City, GFES discussing ambulance contract renewal, community needs

The city’s contract for ambulance transport services is up for renewal in May and discussions are underway on how the process should proceed.

During the Nov. 20 work session, the Great Falls Fire Rescue chief and assistant chief walked City Commissioners through the current emergency medical system and challenges they see in meeting the community’s needs.

GFFR Chief Steve Hester said they wanted to talk to commissioners “about where the future of EMS is going. Things have changed drastically,” since the contract was first issued in 2008.

Hester told commissioners that they were focusing specifically on 911 emergencies within the city limits, since that’s what the city regulates. They weren’t including lift assists, county or private calls for transport.
City considering contract amendment to adjust for paramedic shortage

“We are responsible for EMS in our community,” per city ordinance, Hester said.

There’s some disagreement so far between the city and GFES about how the process should proceed.

GFES stance is that the contract should automatically renew for another five years, based on the contract language. The city is arguing that changes to the performance contract need to be made to best serve the public and that under the current contract, once an amendment expires, and city ordinance, GFES could be in breach over paramedic staffing.

In an initial version of presentation slides for the work session, GFFR officials included that their recommendation would be to put the contract out for bid, which caused GFES concern.

GFES officials said the instability of having to bid a contract regularly wouldn’t allow them to make the $200,000 worth infrastructure and equipment investments they’re currently planning to make.
[READ: GFES documents submitted to the city]
[READ: GFFR response to GFES documents]
[READ: GFFR powerpoint slides from Nov. 20 meeting]

But both parties have confirmed that they are open to discussing updates to the performance contract.

Earlier this year, GFES notified the city that it was facing a paramedic shortage and would not be able to staff all ambulances with paramedics. The city ordinance and the performance contract specifically requires that each responding ambulance shall be staffed with at least one paramedic and one emergency medical technician.

The city approved an amendment to the contract this fall allowing GFES to operate with two Advanced Life Support ambulances, which means they have paramedics onboard, and anything beyond that could be staffed at the Basic Life Support level, meaning the ambulance is staffed with EMTs.

In the event that a BLS ambulance from GFES is at the scene of an ALS incident, the city will provide a paramedic for transport. GFFR has provided ALS non-transport services to the community since 2000. The city also provides emergency medical and transport for continuity of care for critical patients.

That amendment expires in May and if the paramedic staffing hasn’t returned to normal, the city could hold GFES in breach, which it indicated over the summer was a possibility. The performance contract and the ordinance allow options to remedy a breach.

Justin Grohs, GFES manager, told The Electric on Monday that the company would be a fan of keeping the amendment or some variation of it in place with the updated contract. To do so, however, would require changing the city ordinance.

“The concept of amending the contract to do BLS response, was to me a sophisticated common sense tactic, but it wasn’t our only option,” he said.

Grohs said GFES could have altered their deployment plans with the county or the base to reallocate ALS resources to the city and improved response times, but said in the bigger picture, that wasn’t ideal.

“The BLS concept just makes a ton of sense,” Grohs said.

GFES also transports for Mercy Flight from the airport to the hospital, Malmstrom Air Force Base, the county and other needs.

In a letter to the city this summer, Grohs said the paramedic shortage was caused by employees moving away, pursuing other employment and maternity leave.

During last week’s work session, Dave Kuhn, GFES owner, said the company also lost more employees than anticipated when they switched from a 24-hour shift to a 12-hour shift. Grohs said they made that change for safety reasons.

Grohs said that he anticipates being fully staffed with paramedics again before the contract expires May and likely shortly after the new year.

During the meeting, City Commissioners didn’t give a clear direction on whether they wanted to consider an ordinance change, but GFFR officials and City Manager Greg Doyon said they are still working through drafts of the proposed changes to the performance contract. Those drafts have not yet been made public.

Hester and Assistant Fire Chief Jeremy Jones said that Great Falls was the first Montana city to recognize the importance of ALS service and now others statewide are following their example.

Hester said that in 2006, the city conducted a study that determined the best option was to outsource transport and city officials have indicated that it’s not likely that the city could take over that function at this time, without significant costs.
City considers change to labor agreement to address paramedic shortgage

But, they’re effectively operating from the same transport contract that was adopted in 2008, Hester said, and changes are needed to reflect current realities.

Call volume has increased and they’re now using emergency medical dispatch to better utilize resources, Hester said.

According to city data, counting only 911 emergency medical calls, there were 4,297 calls in 2012 and in 2017 that number had increased to 5,624.

In the past, three ambulance providers operated in the city, but the transport contract was never bid out but instead the city worked with GFES to develop the agreement, Hester said.

“They have some exclusivity,” Hester said, since they’re currently the only operator in town, but state law does not allow the city to actually grant exclusivity.

According to the city ordinance, the city has full responsibility and accountability for the emergency medical system, Hester said.

GFFR officials have proposed some changes to the performance contract language to try to meet needs they see in the community, Jones said.

One area both parties appear interested in revisiting relates to response times and fines associted with missing those marks.

The contract requires that GFES arrive on scene within nine minutes 90 percent of the time or better. GFES says they are making it within nine minutes 95-96 percent of the time, but get fined for each call that they’re late, which they feel is unfair, Grohs said.

“We all have surge events,” Grohs said on Monday. “Individual fines like that just simply not fair.”

Hester and Jones said that when the contract started in 2008, the annual fines to GFES averaged $3,200 to $3,500. Over the last two years, the fines have averaged $12,500 annually.

The city also has an ambluance and transports when other resources aren’t available. While GFES is operating with fewer paramedics, GFFR paramedics have jumped on an ambulance when needed and the department has increased their paramedic staffing to meet what they believe is a need.

The city is also struggling with the paramedic shortage that is impacting departments nationside.
GFFR hires new paramedic, third female in department history

When the city transports, there’s no charge to the patient, but GFES is fined. Jones said the department was looking at options to change that provision.

According to city data, at the start of the contract in 2008, the city was transporting 3-5 times a year in surge events and this year, GFFR was averaging five transports monthly.

That’s impacting the city’s budget.

Hester said that for the last pay period, the deparmtent had $10,000 in overtime costs to overhire paramedics and provide ALS service.

“It’s well worth it but it’s a cost to the city,” Hester said.
Facing shortage of paramedics, Great Falls Fire Rescue actively recruiting, training their own

Grohs told The Electric that since the bulk of 911 calls are basic life support, it makes sense to have an ambulance staffed at that level instead of having all ambulances staffed for the advanced life support level. City staffers have not indicated a desire to lessen the ALS requirement and to do that longterm would require that City Commissioners approve an ordinance change.

GFFR is proposing a matrix that would adjust the level of required amulances based on call volumes.

GFES officials indicated a conern with that since based on their utilization reports, they believe they’re reaching a level of overstaffing and that using blanket coverage under the matrix could be cost prohibitive.

Jones told commissioners that the agencies have worked together over the years and made a number of improvements to the system, but “we’re just here to make sure the system is secure. We’re proposing changes so the citizens in our community are safer and get the highest quality care.”