2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2358
1 BEFORE THE OFFICE OF ADMINISTRATIVE HEARINGS
2 IN THE MATTER OF: )
3 ) MARICOPA AMBULANCE, LLC, ) No. 2015A-EMS-0190-DHS
4 ) Applicant. )
5 ____________________________)
6
7 At: Phoenix, Arizona
8 Date: January 13, 2016
9
10
11
12 REPORTER'S TRANSCRIPT OF PROCEEDINGS
13
14 VOLUME 13 (Pages 2358 through 2655)
15
16
17
18
19
20 COASH & COASH, INC. Court Reporting, Video & Videoconferencing
21 1802 N. 7th Street, Phoenix, AZ 85006 602-258-1440 [email protected]
22 Prepared By:
23 JODY L. LENSCHOW, RMR, CRR Certified Reporter
24 Certificate No. 50192
25
COASH & COASH, INC. 602-258-1440 www.coashandcoash.com Phoenix, AZ
2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2359
1 INDEX TO EXAMINATIONS
2 WITNESS PAGE
3 JAMES WOLFE
4 DIRECT EXAMINATION BY MS. FICKBOHM 2375 CR0SS-EXAMINATION BY MR. BELANGER 2413
5 CROSS-EXAMINATION BY MR. RAY 2421 REDIRECT EXAMINATION BY MS. FICKBOHM 2430
6 JOHN VALENTINE
7 DIRECT EXAMINATION BY MS. FICKBOHM 2437
8 CROSS-EXAMINATION BY MR. BELANGER 2489 CROSS-EXAMINATION BY MR. RAY 2521
9 REDIRECT EXAMINATION BY MS. FICKBOHM 2530
10 GLENN KASPRZYK
11 DIRECT EXAMINATION BY MS. FICKBOHM 2534 CROSS-EXAMINATION BY MR. RAY 2571
12 REDIRECT EXAMINATION BY MS. FICKBOHM 2572
13 MARCO RIVERA, JR.
14 DIRECT EXAMINATION BY MR. ROSENFELD 2581 CROSS-EXAMINATION BY MR. BELANGER 2612
15 CROSS-EXAMINATION BY MR. RAY 2617
16 ITHAN YANOFSKY
17 DIRECT EXAMINATION BY MR. ROSENFELD 2620 CROSS-EXAMINATION BY MR. BELANGER 2623
18 KEVIN STOCK
19 DIRECT EXAMINATION BY MR. ROSENFELD 2626
20
21 INDEX TO EXHIBITS
22 NO. DESCRIPTION OFFERED ADMITTED
23 Exhibit AMR-2B Valentine Resume 2448 2448
24 Exhibit AMR-3R Defining and Improving 2559 2559
25 Quality at AMR
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2360
1 INDEX TO EXHIBITS CONTINUED
2 NO. DESCRIPTION OFFERED ADMITTED
3 Exhibit AMR-15 Glenn Kasprzyk Resume 2544 2544
4 Exhibit AMR-99 12/11/2015 First 2576 2577 Amended Complaint
5 Exhibit AMR-100 12/18/2015 Stipulated 2548 2548
6 Proposed Findings of Fact and Conclusions
7 of Law Made by Joint Applicants
8 Exhibit AMR-101 James Wolfe Resume 2382 2382
9 Exhibit AMR-102 Call Count 2/26/2015- 2389 2389
10 10/20/2015 all HonorHealth Scottsdale
11 Exhibit AMR-103 On Time Performance 2396 2396
12 2/26/2015-10/20/2015 all HonorHealth
13 Scottsdale
14 Exhibit AMR-104 On Time Performance 2398 2398 Report 2/26/15-
15 10/20/15 Deer Valley
16 Exhibit AMR-105 On Time Performance 2401 2401 2/26/15-10/20/15
17 John C. Lincoln
18 Exhibit AMR-106 On Time Performance 2402 2403 2/26/15-10/20/15
19 Scottsdale Osborn Medical Center
20 Exhibit AMR-107 On Time Performance 2404 2404
21 2/26/15-10/20/15 Scottsdale Shea
22 Medical Center
23 Exhibit AMR-108 On Time Performance 2405 2405 2/26/14-10/20/15
24 Scottsdale Thompson Peak
25
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2361
1 INDEX TO EXHIBITS CONTINUED
2 NO. DESCRIPTION OFFERED ADMITTED
3 Exhibit AMR-109 On Time Performance 2407 2407 2/26/15-10/20/15
4 Sonoran Health & Emergency Center
5 Exhibit AMR-110 Call Count 2/26/15- 2408 2408
6 10/20/15 all HonorHealth
7 Exhibit AMR-111 On Time Performance 2412 2412
8 2/26/15-10/20/15 all HonorHealth
9 Exhibit AMR-112 10/7/2013 E-mail from 2574 2575
10 Blackburn re Desktop Appraisal
11 Exhibit AMR-113 12/5/2013 E-mail from 2575 2576
12 Chandra re Wind down discussion
13 Exhibit AMR-114 ALJ Decision on 2549 2549
14 Transfer of CONs
15 Exhibit MA-203 Amended MA Exhibit 34 2515 2663
16 Exhibit RM-6 Marco Rivera, Jr. 2586 2586 Resume
17 Exhibit RM-9 Kevin Stock Resume 2629 2629
18 Exhibit RM-114 CON 66 (SWARA) 2603 2603
19 Response Time Compliance
20 (8/1/14-7/31/15)
21 Exhibit RM-115 CON 71 (PMT) Response 2605 2605 Time Compliance
22 (8/1/14-7/31/15)
23 Exhibit RM-116 CON 86 (SW Maricopa) 2607 2607 Response Time
24 Compliance (8/1/14-7/31/15)
25
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2362
1 INDEX TO EXHIBITS CONTINUED
2 NO. DESCRIPTION OFFERED ADMITTED
3 Exhibit RM-117 CON 109 (RM Maricopa) 2611 2611 Response Time
4 Compliance (8/1/14-7/31/15)
5 Exhibit RM-152 10/6/2016 E-mail from 2636 2636
6 Rudnick re Meeting with AHCCCS and
7 Ambulance Representatives re
8 Community Paramedicine
9 Exhibit RM-153 Excerpt from MA-38, 2635 2635 Pages 140 and 141
10 Exhibit RM-156 Central Arizona 2593 2593
11 Response Time Compliance
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2363
1 BE IT REMEMBERED that the above-entitled
2 and numbered matter came on regularly to be heard
3 before the Office of Administrative Hearings, 1400 West
4 Washington Street, Suite 101, Phoenix, Arizona,
5 commencing at 8:33 a.m. on the 13th day of January,
6 2016.
7
8 BEFORE: Administrative Law Judge Diane Mihalsky
9
10 For the Applicant:
11 COPPERSMITH BROCKELMAN, P.L.C.
12 Mr. James J. Belanger Mr. Scott M. Bennett
13 2800 N. Central Avenue Suite 1200
14 Phoenix, Arizona 85004 602-224-0999
15 [email protected] [email protected]
16
17 For Intervenor ABC:
18 (APPEARED TELEPHONICALLY)
19 MUNGER CHADWICK, P.L.C. Ms. Adriane J. Hofmeyr
20 333 N. Wilmot Suite 300
21 Tucson, Arizona 85711 520-721-1900
23
24
25
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1 APPEARANCES CONTINUED:
2 For Intervenor AMR Maricopa:
3 FLETCHER, STRUSE, FICKBOHM & MARVEL, PLC
4 Ms. Ronna L. Fickbohm 6750 N. Oracle Road
5 Tucson, Arizona 85704 520-575-5555
7 SHORALL McGOLDRICK BRINKMANN Mr. Paul J. McGoldrick
8 1232 E. Missouri Avenue Phoenix, Arizona 85014
9 602-230-5400 [email protected]
10
11 For Intervenor Rural/Metro:
12 SQUIRE PATTON BOGGS (US) LLP Mr. Lawrence J. Rosenfeld
13 One East Washington Street Suite 2700
14 Phoenix, Arizona 85004-2556 602-528-4000
16 For Arizona Department of Health Services, Bureau of
17 Emergency Medical Services and Trauma System:
18 OFFICE OF THE ATTORNEY GENERAL Education and Health Section
19 Ms. Laura T. Flores Mr. Kevin D. Ray
20 Assistant Attorneys General 1275 W. Washington Street
21 Phoenix, Arizona 85007-2926 602-542-8328
23
24
25
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2365
1 ALJ MIHALSKY: We're on the record. It
2 is now 8:33 a.m. on January 13th, 2016. This is the
3 further hearing in Case No. 2015A-EMS-0190-DHS that is
4 in the matter of Maricopa Ambulance, LLC, the
5 applicant. My name is Diane Mihalsky. I'm the
6 Administrative Law Judge who has been conducting the
7 hearing in this matter.
8 I'll allow the attorneys to make their
9 appearances for the record, starting with Ms. Hofmeyr,
10 who is appearing telephonically, and then on my left.
11 Go ahead, Ms. Hofmeyr.
12 MS. HOFMEYR: Good morning, Judge. This
13 is Adriane Hofmeyr representing Intervenor ABC
14 Ambulance.
15 ALJ MIHALSKY: Mr. Bennett.
16 MR. BENNETT: Good morning, Judge.
17 Scott Bennett and Jim Belanger, along with our
18 paralegal, Kim Derus, on behalf of Maricopa Ambulance.
19 MR. BELANGER: And Dennis Rowe from
20 Maricopa Ambulance is also present, Your Honor.
21 MR. RAY: Good morning, Judge. Kevin
22 Ray and Laura Flores on behalf of the Bureau, and here
23 today on behalf of the Bureau is Ithan Yanofsky, who is
24 the Deputy Bureau Chief.
25 MS. FICKBOHM: Good morning, Your Honor.
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1 Ronna Fickbohm and Paul McGoldrick on behalf of AMR of
2 Maricopa, Inc., and present and with us today are Glenn
3 Kasprzyk, John Valentine, and Jim Wolfe.
4 MR. ROSENFELD: Good morning, Your
5 Honor. Lawrence Rosenfeld representing the Rural/Metro
6 intervenors, and with me at counsel table is Corporate
7 Representative Marco Rivera.
8 ALJ MIHALSKY: Very good. When we last
9 met, which was before Christmas, we heard from
10 Mr. De Luca, and none of the other parties, I don't
11 believe, have cross-examined Mr. De Luca.
12 Mr. Belanger, where is -- and
13 Mr. Bennett.
14 MR. BELANGER: I believe the
15 cross-examination of Mr. De Luca is complete. Am I
16 misremembering?
17 ALJ MIHALSKY: Oh, well, I may have put
18 down the wrong notes.
19 MR. ROSENFELD: No, you're correct, Your
20 Honor. You're correct, Your Honor. It was reserved.
21 ALJ MIHALSKY: Okay, well, I didn't --
22 at least someone didn't cross-examine Mr. De Luca, and
23 I think that I left open the possibility of him
24 appearing telephonically for cross-examination.
25 MR. BENNETT: Oh. Well, that is our
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1 error. We did not remember that. So we had not
2 arranged for Mr. De Luca to be available.
3 MS. FICKBOHM: With regard to AMR, I
4 looked through his testimony and his report. He really
5 didn't say anything about AMR, so we don't intend any
6 cross-examination.
7 MR. ROSENFELD: And, Your Honor, in
8 light of my review of the testimony, I am waiving my
9 cross-examination as well.
10 ALJ MIHALSKY: Okay. Very good.
11 Mr. Ray.
12 MR. RAY: Well, Your Honor, we don't
13 have any questions for Mr. De Luca.
14 ALJ MIHALSKY: Mr. Belanger?
15 MR. BELANGER: Just in terms of all the
16 conversations regarding witnesses, I mean we've been
17 operating under the assumption that AMR was going to
18 start with its witnesses today. So it never even came
19 up in the conversation with the parties over the last
20 several weeks.
21 ALJ MIHALSKY: I wasn't a party to those
22 conversations.
23 MR. BELANGER: I understand, Your Honor.
24 ALJ MIHALSKY: So I rely on my notes,
25 which are sometimes accurate and sometimes aren't.
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1 So I just wanted to clarify that on the
2 record.
3 MR. ROSENFELD: Thank you.
4 ALJ MIHALSKY: And so that's been
5 clarified. So --
6 MS. HOFMEYR: Judge?
7 ALJ MIHALSKY: Ms. Hofmeyr. I'm sorry.
8 MS. HOFMEYR: I should probably weigh in
9 and say ABC also will not be cross-examining
10 Mr. De Luca.
11 ALJ MIHALSKY: Very good. My apologies
12 for overlooking you, because you aren't here to look
13 at.
14 MS. HOFMEYR: Well, I'm sorry I'm not
15 joining everybody today.
16 ALJ MIHALSKY: Well, remind me if I do
17 that again, and I'll try to be more careful.
18 MS. HOFMEYR: I will do. Thank you,
19 Judge.
20 ALJ MIHALSKY: Okay. In that case, I
21 guess the next thing we're going to do is start with
22 AMR's case-in-chief.
23 Are there any other preliminary matters
24 or things that came up during the break that need to be
25 addressed before we do that?
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1 MS. FICKBOHM: I don't think so.
2 MR. BELANGER: No.
3 MS. HOFMEYR: I do have one thing. I
4 don't know if everybody is raising their hands
5 currently.
6 ALJ MIHALSKY: Only you. Well, I mean
7 you're actually -- I don't know if you are or not, but
8 go ahead, Ms. Hofmeyr.
9 MS. HOFMEYR: Okay. So ABC doesn't plan
10 to put on a case-in-chief. We reserve the right, if
11 anything comes up in rebuttal, if we need to; but we're
12 probably not going to.
13 But I do have some exhibits. I've got
14 ABC 1 to 18 that at some point before everybody closes
15 up, I would like to move and to put into evidence. So,
16 Judge, I don't know if you want me to do that now, or
17 we can do it later. It doesn't really make any
18 difference to me.
19 ALJ MIHALSKY: Okay. What we'll do then
20 is I'll try to remember that. Remind me if I don't.
21 MS. HOFMEYR: Okay.
22 ALJ MIHALSKY: And the attorneys can
23 look at ABC 1 through 18 and decide whether they have
24 any objections to it, and I'm confident we'll address
25 that in not too -- too far away.
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1 MS. HOFMEYR: Okay. So that was my
2 first issue. And then my second issue is I don't -- if
3 you don't have any objections, I don't plan to sit in
4 telephonically on AMR's case or Rural/Metro's case.
5 ALJ MIHALSKY: Okay.
6 MS. HOFMEYR: But as soon as we get to
7 the point where the applicant is doing rebuttal, I
8 would like to join again. Now, I don't know how you
9 would like me to do that. Either I just keep checking
10 in periodically or maybe somebody could let me know
11 when that is about to happen, and then I can sign on
12 again.
13 ALJ MIHALSKY: I think we can do the
14 latter. As we go along, certainly before rebuttal,
15 I'll have someone in my office contact you.
16 Do you want to sit in on DHS's case?
17 MS. HOFMEYR: From all the e-mails that
18 have been going around, I didn't realize DHS was going
19 to be having enough time to put on evidence. My
20 understanding was that it was just going to be
21 Rural/Metro and AMR. Can anybody else comment on that?
22 ALJ MIHALSKY: Okay. Again, I wasn't a
23 party to these e-mails, so I did not know.
24 MS. HOFMEYR: Right.
25 ALJ MIHALSKY: Mr. Ray.
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1 MR. RAY: Good morning. DHS does not
2 plan on putting on any independent case.
3 ALJ MIHALSKY: Okay. And if that
4 changes, I'll also let you know about that,
5 Ms. Hofmeyr.
6 MS. HOFMEYR: That would be greatly
7 appreciated.
8 ALJ MIHALSKY: Okay. And since we're
9 starting with AMR, is it okay if I disconnect the phone
10 and wish you a good day?
11 MS. HOFMEYR: Yes, that would be
12 wonderful.
13 And, you know, Judge, also, if ever the
14 time comes that we're going to discuss scheduling, I
15 would appreciate being involved in that, because there
16 have been e-mails going around about -- on how we're
17 going to schedule posthearing briefs.
18 ALJ MIHALSKY: Okay. That discussion
19 probably will occur at the end of the presentation of
20 evidence. That's generally when it occurs.
21 MS. HOFMEYR: Great.
22 ALJ MIHALSKY: Because at that time
23 we're discussing what we're going to do with closing
24 argument or to do briefing in lieu of closing argument
25 and so forth.
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1 So certainly, you know, I believe that
2 Maricopa will present rebuttal evidence. And even if
3 they don't, we will bring you in, and I'll just have
4 my staff contact your office and give you the
5 information.
6 MS. HOFMEYR: Thank you, Judge. That
7 would be greatly appreciated.
8 ALJ MIHALSKY: Okay. Thank you very
9 much, Ms. Hofmeyr. I'm going to disconnect the phone
10 and wish you a good day.
11 MS. HOFMEYR: And to you. Thank you,
12 Judge.
13 ALJ MIHALSKY: Okay. Are we ready to
14 begin?
15 Mr. Rosenfeld.
16 MR. ROSENFELD: Your Honor, will you be
17 giving us access to the exhibits?
18 ALJ MIHALSKY: Oh, thank you so much. I
19 did remember yesterday to ask our webmaster to download
20 the exhibits, and it appears that's where we are.
21 And there's the exhibit list.
22 MS. FICKBOHM: This is looking kind of
23 weird.
24 MR. BELANGER: Yeah, it is.
25 MR. ROSENFELD: Yeah.
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1 MS. FICKBOHM: I'm just saying.
2 ALJ MIHALSKY: That is looking weird.
3 MR. RIVERA: I think if you launch the
4 document that says "Index," Your Honor, it should look
5 a little more familiar. It's the fourth one down.
6 ALJ MIHALSKY: Okay.
7 MS. FICKBOHM: That's okay. We can get
8 there from here.
9 MR. ROSENFELD: 47a.
10 ALJ MIHALSKY: Well, and I think,
11 yeah, you can -- that there's links set up that you can
12 go --
13 Oh, very good. That's looking
14 familiar.
15 MS. FICKBOHM: And I'm just checking to
16 make sure. I checked online, but I wanted to make sure
17 that this one has all of the --
18 ALJ MIHALSKY: I did check the most
19 recent changes that I put in. I checked those
20 yesterday to make sure, and they looked correct to me.
21 MS. FICKBOHM: Me too.
22 ALJ MIHALSKY: Okay.
23 MS. FICKBOHM: Okay, good to go.
24 ALJ MIHALSKY: We're good to go.
25 MS. FICKBOHM: You scared me with that
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1 first thing.
2 ALJ MIHALSKY: Oh. Well, I did review
3 my notes. Sadly, I didn't do anything else. I've been
4 busy doing lots of hearings. So, you know, that's kind
5 of what I rely on, and then back up with the court
6 reporter's transcript when it comes time for drafting.
7 Is AMR ready?
8 MS. FICKBOHM: Yes. We call James Wolfe
9 to the stand.
10 ALJ MIHALSKY: Mr. Wolfe.
11 (Mr. James Wolfe was duly sworn by the
12 Administrative Law Judge.)
13 ALJ MIHALSKY: Thank you. Could you
14 state your name for the record and spell your name for
15 the court reporter.
16 THE WITNESS: Yes, ma'am. My name is
17 James Wolfe, W-O-L-F-E; first name J-A-M-E-S.
18 ALJ MIHALSKY: Ms. Fickbohm?
19 MS. FICKBOHM: Thank you.
20
21 JAMES WOLFE,
22 called as a witness on behalf of Intervenor AMR herein,
23 having been previously duly sworn by the Administrative
24 Law Judge to speak the truth and nothing but the truth,
25 was examined and testified as follows:
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1 DIRECT EXAMINATION
2 BY MS. FICKBOHM:
3 Q. Mr. Wolfe, okay with you if I call you Jim?
4 A. Absolutely.
5 Q. Okay. Thanks. I know I'm going to slip up
6 and do that.
7 Can you tell the judge what your position
8 with the American Medical Response organization is?
9 A. Yes, ma'am. Your Honor, I work in the
10 official capacity of title of operations supervisor.
11 With that comes a multitude of responsibilities,
12 primarily in the communications and IT technology
13 fields, some oversight in the field operations. I do a
14 lot of reporting and analysis, kind of a
15 jack-of-all-trades, whatever needs to be done, really.
16 Q. When it comes to communications and
17 technology?
18 A. Yes, ma'am. I oversee communication centers,
19 the one here in Maricopa, one in Lake Havasu. I have
20 some insight and help with the operation in Prescott.
21 And I do some field tech work, repair, troubleshoot,
22 stuff like that.
23 Q. And with regard to the organization's
24 computer-aided dispatch software, what's your level of
25 proficiency and involvement?
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1 A. I've been on the system for seven years, I
2 mean since I've been with AMR. Pretty comfortable with
3 it, administration, building, the day-to-day
4 operational CAD that the dispatchers use for dispatch
5 purposes, the reporting sections. I'm pretty familiar
6 with them.
7 Q. So if someone needs data about operations in
8 Arizona, be they River Medical or AMR Maricopa, who's
9 the person that would be responsible for obtaining that
10 data?
11 A. Currently it's myself.
12 Q. And is that something you have been doing for
13 some time now?
14 A. Yes, pretty much my entire time with AMR.
15 Q. And then if my computer breaks and I'm over
16 at River Medical, who is the guy whose desk I put it
17 on?
18 A. Pretty much mine.
19 Q. So I would like you to talk for a minute
20 about how it is you got to where you are today. How
21 long have you been in the EMS industry?
22 And by EMS, just for purposes of the record,
23 we're referring to emergency medical services.
24 A. Yeah. 21 years in July.
25 Q. 21 years?
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1 A. Yes, ma'am.
2 Q. And how did you start?
3 A. Actually, I piqued an interest in the Army,
4 actually. They had a program called Combat Lifesavers
5 where we started with started basic IVs and
6 medications, wound treatment and stuff, and I enjoyed
7 it. So when I got out of the Army, I looked around,
8 and there was a Fire Department rural in Pennsylvania
9 where I came from that I started working with, went
10 through my first EMT class, and then onto a career in
11 public safety.
12 Q. So is that the -- is that Kuhl --
13 A. Kuhl's, yeah, that's it.
14 Q. -- Fire Department?
15 A. Yes, ma'am.
16 Q. And within that department itself, you
17 progressed from a basic firefighter level role to what?
18 A. The deputy chief the last three years.
19 ALJ MIHALSKY: And could you spell that
20 name?
21 THE WITNESS: It's K-U-H-L.
22 BY MS. FICKBOHM:
23 Q. And when did you leave the Kuhl Hose Fire
24 Department?
25 A. I left them when we moved to Arizona back in
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1 September of '06.
2 Q. And while you were working with that Fire
3 Department, did you have overlap work for another
4 company?
5 A. I did. Go ahead. I'm sorry.
6 Q. And can you tell us about that?
7 A. Yeah. EmergencyCare Ambulance in Erie,
8 Pennsylvania. It's a private ambulance in Erie
9 Pennsylvania; ALS, BLS, wheelchair, med taxi type
10 service. I started as an EMT on the street, and not
11 long after, got drawn into the communications center
12 with an opening there, and I kind of fell in love with
13 it.
14 The communications center for that company
15 did more than just emergent care. Emergent care, they
16 ran about 70,000, 100,000 calls a year, somewhere in
17 there, depending on the year, as they progressed. But
18 we also dispatched for two additional EMS agencies,
19 private companies. We dispatched for ten fire
20 departments, three police departments, and a medical
21 aircraft.
22 Q. So I want to back you up and just clarify or
23 elaborate on a couple of terms you've used.
24 When you say you did ALS, BLS, you're talking
25 about advanced life support, basic life support
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1 ambulance transports?
2 A. Yes, ma'am.
3 Q. And when you talk about working in
4 communications, is this just radio traffic back and
5 forth, or does it involve more than that?
6 A. Oh, there's more than that, especially that
7 we're a multi-agency dispatch center. There was
8 obviously the call-taking, the entry work.
9 Q. When you say entry work, what does that
10 mean?
11 A. Putting the call for service in, so talking
12 to the caller, entering the call, 911 system or even,
13 you know, interfacility work, enter the call
14 information, gather all the data that the units would
15 need to respond to the proper calls.
16 Q. So it did include data management?
17 A. Yes, ma'am.
18 Q. Report generation?
19 A. Yes, ma'am.
20 Q. When you left the Kuhl Fire Department from
21 your capacity as deputy fire chief, where did you go
22 next?
23 A. The Erie Police Department.
24 Q. Erie, Pennsylvania?
25 A. Yes, ma'am.
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1 Q. Okay. And what did you do there?
2 A. They had created a new position, quality
3 assurance and training coordinator over the civilian
4 communications department. So I went in and I assumed
5 that role. It was a brand-new position. Pretty much
6 to implement -- design and implement quality assurance
7 measures to promote customer service and responder
8 safety.
9 Q. Did that include data management also?
10 A. Oh, of course, yes.
11 Q. And then you moved to Arizona in 2006?
12 A. Yes.
13 Q. And can you tell us how you moved your EMS
14 career to Arizona?
15 A. I actually switched gears briefly and went
16 into the law enforcement side of the house and worked
17 as the communications supervisor for Glendale Police
18 Department here in Arizona.
19 Q. For how long?
20 A. Three years.
21 Q. And did that also involve data management and
22 reporting?
23 A. Yes.
24 Q. You have to wait for me to finish asking the
25 question --
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1 A. Okay. I'm sorry.
2 Q. -- and then you answer.
3 A. Yes, ma'am.
4 Q. Or Jody can't write it all down.
5 So your answer was?
6 A. Yes.
7 Q. Okay. Sorry.
8 A. No, I'm sorry.
9 Q. Deep breath.
10 And you left Glendale in 2009?
11 A. Yes.
12 Q. So what did you do when you left Glendale in
13 2009?
14 A. I started a career with AMR.
15 Q. And which brings us up to what we talked
16 about when you started testifying?
17 A. Yes, ma'am.
18 Q. Okay. Thank you, Jim.
19 MS. FICKBOHM: Your Honor, I --
20 BY MS. FICKBOHM:
21 Q. Oh, I've got up, Jim, on the computer screen
22 what's been marked as AMR Exhibit 101. You can take
23 the mouse and look at it, if you want, or you can see
24 there's a second page to that, also. Is this a summary
25 of your professional qualifications?
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1 A. Yes.
2 MS. FICKBOHM: Your Honor, I would move
3 for admission of Exhibit 101.
4 ALJ MIHALSKY: AMR Exhibit 101 --
5 MR. BELANGER: No objection.
6 ALJ MIHALSKY: -- is admitted.
7 BY MS. FICKBOHM:
8 Q. Jim, in your capacity as a communications
9 operator for AMR working in Arizona, you're familiar
10 with the certificate of necessity issued to American
11 Medical Response of Maricopa?
12 A. Yes.
13 Q. And I'm showing you what's already been
14 admitted into evidence as AMR Exhibit 18.
15 And can you -- we haven't had much
16 opportunity to talk about this yet, since you're the
17 first AMR witness, so could you explain to the judge
18 what response time and arrival time commitments
19 American Medical Response of Maricopa, Inc. is
20 responsible for adhering to vis-à-vis the Department of
21 Health Services' regulatory scheme?
22 A. So in No. 3 there, the response times and
23 arrivals, it talks about response times to not only
24 emergency calls for service, but also for interfacility
25 calls for service, and then any independent contract
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1 that would be developed between the entity agency and
2 AMR.
3 Q. So let's look at the emergency calls first.
4 When we reference the Sub a, 3.a section, when we
5 reference emergency calls, we're talking about,
6 basically, 911 system, correct?
7 A. Yes, ma'am.
8 Q. Okay. So what's AMR of Maricopa's commitment
9 to the Department of Health Services with regard to
10 responding to 911-generated calls?
11 A. Would be 10 minutes and zero seconds on
12 80 percent of all emergent 911 calls.
13 Q. That's responding?
14 A. Correct.
15 Q. From dispatch to on scene arrival?
16 A. From, actually, call saved in the CAD system
17 to on scene.
18 Q. And then what's the next criteria?
19 A. 15 minutes and zero seconds on 95 percent of
20 all emergency calls.
21 Q. And the third?
22 A. Would be 20 minutes and zero seconds on
23 99 percent of all emergency calls.
24 Q. And AMR of Maricopa also made a commitment to
25 the Department of Public Safety -- or Department of
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1 Health Safety with regard to contractual response
2 times, correct?
3 A. Yes.
4 Q. And what's the commitment there?
5 A. They would meet all contractual response time
6 negotiated with the client.
7 Q. And then with regard to non911 system calls
8 where a transport is going from one medical facility to
9 the other, which we refer to as IFT or interfacility,
10 what's the commitment there?
11 A. There's actually two criteria there. One
12 would be to arrive within 60 minutes of the requested
13 at-the-bedside pickup time 90 percent on all
14 nonemergent -- or, I'm sorry, excuse me, nonurgent
15 transfers; and 30 minutes of the requested bedside
16 pickup time on 90 percent of all urgent transfers.
17 Q. And can you just give an example, us an
18 example, of what a nonurgent transfer might be?
19 A. For us, I mean we have everything from an
20 abscess to a twisted ankle, a broken bone. Those would
21 all be nonurgent interfacilities.
22 Q. And give us an example of what an urgent
23 transfer would be.
24 A. The definition for urgent is actually in the
25 CON; I mean STEMIs, active STEMIs, strokes.
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1 Q. What's a STEMI?
2 Uh-oh.
3 A. Yeah, right. I don't know the actual
4 verbiage.
5 UNIDENTIFIED SPEAKER: ST elevation.
6 THE WITNESS: Yeah, it's an ST
7 elevation, myocardial infarction, heart attack. So --
8 BY MS. FICKBOHM:
9 Q. That I understand.
10 A. Right. A stroke, multisystem traumas.
11 Q. Stroke, heart attack?
12 A. Yeah.
13 Q. Gunshot?
14 A. And not even that. I mean if it was a
15 peripheral gunshot, it wouldn't meet that criteria. If
16 it was an arm or a leg or something like that, it
17 wouldn't meet that.
18 So anything where the patient is drastically
19 hemodynamically unstable, airway is not secure, things
20 that would be very high acuity, very need to get quick
21 type calls. But there is criteria in here that --
22 Q. Yeah, I'm sorry, I don't mean to quiz you.
23 On Page 3 of the exhibit, urgent transfers are actually
24 defined, correct?
25 A. Yes.
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1 Q. So there isn't any misunderstanding. Yeah, I
2 just was looking for an example.
3 A. Yep.
4 Q. And, I'm sorry, did I ask you to tell us the
5 arrival on urgent transfers commitment is within how
6 long what percentage of the time?
7 A. 30 minutes 90 percent of the time.
8 Q. Thank you.
9 MS. FICKBOHM: And this has already been
10 admitted into evidence, Your Honor.
11 BY MS. FICKBOHM:
12 Q. Jim, at your boss's request, did you prepare
13 and then check for accuracy some reports regarding AMR
14 of Maricopa's -- I've not used the word response. It's
15 arrival times vis-à-vis the CON parameters with regard
16 to calls unique to the HonorHealth system in Maricopa
17 County?
18 A. I was. Yeah, I was asked.
19 Q. Okay. And can you tell the judge how it is
20 you, out of all of the calls in AMR Maricopa's
21 computer-aided dispatch records system, you're able to
22 winnow out the ones that are unique to the HonorHealth
23 system?
24 A. Sure. In our CAD reporting there are various
25 selectors in each report that we pull. This report
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1 that's on the screen is a trip count by pickup
2 facility. So we would set the date range that was
3 required. Sorry. We would set the date range that was
4 required. We would also go in and use the selector of
5 facility. So each of our facilities is built in the
6 CAD system as a permanent place, and we would use the
7 selector to include the facilities that we were looking
8 for, for whatever reason or what I was asked to pull.
9 Q. So when we look at AMR Exhibit 102, this
10 shows us three HonorHealth facilities, all located in
11 the Scottsdale area, correct?
12 A. It does.
13 Q. And this shows us -- can you tell us what
14 we're looking at here with regard to the numbers?
15 A. Sure. At the top -- and I apologize, the
16 reporting, when it prints out these, leaves off the end
17 of it; but you can see the date range is listed there
18 at the top.
19 Q. You're talking about not the Trip Count line,
20 but the smaller print below it, you can only get two
21 lines printed on the report?
22 A. Yeah, that's all. When it converts over from
23 the reporting, it drops off the end of that.
24 Q. So we lost the end of "Thompson Peak Medical
25 Center"?
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1 A. Correct, correct.
2 Q. Okay. And we'll see bigger deletions on ones
3 where we have more verbiage?
4 A. That were longer, yeah.
5 Q. So tell us what we're looking at here.
6 A. This would be a trip count by pickup facility
7 and call type for HonorHealth Scottsdale Osborn,
8 HonorHealth Scottsdale Shea, and HonorHealth Thompson
9 Peak from the time period of February 26 to
10 October 20th.
11 Q. And then it lists calls broken down by ALS
12 and BLS?
13 A. Correct.
14 Q. Okay. And after you generate these reports
15 and find out that -- that, in fact, have been requested
16 of you, do you go back and you have some ways of
17 checking accuracy?
18 A. Sure. I'll typically run the pure data or
19 the initial data and forward it off, and then once
20 we're sure that this is what we want to go with and
21 use, I'll go back and I'll research and verify by a
22 couple of different reports, just to make sure
23 everything lines up and is accurate.
24 Q. And did you do that with this one?
25 A. I did.
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1 MS. FICKBOHM: Your Honor, I would move
2 for admission of Exhibit 102.
3 MR. BELANGER: No objection, Your Honor.
4 ALJ MIHALSKY: Exhibit AMR-102 is
5 admitted.
6 BY MS. FICKBOHM:
7 Q. Now, Exhibit 3, we're looking at this -- I'm
8 sorry, 103.
9 Thank you, Paul.
10 AMR Exhibit 103, we're looking at the same
11 three facilities, but this time we're not looking at
12 number of calls; we're looking at actual transports,
13 correct?
14 A. Correct.
15 Q. And, Jim --
16 A. Well, actually, I'm sorry.
17 Q. Sorry.
18 A. This would be -- it doesn't necessarily
19 reflect pure transports, because we could arrive at the
20 facility and be canceled on scene at that facility. So
21 it's times that we had a call for service where we
22 arrived on scene.
23 Q. Okay. So we've got three different measures.
24 Thank you for that correction. We've got three
25 different measures that we could be looking at. We
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1 could look at calls that come into the system, correct?
2 A. Correct.
3 MR. BELANGER: Your Honor, I understand
4 this is some preliminary stuff, but she's leading the
5 witness. She ought to ask him. This is leading
6 questions.
7 ALJ MIHALSKY: Okay.
8 MS. FICKBOHM: I'm just trying to
9 clarify the different things we're going to talk about.
10 It's a preliminary matter.
11 ALJ MIHALSKY: Overruled. I'll allow
12 it. But when it gets to the important, quit leading.
13 MS. FICKBOHM: Okay. Yeah, I don't
14 think I've been leading on the important stuff. This
15 is just preliminary stuff, Your Honor, so I'm mindful
16 of that. Thank you, though. I'll continue to be
17 mindful.
18 BY MS. FICKBOHM:
19 Q. Jim, when you have the category of calls
20 coming into AMR Maricopa, do all of those calls result
21 in an arrival on scene?
22 A. No.
23 Q. So those two numbers will be different?
24 A. Correct.
25 Q. And arrivals on scene, I think what you've
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1 just clarified for me, was that all arrivals on scene
2 don't equate with all transports?
3 A. Correct.
4 Q. Okay. So there are three possible different
5 numbers. Which one is this showing us, Exhibit 103?
6 A. This would show calls for service where AMR
7 arrived on scene.
8 Q. And with regard to AMR of Maricopa's
9 responsibility to the Department of Health Service, is
10 it arrivals that matter or is it transports that
11 matter?
12 A. The stipulations within the CON regard
13 arriving on scene within a prescribed time.
14 Q. Regardless of whether or not you trans --
15 A. Regardless of whether we transport or not,
16 correct.
17 Q. Okay. So tell us what we see here with
18 regard to the subject time period, which is the same as
19 the first report, correct?
20 A. Correct.
21 Q. In fact, are all the reports we're going to
22 look at be for the same time period?
23 A. Yes.
24 Q. Okay. Tell us what this shows with regard to
25 on scene arrival for interfacility requests from the
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1 Honor system, HonorHealth system, the three Scottsdale
2 branches.
3 A. What this tells us, as we just mentioned, the
4 date range involved in it, the three facilities that we
5 mentioned. At the time that the call is taken, there's
6 discussion, obviously, between the facility and the
7 call-taker. During that discussion, the arrival time
8 or requested pickup time is established during that
9 conversation. That time is then changed in the CAD
10 system to be the scheduled pickup time.
11 What this report shows is the times that we
12 arrived on scene in relation to that scheduled pickup
13 time.
14 Q. So the dispatcher enters the scheduled pickup
15 time, and the first line is arriving before then or at
16 that time? Yes?
17 A. Yes.
18 Q. Okay. So what do we see here?
19 A. We see that we were early or on time for that
20 scheduled pickup time 78.3 percent of the time.
21 Q. And just to discuss the individual columns
22 after Time After Pick-Up, the first is -- when it says
23 Number of Trips, what does that mean?
24 A. The total number during that time frame for
25 that criteria of the hospital's date range.
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1 Q. Okay. So out of all of the trips to those
2 three facilities, we've got 83 for that first category?
3 A. Yes.
4 Q. And what does the second column show us?
5 A. The total number of cumulative trips.
6 Q. So when we get down to the bottom of that, we
7 can tell that there were 106 calls all together?
8 A. 106 arrivals at the facility, correct.
9 Q. Arrivals, thank you.
10 And then the next column is?
11 A. The percentage of total trips individually
12 for the number of trips.
13 Q. Okay. And then the last one is?
14 A. The cumulative percentage of the trips.
15 Q. So in a perfect math world, that first line,
16 those first two, the last two columns should always
17 match?
18 A. No.
19 On the first line, yes, yes.
20 Q. And then in a perfect math world, those last
21 two columns at the bottom line, the one to the far
22 right should be how many, what percentage of the calls?
23 A. 100 total.
24 Q. So we've got 78.3 you testified early/on
25 time.
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1 Skipping to, even though it's not on the CON,
2 in 15 minutes or less, how many -- what percentage of
3 calls was AMR of Maricopa arriving on scene at the
4 requested time?
5 A. Within 15 minutes would be 91.51 percent.
6 Q. And the 30-minute mark associated with urgent
7 transports, what's the arrival statistic for the
8 30-minute mark?
9 A. 30-minute mark would be 98.11 percent.
10 Q. That's less than 30 minutes?
11 A. Correct.
12 Q. And then less than an hour?
13 A. It's hard to pull from this because it stops
14 at the 45-minute mark. I would have to go into the
15 actual database.
16 Q. Just because of the shear number of calls?
17 So there was one --
18 A. So, yeah, so 105.
19 Q. Okay. Now, Jim, this chart doesn't tell us
20 how many of these calls were urgent versus nonurgent,
21 correct?
22 A. Correct.
23 Q. And tell me what category of calls this chart
24 is showing us.
25 A. This is a very broad stroke of all calls that
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1 we received for the facility, regardless of the acuity,
2 nature.
3 Q. So would this include urgent?
4 A. It would, yes.
5 Q. Would this include all urgent calls from
6 these facilities?
7 A. Yes.
8 Q. Would this include all immediate calls?
9 A. Yes.
10 Q. Would this include all prescheduled calls?
11 A. Yes.
12 Q. If you needed to, could you go back into this
13 body of calls and break it out between urgent and
14 nonurgent?
15 I don't mean sitting here right now.
16 A. Right.
17 Yeah, it can be done, yes.
18 Q. With regard to CON parameter compliance, was
19 that something that would technically need to be done?
20 A. I don't think so, no.
21 Q. Okay. And why is that?
22 A. Well, I think that showing that a total of
23 the entire volume of calls within 30 minutes being at
24 98.11 percent would be well within the expectations of
25 the parameters of the CON.
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1 Q. Thank you.
2 MS. FICKBOHM: Your Honor, I would move
3 for admission of AMR-103.
4 MR. BELANGER: Objection, foundation.
5 It's a summary exhibit based on data we've not seen.
6 I'm not sure anybody else has seen it.
7 MS. FICKBOHM: Well, Your Honor, in
8 response to that, I'm going to say that I never got a
9 request for any of the backup data for this from the
10 applicant, and it's electronic data that this witness's
11 testimony I think very well established the foundation
12 for the admissibility of.
13 ALJ MIHALSKY: For what it's worth,
14 Exhibit AMR-103 is admitted.
15 Maricopa may inquire about the
16 foundation for this exhibit on cross-examination. And,
17 as always, the parties may supplement the exhibits.
18 But for what it's worth, AMR-103 is in evidence.
19 BY MS. FICKBOHM:
20 Q. Jim, I'm showing you what's been marked as
21 AMR-104, and can you tell us what we have here?
22 A. This is an on time performance report for the
23 date range of February 26 to October 20th, 2015, with
24 the facility being HonorHealth Deer Valley Medical
25 Center.
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1 Q. So this is one of the HonorHealth systems not
2 in Scottsdale; this is a different one?
3 A. Correct.
4 Q. Okay. And was this built in the same --
5 acquired and built in the same manner that we just
6 discussed with regard to the cumulative one for the
7 three Scottsdale facilities?
8 A. It was, yes.
9 Q. And did you generate and confirm the accuracy
10 in the same manner we've already discussed?
11 A. Yes.
12 Q. And does it capture the same body of all
13 non911 calls as discussed in connection with
14 Exhibit 103?
15 A. For HonorHealth Deer Valley Medical Center,
16 yes.
17 Q. And the reporting columns, et cetera, are set
18 up the same as the exhibit we previously discussed?
19 A. Yes.
20 Q. Okay. Can you tell us, with regard to the
21 Deer Valley facility, how many arrivals, on scene
22 arrivals, this exhibit collects?
23 A. The total number would be 704.
24 Q. And that's at the bottom of the second column
25 of data?
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1 A. Correct.
2 Q. Okay. And of those 704, how many of those
3 arrived either early or precisely at the requested
4 time?
5 A. 589 or 83.6 percent.
6 Q. And how many arrivals were under 15 minutes,
7 cumulatively speaking?
8 A. Cumulatively, 678 or 96.31 percent.
9 Q. And cumulatively under the 30-minute mark
10 that's set forth for urgent requests on AMR of
11 Maricopa's CON, what's the number of calls
12 and percentage?
13 A. 30 minutes is 697 total trips, 99.01 percent.
14 Q. And within the -- under the 60-minute mark,
15 the percentage?
16 A. A total of 703 out of the 704, for
17 99.86 percent.
18 MS. FICKBOHM: Your Honor, I would move
19 for admission of Exhibit 104.
20 MR. BELANGER: Same objection, Your
21 Honor, foundation.
22 ALJ MIHALSKY: Same ruling. For what
23 it's worth, Exhibit AMR-104 is admitted into evidence.
24 BY MS. FICKBOHM:
25 Q. And, Jim, when we look at the second page of
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1 this exhibit, does this tell us anything different, or
2 is this just a different way of representing the same
3 data?
4 A. Just a graph that represents the percentages
5 in the upper page.
6 Q. Moving to Exhibit 105, AMR, can you tell us
7 what we're looking at here?
8 A. That's the same type of report with the 26th
9 of February through October 20th, 2015 time frame for
10 the facility of HonorHealth JCL Medical Center, John C.
11 Lincoln Medical Center.
12 Q. And this is one of the Honor facilities
13 that's outside of the Scottsdale area, correct?
14 A. Correct.
15 Q. And how many total arrivals does this exhibit
16 represent?
17 A. 519.
18 Q. And did you collect and confirm the accuracy
19 of the data contained in this exhibit in the same way
20 that we've already discussed with regard to the prior
21 exhibits?
22 A. Yes.
23 Q. And does it collect the same body of all
24 non911 emergency calls, everything from prescheduled to
25 urgent?
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1 A. It does.
2 Q. Okay. And looking at this chart, can you
3 tell us, of the 519 calls for interfacility service
4 made by the John C. Lincoln Medical Center during the
5 subject time period, how many of those involved an
6 arrival that was early or at precisely the time
7 requested?
8 A. 406.
9 Q. Which is what percentage?
10 A. Would be 78.23 percent.
11 Q. And the arrival cumulatively within
12 15 minutes or less is what percentage?
13 A. 92.29 percent.
14 Q. And then the 30 percent -- I'm sorry,
15 30 minutes, within 30 minutes, as required by AMR of
16 Maricopa's CON for all urgent calls for service, the
17 mark is what?
18 A. 98.27 percent.
19 Q. But, again, that collects all calls, not just
20 urgent calls?
21 A. Correct.
22 Q. And then within an hour?
23 A. 99.61 percent.
24 Q. And two outside of an hour?
25 A. Correct.
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1 Q. And the second page of this, different data
2 or the same data reflected pictorially as opposed to by
3 numerical?
4 A. Same data as above.
5 MS. FICKBOHM: Your Honor, I would move
6 for the admission of AMR-105.
7 MR. BELANGER: Same objection, Judge.
8 ALJ MIHALSKY: Exhibit AMR-105 is
9 admitted for what it's worth.
10 BY MS. FICKBOHM:
11 Q. Jim, I've pulled up AMR-106. Can you tell us
12 what we're looking at here?
13 A. The on time performance report for
14 February 26th to October 20th, 2015, and this facility
15 is the HonorHealth Scottsdale Osborn Medical Center.
16 Q. Now, Exhibits 102 and 103 that we started
17 with included the Osborn facility, correct?
18 A. Correct.
19 Q. And is this one just the Osborn facility?
20 A. This is just the HonorHealth Scottsdale
21 Osborn Medical Center.
22 Q. And was this data collected, arranged and
23 confirmed in the same manner previously discussed?
24 A. Yes.
25 Q. How many on scene arrivals are we talking
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1 about being collected in this one?
2 A. A total of 69.
3 Q. And of those 69, how many involved an arrival
4 that was early or at exactly the time requested?
5 A. 56 or 81.16 percent of them.
6 Q. And how many were under the 15-minute mark?
7 A. 91.30 percent.
8 Q. And the reason that we jump from under
9 10 minutes to under 30 minutes without the intervening
10 lines like we see in the prior exhibits is what?
11 A. There would be no calls within that time
12 frame.
13 Q. Okay. So within the 30 minutes or less
14 fractile, what percentage of the time did AMR arrive on
15 scene within 30 minutes or less of the requested
16 arrival time for all calls?
17 A. 98.55.
18 Q. And 100 percent of the calls involved on
19 scene arrivals within what time frame?
20 A. 45 minutes.
21 Q. And the chart below, same data or different
22 data just presented pictorially?
23 A. Same data as above.
24 MS. FICKBOHM: Move for admission of
25 Exhibit 106, Your Honor.
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1 MR. BELANGER: Same objection, Judge.
2 ALJ MIHALSKY: For what it's worth,
3 Exhibit AMR-106 is admitted.
4 BY MS. FICKBOHM:
5 Q. Jim, I'm showing you what's been marked as
6 AMR Exhibit 107, and can you tell us what this is?
7 A. The on time performance report dated
8 February 26th to October 20th 2015 with the pickup
9 facility being HonorHealth Scottsdale Shea Medical
10 Center.
11 Q. Was this put together and confirmed in the
12 same manner discussed with regard to the previous
13 exhibits?
14 A. Yes, it was.
15 Q. And how many arrivals does this time period
16 involve for this facility?
17 A. 28.
18 Q. Okay. And of those 28 requests for non911
19 transports from Scottsdale Shea Medical Center, how
20 many of those did AMR of Maricopa arrive on scene at
21 the time requested or early?
22 A. 19 of them or 67.86 percent of the time.
23 Q. And what percentage was AMR of Maricopa at
24 bedside within -- I'm sorry, in under 10 minutes?
25 A. 89.29 percent of the time.
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1 Q. So, again, we don't have a specific breakout
2 for the intervening time periods immediately above that
3 because there just were no calls?
4 A. Correct.
5 Q. Okay. So moving to the 30 minutes or less
6 fractile, what percentage of the time was AMR arriving
7 on scene within 30 minutes or less?
8 A. 96.43 percent of the time.
9 Q. And the number of calls outside of that
10 30-minute range?
11 A. 1.
12 Q. And as with the prior exhibits, the chart
13 below is the same data?
14 A. Yes.
15 Q. Represented in a pictorial fashion?
16 A. Correct.
17 MS. FICKBOHM: Move for the admission of
18 AMR-107.
19 MR. BELANGER: Same objection, Judge.
20 ALJ MIHALSKY: For what it's worth,
21 Exhibit AMR-107 is admitted.
22 BY MS. FICKBOHM:
23 Q. This one should be quick to go through, Jim.
24 A. Yeah.
25 Q. I'm showing you what's been marked for
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1 purposes of identification as AMR Exhibit 108. What
2 are we looking at here?
3 A. This is the on time performance report for
4 the date range of February 26 to October 20, 2015 with
5 the pickup facility of HonorHealth Scottsdale Thompson
6 Peak.
7 Q. And how many total trips were there arrivals
8 within that time frame?
9 A. 10.
10 Q. Okay. And tell us what we see here.
11 A. Of those 10, we were early or on time for the
12 scheduled pickup time 90 percent of the time and within
13 15 minutes of the scheduled pickup time captured all
14 trips, 100 percent.
15 MS. FICKBOHM: Your Honor, move for the
16 admission of Exhibit 108.
17 MR. BELANGER: Same objection.
18 ALJ MIHALSKY: For what it's worth, AMR
19 Exhibit 108 is admitted.
20 BY MS. FICKBOHM:
21 Q. Jim, I'm showing you what's been marked as
22 AMR-109. Tell me what we have here.
23 A. This is the on-time performance report dated
24 for the date range of February 26th to October 20th
25 with a pickup facility of HonorHealth Sonoran Health &
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1 Emergency Center.
2 Q. This is not one of HonorHealth's Scottsdale
3 facilities?
4 A. Not in Scottsdale, no.
5 Q. Okay. And tell me -- I want to make sure we
6 don't have a line item on the next page here.
7 Tell me, in that time period, with regard to
8 the Sonoran Health & Emergency Center, the number of
9 arrivals that are captured here.
10 A. 982.
11 Q. Okay. And of those 982, how many of those
12 were early or on time arrivals?
13 A. 494 or 50.31 percent.
14 Q. And, Jim, I may not have asked you this with
15 regard to a prior exhibit, and I didn't ask you with
16 regard to this one, but with regard to all of these
17 similar formatted exhibits, did you extract and confirm
18 and categorize the data in the same way we discussed
19 with regard to the earlier exhibits?
20 A. Yes.
21 Q. And do they all collect all requests for
22 transports; not simply urgent, but nonurgent, urgent
23 and prescheduled?
24 A. All, correct.
25 Q. Okay. So going back to the Sonoran Health &
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1 Emergency Center's statistics as seen on Exhibit 109,
2 we did the first line, so tell me what the percentage
3 is for the under 15-minute mark.
4 A. It's 91.14 percent of the time.
5 Q. And the percentage for under 30 minutes?
6 A. 97.66 percent of the time.
7 Q. And the percentage for under 60 minutes?
8 A. 100 percent of the time.
9 MS. FICKBOHM: Your Honor, I would move
10 for the admission --
11 BY MS. FICKBOHM:
12 Q. Oh, well, look at Page 2. As with the other
13 exhibits, the pictorial representation here, same data,
14 different data?
15 A. It's the same data as above.
16 Q. For those of us that are more
17 picture-oriented as opposed to number-oriented?
18 A. My boss.
19 Q. Your boss?
20 MR. BELANGER: Same objection.
21 MS. FICKBOHM: Move for admission, Your
22 Honor.
23 ALJ MIHALSKY: For what it's worth,
24 Exhibit AMR-109 is admitted.
25 MS. FICKBOHM: Sorry, my mouse is not
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1 very responsive this morning. It needs to wake up.
2 ALJ MIHALSKY: It's been a while.
3 BY MS. FICKBOHM:
4 Q. Jim, I've pulled up AMR-110. Can you tell us
5 what data this exhibit collects?
6 A. This is a trip count in our system by pickup
7 facility.
8 Q. So are these all of the Honor systems,
9 HonorHealth facilities?
10 A. This report is, yes.
11 Q. And is this an itemization of arrivals?
12 A. No, this was calls that were entered into the
13 system.
14 Q. So calls for service that may or may not have
15 resulted in a transport or an arrival?
16 A. Correct.
17 Q. Okay. And was this data collected and
18 confirmed in the same manner previously
19 discussed?
20 A. Yes.
21 MS. FICKBOHM: Move for admission of
22 Exhibit 110, Your Honor.
23 MR. BELANGER: Same objection.
24 ALJ MIHALSKY: For what it's worth,
25 Exhibit AMR-110 is admitted.
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1 BY MS. FICKBOHM:
2 Q. Jim, does this exhibit allow us to see where
3 the greater number of calls are coming from?
4 A. It does.
5 Q. Finally, the last exhibit I'll ask you to
6 discuss, AMR-111. Is this on time performance for all
7 of the HonorHealth facilities combined?
8 A. It is.
9 Q. Okay. The same time period we've been
10 talking about?
11 A. Correct.
12 Q. And obtained and confirmed in the same
13 fashion?
14 A. Yes.
15 Q. Okay. So if we look at all of the
16 HonorHealth facilities together, how many of the calls
17 for service resulted in an on scene arrival?
18 A. 1,573 of the total or 68.04 percent of the
19 time.
20 Q. What's the total body of arrivals we're
21 looking at?
22 A. 2,312.
23 Q. And the number you just gave us was for early
24 or on time?
25 A. Yes.
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1 Q. And the percentage of that?
2 A. 68.04 percent.
3 Q. And of the total body of HonorHealth system
4 calls for transports, how many -- what percentage of
5 those was AMR on scene within 10 minutes of the
6 requested arrival time?
7 A. 88.37 percent at 10 minutes.
8 Q. And for the total body of calls, how many
9 under -- what percentage was the arrival under
10 15 minutes?
11 A. It would be 92.99 percent of the time.
12 Q. And that's cumulative, and if we wanted to
13 see the difference between under 10 minutes and under
14 15 minutes, how do we get that?
15 A. We would actually go into the report and
16 actually look for the calls and exactly what time.
17 Right now it would be a manual manipulation on my part,
18 or not manipulation, but to go in and manually look at
19 each call for service.
20 Q. And maybe my -- my question was obviously
21 poorly worded. I didn't mean looking at the individual
22 calls; but if we wanted to see the precise number of
23 calls falling in that 10 to 14.5-minute range, where
24 would we see the exact number of calls?
25 A. In that first column to the right of the time
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1 frame.
2 Q. So are you saying 107 calls fell within 10 to
3 14.59 minutes or that's the cumulative total?
4 A. No, that's the number that fell --
5 Q. That's the number that fell --
6 A. -- between 10 minutes and 14.59.
7 Q. Okay. Exactly.
8 And under 20 minutes, what cumulative
9 percentage of the time was AMR of Maricopa on scene or
10 early under 20 minutes?
11 A. 95.37 percent of the time.
12 Q. And that was another really bad question.
13 I'm sorry. I meant on scene within 20 minutes.
14 And then under on scene within 30 minutes?
15 A. 98.23 percent of the time.
16 Q. And on scene within 60 minutes?
17 A. 99.83 percent.
18 Q. And how many was there an on scene arrival
19 over an hour?
20 A. Four.
21 Q. And, Jim, just tell us, for educational
22 purposes, why it is that there might be an on scene
23 arrival over an hour.
24 A. There could be many, many reasons. Some of
25 the ones that come to mind immediately would obviously
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1 be traffic. I don't know if anybody's familiar with
2 the traffic here, but it's crazy. Could be an accident
3 scene. We could have had to divert a car to a more
4 critical call or patient and then send a second unit.
5 Volume of traffic for the day. Not traffic street
6 traffic, but our traffic, our volume of calls could
7 have us in a position that, you know, we would have to
8 respond further away based on how many calls for
9 service there were at that time. So there's a lot of
10 different reasons.
11 Q. Thank you. And, Jim, again, what we're
12 seeing for all of the Honor system facilities in the
13 time frame selected here, these are all calls for
14 service, not just urgent, correct?
15 A. Correct. Yes.
16 MS. FICKBOHM: Your Honor, move for the
17 admission of Exhibit 111.
18 MR. BELANGER: Same objection.
19 ALJ MIHALSKY: Exhibit AMR-111 is
20 admitted for what it's worth.
21 MS. FICKBOHM: Thank you, Your Honor.
22 And thank you, Jim.
23 I'm done, Your Honor.
24 THE WITNESS: Uh-huh.
25 ALJ MIHALSKY: Okay. Do you have any
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1 questions, Mr. Rosenfeld?
2 MR. ROSENFELD: I don't, Your Honor.
3 Thank you.
4 ALJ MIHALSKY: Very good. Mr. Bennett,
5 Mr. Belanger?
6 MR. BELANGER: Yeah. Thanks, Your
7 Honor.
8
9 CR0SS-EXAMINATION
10 BY MR. BELANGER:
11 Q. How you doing?
12 I'm curious about these exhibits, Mr. Wolfe.
13 So we're looking at AMR Exhibit 18, which is the CON
14 that was awarded.
15 A. Uh-huh.
16 Q. And we're looking at Page 2, which is Bates
17 00 -- I guess the Bates is -- I'm sorry, for AMR,
18 AMR 18-002.
19 Are your charts correlating to response and
20 arrival times in Paragraph 3 for interfacility arrival
21 times?
22 A. Yes.
23 Q. Okay. And is an interfacility arrival time,
24 that's -- explain to me how that would work. And by
25 this is what I want to know: Does AMR get a call and
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1 it says, "We need to have an ambulance here to
2 transport somebody from Facility A to Facility B," and
3 that's how the dispatch is generated? Do you
4 understand my question?
5 A. Not quite.
6 Q. Okay. When we're looking at Paragraph 3 for
7 response times and arrival times, right, and for
8 interfacility transports --
9 A. Uh-huh.
10 Q. -- I'm assuming that there's a scheduled
11 interfacility transport. For example, let's say it was
12 at 4:00 p.m. today, January 13th, 2016, 4:00 p.m.
13 today. The interfacility arrival time under c.i. is
14 within 60 minutes of the requested at-the-bedside
15 pickup time. So that means that you could be up to
16 60 minutes late or after the requested time?
17 A. Correct. So it says 60 minutes 90 percent of
18 the time of that scheduled time. So, yeah, so if it
19 was a 4:00 pickup, within 90 percent I would have to be
20 there within that hour of that scheduled pickup.
21 Q. Okay. So let's look at, for example, AMR
22 Exhibit 111, and this is Page 1. This is for John C.
23 Lincoln Medical Center, I believe.
24 MS. FICKBOHM: This is all of them
25 combined, Jim.
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1 MR. BELANGER: Is this all of them
2 combined? I'm sorry. Thanks, Ronna. I'm going to go
3 back then to -- let's look at one where --
4 MS. FICKBOHM: You found it.
5 BY MR. BELANGER:
6 Q. Great. Okay, so John C. Lincoln.
7 ALJ MIHALSKY: And for the record, that
8 that's AMR-105.
9 BY MR. BELANGER:
10 Q. AMR-105, and we're looking at Page 1, which
11 is 001. Early or on time, that is when an ambulance
12 actually arrives at the requested scheduled time?
13 A. Correct.
14 Q. So using my hypothetical, if it was for 4:00
15 this afternoon, they would arrive at 4:00 or earlier,
16 and that's captured in the early or on time?
17 A. Yes.
18 Q. And so it's not -- and I don't mean to put
19 words in your mouth. It's not -- when we're looking at
20 the -- what is the column when it says "Time after
21 Pick-Up"? What does that actually mean?
22 A. It's for the times that are below. So if the
23 scheduled pickup time was 4:00 p.m., the second group
24 down, the 01-01:59 would be 1 to 2 minutes past that
25 4:00 p.m., so it would be 4:01 to 4:02.
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1 Q. So on this exhibit, AMR-105, it says "Early
2 or On Time" at 78.23 percent of the time?
3 A. Uh-huh.
4 Q. And they would be late approximately
5 21 point -- 21, 22 percent of the time; fair enough?
6 A. That's a fair question. Yeah, that's a fair
7 statement.
8 Q. But what you're saying, though, is that
9 vis-à-vis your CON, you're still within the times that
10 you articulated in AMR's CON?
11 A. Yes, because it's a 60-minute window past
12 that time or 30-minute on urgents past that time.
13 Q. Okay. So it's not fair to say that they're
14 on time in terms of the scheduled time of pickup, but
15 they are within the times articulated in AMR Maricopa's
16 CON for interfacility transports?
17 A. Well, yeah, the 78.23 percent they would be
18 on time or prior to time.
19 Q. Understood. But for the balance of them,
20 they're not?
21 A. Correct.
22 Q. And I understand that, you know, you
23 generated these reports in response to a request from
24 somebody at AMR. Have they been provided to the
25 Department, the underlying data regarding these
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1 particular transports or this data?
2 A. I don't know. My job was to forward to my
3 boss.
4 Q. And I assume -- do you have the underlying
5 data regarding AMR exhibits that have been objected to
6 and admitted, I think it's 105 through, approximately,
7 112?
8 A. On me, no, sir; but they're part of our
9 permanent database.
10 Q. I assume you don't have them on you, unless
11 you have a little thumb drive.
12 A. Yeah.
13 Q. In terms of when you're talking about an
14 early or an on time call in AMR-105, for example, if
15 you know the answer to this question, when AMR receives
16 a call for an interfacility transport, do they -- is
17 there ever a situation where you call back and say --
18 for example, they requested a pickup at 4:00. "Well,
19 we can't be there at 4:00. We can be there at 5:00 or
20 5:30." Does that happen?
21 A. It does, yeah.
22 Q. And if that happens, is that captured in your
23 data, in the sense that the initial requested response
24 time was 4:00, but we're telling you we can't be there
25 until 5:30? Is that captured in your data?
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1 A. I mean the notes of the call would have it in
2 there. I mean as it stands today, we wouldn't just
3 dwell on the fact that we would be 90 minutes. We
4 would pick up the phone and call Rural/Metro to see if
5 we could facilitate a faster time frame for the
6 customer and make that phone call to make sure, you
7 know, if they had something faster, we would then call
8 the customer back and say, "We can have an ambulance to
9 you in 30 minutes."
10 If both of those resources were exhausted,
11 yes, the time is the scheduled pickup time, which at
12 that point would be agreed upon by both agencies. Then
13 it would be entered as the scheduled pickup time.
14 Q. Okay. So using my example, if the original
15 requested time was 4:00, but you determined and agreed
16 with the facility that you couldn't get there until
17 5:30, that would become the new requested pickup time?
18 A. Correct.
19 Q. And that would be the -- if you arrived on or
20 before 5:30 p.m., that would be considered an early or
21 on time pickup?
22 A. Yes.
23 Q. Even though it was 90 minutes after the
24 originally requested time?
25 A. Sure. But once the customer agrees to a new
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1 scheduled pickup time, that becomes the scheduled
2 pickup time.
3 Q. Understood.
4 Were these -- the Exhibits 105 through 112,
5 and I may be missing some of the numbers, but I'm
6 referring to the charts that you prepared, both the
7 charts and the diagrams. Were they prepared from CAD
8 data or data that was AMR data?
9 I mean, for example, I'm assuming that you
10 didn't go into Rural/Metro's CAD system to extract this
11 data, but you used your AMR systems that had previously
12 existed?
13 A. Correct.
14 Q. Could you do this with Rural/Metro's CAD
15 data?
16 A. I couldn't, but I'm sure we have the
17 resources somewhere down there. I mean for this data
18 specific, they wouldn't have our data, you know what I
19 mean. So there would be no way to pull that.
20 Q. On an interfacility transport, transports
21 such as are reflected in AMR-105, when does the actual
22 clock time start for the dispatch of the ambulance? Is
23 it when it leaves its docking station, for lack of a
24 better word, or when does the actual time start for
25 this calculation?
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1 A. For the on time performance, it would be
2 the -- let me think for a second.
3 Q. It may not matter, actually.
4 A. Well, no, it wouldn't matter.
5 Q. Right.
6 A. This would be solely based on the clock
7 starts at the scheduled pickup time, so that's already
8 preestablished, right.
9 Q. And that call could have come in four hours
10 beforehand?
11 A. Could have come in four days ago.
12 Q. Four days ago, okay.
13 A. Yeah.
14 Q. When does the clock actually stop for
15 determining whether or not you are early or an on time
16 arrival?
17 A. When the unit reports on scene of the pickup
18 location.
19 Q. Are you familiar with, for example -- does
20 the arrival time -- is it when the ambulance arrives in
21 the parking lot or is available to actually take the
22 patient, or is it we are now driving into the parking
23 lot of Banner Samaritan?
24 A. Typically, it's they park and stop and pick
25 up the radio and say, "Hey, we're at location or at
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1 scene."
2 Q. And you may not know the answer to this,
3 Mr. Wolfe, so it may be an unfair question. Do you
4 know if this kind of information in terms of the on
5 time performance data that's reflected in these charts,
6 AMR-105, et. seq, is that data that will be provided to
7 the Bureau for purposes of their being able to analyze
8 it?
9 A. Yeah, I have no idea.
10 Q. Okay.
11 MR. BELANGER: Thanks, Mr. Wolfe. I
12 don't of any other questions. Thank you.
13 ALJ MIHALSKY: Mr. Ray, Ms. Flores, any
14 questions?
15 MR. RAY: Yes, Judge, thank you, just a
16 couple.
17
18 CROSS-EXAMINATION
19 BY MR. RAY:
20 Q. Mr. Wolfe, as a follow-up to Mr. Belanger's
21 questions, so I want to focus on the first column.
22 This is AMR-105, and this is just an example of the
23 exhibits you've been testifying about.
24 Early or on time, I think your testimony with
25 Mr. Belanger was that that is a negotiated time between
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1 the calling facility and AMR's dispatch. They arrive
2 at an agreed-upon time?
3 A. I mean, yes and no. On a prescheduled trip,
4 like an example where I said four days from now they
5 say, "We want you to be here at 2:00," they know
6 they're discharging a patient and have that ability to
7 be ready, right.
8 In other situations where they call and say,
9 "We need to transport a patient" -- typically, the
10 phone call comes in, "We need to transport a patient."
11 "Okay. You're at what facility," and we get
12 the patient demographics and information, and we
13 typically say, "Okay, we can have an ambulance there in
14 20 minutes," as an example. That becomes -- if the
15 customer agrees to that, then that becomes the
16 scheduled pickup time between the facility and us.
17 Q. Okay. So let me ask you another follow-up
18 with that.
19 A. Sure.
20 Q. So if, instead of saying, "We have a patient.
21 When can you pick him up," what if they said, "We have
22 a patient who's ready to go at X facility"? Would you
23 agree that is a requested pickup time?
24 A. Oh, yes, and that would be the time it was
25 put up in the prescheduled pickup time in the CAD
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1 system. We have those. Like the urgents, those are
2 like, hey, we got to get this guy going. So the
3 scheduled pickup time then becomes that time right
4 then.
5 Q. Okay. So I want to -- perhaps my questions
6 aren't as clear as I would like them to be.
7 So what I want to focus on for purposes of
8 your answers, when is it a facility requests a
9 particular pickup time, and when does that turn into a
10 negotiated pickup time? What are the circumstances?
11 A. It would depend. So I mean just so maybe I
12 wasn't clear, to clarify what I was saying, we do that
13 prescheduled time on every trip, regardless if it's
14 scheduled four days from now, four hours from now, four
15 minutes from now, right now. We put that scheduled
16 pickup time in every call that we enter into the CAD.
17 So most of the time on emergency or 911-type trips,
18 it's done automatically as the time of the call save.
19 Q. Sure.
20 A. And the same with the nonemergent. So once
21 we save the call in the initial swing of
22 information-gathering and enter, it establishes that
23 pickup time as right then.
24 Q. Okay.
25 A. We then go back on the ones that are four
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1 days, four hours, four minutes from now and adjust that
2 pickup time to that time frame, if that makes sense.
3 So some of these absolutely were right now.
4 In the case of a Deer Valley, you know, it's a posting
5 location for us. It's close. We have a unit in the
6 parking lot. You're going to have a lot of those that
7 are right there at that time frame, you know, "Copy,
8 we're on scene." Click them through. They were early
9 or on time.
10 Q. Okay. And those where they request a pickup
11 now or in 10 minutes and the response is, "We don't
12 have a unit that close. Is 20 minutes okay," that
13 happens?
14 A. That happens, yes, sir.
15 Q. Okay. And those calls are also represented
16 on the line that says "Early or On Time"?
17 A. Well, not necessarily. If we didn't have a
18 unit that was within that time frame, you know, we
19 would still leave the original pickup time. We
20 wouldn't -- I mean, yes, we would change it upon the
21 negotiated time for those trips. But --
22 Q. Okay. So stop right there.
23 A. Yeah.
24 Q. So if you change it based on a negotiated
25 pickup time, then the negotiated pickup time becomes
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1 the On Time category that is line one?
2 A. Yes.
3 Q. Even though the original request for that
4 hypothetical call could have said 10 minutes, the
5 negotiated time is 20, so for your purposes for this
6 series of charts, On Time becomes 20?
7 A. Yes.
8 Q. Okay. Let me ask a couple of other questions
9 while we're in this series.
10 So Early or On Time, and this is AMR
11 Exhibit 109, the cumulative percentage is
12 50.31 percent, correct?
13 A. Yes.
14 Q. That appears to me to be a significant
15 difference than the Early or On Time percentages for
16 the other facilities. Do you know why that is?
17 A. This facility, HonorHealth Sonoran, position
18 location of the facility could have something to do
19 with it; volume of calls, you know, within the system,
20 being that they are up off of the 17, you know, close
21 to, what is it, the 74 there. So it's kind of not an
22 outlier, but kind of an outlier facility. We do our
23 best to post in that area, but with volume, you know,
24 we handle the calls that we have.
25 Q. Okay. So that is primarily a function of
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1 geography; it's further north than the other
2 facilities; is that fair?
3 A. It is.
4 Q. All right. And I didn't -- can you tell me
5 what -- if we're looking at columns, the labels of the
6 columns -- it is AMR-110 we're looking at. You have
7 calls for ALS, BLS, and then you have SCT. What does
8 that column stand for?
9 A. Specialty care transport.
10 Q. And what would those be?
11 A. You can have a couple of different reasons; a
12 bariatric patient, where a special resource would be
13 needed. It could honestly be a coding error at the
14 dispatcher level.
15 Q. Okay. So why are you capturing that data
16 separate and apart?
17 A. To be included as the total of the volume.
18 So in the example that I used, if there was an entry
19 error by a dispatcher, if I didn't search that criteria
20 as well, that would be a call that I wouldn't have. I
21 wouldn't capture it in the report. I wouldn't even
22 know it existed at that point.
23 Q. So, Mr. Wolfe, thank you. Let me go back. I
24 only have a couple more questions.
25 A. Yes, sir.
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1 Q. So before you again is AMR-105, and this is
2 simply an example of the exhibits that you've testified
3 to. And we've talked about the difference between a
4 request and a negotiated pickup time, based on this
5 exhibit, correct?
6 A. Yes, sir.
7 Q. I'm going to go back to the CON itself.
8 A. Yes, sir.
9 Q. And it's AMR-18. If you would take a look at
10 3 under Response Times and Arrivals, which is
11 Paragraph 3, 3.c., which is titled Inter-Facility
12 Arrival Times. Under both c.i., which is nonurgent
13 transfers, and ii., which is urgent transfers, do you
14 see what is your arrival time requirement under the
15 certificate of necessity?
16 A. Under i., arrive within 60 minutes zero
17 seconds of the requested at-bedside pickup time on
18 90 percent.
19 Q. Okay. And for ii., it would be --
20 A. Within 30 minutes zero seconds of the
21 requested at-the-bedside pickup time on 90 percent of
22 all urgent transfers --
23 Q. Okay.
24 A. -- from a licensed health care facility.
25 Q. Okay. From a CON standpoint, your legal
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1 requirements are set forth on this exhibit, correct?
2 A. Correct.
3 Q. And that exhibit uses the term 60 minutes
4 zero seconds of the requested bedside pickup.
5 A. Correct.
6 Q. Now, you've talked about where a facility can
7 call and request a pickup, and you've also talked
8 about -- and sometimes that works out for AMR; and
9 sometimes you've talked about a request will come in,
10 and my example was, "We have a patient ready in
11 10 minutes," and the example we talked about, AMR could
12 say, "We probably can't get there in that period of
13 time. Is 20 minutes okay?"
14 That's a negotiated pickup time.
15 A. Uh-huh.
16 Q. In your opinion, would that negotiated pickup
17 time be counted for the arrival time calculation under
18 the CON?
19 A. You're asking my --
20 Q. Yes.
21 And so what we're talking about is the
22 difference between what requested means versus a
23 negotiated pickup.
24 A. Sure. No, I get that. And I think that, you
25 know, one of the pieces to it is, I mean, if -- I mean
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1 we're all in the health care business, and we
2 understand that I can't put an ambulance in every
3 parking lot of every facility within Maricopa County;
4 not just hospitals, but urgent cares and everything
5 else. I think that there's an expectation of providing
6 the best service possible and the customer expecting
7 that best service possible based on the realism of the
8 resources out there and drive times and traffic and
9 things that can't be avoided. I think that they
10 understand that without that ambulance sitting in the
11 parking lot, that 15 minutes can be a reasonable
12 expectation of moving that time.
13 I think that, you know, the times that we had
14 those delay -- you know, if we had delays, like on the
15 graphs that were testified to, you know, we do have
16 some of those delays that are outside; but the times
17 where we would absolutely say that we can't make your
18 10 minutes would be far and few compared to the total
19 number of calls that were requested for a specific
20 time, if that makes sense.
21 Q. Okay.
22 A. But by your first original question, the way
23 the CON states, that it would be the initial requested
24 at-bedside pickup time.
25 Q. One final question. I think you testified
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1 with respect to all of these exhibits --
2 A. Yes, sir.
3 Q. -- you haven't broken them out/down between
4 initial requested time versus, using my language,
5 negotiated pickup time?
6 A. No. There would be no way to really capture
7 that right now.
8 Q. All right.
9 MR. RAY: Mr. Wolfe, thank you for your
10 testimony.
11 THE WITNESS: Thank you, sir.
12 ALJ MIHALSKY: I think this is a good
13 time for a break.
14 MS. FICKBOHM: Okay.
15 ALJ MIHALSKY: It's 9:53. We'll be back
16 on the record at 10:10.
17 (A recess was taken from 9:53 a.m. to
18 10:11 a.m.)
19 ALJ MIHALSKY: We're back on the record.
20 Ms. Fickbohm.
21 MS. FICKBOHM: Thank you, Your Honor.
22
23 REDIRECT EXAMINATION
24 BY MS. FICKBOHM:
25 Q. Clear up a couple things, Jim, and sort of
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1 consolidate what you talked about on cross.
2 Looking at 110, the SCT, is that a higher
3 level of care?
4 A. It can be, yeah. Specialty care could also
5 be a nurse car situation, where there would be an EMT,
6 a medic, and a nurse on a vehicle.
7 Q. And during the time period in question, is
8 this a transport that AMR of Maricopa would have done,
9 or is that something that would have been a call and
10 given to somebody else?
11 A. For this time period we don't have a nurse
12 car on the street during this time period, or did not.
13 We took the call information, and then our process
14 would have been to pick up the phone and to call
15 Rural/Metro, who does have nurse cars on the street, to
16 give them that traffic.
17 So this would be the difference between, as
18 discussed before, with the trip count being a total
19 number entered into the system versus arrivals and
20 transports on the other end.
21 Q. Let's talk about the total body of calls,
22 just approximate numbers coming in. We've got
23 prescheduled; we've got urgent, like we need you now;
24 and then we've got the nonurgent stuff in between.
25 What's the percentage of prescheduled calls?
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1 Is that high, low, in between?
2 A. Prescheduled, like well in advance days or
3 more, would be a very low percentage.
4 Q. And then the urgent, what percentage, like we
5 need you now; what percentage of the calls is that
6 going to be?
7 A. The urgent, 30 minutes, we need you right now
8 on the CON, that's also a very small number.
9 Q. And so the group in between of not urgent
10 interfacility, but not known far enough ahead of time
11 to actually preschedule, give me an approximate range
12 of the number of transports we're talking about.
13 A. Probably 80, 85 percent of the total, you
14 know, without the urgents or the prescheduled.
15 Q. When you're arriving for that middle group,
16 the 80, 85 percent of nonurgent, but not prescheduled
17 interfacility transports, how important is
18 predictability of arrival time?
19 A. Oh, it's important.
20 Q. And let's talk about with regard to the
21 requesting facility. Why would that be important to
22 them?
23 A. There's things that they're doing on their
24 end of the house, finishing up paperwork, getting last
25 orders, taking care of their documentation and whatnot
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1 for that patient to then be transferred out.
2 Q. Any possible medical equipment changes?
3 A. Sure. Yeah. Verifying medications. If they
4 were on a ventilator, all their settings, verifying all
5 that. I mean there's things that would take time to
6 have that patient completely ready to go out the door.
7 Q. And when we're talking about this 80 to
8 85 percent -- well, let me back up for a second. With
9 regard -- I just want to clarify, because I think I
10 heard you say it maybe two different ways.
11 With regard to the urgent call, we need you
12 now, is that ever negotiated?
13 A. No. I mean if the call -- if it meets the
14 urgent criteria, the 30-minute window criteria, we
15 would not adjust that, that time frame, based on a
16 negotiated time where we can't be there within
17 30 minutes. We wouldn't change that criteria of the
18 total volume for that.
19 The urgents, the STEMIs, the strokes are
20 handled of a more emergent nature, kind of more
21 aggressively. So I mean if we couldn't be there within
22 that 30 minutes, we're looking, we can't be there
23 within that 30 minutes, we would call Rural to see if
24 they could and then go from there and let the facility
25 know what the options are at that point.
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1 Q. And if they can't and you can't, then your
2 fractiles show up as late, outside of 30 minutes?
3 A. Correct. For the urgents, yes.
4 Q. Okay. Let's go back. So we've got the
5 prescheduled. We've got the urgent. Let's go back to
6 the 80, 85 percent range in between of interfacility
7 requests that aren't urgent. How common is it for the
8 dispatchers to receive a request that says, "Hey, I've
9 got somebody that needs to go from here to there. I
10 need you here in 18 minutes. I would like you here in
11 10 minutes. I would like you here in 43 minutes"? How
12 common is that?
13 A. Very uncommon.
14 Q. Is it usually -- tell me what kind of
15 information is exchanged between dispatch and the
16 calling facility.
17 A. The process usually -- typically, I should
18 say, goes in this manner: The facility calls in. Our
19 operators answer the phone. The facility identifies
20 themself and that typically the response is, "I have a
21 patient that I need to send to X facility." Okay. We
22 get some basic demographic information. We get --
23 Q. Such as?
24 A. The patient name, billing information, the
25 age, what the diagnosis of the patient is, are there
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1 any special needs en route, all the things that would
2 facilitate us getting that patient from here to there.
3 And then typically we will say, "Okay, we can
4 be there in X amount of time. We can be there in
5 20 minutes. We can be there in 30 minutes. We can be
6 there -- it will take us 60 minutes," you know. And,
7 typically, that's the way it works, is we throw a
8 number out there and the facility says, yes, we can be
9 there.
10 Very, very rarely does a facility say, "I
11 need you to be here in 12 minutes or 15 minutes or
12 30 minutes."
13 Typically it's "I have a patient I need to
14 move," kind of a "What can you do for me" type
15 environment.
16 Q. Now, if the facility was saying, "No, I
17 absolutely need somebody here in 20 minutes," and
18 nobody else can take the call and AMR is the one to
19 take the call, what's the arrival time?
20 A. Well, the average time would be whenever we
21 get an ambulance there, so --
22 Q. I'm sorry. What's the requested time entered
23 at if they say "Absolutely 20 minutes"?
24 A. Yeah. Yeah, so there's several things.
25 Again, we would call Rural. We would also look and
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1 evaluate the current calls that we have going on, and
2 we would look at the condition of the patient, the
3 acuity of the patient, what's going on. And if it
4 truly matched within that urgent criteria, we could
5 always reroute one of our existing units that could be
6 in the area or on the way to another facility, reroute
7 them to get there faster then.
8 So I mean if we did it for every single call,
9 it would be a little cumbersome and it would kind of
10 hurt the system more; but for the urgents, for the ones
11 that truly meet that 30-minute window, we do look at
12 that.
13 Q. Do your dispatchers -- are they allowed to
14 ever enter an on time number that has not been okayed
15 by the customer?
16 A. No.
17 MS. FICKBOHM: Thanks, Jim.
18 THE WITNESS: Thank you.
19 ALJ MIHALSKY: Mr. Wolfe, thank you.
20 THE WITNESS: Thank you, ma'am.
21 MS. FICKBOHM: Call John Valentine to
22 the stand, Your Honor.
23 ALJ MIHALSKY: Mister -- is it
24 Balentine?
25 MS. FICKBOHM: Valentine.
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1 ALJ MIHALSKY: Balentine.
2 MS. FICKBOHM: Valentine. V, as in
3 victory.
4 THE WITNESS: February 14th.
5 ALJ MIHALSKY: Oh, okay. Mr. Valentine.
6 THE WITNESS: Good morning, Your Honor.
7 ALJ MIHALSKY: Good morning. Could you
8 raise your right hand.
9 (Mr. John Valentine was duly sworn by
10 the Administrative Law Judge.)
11 ALJ MIHALSKY: Could you state your name
12 for the record and spell your last name for the court
13 reporter.
14 THE WITNESS: John Valentine. Last name
15 Valentine, V-A-L-E-N-T-I-N-E.
16 JOHN VALENTINE,
17 called as a witness on behalf of Intervenor AMR herein,
18 having been previously duly sworn by the Administrative
19 Law Judge to speak the truth and nothing but the truth,
20 was examined and testified as follows:
21
22
23 DIRECT EXAMINATION
24 BY MS. FICKBOHM:
25 Q. Mr. Valentine, what's your position in the
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1 American Medical Response organization?
2 A. I'm a regional director of Arizona,
3 overseeing part of Maricopa County and River Medical on
4 the Colorado River.
5 Q. How many years have you been in the emergency
6 medical services field?
7 A. Since 1980. In California I was certified as
8 an EMT.
9 Q. I would like to have you spend a little bit
10 of time explaining to the judge the path that your
11 career has taken. So you just mentioned 1980. So in
12 1980 you became an EMT?
13 A. Yes, in 1980. Probably many people in this
14 room saw the Shell emergency as a small child. I
15 wanted to be a firefighter/paramedic, and the way to
16 get into that service was to become an emergency
17 medical technician.
18 I went to a junior college right out of high
19 school and became an EMT and started working in the
20 California market in a private ambulance service. From
21 that point I, in 1982, went to Daniel Freeman Paramedic
22 School in L.A. County and became a certified California
23 paramedic, and at that time the paramedic
24 certifications were good by Counties only in
25 California. We didn't really have National Registry.
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1 So I stayed in California for a little while and then
2 came to Arizona in 1984 and went back through the
3 process of kind of recertifying myself in Arizona. And
4 in 1992 became a paramedic in -- or 1993 became a
5 paramedic in Arizona. I worked for a private ambulance
6 service here for about two years and then went into the
7 fire service.
8 Q. Okay. So let's talk first about your work
9 for a private ambulance service company. So that was
10 in 1984?
11 A. Yes, ma'am. I worked from 1984 to 1988 with
12 what is River Medical, Incorporated.
13 Q. Okay. And was this -- involve anything more
14 than being an EMT?
15 A. In 1984 it involved kind of everything. Very
16 rural, very rural ambulance provider. Had a huge
17 geographic area. Back in those days we pretty much did
18 everything from change oil to work on patients to any
19 kind of leadership that was available. Very small
20 operation.
21 Q. In 1988 you made a move?
22 A. I made a move to the fire service. I was
23 hired on with Quartzsite Fire District. They were
24 trying to expand their service, and worked my way up
25 through the ranks there. I was hired on as a
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1 lieutenant, became an EMS captain, and then went on to
2 division chief. I oversaw operations and coordinated
3 all the EMS services we had.
4 Q. And what kind of involvement did you have
5 with employees as the division chief?
6 A. So I oversaw all of the day-to-day operations
7 of the Fire Station, including interacting with all of
8 the employees at various ranges from training to
9 corrective action to coaching and counseling to any
10 number of things.
11 Q. While you were working for the Quartzite Fire
12 Department, were you overlapping with another job?
13 A. Yes, I was. I was -- I went to work with
14 Petroleum Helicopter Corporation. It was originally
15 Samaritan Air Evac, owned by the Samaritan company. It
16 was bought out during my tenure as a flight paramedic.
17 I worked for a couple of years as a flight paramedic
18 and decided to kind of move out of that industry.
19 Q. Helicopters too risky?
20 A. Helicopters are pretty risky.
21 Q. When you left the Quartzsite Fire Department,
22 what was your next position?
23 A. I kind of went up the river a little ways and
24 was looking for a position that was a little less
25 intense than every day seven days a week, 365 days a
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1 year, kind of oversight of a small department. I went
2 and became an EMS captain with the Buckskin Fire
3 Department.
4 Q. And what does an EMS captain do?
5 A. So I'm the person that sits right seat in the
6 front of the engine and directs the other crew members
7 as we respond on calls and some fires. I oversee the
8 day-to-day operations of that station, training,
9 training needs, complaints, issues, anything that comes
10 up.
11 Q. And you left Buckskin when?
12 A. In 2002.
13 Q. And just for those of us not intimately
14 familiar with Western Arizona, where is Buckskin? Is
15 that in Arizona?
16 A. That is in Arizona. It's on the Colorado
17 River.
18 Q. Okay. And north of Havasu?
19 A. North of Parker, Arizona and south of Lake
20 Havasu, kind of in between.
21 Q. Okay. After the Buckskin Fire Department,
22 did you go back to paramedicine?
23 A. I was a paramedic at the time.
24 Q. Okay.
25 A. I was currently still working as a paramedic
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1 captain, and at that time I went back to work private
2 ambulance on the side, as many firefighters do and
3 paramedics do. We moonlight doing other jobs, so...
4 Q. So while you were working for Buckskin, you
5 were also working for who?
6 A. River Medical.
7 Q. So back to River Medical?
8 A. Back to River Medical.
9 Q. Okay.
10 A. Small area, not a lot of places to work.
11 Q. Okay. And after you left Buckskin, you
12 worked just for River Medical for a while?
13 A. I went back to River Medical. I was
14 offered -- I was torn between promoting on and going up
15 with -- I tested with Lake Havasu City Fire and got on
16 their list, but had an opportunity to go back to the
17 private sector. I was 42 years old and competing with
18 20-somethings, and I felt it was a better move for me
19 to look at maybe going back to private sector. It was
20 a much more lucrative endeavor at the time.
21 Q. Than working for a small rural Fire District?
22 A. Yes.
23 Q. So you went into a management position?
24 A. I went into a management position. I oversaw
25 operations for La Paz County.
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1 Q. And this is with River Medical still?
2 A. With River Medical.
3 Q. Okay.
4 A. It's about 4,500 square miles of dirt, with
5 some sparsely inhabited areas.
6 Q. So your assuming managerial duties
7 above/beyond moonlighting as a paramedic with River
8 Medical started in what year?
9 A. It started, if you scroll on my --
10 Q. Yeah, feel free to grab the mouse there. I
11 don't expect you to have all the dates memorized.
12 A. Thank God.
13 In 2004.
14 Q. And as an area manager for La Paz County, the
15 La Paz County part of River Medical's operation, can
16 you tell the judge on a day-to-day basis what you would
17 be doing?
18 A. Yeah, day-to-day operations, interacting with
19 employees, customers, Fire Districts, municipal Fire
20 Departments, air ambulance companies, the hospital,
21 prehospital care coordinators, any number of things
22 that went on with the employees.
23 We only, roughly, had 40 or so employees at
24 the time down there. So most of my time was consumed
25 with dealing with our customers and really just my
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1 involvement with them and then some of the many
2 committees that are involved with being in that kind of
3 a small area.
4 Q. And that was ambulance work?
5 A. That was all ambulance work.
6 Q. Okay. Would you have been involved in policy
7 decisions?
8 A. I was.
9 Q. At the time you went to work for River
10 Medical, Inc. in a managerial role as opposed to
11 straight paramedic moonlighting, who owned River
12 Medical, Inc.?
13 A. River Medical, Inc. was owned by the Fotis,
14 and the spelling is F-O-T-I. It was a mother and two
15 brothers.
16 Q. So mom and bro as opposed to mom and pop?
17 A. Mom and bro.
18 Q. Okay. And did that eventually change?
19 A. It did.
20 Q. Tell us about that.
21 A. In 2008 the company was acquired by American
22 Medical Response.
23 Q. And when it was acquired by American Medical
24 Response, did your job description and duties change?
25 A. Yes. I applied for the position of general
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1 manager to run the Arizona operation at the time, which
2 was only River Medical. I took over that position.
3 Shortly after I took over that position, within a year,
4 I was also over our New Mexico operation, which was two
5 different business units there.
6 Q. And where is the New Mexico operation?
7 A. In Las Cruces, New Mexico, which is a
8 high-speed 911 system; and in Alamogordo, New Mexico,
9 which is a smaller rural New Mexico city. It's a 911
10 and interfacility market as well.
11 Q. What do you mean by high-speed 911?
12 A. It's a contracted. We contract with the
13 County there. There's response time parameters tied
14 into that. It was a much more unique system than I had
15 been used to dealing with before.
16 Q. Does New Mexico have a similar regulatory
17 scheme to Arizona?
18 A. It's similar. Not exact, but it is similar.
19 Q. And at some point in time, you also took on
20 oversight of Blythe, California?
21 A. Yes, ma'am. They went through a change as
22 well, and we purchased the Blythe operation, which lies
23 in Riverside County, which borders our River Medical
24 operation down by Ehrenberg, Arizona.
25 Q. So I was going to ask how California got
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1 swept in as opposed to having one of the California
2 managers oversee Blythe. Was Blythe -- was it
3 geographical proximity?
4 A. It's basically a border city, and there's
5 nothing on the other side of Blythe for 120 miles.
6 Q. On the other side, you mean the west side?
7 A. The west side of Blythe.
8 We interact back and forth with Blythe for
9 mutual aid, if they need mutual aid from us or we need
10 mutual aid from them. And we transport several of the
11 patients from Ehrenberg, Arizona into the Blythe
12 community. So we interact with Blythe and had a good
13 relationship with them.
14 Q. And tell us with the size of Blythe, urban,
15 rural, size, 911, IFT. What's going on?
16 A. It's 911 and IFT. It's a two-ambulance
17 operation. Its main populous is two State Prisons. So
18 most of the folks that live in the Blythe community
19 either, you know, work or work around the prison area.
20 Q. And with AMR Maricopa entity coming online in
21 2015, how did your responsibilities change?
22 A. So through some chatting with the bosses, we
23 decided that we promoted me into New Mexico to take
24 over the now three operations in New Mexico. And the
25 Blythe division that I was responsible for went back to
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1 Riverside County, and the oversight for Blythe is
2 overseen by Riverside. And my focus was to pull back
3 and work with Mr. Kasprzyk on the Maricopa Ambulance
4 project that was put before us.
5 Q. And by Maricopa, you mean -- Maricopa
6 Ambulance project, I know all the similar words --
7 A. Right.
8 Q. -- come together. Are you talking about
9 American Medical Response of Maricopa?
10 A. Correct.
11 Q. And do you continue to also be the general
12 manager over River Medical?
13 A. Yes, ma'am. They've changed our titles now
14 to regional directors, but like-like in
15 responsibilities.
16 Q. And up through the time before AMR Maricopa
17 became an operational entity, up to that point in time
18 or before that occurred, is what I'm showing you as AMR
19 Exhibit 2B, is that a general summary of your
20 professional background?
21 A. Yes, ma'am.
22 Q. So this doesn't include the changes that went
23 into place in 2015?
24 A. No, it does not.
25 MS. FICKBOHM: Your Honor, I would move
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1 for admission of AMR-2B.
2 MR. BELANGER: No objection, Judge.
3 ALJ MIHALSKY: Okay. AMR-2B is
4 admitted.
5 BY MS. FICKBOHM:
6 Q. One thing I did want to ask you about on 2B,
7 John, is you list the professional committees you're
8 on. You've been a member of both the American and the
9 Arizona Ambulance Association since 2008, correct?
10 A. Yes, ma'am.
11 Q. And you actually had a leadership role with
12 the Arizona organization for a while?
13 A. Yes, ma'am.
14 Q. Tell me, does that give you some familiarity
15 with what's happening statewide with other entities in
16 the ambulance transport business?
17 A. I believe being members of those associations
18 helps us collaborate with other like-like entities or
19 non-like entities, either Fire Districts or
20 municipalities. So I think anytime we get the
21 opportunity to be together, we can do good
22 collaborations, build synergies between agencies.
23 Q. John, the primary purpose we have you here
24 today is to discuss how AMR Maricopa got up and running
25 once it got its CON and what it's been doing in
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1 Maricopa County since then. So let's start at the
2 beginning of that.
3 I'm showing you what's been marked as AMR-1,
4 which is already admitted into evidence. Do you
5 recognize what this is?
6 A. Yes, ma'am. It's CON 136 for the American
7 Medical Response of Maricopa.
8 Q. And what date was this issued by the
9 Director?
10 A. February 25th of 2016.
11 I'm sorry. February 25th of 2016. I'm
12 sorry.
13 MR. BELANGER: No, no, it's -- I think
14 the document speaks for itself, but I think you got the
15 expiration date, John.
16 BY MS. FICKBOHM:
17 Q. It's the one that Will Humble wrote in the
18 handwriting that's hard to read.
19 A. Oh, I'm sorry. Excuse me. It's February of
20 2015. I'm sorry.
21 Q. That would have been impossible.
22 A. Yeah, that's a little tough.
23 Q. And since issuance of this, of that initial
24 CON, was the CON reissued in an amended form?
25 A. I believe it was, yes.
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1 Q. And I'm showing you what's already been
2 admitted into evidence as AMR-18, and is this that
3 amended certificate of necessity?
4 A. I believe so. It has an August 3rd of 2015
5 date.
6 Q. And did that change any of the response or
7 arrival time criteria or the level of service?
8 A. No, ma'am.
9 Q. And in connection with issuance of AMR of
10 Maricopa's certificate of necessity, there was a
11 commitment made to the Department about interfacility
12 transport arrival times in the urgent and nonurgent
13 setting, correct?
14 A. Yes, ma'am.
15 Q. Are you aware whether anyone else in Arizona
16 has made -- well, let's break it down.
17 Prior to AMR of Maricopa making that
18 commitment through their CON, are you aware of anyone
19 else in the state ever offering to do that?
20 A. No, ma'am.
21 Q. Are you aware of any certificate of
22 necessities being issued in Arizona that contained
23 commitments to interfacility transport arrival times
24 before AMR of Maricopa?
25 A. No, not to my knowledge.
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1 Q. And since AMR of Maricopa had its CON issued
2 with that new, unique aspect, are you aware of anyone
3 else applying to have their CONs changed in a similar
4 fashion or getting their CONs changed in a similar
5 fashion, so as to add IFT arrival times?
6 A. No, ma'am.
7 Q. With regard to AMR Maricopa's entry into the
8 Maricopa market, I would like to start big picture and
9 then kind of move down. So if I'm using any terms of
10 art while we're having this discussion that have
11 specific meaning to you, please feel free to let me
12 know that in your world that's a special term and has
13 special meaning, okay?
14 A. Okay.
15 Q. Thanks.
16 How many ambulance vehicles, the trucks
17 themselves, did AMR of Maricopa start with after the
18 certificate of necessity was issued at the very end of
19 February 2015?
20 A. We started with five units.
21 Q. Okay. And how many do you have on the road
22 at any one time now?
23 A. Anywhere between 20 and 23 IFT units and
24 another 7 911 units.
25 Q. And do you currently run every single vehicle
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1 you have on the road at the same time?
2 A. No. We keep units back for reserve to send
3 units in for PMs or to get their oil.
4 Q. PM?
5 A. Their oil changed, regular routine
6 maintenance; or if a unit has an issue, we need to have
7 a backup unit to make sure it goes into the shop or
8 have a dent fixed or whatever. We always keep a
9 reserve.
10 Q. So could you summarize for us how the buildup
11 from 5 to 20 to 23 interfacility transport and 7 911
12 units in approximately, I'm going to say, a 10-month
13 period of time, how that progressed?
14 A. So one of the most important things we have
15 on the ambulance, obviously, is the personnel. We felt
16 it was important that we ramp up in 5-unit increments,
17 for several reasons. One, there's a process in getting
18 an ambulance certified by the Bureau. The rig has to
19 be stocked and that unit has to be inspected. There's
20 radios that have to go in that. We attach advanced
21 vehicle locators to all of our vehicles so the
22 dispatchers can see them moving around. There's a lot
23 to putting a unit in service.
24 So we put those in service 5 at a time, but
25 one of the most important parts was taking the time to
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1 get the employees through the application phase.
2 Unfortunately, with the way this system is set up, it's
3 very difficult to on-board 40 or so employees before
4 you have the license to operate, and it takes time to
5 do new hire orientation, verify certifications, and
6 then make sure that everybody's trained on the
7 equipment that's on your vehicle. There are some
8 varieties.
9 Q. I'm sorry. So let me just interrupt for a
10 minute and ask you, to put 5 units on the road, how
11 many employees do you need?
12 A. We did it in 40-employee blocks, and the
13 reason being some of those are part-timers; some of
14 those folks may or may not make it through the new hire
15 orientation; some decide, after they get hired, that
16 they want to go on to do other things. So we just
17 started with pretty much 40-person blocks. And we also
18 had to look at the commitment to having enough people
19 to train those folks that we brought in from other AMR
20 operations.
21 Q. So on day one of having the certificate of
22 necessity, did you have 40 employees ready to go?
23 A. We did not.
24 Q. Okay. Takes a little while to acquire that?
25 A. It does.
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1 Q. Okay. So thank you. I interrupted you. You
2 said that there were -- you ramped up in 5-unit
3 increments for a variety of reasons. One was the need
4 to get the units properly put together, certified, and
5 then to get your 40 employees ready to go per 5-unit
6 cluster.
7 A. Right.
8 Q. What else?
9 A. The other thing that we wanted to make sure
10 that we were committed to is, you know, the Rural/Metro
11 Corporation had been operating here for a long time.
12 We know the nature of EMS workers. They tend to drift
13 from one organization to the next organization. They
14 think the grass is greener, maybe, kind of theory.
15 What we didn't want to do was degradate any
16 of the current service that was going on from the
17 Rural/Metro Corporation at the time. We knew that we
18 were going to take some of their employees, but we
19 wanted to make sure that they were still able to meet
20 their commitments on the 911 side and that the system,
21 the overall system, wasn't harmed in putting together
22 our company.
23 Q. So if you had hired 120 employees for 15
24 ambulances right out the door, do you think that would
25 have had a negative impact on the existing system?
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1 A. I think it would have given the -- I couldn't
2 speak to them, but I believe that it would have had a
3 negative impact to the system, just from having to go
4 back out and rehire those employees or try to retrain
5 enough employees to do that.
6 Q. So how did you stretch the 5 ambulances,
7 roughly 40 employees, in a training class sequence out
8 over time? Was it every month, every two months, every
9 three months?
10 A. So we did training classes every month the
11 very first three, and then after that we stretched them
12 out, because we wanted to see what the demand on the
13 system was, so, you know, how many calls were we
14 getting.
15 A private ambulance company just doesn't
16 throw 30 ambulances at the system and kind of hope they
17 stick. You want to make sure that we're receiving
18 calls, that we're doing business, that the number of
19 units meets the demand that's out there.
20 Q. And so we're talking about numbers of
21 employees and number of ambulances. Let's look at a
22 different measurement; and tell me, when you first went
23 live in Maricopa County with AMR, how many calls for
24 service were you getting, how many transports were you
25 doing, and where are you now?
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1 A. So we started off day one with two calls in a
2 24-hour period, and it started ramping up from that.
3 We're currently averaging 150 transports a day.
4 Q. Now, your certificate of necessity is for all
5 advanced life support, ALS, and basic life support,
6 BLS, calls, correct?
7 A. Yes, ma'am.
8 Q. And all ALS/BLS, does that include emergency
9 911?
10 A. It does.
11 Q. Does that include calls -- transports and
12 calls arising under contracts with municipalities, Fire
13 Districts or health care facilities?
14 A. It does.
15 Q. Does that include transports between
16 facilities, also known as IFT or interfacility
17 transports?
18 A. Yes.
19 Q. And does that include convalescent, taking
20 people from, say, a skilled nursing -- or not even a
21 skilled nursing. Say taking somebody from an assisted
22 living facility to a dialysis center --
23 A. Yes, ma'am.
24 Q. -- type calls? Okay.
25 When you entered the Maricopa County market,
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1 did you expect to receive any appreciable number of
2 911-generated calls for transports within, say, the
3 first six months?
4 A. No, we didn't.
5 Q. Why not?
6 A. We testified in court that the majority or
7 all of the current 911 contracts at the time were held
8 by the Rural/Metro Corporation or any of its
9 operations, PMT, a number of them. So we didn't feel
10 that we would get any of those. We would potentially
11 get an occasional mutual aid call from Rural/Metro or
12 one of its subsidiaries, but we didn't anticipate very
13 many at all.
14 Q. Basically, the same as we heard from Maricopa
15 Ambulance's principals when they talked about their
16 intended initial operation plan, right?
17 A. Correct.
18 Q. Did that prove to be true, the expectation
19 that there would be no significant 911 work during at
20 least the first six months, while all the existing
21 municipal contracts were in place?
22 A. Well the expectation was there, but that
23 didn't happen.
24 Q. So tell us what happened instead.
25 A. Well, what happened was we ended up about two
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1 days into the CON receiving a call from the Rural/Metro
2 Corporation and basically telling us that there was an
3 area of no man's land that was outside of their
4 certificated area, that was now inside of our
5 certificated area, that we were going to have to be
6 responsible for covering.
7 Q. And where is that area?
8 A. So, actually, it's Canyon Lake, Apache Lake.
9 You actually have to go outside of Maricopa County,
10 into Pinal County, and then back into Maricopa County
11 and climb up to the lake.
12 Q. So tell us, if you're in Central Phoenix,
13 what -- so you go to Pinal County. Tell me how you get
14 there.
15 A. Well, I've only been there once. It was
16 quite the drive. Basically, you go down by the
17 Superstitions and then you climb up. I don't have it
18 in front of me with a map, but you climb up to the
19 lake. It's, from downtown Phoenix, probably an hour,
20 hour 15, depending on traffic and weekend traffic or
21 not. It's a very narrow stretch of road.
22 Q. Okay. And so when Rural/Metro contacted you
23 and said, "Hey, our CON doesn't cover that area, but
24 since you asked to cover the whole county, yours does,"
25 did you consider saying, "Well, no, we can't go there.
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1 That's too far"?
2 A. No. It was our responsibility.
3 Q. And were there a sufficient number of
4 transports coming out of that area to allow a
5 sustainable ambulance posting anywhere nearby, say
6 within 30 minutes?
7 A. No, and to post within 30 minutes, it would
8 be probably in Pinal County, which we didn't have a
9 certificate for. And there was two pieces to that.
10 The Superstition Fire Department -- I'm not sure what
11 their name now. I think it's Superstition Fire and
12 Rescue, also did some mutual aid work up in that market
13 with Rural/Metro, and Rural/Metro was stationed in
14 Pinal County. So they were a much closer resource at
15 the time; but it was outside of their certificate, you
16 know, in fairness.
17 Q. So Rural/Metro was servicing that area that
18 nobody covered out of Pinal County?
19 A. I would assume. I don't want to speak for
20 them.
21 Q. Okay.
22 A. But I would imagine.
23 Q. So can you tell us how, when this unexpected
24 development occurred, how AMR handled it?
25 A. Well, first of all, we met. We went up and
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1 met with the Sheriff's Department up there. The
2 Sheriff's Department, Maricopa County Sheriff's
3 Department, deploys boating officers and officers up in
4 that area. Several of them, I think two or three of
5 them, are trained paramedics and also work as law
6 enforcement and paramedics.
7 So we wanted to go up and see what the need
8 was and find out, you know, how many calls for service,
9 where are they at, can we get to them. Because
10 remember, this is a very, very remote part of Maricopa.
11 When I drove up there, I was like I couldn't believe
12 it.
13 So we spoke with the Sheriff's Department and
14 the folks that were in charge up there, and they said
15 that they don't frequently get a lot of calls up there,
16 especially in the winter, ans most of their traffic is
17 on the weekends or on the holidays. It really revolves
18 around kind of the boater, the boater or recreational
19 folks during the summer.
20 They did have a little bit of traffic in the
21 winter with some snowbirds that camp in some various
22 camps, but not a lot of traffic.
23 Q. So how have -- you've done calls there?
24 A. We have done calls there.
25 Q. And as a result of doing calls there, has AMR
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1 Maricopa's 911 transport mix been as expected when it
2 applied for a certificate of necessity?
3 A. No. We had a very small bank of calls that
4 were 911, with extreme ETAs.
5 Q. That's what you ended up with?
6 A. That's what we ended up with.
7 Q. And extreme ETAs mean what?
8 A. Some of those calls can be an hour. Some of
9 them can be an hour and 50 minutes, just drive time.
10 Some of the areas are barely accessible at 5 or
11 10 miles an hour in a vehicle.
12 Q. So did you discuss with the Sheriff's
13 Department up there alternative measures that might be
14 required for people who are really critical?
15 A. So the Sheriff's Department, through their
16 interactions with the Rural/Metro Corporation, had
17 already pretty much figured out ways that -- a lot of
18 their patients are transported by helicopter up there.
19 They actually have built a landing pad at their
20 suboperation station, and the majority of the patients
21 that are critical are truly flown from that location.
22 Q. Yeah, because boating injuries can be really
23 nasty?
24 A. They can.
25 Q. So if you've got somebody that's got a
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1 significant head trauma, they need to be out there in
2 less than 30 minutes, right?
3 A. Correct.
4 Q. So those would be done via helicopter.
5 What about the holiday postings?
6 A. So we decided that because we only had a
7 limited number of resources at the time, we were only
8 deploying 5 units at the time, we discussed and did
9 post an ambulance up there at the suboperation station
10 for a period of around from 6:00 in the morning until
11 6:00 in the evening. After communicating with the
12 Sheriff's Department, they were pretty clear about this
13 is really their peak time. They get traffic coming up
14 during the day, and then as people leave, you know,
15 you're getting your alcohol-related either assaults or
16 accidents and those kind of things, so -- sorry.
17 Q. Sad.
18 A. Sad, but true.
19 So we did that during the holiday weekends,
20 really the 4th of July, Memorial Day, really some of
21 the bigger holidays.
22 Q. So when you say a suboperation station,
23 you're not talking about an AMR suboperation station,
24 are you?
25 A. No, no, no. This is Maricopa County's
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1 suboperation station there.
2 Q. Okay. And when you started doing these
3 extremely remote rural calls, did you have a healthy
4 mix of urban 911 transports to counterbalance how that
5 was going to impact your response time fractiles?
6 A. I don't think we had very many 911 calls at
7 all in the core. We might have gotten a couple from
8 Phoenix Fire, but very few.
9 Q. So obviously that has impacted your response
10 fractiles for 911 transports today?
11 A. Yes, ma'am.
12 Q. Have you recently started doing any urban 911
13 transports?
14 A. We have. In December we got the contract to
15 provide 911 services as an exclusive provider for the
16 communities of Gilbert and Queen Creek, Arizona.
17 Q. And so when you end up looking at your annual
18 reporting, will that even some of that out?
19 A. It should, yes.
20 Q. Okay. What if you can't meet your required
21 911 fractile response times come end of year one of
22 operations because of, you know, this unexpected need
23 to serve the Apache and Canyon Lake areas?
24 A. Well, I think it's incumbent on us to go back
25 and reevaluate where we're at with our deployment and
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1 build a deployment that meets our response times.
2 That's what we've agreed to in a certificate.
3 The problem with the first year of data, we
4 really don't even get to capture a full year's worth of
5 data for our renewal, because by the time the renewal
6 date is, we have to back-date that a couple of months
7 to submit that application.
8 So what the Bureau is probably getting is
9 more of a snapshot of ten months worth of response
10 versus a full year. I don't have that right in front
11 of me, but, you know, we have to get that submitted in
12 a timely manner, the Bureau has to review it, and then
13 they have to issue their renewal by the one year mark.
14 So that full year of data will be shortened.
15 Q. So this area is not in any of the Rural/Metro
16 entity, any of the Rural/Metro intervenors' CON service
17 areas?
18 A. I don't believe it is.
19 Q. Will it be in Maricopa Ambulance's if they
20 get a CON?
21 A. Based on their application, as it mirrors
22 ours, yes.
23 Q. Tell me, do you think that there's going to
24 be any sustainable way -- and I use the word
25 sustainable on purpose, because obviously there's a
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1 way. You could put an ambulance there a
2 hundred percent of the time if they grew on trees,
3 right?
4 A. Right.
5 Q. Is there any sustainable way, given the call
6 volume there, for AMR of Maricopa alone to basically
7 have a vehicle constantly posted in the Apache/Canyon
8 Lake area?
9 A. No. And even if it was posted at the first
10 lake, the Canyon Lake, Apache Lake is another
11 45 minutes away on literally a one-lane dirt road. So
12 it would still have an hour ETA. There's no
13 sustainable way to keep a unit sitting there, no.
14 Q. What about two units; one for AMR, and if
15 they got a CON, one for Maricopa Ambulance, since they
16 would have to cover it too?
17 A. No.
18 Q. So let's switch gears and talk about more
19 urban 911 transport business. I mean obviously the
20 rural Arizona/Maricopa business is important, correct?
21 A. Yes, ma'am.
22 Q. And when you look at Maricopa County in
23 general and we talk about the more rural, with a lower
24 case R, transports, are there any areas in AMR's CON
25 where it might be required to go and do a 911 transport
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1 in a not urban area that is going to be more difficult
2 to get to than this Apache and Canyon Lake area?
3 A. Well, we haven't had one as of yet. Most of
4 those are probably covered by a municipal Fire
5 Department or one of the Districts that already
6 provides ambulance services or has an ambulance
7 contract with the Rural/Metro Corporation.
8 Q. So you testified that AMR Maricopa has
9 entered into an exclusive contract with the Gilbert and
10 Queen Creek area?
11 A. Yes, ma'am.
12 Q. Okay. What is AMR doing with regard to other
13 911 transport needs in Maricopa County?
14 A. So we've met with -- when we entered the
15 market, we met with several or all of the Fire Chiefs
16 or their community leaders or the members of their
17 Council and discussed, you know, where they were
18 currently at with their provider and then where could
19 we assist going forward.
20 Since that time and since we've entered the
21 market, we have since gone back out and, you know, met
22 with those Fire Chiefs or those city leaders that want
23 to talk about, you know, where they're at with their
24 current contract, are they happy, is there anything
25 that we could do to assist in that process.
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1 Q. And as you get into the system, in particular
2 working with Gilbert and Queen Creek under contract,
3 what are you seeing insofar as the contributions that
4 AMR Maricopa can make to the 911 system?
5 A. Well, it's kind of an interesting process,
6 and I mean years ago everything was about throwing out
7 an RFP. Everybody wanted an RFP and we had multiple
8 bidders. And if you look across the country, sometimes
9 the lowest bidder always isn't the one that you really
10 want, because they maybe either don't know the full
11 scope of the system that they're bidding on or it's
12 just not the right fit.
13 We kind of went into this with a new
14 philosophy, and that new philosophy is to meet with the
15 individual agencies, see what their needs are, and then
16 build a unique system around their needs. Not always
17 about their wants, but really how do you build a unique
18 synergistic relationship and a strategic partnership
19 that allows you to meld that into their community. And
20 that seems to work good, and that becomes a living
21 document that you use going forward to start the
22 contract and then to work your way through it.
23 Q. So when you talk about old-school RFP, give
24 me an example.
25 A. So Peoria Fire puts out an RFP for we want 10
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1 ambulances, we want them equipped this way, we want
2 them this color, we want you to have this response
3 time, we want this, this and this.
4 Q. And why is that a bad thing? That's what
5 they want.
6 A. Yeah, it's what they want; but it may not be
7 what the system really needs, which makes for a bad
8 partnership, because then you commit to that kind of an
9 RFP and it's not sustainable from a financial
10 standpoint and/or the response times were not -- you
11 know, were not within what you could truly respond to.
12 It's not the right way to build systems anymore. It's
13 about strategic partnerships between those two to build
14 those partnerships.
15 Q. And does AMR have -- AMR Maricopa have access
16 to any national AMR resources that are unique and
17 beneficial in putting together those types of strategic
18 alliances?
19 A. So the first thing we do is meet with the
20 customer, really, and kind of ask them what their needs
21 are. The second thing is we engage with, you know,
22 folks like Jim, who do deployment, and then nationally,
23 Doug Jones and his group, which is part of our national
24 deployment team. They build a series of heat maps and
25 response maps around gathering data from that agency.
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1 So the Fire Department sends us CAD data that
2 shows where their clusters of calls are and what their
3 response times are. And then from that, we sit down
4 and can build a model that can work alongside them to
5 better provide service to the communities. I can give
6 you a good example.
7 Q. Okay.
8 A. So Gilbert, one of the things that Gilbert
9 and Queen Creek are both doing is a system called
10 priority dispatching.
11 Q. Priority?
12 A. Priority dispatching. So a dispatcher
13 receives the call. He or she takes that call, and
14 based on a series of questions, figures out whether
15 that call falls in a different category, as a priority
16 Code 3 call or a Code 2 call and no lights and sirens
17 or lights and sirens.
18 From there we have committed to respond with
19 an ambulance to about 7 of those calls when the Fire
20 Department is dispatched. So the way it works is a
21 call comes in. The dispatcher punches out a fire truck
22 to an incident. Well, currently, right now, if that
23 incident is a fall victim, our ambulance would not get
24 punched out with that, to that incident, because we
25 know that on a majority of fall victims, about 40 or
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1 50 percent of those results in a nontransport. So what
2 that does is leaves a resource available in that
3 geographic first-do area to respond to the next, more
4 critical call.
5 So what it's done is, by doing that, is
6 you've doubled your resources. So there's a paramedic
7 on that ambulance. There's a paramedic on that engine.
8 Now, if that came out as, we'll call it, a
9 pediatric code arrest or a baby not breathing, then the
10 ambulance and the fire truck would be dispatched to
11 that simultaneously, as a high-acuity call. It's a
12 better utilization of resources.
13 Q. And that's something you've worked on with
14 Queen Creek and Gilbert?
15 A. And Gilbert.
16 Q. And that's under a contract that's been
17 approved by the Bureau of Emergency Medical Services?
18 A. It has; and, yes, it is.
19 Q. I just want to back up for a second. When
20 you were talking about AMR's resources through Doug
21 Jones and his group, you mentioned heat maps?
22 A. Heat maps.
23 Q. And can you tell us what heat maps are?
24 A. Well, they're very colorful, and I love
25 colors. But it basically takes the data that comes out
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1 of the CAD and it builds on a map where a large percent
2 of your call volumes are, either by a Fire Station
3 location or by, really, the demographics. And you can
4 just see it on a map. A highly red area would be a
5 high concentration of calls, orange would be a little
6 less, and green would go out.
7 And what that does is allows you to predict,
8 really, where the majority of your calls are going to
9 be. And if you looked at a heat map, for example, of
10 Gilbert when we did one, you would see a series of Fire
11 Stations built around the middle of those very highly
12 dense population areas or call volume areas.
13 Q. And Doug Jones and his people, they help
14 predict resource utilization?
15 A. They do.
16 Q. And so do you then take that information back
17 to the Fire District municipality you're talking with
18 and say, "Look, our national people predict A, B, C"?
19 A. Uh-huh. We met face-to-face with the Gilbert
20 folks on what we felt the deployment of those units
21 were, because you can have all the data in the world
22 and the data guys will probably tell you there's some
23 real life, on-the-scene, day-to-day that can vary that
24 and either a drive time or, you know, there's a street
25 that doesn't go through and it could cause a delay.
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1 There's a number of reasons.
2 So you need real live input from the
3 providers that do it every day. So we did that. We
4 met face-to-face and said, "Does this look feasible,"
5 and that's where we deployed from there.
6 Q. So Gilbert and Queen Creek are in the process
7 of getting certificate of necessities of their own,
8 correct?
9 A. Yes, ma'am.
10 Q. So what's that going to mean going forward
11 insofar as their relationship with American Medical
12 Response of Maricopa?
13 A. We see them being able to provide some of
14 their transport as a good thing. We eventually would
15 like to see them work into a position where they can
16 augment the system in high-volume times of the day or
17 if there was an overload or in a disaster. We see that
18 as a good thing.
19 I know that they want to utilize those
20 vehicles as well for their MIH program or their mobile
21 integrated health programs or community paramedic
22 programs, but they could be very -- they could be an
23 active transport unit in the system while they're doing
24 that as well.
25 Q. Has AMR of Maricopa entered into any other
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1 agreements for service or contracts relating to 911
2 transports?
3 A. No, not currently. We have some that we're
4 working on that are close to being finalized.
5 Q. Have any been submitted to the Department for
6 review and approval?
7 A. I would have to refer to you, but I believe
8 some of those are back and forth with the Bureau at
9 currently discussions.
10 Q. Okay. And just to back up, do you think that
11 in today's modern, state-of-the-art EMS science,
12 there's a one size fits all RFP?
13 A. No, you know, it's not. And, you know, I
14 will tell you, honestly, when I first came to the
15 valley, I thought it was really just a big giant system
16 and all the cities all meld together. But when you
17 really dig in and meet with the individual customer or
18 partner or Fire Chief, they all have different
19 demographics. They all have different needs or wants
20 or requests. I wouldn't even say wants. More
21 requests.
22 So they're all unique. You've seen one
23 ambulance company, you've seen one ambulance company or
24 system.
25 Q. So I think what I heard you say, and tell me
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1 if this is wrong, is that you're engaging in more
2 negotiated back-and-forth discussions with these
3 municipalities and Fire Districts than simply
4 responding to an RFP?
5 A. Yes, ma'am. We feel that's the better way to
6 build a system approach to take care of the patients.
7 Q. You heard testimony in Maricopa Ambulance's
8 case-in-chief that some Fire Districts and
9 municipalities have expressed concern regarding options
10 available for 911 service and the level of service
11 historically provided.
12 When AMR Maricopa was evaluating its entry
13 into the system, did you hear similar concerns?
14 A. We did.
15 Q. And have you -- and then as you got the CON
16 and prepared to enter the market and you were out
17 talking to people, did you hear similar concerns?
18 A. We did.
19 Q. And what has AMR done to sort of flesh those
20 specific concerns out and see what AMR can do to help
21 address them?
22 A. Well, let me back up a little bit, because I
23 think a large percent of the concerns revolved around
24 the current financial state of the company at the time.
25 We --
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1 Q. State of --
2 A. Of Rural/Metro. I'm sorry.
3 And that's where a large percent of the
4 concerns for -- that the departments or the City
5 officials were worried about.
6 And what was the second part of your
7 question?
8 Q. Oh, so I was asking what you did to flesh
9 those concerns out and see what AMR can do to help?
10 A. So we really just -- it was about coming in
11 and meeting with the customer, finding out what the
12 concerns was; was it response times; was it, you know,
13 equipment issues. And then just start to work our way
14 through, you know, what the new model in the valley of
15 the metroplex here was going to look like as we went
16 forward.
17 Q. And is that something that you've finished
18 doing?
19 A. No. This is going to be an ongoing process.
20 You know, there's several contracts out there that are
21 coming up for renewal or sunsetting out, that we're,
22 you know, having to go back and we're looking through
23 all of those.
24 Q. Let's switch gears and talk about
25 interfacility transports and contracts, contract
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1 service.
2 When AMR Maricopa was looking at entering the
3 local market, did you also hear concerns from users of
4 these services --
5 A. We did.
6 Q. -- about historically available services and
7 existing services?
8 A. We did.
9 Q. And what was the general nature of the
10 concern expressed?
11 And I'm talking about even as recently as
12 after AMR received its CON in February, when you went
13 out and started meeting and talking to people in March,
14 April, May. You know, what were the concerns being
15 expressed to you by interfacility transport users?
16 A. Most of the concerns revolved around ETAs.
17 Q. And ETA being?
18 A. Just your estimated time of arrival, just
19 getting an ambulance on scene.
20 Q. Okay. And what -- overall, what has AMR's
21 goal and objective been with regard to entering the
22 Maricopa County market?
23 A. I think our goal was to kind of plug the
24 system, to make sure that there was enough resources in
25 the marketplace to fill that gap. I mean we've been
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1 pretty stagnant right now with this 20, 23 units, that
2 kind of unmet need out there. We wanted to make sure
3 that we were able to get resources to scenes in a
4 timely manner and commit to our CON response times.
5 Q. So what does stagnant tell you?
6 A. That we've filled that void. That there was
7 a number of calls that were out there that had long
8 ETAs, and we've kind of filled the void that was in the
9 system.
10 Q. So with regard to philosophy and customer
11 service, what's AMR's overall goal and objective?
12 A. Well, one other thing that we heard was the
13 timeliness of getting back on either a complaint or an
14 issue. So one of the things we've done is we've
15 embedded what we call quality assurance folks into some
16 of the major hospitals here to deal with day-to-day
17 issues that come up in regards to interfacility
18 transports; you know, "You left my mom's glasses at a
19 facility" or "Hey, I'm having problems getting this
20 transport set up."
21 Whatever those issues are, those people are
22 imbedded into those facilities to deal with those
23 day-to-day and deal with just the quality assurance
24 part of our business.
25 Q. And tell me what large IFT user facilities
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1 that we're talking about.
2 A. The Honor health care system, the Dignity
3 health care system, and soon the Banner health care
4 system.
5 Q. So the Banner is in the works?
6 A. Yes, ma'am.
7 Q. What about the Abrazo?
8 A. Abrazo. I'm not sure if we're embedded there
9 or not.
10 Q. You talked about people that have complaints,
11 whether it's you lost my mother's glasses to I don't
12 think this bill is right to I don't think you -- your
13 people were rude.
14 Was there any systemic concern in that regard
15 when AMR of Maricopa entered the market?
16 A. When we entered the market, there was some
17 concerns that those things weren't on a timely manner
18 being addressed.
19 Q. And so what has AMR done about that?
20 A. We're pretty much to the point where we're
21 turning most of these around in a very short period of
22 time, usually within hours of the incident, if not
23 within 24 hours of the incident. Sometimes it takes
24 investigation; you know, you have to dig back into CAD
25 records or listen to, you know, tape-recorded phone
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1 calls of, you know, the client calling in. It could be
2 a billing issue, and that gets diverted off to billing,
3 who has the same, you know, responsibility of going
4 through and digging into the complaint.
5 Q. And are complaints like that necessarily a
6 sign of bad service, or are they, you know, uncommon?
7 A. No, I don't think they're uncommon for any
8 ambulance company. We don't get a lot of them, but
9 every company gets them. When you're transporting the
10 number of patients that you are, every company's going
11 to get those kind of things. And they, lots of times,
12 start off as a complaint, or not even a complaint; just
13 an issue. So I don't want to use the word complaint on
14 all of them.
15 Q. And let me ask you. So has AMR of Maricopa
16 entered into any contracts or agreements for
17 interfacility services?
18 A. We have entered into some, I will call them
19 service agreements, with the Dignity facilities, the
20 HonorHealth facilities.
21 Q. And are these agreements for service that are
22 approved by the Bureau of Emergency Medical Services?
23 A. Yes, ma'am.
24 Q. And do they involve any kind of a price
25 reduction off of the rates and charges listed on AMR of
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1 Maricopa's CON?
2 A. They do.
3 Q. And what reduction has been allowed?
4 A. Well, I believe they're 30 percent.
5 Q. With regard to service agreements with major
6 IFT users, are these being done under the one size fits
7 all RFP or the system that perhaps has been the
8 historic norm across the country, or is AMR doing
9 something different?
10 A. Once again, we meet with the customer and see
11 where their pinch points are and see which, you know,
12 facilities. And the larger facilities such as a
13 Dignity or Honor that has multiple facilities, they may
14 have one particular facility or a couple of facilities
15 that they have a harder time with certain transports or
16 they need a specialized piece of equipment at a certain
17 facility that we try to go in and work with them on
18 those.
19 They're pretty customized. We send out the
20 a la carte menu and see what they need.
21 Q. Okay. And this involves a certain amount of
22 back and forth?
23 A. A lot of back and forth.
24 Q. You used the phrase -- and, again, you talk
25 in your language and me talk in mine -- pinch points?
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1 A. Areas where they have problems.
2 Q. Okay. Give us an example.
3 A. Sonoran, for example. I think Mr. Wolfe
4 spoke about it. It's a very north, northerly located
5 freestanding emergency room. They were having problems
6 moving patients rapidly that were emergent. A lot of
7 those patients came out of there on a ventilator with
8 drips hanging. So they needed some specialized
9 equipment and they needed a better response time.
10 That's just one example.
11 Q. And so how has AMR stepped in to help solve
12 that problem?
13 A. Well, that particular facility, we placed an
14 ambulance there with those required pieces of equipment
15 and then made that a priority to backfill that in the
16 case that they, you know, got pulled out.
17 Q. So you said a ventilator. Let's talk for a
18 minute about that. Are ventilators required equipment
19 on ambulances in Arizona?
20 A. No, they're not.
21 Q. And how many units is AMR currently running
22 with ventilators?
23 A. I knew you were going to ask me that.
24 I believe between 6 and 8 of them have
25 ventilators on them currently.
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1 Q. And so you're placing one near Sonoran, and
2 what are you doing with the rest?
3 A. We strategically place those around. You'll
4 find -- through the deployment you'll find specific
5 facilities where there's maybe long-term vent patients
6 that are coming out of rehab, going for specialized
7 treatments, where we utilize ventilators more often
8 than not. So we've strategically located those and
9 where they're at.
10 Q. And is that -- tell us how not having a
11 ventilator on the ambulance impacts ambulance response
12 time.
13 A. Well, if you had to literally drive across
14 the valley, depending on the time of the day, to move a
15 piece of equipment, you can delay the transport by an
16 hour or more getting a specialized piece of equipment
17 delivered.
18 Realizing that ventilators cost anywhere
19 from, you know, 10 to $16,000 apiece, it doesn't make
20 it cost-effective to put them on every unit, but really
21 just kind of specializing them and strategically locate
22 them.
23 Q. Tell me what other kinds of specialized
24 equipment AMR of Maricopa identified a need to put on
25 at least some of its ambulance in order to cut down on
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1 IFT delayed arrivals.
2 A. We did place IV pumps on all of the units, so
3 all 23 of the units or 20 to 23 of the units that are
4 deployed come with a three-chamber IV pump to monitor
5 drips. That just helps facilitate ease of moving
6 patients with drips. They're pretty common in the IFT
7 world. There's a whole host of them that, by rule, a
8 paramedic has got to have on a pump. So we deployed
9 those.
10 Q. And is that IV pump, is that something that's
11 required by the State to be on every ambulance?
12 A. It's not required, but it's required if
13 you're going to be taking certain medications; it's
14 required to do that.
15 Now, there are ways to get around it or meet
16 the rule, but we didn't feel that was as adequate as
17 providing the pump. The pumps are very expensive.
18 They're 3, $4,000 apiece. But by the letter of the
19 law, you could actually put a filtered drip system on
20 them for two bucks, but a lot of the medications that
21 we're dripping in can be altered in transport, so
22 that's why a pump is very important. And those
23 medications can be pretty severe if they're not
24 maintained.
25 Q. What about the type of stretchers that AMR of
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1 Maricopa is using; baseline compliant with ADHS
2 requirements or above and beyond?
3 A. We went above and beyond. We dispatched to
4 all of the units Power-PRO stretchers. They're about
5 14, $15,000 apiece, depending on the model you get.
6 They're couple of 700 pounds. They're hydraulic.
7 There's a couple of reasons we've done that across the
8 venue. There's an ease on our employees for lifting
9 the patients, doesn't allow them to bend down; and it
10 also allows them to bring the bed from the ground level
11 up hydraulically, instead of actually lifting it.
12 Along with that, we deployed six of our units
13 with what we call a bari wing. They're a side rail
14 that allows for a larger patient to be placed on them,
15 makes it safer and more comfortable. It's much more
16 ergonomically set for a patient with a very large
17 girth. Lots of times we heard, in talking to our
18 customers, that a patient that may weigh 300 pounds or
19 more requires a special kind of stretcher called a
20 bariatric stretcher. We found that these stretchers
21 made us more capable of, one, a quicker response; and,
22 two, a much more comfortable ride for the patient and
23 much safer ride for the patient.
24 Q. Tell us how having that equipment available
25 makes for a quicker response.
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1 A. Well, once again, if you're waiting for a
2 bari unit, a bariatric truck is a very specialized
3 piece of equipment, and you don't have ten of those in
4 the valley running around. They're expensive to put
5 together. They're cumbersome. It takes a lot of
6 people to work them.
7 We do have one of those units capable of
8 transporting a patient up to 1,500 pounds. Comes with
9 a wench system and ramps. It's a big process.
10 So if they're strategically placed around, we
11 can take the information gathered by the dispatcher and
12 deploy that unit much quicker than we can deploy just a
13 bariatric unit from across the valley.
14 Q. Understood.
15 So what about using ALS crews versus BLS
16 crews and whether you identified any way to cut down on
17 response times that way?
18 A. Well, one of the issues we heard from some of
19 our customers, you know, prior to us entering the
20 market was that, you know, they would request a unit
21 and an ALS unit would respond to their hospital to pick
22 up Patient A. And when the crew arrived there, that
23 patient was not an ALS-level patient, but a BLS-level
24 patient. So now they would pretty much cancel off that
25 call and request a BLS-level unit. That's stretching
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1 out, you know, the patient's transport.
2 We felt, at least initially, that we would
3 come into the market with ALS units only to prevent
4 that. So if an ALS unit is dispatched to a BLS call,
5 they handle that call no matter what the level is. It
6 just makes our whole citywide deployment much easier,
7 because the closest unit goes to the call no matter
8 what their level is. And currently that's what we've
9 deployed.
10 Q. Can you summarize for us where AMR Maricopa
11 is now with regard to its entry in the market and what
12 you see happening over the next three months, six
13 months, forward?
14 A. Well, I think we've kind of reached the point
15 on our deployment where we're meeting the needs of our
16 clients and customers out there; that we've filled a
17 gap that was there between the agencies.
18 Obviously with the merger of the companies,
19 we are now, on a daily basis, probably a hundred times
20 a day, collaborating between communication centers on
21 getting the right resource to the patient quicker. And
22 hopefully, you know, by the end of February, we'll be
23 actually dispatched out of the same building to even
24 make that a quicker process.
25 I think obviously we're continuing to monitor
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1 and meet with customers in regards to fire and 911
2 contracts around the valley. We currently have several
3 of those that we're in communications with or responded
4 to requests for information on those. And we're
5 currently involved with talks with several communities
6 on contracts, 911 contracts, where they have contracts
7 coming up for renewal in, let's say, 2017 that were out
8 there with the Rural/Metro Corporation.
9 Q. What about are you intending to continue --
10 well, let's say assuming that the same number of the
11 Rural/Metro entity ambulances remain on the road,
12 regardless of whether that's under AMR's operation if
13 the CON transfer is ultimately approved by the Director
14 or other; but assuming you've got the same number, do
15 you anticipate adding -- continuing to add blocks of 5
16 ambulances by AMR Maricopa?
17 A. Not at this time. What we really want to do
18 is get in and dig into all of the operations and figure
19 out what the global deployment is needed for the
20 valley. I think we will find -- I love the word --
21 synergistic avenues to better deploy all of the
22 resources under both the Rural/Metro Corp.'s and all of
23 their subsidiaries and the AMR pieces. They have some
24 pieces and parts that AMR don't have, such as BLS
25 units, critical care, nurse units. So they have some
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1 resources that once we have a real global idea of what
2 all that looks like, I think that we can deploy even
3 better than we currently do today.
4 Q. You used the word stagnant in talking about
5 the IFT transports. What did that mean?
6 A. Well, I spoke earlier about the fact that you
7 don't throw 30 units at the board and hope that you get
8 the amount of volume to fill those units. You really
9 look at the amount of volume coming in the door, and
10 then you blend the units to meet that volume. And
11 we've got the units at a place where we're meeting the
12 volume that's coming in the door. So I don't -- we're
13 kind of in this kind of limbo phase right now of where
14 to go from there.
15 Q. And does AMR Maricopa, including through its
16 parent, AMR the national organization, have access to
17 the resources necessary to bump the available
18 ambulances and employees in Maricopa County if that
19 stagnated situation changes?
20 A. So to answer that question, I've added four
21 new units to the system as far as brought the metal,
22 the physical ambulance in place, and we're going
23 through the inspection process right now. And we're
24 running a new hire orientation currently, with the
25 anticipation if there is a need, that we have that.
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1 Those folks are being put into part-time status.
2 And there's attrition. There's always
3 attrition in our world, as the Fire Departments are
4 starting to hire, and we're seeing a large number of
5 employees now going to other industries. Both EMTs and
6 paramedics are going to casinos to go to work. They're
7 going to large industrial complexes as paramedics or
8 flight world.
9 So we lose employees just like everybody else
10 does. So we are kind of constantly backfilling as we
11 go.
12 MS. FICKBOHM: Thank you, John. I don't
13 have any other questions.
14 MR. ROSENFELD: I have no questions,
15 Your Honor. Thank you.
16 THE WITNESS: Oh, thank God.
17 ALJ MIHALSKY: Thank you.
18 Mr. Belanger, Mr. Bennett?
19 MR. BELANGER: Yeah, Your Honor.
20 ALJ MIHALSKY: Okay.
21
22 CROSS-EXAMINATION
23 BY MR. BELANGER:
24 Q. Hi, Mr. Valentine. How are you doing?
25 A. I'm doing well. You sound like you have a
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1 cold.
2 Q. Yeah. I'm actually coming out of it.
3 So let's talk a little bit about the transfer
4 process.
5 A. Okay.
6 Q. When was AMR's application to transfer the
7 Rural/Metro CONs? That was filed in October of 2015?
8 A. I believe so, yes.
9 Q. And then the hearing on the transfer -- I
10 don't know if the ALJ knows this. Let's kind of bring
11 her up to speed on it. -- was held, I believe it was --
12 I may have the date wrong, but December 15th, is
13 that -- somewhere thereabouts?
14 MS. FICKBOHM: 16th.
15 THE WITNESS: 16th.
16 BY MR. BELANGER:
17 Q. December 16th?
18 A. Yes.
19 Q. And there's been a recommendation from the
20 ALJ, I think it was Administrative Law Judge Shedden,
21 to approve the transfer?
22 A. That's my understanding, yes.
23 Q. And so they're just, at this point, just
24 awaiting the Director's decision on approving the
25 transfer of Rural/Metro CON's to --
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1 A. Envision.
2 Q. To Envision, okay.
3 A. Yes.
4 Q. Okay. And then there would be a denomination
5 of -- it might be the same Rural/Metro company,
6 Southwest Ambulance dba AMR or an AMR entity or
7 something to that effect?
8 A. I believe that's the second phase of the
9 process, yes.
10 Q. Okay. And we can get into that in a little
11 bit.
12 A couple of things that you talked about that
13 I thought were kind of interesting.
14 So it's been your experience -- you've
15 obviously been involved in this industry for a long
16 period of time. We've met each other in the Golden
17 Valley --
18 A. Right.
19 Q. -- is that fair enough? Right.
20 And so you've seen a fair amount of change in
21 the health care industry since you've kind of come on
22 board as an EMT?
23 A. Yes.
24 Q. And particularly in the last several years,
25 it's been a rapidly developing area in terms of the
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1 changes in the health care industry; is that fair to
2 say as a general matter?
3 A. That's fair.
4 Q. And so one of the things that -- when AMR
5 Maricopa received its CON for the Maricopa area, one of
6 the things that you did and other people with AMR
7 Maricopa, you went out into the community to talk to
8 potential customers regarding what their needs were in
9 this rapidly changing health care context --
10 A. Yes.
11 Q. -- fair enough?
12 And that's an intelligent approach, in terms
13 of Ms. Fickbohm was asking you questions about the old
14 RFP process, but given the environment today, I would
15 think you would think it's an intelligent approach to
16 go speak to your customers regarding what their needs
17 are, so that if an interfacility contract comes up for
18 bid, you have had a full dialogue with them regarding
19 what kind of equipment they might need, what their
20 needs would be, response times, and things along those
21 lines?
22 A. That's fair.
23 Q. And you can fashion your response -- based on
24 that dialogue, you can fashion your response to what
25 their needs are and what they think they might want in
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1 a contract with AMR Maricopa?
2 A. That's fair.
3 Q. But at the same time, I think one of the
4 things I think you talked about is that just because a
5 customer wants something doesn't mean that they're
6 going to get it, because it might not be
7 cost-effective, given AMR Maricopa's approach to
8 responding to that contract?
9 A. Go ahead.
10 Q. For example, they might want a piece of
11 equipment, and I think -- I don't know how to pronounce
12 his last name. Glenn.
13 A. Kasprzyk.
14 Q. Kasprzyk mentioned -- he testified in a prior
15 hearing regarding the widget; that a customer might
16 want a widget, but it doesn't really make sense to have
17 that in your contract. And so you would have a
18 negotiation with the customer regarding we're not going
19 to put that piece of equipment on our ambulance because
20 it doesn't make sense?
21 A. Usually that's driven by medicine.
22 Q. Right.
23 A. Like that widget has no data support, it's
24 better for the patient or --
25 Q. There's no best practices data, empirical
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1 data, to support the viability of that piece of
2 equipment?
3 A. That piece of equipment, right.
4 Q. So, in other words, to put a $15,000 piece of
5 equipment on an ambulance, when the medical data
6 suggests that maybe 1 in every 700 transports it would
7 be used, doesn't make sense?
8 A. That's fair.
9 Q. I think you indicated that at present AMR
10 Maricopa has a 911 contract with Gilbert and Queen
11 Creek?
12 A. Yes.
13 Q. I don't know if Gilbert/Queen Creek is the
14 appropriate entity name. I assume it's --
15 A. Yeah, it's the Town of Gilbert and the Town
16 of Queen Creek.
17 Q. Was that a new contract, or was that a
18 contract that was previously held by Rural/Metro that
19 AMR Maricopa then bid on?
20 A. Rural/Metro was currently in a month-to-month
21 contract with them, and it was part of a regional
22 contract. Those two entities were part of a regional
23 contract with AJ or Apache Junction, that's now
24 Superstition Medical Rescue or something, and Mesa.
25 And Gilbert and Queen Creek had a -- they wanted to
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1 have their own contract, basically.
2 Q. And so do you know -- and you may not. -- did
3 they entertain bids from Rural/Metro at the time, or
4 was that a single source?
5 A. I think they had dialogue with Rural/Metro,
6 and that's where that dialogue stopped, and we picked
7 up dialogue from there.
8 Rural/Metro was still providing them service,
9 but there was a month-to-month contract, I believe.
10 Q. When AMR Maricopa initially applied for a
11 CON, I think their proposed number of transports for
12 the first year were 28,973 transports. Am I roughly --
13 A. You're pretty close, yeah, right.
14 Q. Pretty close.
15 And I think you testified that on the day
16 that an entity such as AMR Maricopa receives its CON,
17 you're not going to have a full allotment of ambulances
18 on the ground, like 23 ambulances, prepared to do
19 28,000 transports?
20 A. Well, it's my understanding that you couldn't
21 even get them inspected until you had a certificate to
22 do so and then pay your registration fees and go
23 through the inspection process. We couldn't -- at the
24 time, we couldn't pre do that.
25 Q. Right. And not only that, but the initial
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1 application for a CON, when it's anticipating that
2 there will be 28,000 -- in excess of 28,000 transports,
3 would you agree with me that it only makes business
4 sense to not deploy a number of ambulances and
5 employees until you actually have an identifiable
6 source of transports that those units can actually
7 service?
8 In other words, you're not going to put
9 25 ambulances on the road if you only have an
10 annualized basis of 1,600 calls or 2,000 calls?
11 A. Correct, with the caveat, though, that you
12 have to build up to a point where you can meet your
13 response times.
14 Q. Right. And that kind of goes to the question
15 in some respects. You have obligations under your CON
16 regarding 911 response times. You've actually -- AMR
17 Maricopa has interfacility response times that are
18 dedicated.
19 Ms. Fickbohm asked you questions about that
20 Canyon Lake/Apache Lake area. I, frankly, think you
21 understated inaccessibility, in some respects, if
22 you've ever driven through to Lake Roosevelt.
23 A. One time.
24 Q. You're familiar with the concept of
25 cherry-picking?
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1 A. I've heard it.
2 Q. Right. And so that would be the antithesis
3 of cherry-picking if that was -- obviously AMR Maricopa
4 has a CON to service the approximately 9,000 miles that
5 are encompassed in its CON, and you have a duty to
6 respond to every call that's presented to you within
7 that CON?
8 A. Yes.
9 Q. Right. And so there are going to be
10 situations, and the Canyon Lake/Apache Lake scenario is
11 one of them, where if you were cherry-picking routes to
12 buttress your bottom line, you wouldn't necessarily
13 pick the Canyon Lake/Apache Lake route?
14 A. No.
15 Q. Right. And so -- and after Rural/Metro made
16 it clear to you that they didn't have a CON in that
17 area and that AMR Maricopa did, did they -- did you
18 somehow work out an arrangement to where they were
19 sending ambulances into that area?
20 A. We did. We did. We now have the certificate
21 to provide the service. We would work pretty much hand
22 in hand with them, if they had a closer response to a
23 severe call. They sometimes had resources there.
24 Sometimes we would deploy both resources until we could
25 figure out which one had a closer resource.
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1 Q. And was that pursuant to a mutual aid or a
2 backup agreement?
3 A. A backup agreement, a mutual aid agreement.
4 Q. We've talked about this before. Mutual aid
5 and backup agreements are not atypical among ground
6 ambulance service providers?
7 A. They're very common.
8 Q. They're very common. And, in fact, probably
9 the Department would be pretty upset if there was a
10 ground ambulance service provider that refused to enter
11 into a mutual aid agreement or a backup provision?
12 A. I believe it's in, actually, one of the
13 rules, that you're supposed to obtain mutual aid
14 agreements as needed.
15 Q. At the time that you received -- Maricopa
16 Ambulance received its CON and became aware of the fact
17 that it was now going to be responsible for this Canyon
18 Lake/Apache Lake area, if you know, did Envision
19 Healthcare -- was it already in the process of
20 acquiring Rural/Metro; do you know?
21 A. I don't.
22 MS. FICKBOHM: Jim, I'm just going to
23 interrupt for a second. I think you're making the same
24 mistake. You said Maricopa Ambulance. It's really
25 easy to do.
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1 BY MR. BELANGER:
2 Q. Oh, did I say that? I mean AMR Maricopa. I
3 apologize.
4 A. I wasn't aware of that.
5 Q. Whether that was in the works or not, did
6 you -- did AMR Maricopa go to Rural/Metro and say,
7 "Look it, the best interest of the patient is what
8 we're concerned about. Can we not reach some
9 resolution regarding the availability of ambulances in
10 this remote area?"
11 A. Well, we talked to them about a mutual aid
12 agreement, but they didn't have a certificate to
13 provide service there. So it wouldn't be like they
14 could just place a unit in that area and respond to
15 those calls without the mutual aid agreement.
16 Q. No, there would have to be a mutual aid
17 agreement.
18 A. Right. And then that really has to go
19 through us to give permission for them to respond to
20 those areas. We didn't set up an automatic aid.
21 Q. Did you do that, though; did you set up a
22 mutual aid contract with them for that area?
23 A. We did. We sat down and talked to them
24 about, you know, closest resource kind of responses.
25 Q. You understand if Maricopa Ambulance is
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1 granted a CON, they will actually have a CON for that
2 area?
3 A. Yes.
4 Q. I assume that you would expect that -- or
5 would you, given the remoteness of that area, enter
6 into a dialogue with Maricopa Ambulance, if they were
7 awarded a CON, regarding providing service to that
8 remote area of Maricopa County?
9 A. Sure.
10 Q. Any reason to believe that they wouldn't
11 negotiate with you regarding a sustainable provision of
12 ground ambulance services to that area?
13 A. I don't see why they wouldn't engage in that.
14 Q. There's been a fair amount of discussion over
15 the course of these hearings regarding AMR Maricopa's
16 commitment in its CON regarding interfacility response
17 times.
18 A. Yes.
19 Q. You're aware of that?
20 A. Yes.
21 Q. You've been here almost every day?
22 A. Yeah. Yes, sir.
23 Q. And so -- and I'm assuming, and based on
24 testimony from you and others, that AMR Maricopa
25 believes that that is kind of an innovation in this CON
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1 marketplace in terms of putting the interfacility
2 response times into a CON; that that is, for lack of a
3 better word, a best practice?
4 A. Yes.
5 Q. Okay. And are you aware of whether the
6 Bureau or the Department has done anything to mandate
7 that interfacility transport times be contained within
8 a CON?
9 A. I don't believe they're in any other CON.
10 Q. You were here when Maricopa Ambulance said
11 that they would commit to doing interfacility transport
12 times in their CON?
13 A. I remember that.
14 Q. Let me ask you something about best
15 practices. If AMR engages in something that it
16 believes to be a best practice, for example, like
17 interfacility transports in the CON, response times, do
18 you believe that the market that is consuming ground
19 ambulance services would develop an expectation that
20 other providers would also aspire to those best
21 practices or agree to provide them?
22 A. My personal opinion?
23 Q. Yeah.
24 A. My personal opinion is, the hope is that they
25 would inspire to be at that same level.
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1 Q. And that they would aspire to be at the same
2 level of best practices. And at some point -- and
3 you've been doing this business for a while. You've
4 negotiated contracts. If a provider was not making
5 available to its customers, a ground ambulance service
6 provider was not making available to its customers,
7 best practices along the lines of AMR Maricopa, what
8 you would propose to be doing, that would be a
9 competitive advantage for AMR Maricopa; would you agree
10 with that?
11 A. It is a competitive.
12 Q. It is a competitive advantage.
13 A. Uh-huh.
14 Q. And so Ms. Fickbohm asked you questions about
15 your conversations both before and after AMR Maricopa
16 was awarded a CON regarding the customers of ground
17 ambulance services, what their needs and concerns were.
18 Do you remember that?
19 A. Yes.
20 Q. And, in fact, you've testified -- you
21 testified about that in the AMR Maricopa hearing?
22 A. Yes.
23 Q. And obviously, at least at the outset, one of
24 the concerns was that Rural/Metro, which had just filed
25 a bankruptcy or was having financial straits -- that
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1 was a concern of the customers that you spoke to, the
2 consumers of ground ambulance services?
3 A. Yes, that was a concern.
4 Q. Do you remember the line of questioning,
5 including by your own counsel, that separate and apart
6 from Rural/Metro's financial issues, that there was
7 also -- what were the other reasons that ground
8 ambulance service consumers desired another presence in
9 the market? Do you remember?
10 And I can actually refer you back to your
11 testimony or we can talk about it.
12 A. You would have to refer me back to the
13 testimony. Some of it was just ETAs.
14 Q. ETAs, and it was also -- and you've -- one of
15 the things that consumers of ground ambulance service
16 provided is they wanted to have at least an
17 alternative. They didn't want to just have one service
18 provider. Was that a comment that you heard when you
19 were out doing your due diligence regarding the CON?
20 A. I would have to refer back to it. I'm sure.
21 I'm sure. That could have been said, yes.
22 Q. Yeah, we can go back there. I'm not trying
23 to trap you.
24 A. No, I know you're not. I know. That's one
25 of the things that was said, correct.
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1 Q. One of the concerns was that they didn't want
2 to have just one service provider. They wanted to have
3 an alternative, so that if -- even using the old RFP
4 process, that they would have at least two people
5 competing for the business; fair enough?
6 A. Fair enough.
7 Q. And that's not -- that doesn't -- that's not
8 something that seems outlandish or absurd to you, in
9 the sense of what a consumer might want in terms of
10 choice?
11 A. No, but you'll also talk to the consumer and
12 the consumer would love to have ten people bid for an
13 RFP to get what they feel is maybe the best price, but
14 maybe not the best service.
15 Q. Right. And in responding to RFPs, AMR
16 Maricopa would take the position that a consumer may
17 ask for 11 different widgets, but it doesn't make
18 sense, so we're not going to give you 11 different
19 widgets. This is how we're going to bid on the
20 contract, and you can either choose us because this is
21 the service we provide, which AMR Maricopa believes is
22 best services, or not. If you have an alternative, you
23 can go with the other person.
24 MS. FICKBOHM: I'm going to object to
25 the form of the question. I'm not sure if that was
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1 just a manifesto that you want him to agree with or if
2 that's what he's saying that --
3 BY MR. BELANGER:
4 Q. Do you understand the question?
5 A. Not really.
6 Q. Let me ask it again then. And it's really
7 something I'm probably going to get into more with --
8 when -- just because -- well, strike that.
9 When a consumer of ground ambulance services
10 is seeking -- putting out an RFP for services, one of
11 the things that I think you've already agreed to is
12 that one of the things that they've articulated is they
13 would like some choice?
14 Yes? I think you have to say yes or no.
15 A. Yes. I think I said that earlier. Yes.
16 Q. Yeah, you did.
17 A. Okay.
18 Q. Would you agree that if there is another
19 service provider competing or applying for those kinds
20 of contracts, that there is a beneficial effect on the
21 overall service provided to the consumer of ground
22 ambulance services?
23 A. I would not currently, with the way the
24 market is set now in Maricopa.
25 Q. Why not?
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1 A. The old process of doing the RFPs and not
2 being able to meet with your customer and just bidding
3 on it I feel is an antiquated system.
4 Q. Right.
5 A. I think the fact that with the scope and size
6 of our current organization, we're able to offer an
7 a la carte menu that meets or exceeds the needs of
8 those customers requesting service. For example, from
9 offering basically from wheelchair service through
10 Learjet services in my a la carte menu, there's
11 probably not a so-called widget that's not available to
12 them. So I think the current market here is covered
13 for that.
14 Q. But if somebody wanted a Learjet service that
15 was available to them, a consumer, and it was something
16 that they didn't have any need for, AMR Maricopa
17 wouldn't make that available?
18 A. Not if they didn't have any need for it.
19 There wouldn't also be a cost involved in that as well.
20 Q. Right.
21 When you talk about this new system of
22 negotiation, is that something that because AMR has
23 come into the market, they've actually started a
24 dialogue with potential customers of ground ambulance
25 services? When you say that that's a new model, is
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1 that a model that just AMR Maricopa is using, that
2 historically had not been used before?
3 MS. FICKBOHM: I'm going to object to
4 the form. I think you asked a couple different
5 questions, Jim. Objection to the form.
6 THE WITNESS: Can you just restate it?
7 BY MR. BELANGER:
8 Q. Sure.
9 When you're referring to a new model of
10 dialogue with ground ambulance customers, what new
11 model are you talking about that didn't exist
12 previously?
13 A. I think the one size fits all model that used
14 to be here has gone away. I think there's been the
15 change in the health care services to where they're now
16 consolidating down more and more and more, so we have
17 fewer large facilities. Those larger facilities are
18 looking for an a la carte menu to take care of their
19 spectrum of patients. And I think that's changed over
20 the years, not only here in Arizona, but probably
21 around the country; but I know what I'm dealing with
22 here. When we've dealt with our customers, they want
23 to sit down and talk about their needs, and they want
24 to talk about what we have available. So that's where
25 we're at.
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1 Q. But you're not suggesting that another ground
2 ambulance service provider such as Maricopa Ambulance
3 couldn't come in and have the same dialogue with
4 customers regarding the array of services that could be
5 available to them?
6 A. Yeah, I can't speak to what they would or
7 wouldn't do, so...
8 Q. So it's not like it's a regulatory model from
9 the Department that says contracts shall be led in this
10 fashion; that's just a business practice of you and AMR
11 Maricopa?
12 A. That's correct.
13 Q. And in your mind, it's a best business
14 practice?
15 A. It's our business model currently.
16 Q. Or your business model. But it's not a model
17 that's proprietary or exclusive to AMR Maricopa?
18 A. No.
19 Q. Were you here when Mr. Gibson and I believe
20 Mr. Blackburn testified that they had also, in terms of
21 anticipating applying for a CON, had engaged in
22 conversations with potential customers of ground
23 ambulance services?
24 A. I vaguely remember some of their
25 conversations, yeah.
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1 Q. Is it your experience -- well, let me ask you
2 this question first: Is it your experience that since
3 you've been the general manager of AMR Maricopa, that
4 RFPs are just issued cold, without having had any
5 dialogue with the potential providers of ground
6 ambulance services prior to the issuance of the RFP?
7 A. I'm not sure how they come to the point where
8 they decide to put out an RFP. I think it would be,
9 you know, one, I would be speculating if I said that;
10 but, two, if they would have dialogue with ambulance
11 services, I think that would kind of void those
12 services bidding on an RFP if they already knew what
13 was coming out in the RFP.
14 I mean there's a certain amount of
15 confidentiality that's revolves around those RFPs. So
16 if you basically came to me, as a hospital, and said
17 "We're going to want X, Y, Z," that would kind of moot
18 the point of the RFP.
19 Q. In fact, there are. There are laws that deal
20 with secrecy of RFPs and things along those lines. And
21 that was a bad question, obviously, then; but that was
22 not really my question.
23 So you've, I assume, for example, with
24 Gilbert and Queen Creek, you've bid on and received a
25 contract for 911 services?
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1 A. We didn't bid on it. They didn't put an RFP
2 out.
3 Q. Was there -- have you -- has Maricopa --
4 AMR Maricopa, have they -- and I don't know
5 if you said this or not. -- bid on an RFP for
6 interfacility services and been awarded one?
7 A. We have not been awarded one. Well, let me
8 think. Let me think real quick.
9 Q. Okay.
10 A. I would be speculating. I know that we've
11 bid on an RFP. I don't know if it's been awarded yet.
12 Q. And this is -- and my question is not
13 regarding that you had secret access to the RFP or
14 something like that. But you have had dialogue with
15 consumers of ground ambulance services that you would
16 expect -- I assume that AMR Maricopa would be expecting
17 would be issuing RFPs for ground ambulance services,
18 whether they've issued them or not at this point?
19 A. Are you talking about hospitals?
20 Q. Hospitals.
21 A. Or 911 contracts?
22 Q. 911 contracts, the gamut of those.
23 Have you had contracts with potential
24 customers for ground ambulance services?
25 A. I don't know of any upcoming RFPs for either
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1 911 service or interfacility currently.
2 Q. And I'm not suggesting you do; but that when
3 you're having those conversations, I'm assuming that
4 you're talking to them about what AMR Maricopa can
5 provide and what it is they expect their needs are in
6 the market?
7 A. So let's take one, for example, a 911
8 contract.
9 Q. Right.
10 A. That contract is currently held by the
11 Rural/Metro Corporation that's coming up for a renewal
12 in 2017.
13 Q. Right.
14 A. We are having dialogue with them regarding
15 how we would like to see changes and how they would
16 like to see changes to that contract going forward. So
17 that's just dialogue back and forth.
18 Q. Understood.
19 A. And they don't anticipate putting out an RFP
20 for that, but really just to change that contract and
21 have it resubmitted to the Bureau for approval.
22 Q. Okay. So, for example, would that be where
23 AMR Maricopa is a successor to Rural/Metro in the
24 contract, and it's just going to be renewed, but it
25 will be renewed under different terms, subject to the
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1 Department's approval?
2 A. From a legal standpoint, I don't know how all
3 that works --
4 Q. Sure.
5 A. -- whether it's --
6 I just don't know. I guess we would
7 renegotiate a new contract, but that would be
8 speculative on my part. I don't know the legal
9 wranglings of how that works.
10 Q. Yeah, and I don't want you to speculate,
11 John. I do want you to speculate a little bit, but
12 your attorney is probably not going to want you to do
13 that.
14 A. I'm a paramedic, not an attorney.
15 Q. Right.
16 A. If you rip your arm off, I can help you; but
17 I can't draft a document for you.
18 Q. And I don't know that you named it, but the
19 entity you were just discussing regarding the 911
20 contract that you were having conversations of
21 potentially a renewal, is there something that would
22 prevent that entity from doing an RFP?
23 A. No. That would be up to the entity.
24 Q. That would be up to them.
25 So they could renew with AMR Maricopa, as a
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1 successor in interest to Rural/Metro, or they could
2 decide maybe there's an alternative in the market and
3 we would like to explore that?
4 MS. FICKBOHM: I'm going to object to
5 the form of the question, because it sort of assumed
6 the answer to the last question that he didn't answer
7 because he said he's not a lawyer.
8 ALJ MIHALSKY: That's overruled. The
9 witness may answer that question, if he can.
10 THE WITNESS: Can you restate the
11 question?
12 BY MR. BELANGER:
13 Q. I'm not sure I can.
14 A. Yeah, could you read it back, Jody?
15 MR. BELANGER: Can you read it back?
16 (The record was read by the court
17 reporter as follows:
18 QUESTION: So they could renew with AMR
19 Maricopa, as a successor in interest to
20 Rural/Metro, or they could decide maybe
21 there's an alternative in the market and we
22 would like to explore that?)
23 THE WITNESS: I would be speculating on
24 what they would or wouldn't do. That would be up to
25 them.
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1 BY MR. BELANGER:
2 Q. There's nothing in the contract, though, that
3 requires them to renew with a successor in interest to
4 Rural/Metro?
5 A. I don't have the contract in front of me,
6 but...
7 Q. Well, you're the general manager. I mean do
8 you --
9 A. I don't have the contract in front of me. I
10 would say no.
11 MR. BELANGER: Is this a good time,
12 Judge, to take a break?
13 ALJ MIHALSKY: I was just about to ask
14 you when you got to a good time.
15 Are we taking an hour, an hour and
16 15 minutes, or an hour and a half for lunch?
17 MR. BELANGER: I think an hour and
18 15 minutes would be good.
19 ALJ MIHALSKY: An hour and 15 minutes.
20 Very good. We'll see you all back here at 1:15.
21 (A lunch recess was taken from
22 11:57 a.m. to 1:14 p.m.)
23 ALJ MIHALSKY: We're back on the record.
24 And before we resume the examination of
25 Mr. Valentine, it occurred to me that at some point we
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1 probably should get back in touch with Ms. Hofmeyr
2 about admission of her exhibits. And so maybe by
3 tomorrow, if the parties can look at those exhibits and
4 see if they have any objections.
5 MR. BENNETT: We looked at them, and
6 we're ready to go, so...
7 ALJ MIHALSKY: Oh, okay. No objections?
8 MR. BENNETT: Only to one.
9 ALJ MIHALSKY: Okay. Well, we'll take
10 care of that then maybe tomorrow morning.
11 MR. BENNETT: Sure.
12 ALJ MIHALSKY: Though, I didn't tell
13 Ms. Hofmeyr we would be calling her, but we can try and
14 leave a message if she's not there.
15 Are we ready to resume the examination
16 of Mr. Valentine?
17 MR. BENNETT: We just have one exhibit
18 we want to move for the admission of, Judge.
19 ALJ MIHALSKY: What is it?
20 MR. BENNETT: Actually, we're amending
21 an existing exhibit. It's Exhibit No. 34, which is a
22 chart of transports for 2014 in the state of Arizona by
23 the various providers. Since we filed that last
24 version of the exhibit, a few of those providers filed
25 their 2014 revenue and cost reports, so we have updated
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1 numbers; and then there were some very small rural
2 districts that were omitted from the current version of
3 34, so we've added those. And I had e-mailed copies to
4 everyone last night. I have hard copies, if anybody
5 else would like to see it.
6 MS. FICKBOHM: I haven't had a chance to
7 see my e-mail so I haven't seen it yet.
8 MR. ROSENFELD: Neither have I.
9 MS. FICKBOHM: Fairly noncontroversial
10 topic, but I would like to see it.
11 MR. BENNETT: Yeah, sure.
12 MR. ROSENFELD: Can I take a look at the
13 break or something, so we don't have to keep the
14 witness waiting, rather than do it now? It's four
15 pages.
16 MS. FICKBOHM: Yeah.
17 ALJ MIHALSKY: Okay, yeah, we'll address
18 that then at the break.
19 MR. ROSENFELD: Thank you.
20 ALJ MIHALSKY: So I anticipate --
21 MS. FICKBOHM: Is there a new number on
22 this one?
23 MR. BENNETT: A new number?
24 MS. FICKBOHM: Because I don't think
25 there's any way, any mechanism at OAH to replace an
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1 exhibit that's already been admitted with another one.
2 So are you just putting a new number on it?
3 MR. BENNETT: Well, we were intending to
4 substitute it as just take the place of the old 34.
5 MR. ROSENFELD: You can't. The
6 webmaster won't, at least in my experience, won't allow
7 you to do that.
8 MR. BENNETT: Okay. Sure.
9 ALJ MIHALSKY: Okay. I was going to
10 check into that, but --
11 MR. BENNETT: We're happy to introduce
12 it as a new number too, if it's not possible to replace
13 it.
14 ALJ MIHALSKY: Okay, very good. And
15 we're up to MA-203. Our last one is MA-202, according
16 to my list, which I think is the most current. I
17 printed it out yesterday.
18 MR. ROSENFELD: So what number would it
19 be, Your Honor? I'm sorry.
20 ALJ MIHALSKY: It would be MA-203.
21 MR. ROSENFELD: Thank you.
22 MR. BELANGER: Well, are we good to
23 go?
24 ALJ MIHALSKY: I think we are.
25 Yes.
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1 BY MR. BELANGER:
2 Q. Mr. Valentine, I'm showing you what has been
3 admitted as Maricopa Ambulance 34, which is the
4 precursor to the document we were just discussing off
5 of the record. I believe that was off of the record.
6 It's Maricopa Ambulance 203. Could you take a look at
7 this for just a second?
8 In particular, look at the column that's over
9 on the right-hand side, AMR/RM. And it's actually
10 four. It's more than one page, yeah, John, so...
11 A. Oh.
12 Okay.
13 Q. Are you familiar with the CONs, the
14 Rural/Metro CONs, that were proposed to be transferred
15 to AMR Maricopa in the application to transfer?
16 A. I would probably not be the person to speak
17 to about that.
18 Q. Who would be?
19 A. Probably Glenn Kasprzyk or Mr. Van Horne. I
20 haven't been really involved in those proceedings with
21 the movement of those back and forth.
22 Q. Okay. As the general manager, are you aware
23 of the Rural/Metro entities that -- and I always get
24 this wrong, but EVHC is acquiring as far as AMR? I
25 mean --
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1 A. I'm fairly familiar.
2 Q. So that's really what my question is. When
3 you look at this exhibit, if you look at the left-hand
4 side, it will say the name of the entity. For example,
5 on Page No. 1, which is Maricopa Ambulance 34-0001 --
6 A. Yes.
7 Q. -- it says that "American Ambulance," and
8 then on the far right-hand corner it says "RM." Do you
9 understand that to be a Rural Metro entity?
10 A. Yes.
11 Q. Yeah.
12 And just going down the list, Canyon State
13 Ambulance dba LifeStar, do you understand that to be a
14 Rural/Metro entity?
15 A. I do.
16 Q. And ComTrans Ambulance Service, Inc., you
17 understand that to be a Rural/Metro entity?
18 A. Yes.
19 Q. I'm now on page Maricopa Ambulance 34-0002.
20 Kord's Southwest?
21 A. Yes.
22 Q. That's a Rural/Metro entity?
23 A. Yes.
24 Q. And then obviously Life Line Ambulance
25 Service, that's an AMR entity?
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1 A. That's correct.
2 Q. That's based up in Yavapai.
3 PMT?
4 A. Yes.
5 Q. Rural/Metro.
6 River Medical, that's the one up in Mohave
7 County primarily?
8 A. Yes.
9 Q. That's an AMR entity?
10 A. Yes, it is.
11 Q. And then the next four, Rural/Metro Ambulance
12 Service Maricopa, Rural/Metro Ambulance Service Pima,
13 Rural/Metro Ambulance Service Pinal, Rural/Metro
14 Ambulance Service Yuma, those are all Rural/Metro
15 entities?
16 A. Yes.
17 Q. And on the third page of the exhibit,
18 34-0003, Southwest General, Inc. dba Southwest
19 Ambulance, that's a Rural/Metro entity?
20 A. Yes.
21 Q. And then right below that, Southwest
22 Ambulance of Casa Grande --
23 A. Yes.
24 Q. -- Rural/Metro entity?
25 Southwest Ambulance and Rescue of Arizona,
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1 Rural/Metro entity?
2 A. Yes.
3 Q. And then Southwest Ambulance of Safford?
4 A. Yes.
5 Q. Also a Rural/Metro entity.
6 I'm sorry. On the last one, Southwest
7 Ambulance of Safford, do you understand that to be a
8 Rural/Metro --
9 A. Yes. Yes, I do.
10 Q. Is it your understanding that all of
11 Rural/Metro's CONs in Arizona are being transferred to
12 AMR?
13 A. Yes.
14 MR. BELANGER: I don't have any other
15 questions, Judge.
16 ALJ MIHALSKY: Very good.
17 MR. RAY: Yes, judge.
18
19 CROSS-EXAMINATION
20 BY MR. RAY:
21 Q. John, I have a few for you.
22 You've talked about the new 911 contract in
23 Queen Creek and Gilbert?
24 A. Yes.
25 Q. When did AMR begin responding to those 911
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1 calls?
2 A. Latter part of December.
3 Q. Okay.
4 A. Yeah. I don't have exactly.
5 Q. I want to talk for a few minutes about the
6 renewal application process.
7 AMR has currently submitted a renewal
8 application to the Bureau, correct?
9 A. I believe so. I'm not in charge of doing
10 that renewal application, but yes.
11 Q. As part of that renewal application, AMR
12 submitted a response time analysis, correct?
13 A. Yes.
14 Q. And it was in that response time analysis
15 that there was a disclosure of a problem in compliance
16 with the 911 calls, largely as a result of the Canyon
17 Lake and Apache Lake issues you've testified about,
18 correct?
19 A. Yes.
20 Q. Do you know how many of those calls AMR's
21 responded to?
22 A. I'm going to take an educated guess. I
23 believe between 70 and high 80s.
24 Q. Okay. Do you know how many or do you have an
25 educated guess of how many 911 calls you're going to
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1 respond to in the Queen Creek/Gilbert areas?
2 A. Roughly, around 10,000.
3 Q. Okay. On an annual basis?
4 A. On an annualized basis, both sides.
5 Q. Okay. Okay.
6 A. And let me quantify that. Originally that we
7 thought that would be the number that we would respond
8 to; but with the new priority dispatching system, there
9 may be a bank of calls that the Fire Department
10 responds to that we do not respond to. So that number
11 may be a little lower than initially anticipated.
12 Q. So with respect to these calls out at the
13 edges of Maricopa County, you admit those are in your
14 CON area?
15 A. That's correct.
16 Q. In the upcoming spring and summer holiday
17 season, I want to understand what AMR's plan is to
18 staff ground ambulance service to that area. I think
19 you testified that you've worked out perhaps some
20 protocols with the Sheriff's Office as to use of a
21 helicopter ambulance, as necessary?
22 A. We have.
23 Q. Okay. And do you have a rough estimate,
24 John, as to how many calls would go to a helo or an air
25 ambulance versus ground ambulance?
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1 A. So a couple of things come into play. One
2 thing is, when you get in that area, about 45 minutes
3 to 50 minutes into that area we lose radio
4 communications. So several of those long responses
5 that we go to, we could have been canceled maybe
6 45 minutes before we arrived on scene because the
7 patient had left by helo, but there's just such a
8 remote area it was difficult.
9 I would say a large percent of those patients
10 that come from that, there's really two kinds of
11 injuries that come out of these really rural areas.
12 They're either really, really hurt and they need to go
13 by helo or they're not hurt very bad and they usually
14 either go by private vehicle or not by ambulance.
15 So in talking to the Sheriff's Department up
16 there, that's the analogy he used with me. So I would
17 say, you know, if you cut it in half, the majority of
18 those patients are going to go out; and specifically
19 from just an access, just being able to get a ground
20 ambulance to the scene, especially as you get up toward
21 the Apache Lake area, and then get the patient out.
22 Give you the suggestion of a back injury
23 per se. If we were to take that patient out by ground
24 on a backboard for an hour and 40 minutes down a dirt
25 road, we're obviously going to compromise patient care.
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1 So some of those patients are flown for that reason,
2 and I would say that number is going to be fairly high.
3 Q. Okay. Now, the cost for an air ambulance is
4 much, much higher than a ground ambulance?
5 A. Yes, it is.
6 Q. The 60 to 70, I think estimated, did you use
7 the term calls or transports for that area?
8 A. I used the word calls.
9 Q. Okay. Would those -- going forward, would
10 that be a fair share of the number of calls you would
11 run as a ground ambulance service, assuming no other
12 providers in the market?
13 A. Yeah. I would hope that through, you know,
14 the merger of the Rural/Metro entities that we have
15 before the Director currently and AMR, that we can
16 better deploy ourselves to meet the needs in those
17 areas, either seasonally by, you know, weekend traffic
18 and work with the Sheriff's Department with some kind
19 of new, you know, strategic alliance to do a better
20 way, a joint unit or something.
21 I don't know exactly how we're going to do
22 it, but we've got to do, I think, a better job in that
23 area. It's getting more and more busy.
24 Q. Does the current operational plan involve
25 staffing a twelve-hour car at Canyon Lake for holidays
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1 only?
2 A. That's current. That's what we did.
3 Q. Okay.
4 A. Just one -- I think a couple of things. I
5 think that we'll be able to sit down with the
6 Rural/Metro organization, who's been covering that area
7 for decades, either that or the Superstition Fire &
8 Medical, who have been running mutual aid responses to
9 that area, and hopefully be able to get a better
10 understanding of either seasonality or criticality of
11 the patients, and maybe we can figure out a better way
12 to do it; you know, some kind of an alternative
13 deployment in that area.
14 Q. Okay. Do you know how many calls Rural/Metro
15 responded to on an annual basis in that area?
16 A. I don't. And, no, we really never shared
17 that information.
18 Q. So AMR has been granted temporary authority
19 over the Rural/Metro CONs?
20 A. That's correct.
21 Q. In the Maricopa County area. Well, all
22 state, over all the state.
23 So as you look at a combined resource
24 response, is it possible that you will staff an
25 ambulance at the Canyon Lake area on weekends, in
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1 addition to the holidays?
2 A. I think we're going to have to take a look at
3 what that whole global deployment looks like. It is
4 one of those areas that's an outlier that we have to do
5 a better job in.
6 It's interesting when you talk to the
7 Sheriff's Department up there. They're very well aware
8 of their remoteness and, you know, the fact that
9 ambulances take some time to get there. But, once
10 again, I think the strength of our company and the
11 merger of the two companies will allow us a lot more
12 data to understand it better, to figure out whether we
13 can do something up there to meet the needs of what the
14 public needs up there are.
15 Q. Okay. Let me shift gears on you and talk a
16 little bit about priority dispatch. Now, priority
17 dispatch, is that a new concept in Arizona?
18 A. No, priority dispatch has been around for a
19 long time, and I guess they're trying to -- I guess
20 they're really trying to come up with a word, but that
21 was the first word that kind of came to mind is
22 priority dispatch.
23 Priority dispatch as a whole is a system
24 that's used in the communications center to prioritize
25 the caller coming in, and from those certain questions,
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1 give that patient a candidate ranking, per se, or a
2 number code of what kind of type of call that is and
3 then generate the resources required to that.
4 The new model that we're kind of -- and it's
5 not a new model. It's run around the country. It's
6 just kind of new to the valley, is where the first
7 responders that are strategically deployed around their
8 communities are responding to those calls anyway, but
9 through building -- by looking at the data, we can
10 realize that a large percent of those calls end up in
11 dry runs or canceled calls.
12 In the very short time that we were operating
13 in that window in Gilbert while that wasn't happening,
14 we were running a 40 percent dry run or cancel rate.
15 That's a lot of resource tied up going to a
16 nontransport type call, and ambulances are a very
17 unique and costly resource.
18 Q. So prior to AMR entering into this new
19 priority dispatch system, there would be a simultaneous
20 dispatch of the fire or first responder assets with an
21 ambulance?
22 A. Correct, on every call. And that system
23 still plays out around the valley today. In Mesa, for
24 example, every call gets an ambulance, gets a -- ever
25 fire truck gets an ambulance with every call.
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1 Q. So is it fair to say that with the priority
2 dispatch protocol you've worked or you've got in place
3 in Gilbert, there is a triage at the receipt of the
4 call stage, and then a determination is made whether an
5 ambulance needs to be simultaneously dispatched?
6 A. So, yes, and it goes even more detailed than
7 that. So the region sat down or the Fire Department
8 sat down with their medical directors and looked at the
9 priority dispatching system, and then from that they
10 dove into the ten calls where they want an ambulance to
11 respond simultaneously. And with joint medical
12 direction, they agreed that we could have an ambulance
13 not go on these or go on these type of calls; and not
14 only that, but the kind of code that we would respond
15 with, either lights and sirens or no lights and sirens
16 to those types of calls.
17 Because of the ten calls that we go out
18 simultaneously to with the Fire Department, there's
19 only seven -- there's seven of them that we respond no
20 lights and sirens, and only three of them that we
21 respond lights and sirens to initial dispatches.
22 So, one, it greatly reduces our liability of
23 responding with lights and sirens, because now you have
24 not only a big fire truck responding with lights and
25 sirens, and an ambulance. It better utilizes the
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1 equipment.
2 MR. RAY: All right. I don't have any
3 further questions. Thank you, John.
4 ALJ MIHALSKY: Ms. Fickbohm?
5 MS. FICKBOHM: Just a few, Your Honor.
6
7 REDIRECT EXAMINATION
8 BY MS. FICKBOHM:
9 Q. John, there was a lot of discussion about
10 RFPs. Could you, for the purposes of the record, tell
11 us what an RFP is?
12 A. That's a request for proposals. They're
13 usually put out by a municipality. They're a
14 confidential document that lays out what, you know, the
15 municipality wants you -- wants in their contract.
16 Q. And do you see a certain amount of repetition
17 or reusing RFP forms?
18 A. From around the country, a lot of these are
19 cut and pasted from other agencies or communities and
20 put together all the time.
21 Q. And is there something between an RFP and a
22 back-and-forth negotiation that ends up resulting in a
23 service agreement; is there something in between the
24 two of those?
25 A. You get a request for information, an RFQ,
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1 where they're asking for information. They may throw
2 out, you know, we would like to see a request for
3 information on a specific area or location.
4 Q. On cross-examination Maricopa Ambulance's
5 attorney asked you if you've heard their company
6 representatives say they were willing to make a
7 commitment to IFT arrival times, and you answered in
8 the affirmative. I wanted to follow up on that. Is
9 that something they put in their application?
10 A. No, it wasn't in their initial application.
11 Q. And was that something that was in the notice
12 of hearing that was issued in this case?
13 A. No, I don't believe so.
14 Q. And you were here during that testimony. Did
15 their representatives state any particular arrival time
16 criteria that they would commit to?
17 A. No. I believe just to arrival times, but no
18 exact numbers.
19 Q. You were asked about conversations with
20 customers or ambulance transport users saying that they
21 would like an alternative to the Rural/Metro group.
22 What was your understanding was the main reason driving
23 that desire for an alternative?
24 A. There was a fear of the bankruptcy; that the
25 Rural/Metro Corporation would go away with the
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1 bankruptcy. So they wanted an alternative to that.
2 Obviously Rural/Metro was in the midst of trying to
3 shore up and get, you know, out of bankruptcy. But
4 they wanted some commitments that there would be
5 another provider. That was my understanding most of
6 the times we went around. They were afraid that that
7 large company was going to go away.
8 Q. Mr. Belanger asked you if the negotiated
9 service agreement was something that was proprietary or
10 exclusive to AMR; and you testified, no, that's not.
11 No, it's not. Can I ask you if there's anything that
12 AMR, through its national organization, does bring to
13 the table in those types of service agreement
14 negotiations that is proprietary and exclusive?
15 A. Well, I mean, how we do and build our
16 deployments to, you know, our customer service and what
17 we do within our customer service; how we provide, you
18 know, medical data on the medicine that we provide
19 would be obviously proprietary to AMR with our medical
20 director and those pieces.
21 Q. And does AMR have any unique resources when
22 it comes to building deployment models?
23 A. We put together kind of a world-renowned team
24 of deployment experts that work for us, that have, you
25 know, many years of industry knowledge in both 911
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1 systems, IFT models. I think a tremendous amount of
2 money has been spent on technology and software to
3 produce some of these contracts.
4 MS. FICKBOHM: Thank you, John. I don't
5 have any other questions.
6 ALJ MIHALSKY: Thank you, Mr. Valentine.
7 THE WITNESS: Thank you, Your Honor.
8 MS. FICKBOHM: Call Glenn Kasprzyk.
9 ALJ MIHALSKY: Mr. Kasprzyk, please take
10 a seat and raise your right hand.
11 (Mr. Glenn Kasprzyk was duly sworn by
12 the Administrative Law Judge.)
13 ALJ MIHALSKY: Please state your name
14 for the record and spell your last name for the court
15 reporter.
16 THE WITNESS: Sure. Glenn Kasprzyk.
17 Glenn with two N's, last name K-A-S-P-R-Z-Y-K.
18 ALJ MIHALSKY: Very good. Go ahead.
19 MS. FICKBOHM: Thank you, Your Honor.
20
21 GLENN KASPRZYK,
22 called as a witness on behalf of Intervenor AMR herein,
23 having been previously duly sworn by the Administrative
24 Law Judge to speak the truth and nothing but the truth,
25 was examined and testified as follows:
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1 DIRECT EXAMINATION
2 BY MS. FICKBOHM:
3 Q. Mr. Kasprzyk, what's your current position
4 with American Medical Response?
5 A. Currently, I am the regional chief operations
6 officer for Arizona.
7 Q. Before I ask you what that involves, I would
8 like to talk to you about your professional career
9 leading up to that position.
10 How many years, approximately, have you been
11 involved in EMS?
12 A. It's been some time. I started out in 1989.
13 While in high school, our high school was one of the
14 first in New York to offer a first responder program.
15 I think, like Mr. Valentine alluded to about the
16 emergency program, I kind of got the bug, and from
17 there just evolved my career professionally onto EMT,
18 paramedic, served in the fire service, volunteer fire
19 service for a while in Western New York, and really
20 have had tremendous opportunity in this industry to
21 grow myself professionally, starting from the ground
22 up.
23 Q. So you started out being trained as an EMT
24 when you were in high school?
25 A. Yes.
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1 Q. Did you work as an EMT in high school?
2 A. My first job was in 1991, just as I was
3 graduating, with Towns Ambulance Service.
4 Q. Okay.
5 A. White shirt, green pants. It was exciting
6 times.
7 Q. And you eventually became certified as a
8 paramedic?
9 A. That is correct, in 1994.
10 Q. And in 1994, who did you work for as a
11 paramedic?
12 A. I worked both for the Murillo Fire
13 Department, which was a Volunteer Fire Department, and
14 LaSalle Ambulance Service in Buffalo, New York.
15 Q. And what was your next job?
16 A. I stayed with LaSalle Ambulance. They were
17 acquired by Rural/Metro. In the latter part of the
18 '90s into 2000, I went from field operations into
19 communications and started learning the internal
20 intricacies of the business, which gave me exposures to
21 billing. And, also, during that period of time just
22 prior, I also served as a flight paramedic for Mercy
23 Flight of Western New York.
24 Q. After working for Rural/Metro in sunny
25 Buffalo, did you make a move?
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1 A. I did. I realized it was tough to shovel
2 sunshine, so I moved to Orlando, Florida for four
3 years, and then was recruited to come out to Life Line
4 Ambulance in 2006.
5 Q. Now, let's talk about your Orlando experience
6 just a little bit. You were there for four years?
7 A. That is correct.
8 Q. And you moved there with the Rural/Metro
9 organization?
10 A. Yes.
11 Q. And what was your position there?
12 A. I served as the operations manager for that
13 operation. Originally went down as the communications
14 center manager. The operations manager there retired,
15 and very shortly after my arrival, went back into
16 operations.
17 Q. So as the operations manager, can you give us
18 an idea of what you were responsible for?
19 A. Yeah. So day-to-day activities of the
20 organization as it related to, obviously, the
21 communications center was under my purview, responding
22 to calls, interacting with our customers, ensuring that
23 our market was compliant with its response times for
24 Orange County, Florida. Also, interacted with a lot of
25 the regulatory bodies in Orange County and Orlando,
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1 Florida, and had direct accountability to the market
2 general manager. Also had some oversight of fleet
3 operations, scheduling, and support services as it
4 relates to restocking and supply for ambulances.
5 Q. So can you tell us what the Orlando, Florida,
6 Orange County ambulance transport, for lack of a better
7 word, market is like? Are we talking mixed
8 urban/rural, mostly rural, mostly urban? What are we
9 talking about?
10 A. It was highly urbanized, with exception if
11 you looked out towards the fringe areas of Orange
12 County, out towards the airport, in an area called
13 Hunters Creek, which was in South Orange County.
14 Somewhat very similar to how we operate in Maricopa.
15 You have a large urban core, but you had some pretty
16 fringe areas, and the same would apply out towards --
17 if you're familiar with Florida and you jumped on
18 Highway 50 heading out towards Cocoa Beach, you would
19 get into some rural farm area there as well. So a lot
20 of dense population in the core and then highly rural
21 throughout the rest of the county.
22 Q. And when did you leave the Orlando, Florida
23 area?
24 A. Left in 2006, ironically kind of under the
25 same terms. I came to Life Line to go back into the
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1 communications side of the house, and shortly after my
2 arrival, the general manager there or operations
3 manager left, and Cheryl Smith, who was the owner,
4 convinced me to go back to the operations side.
5 And I have tried many times in my career to
6 just focus on communications, but always get drawn back
7 to operations. So I do enjoy the communications side
8 of the house. It's really what I think is the hub of
9 an organization, because there's so much that comes
10 through a comm center that you're responsible for. But
11 the excitement of operations is also fulfilling as
12 well.
13 Q. And so as the chief operations officer for
14 Life Line, did you have quality assurance
15 responsibilities?
16 A. We had expanded -- let me back up a little
17 bit, because I think it's important to note that where
18 our industry has changed fairly quickly over the last
19 several years. And when I arrived in 2006, the focus
20 on quality and medicine really was not the priority in
21 ambulance services. They did quality assurance and you
22 monitored performance, but really from a level of what
23 was your IV success rate and what was your intubation
24 success rate and did you put patients on cardiac
25 monitors.
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1 It's really not over until the last couple of
2 years that we got into the medicine, and we saw that
3 evolve at Life Line. About in 2009, 2010, we brought
4 on a compliance manager. We expanded it outside of
5 operations to really get an independent person, who was
6 an RN that we brought in, to start giving us a medicine
7 perspective; really, following the national trend of
8 where the industry was evolving to, to start focusing
9 on patient outcomes.
10 We knew that the insurance marketplace was
11 going to start to change to outcome-based
12 reimbursement. We're starting to see that now. So we
13 had a focus, but we expanded that focus. And certainly
14 when AMR acquired Life Line, that really has become
15 such a strong focus now in our industry. We've seen
16 those departments expand tremendously.
17 Q. And when was it that AMR, the national
18 organization, acquired the Life Line business from
19 Cheryl Smith?
20 A. February 2014.
21 Q. And what did that mean with regard to your
22 job responsibilities?
23 A. My job responsibilities really maintained at
24 that level for Life Line. As we started to integrate
25 into the AMR systems and bringing on board the changes
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1 to integrate in the organization, you know, my role,
2 albeit chief operations officer, maybe somewhat
3 semantics. More of a general manager or operations
4 business leader. I try not to focus on that piece.
5 It's really just maintaining the day-to-day activities
6 of what we did.
7 And then certainly as AMR wanted to grow its
8 footprint in Arizona, really became intimately involved
9 with John Valentine putting that together for AMR.
10 Those plans were somewhat in place a little
11 bit prior to the sale, because the market was changing
12 here; but then working together with John as we put the
13 application in and began to start the market analysis
14 of what the need was in the community, as far as what
15 the temperature was of the customers, and then
16 certainly with the Rural/Metro bankruptcy, really kind
17 of accelerated those plans.
18 Q. And what you were just discussing was with
19 specific regard to AMR moving into the Maricopa County
20 market?
21 A. That is correct.
22 So my role somewhat transitioned from less of
23 a focus on the day-to-day Life Line operation to really
24 more of a focus working at the greater level with AMR
25 here in Arizona.
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1 Q. And since American Medical Response was
2 granted a CON in Maricopa County through AMR Maricopa,
3 did your job title change?
4 A. Yeah, at the point -- initially, no; but once
5 we announced the acquisition of Rural/Metro, we did
6 some internal realignment so there would be some focus,
7 and then my role changed to a regional chief operations
8 officer, and really now remove myself from most of the
9 day-to-day and support the regional director like John
10 Valentine and the operations managers and our
11 operations, to ensure that we're working efficiently
12 and effectively from a 30,000-foot view from an AMR
13 support side.
14 Q. So regional, does that mean that you're
15 responsible for all AMR-affiliated organizations in the
16 state of Arizona?
17 A. Yes.
18 Q. So that includes the Rural/Metro-owned
19 entities during the period of temporary authority?
20 A. Yes.
21 Q. And in the event the Director approves the
22 transfer of the CONs, it will include all of those
23 operations on a permanent basis?
24 A. Yes.
25 Q. Glenn, I noticed that you've been a member of
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1 the Arizona EMS Council, correct?
2 A. That is correct.
3 Q. And can you tell me how long you've been on
4 the EMS Council?
5 A. I believe I got an appointment 2011, 2012,
6 somewhere in that range. I'm now through my second
7 renewal, so it's been at least five years, because I
8 came in midterm on one.
9 Q. And what is the EMS Council?
10 A. So the EMS Council here in Arizona is really
11 the guiding body for our industry. It's made up of a
12 well-rounded group of representatives from private
13 providers to public providers to other industry folks
14 that get together and talk about where our industry is
15 going, as there's changes on the regulatory side.
16 The EMS Council has subcommittees under it, a
17 medical direction committee, education committee, that
18 begin to vet those changes when rules are adjusted, to
19 ensure that they really can be implemented, and then
20 provide whatever necessary guidance to those
21 organizations as they roll those changes out. And I
22 currently also serve as the vice-chair of that Council.
23 Q. So you're currently the vice-chair of the
24 entire Arizona Emergency Medical Services Council?
25 A. Yes.
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1 Q. And previous, before coming the vice-chair,
2 were you the chair of any of its standing committees?
3 A. I had the opportunity to serve as chair of
4 the education committee, which was a very unique
5 perspective, because the education committee's role and
6 goals were, again, as these rules changed and certain
7 protocols were changing and new care methodologies were
8 coming out and modalities, was putting together those
9 curriculums with the educators.
10 So a lot of work was done with the education
11 committee. But there's also been a big change in focus
12 there now on the medicine. And as I transitioned out,
13 Dr. Gail Bradley is now the chair and bringing the
14 physician side, the medicine side. You see education
15 committee go from the educators' perspective to the
16 medicine perspective now. So it's been exciting to see
17 those changes occur at the State level, because it
18 really shows that Arizona is on the forefront of making
19 a world-class EMS system here.
20 Q. And have you served on the Arizona Ambulance
21 Association leadership at all?
22 A. Yes, for a period of time served as both a
23 regional representative and a vice president and
24 secretary for a period of time. I no longer serve as
25 an executive member of the Association. I'm still a
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1 member through our organizational affiliation with our
2 companies here in Arizona.
3 Q. Glenn, I have up on the screen what's been
4 marked as AMR Exhibit 15, and is this a copy of your
5 most current professional summary?
6 A. Yes, it is.
7 Q. Down to one page.
8 MS. FICKBOHM: Your Honor, I would move
9 for admission of Exhibit 15.
10 MR. BELANGER: No objection.
11 ALJ MIHALSKY: AMR Exhibit 15 is
12 admitted.
13 BY MS. FICKBOHM:
14 Q. Now, we've already heard that AMR, Inc., the
15 national company, has been operating the Rural/Metro
16 entity-held CONs under a grant of temporary authority.
17 When did that start?
18 A. Around about October 23rd, 24th, as we had
19 received Federal Trade Commission approval to move
20 forward with the sale. And as that occurred, which
21 happened sooner than we had anticipated, in order to
22 operate those CONs from the ownership level change, we
23 were issued that temporary authority for 90 days.
24 Q. And under this temporary authority, has the
25 day-to-day -- has, for the most part, the day-to-day
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1 entity operations of the Rural/Metro-held CON entities
2 changed very much?
3 A. Not significantly.
4 Q. And why not?
5 A. Well, under the temporary authority, we have
6 to be able to operate and maintain those service areas.
7 So until we can get, you know, a complete snapshot of
8 how the operations are running and begin to integrate
9 postapproval, assuming the Director grants that, the
10 pledge was to keep those operations intact. If there
11 needed to be some additional resources that needed to
12 be infused in, AMR certainly has the ability to do
13 that.
14 In John's testimony, I believe he talked
15 about the communications between the communications
16 center and leveraging resources between the
17 organizations.
18 An acquisition of this type will take some
19 time to be able to blend organizations together, but
20 certainly how they've been operating, you know, we
21 wanted to maintain that level that they were doing.
22 Where there were gaps, immediately fill those in. And
23 then work to build relationships where those
24 relationships were strained, as well as infuse, you
25 know, any type of emergency capital that was needed in
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1 the short term.
2 Q. Were there changes at upper level management?
3 A. There were no changes at the upper level
4 management. What had began to take place is there was
5 more of a line drawn between the Rural/Metro and AMR
6 side, so there was sharing of information. So Greg
7 James being the West vice president, he and I really
8 had a line between us. So as issues came up, we were
9 communicating both from the AMR side and Rural/Metro
10 side and then subsequently under that.
11 Q. So I'm a lawyer. When I hear "a line drawn,"
12 I think it's like the line is drawn and you stay on
13 your side, I stay on my side. That's not what you're
14 talking about?
15 A. No. A line across as far as how we
16 communicated and, basically, the first step in creating
17 a leadership structure that we could identify a
18 pathway. If there were things that needed to be
19 resolved or have dialogue on, that the organization
20 internally and, to some degree, externally began to
21 know that AMR was there and obviously Rural/Metro
22 existing was still there.
23 Q. So during the period of temporary authority,
24 were you able to identify a few discrete significant
25 issues that required immediate attention?
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1 A. Absolutely.
2 Q. And did AMR apply that attention?
3 A. Yes.
4 Q. Can you give us -- tell us what those were?
5 A. Sure. I think two examples. One is the
6 backpay issue with the I60 union here in Arizona, which
7 was somewhere arranged $750,000. We worked to rebuild
8 that with the union and make that whole, as well as
9 entering into -- Greg James, John Karolzak worked with
10 the City of Glendale to rectify some contract
11 discrepancies and had entered into a settlement
12 agreement, I believe around $1 million, to do that as
13 well.
14 So it's rebuilding those relationships and
15 working to recover those areas that, as a result of the
16 bankruptcy, were left unattended, for lack of a better
17 term.
18 Q. And you heard some questions to John
19 Valentine during his direct examination about the
20 status of the transfer of CON application, and he gave
21 some basic information, but then sort of deferred that
22 he wasn't as intimately involved in that as you. So I
23 just wanted to ask you. In fact, there was a hearing
24 on the application to transfer the CONs in December,
25 correct?
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1 A. Yes.
2 Q. And subsequent to that hearing, I'm going to
3 show you what's been marked, if I can get the mouse to
4 move -- I'm going to show you what's been marked as AMR
5 Exhibit 100. Subsequent to the hearing, a document
6 entitled Stipulated Proposed Findings of Fact and
7 Conclusions of Law, as between the Bureau's attorneys,
8 the Rural/Metro entities' attorneys, and the AMR joint
9 applicants was submitted to the Administrative Law
10 Judge through OAH?
11 A. Yes.
12 Q. And you're familiar with that?
13 A. Yes.
14 MS. FICKBOHM: Your Honor, I would move
15 for admission of AMR Exhibit 100.
16 MR. BELANGER: No objection, Your Honor.
17 ALJ MIHALSKY: Exhibit AMR-100 is
18 admitted.
19 BY MS. FICKBOHM:
20 Q. And just at the end of last week there was a
21 decision entered by the Administrative Law Judge,
22 correct?
23 A. That is correct.
24 Q. And I'm showing you what's been marked as
25 Exhibit 114. You have had an opportunity to review
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1 that before you took the stand?
2 A. Yes, I have.
3 Q. And this, in fact, is that decision, correct?
4 A. From the Law Judge.
5 Q. And what was the Administrative Law Judge's
6 recommendation?
7 A. Recommended approval of the transfer.
8 MS. FICKBOHM: Your Honor, I would move
9 for admission of AMR Exhibit 114.
10 MR. BELANGER: No objection, Judge.
11 ALJ MIHALSKY: Exhibit AMR -- it's
12 actually not on my list, and I'll look into that. --
13 114 is admitted.
14 BY MS. FICKBOHM:
15 Q. Glenn, does entry of that decision mean it's
16 a foregone conclusion that the transfers will be
17 approved?
18 A. No.
19 Q. Ultimately, whose decision is that?
20 A. The Director, Dr. Cara Christ.
21 Q. I would like to talk to you next about AMR's
22 intentions, and I'm going to talk now about AMR the
23 parent organization as opposed to AMR Maricopa.
24 The two may come together at some point in
25 time. Intentions if and when there is a decision from
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1 the Director approving the transfer, and I just want to
2 be clear on the record that to the extent that I ask
3 questions about this, I am also not presuming that
4 anything is a fait accompli; but I just want to ask you
5 questions about in the event there is an approval, what
6 AMR's intentions are, okay.
7 A. Sure.
8 Q. Let's talk big picture and then go small,
9 okay?
10 A. Okay.
11 Q. So overall, in the event the transfer is
12 approved, what is AMR's goal with regard to these
13 transfers?
14 A. So the goal is to bring the two organizations
15 together, to be able to take the strength of American
16 Medical Response and infuse that into the existing
17 Rural/Metro operations across not only here in Arizona,
18 but across the country, to make them sustainable,
19 especially financially sustainable.
20 In a changing health care marketplace, you
21 have to put systems in place from communications and
22 customer service and billing and collections to be able
23 to make yourself an organization that has the ability
24 to maintain a high level of readiness for a community
25 and, also, the long-term readiness by being fiscally
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1 sound.
2 And I think AMR has demonstrated that through
3 previous hearings through Envision Healthcare, our
4 parent company. Certainly those commitments have been
5 made in previous testimony as to what the plan is.
6 Our strength is what -- is in our size, and
7 one area certainly that will be a big impact is, what
8 we purchase across the United States for medical
9 supplies, we'll be able to additionally put more buying
10 power into that by bringing the Rural/Metro
11 organization under that. As an organization now, we
12 will have a footprint globally in 40 states and
13 transport nearly 5 million patients a year under the
14 AMR brand.
15 Q. Can you give us an example about what we're
16 talking about when we say purchasing power for medical
17 supplies?
18 A. Yeah. In the purest form, is we purchase
19 tens of thousands of IV catheters, so we're able to
20 purchase at a much cheaper price than a smaller
21 organization, who buys maybe a hundred catheters. So
22 our buying power gives us a unique ability to maximize
23 cost savings there.
24 I don't like to use the term the Wal-Mart
25 theory there, but globally, when you have a size of AMR
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1 and what we purchase, it certainly gives us the ability
2 to negotiate with those vendors a much better price,
3 which adds up to significant cost savings that is able
4 to be put back into the system in other areas, whether
5 it's medical equipment or quality assurance or
6 technology. So it sometimes is very difficult for
7 small organizations.
8 And to tell you the truth, looking back at
9 Life Line, we felt that pain. We just didn't have the
10 ability to leverage, when you're buying one or two
11 ambulances, to get a deep discount when you want to buy
12 a hundred ambulances or 50 ambulances. Vendors tend to
13 want to do business with you and give you a bigger
14 break, and that leads to substantial savings.
15 Q. Overall goals, any goals with regard to
16 system user relationships?
17 A. Very important. One is ensuring that those
18 relationships are sound, we understand the needs of
19 everyone, whether it's our patients, our customers,
20 putting systems in place to help our front line
21 leadership be able to address issues or concerns, to be
22 responsive. That is an area of focus that is a
23 priority, not only for the AMR side, but the Envision
24 side. We're in health care, and people's perception of
25 the service that you provide is extremely important,
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1 and that's a commitment that I've seen from this
2 organization from day one, and that is something that
3 is priority one for us here, not only locally in
4 Arizona, but across the country, especially when you
5 bring two organizations to one.
6 Q. And then any goals with regard to consumer
7 choices?
8 A. When it comes to choice, you know,
9 Mr. Valentine talked a lot about the changing
10 marketplace and not having a menu that doesn't offer
11 choices, is listening to what your customers or your
12 patients ultimately need through their customers when
13 you look at large health care systems and building a
14 model that works for them, that's unique, that meets
15 their needs specifically.
16 And it's going to continue to evolve and
17 change rapidly. What we've seen occur over the last 4
18 to 5 years compared to the last 12 to 18 months in our
19 industry is accelerating at the pace of, to use an
20 analogy, of technology in the '80s to '90s to now look
21 over the last couple of years with smartphones. You
22 literally buy it, it's obsolete today; versus years ago
23 you bought a computer, it lasted for 5 years. Well,
24 the health care marketplace is changing that fast
25 today.
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1 Q. Let's break that down, those larger goals,
2 into some smaller movement or plans or actions that AMR
3 intends to take or focus on in the event the transfers
4 are approved.
5 First of all, does AMR ultimately intend to
6 modify any of the Rural/Metro entity-held CON
7 parameters themselves?
8 A. So assuming the first phase of the transfer
9 is approved at the ownership level, our commitment is
10 to then take the existing 13 CONs and begin to clean up
11 some of the overlaps that exist in there, and then work
12 with the Bureau to provide more transparency and
13 clarity as to how each of those unique CONs are
14 operating.
15 So the goal there is to be able to
16 collaborate internally to optimize; and then, two,
17 again, you know, can't emphasize enough, working with
18 the Bureau to provide that level of transparency and
19 comfort, in saying here's how that individual CON level
20 is performing financially, operationally, and holding
21 the day-to-day operators of those CONs accountable for
22 that, and then reporting up through the regional
23 directors.
24 Q. As part of that second round of CON
25 applications, I hear you say you want to get rid of
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1 some overlapping, so you're going to make the system
2 more whole?
3 A. To some degree more whole; but, in essence,
4 where certain CONs overlap today, it's my understanding
5 that Rural/Metro has been kind of allocating the total
6 system volume by percentage there, which may or may not
7 be an accurate way to really show the performance of
8 that CON.
9 So working to say if these two areas are
10 covered, in essence, by one CON, how can we consolidate
11 that down so we're not creating, in essence, double
12 work by creating multiple ARCRs then that are allocated
13 out by a volume of percentage, but saying here's the
14 true picture of what this CON does, the communities it
15 serves, its total volume, and its end performance.
16 Q. As part of that second round of CON
17 applications, is it AMR's intention to introduce
18 interfacility transport arrival commitments to other
19 parts of the state?
20 A. Absolutely. That has been, you know, a
21 game-changer, in my opinion, here in Arizona. But,
22 again, as health care has changed, your customers are
23 looking for different levels of service response and
24 commitments, because not all health care systems are
25 all-inclusive. They leverage those partnerships
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1 amongst other systems and move patients between
2 facilities. So not each facility has to have a cath
3 lab or this or that. It's very costly.
4 So, yes, we are going to incorporate those
5 interfacility response times for the Pima County
6 operation, as well as the existing Maricopa operations
7 would be encompassed in the IFT response times as well.
8 Q. Insofar as they become included in AMR
9 Maricopa?
10 A. Yes.
11 Q. What about some of the Rural/Metro
12 entity-held CONs, one or more, have some response time
13 definition language that was put into place before
14 existing statutes and regulations more tightly defined
15 that term; will that be cleaned up?
16 A. Those things will be cleaned up. Any
17 technical piece that was not in alignment with current,
18 you know, State statute or rule will be cleaned up
19 through that process. I believe in phase one some of
20 that was already agreed to, if I recall; and then
21 ongoing phase two, ensuring that the bow tie is put on
22 those things so they are in alignment with what the
23 Bureau's desire is.
24 Q. Does AMR intend any improvements in
25 technology?
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1 A. Absolutely. For one, is infusing the capital
2 not only in vehicles, but medical equipment, cardiac
3 monitors, new technology that's out there from the
4 medicine side that has proven to make a difference in
5 patient outcomes.
6 Those types of things we want to bring and
7 ensure that Rural/Metro is at industry standard and is
8 at AMR standard, because in some aspects AMR looks
9 beyond where the industry is going and ties the
10 medicine into it. And things that we've identified as
11 what we call things that matter, we want to make sure
12 that our health care providers have the technology to
13 be able to analyze that from a clinical quality
14 performance perspective.
15 So somewhat to the earlier testimony of,
16 well, just IV starts and intubations, well, now when we
17 interface with the patient, what did we do and what was
18 the outcome and the change of that patient.
19 So in order to capture that, you have to have
20 new technology, electronic patient care reporting. You
21 have to be able to get the data into the system. And
22 those are the commitments that AMR has made to bring to
23 the Rural/Metro operations that may be lacking in some
24 of those areas.
25 Q. When you talk about things that matter, I
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1 understand that within the AMR organization, that's a
2 term of art. Could you explain, for purposes of the
3 record, from AMR's perspective, what is things that --
4 or what are things that matter?
5 A. Things that matter are clinical components
6 such as did we monitor end title CO2 on a patient when
7 they had oxygen or they were intubated, or what was the
8 time that we arrived with a patient with chest pain and
9 put a 12-lead on them to really determine if they were
10 having a heart attack.
11 Dr. Racht and the AMR medicine and clinical
12 team have really done a phenomenal job looking at where
13 health care is going in the prehospital realm and
14 focusing on not a hundred things, but ten things that
15 really have an impact on patient outcomes. And if we
16 do those things, everything else falls in order.
17 That's really the level of performance that
18 AMR medicine and things that matter is about from a
19 30,000-foot view.
20 Q. I was thinking that I might actually have
21 listed in evidence the --
22 I'm showing you what's been marked as AMR-3R,
23 and is this a good summary of the things that matter
24 that you talked about?
25 A. Yes, those are the things that matter.
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1 Q. And a description of how that conclusion was
2 reached?
3 A. Yes.
4 MS. FICKBOHM: Your Honor, just for
5 purposes of the record, I would like to move for
6 admission of AMR-3R.
7 MR. BELANGER: No objection.
8 ALJ MIHALSKY: Exhibit AMR-3R is
9 admitted.
10 BY MS. FICKBOHM:
11 Q. In the event that the transfer is approved,
12 will AMR's leadership step in and oversee
13 communications and training for the Rural/Metro
14 entities?
15 A. Yes. We are already in some of the
16 preplanning phase of looking at the current existing
17 overall Arizona leadership structure as it relates to
18 those types of support departments. Recently we've
19 posted for a regional communications center director to
20 be housed in Glendale, as well as a regional director
21 to work alongside John Valentine here in Arizona.
22 Q. What about chain of command concerns? Are
23 there going to be changes insofar as the Rural/Metro
24 entities' chain of command?
25 A. That was a very important piece that needed
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1 to be identified and corrected, is when there's
2 concerns, whether it's clinical, operationally,
3 customer concerns, is who's ultimately responsible and
4 where do I start to get an answer so it doesn't fall
5 through the cracks.
6 There is a very defined plan, a very defined
7 leadership hierarchy here that will be implemented. To
8 some degree, it's already operationalized as we're
9 working through the temporary authority; from myself
10 being responsible for Arizona, reporting into the
11 regional CEO, Leslie Mueller, and then to Ted
12 Van Horne.
13 The commitment from the very lowest level to
14 the very highest level will be very defined. So when
15 there's an issue, people know who to go to to be able
16 to get it resolved. In the event that it wasn't
17 resolved, they know who the next person is in the chain
18 to be able to get it resolved.
19 Q. So when you have -- you said that there are
20 13 Rural/Metro entity-held CONs at issue in the
21 transfer application?
22 A. Yes.
23 Q. And then you've got AMR Maricopa, AMR --
24 you've got AMR's operation in Life Line and AMR's
25 operation at River Medical. When you have all of those
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1 different entities operating simultaneously, especially
2 if they're all brought together, does the chain of
3 command become an even larger issue?
4 A. Yes, it can. And what you have to do with
5 the local operations is also ensure that the local
6 leadership understands the chain, and that's defined
7 from the local level all the way up.
8 So the more you start to put into the bushel
9 of apples, the more it potentially can get confusing;
10 but, also, educating the whole entire leadership team
11 on that structure is going to be very important going
12 forward.
13 Q. Let's talk money for a little bit. In the
14 event of approval of the transfer, what kind of
15 capitalization infusions are immediately intended?
16 A. So one of the commitments was vehicles and
17 equipment. In previous testimony at the hearing, our
18 chief operating officer/chief financial officer, Tim
19 Dorn, committed to a hundred ambulances, also
20 additional ePCR technology resources, and any other
21 medical equipment that is identified as in existence
22 that is still operationally sound, but maybe not the
23 latest technology to help us get to measure the things
24 that matter and other core components.
25 So there's a strong commitment from our
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1 organization to infuse that here in Arizona.
2 Q. And the hundred new ambulances, that's over
3 what time frame?
4 A. Over the first year.
5 Q. And are more new ambulances intended in year
6 two?
7 A. Yes. The ongoing capital infusion will
8 happen over a sustained period of time. You can
9 replace initial equipment, but you still have aging
10 equipment that also reaches a certain end point as
11 well. So you just can't stop. You have to ongoing
12 have a plan for that.
13 Q. And does that capitalization commitment
14 extend to things as mundane as the clothes the staff is
15 wearing when they go out in the field?
16 A. Absolutely. One of the pieces we've
17 identified is, you know, shoring up the uniforms.
18 We've already implemented a process in the Glendale
19 communications center to get that team back in a
20 uniform. Currently, they don't have a uniform assigned
21 to them. We want to make sure that every one of our
22 team members portrays a professional appearance. I
23 believe the uniform is your brand identity. And,
24 unfortunately, sometimes when things go bad, it gets
25 cast on it.
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1 If you don't take pride in the simple things
2 that you wear, that you represent, I personally believe
3 it has an impact just on the overall performance of an
4 organization. And something as so simple as uniforms
5 can have such a significant impact, whether it be in
6 morale, in pride, that really helps improve
7 performance.
8 Those are things that are extremely important
9 to employees. They may not seem like they're that big
10 in the grand scheme of things, but very important and
11 have a significant impact.
12 Q. Has AMR looked at these capital expenditures
13 it intends to make and set aside funds?
14 A. There have been funds that have been
15 reserved. Certainly the ongoing national integration
16 team is part of that. We've been working to identify
17 areas here in Arizona that do need to be recapitalized,
18 and there's a whole internal communication chain that
19 exists to be able to put that infrastructure in and get
20 approval to do that.
21 Q. Let's talk for a minute about corporate
22 overhead. As part of the annual ambulance cost and
23 revenue -- Arizona -- yeah, the ARCR, the ambulance
24 revenue and cost report. I was able to back into that.
25 Corporate overhead allocated to individual operations
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1 is something that has to be reported, correct?
2 A. That is correct.
3 Q. And what is the anticipated impact of a
4 merger of the two entities, as finalized through
5 approval of the CON transfers, on corporate overhead
6 allocations for both the Rural/Metro entities and AMR's
7 existing Arizona operations?
8 A. As previously testified in the transfer
9 hearing, is we expect to realize a significant cost
10 savings from the overhead side of it. We'll be able to
11 synergize leadership. We'll be able to maximize what
12 the oversight is. We're not going to create redundant
13 departments in each CON. You'll be able to leverage
14 those pieces across the enterprise.
15 And, also, just in the consolidation of the
16 CONs from 13 to 10, you'll have much more consistent
17 oversight. So that's an area that we anticipate some
18 cost savings on.
19 Q. And what about any impact of what we call
20 front end or back end billing changes?
21 A. So billing is extremely important to an
22 organization. That's really your life blood. But it's
23 just not a process on the back end. It starts on the
24 call-taking side of the house. When the call comes in,
25 making sure -- not so much on the 911 side, but on all
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1 your -- mostly your interfacility transfers, because
2 insurance companies today are now requiring a lot of
3 preauthorization. So if you want to move a patient,
4 the insurance company wants to know what mode they're
5 going to.
6 What we've also seen through the years is
7 really a downgrade in that effect; is patients that
8 were ALS before, or advanced life support, are now
9 being transported basic life support, and basic life
10 support patients are transported by wheelchair or
11 stretcher van or even car service. You have to be able
12 to document that as the call comes in. That now gets
13 passed along to the crew. So the crew's documentation
14 is extremely important of what transpired on that call.
15 And then, lastly, is the billing, the actual
16 billing side of that. AMR has had strong billing
17 practices in place. We've seen that from the Life Line
18 side of the house. We had extremely good billing
19 practices in place, and they got even better because of
20 the leverage of a national company. Improving
21 collections.
22 Q. When you say they got even better, are you
23 talking about before or after AMR ownership?
24 A. After AMR ownership, from a process
25 improvement standpoint.
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1 Q. Okay.
2 A. Because what we were doing was somewhat
3 redundant in-house, where when you take a small
4 organization and you have to have one person doing a
5 specific task for a specific number of calls, may not
6 be at their capacity level. They could have a
7 tremendous amount of excess capacity.
8 So we were able to improve those processes,
9 utilize technology and auditing through the national
10 side of it, and in turn, you improve your billing
11 collections and your -- what's most important is your
12 days outstanding, which is the time that you start that
13 ticket to the time that you get paid.
14 AMR has a core team in place to do that, and
15 that is an area that we will see significant
16 improvement on the Rural/Metro side, from where they
17 were in bankruptcy to what they were collecting to what
18 AMR's benchmark is to get to.
19 Q. Let's talk about clinical matters. Is the
20 clinical oversight currently the same at the
21 Rural/Metro entity side of the table as it is on the
22 Rural/Metro -- or on the AMR side?
23 A. They're very different currently.
24 Rural/Metro's clinical programs, from what I've
25 observed and had the ability to see, have been somewhat
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1 managed at the local level, so based on local
2 protocols, regional protocols, local medical direction.
3 Each operation or regional maintain that.
4 Where AMR's focus is not only local, it's
5 regional, and then it's national.
6 And the other nice thing about our clinical
7 perspective and the systems we have in place is we have
8 the ability to check the checker. So when we analyze
9 our clinical quality, we have an expectation that our
10 local clinical managers look at X number of charts or
11 they review certain types of calls. That gets fed up
12 into our national system. In essence, our regional or
13 national clinical directors can go in and see what the
14 local performance has been done, to make sure that
15 those managers are doing those tasks; where Rural/Metro
16 has been somewhat on an individual business unit to
17 business unit basis. Big difference between
18 organizations.
19 Q. And with regard to clinical practices, is it
20 AMR's intent to just throw out all of Rural/Metro's
21 clinical practices?
22 A. Absolutely not. You want to look and see
23 where they're strong, and now we'll be able to
24 benchmark that against our areas. And if we're weak
25 clinically somewhere, from a best practice standpoint,
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1 what are they doing and how are they doing it.
2 So it's the strength of organizations and
3 leveraging best practices; that when you're weak, you
4 identify where you're weak, and where you're strong,
5 you work to improve on even more it.
6 I never like to live by the theory of, well,
7 it's there. It will just go away. It won't. And
8 ultimately you have to be willing -- and we've done
9 this as an organization. Where we've been weak we've
10 partnered with national corporations like Medtronic and
11 we've looked to improve patient outcomes.
12 In medicine today, both prehospital and all
13 the way up, you have to be willing to improve, because
14 more and more people are watching what you do. When
15 you look at hospital systems, there's something called
16 HCAHPS score. So you get a survey from your hospital
17 when you were admitted.
18 Well, AMR embraced that concept, and we have
19 Ambu CAHPS, in essence, where we send out quality
20 surveys, and we want to measure the performance and
21 feedback from our customers' perspective, because what
22 they see and feel might be different than what we
23 really do. And we have to be able to recognize that a
24 lot of patients we interface with in their time of need
25 may not see and feel everything they experience. But
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1 we get that feedback. We're able to match it up
2 against what we document and look for ways to improve
3 our customer service and patient outcomes.
4 Q. And that will be integrated into Rural/Metro
5 also?
6 A. Yes.
7 Q. Let me ask you. There are a variety of, for
8 lack of a better word, quality assurance programs that
9 the Bureau would like to see all Arizona operations
10 participate in, which includes using ePCR technology,
11 submitting that ePCR data to the Arizona PIERS,
12 P-I-E-R-S, system, participating in the Premier EMS
13 Agency programs, and participate in other quality
14 improvement initiatives, including SHARE and EPIC-TBI.
15 Are all of AMR's Arizona operations currently
16 doing all of those things?
17 A. Yes, they are.
18 Q. In the event that the transfer of the CONs
19 are approved, what will AMR do with regard to the
20 currently Rural/Metro-held CON entities?
21 A. We will ensure that each of those CON
22 entities are participating at the full level. It's our
23 understanding that some are, to some degree. Some
24 lack, whether it's from a data side, of getting the
25 data into the system. We want to ensure that the State
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1 is getting the information and we're participating.
2 Again, not only as AMR is passionate about patient
3 outcomes, the Bureau of EMS is, Dr. Bobrow, the
4 relationships they have with the University here, the
5 medical school. All of the information that comes into
6 those systems from the prehospital side is making a
7 difference in patient outcomes in Arizona.
8 MS. FICKBOHM: Thank you, Mr. Kasprzyk.
9 THE WITNESS: Thank you.
10 MS. FICKBOHM: I don't have any other
11 questions, Your Honor.
12 ALJ MIHALSKY: Mr. Rosenfeld?
13 MR. ROSENFELD: No questions.
14 MR. BELANGER: Yeah, Judge. Can we take
15 a break, though?
16 ALJ MIHALSKY: I think it would be a
17 good time. We'll be back on the record at 2:45.
18 (A recess was taken from 2:27 p.m. to
19 2:48 p.m.)
20 ALJ MIHALSKY: We're back on the record.
21 Did everyone have a chance to review
22 MA-203, which is the amended MA-34?
23 Did anyone remember to review that?
24 Okay. We'll take it up later.
25 MR. BELANGER: We can take it up now,
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1 Judge. I don't have any questions for Mr. Kasprzyk, so
2 we can take it up now, if you like.
3 ALJ MIHALSKY: Well, yeah. We would
4 have to take another break for people to have time to
5 review it.
6 MS. FICKBOHM: We probably would need to
7 include Ms. Hofmeyr, because she said that she wasn't
8 interested in participating in the --
9 ALJ MIHALSKY: That's true. We need to
10 contact her tomorrow morning anyway --
11 MS. FICKBOHM: -- in the presentation.
12 ALJ MIHALSKY: -- about her admitting
13 her exhibits. So we'll do exhibits tomorrow morning.
14 MR. BELANGER: Mr. Kasprzyk, I have no
15 questions.
16 THE WITNESS: All right. Thank you.
17 ALJ MIHALSKY: Mr. Ray, do you have any
18 questions?
19 MR. RAY: Yes. I just have one area to
20 go into.
21
22 CROSS-EXAMINATION
23 BY MR. RAY:
24 Q. Under the public necessity rule, it
25 identifies a number of factors that are to be
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1 considered in a CON application. One of those is
2 whether there's any negative financial impact on
3 current CON providers. You're familiar with that?
4 A. Yes.
5 Q. Okay. Has AMR prepared any analysis,
6 financial analysis, of what the negative financial
7 impact would be if Maricopa was granted a CON?
8 A. Kevin, I haven't participated in any of that.
9 I don't have an answer, what was done internally to
10 evaluate that. That's just not part of what my scope
11 is.
12 MR. RAY: Okay. I don't have any other
13 questions. Thank you, Judge.
14 ALJ MIHALSKY: Do you have any questions
15 on redirect?
16 MS. FICKBOHM: One follow-up question.
17
18 REDIRECT EXAMINATION
19 BY MS. FICKBOHM:
20 Q. Mr. Kasprzyk, if AMR of Maricopa were to do a
21 financial impact analysis, what information do you
22 think we would need to get from the applicant itself
23 with regard to transports AMR of Maricopa would
24 otherwise do?
25 A. I have a very limited financial background
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1 from what I do, but I can tell you that putting those
2 types of analyses together requires a tremendous amount
3 of information to be able to realize what the impact
4 would be. There's just no simple methodology to do
5 that. You want to be accurate, and it's going to be
6 complex.
7 Q. Would you need to know how many trips that
8 AMR Maricopa projects doing, it would not be able to do
9 because those trips went to Maricopa Ambulance?
10 A. That would be one part of it.
11 Q. And to the best of your knowledge, have we
12 received that specific information from them?
13 A. The only information that we had available is
14 what's been entered into evidence as far as their
15 projected ARCR. No significant detail beyond that, to
16 the best of my knowledge.
17 MS. FICKBOHM: Thank you.
18 ALJ MIHALSKY: Thank you very much.
19 THE WITNESS: All right. Thank you.
20 ALJ MIHALSKY: You can go back.
21 MR. MCGOLDRICK: Judge, we don't have
22 any more witnesses to present, but I've got some
23 exhibits to introduce.
24 ALJ MIHALSKY: Okay.
25 MR. MCGOLDRICK: Judge, AMR-112 is an
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1 e-mail from Steve Blackburn, and Mr. Blackburn you had
2 met. He testified the first session. It's to a
3 gentleman named Shawn Heming, whose identity was
4 discussed at the first hearing, and it's an e-mail
5 dated October 7th, 2013. It has a discussion, and it
6 looks like one of the lenders of the organization
7 wanted an inventory of ambulances. And Mr. Blackburn,
8 in his e-mail to Mr. Heming and to other organizational
9 members, including Mr. Gibson, who you met, indicates,
10 quote, Please start work on this, but I want to review
11 before you forward to Shawn. Ken I would like you to
12 handle the units at Shoals being prepped for TN, which
13 I believe is Tennessee, and AL, which I believe is
14 Alabama.
15 And I believe that this e-mail
16 contextually fits in with the testimony and exhibits we
17 discussed at the first session. So, therefore, I would
18 move Exhibit AMR-112 into evidence.
19 MR. BELANGER: I'm going to object, Your
20 Honor. I mean obviously it's an administrative hearing
21 and you'll do whatever weight it's entitled to; but
22 foundation, and this could have been introduced a long
23 time ago when Mr. Blackburn was testifying, where you
24 would then get some explanation regarding it. So I'm
25 going to object to its admission as untimely and
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1 lacking foundation, hearsay.
2 ALJ MIHALSKY: Okay. I will consider
3 those objections as going to the weight of the
4 evidence.
5 MR. BELANGER: Sure.
6 ALJ MIHALSKY: And certainly if you
7 want, you're free to introduce rebuttal testimony about
8 it. But for what it's worth, Exhibit AMR-112 is
9 admitted.
10 MR. MCGOLDRICK: And, Judge, if I may
11 address the foundational issue. These were not given
12 to us at the time the first hearing was conducted.
13 They were disclosed after that date, so we couldn't
14 have questioned Mr. Blackburn or Mr. Gibson about it
15 because we didn't have possession of it, Your Honor.
16 Exhibit No. 113. Judge, that is an
17 e-mail from Mr. Samarth, S-A-M-A-R-T-H, who you met at
18 the first hearing. Mr. Chandra. I apologize. You did
19 meet him at the first hearing. It's an e-mail dated
20 December 5, 2013, and it is an e-mail which is sent to
21 a number of individuals, including Mr. Gibson, who you
22 met at the first hearing. It discusses the wind-down,
23 and it discusses -- at the bottom, it says, quote,
24 There are some assets at FirstMed whose value is
25 diminished in Chapter 7 that we would like to bid in,
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1 if possible. It says the Kentucky CON and 20
2 ambulances.
3 And, again, Your Honor, this gives some
4 context to the discussion that Mr. Chandra had with us
5 about the bankruptcy and pursuing new business
6 disputes -- I mean new business acquisition of
7 ambulance companies. And it's just simply additional
8 information for you to consider. So I move AMR-113
9 into evidence.
10 MR. BELANGER: And I would have the same
11 objections, Judge.
12 ALJ MIHALSKY: Very good.
13 Exhibit AMR-113 is admitted for what it's worth.
14 MR. MCGOLDRICK: And, finally, Your
15 Honor, I would like to discuss AMR-99. And to give
16 some context, Your Honor, a number of exhibits were
17 moved into evidence by me during the first -- in the
18 first hearing. As you know, there was a bankruptcy
19 filed. There were some subpoenas issued that we had
20 discussed that were moved into evidence. There was
21 some discussion about members of the Maricopa Ambulance
22 team not being directly implicated in the adversary
23 proceedings that are going on in North Carolina.
24 After our first session concluded, the
25 bankruptcy trustee did, in fact, file a complaint,
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1 naming not only Enhanced Equity Fund II, LP and some of
2 the other corporate entities, but also personally Bryan
3 Gibson, Steven Blackburn, Robert Jewell, Priority
4 Ambulance and Shoals Ambulance. And in addition to the
5 Enhanced Equity Fund itself, it named its principals,
6 Malcolm Kostuchenko, Andrew Paul, and Samarth Chandra.
7 This adversary complaint is well over a
8 hundred pages with exhibits. It sets forth, in a
9 16-count complaint, allegations of fraud, actual and
10 constructive fraud, fraudulent transfer of assets,
11 breach of fiduciary duty, negligence, gross negligence,
12 breach of duty of loyalty, conflict of interest,
13 conversion, misappropriation of corporate assets and
14 corporate opportunities. It's got a claim for unjust
15 enrichment, breach of the employment agreements of
16 Mr. Gibson and Mr. Blackburn, and has a claim of
17 punitive damages. And this complaint filed by the
18 bankruptcy trustee also has supporting exhibits. And
19 we would like to move Exhibit No. 99 into evidence for
20 your consideration.
21 MR. BELANGER: Same objections, Judge;
22 hearsay, foundation.
23 ALJ MIHALSKY: Okay. For what it's
24 worth, the complaint in Exhibit AMR-99 is admitted.
25 And that's all?
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1 MR. MCGOLDRICK: That's all, Your Honor.
2 ALJ MIHALSKY: Okay.
3 MS. FICKBOHM: We're done.
4 ALJ MIHALSKY: Very good.
5 Mr. Rosenfeld, do you have any
6 witnesses?
7 MR. ROSENFELD: I do, Your Honor, and if
8 I may, I did reserve my opening statement, as you may
9 recall, way back in October, and I will take just a
10 couple of minutes just to review who my witnesses are
11 and what areas they're going to touch upon.
12 ALJ MIHALSKY: Okay.
13 MR. ROSENFELD: So let me say that I
14 have spent time during the hiatus to review the record
15 and have also considered, with respect to a number of
16 the exhibits that were admitted en masse by the
17 applicant at the very end, that many of them were very
18 old, contained multiple levels of hearsay, and we're
19 probably going to leave all of those alone, for I think
20 obvious reasons.
21 There are a couple of those exhibits
22 that are of more recent vintage that I do plan to
23 address, and the witness I'll be calling to talk about
24 operational matters, including some of those exhibits,
25 will be Mr. Kevin Stock. His title is vice president
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1 of operations, and he is the senior-most operations
2 officer responsible for oversight of the Rural/Metro
3 intervenors' Maricopa County operations.
4 Mr. Stock will also testify to a couple
5 of matters that Mr. Blackburn spoke about, a couple of
6 protocols that Mr. Blackburn expressed an opinion on,
7 that Mr. Stock will shed light on. Mobile integrated
8 healthcare, Mr. Stock will talk about that, and perhaps
9 a couple of other operational issues.
10 We'll also be calling Mr. Marco Rivera,
11 who will be kind enough, not sitting at my side, but on
12 the witness stand, to continue to operate the exhibits,
13 manipulate the exhibit list, so I don't have to do it.
14 But Mr. Rivera can multitask, and I have a high degree
15 of confidence he'll be able to testify and help us with
16 the exhibits.
17 He will testify principally with respect
18 to some of the statistical documents that we have
19 identified as exhibits and will talk about how that
20 data should be interpreted. His title, by the way, is
21 business analysis manager.
22 Also, my third witness -- and I'll talk
23 about my sequencing in a moment here, but my third
24 witness will be Mr. Yanofsky from the Bureau, and this
25 will be very brief. There was one exhibit that was
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1 among those offered at the rush of the last minute by
2 applicant as it was closing its case, Maricopa
3 Ambulance 53J. And since that exhibit was not
4 presented to Mr. Jaramillo, the DHS witness who
5 testified during the applicant's case-in-chief, we
6 didn't have a chance to ask him about that document.
7 But I will, as part of my case-in-chief, have
8 Mr. Yanofsky very briefly address it.
9 In terms of sequencing, my plan is to
10 call Mr. Rivera first. Assuming Mr. Yanofsky is
11 available when I complete my -- when we complete the
12 examination of Mr. Rivera, I will call him second; and
13 then Mr. Stock would be our concluding witness.
14 So with that, we're prepared to call
15 Mr. Rivera, Your Honor.
16 ALJ MIHALSKY: Mr. Rivera, if you would
17 come up here. And I think, hopefully, you have enough
18 wire to be able to operate the mouse; and if not, we'll
19 make adjustments.
20 THE WITNESS: It will work.
21 ALJ MIHALSKY: Okay, good.
22 Would you raise your right hand.
23 (Mr. Marco Rivera was duly sworn by the
24 Administrative Law Judge.)
25 ALJ MIHALSKY: Thank you. Would you
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1 spell your name -- or, excuse me, say your name for the
2 record and spell your name for the court reporter.
3 THE WITNESS: Marco, M-A-R-C-O. My last
4 name is Rivera, R-I-V, as in Victor, E-R-A, and if you
5 put the suffix Junior on there, otherwise my dad will
6 freak out and my son will freak out.
7
8 MARCO RIVER, JR.,
9 called as a witness on behalf of Intervenor Rural/Metro
10 herein, having been previously duly sworn by the
11 Administrative Law Judge to speak the truth and nothing
12 but the truth, was examined and testified as follows:
13
14 DIRECT EXAMINATION
15 BY MR. ROSENFELD:
16 Q. So, Marco, where do you work?
17 A. I work for Rural/Metro Corporation.
18 Q. And in what capacity?
19 A. My title is business analysis manager.
20 Q. Would you tell Judge Mihalsky a bit about
21 your duties in that position?
22 A. I assist, at a corporate level, our
23 operations coast to coast with things like business
24 intelligence, which is a fancy way of looking at their
25 data, looking at their numbers, giving them guidance
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1 and insight into their operations, how they're doing,
2 how they want to do, research as far as endeavors that
3 they want to implement, things that they want to look
4 at, RFPs.
5 I'm a techie and a geek, so a lot of my job
6 duties have to do with looking at processes, looking at
7 data, and giving the operations feedback, the tools
8 necessary for them to manage their operations day to
9 day and take care of their customers or patients and
10 their employees.
11 Q. How long have you been with Rural/Metro?
12 A. February 25 of this year it will be 21 years.
13 Q. And can you take just a couple of minutes
14 then to walk us through your progression through the
15 company?
16 And if you would like, since I'm going to
17 offer it eventually, if you would like to get Exhibit
18 Rural/Metro 6 on the screen, if that would be of
19 assistance, go ahead and do that.
20 A. Okay. I started -- and I think this is going
21 to be a little bit of déjà vu for the audience members.
22 I did watch Emergency, and I was inspired to become an
23 EMT, which is one of the, typically, two attendants on
24 an ambulance. Our emergency medical technicians are
25 trained to basic life support. I started
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1 February 25th, 1995, in Tucson, Arizona, for what was
2 then Rural/Metro Ambulance & Fire on the ambulance as a
3 part-time employee.
4 Quickly I became even more impassioned and
5 even more interested in the operation itself, and I
6 moved into the communications center, where, again, I'm
7 a geek, so there's bright lights and there's buttons
8 and there's data and there's screens and there's a
9 bunch of technology and a group of people working
10 collaboratively, as Glenn said, to move the operations
11 along, really keep the operations running, taking the
12 calls in, giving the calls to the ambulances. And I
13 developed a quick interest to that. They accepted my
14 application to become a dispatcher, and that's kind of
15 where my data story begins, believe it or not.
16 That was my foray into the back end, kind of
17 the back stage part of our operations. Our front line,
18 EMTs, firefighters, and paramedics, are working with
19 the patients, working with our customers. Behind them,
20 supporting them directly, is our communications center
21 giving them the calls, talking to the customers on the
22 phone, giving dispatch life support, doing the priority
23 dispatching that we talked with earlier. And that's
24 where I really dug in. I became a full-time employee
25 of the dispatch center, and through a couple
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1 progressions and I think I lost a couple of bets, I
2 made it up to supervisor and eventually communications
3 center manager.
4 In that time I also inherited the
5 computer-aided dispatch system, which involved not only
6 maintaining it technologically, which was great for a
7 want-to-be techie like me, but also into the data piece
8 of it. I was not only taking care of the hardware
9 itself, the computers, but the data that lived in it,
10 and began my career in providing the operations with
11 the intelligence that that data provides them; response
12 times, CON compliance, all the ambulance key
13 performance indicators that we monitor day in and day
14 out as a company.
15 That then led into a regional role. I was
16 asked to move to a more regional level, moving out of
17 the Southern Arizona geographic area in Tucson into
18 providing support to our regional executive team based
19 out of Mesa, Arizona. And they were providing support.
20 They were administrating not only Southern Arizona,
21 which includes Tucson, Pima County, Safford, but also
22 includes Western Arizona, our Yuma operations, as well
23 as Central Arizona, which includes Maricopa and Pinal
24 County. That consisted much of the same thing. I was
25 still project managing, still providing data, looking
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1 at processes. I was still able to do what I was doing,
2 just at a much bigger level.
3 That then ultimately, and where I am today,
4 led to a corporate role, doing the same thing and
5 providing -- and I say providing to the company.
6 Really, they provided me with the opportunity. It's
7 been an amazing opportunity to work with all our team
8 members across the country, from the Pacific-Bowers
9 operation in L.A. to our operations in New York and
10 Buffalo, Syracuse and Rochester.
11 So I took what I had been doing locally and
12 then in Arizona, I took it on a road show across the
13 country on behalf of the corporate company. And that's
14 what I've been doing, in essence, ever since.
15 Q. And for how long have you been doing that,
16 Marco?
17 A. It will be 21 years.
18 Q. And specifically in the corporate role, how
19 long have you --
20 A. The corporate role? Four or five years. I
21 think that's what I've got here.
22 Yes.
23 Q. And you're looking at your CV, I noted. So
24 would you take a look at it now, each of its pages, and
25 let me know if this is an accurate description of your
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1 progression through the company.
2 A. It is an accurate description.
3 MR. ROSENFELD: Your Honor, we offer
4 Rural/Metro 6.
5 MR. BELANGER: No objection.
6 ALJ MIHALSKY: Rural/Metro 6 is
7 admitted.
8 MR. ROSENFELD: Thank you, Your Honor.
9 BY MR. ROSENFELD:
10 Q. Marco, I would like to then talk next, given
11 your background, your experience, and what you
12 currently do as business analysis manager, to ask what
13 role you played in terms of the preparation for this
14 hearing generally and, more particularly, the data
15 presentations in this hearing?
16 A. In my previous incarnations, I participated
17 in several CON, certificate of necessity, related
18 hearings. So I had some context and experience in that
19 sense. So Mr. Stock and his team engaged me to work
20 with them to put together the data that was then going
21 to result in the exhibits, some of the exhibits that
22 we're going to look at today.
23 And that involved not only helping them
24 prepare the exhibit, but, again, as an analyst, I kind
25 of go end to end. So we started with, to quote
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1 somebody way smarter than me, seek first to understand.
2 So we looked at the market. We looked at the
3 components of the market, not only from what ambulances
4 and how many ambulances do we have in the area, but we
5 looked at our current CONs. We looked at the proposed
6 CONs. We looked at the reporting systems, the data
7 that we have in place, the contracts that we have in
8 place, how we're currently reporting day to day, who we
9 report to as far as our customers go, as far as our
10 regulators go.
11 And through all that, we started looking at
12 time frames, and we ended up at the exhibits that I
13 think we're about to discuss.
14 Q. Were you also involved, Marco, in what I'll
15 call the quality assurance process, to make certain
16 that the data being presented is accurate and properly
17 depicts the points that are reflected in the various
18 items of data that appear on each of those exhibits?
19 A. Yes. So part of my seeking to understand is
20 to observe and ask questions about what the operation's
21 actually doing as quality assurance, what they do,
22 where the data starts, where it ends up, who's running
23 the report, what they're using, what tools, literal
24 tools they're using to run the reports, how they
25 determine what goes into each bucket.
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1 And that's -- so I'm not involved necessarily
2 in the quality assurance, but I observed as part of my
3 analysis, so that I understand what the operation's
4 doing as far as quality assurance for the data.
5 Q. And with that, let's start looking at the
6 actual exhibits containing the data that you've
7 described, and let's start with Rural/Metro 156.
8 And this is a document entitled Monthly
9 Response Time Percentage (July 2014-September 2015) For
10 Seven Jurisdictions Addressed in MA-178, Plus City of
11 Mesa; is that correct?
12 A. That is correct.
13 Q. Do you know what MA-178 was?
14 A. It is. It's the -- those are the
15 documents -- it's a document, multiple pages, that
16 Mr. Lindberg prepared.
17 Q. Reflecting his analysis of response times
18 based on the CAD data?
19 A. Based on data that he had received from
20 Phoenix Fire, that's correct.
21 Q. Right.
22 And this exhibit, just so we're clear, this
23 exhibit is based on the CAD data maintained by
24 Rural/Metro?
25 A. That is correct.
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1 Q. And this data is the data that was turned
2 over to Maricopa Ambulance, the applicant here,
3 pursuant to its requests for subpoena, at least through
4 the month of June 2015 -- or, excuse me, July 2015, per
5 their request; is that true?
6 A. That's correct.
7 Q. So talk generally -- before we get to the
8 specific line items, Marco, talk generally about what
9 this exhibit is designed to depict.
10 A. In a table format we took, again, the
11 jurisdictions that Mr. Lindberg was looking at and we
12 added Mesa. And in the first column on the left, we
13 list the name of the jurisdiction. It's a geographic
14 area in our service area. The second column is a
15 Code 3 requirement, our benchmark that we're using to
16 measure the percentages then that you see in the last
17 columns on the right. The top section is year 2014,
18 months July through December. The second section is
19 year 2015, months of January through September.
20 Q. All right. Just, again, as a preliminary
21 matter here, before we dive into the data, is this data
22 compiled or was it compiled solely for purposes of
23 presentation at this hearing?
24 A. No, it was not. Again, this is something
25 that the operations monitors every hour of every day
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1 and compiles internally at each of those different
2 levels of granularity; monthly, yearly, depending on
3 the contract, the agreement, or whatever the response
4 time reporting period is for that particular
5 relationship, then they get reported within those time
6 frames, again, monthly, yearly.
7 We're seeing a per month, on an 18-month
8 trend, summary of those efforts that the operation
9 does. So short answer, no, it's not something that was
10 done solely for the purposes of this exhibit. This
11 exhibit was summarized and compiled for the purposes of
12 this hearing, but it is as a result of ongoing, every
13 day, hour-to-hour work that the operation does.
14 Q. And just a quick correction. You said it was
15 18 months. It's actually 15 months.
16 A. 15 months. I'm sorry.
17 Q. Looking now more specifically at the
18 left-hand column, where it says City or Region, there
19 are eight jurisdictions listed there, correct?
20 A. We just saw my ability to count on the fly.
21 So, yes, I'll take it as eight jurisdictions.
22 Q. I can't lead you. I'm sorry. You have to
23 count them for yourself.
24 A. Yes, sir. Yes, sir.
25 Q. Why did you pick these particular
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1 jurisdictions?
2 A. They were the ones that were included in
3 Maricopa Ambulance Exhibit No. 178, and we added Mesa.
4 David mentioned -- I'm sorry. Mr. Lindberg mentioned
5 that he could not quite get the numbers he wanted to
6 using the Mesa data. It wasn't formatted in the way he
7 could use it. So we went ahead and added it using our
8 data as the additional jurisdiction here.
9 Q. And why the time frame, beginning July 2014
10 through September '15?
11 A. It lines up with the data that not only was
12 requested, but was given with the data requests that
13 Mr. Lindberg was working with. That was July through
14 June. We added July, August and September to bring us
15 up to current for the months preceding October, which
16 is when this proceeding started.
17 Q. Let me ask you next then about the column
18 after, the column to the right of the column that says
19 City/Region, Code 3 Requirement. You talked earlier in
20 your testimony about benchmarks. Where did the
21 specific descriptors of those benchmarks come from for
22 purposes of this exhibit?
23 A. So we're looking at the second column on the
24 right. 10 minutes 90 percent of Code 3 calls is the
25 first one. Those line items came from the contracts
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1 themselves that we have with those geographic
2 locations, with the exception of Glendale.
3 Q. We have no contract with Glendale?
4 A. We have no contract with Glendale.
5 Q. So where did the Glendale benchmark come
6 from?
7 A. The operation's chosen to measure themselves
8 against the fractile -- it's misapplied, and I'll
9 explain what I mean here in just a moment, but the
10 fractile that is contained within our CONs in the
11 section that specifies response times for areas in
12 which we have a suboperating station.
13 Now, it was misapplied in that that is a
14 general -- that's an aggregate time frame that we use
15 on our CON for all areas in which we have a
16 suboperation station. We chose to take that benchmark,
17 that is, the 10 minutes 90 percent of the Code 3 calls,
18 and measure our performance within Glendale itself,
19 just the geographic isolated location.
20 Q. Would you then, next, walk us through just --
21 and we can pick Avondale, whichever one you want, and
22 Avondale is the first one here. So just sort of go
23 left to right through that line item and talk about
24 what we're looking at here.
25 A. So Avondale, again, is the geographic
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1 location in which the calls occurred. Code 3
2 requirement is 10 minutes on 90 percent of Code 3
3 calls. Again, that means we're arriving -- what
4 percentage of the time we're arriving at 10 minutes for
5 calls that we responded to lights and sirens.
6 Q. And when we say lights and sirens, we're
7 talking about an emergency response through the 911
8 system?
9 A. Code 3 emergency, that's correct.
10 And then in the following columns we see what
11 percentage of the calls that we responded to Code 3 we
12 arrived in 10 minutes or less. July it was
13 92.7 percent, August it was 94.0 percent, September
14 92.9 percent, and on through September of 2015.
15 Q. And does that same protocol, I guess, for
16 lack of a better term, apply as we look at each of
17 those jurisdictions across each of those columns?
18 A. Yes, the same way to read it would apply.
19 MR. ROSENFELD: Your Honor, we offer
20 Rural/Metro 156.
21 ALJ MIHALSKY: Exhibit RM-156 is
22 admitted.
23 MR. ROSENFELD: Thank you, Your Honor.
24 BY MR. ROSENFELD:
25 Q. The exhibit contains all of the individual
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1 numbers for each of these regions for each of these 15
2 months, and anyone reading it can read those numbers,
3 so I'm not going to ask you to go line by line for
4 each.
5 I think for these purposes, what I would like
6 to know, Marco, is, when you're looking at a document
7 like this and data like this, how do you analyze it, as
8 a business analyst, substantively in terms of
9 determining the quality and the rapidity, if you will,
10 of the performance as compared to the benchmarks that
11 you've identified?
12 A. In analyzing, I take a holistic approach. I
13 don't look at one or two or three months. I don't look
14 at one or two or three cells on this table to draw my
15 conclusion. I look at it as a system as a whole.
16 So using this specific example, I look at
17 performance across all of the eight communities that we
18 have listed, how they interplay. That tells me a lot
19 about the interoperability of the operation, especially
20 in an area like this where, for the most part, our
21 ambulances are moving relatively fluidly from one area
22 to the next to provide support.
23 I then look at trends over time. Not only,
24 again, each line, but how they're moving together in
25 all eight communities over the time frame July to
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1 September; are there variances; how big are the
2 variances. If there's a variance below 90 percent, how
3 long did that sustain; by how much was that variance;
4 was it 2 percent, 3 percent, 6 percent.
5 And I measure that against, again, the whole
6 trend over time, and I look for patterning. And then
7 there's a continued discovery, because, again, these
8 numbers are being looked at very, very diligently by
9 the operation here to discover what is playing into
10 those variances, what are the root causes, what are the
11 contributors. Do we have hospital delays; do we have
12 extended task times; what may be playing into those
13 numbers and those variances.
14 So, again, not just cell by cell. That would
15 be like rating pizza solely on pepperoni. And I'll
16 apologize for my analogies. If it's not food, it will
17 be Star Wars. So my apologies to the audience now.
18 Here is my first food analogy. To look at one cell
19 would be to look at just the pepperoni on a pizza.
20 Looking at each cell would be an incomplete picture.
21 We have to look at it as a whole. It has to be
22 holistic.
23 Q. And in terms of the opinions you're going to
24 express here today, is that what you did?
25 A. That is what I did, yes. I looked at the
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1 patterns over these eight communities over this time
2 frame.
3 Q. And can you give us a couple of examples
4 before we get to the overall analysis of the document?
5 Just pick a couple of these communities and give us
6 examples of how you approached your assessment of
7 performance in that given community.
8 A. I can, and I'll go through two specific
9 examples. I looked at Tempe and saw consistent
10 performance in the system for all of the months July
11 through September, consistently exceeding the
12 90 percent benchmark at 8 minutes 59 seconds.
13 Q. You say July through September. Just so
14 we're clear, you don't mean 3 months. You mean
15 15 months?
16 A. That's correct.
17 Q. July '14 to September?
18 A. July 2014 to September, yes, that's correct,
19 of 2015.
20 That's an example of how I would look at one
21 line item. It's not just that we were 96 percent in
22 April of 2015. That, as an analyst, is not a complete
23 picture. I want to look at it from end to end.
24 As an example of what I saw in the system as
25 a whole, I noticed that in the first several months of
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1 2015, every system saw a declination in their overall
2 response times. It was a significant dip, a noticeable
3 dip in the percentages for all eight of these
4 communities, about January through April-ish, into
5 May-ish.
6 And my understanding, I went -- as I was
7 working with the team, my understanding was that there
8 was a staffing challenge that Mr. Stock will go into
9 more in depth in his testimony. But that's just an
10 example, again, of something that played into the
11 system as a whole, and then I was able to see. I
12 wouldn't have noticed that if I had just stayed focus
13 on Tempe. I had to look at the system as a whole in
14 order to pick that particular contributing factor that
15 was playing into it.
16 Q. And when you notice a dip like that, as you
17 talked about, is it correct to say that even in, for
18 example, Tempe, or Mesa, where even through the first
19 few months of 2015 the percentages were still routinely
20 over 90 percent, the dip still is something that you
21 would inquire into as part of your analysis?
22 A. That's correct. In other words, it doesn't
23 have to dip below 90 percent to mean something.
24 Q. All right. And then having identified that
25 sort of a dip, as you've characterized it, and then
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1 having spoken to operations personnel to determine what
2 the root cause, as you said, was of that circumstance,
3 when you get beyond the period of decline and look at
4 performance subsequent to the dip, how do you approach
5 that in determining whether whatever the staffing issue
6 in this instance was has been satisfactorily addressed?
7 A. How that -- well, at first it's if the
8 operation can answer the question, right. There's
9 no -- and when I asked Kevin, is that they knew exactly
10 what was happening. They had addressed it.
11 And I don't have to take their word for it.
12 I can see the trend back up in this exhibit, as an
13 example. And when I go back and I revisit, there's no
14 unknowns. There's a clear understanding, a diligence
15 by the team to understand what's affecting their
16 system; this being the staffing component.
17 So that they identified it, that they
18 recognized it, that they did something, and that what
19 they did to address it worked.
20 Q. And how can you determine that what they did
21 to address it worked? What are you looking at in the
22 exhibit?
23 A. In this exhibit I am looking strictly at what
24 the percentages did after April, May, into the June,
25 July, August, September of 2015 time frame.
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1 Q. And what did you see?
2 A. I saw the uptick. So if there's a dip, this
3 would be the uptick headed back up above the
4 90 percent.
5 Q. And did the data seem to -- how did it
6 compare to what you were seeing in the months prior to
7 the dip, I guess is the simplest way to ask that
8 question?
9 A. There was an improvement. From an analyst's
10 standpoint, they had addressed the main contributing
11 issue.
12 Q. So as you look at this overall, at the
13 overall performance and including the several-month
14 decline that you saw and then the rebound, what is your
15 overall assessment of how the system is performing in
16 these eight jurisdictions?
17 A. I was able to draw a couple conclusions.
18 One, the system's relatively stable. The staffing
19 challenge that the team experienced notwithstanding,
20 the system is stable. They're able to affect change.
21 They're able to monitor effectively. They're able to
22 identify the problem and react to it. Overall, it's a
23 stable system. There's certainly, not only from what
24 Kevin had said, a fluidity in the system, ambulances
25 are moving through the different communities in
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2600
1 Maricopa County, supporting each other, supporting each
2 of the systems, but there's not great variation in the
3 data; again, outside the staffing issue that we talked
4 about.
5 Secondarily, that the team's diligence is
6 obvious. They're not disengaged in any way, shape or
7 form, and the data supports that. They are watching
8 this day-to-day, and because they're able to watch the
9 gauge, they can react and make effect so that we can
10 get to the calls in the times that we need to get to
11 them.
12 Those are the main conclusions I was able to
13 draw from this specific exhibit over these eight
14 communities.
15 Q. Okay. I want to look next then, moving from
16 the analysis of particular jurisdictions, to overall
17 response time compliance by the Rural/Metro intervenors
18 in Maricopa County per their CONs. So let me ask
19 initially a couple of prefatory questions.
20 When we talk about response time compliance,
21 one of the terms that has been used in this hearing,
22 and it appears in the regulatory compendium, is
23 response time tolerances. Can you talk about what a
24 response time tolerance is?
25 A. Response times tolerance, to use what
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1 Ms. Fickbohm said earlier, it's a term of art that we
2 use that encompasses not only the response time
3 benchmarks that we're measured against, but the
4 reporting period as well.
5 In the case of our Arizona regulatory
6 reporting, it is a 12-month reporting period.
7 Q. So a rolling 12 months?
8 A. It is a rolling 12 months, correct.
9 Q. Now, you're aware that there are six
10 Rural/Metro CON holder intervenors in this case,
11 correct?
12 A. Yes.
13 Q. Did you look at the response time performance
14 for all six of the intervenors?
15 A. No.
16 Q. Which -- first, how many did you look at?
17 A. Four of the six.
18 Q. And then, next, which two didn't you look at?
19 A. We didn't look at American and ComTrans, and
20 the reason is American doesn't have any response time
21 benchmarks to measure against. It's strictly a BLS
22 CON. And ComTrans does have response time criteria
23 attached to it, but it's strictly behavioral health
24 type scenarios. So what we felt would be more
25 effective was to take the remainder of the four, which
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2602
1 is SWARA, PMT, Southwest and Rural/Metro of Maricopa,
2 and for comparative purposes in this proceeding just
3 use those four.
4 Q. Okay. Well, let's then dive into those and
5 let's start with Rural/Metro 114.
6 In terms of the response time tolerance
7 period that this exhibit and the succeeding ones used,
8 can you tell us what that was?
9 A. It's August 1st, 2014 through July 31st,
10 2015.
11 Q. And, again, before we delve into the
12 specifics of each exhibit, can you tell us what --
13 looking at 114, for example, what the left and the
14 right-hand columns depict?
15 A. Certainly. At the top of the table is the
16 CON, in this case CON No. 66, and then one of the dba's
17 is SWARA. The left-hand column is the requirement as
18 it is listed on the certificate of necessity. The
19 right-hand side is what we actually achieved for each
20 one of those requirements, and we see the percentage,
21 as well as the number that make up the universe for
22 that response time fractile.
23 Q. And when you say the universe, so, for
24 example, looking at Exhibit 114, where it says
25 10,792/12,256 in the first line, what does that mean?
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1 A. We're showing our work, in essence. So if
2 you take 10,792 divided by 12,256, we get 88.1 percent.
3 Q. So the 12,256 is the universe of the Code 3
4 responses during that 12-month rolling period?
5 A. That is correct.
6 Q. And the 10,792 would be the portion of those
7 12,256 that satisfied the 80 percent in 10-minute -- or
8 that achieved a 10-minute or less response time?
9 A. To which we got to in 10 minutes or less,
10 that is correct.
11 Q. So, and your involvement in the preparation
12 of these exhibits was what?
13 A. Again, same as I had stated previously. I
14 sat with the team, sought to understand what the CON
15 requirement was, how they were reporting and how
16 they've been reporting it to Arizona Department of
17 Health Services, and how they determine what goes into
18 what bucket.
19 Q. And does this exhibit depict the results of
20 those efforts as it relates to CON 66, SWARA?
21 A. It does.
22 MR. ROSENFELD: Your Honor, we offer
23 Rural/Metro 114.
24 ALJ MIHALSKY: Exhibit RM-114 is
25 admitted.
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2604
1 MR. BELANGER: No, no objections, Your
2 Honor.
3 BY MR. ROSENFELD:
4 Q. Stay on that one.
5 And so looking at the substance of 114, am I
6 correct that there are three segments or three
7 fractiles that are set forth on the SWARA CON?
8 A. Yes, that is correct.
9 Q. And can you walk us through then, for each
10 fractile, how SWARA is doing in terms of its response
11 time compliance with its CON?
12 A. In the 10-minute fractile at 80 percent of
13 the time, Southwest Ambulance and Rescue is reporting
14 88.1 percent. At the 15-minute 90 percent fractile,
15 SWARA is reporting 98.3 percent. At the 20-minute
16 100 percent fractile, SWARA is reporting 99.8 percent.
17 Q. Let's look next at Exhibit 115. And for
18 which of the Rural/Metro CON holder intervenors or to
19 which of the Rural/Metro CON intervenors does this
20 exhibit pertain?
21 A. This is for certificate of necessity No. 71,
22 PMT.
23 Q. And I note initially here that unlike the
24 SWARA CON, which had three separate fractiles, this one
25 has six?
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1 A. Correct.
2 Q. A Section A and a Section B?
3 A. That's correct.
4 Q. And why is that?
5 A. It's as it is represented and reported for
6 our certificate of necessity compliance.
7 Q. And do you recall what the difference is
8 between the Section A and the Section B?
9 A. Section A is areas with substations, and
10 Section B is areas without or vice versa. You're
11 relying on my memory.
12 Q. I think A is with and B is without.
13 All right. And, again, is this a document in
14 whose preparation you assisted?
15 A. In exactly the same fashion, yes, sir.
16 MR. ROSENFELD: Your Honor, we would
17 offer Rural/Metro 115.
18 MR. BELANGER: No objection.
19 ALJ MIHALSKY: Exhibit Rural/Metro 115
20 is admitted.
21 MR. ROSENFELD: Thank you, Your Honor.
22 BY MR. ROSENFELD:
23 Q. Would you then, Marco, take us through
24 Rural/Metro 115 at each of the six fractiles depicted
25 on this exhibit?
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1 A. Starting at Section A in the 90 percent
2 10-minute fractile, PMT is reporting 90.1 percent. In
3 the 95 percent in 15 minutes fractile, PMT is reporting
4 98.2 percent. In the hundred percent 20-minute
5 fractile, PMT is reporting 99.5 percent.
6 Q. And you were here when Mr. Jaramillo
7 testified that there is a 1.5 percent forgiveness or
8 tolerance, if you will, for variance from the fractile?
9 A. I was here, and I heard that, yes.
10 Q. Looking at then Section B of Exhibit 115, can
11 you take us through the compliance by PMT with each of
12 those CON requirements, each of those fractiles.
13 A. Section B, 80 percent 10 minutes, PMT is
14 reporting 85 percent of the time. 90 percent in the
15 15 minutes, PMT is reporting 97.9 percent. 20 minutes
16 a hundred percent of the time, PMT is reporting
17 20 minutes a hundred percent of the time.
18 Q. And before we leave this exhibit, I guess
19 it's worth asking as well, especially looking at
20 Section A, what is the volume of transports that PMT
21 has engaged in over this given 12-month period?
22 A. In Section A alone it's over 25,000
23 transports.
24 Q. Let's look next at Rural/Metro 116.
25 And can you tell us for which -- as to which
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1 CON holder this exhibit relates?
2 A. This is certificate of necessity No. 86,
3 Southwest Ambulance of Maricopa.
4 Q. And am I correct this exhibit shows,
5 actually, nine different fractiles?
6 A. That is correct.
7 Q. And, again, on the required side, the numbers
8 are taken right from the face of the Southwest Maricopa
9 CON, correct?
10 A. That is correct.
11 Q. And, again, is this an exhibit that you
12 assisted in preparing as you did Rural/Metro Ambulance
13 114 and 115?
14 A. Yes.
15 MR. ROSENFELD: Your Honor, we offer
16 Rural/Metro 116.
17 MR. BELANGER: No objection.
18 ALJ MIHALSKY: Exhibit RM-116 is
19 admitted.
20 MR. ROSENFELD: Thank you.
21 BY MR. ROSENFELD:
22 Q. And so, Marco, again, if you would take us
23 through each of these nine fractiles and talk about
24 response time compliance.
25 A. In Section A, and this is similar to PMT that
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1 we had discussed previously, this is in areas where we
2 have an operation substation. 90 percent in
3 10 minutes, Southwest is reporting 91.3 percent.
4 95 percent in 15 minutes, Southwest is reporting
5 98.6 percent. 100 percent in 20 minutes, Southwest is
6 reporting 99.7 percent.
7 Q. And that's in a universe of how many
8 transports?
9 A. That universe itself is almost 16,000.
10 Q. Moving to Section B.
11 A. Section B, 80 percent 10 minutes, Southwest
12 is reporting 77.9 percent. 90 percent in 15 minutes,
13 Southwest is reporting 93 percent. And in a
14 hundred percent in 20 minutes, Southwest is reporting
15 98.0 percent.
16 Q. Section C.
17 A. Section C, 80 percent in 15 minutes,
18 Southwest is reporting 83 percent. That is,
19 83.3 percent. Section 90 percent in 25 minutes,
20 Southwest is reporting 99.6 percent. And in the
21 hundred percent in 30 minutes, Southwest is reporting a
22 hundred percent.
23 Q. All right. Let's move to Rural/Metro 117.
24 And for which CON holder was this exhibit prepared?
25 A. This is certificate of necessity No. 109,
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1 Rural/Metro of Maricopa.
2 Q. Marco, was this exhibit, likewise, prepared
3 with your input as you've described for
4 Exhibits Rural/Metro 114 through 116?
5 A. It was.
6 Q. So, again, would you take us through each of
7 these six fractiles?
8 A. Section A, 90 percent 10 minutes, Rural/Metro
9 is reporting 92.3 percent. In the 95 percent in
10 15 minutes fractile, Rural/Metro is reporting
11 98 percent. In the hundred percent in 20 minutes,
12 Rural/Metro is reporting 99.1 percent.
13 Q. And in Section B?
14 A. Section B, 50 percent 10 minutes, Rural/Metro
15 is reporting 82.4 percent. 70 percent in 20 minutes,
16 Rural/Metro is reporting 97.3 percent. 85 percent in
17 30 minutes, Rural/Metro is reporting 99.3 percent. And
18 in the hundred percent fractile, which is 60 minutes,
19 that's six-zero minutes, Rural/Metro is reporting
20 99.9 percent.
21 Q. Have you had the opportunity to take a look
22 at -- having gone through the response times at
23 Rural/Metro, the Rural/Metro intervenor CON holders are
24 actually achieving, have you also had an opportunity to
25 look at the response times that the applicant, Maricopa
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2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2610
1 Ambulance, is proposing?
2 A. I have looked at what Maricopa Ambulance is
3 proposing.
4 Q. And you may want to take a look at that. If
5 you look at Maricopa Ambulance 1, I believe it's Bates
6 No. 78 on that exhibit.
7 You're familiar with that series of response
8 time proposals?
9 A. I am.
10 Q. And like the -- at least several of the CONs,
11 not SWARA, but the others, Maricopa Ambulance's
12 proposed response times draw distinction between the
13 bucket where -- the bucket of cities, if you will, or
14 jurisdictions where they do have a substation and the
15 other bucket of cities where they do not have a
16 substation; is that your understanding?
17 A. That's correct.
18 Q. Have you had the opportunity to compare,
19 using Exhibits 114 through 117 and Page 78 of
20 Maricopa 1, how Rural/Metro, the Rural/Metro
21 intervenors, are actually performing with respect to
22 their response times in both of these categories as
23 compared to what Maricopa Ambulance is simply
24 proposing?
25 A. Yes.
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1 Looking at the exhibits that you and I just
2 reviewed told me two things. One, it validated, it
3 helped to validate what we were looking at before in
4 those seven communities, the strength of our response
5 time -- rather, the team's response times with the
6 ambulances within this area. So in an effort to kind
7 of complete that loop, looking at our response times in
8 our CONs validated the response times in Avondale,
9 Glendale, and so on.
10 Secondly, when I went back and reviewed this,
11 I was able to see quite clearly that overall, in the
12 fractiles that are directly comparable between what
13 Maricopa is proposing and what we're actually doing,
14 we're actually performing higher than what they're
15 proposing to do. We're performing better than what
16 they're proposing to do.
17 MR. ROSENFELD: Thank you, Marco.
18 I don't have any additional questions,
19 Your Honor.
20 MR. RAY: Larry, did you move 117 into
21 evidence?
22 MR. ROSENFELD: Thank you, Kevin.
23 ALJ MIHALSKY: Exhibit 117 is admitted.
24 MR. ROSENFELD: Thank you, Your Honor.
25 ALJ MIHALSKY: Mr. McGoldrick,
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1 Ms. Fickbohm, do you have any questions?
2 MR. MCGOLDRICK: No.
3 ALJ MIHALSKY: Mr. Belanger?
4 MR. BELANGER: Okay. Yeah.
5
6 CROSS-EXAMINATION
7 BY MR. BELANGER:
8 Q. Mr. Rivera, if you would look at -- this is
9 Maricopa Ambulance 40A. Not Maricopa Ambulance; PMT,
10 Professional Medical Transport. This is Maricopa
11 Ambulance Exhibit 40A, but it's the CON for
12 Professional Medical Transport, Inc. Do you see
13 that?
14 A. Yes.
15 Q. Is that one of the entities that you looked
16 at when you were preparing your charts?
17 A. It is.
18 Q. And you just talked about -- Mr. Rosenfeld
19 showed you the Maricopa Ambulance proposed response
20 times. Do you remember that?
21 A. Yes.
22 Q. And you testified that Rural/Metro's actual
23 response times were in excess of Maricopa Ambulance
24 proposed response times?
25 A. What I said is overall.
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1 Q. All right. Okay. And you understand that
2 those -- the response times are the minimum proposed
3 response times in the CON that you're required to meet,
4 or not?
5 A. Sorry. My mind went. You said minimum. I
6 expect a maximum.
7 They're the response times on our CON, yes.
8 Q. Well, look at the page that's in front of
9 you, which is Maricopa Ambulance 40A-002. Does that --
10 are those the same proposed response times as in the
11 Maricopa Ambulance proposed CON?
12 A. They are, yes.
13 Q. And so what you're looking at here is a
14 baseline proposal and that you would be in
15 noncompliance with your CON if you fell below those
16 response times, I guess on an overall basis; fair
17 enough?
18 Was that a bad question?
19 A. I wouldn't say it was a bad question.
20 Q. Okay. That's fine.
21 What I'm getting to is that you're talking
22 about the proposed response times of Maricopa Ambulance
23 when you looked at Maricopa Ambulance Exhibit No. 1,
24 the CON, do you remember that?
25 A. Yes, sir.
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1 Q. These are the proposed times for PMT, and
2 this is Maricopa Ambulance Exhibit 40A. Do you see
3 that?
4 A. Where I'm stuck is they're not proposed.
5 They is what we're being held to on our certificate.
6 Q. Okay. Right. So these are your response
7 times. These are the response times that PMT is
8 obligated to perform under its CON?
9 A. Yes.
10 Q. Okay. And if Maricopa Ambulance is awarded a
11 CON, it would be obligated to perform at least to this
12 level, if not surpassing this level?
13 A. It would be obligated to perform to this
14 level, yes.
15 Q. Okay. And so when you say that those are the
16 proposed response times of Maricopa Ambulance, you
17 don't have any ability to predict whether or not they
18 would exceed or do better than the response times in
19 their CON, do you?
20 A. I do not.
21 Q. And, also, if you note the language in PMT's
22 CON, which is Exhibit 40A, Page 2, it talks about
23 transports, right?
24 A. Yes, sir.
25 Q. And do you understand that if this CON is
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1 modified or if AMR eventually gets the transfer of the
2 CON and they're amalgamated, that those will no longer
3 be transports; those will be required to be calls? Do
4 you understand that? Transports would have to be
5 calls.
6 A. I understand what it means, and I understand
7 that that's what may happen, yes.
8 Q. Okay. When you prepared your charts, were
9 you looking at transports or calls?
10 A. We're looking at the -- as it currently sits,
11 which is transports.
12 Q. Transports.
13 Was there any inclusion of -- in the work
14 that you did, were there any inclusion of response
15 times for interfacility transports?
16 A. Not for this and what we reviewed, no, sir.
17 Q. Well, when you talk about Code 3 responses in
18 your charts, are those the same thing as emergency
19 transports?
20 So the exhibits that you just went through
21 with Mr. Rosenfeld, the Exhibits 110, 111, 112,
22 whatever they were, and you looked at the response
23 times, were you looking at -- when you talk about
24 Code 3 responses, are those the same thing as emergency
25 transports, as defined in the CON, for example, for
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1 PMT?
2 A. So in the exhibit where we have the eight
3 communities, it says Code 3 Response Requirements, and
4 those are specific to -- those happen to all be
5 transports; but those Code 3 requirements are what are
6 listed in the contracts, except for Glendale, and which
7 we're using the language out of the CON.
8 When we're looking at the CON exhibits, 114
9 and so on, those I don't believe say Code 3 responses
10 on them. The reason being that not all of our CONs are
11 based on emergency transports.
12 So they would just match directly what's
13 listed on the certificate of necessity, and I hope I
14 answered your question.
15 Q. Well, I'm not sure if you did or you
16 didn't.
17 My question really was, when you were
18 preparing your charts, you talked about Code 3
19 responses; and I want to know if that compares directly
20 to the language "emergency transports" in the CONs that
21 you're obligated to abide by?
22 A. For the CON exhibits, where the CON says
23 "emergency transports," yes.
24 MR. BELANGER: Thanks, Mr. Rivera. I
25 don't have any other questions.
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1 CROSS-EXAMINATION
2 BY MR. RAY:
3 Q. Marco, I can't -- don't think I'll pass up
4 the opportunity. You're never on the stand.
5 So, Marco, my first question, and I think
6 Mr. Belanger has clarified this, but in the second
7 column of both charts, you use Code 3 calls. Now, I
8 think your testimony is that those represent
9 transports, actual transports, not calls?
10 A. For the CON exhibits, 114 and so on, they're
11 transports.
12 For these, they're actually calls.
13 Q. Okay. And define for me how you measured a
14 call.
15 A. So dispatched with an on scene time,
16 essentially.
17 Q. Okay. So an arrival time would set -- would
18 be the end time for this call?
19 A. Yes, sir.
20 Q. Okay. When your counsel asked you for some
21 conclusions based on this data, I think one of the
22 things you said was something to the effect that it
23 shows a fluidity of unit movement throughout
24 jurisdictions. Do you recall that?
25 A. I recall that, yes.
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1 Q. Okay. Do you know how many of these
2 contracts require dedicated ambulances that do not move
3 through jurisdictions?
4 A. I do not, specifically, no.
5 MR. RAY: All right. Well, Marco,
6 you'll be happy to know that that's all from me. Thank
7 you.
8 THE WITNESS: Thank you.
9 MR. RAY: And it was nice to hear you.
10 THE WITNESS: Once I slowed down, I hope
11 I probably got better.
12 MS. FICKBOHM: No comment.
13 MR. ROSENFELD: I have no further
14 questions.
15 ALJ MIHALSKY: Thank you, Mr. Rivera.
16 THE WITNESS: Thank you.
17 ALJ MIHALSKY: I think we're going to do
18 fine for time. I must admit, when I saw the
19 stipulation, I really didn't believe you, you know,
20 that we would be moving this quickly.
21 MS. FICKBOHM: I'm not actually going to
22 take offense to that. Are you, Scott?
23 MR. ROSENFELD: We're lawyers. Of
24 course I understand.
25 ALJ MIHALSKY: Yeah, but my faith is
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1 being restored.
2 Do you want to call your next witness,
3 or do you want to wait until tomorrow?
4 MR. ROSENFELD: No, actually, I would
5 like to call Mr. Yanofsky. He's here, and it's going
6 to be brief, and let's get this one done.
7 ALJ MIHALSKY: Could you raise your
8 right hand.
9 (Mr. Ithan Yanofsky was duly sworn by
10 the Administrative Law Judge.)
11 ALJ MIHALSKY: Thank you. Could you
12 state your name for the record and spell your last name
13 for the court reporter.
14 THE WITNESS: Ithan Yanofsky. First
15 name is I-T-H-A-N. Last name is Y-A-N-O-F-S-K-Y.
16 MR. ROSENFELD: We're having a problem
17 with the mouse, so just give us one moment.
18 ALJ MIHALSKY: Oh, okay. Let me know if
19 I need to get the webmaster.
20
21 ITHAN YANOFSKY,
22 called as a witness on behalf of Intervenor Rural/Metro
23 herein, having been previously duly sworn by the
24 Administrative Law Judge to speak the truth and nothing
25 but the truth, was examined and testified as follows:
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1 DIRECT EXAMINATION
2 BY MR. ROSENFELD:
3 Q. Ithan, are you comfortable taking control of
4 the mouse there?
5 A. Sure. I don't know what I can do with it.
6 Q. Can you get Maricopa 53J up?
7 There you go. Go to 47a and click on the
8 combined, right, and then go to Maricopa 53J, Maricopa
9 Ambulance 53J.
10 A. 53J.
11 Q. You were just there. Slide down a little bit
12 more. Oh, there.
13 And it occurs to me you haven't testified in
14 this case as of yet, have you? It was Todd who
15 testified.
16 A. I can't recall, but I'll take your word for
17 it.
18 MS. FICKBOHM: Off to a good start.
19 BY MR. ROSENFELD:
20 Q. Well, don't shake my faith in what's left of
21 my memory. So let's assume you haven't.
22 Can you tell us who you're employed by and
23 what you do?
24 A. I'm employed by the Arizona State Department
25 of Health, Bureau of Emergency Medical Services and
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1 Trauma System.
2 Q. And what are your duties in that position?
3 A. I'm currently the Deputy Bureau Chief, and
4 have been for four years.
5 Q. How long in total have you been with the
6 Bureau?
7 A. 18 years total.
8 Q. Time does fly.
9 I just have a couple of questions for you.
10 You have Exhibit Maricopa 53J on the screen in front of
11 you. Are you familiar with this document?
12 A. Somewhat, yes.
13 Q. And you're aware this is a memorandum
14 prepared by the Bureau, directed to Will, meaning the
15 then Director, Will Humble; is that correct?
16 A. Yes.
17 Q. All right. And this was prepared on the
18 heels of Rural/Metro filing its Chapter 11 bankruptcy
19 petition; is that true?
20 A. It could have been at that point, or it could
21 have been at the point where a bond payment was not
22 made in California.
23 Q. Okay. But it was prepared at a point where
24 there was some uncertainty as to the financial future
25 of Rural/Metro?
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1 A. That's a true statement, yes.
2 Q. All right. And if you look at the first
3 paragraph of this document, does it appear to you that
4 its purpose was to assess, quote, what would happen and
5 our response if there were a partial or complete
6 failure of Rural/Metro Corporation?
7 A. Yes.
8 Q. And so this was a contingency plan in the
9 event if there was a partial or complete failure of
10 Rural/Metro Corporation?
11 A. It's an accurate statement. I think this was
12 the beginning of that, yes.
13 Q. And the document itself addresses, if there
14 were a partial or complete failure of Rural/Metro, what
15 the Bureau's response would be, both with respect to
16 911 transportation needs in the county and
17 interfacility transportation needs within the county;
18 is that a fair statement?
19 A. Yes.
20 Q. And the document sets forth the available
21 resources or remedies that the Department and the
22 Bureau would have if that were to occur; is that true?
23 A. Just looking through the --
24 Q. Sure. Take your time.
25 A. -- the other pages that are associated with
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1 the memo.
2 Yes.
3 Q. Going back to the top of the first page, if
4 you would, Ithan, and I want to use the exact words
5 here. The reference, again, is to a partial or
6 complete failure of Rural/Metro Corporation.
7 Was there a complete failure of Rural/Metro
8 Corporation, to your knowledge?
9 A. No.
10 Q. Was there a partial failure?
11 A. No.
12 Q. Were any of the steps that are described in
13 this contingency plan ever implemented?
14 A. No.
15 MR. ROSENFELD: Thank you. That's all I
16 have, Your Honor.
17 MS. FICKBOHM: No questions, Your Honor.
18 ALJ MIHALSKY: Okay.
19
20 CROSS-EXAMINATION
21 BY MR. BELANGER:
22 Q. I'm sorry, Ithan. I took this back from you.
23 A. That's okay.
24 Q. At the time that the contingency plan was
25 drafted, do you know what percentage of ALS and BLS
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1 transports that Rural/Metro did statewide?
2 A. Off the top of my head, I don't.
3 Q. Do you think it was more than 50 percent?
4 A. I don't believe so, no.
5 Q. Does the Department have any kind of
6 contingency plan now? Having gone through this
7 exercise, does the Department have a generic
8 contingency plan in the event that a large-scale
9 carrier has some kind of economic distress or is unable
10 to perform its ground service ambulance duties?
11 A. I think this exercise better prepared us for
12 a situation like that. Do we have a definitive plan
13 that's in writing? Not that I'm aware of. But I think
14 that this helped us greatly in making sure that should
15 something like that happen, we're better prepared.
16 Q. As we sit here today, with the combined
17 number of transports of AMR in Arizona and Rural/Metro
18 in Arizona, would that exceed the number of transports
19 that Rural/Metro was doing alone at the time you were
20 looking at this contingency plan?
21 A. Yes.
22 MR. BELANGER: I don't have any other
23 questions, Judge. Thanks.
24 MR. RAY: Look out, Ithan. I'm coming
25 for you.
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1 No questions, Your Honor.
2 ALJ MIHALSKY: Thank you very much.
3 MS. FICKBOHM: This is your chance,
4 Kevin.
5 MR. ROSENFELD: I had no redirect, Your
6 Honor. No redirect.
7 ALJ MIHALSKY: Okay. Very good. I'm
8 sorry, I cut you off. It's getting late in the day.
9 Well, I anticipated.
10 MR. ROSENFELD: Thank you.
11 ALJ MIHALSKY: Okay. Now --
12 MS. FICKBOHM: Maybe this would be a
13 good time to try to get Ms. Hofmeyr on the phone.
14 ALJ MIHALSKY: We can do that. Let's go
15 off the record.
16 (A brief recess was taken.)
17 ALJ MIHALSKY: We're back on the record.
18 Your next witness, Mr. Rosenfeld.
19 MR. ROSENFELD: Yes, Your Honor. Kevin
20 Stock.
21 Your Honor, could we go off the record
22 just for one more minute? We need to see where our
23 mouse is unplugged, so we can get it back.
24 ALJ MIHALSKY: Very good.
25 MR. ROSENFELD: Thank you.
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1 (A brief recess was taken.)
2 ALJ MIHALSKY: We're back on the record.
3 Go ahead, Mr. -- wait, I haven't sworn
4 this witness in.
5 (Mr. Kevin Stock was duly sworn by the
6 Administrative Law Judge.)
7 ALJ MIHALSKY: Thank you very much.
8 Could you state your name for the record and spell your
9 last name for the court reporter.
10 THE WITNESS: Kevin Stock, K-E-V-I-N,
11 S-T-O-C-K.
12 MR. ROSENFELD: Thank you, Your Honor.
13 ALJ MIHALSKY: Mr. Rosenfeld, go ahead.
14
15 KEVIN STOCK,
16 called as a witness on behalf of Intervenor Rural/Metro
17 herein, having been previously duly sworn by the
18 Administrative Law Judge to speak the truth and nothing
19 but the truth, was examined and testified as follows:
20
21 DIRECT EXAMINATION
22 BY MR. ROSENFELD:
23 Q. Good afternoon, Kevin.
24 A. Good afternoon.
25 Q. Where do you work?
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1 A. Rural/Metro Corporation.
2 Q. And what is your current position there?
3 A. Vice president of operations.
4 Q. How long have you served in that capacity?
5 A. In this capacity since April 1st in Arizona,
6 but I have been with the company since November of last
7 year, '14.
8 Q. Of 2014.
9 A. Yeah.
10 Q. And would you tell Judge Mihalsky what your
11 duties and responsibilities are as vice-president of
12 operations?
13 A. Sure. So currently I oversee Arizona,
14 Colorado, Nebraska and South Dakota in the operations
15 role. So what that means is anything to do with P&L
16 responsibility, obviously compliance, things like that.
17 The departments that report up through me are
18 scheduling, duty office, fleet, communications center,
19 so, basically, everything that is in our operation,
20 minus business development.
21 Q. How many employees do you directly supervise?
22 A. 12.
23 Q. How many do you indirectly supervise?
24 A. 1,800.
25 Q. And, Kevin, would you consider yourself to be
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1 or are you, in fact, the senior operations officer
2 responsible for Rural/Metro's ambulance operations in
3 Maricopa County?
4 A. Yes.
5 Q. Let's take just a few minutes here or as long
6 as you need, actually, to walk through your work
7 history. We've put up on the screen Rural/Metro
8 Exhibit 9. That's your CV. So if you need to refer to
9 it to refresh your recollection, please feel free to do
10 that; but walk us through your employment history.
11 A. Sure. So at a high level, for the last
12 13 years I've been in the health care industry. For
13 the first 10 of those, I was in durable medical
14 equipment with a company called Pacific Pulmonary
15 Services. Started in sales, moved up through
16 management, went over to operations. And when I exited
17 that organization, I did have a short stint with a
18 hospice provider in the Midwest, and in that position I
19 was actually the second person in command of the
20 company. I had about 330 employees, full P&L
21 responsibility, basically ran the company. And when I
22 left that company, that's when I came to Rural/Metro in
23 November of 2014.
24 Q. And do you have a college degree?
25 A. Yes.
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1 Q. And from where?
2 A. Bowling Green State University.
3 Q. And when did you obtain that degree?
4 A. May of '02.
5 Q. And what is your degree in?
6 A. Business administration.
7 Q. Looking at Rural/Metro Exhibit 9, does this
8 document accurately set forth both your work history
9 and your educational background?
10 A. Yes.
11 MR. ROSENFELD: Your Honor, we offer
12 Rural/Metro 9.
13 ALJ MIHALSKY: Rural/Metro Exhibit 9 is
14 admitted.
15 MR. ROSENFELD: Thank you.
16 BY MR. ROSENFELD:
17 Q. I want to walk through just a few discrete
18 operational areas with you, Kevin, to pick up on some
19 of the things that were testified to during the
20 applicant's case-in-chief, and I want to start with
21 MIHS or mobile integrated healthcare services.
22 A. Okay.
23 Q. You're familiar with that, aren't you?
24 A. Yeah. Yes.
25 Q. Do you know what that is?
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1 A. Yes.
2 Q. Can you tell us?
3 A. Yeah. So in some markets they call it
4 community paramedicine or mobile integrated healthcare,
5 but obviously it's the ability to help with some of
6 those patients that do use the 911 system quite often
7 or in and out of facilities, to help to, obviously,
8 control some of those costs; but just as important, to
9 help with those patients and their conditions.
10 Q. Were you here when Mr. Blackburn and
11 Mr. Gibson testified regarding MIHS?
12 A. Yes. Yeah.
13 Q. And I want to put on the screen now an
14 exhibit that is in evidence, Maricopa Ambulance 32.
15 And you've seen this document before, have
16 you not?
17 A. Yes.
18 Q. It's the Maricopa Ambulance mobile integrated
19 healthcare plan, correct?
20 A. Yep.
21 Q. Looking at this document, do you see -- and
22 I'm looking in particular at Page -- well, it's
23 Bates-labeled 3. There's a section called Needs
24 Assessment?
25 A. Correct.
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1 Q. And were you present when Maricopa Ambulance
2 testified that they were in the very preliminary stages
3 of determining whether mobile integrated healthcare
4 services is something that they could feasibly do in
5 Maricopa County?
6 A. Yes.
7 Q. Were you also present when Mr. Blackburn
8 testified that as of the time he testified in October,
9 Maricopa Ambulance was not prepared to commit to
10 actually implementing an MIHS system in this county?
11 A. Yes.
12 Q. And were you also present when both
13 Mr. Blackburn and Mr. Gibson testified that, in any
14 case, Maricopa Ambulance could implement a mobile
15 integrated healthcare system in this county without
16 even having a CON?
17 A. Yes.
18 Q. Let me ask you generally whether Rural/Metro
19 is committed to the delivery of mobile health care --
20 excuse me, mobile integrated healthcare services?
21 A. Sure. Yes, absolutely. You know, there are
22 a few markets around the country that we have
23 committed, and specifically in San Diego, we've
24 actually funded a project there, so...
25 Q. A mobile integrated healthcare system?
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1 A. Correct. Yes.
2 Q. Let's look at Maricopa Ambulance 38.
3 Do you recall that Maricopa Ambulance offered
4 testimony regarding this book, MedStar Mobile
5 Healthcare, Mobile Integrated Healthcare, Approach to
6 Implementation?
7 A. Yes.
8 Q. I want to look next at a certain portion of
9 this book, a couple of pages in particular. And let's
10 look at Rural/Metro 153, and this is an excerpt from
11 Maricopa Ambulance 38, specifically Pages 140 and 141.
12 Have you reviewed these pages?
13 A. Yes, I have.
14 Q. And do these pages describe what you've
15 referred to a few minutes ago in your testimony
16 regarding the Rural/Metro mobile integrated healthcare
17 service initiative in San Diego?
18 A. Yes.
19 Q. And would you take a look on the first page
20 of this exhibit, under Outcomes? Do you see that?
21 A. Yep.
22 Q. Would you read the first sentence under the
23 section Outcomes?
24 A. "A pilot study of 51 individuals with 10 or
25 more EMS transports within 12 months demonstrated
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1 resource access program success."
2 Q. All right. Would you then look at the next
3 page of this exhibit, which we'll put on the screen?
4 Under the section called Program Funding, can you read
5 that?
6 A. "This project was funded by Rural/Metro
7 Ambulance."
8 Q. So fair to say Rural/Metro has already had
9 success in implementing a mobile integrated healthcare
10 system that it funded --
11 A. Yes.
12 Q. -- in San Diego, California?
13 A. Yes, definitely.
14 Q. Now, moving to Maricopa County, has your team
15 been involved in efforts to implement here --
16 A. Yes.
17 Q. -- MIHS?
18 Try to wait until I finish the question or
19 Jody is going to throw something at either you, me, or
20 perhaps both of us.
21 So let me --
22 A. Probably me, since I'm closer.
23 Q. I don't know. Her aim looks pretty good. I
24 don't know. But if you could let me finish my
25 question.
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1 A. Sure.
2 Q. So has your team, Kevin, been involved in
3 efforts to implement mobile integrated healthcare
4 services in this county?
5 A. Yes.
6 Q. And do those efforts relate to the Arizona
7 Health Care Cost Containment System or AHCCCS?
8 A. Yes.
9 Q. What is AHCCCS?
10 A. Essentially, it's the association that
11 represents Medicaid for the state of Arizona, and so
12 obviously it's those individuals that are under a
13 certain level of income and can't afford health
14 insurance.
15 Q. Can you then describe the nature of your
16 team's involvement in partnering with AHCCCS to
17 implement mobile integrated healthcare services in this
18 county?
19 A. Sure. Yeah. We've been invited to several
20 meetings, along with some of the other CON providers in
21 the state, and, you know, we've continued those
22 discussions and we're still discussing the plan.
23 Q. Do you recall who those other partners are in
24 this effort with AHCCCS?
25 A. Specifically in Maricopa, AMR.
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1 Q. And let me show you Rural/Metro --
2 MR. ROSENFELD: Before I do that, I'm
3 sorry, Your Honor, I would like to offer into evidence
4 Rural/Metro 153.
5 ALJ MIHALSKY: Okay.
6 MR. BELANGER: No objection, Judge.
7 ALJ MIHALSKY: Exhibit Rural/Metro 153
8 is admitted.
9 MR. ROSENFELD: Thank you, Your Honor.
10 BY MR. ROSENFELD:
11 Q. Now I would like to look at Rural/Metro
12 Exhibit 152, which we're putting on the screen.
13 Can you tell Judge Mihalsky what Rural/Metro
14 152 is?
15 A. Yeah. So this is what I referenced earlier.
16 This is an invitation to one of those such meetings.
17 This one specifically was in October of 2015, which was
18 sent on behalf of the Office of the Director.
19 Q. And would you agree with me in the To line,
20 it does show that, among other invitees, we have
21 Mr. Valentine from AMR and we have Mr. Karolzak from
22 Rural/Metro?
23 A. Yes.
24 Q. And can you tell Judge Mihalsky -- you didn't
25 attend this particular meeting?
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1 A. I did not.
2 Q. But can you tell Judge Mihalsky where things
3 have progressed or where they currently stand since
4 this meeting?
5 A. Yeah. So there has been an additional
6 meeting, and I believe that actually happened within
7 the last few weeks; but, again, I did not participate
8 in that, in that meeting specifically.
9 Q. To the best of your knowledge, is this
10 initiative to institute, adopt or implement mobile
11 integrated healthcare services in Maricopa County
12 through AHCCCS, with Rural/Metro and AMR both
13 participating, still --
14 A. Yes.
15 Q. -- proceeding?
16 A. Yes.
17 MR. ROSENFELD: We would offer, also,
18 Your Honor, Rural/Metro 152.
19 MR. BELANGER: No objection, Judge.
20 ALJ MIHALSKY: Exhibit RM-152 is
21 admitted.
22 MR. ROSENFELD: Thank you.
23 BY MR. ROSENFELD:
24 Q. I want to talk next, Kevin, about
25 HonorHealth, in addition to the testimony -- or, excuse
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1 me, in addition to the exhibit offered by Maricopa
2 Ambulance, a letter from HonorHealth. We've heard some
3 testimony this morning from Mr. Wolfe for AMR, and I
4 want to follow up on that just a bit.
5 Let's take a look at Maricopa 37A, which is
6 already in evidence.
7 And you've seen this letter before, right?
8 A. I have.
9 Q. And this is a letter. It's authored,
10 apparently, by Tony Benedict at HonorHealth. Do you
11 know Mr. Benedict?
12 A. Yes, I've met him.
13 Q. Who is he?
14 A. He's the vice president of supply chain and
15 procurement for HonorHealth system.
16 Q. In your position at Rural/Metro, are you in
17 fairly regular communication with HonorHealth
18 concerning its interfacility ambulance transport needs?
19 A. Yes.
20 Q. Are you in contact particularly with
21 Mr. Benedict?
22 A. No.
23 Q. Who are you in contact with?
24 A. Bill Remus.
25 Q. And who is Mr. Remus?
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1 A. He's the director of procurement and supply
2 chain for HonorHealth.
3 Q. And was he identified to Rural/Metro by
4 HonorHealth as the person with whom Rural/Metro should
5 be speaking regarding any interfacility ambulance
6 service matters?
7 A. Yes.
8 MR. BELANGER: Judge, can I just object
9 to the leading nature of the questions. He can ask him
10 who the person is, instead of testifying and then
11 getting an affirmation.
12 ALJ MIHALSKY: Yeah, I mean I think it's
13 kind of background, but if you can watch it.
14 MR. ROSENFELD: Sure. Absolutely, Your
15 Honor.
16 ALJ MIHALSKY: Thank you.
17 MR. ROSENFELD: Can the witness answer
18 the pending question?
19 ALJ MIHALSKY: If he remembers.
20 THE COURT REPORTER: He did. He said
21 "Yes."
22 MR. ROSENFELD: Oh, I'm sorry. I didn't
23 hear it.
24 BY MR. ROSENFELD:
25 Q. So your principal point of contact, just so
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1 we're clear, is Mr. Remus and not Mr. Benedict?
2 A. Correct.
3 Q. Currently, what CON holders principally
4 provide interfacility ambulance services at
5 HonorHealth?
6 A. Southwest Ambulance, PMT and AMR.
7 Q. And you were here, of course, today when
8 Mr. Wolfe testified regarding AMR's interfacility
9 responsiveness to HonorHealth's requests for service?
10 A. Yes.
11 Q. Did you see the exhibits that were presented?
12 A. Yes.
13 Q. And do you recall -- and we can put the
14 exhibit up there. We should. Let's put the cumulative
15 exhibit up there.
16 Yeah, that's it. This is AMR-111. You've
17 reviewed this exhibit today?
18 A. Yes. Yes.
19 Q. Did you, during a break, have an opportunity
20 to check on Rural/Metro's on time performance to
21 HonorHealth as well?
22 A. I did.
23 Q. And can you tell us specifically, at various
24 fractiles, if you will, although I'm not sure these are
25 properly characterized as fractiles, but at various
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1 breaking points timewise what you determined?
2 MR. BELANGER: Can I object to the
3 foundation regarding this testimony, hearsay.
4 MS. FICKBOHM: I can't hear what you're
5 saying, Jim. I'm sorry.
6 MR. BELANGER: Object to the foundation
7 regarding this testimony and that it's hearsay.
8 ALJ MIHALSKY: I can consider hearsay.
9 You can explore that on cross.
10 MR. ROSENFELD: And I will ask a
11 foundational.
12 ALJ MIHALSKY: You may proceed.
13 MR. ROSENFELD: Thank you. I'll ask a
14 foundational question.
15 BY MR. ROSENFELD:
16 Q. What did you specifically instruct your staff
17 to do with respect to this Exhibit 111 and gathering
18 comparable data for Rural/Metro?
19 A. So we looked at the entire HonorHealth
20 system. Obviously, limited time, since we just saw the
21 information this morning, to look at facility by
22 facility. So we looked at the entire HonorHealth
23 system from the period of January 2015 through
24 September 2015.
25 And what we saw there is that our early and
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1 on time percentage for roughly 4,600 transports during
2 that time period was around 68 percent. And then I
3 also looked at early and on time and then 10 minutes
4 over, so similar to this; and we were around
5 81 percent. Then early/on time up to 20 minutes over,
6 and that was at 88 percent. And then, last, we looked
7 at early/on time up to 30 minutes past being on time,
8 and that was 92 percent of the time.
9 Q. And do you know whether currently, in any of
10 the Rural/Metro intervenor -- Rural/Metro CON holder
11 intervenors' CONs there is a mandated interfacility
12 arrival time?
13 A. Yes.
14 Q. Is there?
15 A. Oh, for intervenors? No.
16 Q. Yeah.
17 There is for AMR?
18 A. For AMR, yeah.
19 Q. During your time at AMR -- excuse me, your
20 time at Rural/Metro, in your conversations with
21 Mr. Remus, has he ever raised with you any issues
22 regarding the adequacy of Rural/Metro's responsiveness
23 to requests by HonorHealth for interfacility ambulance
24 service?
25 A. No.
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1 Q. Has there been an issue that you have
2 discussed with Mr. Remus in particular?
3 A. Yes.
4 Q. And what is that?
5 A. It was specific to our wheelchair and taxi
6 service, which we outsource.
7 Q. Okay. And so what was the nature of that
8 discussion or those discussions?
9 A. There were some concerns from some of the
10 facility leaders and, you know, just around on time
11 responsiveness. And when we dug into it, each one of
12 those instances were actually taxis or wheelchair
13 services showing up late.
14 Q. Are taxi and wheelchair services part of --
15 strike that.
16 Does a provider require a CON to provide taxi
17 and wheelchair service?
18 A. No.
19 Q. So the taxi and wheelchair service is not
20 within the scope of the certificates of necessity that
21 the Rural/Metro CON holders hold?
22 A. Correct.
23 Q. I want to look next, Kevin, at Maricopa
24 Ambulance 165 in evidence.
25 Were you here when Mr. Blackburn testified
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1 regarding this document?
2 A. I was.
3 Q. And do you recall that he expressed concern
4 that this sort of a direction would be given by a
5 Rural/Metro -- by Rural/Metro personnel to the City of
6 Tempe?
7 MR. BELANGER: Judge, I'm going to
8 object to the leading nature of the question. He could
9 ask him what do you recall regarding the testimony.
10 MR. ROSENFELD: I'm simply trying to --
11 it was October, so I'm trying to refresh his
12 recollection as to the context in which this exhibit
13 came up.
14 ALJ MIHALSKY: You can ask leading
15 questions about the context and then stop.
16 MR. ROSENFELD: Thank you, Your Honor.
17 I will do so.
18 BY MR. ROSENFELD:
19 Q. So do you recall that testimony?
20 A. I do.
21 Q. I would like you then to put this in context
22 and talk about how this e-mail came to be. And to
23 begin with, I would like you to identify the people who
24 are named in this document in the From and To and CC
25 lines. Can you do that?
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1 A. Yes. So Barbie Marr is one of our assistant
2 general managers. So she is not a direct report of
3 myself. She's a direct report of one of my general
4 managers. And then Sheila Bryant, she is the
5 prehospital coordinator for Tempe St. Luke's. And then
6 Darrell Duty is one of the Chiefs for Tempe Fire.
7 Q. So would you explain, Kevin, what the
8 context -- strike that.
9 Would you explain, first, what instruction is
10 being given in this e-mail from Ms. Marr to Ms. Bryant?
11 A. That anytime there is an emergency transport,
12 so like she lists here, STEMI, stroke, trauma patient,
13 to call and activate the 911 system.
14 Q. And to your knowledge, is this something that
15 Ms. Marr came up with on her own?
16 A. No.
17 Q. How did this instruction come about then?
18 A. Chief Duty instructed Barbie to send this
19 e-mail -- to cc himself -- to Sheila Bryant. And then
20 he also called Sheila Bryant as well to talk to her and
21 make sure that she understands that any facilities or
22 hospitals within the city of Tempe that require an
23 emergency transport, to activate the 911 system.
24 Q. So just so I'm clear, is this a directive
25 that emanated from Rural/Metro, or is this a directive
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1 that emanated from the City of Tempe?
2 A. The City of Tempe.
3 Q. Would it be within Rural/Metro's prerogative
4 to disregard a lawful dispatch directive given by the
5 Chief of the Tempe Fire Department?
6 A. No.
7 Q. Let's look next at Maricopa Ambulance 180 in
8 evidence.
9 And you've seen this letter before?
10 A. Yes.
11 Q. As you can see, it's a letter to Dr. Christ
12 from Mr. O'Malley at Dignity Health, correct?
13 A. Yes.
14 Q. Do you know Mr. O'Malley?
15 A. I do.
16 Q. Have you dealt with him?
17 A. Yes.
18 Q. More specifically, have you had discussions
19 with Mr. O'Malley regarding Rural/Metro's provision of
20 interfacility ambulance services at Dignity Health?
21 A. Yes.
22 Q. Over what time frame?
23 A. From May till the end of July, early August
24 of 2015.
25 Q. And during those discussions -- well, strike
COASH & COASH, INC. 602-258-1440 www.coashandcoash.com Phoenix, AZ
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1 that. Let me ask it differently.
2 What was the substance of those discussions?
3 A. Sure. So, you know, one of the things that
4 Dignity wanted to do is they wanted to get an RFP
5 together to look at transport provider, obviously, with
6 having another provider in the market with AMR. And,
7 you know, we talked about several things. So obviously
8 some ideas around, you know, how can we improve on
9 response time compliance; are there other things that
10 we can do, you know, to help to innovate the Dignity
11 system as well too. And, I mean, we had multiple
12 discussions in person and via telephone.
13 Q. And were there specific proposals made by you
14 and your team as to how to provide even better
15 interfacility ambulance services to Dignity Health?
16 A. Yes.
17 Q. What did those proposals consist of?
18 A. There's a few different things, but in
19 particular, you know, one of the things that we talked
20 about and Mr. Valentine talked about a little bit
21 earlier, in terms of priority dispatching on the 911
22 side. But what we talked about is something that we do
23 with Kaiser. I think everyone knows Kaiser Permanente.
24 That we do on a national level in other markets, is we
25 actually have levels of calls.
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1 So, again, instead of just having Dignity,
2 what they were doing at the time, just calling and
3 saying "I need an ambulance ASAP," and this could be a
4 patient that, you know, truly was something that was
5 urgent that we need to respond within, you know, let's
6 say, 30, 45 minutes, or it could be something as simple
7 as, you know, there's a patient that just had knee
8 surgery that needs to get transported to another
9 facility that, you know, maybe it wasn't as urgent. It
10 could be four or five hours.
11 So one of the things we talked about specific
12 to that was, you know, what if we looked at it in terms
13 of the patient's acuity and the levels and tried to
14 determine response time compliance based on those
15 levels. So that's an example.
16 Q. And this is something that you're familiar
17 with because Rural/Metro's implemented it at Kaiser
18 Permanente, did you say?
19 A. Yes. And a part of my responsibility is
20 Colorado, and we do have Kaiser in Colorado. So I'm
21 very familiar with that contract.
22 Q. And let's not assume that we all know Kaiser
23 Permanente. So who are they?
24 A. I mean it's one of the largest health systems
25 in the world. So, again, they're predominantly on the
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1 West Coast, so California; but, again, it's a health
2 system just like a Banner Health, for example, would be
3 a good analogy for here in Arizona, but much larger.
4 Q. Let's take a look at the very end of the
5 letter that Mr. O'Malley authored.
6 Sorry about that. Looks interesting, but
7 that's not really what I want to talk about, so...
8 ALJ MIHALSKY: I did that. I'm sorry.
9 MR. RIVERA: No, thank you.
10 ALJ MIHALSKY: Yeah, you don't have a
11 keyboard.
12 MR. ROSENFELD: I think I should just
13 not touch the mouse anymore.
14 BY MR. ROSENFELD:
15 Q. And you see this letter was written on
16 October 19th, 2015?
17 A. Yes.
18 Q. And can you read out loud the last paragraph
19 of the letter and what Mr. O'Malley says about the
20 status of the interfacility service?
21 A. Yes.
22 "Currently, we use both AMR and Rural/Metro.
23 Over the past couple of months, the timeliness of
24 inter-facility ambulance services has noticeably
25 improved."
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1 Q. I want to look next -- and, by the way, do
2 you agree with that assessment?
3 A. Absolutely.
4 Q. I want to look next at Maricopa Ambulance 51X
5 in evidence. And I believe that Mister -- I think it
6 was Mr. Kasprzyk. It could have been Mr. Valentine. I
7 apologize. But one of them addressed this document.
8 This was one of the exhibits that were admitted by
9 Maricopa Ambulance without any testimony.
10 Do you know that the current status of this?
11 MR. BELANGER: Judge, I'm just going to
12 object to the characterization. I mean it was
13 admitted.
14 MR. ROSENFELD: Well, the point being
15 there was no testimony offered, so we're going to offer
16 testimony to explain the document. That's all I'm
17 saying. There's nothing nefarious about what I'm
18 suggesting.
19 ALJ MIHALSKY: Okay, well, just offer
20 the testimony, okay.
21 MR. ROSENFELD: Okay. Fair enough, Your
22 Honor.
23 ALJ MIHALSKY: And the record will speak
24 for itself.
25 MR. ROSENFELD: Thank you, Your Honor.
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1 BY MR. ROSENFELD:
2 Q. So, Kevin, are you familiar with the fact
3 that there was a contractual dispute between Southwest
4 and -- or a billing dispute, I guess, between Southwest
5 and Glendale?
6 A. Yes.
7 Q. And what is the current status of that?
8 A. As Mr. Kasprzyk testified earlier, we have
9 reached an agreement and settled, and both sides are
10 very happy.
11 Q. And lastly, Kevin, I want you to take a look
12 at Rural/Metro -- excuse me. Yes, Rural/Metro
13 Exhibit 156, now in evidence.
14 You were obviously here when Mr. Rivera
15 testified just 30 or so minutes ago. Would you talk to
16 us about what happened in the first several months of
17 2015 that caused what Mr. Rivera referred to as a dip
18 in our response times with respect to these
19 jurisdictions?
20 A. Yes. So as I mentioned earlier, you know, I
21 got here April 1st. Not with the company, but over the
22 Arizona market April 1st of 2015. And one of the first
23 things I noticed, you know, was our compliance, our
24 dip. And so obviously we did some root cause analysis
25 to just try to figure out what that was, and one of the
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1 glaring items was staffing.
2 So I believe Mr. Valentine talked about it a
3 little bit earlier. There was a significant impact,
4 you know, when AMR did enter the market. Although, you
5 know, 20, for example, might not seem like much, what
6 we did typically see is that a lot of those individuals
7 were actually coming out of permanent filled positions
8 within some of these 911 systems. And so as they came
9 out, obviously we had holes to fill, right.
10 So one of the things that I did is, when I
11 got there, as I said, on April 1st, April 15th I gave
12 direction right away during that first week, but
13 April 15 is really when we started to hit the ground
14 running. So we started to increase the amount of
15 overtime that we were spending, as well as I offered
16 incentives to get folks to pick up shifts.
17 Q. Were there also efforts to find new qualified
18 personnel to fill the field positions?
19 A. Absolutely. We actually did a job fair in
20 the summer, that we hired over a hundred EMTs and
21 paramedics.
22 Q. And in terms of, you know, when the company
23 would experience peak demand for its services, which
24 months are typically those that have the spike in call
25 demand?
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1 A. January through April.
2 Q. So the same time frame where you had the
3 staffing issues come up because of departures?
4 A. Yes. I mean it was the perfect storm, if you
5 will. Yeah.
6 Q. And given the efforts that you've just
7 described in terms of addressing the staffing gaps and
8 the numbers that you see on this screen, what is your
9 assessment of how successful you and the company were
10 in filling those gaps and restoring the prior
11 performance numbers?
12 A. Yeah, so I mean obviously if, you know, you
13 look from, you know, even starting in April and May,
14 all the way through September, I think the results
15 speak for themselves; you know, that we're doing a
16 phenomenal job and, you know, we've really turned it
17 around.
18 MR. ROSENFELD: That's all I have, Your
19 Honor. Thank you.
20 MR. BELANGER: So -- I'm sorry.
21 ALJ MIHALSKY: Okay.
22 MR. MCGOLDRICK: No questions.
23 MS. FICKBOHM: No questions, but I
24 wanted to report that I heard back from Ms. Hofmeyr,
25 and she missed you by two minutes. She's driving to
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1 Phoenix tonight. I don't know if specifically for this
2 or for another reason. And she'll be here at 8:30 in
3 the morning.
4 ALJ MIHALSKY: Oh, okay. Well --
5 MS. FICKBOHM: I don't think it has
6 anything to do with you making that call. I think that
7 was her plan anyways to come up here tomorrow.
8 ALJ MIHALSKY: Okay.
9 MS. FICKBOHM: So just FYI.
10 ALJ MIHALSKY: Very good. Yeah, she
11 specifically requested only to appear today and Friday
12 telephonically. So I don't understand, but...
13 Mr. Belanger, Mr. Bennett, do you want
14 to cross-examine this witness this afternoon, or do you
15 want to wait until tomorrow?
16 MR. BELANGER: Yeah, we can wait until
17 tomorrow morning, Judge, and get everybody out of here.
18 We won't have more than 30 minutes, though.
19 ALJ MIHALSKY: Is there any problem with
20 waiting until tomorrow to finish your testimony? Do
21 you have a flight or anything?
22 THE WITNESS: Huh-uh.
23 ALJ MIHALSKY: No.
24 THE WITNESS: No.
25 ALJ MIHALSKY: Okay. And that's all
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1 right?
2 MR. ROSENFELD: I would rather finish
3 the witness, to be very honest with you, if they have
4 30 minutes or less. It just seems sensible to get this
5 done.
6 ALJ MIHALSKY: Well, it's 4:38. I don't
7 want to stay beyond 5:00.
8 MR. BELANGER: I think we'll start
9 tomorrow morning Judge, if that's okay with you.
10 ALJ MIHALSKY: Okay. We'll see you back
11 here then at 8:30.
12 (The hearing adjourned at 4:38 p.m.)
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1 STATE OF ARIZONA ) COUNTY OF MARICOPA )
2
3 BE IT KNOWN that the foregoing proceedings were taken before me; that the foregoing pages are
4 a full, true, and accurate record of the proceedings, all done to the best of my skill and ability; that
5 the proceedings were taken down by me in shorthand and thereafter reduced to print under my direction.
6 I CERTIFY that I am in no way related to
7 any of the parties hereto, nor am I in any way interested in the outcome hereof.
8 I CERTIFY that I have complied with the
9 ethical obligations set forth in ACJA 7-206(F)(3) and ACJA 7-206 (J)(1)(g)(1) and (2). Dated at
10 Phoenix, Arizona, this 21st day of January, 2016.
11
12 _______________________________________
13 JODY L. LENSCHOW, RMR, CRR Certified Reporter
14 Arizona CR No. 50192
15 I CERTIFY that Coash & Coash, Inc., has
16 complied with the ethical obligations set forth in ACJA 7-206 (J)(1)(g)(1) through (6).
17
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23 _______________________________________
24 COASH & COASH, INC. Registered Reporting Firm
25 Arizona RRF No. R1036
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