Multnomah County announced today it is fining American Medical Response (AMR) $513,650 for failing to arrive at 911 calls in the required time.
The County fined AMR for falling short in August across the system, including failing to arrive within eight minutes for high acuity calls in urban areas. AMR responded to 11,577 calls that month; 14% of the responses were late enough to trigger penalties.
“AMR has the power and responsibility to fix these unacceptable response times,’’ said Multnomah County Chair Jessica Vega Pederson. “They have the power to subcontract with other agencies to bring on more paramedics and more ambulances. They have their own paramedic school where they can recruit and train more paramedics. They can also assign paramedics to work in Multnomah County or provide incentives to keep them here.
“We need AMR to work with us to solve this problem.’’
Multnomah County Emergency Medical Services provides medical oversight and coordinates the emergency medical system, including the ambulance services provided by AMR. AMR has been the sole ambulance provider in Multnomah County since 1995.
The penalty comes 17 months after AMR first said it could resolve response times that have worsened since the COVID-19 pandemic. AMR has reported it has been unable to put the required number of paramedics on all the ambulances needed to meet the time standards required by its Multnomah County contract. AMR has also been unable to provide EMTs for a County pilot program designed to improve the response times.
At the same time, in August 2023, the company expanded to Washington County, drawing even more paramedics away from Multnomah County. It also provides ambulance services to Clackamas County and Clark County, limiting Multnomah County’s ability to tap into those regions for help.
Multnomah County requires the company to place two paramedics on ambulances, a critical factor considering that 44% of the County’s 120,000 911 calls are responded to by only an ambulance. That staffing requirement has helped ensure the County’s system has one of the highest cardiac arrest survival rates in the country.
AMR has asked the County to abandon the two-paramedic system for a one-paramedic-one-EMT system, similar to other counties. But those counties have a different model, in large part because their local fire agencies respond to nearly all their 911 calls, unlike in Multnomah County, where they respond to roughly 55%.
However, Chair Vega Pederson noted, “even our partner counties with different models are still seeing delays in response times.”
“This problem was not created by a two-paramedic requirement,’’ she said.
Under its contract with AMR, Multnomah County can levy fines for poor performance, but cannot reduce fines. In addition, all proceeds from the fines must go into system improvements.
Chair Vega Pederson has directed the Health Department to determine how the proceeds can best be directed to improve the situation. Potential investments include:
- EMT and paramedics scholarships
- Retention-related initiatives
- Regional collaboration on Public Service Announcements on when to call 911
- Training funds
- Medical director initiatives to enhance patient outcomes
- Other projects and innovations put forward from within the EMS system
"The Health Department deeply values the expertise and services provided by our contracted partners and we don't make the decision to fine AMR lightly. We are confident that the solutions to current workforce and response time challenges are within reach," said Valdez Bravo, Interim Health Department Director. "The Health Department is committed to high-quality, safe and timely emergency ambulance services for everyone in our community. And we commit to collaborate with AMR to develop the impactful and sustainable changes that will return this system to the high performance standards our community needs."
For a description of the exact penalties and penalty structure, please see Page 25 and 26 2019 AMR Contract- Complete
For compliance, see the CCRRC 6 Month Review-Final Contract Compliance and Rate Regulation Committee Cover Letter.
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