Hall Ambulance has overcome a lot in its nearly five decades of existence but the challenge it is facing now could be the most substantial in years
Kern County Emergency Medical Services, a division of the Kern County Department of Public Health Services, reported to county supervisors Tuesday on serious breaches of performance standards by Hall throughout much of 2017.
The county sets limits on how much time can pass between the moment an ambulance is dispatched to a call and the moment it arrives on scene to provide care to a patient.
In metropolitan areas of Bakersfield, for example, the ambulance has to be on scene in less than nine minutes.
If Hall Ambulance fails to meet those time limits in better than 90 percent of its calls then it is in violation of county standards.
This year the company violated those time standards in 39 distinct areas in five different geographical areas it serves through contracts with the county.
The county found it in breach of contract multiple times.
Hall spokesman Larry Moxley did not dispute the validity of the county report.
Hall’s Director of Media Services, Mark Corum, said the failures outlined in the report don’t represent Hall Ambulance’s historical performance.
“This is unacceptable for us and we apologize to the public,” he said.
Both men said Hall Ambulance has exerted dramatic effort in the past few months to rectify the situation.
And Kern County Public Health Director Matt Constantine said there have been clear signs of improvement.
But Hall still has a lot of work to do to get back in the county and the communities good graces.
Moxley said there were a number of reasons that Hall Ambulance has slipped from its previous high standards.
“These are not excuses. This is me trying to bring some empirical information to what is contained in the staff report,” he said.
One of the issues was data driven.
“We recognized this past year that we had a significant issue with how we collected, collated and reported our data,” Moxley said.
So Hall Ambulance has purchased new software that will pull and report real-time data about ambulance response times, Corum said.
But the biggest concern and complication, Moxley said, is the issue of ambulance wait times at all Kern County hospitals.
When an ambulance arrives at an emergency room the paramedic on board is required to wait with the patient until the hospital formally accepts the patient for care.
By state standards the maximum wait time should be 20 minutes.
But Hall ambulances have been held, cooling staff heels, for one, two or six hours at a time — sometimes more, Corum said.
When ambulances can’t be dispatched to calls, it makes it harder for other ambulances to make it to calls in the allowed time, Hall representatives said.
“This is a big hole in our system. It is dramatic in the impact on us,” Moxley said. “We can’t unload a patient and get patient care.”
Kern County Supervisors urged Hall and the county EMS Division to make changes needed to get a handle both on Hall’s non-compliance with county standards and the ER wait time issue.
“We have been very concerned about this issue,” Supervisor Leticia Perez said.
Supervisor David Couch thanked Hall for its history of excellence and the hard work the company does.
“I feel like Hall can address these issues. I have confidence in the company,” Supervisor Zack Scrivner said.
They asked Constantine about the steps being taken to address the issues and make sure the public is aware of these issues in the future.
Constantine said that Public Health will begin releasing ambulance compliance reports on a monthly basis — rather than annually as they have done in the past.
And the county is working to find a solution to the hospital wait time issue which Hall Ambulance owner Harvey Hall said was an example of hospitals using his ambulance crews to supplement their emergency room staff.
Assistant Public Health Director Brynn Carrigan said the county is working on a draft policy for the ambulance to be transferred to a hospital triage nurse so the ambulance can leave.
The county also is looking at allowing an EMT to stay with the patient while the ambulance returns to service.
Constantine said the county can’t just allow the ambulance crew to dump off the patient and head back out to the next call.
“The patient has to be protected,” he said. “But the county can explore ways to make it more efficient.”
Supervisors voted to simply receive and file the report on Hall Ambulance performance, though technically the company is in breach of its contracts.
One speaker, Attorney Becky Brooks, urged the board to reconsider its current ambulance ordinance which allows exclusive operational contracts for one ambulance service in different geographical regions of the county.
Having more than one ambulance company would ensure that patients could count on an ambulance being available to them in a life-and-death situation.
But supervisors didn’t seem ready to consider that option on Tuesday.
Carrigan said Kern County Public Health will continue to keep a close eye on Hall Ambulance performance, especially since it could take months for the company to dig itself out of its compliance situation.