The D.C. Council approved legislation Tuesday that will privatize a portion of the city’s ambulance fleet, siding with Mayor Muriel E. Bowser in the belief that the District can’t guarantee a timely response to every 911 call without help from an outside source.
The unanimous decision clears the way for Bowser’s new fire chief, Gregory Dean, to hire one or more private ambulance operators to transport hundreds of patients a day who want to go to a hospital but who first-responders decide do not require serious care.
Council members, some of whom expressed displeasure with the move before voting for the emergency legislation, said it was the result of years of neglect and underinvestment in the city’s medical emergency response capabilities. They piled on requirements that Dean provide regular accounting of the private contractors’ performance and a road map for how to ramp up staffing to eventually return the entire ambulance service to city fire department employees.
But it remained unclear if that would happen. Dean urged the council to give the new arrangement a year before deciding whether it should be permanent. The council also gave the administration latitude to sign contracts with private companies that could last more than a year, even as the price tag for the outsourcing remained unclear Tuesday.
In the end, council members agreed that the risks of repeating a series of high-profile failures in 911 responses were too great. By one recent analysis, the District lacked ambulance coverage about 15 percent of the day, when every on-duty unit was busy responding to a call. That happened twice last month, when young children were experiencing medical emergencies. Both were hoisted onto fire trucks and driven to get medical attention.
Council member Charles Allen (D-Ward 6) cast the vote as a referendum on the city’s ability to handle its basic responsibility to provide emergency response.
“Do we believe there is an emergency to take this action? Because this is a big deal,” Allen said. “I think the events that we’ve seen, the challenges that we’ve seen, there is an emergency.”
Council members Mary M. Cheh (D-Ward 3) and Elissa Silverman (I-At Large) were the most outspoken critics of the proposal, saying it lacked safeguards for cost, evaluation and to ensure it would be a temporary fix.
Cheh succeeded in adding requirements for the department to study how it could eventually take responsibility for every ambulance transport.
Pushing the administration to keep the plan a temporary fix appeared to be the consensus of the council, but Cheh said it would be up to lawmakers to keep the pressure on to accomplish that.
The council vote, just one week after Bowser (D) presented it to the panel, marked a swift victory for Dean.
The plan is based heavily on a third-party system that has been utilized for decades in Seattle, where Dean worked for 30 years.
Kenny Stuart, president of Seattle Firefighters Union Local 27, described in an interview a “robust” system where the closest basic-life-support units attempt to arrive within three minutes from dispatch. Upon arrival, the fire department personnel makes the call on whether a patient needs serious care, or if a private ambulance can be called to handle a less serious situation.
“We get to direct patient care and we get to decide what happens to them,” he said. “The primary goal is patient care and service and it’s worked well for us.”
Administration officials say the proposed system would differ from Seattle in that the District would continue to bill residents for private usage rather than vendors sending them bills. Ambulance transport fees are set by regulation.
A basic-life-support ride, which the private company will handle under the new plan, costs $428; advanced life support, which the District’s EMS will continue to manage, can cost either $508 or $735, based on the level of care given. All rides are subject to a $6.55 per mile charge.
The fire department’s book-keeping on those transports offers some clues as to the possible cost to the city; many who were billed for basic transports were never required to pay because of low-
income exemptions or Medicare or Medicaid eligibility. The District billed $16.3 million last year in those transports, but collected only $7.2 million.
Although those costs have been absorbed in the department’s budget, they offer an estimate of the bill the District might face for outsourcing the work.
But the partial privatization could help the city address what many within the fire department term its “frequent fliers,” or those who call 911 repeatedly for low-priority or questionable service.
Last year, 590 patients, or fewer than 1 percent of the people who called 911, accounted for 12,895 transports to emergency rooms — 12 percent of all hospital runs by D.C. ambulances.
As of late last month, the lengthy drop-off time at crowded D.C. hospitals kept city ambulances off the road an average of more than 170 hours a day.
In a hearing last week, Dean called that unacceptable.
“To date, status quo has continued to have us finding ourselves out of resources, out of vehicles and patience waiting for service,” he said.
Judiciary Committee Chairman Kenyan McDuffie (D-Ward 5) also included more requirements for Dean to be transparent with how the privatization is working, but said Dean’s plan must be given a chance.
“I want to let the chief be the chief,” he said.