Monterey County EMS fails a second time in a quest to create a new ambulance contract.

The last time the Monterey County Emergency Medical Services Agency tried to create a workable contract in 2019 to secure an ambulance provider, only one bidder showed up – American Medical Response, the county’s provider since 2008 – and that bid was deemed too expensive and rejected by the agency. Changes were made and a new request for proposals was published in November 2020. This time, the results were even worse. Zero companies bid on the contract as of 3pm March 5. AMR Regional Director Michael Esslinger sent a letter in place of a bid that called the RFP “too seriously flawed to submit a quality-based proposal.

“This is highly unusual, and one of the few times in AMR’s history as an incumbent, to not submit a proposal,” he wrote. “We genuinely want to remain in Monterey County, but we cannot propose a model that we believe could not be realistically achieved at a reasonable cost to the public.” He noted there were improvements over the previous RFP, but said barriers remained to building a system that was practical without adding significant costs.

Part of the ongoing issue for the county is creating a system that is able to cover 3,330 square miles of mostly rural area in a way that is safe for patients and makes financial sense.

In an interview, Esslinger says the county’s RFP included strict response times with financial penalties that were not sustainable for the company, requiring more ambulances in areas with a low number of calls. “We applaud the county wanting to enhance services and create a model that is best for the patient, but there also has to be some level of balance in how you build these systems,” he says. Also at issue is mutual aid with adjacent fire districts, which the county discourages under the RFP.

In 2006 the county entered into a contract with WestMed Ambulance Inc., in an effort to save money. That company fell into financial trouble and had to give up the contract after only about 18 months.

AMR representatives want to sit down with EMS officials and reach some mutually beneficial proposals that will make the next RFP successful. “From my standpoint, we have a great respect for the role of the Emergency Medical Services Agency. They’re also important, but at some point you have to strip away some of the regulations and sit around the table and put the patient at the center,” Esslinger says.

For now, AMR is remaining in service to the county. The contract extension AMR and EMS agreed to, after the company’s last contract ended in February 2020, is good for another year. The company is willing to remain past that contract until either AMR is successful bidding on the next RFP or a different ambulance company is awarded a new contract. “At the end of the day, we aren’t going anywhere. We’re not going to abandon the communities we serve,” Esslinger says. “We aren’t just a contract company, we live here.”

EMS representatives declined to answer questions. The agency sent a statement confirming that no bids were received, adding, “We are assessing our options as our goal is to ensure continuity of services.”