Ambulance Chasers

Winning ambulance contracts? It's all about who you know. (Unless it's about the dirt they've got on you.)

And he had one big problem. For all his entrepreneurial skills, he knew how to build one thing -- ambulance companies. And he knew one area: greater Phoenix.

Rural/Metro had signed him to a non-compete agreement that applied specifically to ambulances. In Phoenix.

He wasn't entirely idle. On Ramsey's way out the door, Rural/Metro sold him rights to an ambulance company it had been planning to launch in Las Vegas.

So Ramsey built his Vegas operation. He made an unsuccessful attempt to enter the market in Contra Costa, California.

He bided his time.

When his non-compete agreement expired in 2002, Ramsey was free. Almost immediately, he started buying small ambulance companies in the Valley: American LifeStar, ComTrans, American Ambulance.

He could only get so much traction. The state keeps a tight rein on the ambulance market, and no company can operate without a very specific state-issued "certificate of need." And, like liquor licenses, a new certificate of need can be almost impossible to obtain.

So while Ramsey's new companies were licensed to transport patients from nursing homes to hospitals, they didn't have the right certificate to take 911 calls.

Ramsey plotted ways to get back in the 911 business. He wanted to partner with a municipality and get the certification through it, but the Arizona Department of Health Services refused to sign off on the idea.

At another point, he vowed to get 911 certification for American LifeStar, but the process proved too onerous even for Bob Ramsey.

"It's probably easier to fly to the moon," he says. "It's easier to buy companies."

This past January, Ramsey and Cantelme purchased PMT. Unlike Ramsey's previous purchases in the Valley, PMT had the proper 911 certification.

After almost five years of waiting, Bob Ramsey was back in the 911 business.

He had the license. (Finally.)

He had the will. (He'd proven that, from his days in Boys' Life to the three years he spent trying to reenter the 911 market here.)

He also had a business partner with enviable connections.

And that, of course, was Pat Cantelme.


When it comes to ambulance contracts, it's all about the people you know.

After all, you can't win the contract by promising cheaper rates. The rate is set by the state. In Maricopa County, it's $621, plus $12 a mile.

You can't win by promising to sweeten the deal, either.

Most "extras" that ambulance companies have attempted to offer have been deemed illegal under federal Medicare rules, since Medicare ultimately foots the bill for most ambulance trips and doesn't want to waste federal dollars to subsidize municipal coffers.

In the end, it comes down to a few key players in the city and whether they trust you.

There are the firefighters, because they have to work with the ambulance companies. (A fire truck usually arrives on the scene before an ambulance and administers first aid until the ambulance workers take over.) Even beyond that, their word is trusted as an important voice for safety.

City officials are key, too. Even though they often know nothing about the ambulance business, they make the ultimate decision as to which company is hired and for how long.

And when it comes to both firefighters and city officials in metropolitan Phoenix, no one could be better connected than Pat Cantelme.

He learned how to deal with one by fighting for the other.

When Cantelme was elected president of the union, back in 1978, firefighters earned 14 percent less than cops, and the Phoenix City Council was disinclined to change that.

And the council members could do that. Because they were all elected at-large, the council's main constituency was a cozy group called the Phoenix 40, the businessmen who ruled the town.

So Pat Cantelme changed the rules of the game: In 1982, he and his union pushed a citywide initiative to elect council members by district.

They were outspent by $340,000.

They won anyway.

That accomplished, they recruited candidates who could win.

The city's old guard never recovered. And the firefighters got their raise.

"Here was this young firebrand who had the audacity to think firefighters should make as much as police officers," recalls Billy Shields, a Cantelme lieutenant for years who himself became president of the United Phoenix Fire Fighters Association when Cantelme retired.

"He was taking on a city council hostile to unions, a power establishment hostile to unions," Shields says. "But he changed the way the government worked. And the world changed."

The old guard didn't give up without resistance.

Phoenix Police Chief Ruben Ortega went after Cantelme with a vengeance. His officers arrested Cantelme for conspiracy and distribution of cocaine just two weeks before the election to change the council system. (They dropped the charges almost immediately after the vote; turns out the only evidence was that one guy claimed to have witnessed Cantelme doing a few lines.)

And when Ortega's department sought to sting a host of politicians and players with bribes in a major operation called AzScam, Cantelme was one of the major targets. He was also one of the only guys who didn't take the bait.

The harder they fought him, the stronger he got.

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