Los Angeles County health officials are recommending that ambulance companies be allowed to raise their basic charge about 40%, boosting the fee for a typical daytime emergency run to $232.
The proposed rate hike is prompted by a fundamental restructuring of ambulance service in most cities and the unincorporated areas of Los Angeles County. Triggered by a 1986 court ruling, health officials devised a new plan to divide the county into service areas, with 16 private ambulance companies each given an area, with the exclusive right to respond, under contract with the county, to all 911 emergency telephone calls.
But even as county officials are negotiating with the Los Angeles County Ambulance Assn. to carve up the territory, a handful of small ambulance companies complain that they have been frozen out of the action. They are criticizing not only the county's exclusive negotiations with the so-called "Sweet Sixteen" ambulance companies but also attacking the proposed rate hike as excessive.
The last rate hike approved by Los Angeles County supervisors eight months ago was less than 4%. In a few weeks, the supervisors are expected to act on the new increase.
Douglas Emslie, president of Lifeline Medical Transport in San Gabriel, accused the county of throwing lucrative business--without seeking competitive bids--to an "old boys club" of ambulance operators represented by the politically influential Los Angeles County Ambulance Assn. The association and its members have contributed more than $16,000 to the supervisors' campaigns during a recent four-year period, records show.
Fran Dowling, head of the County Department of Health Service's contracting and management office, said that while ambulance operators may well be campaign donors, this has no impact on his decisions regarding the ambulance franchise program.
"There have been questions, but no directions," coming from the supervisors' offices, he said.
Dowling acknowledged that a handful of smaller ambulance operators "are not too happy with us." But he said that the county is simply trying "deal with the problem" created by a 2nd District Court of Appeal ruling 18 months ago that ordered the county to assume responsibility for all emergency ambulance service in the county.
Previously, a patchwork quilt of emergency transport service was provided by city-operated ambulance companies and by private companies, either under contract with cities or with the county. The court ruling does not disrupt ambulance service now provided by 23 cities, including Los Angeles, Long Beach, Beverly Hills, Pasadena and San Marino, Dowling said.
But it will require the county to significantly expand its coverage to encompass 30 more cities than it now covers and to assume responsibility for the cost of transporting all sick people throughout the county who cannot pay their ambulance bills. The two biggest of the 30 new cities are Torrance and Glendale, Dowling said.
Despite the looming expense, the county wants to hold the line on its costs. Raising the rates that ambulance operators can charge their paying customers is one way of doing so, county officials said.
A rate increase "makes sense" because without it, "the county will have to come up with more money from the general fund," said Roderick Dorman, attorney for the ambulance association.
Dowling said that ambulance charges must be increased to entice ambulance companies to participate in the county's new franchise program. He said the rates here have long lagged behind those in other counties.
The median baseline charge for ambulance operators in 30 California counties surveyed by health officials is $143, Dowling said.
In Los Angeles County, the baseline charge is now $109. It will rise to $151 under the proposed rate increase.
However, this charge excludes extras such as the fee for oxygen, mileage, waiting time and night service. These charges will also be boosted. The fee for using an ambulance's red lights and siren, for example, will jump 250% from $16 to $56.
According to the proposed rate schedule, a typical daytime emergency run of three miles will cost $232, up from $148. Another $61 would have to be added for oxygen and night service, up 85% from the current rate.
"While I would agree to an increase, this seems excessive," Emslie said in a letter to supervisor Mike Antonovich.
Emslie also criticized a proposal that would force ambulance operators to charge "no more, no less" than the prescribed amounts.
"Is this free enterprise?" he asked.
Paul Duran, general manager of United Ambulance in East Los Angeles, said that half a dozen small, relatively new ambulance companies are upset that the county is negotiating for service exclusively with "the Sweet Sixteen, who have been around many, many years."
"It's a tight little system, and they want to keep us out," he said.
"It's very simple," Emslie said, "If these guys can lock up Los Angeles County, the value of their companies goes way up."