AMR and Las Vegas Fire

AMR and Las Vegas Fire

Sep 10, 2014

For today’s post I was going to share my thoughts about the ongoing fight between American Medical Response and the Las Vegas Fire Department.  Some might say that with the Las Vegas City Council’s approval of the 5 year contract between the two, the “fight” was resolved.  Then, I read the editorial by Glenn Cook that I am going to share below.  There are certainly some alarming constraints that any ambulance provider opting into this deal will have to deal with, including what some may consider a gag order when it comes to speaking with the media.

What could Las Vegas Fire and their chief William McDonald be so afraid of that would make them add this stipulation to the contract?  Ultimately, AMR did what they had to in order to keep their doors open for their 450 employees and their company.  I still feel that this move is more about generating income for the city and the fire department.  I have plenty more that I could say about this but I will defer today’s post to Glenn Cook and his editorial titled “City to AMR: Shut up and drive.”

This is what defeat looks like.


This is what happens when a business, trampled by government yet still dependent on government approval to operate, dares to defend itself and alert the taxpaying public to obvious wrongs. This is what happens when city functionaries decide to expand their empire, regardless of cost, regardless of harm.


Wednesday’s Las Vegas City Council meeting was all about a proposed downtown soccer stadium. But amid the sports circus, the council presided over another significant action, one that officially killed the city’s dual-response medical transport system.


Private ambulance business American Medical Response fought the Fire Department, and the Fire Department won.


Earlier this year, Fire Chief Willie McDonald put his boot on the neck of AMR, which had been paying Las Vegas nearly $400,000 per year to handle most patient transports within city limits. He ordered his paramedic units to drive more patients to hospitals, so that the city could boost its bleeding general fund with transport fees. McDonald also cut off AMR from emergency communications and put the company’s paramedics on perpetual stand-by: We’ll call you if we need you.


Under the dual-response system, a paramedic unit from the Fire Department and an AMR ambulance responded to medical emergencies, ensuring the fastest possible assistance. AMR handled about 75 percent of the patient transports, for which it collected insurance, Medicare or Medicaid reimbursement — or, sometimes, nothing at all. The company did the job with no subsidies from city taxpayers.


But McDonald’s power play had immediate ramifications for public safety. AMR units weren’t dispatched to calls when their units were closer to emergencies than Fire Department units, and AMR response times lagged because the Fire Department waited so long to get AMR units moving. Meanwhile, the Fire Department began cherry-picking calls from higher-income ZIP codes, increasing the likelihood of reimbursement, while routing AMR to low-income neighborhoods where patients were less likely to have insurance.


AMR was open with the public about the problems it faced in doing its job. The Fire Department responded by blocking public access to dispatch information and taking even more of AMR’s business. McDonald pursued his goal of handling 75 percent of patient transports by September 2015.


Then the feud went surprisingly silent for much of the summer. And last month, the city announced AMR had settled on the terms of its surrender. The new contract has the Fire Department responding to serious emergencies and AMR handling less serious calls for help. The city will handle between 60 and 65 percent of transports, not 75 percent. AMR units will regain access to communications and dispatch information. Effective next year, dual response is dead.


But the city wanted much more than revenue. It wanted to put AMR in its place. AMR’s deal is nonexclusive, so the city might allow another company to further cut into AMR’s shrinking business. And the city wanted a guarantee that when the new transport system goes sideways — and you can bet that it will — AMR won’t tattle to taxpayers.


The language is found on page 37 of the contract, under section 29: “Cooperation and support.”


“During the term of this Franchise, the City and the Franchisee shall cooperate and support each other to advance the emergency medical services system with in the City.” The obvious threat is backed up in the next two paragraphs.


First, AMR is required to notify the city if it lobbies for any legislation or regulation that could affect the Fire Department’s medical transport business. If the city doesn’t support AMR’s policy goals, the city can order AMR to stop the campaign.


Then this: “All media contacts and communications regarding the City of Las Vegas 911 Dispatched Ambulance Services and the City of Las Vegas integrated community programs shall be coordinated through the LVFR public information officer. No comments, information or communications shall occur except through this process, and a failure by Franchisee to comply will be considered a breach of the Franchise, which could result in revocation.”


“Cooperation and support”? More like “Shut up and like it.”


Talk about conquest. That language would make the Huns proud.


Can we count on the city to come clean with the public when Fire Department response times and city costs rise? Not likely. But it’s a predictable outcome, considering the city has far fewer, far more expensive ambulances than AMR, and the fact that city firefighters are paid significantly more than AMR paramedics. It’s just a matter of time before the City Council spends millions more dollars on more firefighters and more equipment.


And so a taxpaying business that employs hundreds of taxpaying residents is shoved aside. Never mind the question I asked back in May: Why is a city that spends more than it takes in even offering a service that is capably handled by the private sector?


This is what defeat looks like.


Glenn Cook ( is the Las Vegas Review-Journal’s senior editorial writer. Follow him on Twitter: @Glenn_CookNV. Listen to him Mondays at 4 p.m. on “Live and Local with Kevin Wall” on KXNT News Radio, 100.5 FM, 840 AM.