Provider of Ambulance Service Slow to Respond in Texas

Joshua Hubbard, left, and Raylon Bryant check supplies in their ambulance. Rural/Metro, the ambulance contract provider for MedStar, has had a pattern of slow response in the past year.

When his 9-year-old son and a playmate were bitten by a dog Jan. 7, Darrell McNary recalls waiting for what seemed like 20 or more minutes for an ambulance to arrive at his north Fort Worth home near Alliance Airport.

The boys were eventually treated for their injuries, which were not life-threatening.

"I guess if it had been worse, we would have been in a situation," McNary said recently.

Records from the Area Metropolitan Ambulance Authority, also known as MedStar, indicate that the Rural/Metro ambulance actually arrived in a little more than 12 minutes, faster than McNary recalled but still in violation of its contract.

Slow response has been a pattern for the contract ambulance service in the past year, records indicate.

The company has been hit with $987,620 in penalties for the 12 months ending in February for failing to meet required response times. In February alone, the company was charged more than $180,000 in penalties by the ambulance authority, records show.

The violations have left officials questioning how to improve services -- and whether the company should be replaced.

"Whether other actions will be taken, I think that hasn't been determined yet," said Howard McMahan, the authority's board chairman.

"We are still working with the contractor to get the deficiency corrected. There has been an extended effort by the contractor, but it hasn't solved the problem yet."

Michael Collins, Rural/Metro division manager in Fort Worth, said the company is feeling the pinch of staffing shortages, population growth and the closing of the Osteopathic Medical Center of Texas.

"We do have a history of doing a very good job," Collins said. "We are having some challenges with staffing."

Rural/Metro, based in Scottsdale, Ariz., serves Fort Worth and 13 other cities under a $12 million contract with MedStar.

Under its contract with MedStar, Rural/Metro must meet required response times on 90 percent of calls, said Jack Eades, MedStar's executive director.

Compliance must occur each month in all five categories of response time, which are divided by priority. The most serious emergency is a Priority 1 call; McNary's call about a dog bite was considered a Priority 2 call.

If the company fails to meet the desired response times for three consecutive months, or in four months of a 12-month period, it is considered in default under the terms of the contract.

The company has 30 days to correct the problems or face termination of the contract, Eades said.

In a 12-month period ending in February, however, Rural/Metro failed to meet the required response times for four months -- from July to October, Eades said. The problems have continued sporadically since, he said.

"In October, we notified them that there was a default situation," Eades said. "They cured it in November, then in December they fell back into default. In January they cured it. In February they fell back into default."

Under the contract, the authority may hire another service if the company can't fix the problems in 30 days.

MedStar has already approved extending Rural/Metro's contract for another year beginning Aug. 1, but officials are considering revisions to future contracts with the company or some other provider, Eades said.

"That's certainly an issue to be addressed as to whether to change the amount of time before you would terminate the contract, or if there is some other way to remedy it before you have multiple defaults," Eades said.

Collins said the company has faced problems on several fronts. The closing of the osteopathic hospital caused ambulance crews to wait longer at other facilities to drop patients off at crowded emergency rooms.

Most of the problems, however, stem from staffing shortages caused in part by increasing competition for paramedics, Collins said.