Ambulance board's relationship with commissioner? It's complicated

Patrick Anderson | Argus Leader

Show Caption Hide Caption Anderson: Explaining ambulance response in Sioux Falls Reporter Patrick Anderson explains what happens when there is an emergency and no ambulance is available in Sioux Falls.

What happens when there's a call for help but every ambulance in the city is busy with another emergency?

Jeff Barth doesn't know, and that's a problem, he says.

Barth, a Minnehaha County commissioner who serves on the board that oversees Sioux Falls' 911 dispatch center, says he's frustrated with a lack of transparency.

When city health officials re-wrote the rules last fall on how paramedics respond to emergencies, Barth said he got the "run around" from everyone involved.

“They told us then, it was too complicated for us to understand,” Barth said. “Hell, I’m on the Metro Communications board.”

Now, Barth said it's time for a shake-up with the emergency medical board, which reviews policies for emergency response in the city.

His frustration was echoed this week by two city councilors, who said they also want a better explanation of how dispatchers and ambulances handle peak times when there are more emergencies than vehicles.

►Previously: City looks to limit use of backup ambulance services

City health officials refused to share details of the policy changes last fall with the media or elected officials, saying at the time that they were too complicated to explain.

One Tuesday, the head of Metro Communications, the city's 911 dispatch center, finally shared the policy with Argus Leader Media.

The policy lays out the game plan for dispatchers at times when all on-duty ambulances are busy.

Instead of dispatching a specific ambulance, every paramedic team on duty receives a so-called "980" call that alerts them to the need for assistance. Before last fall, dispatchers had to individually page paramedics to find a free ambulance.

The policy refers to these calls as "phantom" units.

The city's ambulance provider, Paramedics Plus, is on the clock from that moment on. If one of its units doesn't become available within 10 minutes, a call goes out to a neighboring service such as Brandon-based Med-Star.

Previously, firefighters arriving at a scene could call for help from a neighboring service instead of dispatchers.

The change does not affect the response time clock, said Justin Faber, quality assurance director for Metro Communications.

►Previously: Backup ambulance service lacks contract in Sioux Falls

“In our eyes, that clock has started for them,” Faber said.

Mark Postma, vice president of Paramedics Plus, did not respond to an interview request. An attorney for the company replied instead, warning media coverage of ambulance problems could hurt confidence in 911.

The lack of communication from city health officials since fall has helped fuel speculation and misinformation about ambulance response. Questions about the policy have been raised by everyone from bloggers to elected officials.

City Councilor Theresa Stehly said she’s asked to see the contracts in place with neighboring communities' ambulance services, as well as information about the profit margin and number of on-duty ambulances for Paramedics Plus.

“We are also told it is none of our business,” Stehly said.

Jill Franken, the city’s health director, defended Paramedics Plus' track record and said it’s been months since a city councilor reached out with concerns.

Councilor Pat Starr approached her with questions when the procedures were still in a trial stage. She said the department didn't share details because plans weren’t final.

“You have an idea that there is something that can be improved upon,” Franken said. “It’s not as straight and linear.”

Starr asked about the pilot program in October, and again asked for specifics during a January update to the City Council by the health department. He’s also sent emails asking about the fines paid by Paramedics Plus.

The department skirts his questions or gives excuses, Starr said.

“I always want to make sure the citizens of Sioux Falls are getting their best service available,” City Councilor Pat Starr said.

For the most dire of emergencies — priority-one calls — the ambulance company's monthly compliance rate hovers between 96 percent and 100 percent. The ambulance company has been fined $14,000 in the last year for showing up too late or not at all to emergencies.

After reading a copy of the policy provided to him by Argus Leader Media, Starr said the Council should have been involved in the approval process.

“The Council’s responsibilities to set policy is very explicit,” Starr said. “When different boards set policy for the city that needs to come before the Council.”

Not all city councilors agree. Councilor Michelle Erpenbach, who serves with Barth on the dispatch board, said she was satisfied leaving the matter to the health department and Paramedics Plus.

Barth doesn’t understand why emergency medical officials refused to share the policy for so long, or why they haven’t been more willing to talk about some of the practices used by Paramedics Plus.

“Let’s bring it out in the open,” Barth said. “And let the sun shine in.”

Ambulance oversight: Who's who

Paramedics Plus: A Texas-based paramedic company that won an exclusive contract in 2014 to provide ambulance service in Sioux Falls.

Metro Communications: The 911 emergency dispatch center for Sioux Falls and the surrounding area. It's governed by a five-member board of directors comprised of the mayor, city councilors and county commissioners.

Sioux Falls Health Department: The city department is responsible for choosing ambulance providers and monitoring quality assurance.

Regional Emergency Medical Services Authority (REMSA): A five-member volunteer board that works closely with the health department on reviewing and setting policy.

Med-Star: A Brandon-based competitor of Paramedics Plus that lost a 2014 bid to provide coverage in Sioux Falls.

►Read the policy for dispatching ambulances when all units are busy.