Multnomah, facing city resistance, delays 911 change
Multnomah County will postpone a new contract to provide countywide emergency ambulance services to deal with logistical and safety concerns raised by the city of Portland and other jurisdictions.
The six-month delay before awarding the contract provides more time to address concerns raised by some local officials and 911 dispatchers as well as protests from the Portland firefighters union. The concerns relate to a proposal to use the contract to add a new layer of privatized medical-call triage dispatchers to 911 calls, one that critics fear could lead to unnecessary transfers and delays.
"There's a lot of people who are not really very happy about it," said Deb Hussey, a union shop steward and 911 dispatcher for the city of Portland's Bureau of Emergency Communications. "Timeliness is huge if you have a medical call. If somebody needs CPR, you need it now; you don't need it after I transfer you, and you hold again."
With the new contract proposal, county officials want to address the waste inherent in having a large fire truck as well as an ambulance respond to all medical calls, a practice that critics attribute to union influence and antiquated 911 practices.
The goal is to triage out calls that don't need immediate response, or don't need both a fire truck and an ambulance. The idea, which is already used in other localities, has been supported in concept by City Commissioner Dan Saltzman and Mayor Ted Wheeler.
However, that support may be waning as details of the county's proposal are debated. A Wheeler spokesman recently issued a statement that stopped well short of committing to the county's plan: "We are interested in the concept, and want to achieve a solution that works for government, emergency responders and labor."
System under fire
Though 911 for the county is overseen by the city of Portland, state law requires counties to oversee ambulance services, including the plan that details the emergency medical system.
Under the county proposal, the ambulance companies bidding for the contract would have to accept responsibility for the cost of a new medical triage system and its operation. Calls requiring medical care would be transferred to dispatchers employed by the ambulance provider.
Portland's 911 dispatchers handle more than 80,000 medical calls a year. AMR reported $80 million in revenue in 2015 from its countywide operations, coming from insurance companies, Medicare and the Medicaid-funded Oregon Health Plan.
A county consultant last year found that the system ranks quite well compared to other 911 systems, using a system of 50 benchmark measurements.
"These results are among the most positive we have observed in the nearly three decades we have utilized this tool," said the October 2016 report by Fitch & Associates.
Still, the consultant recommended changes to improve efficiency and technology, and Multnomah County updated its ambulance plan in late December along those lines.
This summer the Portland City Council adopted a resolution expressing support of the county's efforts, estimating that as much as a third of fire-truck dispatches are unnecessary. The resolution pledged to work collaboratively with the county to evaluate "different options for implementation in 2018 with a focus on improving dispatch for fire and police and reducing duplicative
demands on fire."
The seeming agreement appeared to be a potential breakthrough, given the longstanding tensions over how such calls are handled in the city of Portland.
But since then, opposition has grown. On Sept. 8, Portland Fire Chief Mike Myers sent a bluntly worded letter that appeared to question fundamental aspects of the county's plan, saying he spoke for the city's 911 bureau and Saltzman as well.
"Not only would there be no appreciable BOEC call processing time savings, this change is likely to result in a delay in response time to community members experiencing medical emergencies," Myers wrote. "BOEC believes that the community is best served by a consolidated emergency dispatch center fully answerable to an advisory board, partner agencies and elected governance. Ceding EMS dispatch to a separate, private, for-profit entity is contrary to nationally recognized emergency services best practices."
Gresham Fire Chief Greg Matthews says it's not just Portland: all the Metro-area fire chiefs have concerns about the plan. His agency serves Troutdale, Fairview and Wood Village as well as a portion of Multnomah County, or about 150,000 residents in all. He said his concern is that the new plan will lead to faster times in urban Portland, and slower times in East County. "Until that all gets worked out, we are very concerned," he said.
The county says there's no truth to the claim that the new system would delay emergency response. Paul Lewis, the Multnomah County health officer, issued a statement, saying: "We're looking forward to integrating a widely used medical triage system that will help us put the right resources in the right place at the right time."
The move to delay the contract followed a meeting two weeks ago between county officials and the office of Mayor Ted Wheeler to discuss the concerns.
For more than a week, the city has not responded to requests for documents that could publicly detail the city's concerns and the county's reaction. The county of Multnomah has denied such a request, saying the records include "frank comments and recommendations," and releasing them could "chill the agencies' efforts to work toward a higher quality, modern, and efficient system."
The county has extended the bid deadline to Feb. 28, 2018.
Documents relating to the contract are posted at multco.us/purchasing/opportunities/emergency-ambulance-services .