CITY OF SAN DIEGO SCOTT CHADWICK CHIEF OPERATING OFFICER December 1, 2016 Mike Murphy General Manager of San Diego and Orange Counties 8808 Balboa Avenue, Suite 150 San Diego, CA 92123 (858)492?3500 Tom Wagner Chief Executive Officer, West Region 6200 8. Syracuse Way, Suite 200 Greenwood Village, CO 80111 (303)495?1200 Subject: Repeated Ambulance Eespense Time Nenw?empiiance Netice 8: Request fer Detailed Pianmtem?ure Dear Mr. Murphy and Wagner: Per the attached .EMS Compliance reports for FY 2017 Quarters 1 and Quarter 2 to date (July through November 30, 2016), Rural/Metro has failed to meet the response time standards in multiple medical response zones for the Emergency (Priority Level 1) category. The City considers repeated non?compliance with response time standards to be a material breach of the terms of the EMS Agreement, and in addition to further penalties being assessed at the conclusion of Quarter 2, may warrant a finding of breach of contract (see 2009 REP, sections V.T.1 and V.T.9). Repetitive quarterly fines for failure to meet response time standards will not be tolerated. Therefore, you are hereby directed to bring EMS response times into compliance no later than 12:00 AM, Ianuary 15, 2017 and address the associated EMS Agreement issues noted in this letter. In addition, AMR must: 1. Pay the'City any penalties owed as a result of failing to comply with response zone standards in Quarter 2. 2. Meet with the City of San Diego team regarding EMS response time compliance. AMR attendees will include local, regional and corporate managers. - 3. Make the changes necessary to the ambulance deployment schedule to regain response time compliance no later than 12:00 AM, on January 15, 2017. 4. By the end of business on December 28, 2016, provide the City a robust ambulance system deployment plan. The plan will contain sufficient rigor and specificity to 1 202 Street, MS 9A San Diego. California 92101 Tel (619) 236?5587 demonstrate onwgoing response time co mpliance with the EMS Agreement. The system deployment plan is to be based on 2016 incident demand by zone from December 1, 2015 to November 30, 2016. The system deployment plan shall include, but is not limited to: a. Statistics such as peak hour demand history; b. Unit Hour Utilization; c. Predicative travel times from planned posts and GIS outputs to demonstrate that the system deployment plan will meet the needs of the City of San Diego topography; d. Incident volumes and; e. Clinical severity needs. 5. By January 31, 2017 show evidence that can build and maintain a stable workforce by submitting evidence that at a minimum shows: a. The steps AMR will take to permanently secure and retain a stable, long term workforce; I b. A showing that wage, hours, and working conditions of AMR employees are sufficient for AMR to retain and grow veteran paramedics and EMTS so as to sufficiently staff its workforce to meet the EMS Agreement?s response time requirements; and c. Provide Paramedic and EMT employment time to date in the San Diego City system as of December 31, 2016 and turnover statistics for calendar years 2015 and 2016 as benchmark years going forward. 6. Starting on January 1, 2017 and within ten (10) days after the first of each calendar month, identify within 10 working days the net gain or loss of EMTs and Paramedics that occurred during the previous month. In addition, within the 2011 portion of the EMS Agreement under Article VII, Section 7.5 records, it states in part: ?2009 REP. Within thirty (30) days after the first of each calendar month, Rural/Metro shall provide and quarterly financial reports to the City in a form as agreed to by the Parties. Rural/Metro shall provide a certification as to the truth and accuracy of the information and signed by its executive accounting personnel with the submission ofall quarterlyfinancial reports?. The City is requesting that within the first 10?days of each month, provide the Fire? Rescue Department the prior month?s information: Total billed by payor category and percent; Total received by payor category and percent; Aging of outstanding receivables by payor category; Balance sheet (specifying local and corporate overhead); Cash flow statement; Statement of retained earnings; g. Year to date written off bad receivables. ween 9?s? Beginning January 1, 2017 and in lieu of or in combination with increased personnel, the City is willing to offer the service of San Diego Fire?Rescue Department Firefighter 8: Rated Paramedics, to staff a limited number of AMR ambulances per day, for a mutually agreed length of time. The City will have its personnel and other incidental costs reimbursed per normal city cost recovery formulas to include direct and indirect costs as allowed by City of San Diego regulations or if needed for specificity, the current Federal OMB Circular Payment to be made to the City within 30-days of the close of each month. It is responsibility to fund what is necessary to staff the requisite number of ambulances. As noted above, AMR will state in its response time plan the steps it will take to permanently secure and retain a stable, long term workforce. This plan?s provisions are to include more than entry training and recruiting. The proposal must include wage, hours and working conditions sufficient for AMR to retain and grow veteran paramedics and and not stay an entry level, high turnover employer that endangers AlVlR?s ability to perform under the EMS Agreement. If AMR will not accept the terms of this Plan?to?Cure notice by end of business on December 30, 2016, and has to pay response time penalties for the quarter ending 12?30?16, the City of iego may have no choice but to begin drafting in January of 2017 a Notice of Breech and Scott Chadwick Chief Operating Officer Attachments: 1. FY 2017 Q1 EMS Compliance Report 2. FY 2017 Q2 EMS Compliance Report (October 8: November) cc: Brian Fennessy, Fire Chief Chris Webber, Assistant Fire Chief Gina La Mantia, Deputy Fire Chief Chris Heiser, Deputy Fire Chief Roger Fisher, Deputy Fire Chief Noah Brazier, Deputy City Attorney Stacey LolVledico, Assistant COO Mike Hansen, Deputy Chief of Staff