Tuolumne County Ambulance

Manteca District Ambulance Service, a Tuolumne County contractor and sole provider of ambulance staffing since 1987, has given the county a notice of intent to end its contract for providing its services in the county effective May 5.

Manteca District Ambulance Service, a Tuolumne County contractor and sole provider of ambulance staffing since 1987, has given the county a notice of intent to end its contract for providing its services in the county effective May 5.

For the past 35 years, the two entities have formed a public-private partnership to provide ambulance service. The county owns the ambulance facilities, vehicles, and equipment necessary, while the contractor has provided the staffing for daily operations.

William “Bill” Caldera, chief executive officer for Manteca District Ambulance Service, gave county staff written notice of the contractor’s intent to terminate its agreement with the county on Nov. 5. That gave the county six months to try to find a replacement for staffing county-owned ambulances.

Representatives for Manteca District Ambulance Service and the county Emergency Medical Services Agency did not respond to requests for comment Friday. They also did not respond to requests from The Union Democrat for comment last month.

The contractor’s intent to terminate its services in Tuolumne County is on a county Board of Supervisors agenda for the board’s next meeting on Tuesday. Eric Erhardt, assistant county administrator, and Steve Boyack, assistant director of county Health and Human Services, prepared a report on the issue that was posted publicly around 3 p.m. Friday.

County staff are pursuing options to try to ensure ambulance services will continue in Tuolumne County when the contract with Manteca District Ambulance Service ends in four months.

Through the county Health and Human Services Agency, the county government has provided fiscal and administrative oversight and billing for the ambulance service. The county currently operates four ambulance stations, with five advanced life support ambulances units operating 24 hours a day, Erhardt and Boyack said in their report.

Advanced life support ambulances, also called ALS ambulances, are staffed with at least one paramedic and one emergency medical technician.

Basic life support ambulances, staffed with two EMTs, are intended to respond for patients that require lower levels of care.

The county’s five ALS ambulances responded to a total of 7,541 calls for service between July 1, 2020 and June 30 last year, Erhardt and Boyack said. Included in those calls for service were about 1,200 calls to Adventist Health Sonora for patient transfers to other facilities outside the county.

Under the current agreement between the county and the contractor, Manteca District Ambulance Service also provides transport of residents suffering from mental health crises from Adventist Health Sonora, once they have been medically cleared to go to other facilities outside the county.

Manteca District Ambulance Service did 201 patient transfers to psychiatric facilities in fiscal year 2021.

The current agreement between the county and the contractor was approved in 2015, after the Board of Supervisors analyzed options for future ambulance services in Tuolumne County, Erhardt and Boyack said.

When that analysis was completed, county staff were directed to maintain the partnership with Manteca District Ambulance Service, and a new agreement was reached with a term to expire in June 2026.

Five years later, in July 2020, Manteca District Ambulance Service notified the county that “due to the incremental increase in minimum wage, they would require a 10% increase in their contracted amount to maintain a satisfactory operational margin,” Erhardt and Boyack said in their report.

The contracted rate for fiscal year 2020-21 was about $3.7 million. The current agreement also includes an annual increase based on the U.S. Bureau of Labor Statistics employment cost index for total compensation for state and local government workers in professional and related occupations.

Less than a year ago, in February, the county Board of Supervisors approved rate increases for ambulance services that took effect incrementally on March 1 and again on July 1.

The rate increases resolution included an annual rate increase moving forward that is supposed to be consistent with the consumer price index for all urban consumers in the San Francisco region.

“The intent of these increases was to cover the ongoing increasing cost of services as well as the 10% increase in the cost of the contract” requested by Manteca District Ambulance Service, Erhardt and Boyack said.

Also in February, the Board of Supervisors approved an increase to compensation for the Manteca District Ambulance Service contract in the amount of 10%, as requested.

For fiscal year 2021-22, the contracted amount is a little over $4 million, which will be subject to the annual increase in July, pursuant to the original agreement.

When Caldera gave county staff written notice of the contractor’s intent to terminate its agreement with the county on Nov. 5, county staff scheduled a meeting with Manteca District Ambulance Service to try to understand why the contractor wanted to do so and attempt to seek a resolution, according to Erhardt and Boyack.

At a Nov. 8 meeting with Manteca District Ambulance Service, county staff learned one of the primary reasons for its notice was its inability to recruit and retain adequate staff to provide the services needed.

“It was expressed that this was due to a national shortage of paramedics as well as the number of transfers that are occurring from Adventist Health Sonora to other facilities outside Tuolumne County,” Erhardt and Boyack said.

Other unspecified issues were brought up, which Erhardt and Boyack described as minor.

The multitude of transfers outside of the county was identified as the primary driving factor for Manteca District Ambulance Service wanting to end the contract.

County staff asked Manteca District Ambulance Service to propose changes to the current contract with the county, changes that would meet their needs and prompt them to rescind their letter of intent to terminate services.

The contractor’s proposed changes include:

• Changes to language regarding county facilities and vehicles.

• Changes to language regarding transfers from the hospital.

• Adding language that would give the contractor discretion on which transfers to respond to and when.

• Eliminate transfers for patients in mental health crisis effective July 1, 2022.

• Staffing one of the county’s five ALS ambulances as a basic life support ambulance.

• A 5% increase in the contract effective July 1, 2022, for staff salaries and to increase hiring incentives to increase recruitment and retention.

Erhardt and Boyack said that if the county agreed to those changes, “there would be significant impacts to the operations of Adventist Health and their ability to get members of our community the level of care they require that is not available in Tuolumne County.”

In addition, the county administrators said, regarding transfers for patients in mental health crises, “Tuolumne County has a legal obligation to provide transportation for those patients to a psychiatric facility which we do not have in Tuolumne County.” 

Erhardt and Boyack are recommending the Board of Supervisors direct county staff to issue a request for proposals for future ambulance services in the county that would include emergency response, medical transfers, and behavioral health transfers.

A Manteca District Ambulance Service webpage states it was founded in 1951 to provide ambulance services in Manteca. It’s identified as a non-profit ambulance company that serves Lathrop, Manteca, and Tuolumne County, and it handles more than 20,000 calls a year.

Contact Guy McCarthy at gmccarthy@uniondemocrat.net or (209) 770-0405. Follow him on Twitter at @GuyMcCarthy.

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