By Amy Silverman
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Fire crews that respond to medical emergencies in Apache Junction are staffed by at least one paramedic and an emergency medical technician. It's their duty to provide emergency treatment until the Southwest Ambulance arrives.
Southwest says that it's required to respond 90 percent of the time in 10 minutes or less. "Are we going to have 15-minute response times?" says Southwest spokesman Jim Hayden. "Yes. That's why it's not perfection."
But the population boom in Apache Junction could mean the situation will get worse. More and more people are being lured to the far east Valley city, tempted by lower housing costs, new golf courses in nearby Gold Canyon, and closer access to popular recreation areas. Also, a large number of elderly snowbirds, who are more likely to have medical complaints, live in the city's numerous mobile-home and RV parks.
Apache Junction Fire Department officials insist that part of the problem is that the two full-time ambulances provided by Southwest are not enough. The department recently applied for a state certificate to operate its own ambulance service, and to add at least one more rescue vehicle to the district.
The department also wants to keep an estimated $1.2 million in annual revenue that Southwest now gets for transporting patients in Apache Junction. "Those monies don't come back to Apache Junction whatsoever," says Apache Junction Battalion Chief Jim Morgan. "They go back to a corporation in another city, so it does nothing to improve service delivery here."
Southwest maintains there is nothing wrong with its service delivery, and state EMS Bureau Director Stephen Hise agrees that Southwest is in "substantial compliance."
"I would expect absolutely anybody to fall short of the mark, if the mark is 100 percent," Hise says. "What's important is that there is some oversight of that system to make sure they're not falling short for reasons that are predictable and preventable."
But Apache Junction isn't the only fire department that's concerned with Southwest's service. Gilbert also wants to run its own ambulance service because of what it feels are inadequate response times by Southwest Ambulance.
He says the Rural/Metro-Southwest merger three years ago created a monopoly in ambulance service for Sun City. The result: The city had to make "quite a few concessions" in its most recent contract.
"In years past, we were always able to pit Rural/Metro against Southwest," he says. "Now that they've let them merge, there's no competition." As a result, Sun City has had to agree to the standard 10-minute response time for Code 3 calls; previously, the city had an eight-minute response time.
Glendale EMS Fire Chief Mike White also believes that Southwest is ruled by its profit margin. Asked about Southwest Ambulance's response times in his west Valley city, he says they're "getting better."
White says Southwest provided Glendale with more ambulances, but only because the city convinced the company it could make more money that way.
The state Auditor General's Office, in an audit commissioned by the Arizona Legislature, recently concluded that the state needs to change how it regulates ambulance services. The audit said that the current certification system "limits competition in the ambulance industry," creating "a barrier to other service providers wishing to enter the market."
The audit cites as an example Yuma's fire department, which eventually gave up applying for a certificate, citing the existing provider's opposition, the long and legally expensive application process and an overall lack of support from the state EMS bureau.
The audit also blasts the certification system for how it monitors ambulance response times. It's critical of the fact that ambulance companies are the ones solely responsible for submitting response times. It also accuses the state EMS Bureau of not consistently conducting analysis of the data.
But the Bureau's Stephen Hise says his agency is now working on an electronic ambulance reporting system, by which paramedics could use laptop computers to download response-time data to the state every month.
Meanwhile, Southwest Ambulance is turning up the heat on Apache Junction, demanding that the fire department reimburse more than $8,000 that Southwest says it's owed for lost revenue and legal fees for nine transports between November 1998 and February 1999.
The state Department of Health Services has also slapped Apache Junction with a cease and desist order because the fire department persists in taking people to the hospital. In effect, the state says, it's running its own unlicensed ambulance service. While the fire district appeals that order, it has already transported several patients to the hospital, claiming it had no choice because Southwest was running late.
Even though the department still plans to apply for the necessary certification to run its own ambulance service by the end of the year, paramedics and firefighters like Morgan and Gomez expect resistance from a state system that looks unfavorably upon competition--and that favors Southwest and Rural/Metro.
"They [Southwest] basically have a monopoly out here," Gomez says. "They're going to hinder us because they have the entire Pinal County area. I don't think that's right. I think the entire process is very restrictive.