated provision of exclusive ambulance service and the provision of mutual aid in their respective areas. During the conversation it was noted that the Bell’s agreement contained an inconsistency between the contract language and an attachment regarding response time expectations. DHS agreed to research and request an amendment to clarify the expectations.
Additionally, since SCFD has the capability to offer First Response ALS, the Bell’s agreement needed amendment to specify under what conditions SCFD would be able to provide ALS response services collaboratively with Bell’s in terms of coordination and addressing cost recovery for SCFD if Bell’s were to satisfy some response requirements through coordination with SCFD.
The requested action will allow the County to amend the existing agreement with Bell’s to clarify response time standards and compliance requirements, to set the terms and conditions by with Bell’s may utilize first responder advanced life support services to meet response time requirements, and to mutually release claims between Bell’s and the County.
Strategic Plan:
N/A
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On November 16, 2021 the Board authorized the Director of Health Services, or designee, to execute an agreement with Bell’s Healdsburg Ambulance Service, Inc., and any amendments that do not substantially change the terms and conditions of the agreement, for the exclusive provision of ground emergency ambulance service within the Bell’s Ambulance historic service area for a term through November 30, 2026, with one option to extend the agreement term through November 30, 2031.
On March 23, 2021 the Board A) approved the expansion of the Exclusive Operating Area to incorporate the West County community of Occidental and adjacent areas formerly supported by Falck Ambulance and the Northern County areas currently support by Bell’s Ambulance Services (Bells) and B) approved the RFP for submission to California Emergency Medical Services Authority (EMSA).
Fiscal Summary
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Expenditures |
FY23-24 Adopted |
FY24-25 Projected |
FY25-26 Projected |
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Budgeted Expenses |
$56,700 |
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Additional Appropriation Requested |
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Total Expenditures |
$56,700 |
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Funding Sources |
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General Fund/WA GF |
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State/Federal |
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Fees/Other |
$56,700 |
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Use of Fund Balance |
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General Fund Contingencies |
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Total Sources |
$56,700 |
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Narrative Explanation of Fiscal Impacts:
The amendment has no fiscal impact beyond that of the current agreement. Revenue of $56,700, is already included in the FY 23-24 budget, which is to be reimbursed by Bell’s per contractual arrangement to the Department for administration and technical systems to support monitoring activities provided by DHS. Initial charges will be $41,700 for oversight and $15,000 for support of technical systems. Future year budgets will be projected annually based on the Bay Area Consumer Price Index.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
None
Attachments:
Attachment 1 - Amendment to Agreement with Bell’s Healdsburg Ambulance Service, Inc.
Related Items “On File” with the Clerk of the Board:
None