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Ambulance services issue gets clarity

LIHU‘E – The state Department of Health met with the Kaua‘i County Council regarding the future of ambulance services on Wednesday, nearly two months after protests led the department to cancel its decision to change emergency medical providers.

Council member Felicia Cowden had requested the Department of Health’s (DOH) presence at the Public Safety and Human Services Committee meeting on Dec. 13, asking the department to provide an update on plans for the upcoming procurement process for ambulance services on Kaua‘i.

The future of emergency medical services has been up in the air since August, when the DOH announced it had awarded emergency medical provider Falck with 3.5-year contracts — totaling roughly $32 million for Kaua‘i and $59 million for Maui, to provide ambulance services on both islands.

The current provider American Medical Response, which has provided the services on both islands for more than 44 years, immediately protested the decision to switch to a new provider, citing flaws with the procurement process and alleging the department was reducing the level of care.

In October, amid its protests, the Kaua‘i County Council passed a resolution in support of AMR, urging the DOH to continue with them as the provider.

The DOH then announced on Oct. 23 that both its procurement and award to Falck had been canceled following their review of AMR’s protest, and that they would restart the process.

At the Wednesday meeting, Debbie Kim Morikawa, the deputy director for the DOH’s health resources department, appeared on Zoom to thank the council for the opportunity to clarify the state’s procurement process and address misconceptions.

“During our most recent solicitation, there was the misperception that the state has the option not to conduct an RFP or request for proposals,” said Morikawa, adding the process is required under Chapter 103 of Hawai‘i Revised Statutes, which addresses procurement procedures for public money and public contracts.

“The RFP process is not optional. It is mandated by state law and that’s why we have had to go through this process as we did just recently.”

Morikawa also addressed AMR’s claims that the DOH planned to lower the level of ambulance services.

“I just want to be clear that the intent of the RFP that we issued was always to request proposals for the same level of service currently being provided or higher,” she said.

AMR had raised the concern of a planned reduction in services amid its protests, following the announcement that the DOH would switch to a new provider.

In September, Speedy Bailey, the regional director of AMR in Hawai‘i, told The Garden Island that the DOH had removed a requirement that every ambulance be an Advanced Life Support (ALS) unit.

Unlike Basic Life Support (BLS) units, ALS units have at least one paramedic staffed alongside EMTs, making them able to provide more advanced care including intubation, the use of EKGs to respond to cardiac conditions and the insertion of IVs.

Bailey referred to the Kaua‘i RFP stating the DOH “does not have a preferred ratio of ALS and BLS deployment,” in a section on commonly raised questions by applicants.

Morikawa said there “may have been some ambiguity in the language of the RFP, which created some confusion” that BLS ambulance units would replace ALS units.

“In reality, that was not the case,” she said. “The RFP specifically stated … that successful applicants will offer services equal to or better than the quality currently enjoyed by the County of Kaua‘i.”

According to Morikawa, the contract was canceled “to be as transparent as possible” with the public, due to perceptions that the department was lowering the level of service.

“I’d like to reassure you that there was never any intent to lower the level of ambulance services we’ve provided. Our goal has always been to continue to be a responsible steward of our public dollars and to provide the people of Kaua‘i with the best possible services that are feasible,” she said.

Cowden called the information from Morikawa “incredibly helpful,” adding it helped lower her blood pressure.

“I have been really concerned that this has been reckless and careless for us,” she said.

AMR’s Bailey was in attendance at Wednesday’s committee meeting and provided lengthy testimony advocating for AMR’s proven record of service.

“We’ve provided service for 44 years. We provide it on time, on point, on budget,” he said.

“We’re prepared to work with the communities, with the Legislature, with you all to determine what’s needed.”

No representative for Falck, the previous winner of the contract, spoke at the meeting. However, Jeff Lucia, the organization’s communications director, said Falck is currently reviewing the DOH’s new application.

“We were honored to attend today’s meeting,” he said in an email response on Dec. 13.

“If Falck competes again to serve Kaua‘i and Maui County, it will be because we believe we can deliver best-in-class ambulance services and the same or better level of care to these communities.”

In an email response on Dec. 13, Shawn Hamamoto, an information specialist with the DOH, said the department is currently in the process of the “Request For Information (RFI), which is required before the State can competitively procure for emergency ground ambulance services through the Request for Proposals (RFP) process.”

State Director of Health Kenneth Fink said he had canceled Falck’s contract in October because an RFI had not been conducted during the procurement process.

“Based upon my review of how the RFPs were written regarding ambulance staffing, RFIs should have been completed,” he said in a statement at the time.

The RFI for the new procurement is in process until Dec. 15, 2023, at 4 p.m., when comments or recommendations will close to the public.

To maintain ambulance services, the DOH has had a procurement exemption approved by the State Procurement Office, which allows AMR’s existing contract to be extended for an additional nine months, until September 2024, according to Hamamoto.

The department plans to release its new Request for Proposals between April and June of 2024, which will be followed by an approximately two-month period to review proposals, and potentially another two months to allow for the award to be protested, according to Hamamoto.

“We are hopeful that the contract will be awarded by September 2024,” he said.


Emma Grunwald, reporter, can be reached 808-652-0638 or
Source: The Garden Island

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