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'Unacceptable performance:' San Diego's new ambulance provider facing fines for non-compliance

San Diego’s new ambulance provider was grilled by city council members Wednesday after an early review found they were regularly understaffing ambulances. The fire department says they will be pursuing financial penalties. KPBS Health Reporter Matt Hoffman has more on why city officials are upset.

The San Diego Fire-Rescue Department (SDFD) on Wednesday said it will be pursuing financial penalties after an early review of Falck’s 911 contract found the firm regularly understaffed ambulances.

“It would inappropriate for me and premature to probably identify a dollar amount right now but I can tell you that once this information is vetted through that we will be pursuing that avenue,” said San Diego Fire-Rescue chief Colin Stowell during a presentation the city council’s Public Safety and Livable Neighborhoods Committee Wednesday.

The review was the first of the city's 911 contract since Falck took over full operations in late November.


RELATED: San Diego's new ambulance provider falls short of staffing promise in progress report

Falck promised 1,008 staffing hours per day, but city data shows the company only hit that mark eight times over the last three months.

Falck has yet to meet its monthly minimum staffing hours and the fire department said daily minimums are also often not met.

“The issue here is there were terms that we agreed to that are not being met,” San Diego City Councilmember Monica Montgomery-Steppe said. “Falck won outright, but if that was based on promises that could never have been fulfilled then we have to go back to the table because that makes it very unfair.”

Councilmember Raul Campillo said Falck is not following through on what it promised.


“I want to first and foremost ask Falck why we shouldn’t see the statistics from the last three months as really a bait-and-switch on the city of San Diego?” Campillo said.

RELATED: Ambulances forced to wait longer as COVID fills up emergency rooms

Falck’s leadership said it has been addressing disparities and is working with the department in areas where it fell short.

“What we’ve seen along with the fire department is a significant improvement in February,” Falck’s managing director Jeff Behm said.

Behm maintained that the recent COVID-19 surge complicated staffing, with up to 25% of its workforce out during the omicron surge.

“We are working hard to continue our recruitment, bring our employees on as quickly as we can,” he said.

Behm also said there may be no ambulances stationed in certain areas because they operate a “dynamic system” aimed at increasing response times.

“A dynamic deployment means all the units start out in one place but as the system begins to get busy those units are moved — whether they are going on an assignment or not — they are moved around the city based on supply and demand,” Behm said. “So even though a unit is staffed in a station for Falck it may end up out of that station throughout its shift and may never go back to that station often based on the volume.”

The Fire-Rescue Department, which runs the city’s 911 system, also said Falck is not following its guidance.

“The city has provided direction to Falck in relation to operational, logistical, education, quality assurance matters that all kind of revolve around not only contract requirements but local and state requirements,” SDFD deputy chief of EMS Jodie Pierce said. “They have not followed that direction which has caused issues with our fire operations and county EMS. We continue to work with them to try and address these issues but yes it has been a challenge.”

The department said there have been times when no ambulances were available and it has had to rely on mutual aid while creating its own contingency plans.

“The other thing that happens is you may rely on mutual aid agreement,” Stowell said. “You may have Spring Valley, you might have Lemon Grove, AMR (American Medical Response) may have to come in from the east and as we’ve seen — at a very disproportionate ratio — we’ve seen Chula Vista have to provide a lot more services in the city of San Diego than we’ve had to provide to them.”

Councilmembers Vivian Moreno and Marni Von Wilpert echoed their colleagues' disappointment in the contract.

“Quite frankly this is unacceptable performance from Falck that needs to improve if we’re going to continue with this EMS contract,” Von Wilpert said.

Moreno suggested that the fire department looks into providing emergency medical services in-house.

“If Falck continues to have problems adhering to their contract I think the only solution is for the department to explore bringing the EMS services in-house,” she said. “Our previous contractor (AMR) also had difficulties adhering to their contract terms, which suggests to me that perhaps for-profit companies are not the best organizations to provide EMS services.”

Some Falck EMS crews are pulling extra shifts and city officials are worried about the potential for burnout or them being overworked.

“My workforce has endured incredible adversity in call volumes, staffing levels and difficult working conditions throughout these last few months of this transition,” said Anthony Sorci, a paramedic and president of the San Diego Association of Prehospital Professionals, which represents Falck employees. He added that conditions have been getting better.

“We are happy to report that the service levels and in-kind working conditions have improved for our members and we are working weekly with Falck management to develop policies, processes and real-time solutions to operations and staffing issues that have challenged the success of this startup,” he said.

Before fines can be issued, Falck will have time to review the city's data. The company has an ambulance contract with the city for the next five years.

Wednesday's presentation did not touch specifically on response times, although Falck officials have said they are currently at or near 90% of their goal across the city.