News Every Day | 18 May 2024, 03:25

Multnomah County disregarded rules, avoided proper oversight of EMS: Audit

PORTLAND, Ore. (KOIN) -- A new audit from the Multnomah County Ombudsman highlights the county's failure to respond appropriately to slow ambulance response times.

Much of what is covered in the audit has been revealed in previous KOIN 6 reporting.

The audit found that the county did not properly oversee its contract with AMR—even though the company has consistently failed to meet response time requirements for years.

The audit also concluded that the county missed critical opportunities to hold AMR accountable. This was a similar revelation revealed in a KOIN 6 investigation in early April.

Additionally, the Ombudsman's report confirms that the board of county commissioners failed to establish a required EMS Advisory Council for oversight. KOIN 6 obtained internal county emails showing Commissioner Sharon Meieran questioning EMS staff about this very issue in April.

An EMS staffer responding: "In short, the EMS Advisory Council (EMSAC) does not exist as written in County Code. No members have been appointed by the Board to the EMSAC since the adoption of the revised ASP [Ambulance Service Plan]." The staffer's email went on to claim that the EMSAC function was accounted for by the the Protocol Development Committee (PDC).

However, according to the audit, the makeup of the Tri-County Protocol Development Committee does not satisfy the language of section 21.419(C) of the County Code, which says that one third of the membership of the Emergency Medical Services Advisory Council will be “Multnomah County community members who may access ambulance services.”

The audit went on to explain, that the process for appointing members to the Protocol Development Committee also does not satisfy the language of the code. County Code says, “The members of the Council shall be appointed by the Board, upon the recommendation of the EMS Administrator.” For these reasons, the Tri-County Protocol Development Committee is not equivalent to the Emergency Medical Services Advisory Council as it was established in County Code.

The audit, however, did not mention several crucial issues that KOIN 6 uncovered.

First, the county commissioners approved the most recent AMR contract through a consent agenda, a process usually reserved for routine matters, not major contracts—only Multnomah County Commissioner Sharon Meieran was absent for that vote.

Second, the audit never acknowledges the national paramedic shortage and the county’s failure to adapt to it.

The audit correctly recognizes that the EMS staff failed to recommend the replacement of AMR for Material Breach of the contract. However, the audit fails to identify why AMR cannot be replaced.

"There is no other ambulance provider in the United States that can meet the county’s response time requirements and also meet the two-medic staffing standard due to the national paramedic shortage," said Dr. Stephen Dean, a former paramedic and EMS director.

Lastly, the audit missed how in addition to failing to make an EMS advisory council, the county also failed requirements of another regulatory body, the Contract Compliance and Rate Regulation Committee (CCRRC). Chapter 21 of the Multnomah County Code requires the CCRRC to meet "at least annually, to review the performance, as specified in the contract,
of the contractor for emergency ambulance service."

Per the Feb. 29th public testimony from Gresham's fire chief, that committee hasn't met either.

Meantime, another KOIN 6 investigative report revealed that costs for patients (ambulance rates) are skyrocketing while ambulances services are slowing.

Overall, the audit, along with multiple KOIN 6 reports, indicate the county selectively follows rules, and avoids proper oversight of EMS.

It's worth noting that the Ombudsman's report also talked about how the county didn't cooperate with the investigation, saying EMS did not answer the Ombudsperson’s questions about compliance.

Ombudsman Recommendations

The Board of County Commissioners should regularly receive ambulance response time data from the Emergency Medical Services staff that is compiled at least monthly for urban areas and every six months for rural areas.
The Emergency Medical Services Advisory Council should be formed and the Emergency Medical Services Administrator should recommend members to the Board of County Commissioners for appointment to the Council.

KOIN 6 reached out to Multnomah County and EMS Dr. Jon Jui for comment. The county responded with a letter drafted by Chair Jessica Vega Pederson and the health department, which can be viewed below.