If you need an ambulance and you're close to the Indio-La Quinta border near Highway 111, the time it takes to reach you, and the cost, could depend on which side of Jefferson Street you're on when you call.

On the west side of the street — in La Quinta — Riverside County EMS, which contracts its paramedic services with the private company American Medical Response Inc., responds to 911 calls. On the east side of the street — in Indio — the city's fire department sends its ambulances.

In La Quinta, ambulance passengers are charged more and, on average, wait longer for units to arrive than those in Indio. In an emergency situation, seconds and minutes can be a matter of life or death.

In the Coachella Valley, a patchwork of local fire departments, Cal Fire and private operators provide emergency response services. In Desert Hot Springs, Palm Springs, La Quinta and Coachella, ambulance services are provided by AMR. In Cathedral City, services are provided by the municipal fire department. In Indio, services are provided by the city's fire department, which is staffed by Cal Fire-Riverside County personnel. And in Rancho Mirage, Palm Desert and Indian Wells, Cal Fire-Riverside County jointly provides ambulance services.

Ambulance services are a hot-button issue in the valley's nine cities.

In Palm Springs, a city council member wants the city to provide its own ambulance services instead of using the county's privatized services.

In Cathedral City, a council member wants the city to consider outsourcing fire department-provided ambulance services to a private provider.

To make these cities more attractive to potential residents, Rancho Mirage, Palm Desert and Indian Wells reimburses residents for all emergency transport costs charged by their contracted ambulance operator, Cal Fire.

Indio subsidizes its ambulance costs to compete with its neighbors.

Coachella and La Quinta both use AMR, the county's emergency transport provider, and have the slowest average response times in the Coachella Valley.

To standardize data on the time it takes ambulances to respond to 911 calls, The Desert Sun analyzed the differences in ambulance service in Coachella Valley cities in 2018 by combining records from three service providers — Cathedral City Fire Department, AMR and Cal Fire — with call processing times from the county's primary dispatch center in Perris, as well as dispatch centers in Palm Springs and Cathedral City.

Partially because they employ different protocols, providers record and disclose their response times data in varying ways. Cal Fire often cites the average time its ambulances take to arrive on scene after leaving the station to describe emergency transport services to the public. And Riverside County EMS tracks the percent of 911 calls where the AMR ambulance takes longer than 10 minutes to arrive on scene and releases the information in compliance reports they require the company to submit quarterly.

Unlike fire department ambulances, AMR medics don't operate out of stations. AMR ambulances plant themselves at strategic locations, like parking lots, and are able to dispatch to calls without having to load ambulances, as fire department paramedics do. To compare AMR ambulance response times to other providers, The Desert Sun added data on the time it took fire department ambulances to leave their stations once a 911 call is assigned — many fire departments call this "turnout time."

Fire chiefs and AMR staff agree that geography and the type of call affect response times. They say tracking instances in which it takes providers dangerously long to respond paints a more accurate picture.

The Desert Sun calculated both average and 90th percentile response times, using the time it takes for ambulances to arrive on-scene once a 911 call is processed. The 90th percentile figures show how quickly ambulances respond nine out of 10 times.

The numbers reveal disparities among the cities. On average, AMR — the private operator that provides emergency transport in most of Riverside County — takes longer to respond to 911 calls than fire department ambulances.

In Desert Hot Springs, Palm Springs, La Quinta and Coachella — the four cities in AMR's jurisdiction — average response times are the slowest in the Coachella Valley. In Cathedral City, where the city fire department provides ambulance services, response times are the fastest among the nine Coachella Valley cities.

City officials from throughout the Coachella Valley looking to provide rapid emergency response services at a low cost said they are troubled by the disparities and the decades-old laws that strip some cities of local control.

La Quinta Mayor Linda Evans, who also works as chief strategy officer at Desert Care Network, said residents in her city haven't brought up many questions about the city's services, but added that local government officials and the public often struggle to understand the patchwork of different service providers throughout the region.

"Nothing's easy. The connection of these services can be complicated at times," she said. "AMR is the contracted 911-response entity for the county, but it works in conjunction with local agencies and the fire services. Then there are different Cal Fire departments that sometimes provide ambulances and sometimes don't. It's kind of like navigating healthcare and healthcare is complicated."

AMR and fire departments typically do not include the time it takes to process calls — from when the 911 operator starts inputting information, to when the medics dispatch. Not all agencies collect the same level of detail from 911 callers, but Palm Springs and Cathedral City process calls faster than other cities, which process calls from Cal Fire's Perris Command Center regardless of whether AMR or Cal Fire is their emergency transport provider.

The fragmented system of different providers dates back decades, to when California legislators passed the 1980 EMS Act. In order to reduce inefficiencies caused by communication breakdowns between providers, the law changed the state’s health and safety code to give counties exclusive rights to provide ambulance services.

But it provided for exceptions. Cities with pre-existing departments were grandfathered in and could continue operating autonomously. And cities operating jointly could retain local control as long as the county permitted them to do so.

AMR spokesman Jason Sorrick said comparing public and private ambulance providers side-by-side omits key information.

Comparing costs, he said, discounted how residents of cities with fire department-administered emergency transport were paying for ambulances through property taxes, some of which go toward funding pensions and retiree healthcare for the firefighters staffing ambulances.

Comparing response times, he said, doesn't account for instances in which AMR provides assistance out of their jurisdiction under the county's "mutual aid" policy. The policy requires providers to aid neighboring departments when call volume is high and all ambulances are dispatched. Cathedral City may have faster average response times than its neighbors who contract with AMR, Sorrick said, but AMR had to provide transport in Cathedral City 223 times in 2018, while Cathedral City only had to provide transport in AMR jurisdiction 43 times.

Riverside County's 2015 contract with AMR requires 90% of ambulance responses to be under 10 minutes in urban areas and under 60 minutes in rural and unincorporated areas. From 2016 to 2018, AMR consistently complied with the contract. The lowest compliance rate was in December 2016, when responders arrived on the scene within 10 minutes 91% of the time and the highest was in June 2018, when responders arrived on scene within 10 minutes 95% of the time.

Sorrick said throughout California, fire departments often juxtapose their ambulance travel times with AMR's, but leave out the time it takes for fire department medics to load into ambulances and leave their stations after 911 calls are processed, he said. Unlike fire department ambulance staff, AMR medics sit in their ambulances and wait to be dispatched on calls.

"A common tactic by fire departments is to compare their average to our contracted response time, which gives a false impression that they are performing better," he said.

In addition to the providers measuring response times differently, in California, the laws governing private and public ambulance service providers also differ. Unlike AMR, cities cannot use fees from services like emergency transport as revenue sources.

AMR, which is owned by the private equity firm Kohlberg Kravis Roberts, charges consumers more for emergency transport in the Coachella Valley than fire departments administering ambulance services. The company charges a base rate of $1,800 for emergency transport, while fire department base rates range from $1,200 to $1,464. AMR also charges more per-mile of transport and for things like oxygen, night calls and false alarm calls.

In Palm Springs, city council members supplement the county's services by staffing the fire department with extra paramedics who arrive on-scene in fire engines with AMR ambulances. Palm Springs City Manager David Ready said he thinks that because AMR is a for-profit company, meaning it has a fiduciary duty to its investors, their services cost more than publicly administered hospital transportation.

“It’s a business model versus a service model,” he said.

Mayor Pro Tem Geoff Kors said the extra staffing is worth the cost because emergency services are a major concern to Palm Springs residents. But he said he finds it unfair that the 1980 EMS Act doesn't apply to cities like Indio and Cathedral City, but forces Palm Springs to use Riverside County AMR for its emergency transport services.

“Our residents are overpaying for paramedics. They pay taxes to fund the Palm Springs Fire Department and then they pay AMR for private services," Kors said. "There are certain necessities government should provide without profit."

People in need of emergency transport in Indio pay the lowest base rate for ambulances at $1,200, almost $600 less than AMR Riverside County's base rate.

Indio Assistant City Manager Rob Rockwell said he believes using the fire department, which is staffed by Cal Fire-Riverside personnel, for emergency medical situations costs Indio more than contracting with AMR, but provides quicker response times. Indio, he said, subsidizes the costs of ambulances in order to compete with other Coachella Valley cities.

"City councils want ambulance rates that are somewhat marketable. The city of Indio doesn’t want to be the highest cost city in the valley so they take into consideration what the other fees are in the cities in order to make sure it's somewhat comparable," he said. "Our paramedic services get there a lot faster than what we believe AMR can do in our region."

In a Cathedral City council meeting earlier this year, Councilman Ernesto Gutierrez said Cathedral City should consider using AMR Riverside County to cut the costs incurred by the department providing emergency services and asked for a report on the fire department's performance.

Gutierrez said he isn't concerned with public services being privatized as long as it doesn't compromise quality, but he said he worried about the $10.7 million the city spends on its fire department annually.

“If we can get similar services and the city can save millions a year, it’ll be unbelievable what else we’re able to do for our residents,” he said in a recent interview with The Desert Sun.

Cathedral City Fire Chief Paul Wilson said some of the revenue from ambulance services helps fund other positions in the fire department and if the city switched to AMR, they'd have to cut staffing.

"We derive about $1.7 million a year from ambulance-related revenues," he said. "There aren’t sufficient funds to make up for the loss of revenues that come in from ambulance transport. If they eliminated ambulances today, there'd be a potential for seven to 12 firefighter-paramedics to be laid off."

Cities operating their emergency transport services autonomously like Cathedral City have the option to switch to county-provided ambulance services, but most cities do not control their emergency transport services, even if they're unsatisfied with the county's performance.

In recent years, state lawmakers have considered reforming the laws that govern emergency transport services. Counties have advocated removing the exceptions that allow cities to opt out of their emergency transport services. Cities and fire chiefs have advocated expanding the rights of local governments to provide their own services.

In 2011, then-Assemblyman Jose Solario, D-Santa Ana, authored AB 210, which proposed repealing sections of the 1980 EMS Act pertaining to emergency services jurisdiction. If passed, the bill would have stripped local governments of the ability to opt out of county-provided emergency transport services. The bill stalled before reaching the floor for a vote.

This year, state Sen. Bob Hertzberg, D-Van Nuys, has proposed SB 438, which, if passed, would prohibit emergency transport providers from contracting out their emergency dispatch to private providers.

The bill is backed by the state's firefighters' unions, which argues private dispatchers are not appropriately processing or routing calls. It's received support from cities that provide their own services and fire departments throughout the state.

"We're the ones who are accountable only to the public and the taxpayers we serve," California Professional Firefighters Union President Brian Rice said in a May Senate Health Committee hearing."Private entities are accountable to their owners and shareholders. This creates the potential for medical decisions based on cost or profit rather than the needs of patients."

The bill has garnered opposition from AMR and county governments. In late May, it passed on the Senate floor. It will next be heard in the state Assembly.

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Sam Metz covers politics. Reach him at samuel.metz@desertsun.com or on Twitter @metzsam.