Stiff fines for poor emergency response times have prompted San Diego’s new ambulance provider to begin manning extra shifts for paramedics and beefing up its operations at the US-Mexico border.
Falck USA, which took over San Diego ambulance operations last November, was fined $351,000 during the second quarter of the year — April, May and June — for more than 50 excessive response times. long and to exceed response time goals in some areas.
Frustration with Falck’s poor response times and other problems since the company took over prompted city officials to request a financial analysis of taking the ambulance service away from Falck and merging it into the Fire Department. -Rescue of the city.
Falck officials admit they are struggling to live up to their contract with the city, but insist Falck provides more comprehensive ambulance service than San Diego has ever received — despite a national shortage of paramedics.
While Falck does not provide the 1,008 hours per day of ambulance coverage required in its contract, the company is averaging 936 hours per day – well above the average of 840 hours per day provided by American Medical Response before be replaced by Falck.
Falck officials also say their numbers will improve soon when they implement mandatory additional shifts later this month and finish negotiations with the US Border Patrol on new protocols for emergencies at the San Ysidro crossing.
Fire-Rescue Department officials declined interview requests, but said in a statement that city officials will continue to work with Falck to ensure he meets his contractual requirements.
“We are optimistic and will continue to monitor Falck’s performance and hold them accountable for the contract,” the department said in the statement.
The statement also said that the analysis of bringing the ambulance service home is ongoing, but there is no estimated date of completion.
Falck’s labor contract with its employees allows the company to mandate overtime, a move Falck officials said they are reluctant to make.
The new policy, called a “mandate,” will require workers to work one or two extra shifts per month, said Jeff Lucia, Falck’s director of communications for San Diego. They will be paid double their normal wages and will receive at least 10 days notice of an assigned shift, he said.
Tony Sorci, president of the San Diego Association of Prehospital Professionals, which represents Falck workers, did not respond to requests for comment on the new policy.
Falck officials say the new policy is needed in part because the company has only 104 full-time paramedics, well short of the 134 it needs and the 148 it wants to have to cover vacations and sick days.
Falck will also strengthen how emergencies are handled at the border, in part because many of the fines issued to Falck are the result of slow response times in the southern part of the city.
Of the $90,000 in fines Falck was charged for poor response times in geographic areas, $60,000 of the money was for poor response times in the southern area of the city. And of the $261,000 in fines for excessively long responses to individual calls, $70,000 was for incidents in that area.
Falck spokesman Troy Hagen said a key element of those numbers is emergencies verbally reported by people crossing the border, which border patrol agents automatically classify as high-priority calls even s They are really low priority calls.
In the rest of the city, emergency calls are routed by dispatchers who assess the priority level of the emergency, Hagen said.
“We’ve exhausted our resources, really, needlessly,” he said. “We are working closely with the Border Patrol, and we are configuring the entire southern area.”
The new approach is likely to include stationing an ambulance at the border, he said.
Falck officials also blamed the company’s poor response times on delays at local hospitals and a sharp increase in ambulance calls.
The shortage of staff in hospitals since the beginning of the COVID-19 pandemic extends the amount of time Falck ambulances spend dropping off patients before they can leave and prepare to deal with the next emergency.
“When hospitals don’t have enough staff to move people out of the ER or through the hospital by admitting them, the flow of patients goes backwards,” Lucia said. “This means that ambulance patients who are stable end up waiting in the ambulance or in the corridor on the ambulance stretcher for hours sometimes.”
Falck officials said wait times at local hospitals have increased 53 percent since April.
“Basically, hospitals are using ambulances as another waiting room,” Hagen said. “Take that ambulance out of service.”
Another problem is the volume of calls, which has grown 17 percent since April. Falck processed 424 responses per day then but processed more than 500 per day in September, Lucia said.
Moving ambulance service home would be a major change for San Diego.
Falck pays San Diego an annual fixed fee of $9 million, maintains a fleet of 66 ambulances and pays salaries for all paramedics and emergency medical technicians.
In exchange for that payment, Falck has the opportunity to bill the patients who receive the ambulance directly. In his proposal to the city, Falck projected that it would receive nearly $75 million in annual revenue.
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