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Golden Valley Fire District attorney raps regulators

Kathy Steadman, an attorney representing the Golden Valley Fire District, criticizes the state’s regulatory process as it relates to acquiring permissiun to operate an ambulance service. She made the comments Wednesday in Golden Valley.

4 years and $300,000 later, fire district still can't offer ambulance service

GOLDEN VALLEY - The state's regulation of ambulance services is a broken system, said Golden Valley Fire District attorney Kathy Steadman during an update on the district's efforts to transport patients to Kingman Regional Medical Center.

"The (process) takes too much money and is too lengthy," said Steadman during a break at Wednesday's meeting. "It's a broken system that needs to be fixed."

Steadman also said the Arizona Department of Health Services, the state entity that regulates ambulance services, does not offer adequate assistance to applicants who want to operate an ambulance system.

The process began in 2010 and roughly $300,000 has been spent, with no resolution in sight. The district seeks a certificate of necessity, which requires reams of data that is evaluated at the Department of Health Services.

Hearings have been held (and more are coming), and studies were conducted in advance of a decision. The fly in the ointment for the district is the fact that River Medical already holds the certificate of necessity to provide ambulance service in Golden Valley - and virtually the rest of Mohave County - and the matter is now in the courts.

Since October, River Medical and the district have been involved in litigation in the Maricopa County court system. The private ambulance provider is not willing to surrender its service to Golden Valley and seeks to put an end to the district's pursuit of the certificate of necessity. Oral arguments could be heard Feb. 12.

Regardless of the court outcome, Steadman said the effort to obtain the certificate would not have to begin anew should the court rule against the district, as has been previously reported, but the costs will continue to increase.

According to Steadman, the current certificate of necessity held by River Medical encompasses 23,000 square miles. Golden Valley, she said, represents about 1 percent of the private ambulance service's current coverage area.

Steadman also noted AMR, River Medical's parent company, has certificates of necessity pending in Maricopa, Pima and Yavapai counties. If the Department of Health Services approves them, AMR would provide ambulance service to more than half of Arizona.

Steadman's point was AMR would not be unduly impacted if it lost its service in Golden Valley, but she also cautioned that another aggressive private ambulance provider in the state, Rural Metro, filed bankruptcy after a rapid expansion.

The filing, however, didn't occur until the city of Yuma spent more than $1 million battling Rural Metro over a certificate of necessity when city officials became unhappy with the private provider's service.

The bankruptcy left Yuma minus the $1 million and no ambulance provider for its residents. Other communities were left scrambling for a provider, said Steadman.

While a survey showed 96 percent of Golden Valley's residents support the district's pursuit of its own ambulance service and four of five directors champion the effort, not everybody believes the push is necessary.

Director Rhonda Brooks has been at odds with her colleagues on the board and Fire Chief Tom O'Donohue on many district issues, including the pursuit of the certificate.

"We have an ambulance service now that's costing us nothing," she said.

"I respectfully disagree," said Steadman, who reminded Brooks that Golden Valley firefighter/paramedics respond to every emergency medical call in the district. If they are first on scene, they stabilize, treat and prepare the patient or patients for transport to Kingman Regional Medical Center.

River Medical does the transporting - and the billing.

River Medical has no intention of giving that up.

"We've been providing services there for two decades, over 20 years," said River Medical General Manager John Valentine in a Thursday interview. "The previous provider left overnight and we were responding to calls in Golden Valley within 24 hours."

Valentine also disagreed losing the Golden Valley marker would not harm the company. He said there is a misconception about AMR's business model.

"River Medical is its own business unit," he said. "It stands on its own merits. We're not some giant company with unlimited resources."

He said each year River Medical must submit an Annual Revenue and Cost Report to the Department of Health Services.

"Absolutely," he said when asked if River Medical will fight to keep its certificate of need. "We never intended to give up any part of our service area. We are invested in that community. We've been providing service there for a long time. We're invested in our employees who have provided services to the people of Golden Valley for a long time."

Valentine said the company buys new ambulances and equipment as part of its investment each year.

Valentine was invited to attend Wednesday's meeting to discuss a number of questions from the Golden Valley Fire District board. Citing the pending litigation, he declined to participate.

He did say that AMR "remains committed to providing quality patient care and ambulance transports to residents and visitors of Golden Valley."

Valentine acknowledged River Medical and the district are at odds over whether a change in ambulance providers is in the public's best interest, but he said the issue should not interfere with the day-to-day operations between the two providers.

Valentine also said he saw no issues with River Medical's response times and patient care.

The district, however, believes the Golden Valley Fire Department can get to patients faster and provide a higher level of care once they do.

"The issue here is service over profit," said Steadman. She said studies indicate Golden Valley can respond to 91 percent of incidents within 15 minutes while the percentage for River Medical is 78 percent.

She acknowledged River Medical's response times are somewhat skewed because of its vast service area.

Service would be enhanced, she said, because "time matters."

Roughly 64 percent of the district's calls regard emergency medical service. By comparison, fire suppression calls represent 2 percent of the calls.

Should the district obtain the certificate of necessity, three ambulances will be on hand 24/7.

Valentine said River Medical currently has two ambulances providing services in Golden Valley.

The district already has the ambulances, having bought them a couple of years ago from a fire department in Washington state.

O'Donohue said the district would have to hire only three more staffers since firefighters are already cross-trained as paramedics or emergency medical technicians.

Steadman said a study conducted by economists concluded the service would net $565,000 its first year in operation, but she cautioned the goal is not for the service to generate a profit, but to place a priority on patient service.

"We need to look at this as revenue-neutral," she said.

As the district continues to move forward with no certainty it will succeed in its quest to run its own ambulance service, Steadman said the effort is worthwhile.

"This is a gutsy board," she said of the directors. "They know what they're doing is in the best interest of the people of Golden Valley, and they know they've got their work cut out for them."

Clearly, with $300,000 already spent and with expensive bureaucratic miles still to walk, the board will eventually balk if the issues aren't soon resolved.

When that moment comes is anyone's guess.

"We haven't come to that bridge yet," said Chairman Mark Vanik when asked what the board's cutoff point would be regarding costs.

The only certainty going forward is that River Medical intends to fight the Golden Valley Fire District over the certificate of necessity and the district intends to fight back.

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