‘Consent agenda’ was key to ‘hide’ MultCo-AMR contract renewal

PORTLAND, Ore. (KOIN) — In December 2016, the Multnomah County Board approved an updated Ambulance Service Plan that was originally written and approved in 1994. Then in 2017, the Health Department asked for ambulance providers to submit proposals. But when the bidding deadline closed in February 2018, only AMR submitted a proposal.

That indicates Multnomah County is not creating a competitive market for ambulance providers. And the county has not adjusted the staffing standard even as the quality of the system continues to decline.

The county could have dealt with AMR’s quality and rate issues in 2022. Though the original contract had a 5-year term, the county had the sole discretion to offer a renewal. However, this renewal offer needed to be presented to AMR at least 18 months before the initial term ended, which was before March 1, 2022.

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This leads to questions about the timing and process followed for the most recent contract renewal.

The first abnormality is that the board made the offer 17 days late. Then there was no hearing or contract review by the board. In fact, it was approved as part of the consent agenda.

A “consent agenda” groups routine meeting discussion points into a single agenda item. That allows the grouped items to be approved in one action, rather than filing multiple motions.

According to the county’s own administrative procedures, items for approval on the “consent agenda” are determined “routine by the Chair.”

The board passed 6 items in about 60 seconds. The “AMR Ambulance Contract Extension” was one of them.

“The consent agenda exists to take care of minor business,” said Commissioner Sharon Meieran. “The fact that renewal of the ambulance contract was done as a ‘consent agenda’ item is so bizarre as to suggest a conscious intent to hide this from the board. And it succeeded.”

In the recorded video of the meeting, then-Chair Deborah Kafoury called a vote. She, Jayapal and Stegmann voted Yes. Vega Pederson (then a Commissioner) had technical difficulties while in the meeting remotely, so her vote is unclear. Meieran was absent.

Regardless, the board’s failure to hold a hearing to review the extension may have been because of a misleading “agenda placement request.”

In the “background” section, it states:

“The County has a contract with American Medical Response for the provision of 911 emergency ambulance services. This contract was issued in September 2018 with an initial term of five years. Contractually, if AMR performance measures are met, an extension of an additional five years shall be issued. The contract is reviewed annually by the County’s Contract Compliance and Rate Regulation Committee (CCRRC) and AMR continues to be in good standing, with performance metrics met. The recommendation is for the five-year extension of the contract.”

Based on the language in the contract, it would have been more accurate to say:

“Contractually, if AMR performance measures are met, an extension of up to an additional five years may be issued.”

The recommendation was not clear about what options were available to the board regarding the extension of the contract. The board may have been led to believe the county was required to extend the contract with AMR for 5 years if AMR was deemed to have met the metrics in the contract.

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In retrospect, it might have been clearer had staff copied the language verbatim from the contract.

On Page 1 of the AMR contract states:

“If, at the sole judgment and discretion of County, the Provider is deemed to be substantially in compliance with the specifications defined in this AGREEMENT the County may grant extensions of the Agreement for up to five additional years. County shall make the offer of extension by formal written notice to the Contractor at least eighteen months prior to the scheduled end of the term of the Agreement.”

The recommendation to renew was based on 3 previous annual reviews. However, the county’s Ambulance Service Plan requires a “complete review” of the contractors performance prior to the contract renewal.

There is no record of such a review being conducted nor shared with the board.

The review should have taken place in January and February 2022 — to allow time for negotiations about any issues, like a national paramedic shortage.

This was perhaps the county’s last opportunity to negotiate on equal terms with AMR about staffing and rate concerns that were, or should have been, evident.

Instead, the contract renewal was swiftly approved on March 17, 2022 and by March 31 AMR was out of compliance with response times standards — and has been ever since.

On February 29, 2024, the Multnomah County Board of Commissioners voted to re-evaluate the Ambulance Service Plan — two years ahead of schedule.

Commissioners Sharon Meieran and Julia Brim-Edwards tried pressuring Multnomah County Chair Jessica Vega Pederson to act urgently on the spot in the Board meeting after they said their efforts were blocked from going through the normal channels.

However, after much debate, there weren’t enough votes to even consider it. Commissioners Jesse Beason, Lori Stegmann and Chair Vega Pederson voted it down.

The county continues formal mediation with AMR and will meet again during the week of April 8.

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