Rochester eyes new ambulance contract after AMR patient death

Rochester Mayor Malik Evans wants to extend the city’s contract with AMR ambulance for another two years.

“This is critical for us,” Deputy Mayor Michael Burns said in an interview.

“It gives the city certainty as to who's going to provide the service. It gives AMR certainty that they will be providing the service," he said. "And it really ... fosters a collaborative partnership with AMR.”

The amended agreement now goes to City Council for approval. And that is not going to be an easy sell.

City residents who call 911 are, by default, sent an ambulance from AMR, previously Rural/Metro. That has been the case for more than three decades, through a series of service agreements. The amended pact provides for continued, unsubsidized service. It would relax some of the city’s strict performance measures and response time penalties for less urgent calls. And as the focus shifts to overall performance across each city quadrant, rather than call-by-call enforcement, the administration plans to waive nearly $1.8 million in fines accrued by the national chain, American Medical Response.

“These per-call penalties haven't had any sort of positive impact on response time,” said Deputy Corporation Counsel Stephanie Prince. “They really haven't moved the needle.”

Critics are sure to question whether it goes far enough to address a critical failure last November, when AMR kicked Julian Coleman off an ambulance while en route to the hospital because the Rochester man panicked and allegedly became combative as he struggled to breathe. Coleman collapsed on the sidewalk and later died.

“We must get to the bottom of this,” Mayor Malik Evans said in January. “We must understand how and why this occurred. And we must identify processes and safeguards to ensure that this does not ever happen again.”

The city’s amended contract proposal includes a clause demanding equitable treatment for all — but with no penalties attached. The city would have to go to court arguing breach of contract, should a future incident occur.

Ultimately, officials said, the city had limited bargaining power as the contract came up for extension or renewal.

In a statement, the city quoted the American Ambulance Association and the Academy of International Mobile Healthcare Integration, stating that “more than 55 communities in the U.S. have lost their ambulance providers in the past two years.” Often, and in the case of AMR, that has involved rural areas and towns, not cities.

"There are increasingly limited service providers in this industry, and the costs of a municipality or any other government entity to start this up, are, are, are massive," said Dr. Jeremy Cushman, the city and county’s EMS medical director.

That hasn't stopped some, including Niagara and Erie counties from doing so . Erie County spent more than $4.5 million to launch service last year with an estimated $2 million annual operating budget, according to WGRZ-TV. AMR is facing criticism for its response times in Buffalo, where it is the sole operator and is not under contract.

"I don't want to get there," City Council President Miguel Meléndez said of not having a contract.

AMR's contract with the city of Rochester expires Nov. 30. The amendatory pact extends the term through 2026, and includes three optional renewals of two years each.

The administration planned to brief City Council members on the proposed contract terms Tuesday evening. Meléndez said he doesn't want the city to give away too much. He planned to take the week and go through the contract "line by line" — expecting to have a better idea come Monday on how to proceed.

In response to media questions, AMR issued a statement that it was committed to strengthening its relationship with the city and its residents, "and adopting a collaborative approach to tackle issues beyond the scope of ambulance services alone." That includes workforce development through its Earn While You Learn EMT Academy and other paramedic education programs.

AMR has begun paying not just tuition and books but also class and clinical time for new paramedics. This summer saw the first graduates of that effort. The 14 new paramedics, coupled with the addition of 16 EMTs in various stages of training, should push AMR's staffing levels to numbers not seen since 2019.

"If we were to be paying these penalties ... we would not have the ability to then put the additional dollars into actually solving the issues," said AMR regional director Tim Frost. "And again, without people, there is no improving services."

The challenges are not just ambulance staffing, but also rising operational costs, emergency room wait times, and increasing call volumes.

"It's one thing to be held accountable for things that you are in control of," Frost said. "It's another thing to be held accountable for complex systems and issues that are above and beyond your ability to control."

All this has dramatically altered the emergency healthcare market in recent years.

"Unfortunately, for many in our community, the only access to healthcare is through the 911 system,” Cushman said. “And so, as a result, we are seeing increasingly larger and larger numbers of what we call low-acuity calls for service.”

A majority of 911 calls do not require an ambulance right away, he said, adding that upwards of one in four are mental health related.

The future of EMS, Cushman continued, is finding how to meet the health care needs of those patients when an ambulance is not the answer. But starting up a municipal ambulance service is cost-prohibitive, he said.

The contract maintains certain compliance standards and data collection requirements. Deputy Mayor Burns pointed to AMR’s capacity, and ability to flex coverage with existing service in Buffalo and Syracuse, as reasons for staying with the national provider.

"To not have a contract,” Burns said, “really means a lack of control or a way ... to hold AMR accountable.”