Will Rochester get its own EMS after patient put on sidewalk by AMR ambulance?

When the public found out that a patient was forced to the sidewalk on Norton Street and left to collapse on the ground, it raised immediate concerns. "Flabbergasted" was the word Rochester Mayor Malik Evans used to describe his feelings.

A longer-term question swirled in the community, too: Would Rochester EMS serve residents better if it was run by the city and not a contractor?

In the incident that recently came to light, a Black Rochester man struggling to breathe was made to leave an ambulance in north-central on Nov. 30, not far from one of the city's "neighborhood service centers." EMT workers from contractor AMR claimed he was being unruly. In the video of the incident, the patient told them he was just trying to find air. What happened in the ambulance is not clear.

The man collapsed on the sidewalk and was left unaided for more than two minutes. He died in the hospital two weeks before Christmas, although the cause of death hasn't been shared.

The Rochester community has been doing soul searching since the tragedy was made public. Questions about services for citizens and about the contractor, under fire in some other parts of the nation, appear likely to persist.

AMR incident reaction: EMS 'under immense pressure'

After the incident, AMR contacted the New York State Department of Health Bureau of EMS and Trauma Systems and requested a formal investigation. The crew is on leave. AMR is not commenting on the Nov. 30 event.

"Emergency medical services nationwide remain under immense pressure from growing demand due to a lack of mental health and social services programs coupled with significant staffing shortages exacerbated by the pandemic," a spokesperson for American Medical Response said.

"There are lessons to be learned," Mayor Evans said at a Jan. 11 press conference. "Particularly to what types of medical services or ambulance services our community are experiencing."

What happens if you call for an ambulance in Rochester?

Suppose you live in Rochester and call 911 for an ambulance. Emergency help often is dispatched, but it's not a city crew that shows up.

A company called Rural Metro is the responder unless you specifically ask for another service, according to the city's official website. In 2015, Rural Metro merged with American Medical Response, a private national ambulance company owned by the private equity firm Kohlberg Kravis Roberts & Co.

"Our EMT partners at AMR do not report to me," Mayor Evans said. "They have a contract with us, and city council has to approve that contract."

The four-year contract expires Nov. 30.

Will Rochester keep AMR as ambulance contractor?

"You need an organization that's large enough to handle a city like Rochester, and AMR has been that partner," Barbara Pierce, the director of the city's communications.

City councilmember Stanley Martin says the council, city attorneys and the administration have had confidential meetings around the new AMR contract negotiations.

"We haven't yet seen a copy of what the new proposed contract includes," Martin said. "I believe the city should strongly consider investing in its own tax-funded municipal ambulatory service. Under these conditions, calling for reform is not enough.

"We know these systems cannot be reformed because we've tried for decades, and yet they keep killing us."

Why does the city outsource EMS in Rochester?

In 1981, the Omnibus Budget Reconciliation Act discontinued federal funding for EMS services, replacing it with block grants allocated to states for preventive health services. This transition resulted in the transfer of EMS responsibility from the federal to the state level.

Once states had more control over the funding, most spent the money in areas of need other than EMS.

Unlike the airline industry, where the FAA holds jurisdiction, no federal agency oversees ambulance services. Instead, each state has regulations that EMS services must follow to maintain compliance.

Dia Gainer has been the executive director of the National Association of State EMS Officials for 13 years and oversaw Idaho's EMS regulations for 19 years.

Gainer said states don't care whether the EMS services are public, private, faith-based or non-profit as long as they comply with the state's minimum requirements for vehicles, required medicine and sufficient staff to respond to calls 24/7.

Speaking on the choice jurisdictions make on EMS models, she said, "It could be the tendency of the city or town to privatize certain city services. The answer is not different in EMS than it is for any other city service."

• Rochester is one of many American municipalities that outsource EMS to private companies. Yonkers does.

• Cities with comparable populations to Rochester, such as Des Moines, Iowa, and Fayetteville, North Carolina, provide public EMS services through their fire departments.

• In larger cities like Philadelphia, public services and exclusive licensing for private options are combined.

When a city provides EMS and ambulance service, often within its fire-rescue operations, it hosts a large workforce, equipment, ongoing maintenance, fuel costs, billing services, and insurance. This is paid for by the taxpayers, just like other beneficial civic services like roads and schools.

By contracting out EMS services, municipalities sidestep the need to establish the infrastructure and manage the expenses of ambulance service maintenance. They also avoid the month-to-month responsibility for the equity and quality of the life-saving care supposedly being offered to a 911 caller. And they pay the company a hefty chunk of taxpayer dollars.

Which is better, public or private? Depends on your criteria

A National Library of Medicine report in the past could not find evidence that one way of handling EMS is better.

But the report dates back to 1998, before private equity firms started acquiring EMS companies as part of their portfolios. The trend gained momentum around 2008 when these companies anticipated President Barack Obama's health care policies would result in more insured Americans, meaning more customers.

The business strategy of numerous private equity firms might, at times, mean cutting expenses and increasing prices for customers, showing the conflict of balancing the need to generate profits against providing care for folks during life-threatening moments, according to national experts.

Are there enough EMTs?

The nationwide shortage of EMTs and paramedics also undermines the condition of private EMS companies.

"In comparison to other healthcare industries, EMS personnel pay is likely to be lower," Dia Gainer said. "If you need six people for the next 12 hours and one person calls in sick, you've just taken out 33 percent of your ambulances."

According to Gainer, a former paramedic who worked for 12 years in the suburbs of Philadelphia and Baltimore, pay is one of many reasons for the shortage.

"It's one of the toughest jobs in the world," Gainer said. "To interact with people during the worst moment in their life and distraught family members, at 2 a.m. when you haven't slept in 20 hours…it sucks the life out of you."

Research indicates that the likelihood of accidents and errors increases significantly among EMTs and paramedics when the workforce is not adequately rested.

The National Association of State EMS Officials developed fatigue risk management guidelines in response to the profession's challenges.

The guidelines resemble those that restrict an airline crew from operating for two consecutive flights without a specified period of rest in between. However, as there are no federal regulations governing Emergency Medical Services, it is the responsibility of each state to establish and enforce such guidelines.

EMS may not be a viable option for the upcoming generation of workers. "You could also say farming, fishing," Gainer said. People in the family have done it two or three generations and come to a realization that this is not healthy economically or personally."

Problems with AMR ambulance services

Nationally, AMR has received some criticism and complaints from DeKalb County, Georgia, to Northern California for employee behavior, massive surprise bills and slow response times.

AMR has been sued in San Mateo, California, for alleged sexual assaults. County officials in Portland, Oregon, launched an investigation into AMR over mounting public issues.

"AMR values its relationships with the communities we serve nationwide," a spokesperson for the company said. "We are acutely aware of the systemic challenges being faced by EMS providers. In an effort to address these challenges, AMR is actively engaged in making meaningful and significant investments in new and innovative programs."

In a city like Rochester, where AMR is the primary ambulance provider and has years of experience operating, it's challenging for a local government to end a contract without another trusted service ready to take its place.

City Councilmember Stanley Martin believes the Rochester community doesn't have to only consider privatization.

"At this juncture, all options have to be thoroughly considered," Martin said. "We must engage in the difficult yet necessary work of building new systems of care that recognize our humanity and support our existence."

'No real concern for him': Rochester patient left to collapse on sidewalk

"The community is in uproar," said Dr. Dwight Fowler, president of the United Christian Leadership Ministry and civil and human- rights organization.

Fowler hosted a press conference on Jan. 18 at First Church of God, where he serves as pastor, to condemn the behavior of AMR emergency medical technicians and Rochester police officers seen on video apparently failing to notice.

"The camera speaks for itself," Fowler said.

"There seemed to be no genuine concern for him, no sensitivity," he said. I'm 100 percent opposed to any paramedic, public or private, treating someone the way this person was treated."

The reverend compared the imagery to the Daniel Prude video, an incident where Rochester Police placed a spit hood on a Black man experiencing a mental health crisis. Prude died as a result of the encounter, and the memory is still fresh in the public mind.

"There are chilling similarities between the AMR incident and the killing of Daniel Prude," councilmember Stanley Martin said. "Especially as it relates to the role of RPD in abusing their power and hiding information from the public and the role of AMR staff in treating a patient with complete disregard and callousness."

Martin was at the front of the protest after the Prude incident before winning a seat on the city council.

"Nearly four years later, finding ourselves in a position where our first responders still devalue the life of a Black man is enraging and heartbreaking," she said.

AMR said it extends its deepest condolences to the patient's family.

— Robert Bell is a multimedia journalist and reporter at The Democrat & Chronicle. He was born in Rochester, grew up in Philadelphia and studied film in Los Angeles. Follow him at @byrobbell on X and @byrobbell on IG. Contact him at rlbell@gannett.com.

This article originally appeared on Rochester Democrat and Chronicle: AMR ambulance forces out Rochester NY man. Will city get its own EMS?