Ambulance district is back from the breach
New manager Peter Sodhy steers turnaround for district after Exeter District Ambulance falls out of compliance with county contract
By Reggie Ellis @Reggie_SGN
EXETER – Exeter District Ambulance was one month away from losing its contract to provide ambulance service in Tulare County when a new manager was able to bring some much needed stability to the tax funded district.
On May 2, just one month after he was hired to serve as district manager, Peter Sodhy received a letter stating that Exeter District Ambulance (EDA) was in breach of its contract with the county.
The contract performance report for the first quarter of 2018, which details if Tulare County’s five ambulance providers are meeting their required response times, showed that EDA was in compliance for the month of January but out of compliance in February and March. Each ambulance provider in Tulare County is required to have their crews arrive within 10 minutes of being dispatched to a life threatening call at least 95% of the time. In January, EDA crews arrived within 10 minutes on 96.36% of their priority 1 and 2 calls. But in February and March, EDA was only able to meet the response time on 92.40% and 86.95% of its calls, respectively. EDA was the only provider that was out of compliance for any month in the first quarter.
Response times are tracked by the Central California Emergency Medical Services Agency (CCEMSA) which oversees contract compliance with ambulance providers in four Central Valley counties. Dale Dotson, an EMS coordinator with CCEMSA, said failure to meet the 95% benchmark in two consecutive months constituted a minor breach of contract. The real issue came in April, when EDA only met the response time on 91.39% of its calls. Dotson said failing to meet the performance standard in three straight months put the public ambulance district in major breach of its contract.
“We met with them and explained they were in jeopardy of losing their contract with the County,” Dotson said.
Dotson said EDA was given a probationary period to continue operating as long as it could meet the requirements each month through July. Any additional months where EDA was non-compliant would have resulted in a hearing before the Tulare County Board of Supervisors to determine if the contract with EDA should be dissolved. Last year, the Tulare County Board of Supervisors slightly amended its agreement with ambulance providers through 2024. Under the agreement, the county may suspend a contractor until their termination is effective if they are in breach of contract.
Dotson said that likely won’t happen now after EDA was able to bring its percent back into compliance in May by meeting the response time on 95.45% of its calls. While June numbers are not yet available, Dotson said preliminary data suggests that EDA will meet the performance standard for last month as well.
“They have improved dramatically since April,” Dotson said.
The turnaround in response times coincides with Sodhy’s hiring. Sodhy is the first permanent district manager since 2005 and EDA’s first non-EMS trained employee to take the reins of public ambulance district. He said previous managers all had strong EMS backgrounds but none had management experience, which meant they often prioritized field operations over management oversight. Sodhy said the first thing he did was to stabilize the administrative environment and made sure routine maintenance was being completed on the ambulance rigs, that the district’s web site (www.edaems.com) was restarted with meeting agendas and supporting documents, that employees had clear goals, and advanced scheduling. For example, Sodhy said shift schedules were set just two days prior under previous management but are now available through next July.
“There were giant holes in the level of administrative support,” Sodhy said. “If you have strong support for employees, I believe they will always succeed.”
Sodhy began holding monthly staff meetings where he set out clear goals for EMTs and paramedics and reiterated the basics of the district’s contract with the County which emphasizes the response time requirements. He was surprised to find that many of the employees did not fully understand the intricacies of Tulare County’s consolidated dispatch network and had never had conversations about how to improve within the structure of the system. He also asked each employee to evaluate how well he was doing his job.
“This gave them the ability to provide direct input on the work environment,” Sodhy said.
Sodhy also identified the biggest obstacles to EDA meeting its response times. As a special tax district EDA has additional requirements for record keeping and reporting that private entities do not. The ambulance district also services an area with the lowest call volume, half that of Dinuba Fire and Ambulance, which has the second lowest call volume. Sodhy is working on new ways to expand EDA’s call volume while still keeping its Exeter area focus.
“Sometimes it just takes a new set of eyes to see things differently,” Sodhy said.
The new outlook on management is not only improving response times but also the work environment. Sodhy said EDA is now fully staffed to operate three full-time rigs with nine full-time paramedics and nine full-time EMTs. The new schedule also allows the EMTs and paramedics who work well with one another to work together more often. The full time employees are backed up by five part time EMTs and paramedics bringing the district to a full staffing level in more than a year. Things have improved so much, Sodhy says there is now a waiting list to work at the district, something EDA hasn’t experienced for several years.
“Emotionally, we’ve had a complete turnaround from the board on down,” Sodhy said. “After years of kind of being a black spot in the community, everyone here is trying to turn this into a bright spot.”
Overall, Tulare County providers are meeting their response times for all calls in nearly every corner of the county except for two. In Zone 3, a rural area that primarily encompasses Three Rivers, providers only met their 20 minute response time for life threatening calls on half the calls in January, half in February and about two-thirds in March. On non-emergency calls, ambulances arrived within the 30 minute mark less than two-thirds of the time in January and about 87% in March.
Three Rivers is also home to Sodhy, who owns the Three Rivers Bed and Breakfast. Sodhy, formerly of ImagineU Interactive Children’s Museum and Pro-Youth HEART afterschool program, said things have been difficult for Three Rivers since it lost its volunteer ambulance service in 2010 but that he has plans to remedy some of this issues of providing advanced life support to patients prior to the arrival of an ambulance.
“I can’t really talk about it yet because we are still working on the details,” he said.
The only other zone that was out of compliance was Zone 12, which runs along the Tulare-Kern county boarder. In all, providers were only able to meet the 20 minute response time for that area 87.50% of the time on life threatening calls in January but met the mark on every call in February and March. In February, providers met the 30 minute mark for non-emergency calls half of the time but were able to respond within the timeframe on every non-emergency call in January and March.
John Cardona, an EMS specialist overseeing Tulare County for CCEMSA, said ambulance providers are fined $15 for every minute past the 10 minute mark and $100 when an ambulance arrives at the 20 minute mark. Those fines are then collected and placed in a holding account for the Health and Human Services Agency of each county. Providers are also charged $1,000 for every percentile they are below the 95% mark on calls and $500 for breach of contract. EDA was fined $950 for late response times for the first quarter and another $12,000 for dropping below the 95% standards for response times in February and March.