When an assault victim suffered a head injury in downtown Merced last Saturday morning, there were no ambulances immediately available. A Merced police officer who responded to the scene apparently was faced with an uneasy choice: Wait for an ambulance to arrive and provide appropriate care, or go ahead and transport the victim, right then and there.
The officer reportedly put the victim in the back seat of a patrol car, and drove to Mercy Medical Center.
In a news flash, the incident predictably made its way onto social media. The local Facebook community responded en masse.
“It should be our concern that there are only one or two ambulances that are serving the whole county!” one person posted. “You’re better off transporting yourself to the hospital.”
Another user tagged Merced Mayor Matt Serratto with the question: “Any information on WHY no ambulance was available locally?”
Riggs Ambulance — the county’s Emergency Medical Services (EMS) provider — posted on their own Facebook site to address concerns: “Unfortunately, our ambulances were tied up at a multi-casualty incident (MCI) in Atwater that resulted in those ambulances transporting patients out of the county as Merced County does not have a trauma center, causing Merced PD to have to transport the patient to Mercy ER.”
Nevertheless, that same morning, there were only four ambulances staffed with paramedics to cover the whole of Merced County, according to the company’s publicly posted schedule.
What should be a rare occurrence — no ambulances immediately available — has become more commonplace for local residents. Public safety officials say the wait time for paramedics to arrive on scene regularly exceeds 30 minutes, and at times approaches multiple hours.
Earlier this month, Merced Fire Chief Derek Parker sounded the alarm during a presentation to the Merced City Council on the need for more city-based EMS funding.
“There are reports of fire engines and police cars transporting patients around to hospitals within this county,” Parker told leaders. “It has happened in this community, as it has happened in other communities. That’s not right. This is not the direction that we need to be going. Patients and families are being directed to drive their own vehicles. This happens every day. We communicate via radio. We ask for an ETA, an estimated time of arrival for an ambulance, and that ambulance may be coming from Turlock, Chowchilla, Fresno, Modesto, Los Banos. It may not be coming from Merced or Atwater. People hear that, and they’ll say: ‘Why don’t I just take myself? Why don’t I take Timmy to the hospital myself. I don’t have to deal with this.’ … That happens every day. That’s not right.”
Workplace challenges
Merced County has been served by the same emergency medical services provider since 1948.
Originally owned by the local Riggs family, it is now run by Sierra Emergency Medical Services Alliance (SEMSA) based in Reno, Nevada. The company has a contract with Merced County to provide exclusive ground emergency medical services. That contract outlines strict criteria for the company. One of those criteria is the time it takes to arrive at the scene of an emergency. According to documents from the Merced County EMS Agency, Riggs has failed to reliably meet those requirements for the past two years.
When the coronavirus pandemic hit, Riggs appeared to suffer along with the rest of the business community. Former employee Stephanie Perez-Tovar said the frequency of calls overall dropped significantly. It seemed to her that individuals were more likely to weather their symptoms at home rather than risk exposure. Publicly available tax documents reveal that there was a sharp decrease of more than $4 million in the company’s program service revenue from 2019-20 to 2020-21.The impact was softened, however, by a PPP loan SEMSA received for more than $3 million dollars.
According to five other employees who spoke with the Times, Riggs has seen a significant drop in their available staff in recent years, resulting in a schedule frequently filled with vacancies, and a lack of ambulances on the road as a result. Fewer ambulances result in more frequent delays in response times. The state of emergency initiated by the pandemic was lifted at the end of February this year, but it would seem that Riggs never fully recovered. SEMSA Chief Operating Officer Carly Strong attributes staffing problems to the pandemic and accompanying issues.
Strong commented on these issues during a recent interview with ABC-30: “There was a huge reduction in interest in our industry at that time, and unfortunately with school closures such as paramedic schools, it takes about two years to recover from those being shut down and not producing any new employees into our workforce, no new paramedics, no new EMTs.”
However, there has not been a decline in certified EMS personnel as a result of the pandemic, according to the National Registry of Emergency Medical Technicians, the official registering body for EMS nationwide.
“I think the No. 1 issue facing EMS today is the workforce challenge – retention and distribution. Notice that I didn’t say shortage,” NREMT Executive Director Bill Seifarth said in May of this year during a discussion of challenges facing EMS. “Overall, the number of EMS clinicians the National Registry tests and certifies continues to increase year over year, and the number recertifying remains relatively constant.”
The NREMT stated that there are currently estimated to be 500,000 EMS clinicians, a significant increase from 400,000 in 2018.
Additionally, the Times could find no evidence of any paramedic school closures in this region.
Waiting for help to arrive
Local residents who experience unreasonable wait times might assume they were an exception, when in reality response times as documented by the Merced County EMS Agency show an increased frequency of delays.
Fire Chief Parker has been at the forefront of attempts to remedy the situation facing Merced County residents. He arrived at the department in January of 2021, and immediately recognized that there was a problem.
Merced County’s contract with Riggs states that Riggs is obligated to arrive on scene to high acuity 911 calls in high call density areas (such as Merced) within 10 minutes and 59 seconds. To remain in good standing they must respond in that time frame at least 90 percent of the time.
From April through June of this year, that number was under 70 percent.
“It’s super disappointing to me,” Parker said. “I’m an alumni of Riggs, and the Riggs today is not the Riggs that I grew up in.” While he was only able to speculate, Parker suggested many of Riggs’ current problems were a result of the company acting too frugally.
“It’s very much a numbers thing, in terms of running lean. Being cost effective does not work in emergency services,” Parker told the Times. “They’re the emergency provider for the whole county, and if you’re going to try and run it lean, that’s a recipe for disaster. That’s where we are.”
Parker said he looked at the explanations for delays provided by Riggs, and began to devise solutions. When Riggs said their ambulances were stuck waiting for beds to free up at the hospital, Merced City Fire made a plan to get patients transported home. When Riggs said there weren’t enough students coming from schools, Merced City Fire partnered with Merced College to start a paramedic program. With each move, the chief said, Riggs has failed to collaborate.
The fire department has access to funds to allow these actions, in part because they are a government agency, rather than a “not-for-profit” like Riggs. This might suggest they have an advantage over Riggs in their resources to address the current crisis, but according to Parker, the fire department attempted to share those same resources with Riggs, to no avail.
“I proposed that we operate in the city, and we support the system, and there was never even a response,” he said. “We said, ‘It looks like you’re short on units. We’ll capitalize the units, we’ll capitalize the equipment, we’d just need to use you as a staffing program.’”
The Merced Fire Department and Riggs appear to be increasingly at odds. During a recent Emergency Medical Care Committee meeting, Riggs Medical Director Dr. Eric Rudnick spoke against complaints being levied against the company.
“I hear a lot of concerns being raised, and I don’t hear a lot of suggestions being offered either,” Rudnick told the committee. “I hear a lot of people who are pointing out the problems, but not a whole lot of solutions coming.”
Chief Parker responded: “The Merced Fire Department has offered a lot of solutions. It’s the Merced Fire Department in coordination with Merced College that started the paramedic program. … Anybody from [Riggs] could have done the exact same thing, but that didn’t happen.”
Frustrated workers
The Times conversations with current and past employees at Riggs revealed feelings ranging from disappointment to just shy of outrage with regard to staffing levels and investment.
Perez-Tovar was an Emergency Medical Technician at Riggs for nearly six years. She left the company on positive terms in April to pursue another career. During her time with the company, she worked in the field as well as filling in for scheduling intermittently. While she maintains sympathy for the difficult choices Riggs management had to make during and after the pandemic, she nonetheless expressed frustration.
“We had all these plans, but nothing was ever executed,” Perez-Tovar said. “Covid happened what, three years ago? You can’t keep using that excuse. There has to be some sort of change.”
Perez-Tovar described confusion as a result of high management turnover, a lack of transparency, and what she perceived to be a disregard for current employees.
“Why aren’t we trying to maintain the people here?” she said. “It felt like there was no investment in the current employees.”
A paramedic who currently still works for Riggs also spoke with the Times, but requested to remain anonymous for fear of retaliation from the company. He painted an even bleaker picture.
“It’s been rough out there. If you look at the scheduling. … There’s only 25 percent of the people who need to be there,” he said. “It is scary to have family here. … I’ve had people with broken legs who have been sitting on the ground for 30 or 40 minutes.”
He described a company refusing to adapt to changing circumstances. “There’s a lot of internal complaints about how the system is being run, in that it feels very stagnant in changes. They’re still running the system as if we had 40 medics, but we don’t, so you’re stuck with the staff trying to fill those gaps. The work conditions are much, much harder.”
According to the source, EMS staff were not the only thing being run beyond reason. He shared that ambulances in varying states of disrepair were currently in use.
“We are out of ambulances,” he said. “Some have transmission issues. They’re having issues that typically would be sent to the shop, but they’re out there running right now.”
What’s next?
Merced County’s Request for Proposal process for a new EMS contract will begin by next year, with a selection made in 2025, according to Chief Parker.
At that time, other EMS companies will have the opportunity to submit a proposal to act as the provider for the county. It is unclear if Riggs intends to bid for the contract again in the future. During the recent EMCC meeting, it was confirmed that Riggs was currently in breach of contract and ineligible for the option of a five-year extension of their current contract.
The question of who would fill Riggs’ role in the instance that they could no longer fulfill their obligation to the county, or opted not to bid for a new contract, poses another daunting problem.
According to Chief Parker, Merced County is not an appealing region to many companies because of the amount of the population who are uninsured or covered by government programs such as Medicare and Medi-Cal.
The exception would be for a municipal service, such as a fire department, to be put in charge of running EMS. Parker shared that while the Merced Fire Department does not presently have the necessary resources to run EMS for the city, it is an option in their sights for the future.
