When San Jose and Santa Clara entered the ambulance business in 2001, city officials declared the new service would be needed more than 400 times a year -- each time a county ambulance couldn't reach critically ill patients fast enough.
The cities spent more than $1.9 million to acquire 10 vehicles. But it's turned out that their ambulances are almost never used.
Since the service began 32 months ago, the city ambulances have transported just 23 patients -- an average of about one patient a year for each ambulance. One of San Jose's ambulances, bought for $151,550 and stationed in Almaden Valley since mid-2002, has never taken a patient to a hospital.
And one high-profile patient who was transported didn't need the city service at all. That was San Jose Mayor Ron Gonzales, who suffered a stroke while delivering his State of the City speech in January. He was taken to the hospital in a city ambulance even though a crew from Santa Clara County's ambulance contractor was standing by to transport him. A San Jose fire official ordered the county ambulance instead to create a diversion for the media.
While pitched as a way to improve critical medical care, the cities' ambulance initiative also was part of a broader effort by fire departments concerned that declining numbers of fire calls could lead to fewer firefighters. Today, even though the ambulances have been used only rarely, fire officials maintain the cost was justified for the lives that have been saved and as a back-up resource in case of a disaster.
In Santa Clara County, decisions on patient transport are more complicated than looking at which ambulance arrives at an emergency call first. The city ambulances are used sparingly because they must operate under a contract that gives the county's contractor, American Medical Response, the responsibility for local ambulance service -- assuming it can provide it quickly.
Since the cities put their ambulances into service, American Medical has arrived on almost every emergency call before the patient was ready to be taken to the hospital. Sometimes a city ambulance reaches the scene earlier, but once American Medical arrives, the city ambulance is not used. In most cases, a slight delay in an ambulance's arrival presents no problem because paramedics riding on fire engines provide the initial medical care.
The two cities established their ambulance business after a long -- and mostly unsuccessful -- political and legal battle with the county. The fire departments in San Jose and Santa Clara had tried to take over all ambulance service in their cities in the mid-1990s but were blocked by county officials seeking to preserve a regional ambulance system and by American Medical, which wanted to protect its business. The business is good: With each transport comes the right to charge a patient a fee that's now $839.
State law was on the county's side. So the cities in 2001 settled for a deal in which they could add a handful of ambulances for their fire departments to supplement the regional service, as long as the cities paid for them and opportunities for their use would be limited.
``I don't want to say that it's too restrictive, because I negotiated it. But it's too restrictive,'' said San Jose Fire Chief Jeff Clet, who led the department's entry into the ambulance business. ``It was a negotiated item because there was a fear on the part of AMR that we were putting these in place to replace them.''
Clet said that wasn't the city's interest.
``We wanted the ambulances in place to take sick people to the hospital when we needed them.''
Clet acknowledges he overestimated the need. But both he and Santa Clara Fire Chief Phil Kleinheinz say American Medical improved its response once the cities got into the business.
``Their service level came way up,'' Kleinheinz said. ``For every time they're not on the scene that we're transporting, that was revenue they wouldn't get, so obviously they wanted to protect their income stream as much as possible.''