By Martin Espinoza
The Press Democrat
SONOMA COUNTY, Calif. 鈥� For more than two decades, AMR ambulances have dominated the streets and highways of Sonoma County鈥檚 urban core thanks to an exclusive contract worth tens of millions of dollars a year.
That dominance, at least in Sonoma County, ended late last month when local officials essentially dumped American Medical Response and awarded the lucrative contract to the rapidly growing Sonoma County Fire District, which promises a significantly lower ambulance transport cost for patients and insurance companies.
But AMR is not ready to bow out so easily.
On April 28, AMR, locally known as Sonoma Life Support, challenged the county鈥檚 decision through an official protest that alleges the county鈥檚 competitive bidding process was skewed in favor of the fire district, tainted by conflict of interest and conducted in a way that was inconsistent with the state constitution.
Key among AMR鈥檚 objections is that one of the people on the review committee had ties to a nonprofit that received a $10,000 donation from a rival ambulance company that is partnering with the fire district.
AMR also alleges the fire district improperly influenced the county鈥檚 decision through a media campaign that violated the bidding process 鈥済ag rule.鈥� The company also raised concerns that the fire district鈥檚 revenue plans may violate the state Constitution 鈥渂y imposing an illegal tax.鈥�
鈥淭here was a clear conflict of interest,鈥� said Jason Sorrick, an AMR spokesman. 鈥淚f that is not justification for throwing out their bid, I am not sure what is.鈥�
Earlier this week, the fire district fired back with a lengthy response to AMR鈥檚 protest, claiming it is 鈥渨ithout merit鈥� and that accusations of conflict of interest are 鈥渄emonstrably false and legally spurious.鈥�
鈥淲e stand by our response to AMR鈥檚 bid protest which clearly demonstrates that there is no problem and no disqualifying conflict,鈥� said Sonoma County Fire District Chief Mark Heine, in an email.
Heine played down AMR鈥檚 protest, saying there is no conflict over local ambulance services. He said there鈥檚 an established 鈥渁dministrative process鈥� to deal with AMR鈥檚 challenge.
鈥淭he county鈥檚 procurement process has an identified procedure for unsuccessful bidders to challenge the outcome,鈥� Heine said. 鈥淎ll of our emergency services agencies continue to provide excellent service while the county facilitates the protest period.鈥�
Still, the stakes are high in the battle for the right to operate ambulance and EMS dispatch services in central Sonoma County, with annual revenues projected at between roughly $25 million for AMR and $30 million for the fire district, according to their bid proposals.
In one corner is the country鈥檚 largest ambulance operator, which says it鈥檚 made huge investments in the county鈥檚 EMS system. And in the other is an ambitious new fire district that, through a series of consolidations since its formation in 2019, now covers Windsor, Rincon Valley, Bennett Valley, Bodega Bay, Guerneville and Forestville.
AMR鈥檚 protest is the latest chapter of the county鈥檚 ongoing dispute between public EMS providers, such as fire agencies, and private operators, each claiming the county鈥檚 contract has unfairly benefited the other.
In the past, the fire district has said the county鈥檚 requirements and criteria for scoring proposals favored established ambulance companies and disadvantaged newcomers. Now, AMR is essentially alleging that the latest bidding process favored the fire district and was rigged.
Conflict of interest?
Foremost among AMR鈥檚 objections to the county鈥檚 bidding process for the exclusive ambulance contract is the role of one of the members of the committee that reviewed proposals. In its April 28, 16-page protest letter, AMR holds that Amy Gnojek, a certified public accountant and EMS consultant, had a 鈥渄isqualifying conflict of interest that infected the entire RFP process.鈥�
Gnojek has ties to an organization called Women in Emergency Services, or WiES, which prior to the bid award received a $10,000 donation from a subcontractor in the fire district鈥檚 proposal. WiES鈥檚 website lists Gnojek as a 鈥渇ounding advisor.鈥�
鈥淎fter we got the results, we looked at who the reviewers were and realized, wow, that is a clear conflict of interest,鈥� said Sorrick, the AMR spokesman.
Sorrick said the fire district, in its bid proposal, indicated that it planned to partner with WiES, a nonprofit organization that supports women鈥檚 careers in emergency services. The fire district鈥檚 bid states that it will use WiES as a vehicle to 鈥渕atch mentees with experienced mentors,鈥� including the subcontractor.
Gnojek, reached via email Friday, said she has not seen AMR鈥檚 protest letter but has read what she described as 鈥渙ne-sided鈥� media coverage about the ambulance company鈥檚 objections.
Gnojek said she is a volunteer, unpaid advisor to WiES and has no financial interest in the organization. She said she does not have any control, influence or duties in or over the organization鈥檚 management or fundraising activities. And she rejected any suggestion that the timing of the donation was aimed at influencing her work on the committee.
鈥淚n fact, (the subcontractor鈥檚) contribution was self-pledged in January 2023 directly to WiES staff and paid in full in March 2023,鈥� Gnojek wrote in her email. 鈥淭he selection review committee heard presentations in April 2023, with all members of the review committee remaining anonymous to all respondents.鈥�
The fire district, in a 36-page response to AMR鈥檚 protest, outright dismisses the conflict of interest charge as speculative, 鈥渃ontrary to the facts, the law and common sense.鈥�
The fire district writes that its subcontractor, Medic Ambulance Service, never had any contact with Gnojek and that its representatives did not know Gnojek. They also didn鈥檛 know she was on the review committee until April 25, the day after the contract was awarded because the county never disclosed committee members鈥� identities.
鈥淢edic鈥檚 and (Sonoma County Fire District鈥檚) support of WiES reflects their commitment to and support of, women in the EMS and ambulance industry,鈥� the fire district鈥檚 response states. 鈥淎MR鈥檚 efforts to tarnish and trivialize the beliefs and efforts of WiES, Ms. Gnojek, Medic, and SCFD should be seen for what they are: a cynical attempt to preserve the status quo contrary to the values of Sonoma County communities.鈥�
Cost and compensation
The fire district鈥檚 response to AMR鈥檚 protest states that the private ambulance company failed to show it was 鈥渁ggrieved or prejudiced鈥� by any alleged procurement errors. The fire district argues that nothing in AMR鈥檚 protest changes the fact that the private ambulance company scored lower in the bidding process because it wanted to charge patients more than the fire district for the same service.
Citing figures in both proposals, the fire district said AMR proposed charging 鈥渁bout $1,200-$1,300 more for representative ambulance transports than SCFD.鈥� The fire district lists an ambulance rate of $3,100 vs AMR鈥檚 rate of $3,900 for advanced life support.
AMR鈥檚 Sorrick said the fire district achieves a lower rate by lowering compensation for ambulance operators. Sorrick pointed to a protest letter submitted by United EMS Workers Local 4911, which represents its local ambulance workers. The union argues that the fire district鈥檚 subcontract with Medic calls for wages and benefits that are lower than what it currently has in its collective bargaining agreement with AMR.
In response, the fire district holds that the union has no standing in the dispute and that its 鈥渕istaken belief鈥� that AMR鈥檚 compensation package is better than Medic鈥檚 is based on 鈥渕isleading numbers supplied by AMR in its proposal.鈥�
Exclusive or not?
Since 1991, the county has granted an exclusive contract for ground ambulance services covering a geographical area that includes Santa Rosa, Sebastopol, Rohnert Park, Cotati, and the surrounding unincorporated areas. The area includes about 250,000 residents, about half the county鈥檚 population.
AMR or one of its forerunners has had the contract since exclusivity was granted, winning renewals in 2000 and again in 2008. The 2008 agreement underwent a series of extensions in 2011, 2013, 2019 and 2022.
AMR contends, however, that the 2022 extension was negotiated in bad faith because the county violated the contract鈥檚 exclusivity by allowing the fire district to provide 鈥渂ackup, standby and/or mutual aid basis鈥� in AMR鈥檚 service area. The county made those arrangements as part of a settlement in an unrelated lawsuit with the fire district.
On March 29 of this year, AMR filed a lawsuit against the county alleging, among other things, that the settlement led the state to declare AMR鈥檚 operating area territory was no longer exclusive because the county had failed to conduct competitive bidding, a requirement for exclusive operating zones.
鈥淥ur position is that the agreement is invalid because they did not deal in good faith with us when we negotiated that (2022) extension,鈥� Sorrick said. 鈥淭hey did not have exclusivity, which is what we are contracting for.鈥�
Heine, in an emailed statement, pointed out that AMR鈥檚 lawsuit against the county does not name the fire district, or any other local, public fire agency.
鈥淚f the county and AMR cannot reach an out-of-court settlement, what I can say is we respect the judicial process and have confidence that the various issues of law and fact will be fairly adjudicated,鈥� Heine said.
AMR鈥檚 protest is currently under review by the county health services department, which through the Coastal Valleys EMS Agency oversees the local emergency medical services system.
On Friday, Tina Rivera, director of health services, said the county purchasing office, in its review, is following the 鈥渘ormal protest process.鈥�
鈥淥nce a decision has been made and a formal response is provided to AMR, we will make the appeal and response documents available to the public,鈥� Rivera said in an email.
鈥淲e have no other comment to make at this time other than to say that the county takes these matters very seriously and is committed to ensuring that this protest review, as well as the process for awarding this contract, is fair, complete and impartial,鈥� Rivera said.
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