Ambulance Chases

If you need anemergency medical vehicle, just hope you're in the right partof Maricopa County. If you're not, questionable dispatching practices could prove hazardous to your health.

At 8:30 on the evening of October 4, 1994, Rebecca haro, lead paramedic for Samaritan AmEvac, and her partner were parked in their ambulance near 83rd Avenue and Glendale. . A call came over the radio: A man had been injured in a fight just blocks away.

All 911 fire and ambulance calls in unincorporated areas of Maricopa County, such as the neighborhood they were parked in, are dispatched by Rural/Metro Corporation, the Scottsdale-based private fire department. Although Rural/Metro is supposed to send the closest appropriate ambulance, in this instance, the dispatcher sent a unit from AMT, an ambulance company owned by Rural/Metro.

Haro knew that ambulance would have to come from Sun City, a few miles to the northwest, and farther from the call than she was, and so she got on the radio to set the record straight.

"We advised Rural/Metro's dispatch what our location was, and they proceeded to tell us to disregard because they had a closer ambulance," Haro recalls. She didn't believe it.

"So we drove normal traffic-type driving--no lights, no siren, obeying the speed limits, not running red lights--and parked on the corner where the call was being dispatched to," she continues. "We advised their dispatch a couple of different times that 'we are here, we are close.' But we were told that there was this other ambulance responding."
Haro and her partner waited three to five minutes before the AMT ambulance arrived. They had a video camera with them, and so Haro's partner taped the event: With the dispatcher's voice in the background, the AMT ambulance--the one allegedly closest to the call--flashed by. A digital read-out on-screen logged the date and time.

Haro turned over the tape to an investigator for the Arizona Department of Health Services, the state agency that oversees ambulance operations.

Haro's video moment was not an isolated incident. The DHS investigator, William McDonald, had a growing file. McDonald spent the summer of 1994 looking into allegations that Rural/Metro was using its 911 authority to give itself an edge in the wildly competitive ambulance business--while gambling with the health of the heart-attack and auto-wreck victims to whom it was dispatching ambulances.

McDonald, a retired New York police captain, refused to speak to New Times, as did his superiors at DHS, all under the direct orders of the department's director, Dr. Jack Dillenberg.

But McDonald's investigation reports, obtained under the Arizona Public Records Law, speak for him. The reports allege that:

Rural/Metro frequently sent its own ambulances or those of its subsidiary, AMT (which has since been absorbed into the parent company), even when other ambulance companies had vehicles closer to the victim.

Rural/Metro dispatchers would sometimes "prealert" their paramedics. They would warn them over private radio frequencies that a call had come in to the dispatch center, giving paramedics time to get closer to the emergency location before the dispatcher would officially dispatch them over the open radio frequencies. Rural/Metro and AMT ambulances would misrepresent their true locations so that they would appear to be the closest unit to the call.

Rural/Metro would frequently respond outside of its own approved zones, putting its own profits above lifesaving, even in instances where profits were not endangered. This is in violation of Arizona statutes and DHS regulations. Rural/Metro's handling of 911 calls is based on little more than a handshake deal with the Maricopa County Sheriff's Office, with no contract formalizing what is and isn't proper and who bears responsibility--and liability--for any mistakes.

Since McDonald started asking questions, the Sheriff's Office has been scrambling to figure out the liability issues uncovered by that investigation, whether it wants to force Rural/Metro into a contract, train its own dispatchers or take its 911 business elsewhere.

If Rural/Metro were found guilty of McDonald's allegations, it could be fined or censured. But this being Arizona, the business state, the DHS investigation mysteriously dried up last January.The ambulance business as usual.

Within recent memory, the ambulance business was cutthroat, with companies racing each other to the scene of an accident to "scoop and run." Many ambulances carried credit-card machines so paramedics could demand payment before transporting the victim to the hospital.

Each ambulance company, private or municipal, operates within a DHS-prescribed-and-regulated zone called a CON, or Certificate of Necessity. But the various CONs overlap, and on-the-scene squabbles still occur.

To avoid such misunderstandings, some municipalities have entered into sole-provider contracts with ambulance operations. The City of Phoenix, for example, has an exclusive arrangement with its own fire department. Glendale contracts with Southwest Ambulance, and Scottsdale with Rural/Metro.

Most emergency and fire calls in the urban Phoenix area are routed through a centralized 911 system that automatically dispatches the closest fire truck or ambulance to your home, regardless of city boundaries.

Scottsdale fire and ambulance calls go directly from the Scottsdale police to Rural/Metro. Calls from anywhere else in the county, including all 911 calls placed from cellular phones, ring at the downtown Phoenix dispatch center of the Maricopa County Sheriff's Office. As soon as MCSO operators hear the words "fire" or "accident," they can hit a button that transfers the call to Rural/Metro's alarm room in Scottsdale.

Rural/Metro offered its 911 services to the Sheriff's Office back in August 1990 so that MCSO could concentrate on police work. Apparently, then-sheriff Tom Agnos jumped at the opportunity, because the deal was in place three days later. In a letter to the sheriff dated September 27, 1990, Rural/Metro vice president Robert Edwards wrote, "Effective August 10, 1990, Rural/Metro Fire Department relieved MCSO of the burden and began acting as County-wide dispatching control center for all fire and EMS activity throughout unincorporated areas of Maricopa County and/or any area served by MCSO, excluding fire districts under the dispatch authority of another agency."

The letter from Edwards was the only apparent record of the agreement between Rural/Metro and MCSO for nearly four years, and the current sheriff's administration was apparently unaware of the oversight until the DHS investigation. To date, no contract has been drawn up between Rural/Metro and MCSO. Between its Scottsdale and county responsibilities, Rural/Metro likes to boast that it handles 70,000 to 80,000 911 calls a year. And although those calls may be for fires or rattlesnakes in the backyard, one can assume that a healthy percentage is for emergency medical treatment.

With calls coming from unincorporated county areas, Rural/Metro is supposed to "take the responsibility for finding the closest appropriate agency to respond to all fire/ambulance-related situations, including those that fall outside of our current service area," as Edwards promised in his 1990 letter.

In reality, Rural/Metro executives and dispatchers make it clear to the other companies that it is the other companies' responsibility to monitor the radio broadcasts for 911 dispatches and inform Rural when they have ambulances closer than Rural's own.

"They tell us they don't know where our units are," says Bob Ramsey of Southwest Ambulance. "If it's in our area, they should call us."
In a report dated June 26, 1994, DHS investigator McDonald cited 14 instances between March 10 and June 10, 1994, in which Rural/Metro dispatchers had either sent their own ambulances to calls when other companies had closer units or had failed to notify closer paramedics that 911 calls had been received from their areas. Most of the incidents took place in the west Valley, but some were as far east as Mesa.

In August and September of that year, McDonald reported on further complaints, and, by October, in a letter to the Sheriff's Office, he referred to 20 incidents in which Rural/Metro had dispatched its own ambulances in the west Valley without consulting AmEvac to see if it had closer units.

Even though the 1990 letter from Rural/Metro had assured the sheriff that Rural would send the closest appropriate ambulance, McDonald wrote in his report, "Rural/Metro does not observe this practice, but instead places the burden on the competitive ambulance companies to notify Rural/Metro of the location of an available ambulance each time emergency call service is broadcast. Rural/Metro exacerbates the situation by occasionally 'prealerting' AMT and Rural/Metro fire/ambulance units on radio frequencies with certain 'PL' tones (designed in part to limit access to the transmissions) . . ."

Nor can any competitor be sure exactly how close Rural and AMT ambulances are to any given call.

"Additionally," McDonald wrote, "Rural/Metro does not always verify or announce on dispatch frequencies, the specific location of either responding or available AMT-Rural/Metro units. [ . . . ] It also made this investigation more difficult, as there was no written record of the location of the starting point for responding AMT and Rural/Metro units."
He cited specific examples: On May 14, 1994, according to McDonald's investigation, employees of AmEvac, which has since been bought out by Southwest Ambulance, were sitting in their station on Litchfield Road in the west Valley when an AMT ambulance screamed past the station, Code 3, with lights flashing and siren wailing.

Since it had to pass the station house, the AMT ambulance clearly was farther from the call than AmEvac. Yet there was no dispatch broadcast over the open radio frequencies so that AmEvac could state its own position. There was no record that the call had ever occurred.

Later, when McDonald questioned Rural/Metro executives about the incident, one of them quipped, "How do you know [the ambulance drivers] weren't going to McDonald's?"

"Code 3?" the investigator fired back.
On May 24, 1994, near Mesa, two Rural/Metro emergency vehicles passed a station owned by PMT, another private ambulance company, on their way to the home of an elderly man who had suffered a heart attack. PMT paramedics heard the call, and advised of their position, but they were told not to respond. There was another AMT ambulance closer--but it got lost. Rural/Metro dispatched one more of its own units as back-up, even though the PMT ambulances were miles closer.

(The PMT executive who filed complaints with DHS against Rural/Metro, Tom Melton, has since been hired by Rural/Metro.)

McDonald also listed a number of 911 irregularities in the tiny town of Wittmann, northwest of Phoenix on the way to Wickenburg.

Wittmann has no ambulance company, and relies on Rural/Metro ambulances 20 minutes away in Sun City. But Wittmann's volunteer fire department has trained paramedics, who are supposed to be the first response to medical emergencies in their town while waiting for the ambulances to come their considerable distance. Then, if the Rural/Metro ambulance transports the victim to the hospital, Rural collects the fee.

All 911 calls in Wittmann get routed to Rural/Metro's Scottsdale communications center by MCSO. Both agencies are then supposed to alert the Wittmann Fire Department, but frequently do not. Or, the Rural/Metro ambulances arrive at about the same time as the Wittmann paramedics, even though they are 20 minutes away, suggesting that Rural/Metro is sending the ambulance several minutes before calling Wittmann.

"We had a little 7-year-old boy that laid on the floor and convulsed for 15 to 20 minutes," says Sherri Morales, a paramedic for the Wittmann Fire Department. "We were never called on that.

"We had a gentleman who lived three houses from my home," she continues. "My mom and myself are both EMT-Ds, and we were both at home. We did not get the call. What we got was a call from AMT for a flight man, which means that when they get in the area, they want someone to meet them so they don't get lost. We could have been there in a minute and a half. Instead, he laid there 25 minutes and died."
Morales speculates that Rural/AMT insists on getting its ambulances on scene as soon as possible to make sure that the volunteer EMTs don't talk a patient out of going to the hospital.

Fred Killingbeck, a resident of Wittmann who also works as area coordinator for Emergency Services at St. Joseph's Hospital, thinks that the Wittmann interloping is a marketing tool.

"It makes it easier to sell your product if you say, 'Look, we've been the first on the scene in all these calls, we're better for your community,'" he says.

On November 28, 1994, McDonald and his supervisor, John Taska, sat down for an "informal interview" with Rural/Metro executives and a Rural/Metro attorney to discuss the particulars of the investigation.

A transcript of that meeting reads like a Monty Python sketch, with Steven Savage, the Rural executive in charge of ambulance operations, and Lawrence Rosenfeld, the attorney, answering questions with questions. Specifically, they asked which statute each of the alleged offenses had violated.

Then McDonald brought up a tape-recorded conversation in which a Rural/Metro dispatcher told a PMT executive that he was under no obligation to send any particular ambulance company to a call. In fact, the dispatcher is obliged to do so.

Savage responded, ". . . It would be easy for [the dispatcher] to be confused with the fact that the City of Tucson and the City of Phoenix and a lot of other municipalities are dispatching any units they want to within their service area.

"They are not necessarily dispatching what I think you call 'the closest, most appropriate agency' to calls. They are dispatching their agency within their jurisdiction, or what they call their dispatch jurisdiction."
The problem is, Rural/Metro is a for-profit corporation, not a municipal agency. It does receive state funding to maintain its 911 equipment: $12,213 in 1995 for logging recorders; $188,563 in 1993 to upgrade its system (not counting monies received for its Tucson and Yuma operations).

But when it comes to questioning Rural about facts and figures, it suddenly becomes a private entity, despite the public monies that keep it in business.

McDonald alludes in his report to the difficulties in getting firm data and straight answers from Rural officials. The other private ambulance companies are even more frustrated.

"My real problem comes in when you're kind of acting like a public agency," says Roy Ryals of Southwest Ambulance, "and you're taking that trusted public role and then turning it into a private agenda without any oversight. And then when someone wants to know about something, then that's 'proprietary, we're a private company.'

"If you're dialing 911, you have the right to get the most appropriate ambulance."
One Rural/Metro paramedic put it more bluntly."It's your fucking life they're gambling with," he says.

The last apparent filing on the DHS investigation into Rural dispatch policies was an inconsequential memo of January 23, 1995, from McDonald to his boss. Then the investigation just quietly went away.

Steven Savage, the Rural/Metro vice president in charge of ambulance operations, says that the charges were dropped because they were invalid.

"They looked into it for a period of time, and John Taska [McDonald's boss at DHS] sat down with myself and Larry Rosenfeld [the Rural attorney], who works with us, and dropped the whole issue," says Savage. "They found there was no substance."
However, when New Times first tried to obtain copies of the investigative reports, DHS refused to turn them over on the grounds that it was an open case.

And though John Taska of DHS refused to talk to New Times, following orders from the DHS director, he did fax a terse memo to the newspaper.

"Allegations against Rural/Metro were not dismissed and remain under Department review," it read. "This is the only comment we will make."
Rumors circulating among ambulance companies point to Rural's friends in high places, specifically Kurt Davis, who spent 18 months as executive assistant to Governor Fife Symington before returning to his old job as national director of public affairs for Rural/Metro.

Davis vehemently denies that he even knew about the investigation, let alone went to bat for his Rural/Metro friends to get it squelched.

Meanwhile, McDonald's investigation raised a quiet ruckus in the Sheriff's Office when it realized just how informal its 911 relationship was with Rural/Metro.

On December 9, 1994, MCSO sent a one-page agreement to Rural/Metro seeking to relieve the Sheriff's Office of any liability that might arise from Rural's dispatch operations and asking that Rural always dispatch the closest appropriate ambulance.

Rural/Metro never signed the document.
"I believe the reason it wasn't signed was that we were trying to clarify the responsibilities of this thing, more than the liability issue--especially with the Department of Health Services looking into it," says Steven Savage of Rural/Metro.MCSO deputy chief Tim Overton says that the liability and contract status has been referred to the county attorney for legal review. The County Attorney's Office would not comment.

"There's a whole bunch of questions that came out of the contract," says deputy chief Overton. "There's a whole lot of questions that came out of a meeting we had with the various fire departments in the Valley. One question begat another."
Among those questions are whether to keep Rural/Metro as a 911 dispatcher, whether to pass the job on to the Phoenix Fire Department (which has not yet been consulted) or whether to train MCSO dispatchers to handle the job.

In the meantime, move carefully through unincorporated Maricopa County. Don't have an accident. Save your heart attack for Phoenix or Glendale or Mesa. You never know where your next ambulance is coming from.

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