|
Date: |
September 15, 2026 |
21 |
Title
Enhancing Emergency Ambulance Transportation Services in the Grossmont Ambulance Operating Area (Districts: 1, 2, and 4)
End
Overview
On May 23, 2023 (19), the Board of Supervisors (Board) authorized the Chief Administrative Officer to enter into a contract with the San Diego County Fire Protection District (SDCFPD) to exclusively provide and/or manage emergency ambulance transportation services in areas where the County of San Diego (County) has, or will have, the responsibility for those services. On August 14, 2023, the County and SDCFPD completed an agreement on ambulance transportation services, which states SDCFD shall manage ambulance services upon expiration of existing contracts or when contracts are transferred to SDCFPD. The County is also responsible for ensuring emergency ambulance transportation services in the Grossmont Ambulance Operating Area (AOA) which includes the cities of La Mesa and Lemon Grove and the unincorporated communities of Rancho San Diego, Mt. Helix, Spring Valley, Casa De Oro, Granite Hills and La Presa. The Grossmont AOA had 23,580 emergency medical services dispatches and 15,798 ambulance transports in 2025.
On May 15, 1979 (27), the Board assigned management of ambulance transportation services in the Grossmont AOA to the Grossmont Hospital District (now the Grossmont Healthcare District) through a contract. On October 1, 1991 (12), the Board re-assigned the contract to the Grossmont Hospital Corporation to reflect a new partnership between the Grossmont Hospital District and Sharp Healthcare for operating Grossmont Hospital. The Grossmont Hospital Corporation acts as an agent for the County and maintains the contract with the private ambulance operator that has been in place since 1979. In 2012, the Grossmont Hospital Corporation and their private ambulance operator extended their contract through April 30, 2025, and short-term extensions were secured before a new two-year extension was made effective on November 30, 2025.
Since the establishment of this contract for ambulance services in the Grossmont AOA, there has been one exclusive ambulance provider. A thorough review by the County of the ambulance service model has not been completed since 1979 despite the population growth and changing emergency medical needs. The County has concerns with a model that has not been studied since 1979 and has heard there are multiple entities interested in providing ambulance service to the Grossmont AOA. Additionally, the Grossmont Hospital Corporation has indicated support for having the County manage the Grossmont AOA. These factors, along with the Grossmont Hospital Corporation’s contract extension with their private ambulance provider ending in 2027, and only an additional 2-year extension without termination for convenience, are the catalyst for today’s recommended action.
The County has a contract with an outside consultant to complete ambulance deployment studies in the San Diego County Fire Protection District (SDCFPD) Ground Ambulance Service Area and County Service Area-17 and will task the consultant with completing a deployment study for the Grossmont AOA prior to June 30, 2027. The study will include estimates from billing public and private health insurance plans, number and type of ambulances, and deployment options to enhance patient outcomes and be used in shaping the statement of work in a future Request for Proposals (RFP) for ambulance transportation services in the Grossmont AOA. The results of the study will be shared with Grossmont AOA stakeholders for transparency. The RFP will be issued after public outreach has concluded, stakeholder input can be incorporated into the future contract deliverables, and the California EMS Authority has certified the process for exclusivity.
Today’s request includes approval of the mutual termination of the existing contract between Grossmont Hospital Corporation and the County of San Diego and the transfer of the transport contract between the Grossmont Hospital Corporation and their private provider to the SDCFPD to maintain continuity of services in the Grossmont AOA. Today’s request also includes authorizing the Director, Department of Purchasing and Contracting, to issue a competitive solicitation for future ambulance transportation services within the Grossmont AOA, with an initial term of five years and five one-year option years that is completed with the Local Emergency Medical Services Agency (LEMSA) and meets the State of California requirements for ambulance procurements. In addition, today’s actions include a request to the Board of Directors to establish and maintain a revenue agreement with the exclusive ambulance transportation provider(s) in the Grossmont AOA to provide system oversight, quality assurance oversight enhancements, and community investment while also collecting penalties should the contractor be unable to meet response times and patient outcomes. Finally, today’s actions include a request for the Board of Directors to authorize the Executive Director, or designee, of the SDCFPD to accept ownership of the Grossmont Hospital Corporation ambulance transportation contract and to take all necessary actions to amend the agreement to support patient outcomes and to include the County of San Diego’s standard terms and conditions.
Body
Recommendation by Chief Administrative Officer:
1) Authorize the Director, San Diego County Fire, on behalf of the Chief Administrative Officer, to reach mutual termination with the Grossmont Hospital Corporation for management of emergency ambulance transportation services within the Grossmont Ambulance Operating Area.
2) Authorize the Director, San Diego County Fire, on behalf of the Chief Administrative Officer, to accept the transfer of the Grossmont Hospital Corporation contract with the ambulance provider and subsequently transfer the contract to the San Diego County Fire Protection District.
(Relates to San Diego County Fire Protection District item no. 25)
End
Equity Impact Statement
Advanced (paramedic) and Basic (Emergency Medical Technician) Life Support ambulances are critical components to an emergency medical services (EMS) system that seeks to reduce health disparities in our region. Today’s actions allow San Diego County Fire staff, on behalf of the San Diego County Fire Protection District, to take actions that enhance ambulance coverage and increase quality assurance monitoring in the Grossmont Exclusive Operating Area to ensure patients are receiving the highest quality of care with equitable outcomes.
Sustainability Impact Statement
Implementing a new ambulance transportation model in the Grossmont Exclusive Operating Area provides for a just and equitable access to County resources. Completion of an ambulance deployment study, community outreach, and close partnership with Emergency Medical Services stakeholders will promote a system that ensure residents receive the appropriate care at the lowest cost.
Fiscal Impact
There is no fiscal impact associated with today’s actions for Fiscal Year 26-27.
The San Diego County Fire Protection District (SDCFPD) staff is recommending that the fiscal responsibility for operating ambulances remains with a private operator so there’s no long-term impacts to the SDCFPD or County of San Diego. A revenue agreement is being authorized for up to $500,000 annually for administrative oversight, service enhancements, community investment and collection of non-compliance penalties through June 30, 2038. Staff will return to the Board or include in future Operational Plans for consideration and approval if revenue is available to support contract monitoring, quality assurance staffing oversight, and community investments.
Business Impact Statement
N/A
Advisory Board Statement
N/A
Background
The County of San Diego (County) is responsible for ensuring emergency ambulance transportation services in the Grossmont Ambulance Operating Area (AOA) which includes the cities of La Mesa and Lemon Grove and the unincorporated communities of Rancho San Diego, Mt. Helix, Spring Valley, Casa De Oro, Granite Hills and La Presa. On May 15, 1979 (27), the Board of Supervisors (Board) assigned management of ambulance transportation services in the Grossmont AOA to the Grossmont Hospital District (now the Grossmont Healthcare District) through a contract. On October 1, 1991 (12), the Board re-assigned the contract to the Grossmont Hospital Corporation to reflect a new partnership between the Grossmont Hospital District and Sharp Healthcare for operating the Grossmont Hospital. The Grossmont Hospital Corporation receives no compensation for its management. Since the establishment of this contract for ambulance services in the Grossmont AOA, there has been one exclusive ambulance provider.
San Diego County Fire (County Fire) staff, on behalf of the San Diego County Fire Protection District (SDCFPD) and the Emergency Medical Services (EMS) Office, acting as the Board of Supervisors-designated Local EMS Agency (LEMSA), have been engaging with representatives from the Grossmont Hospital Corporation and there is mutual agreement to end their system management and return oversight to the County. Should the Board of Supervisors approve the recommendation to mutually terminate the contract with the Grossmont Hospital Corporation, County Fire staff will complete a to transfer of oversight to the SDCFPD as quickly as possible.
Managing Ambulance Transportation Systems
On May 23, 2023 (19), the Board authorized the Chief Administrative Officer to enter into a contract with the SDCFPD to exclusively provide and/or manage emergency ambulance services in areas where the County has, or will have, the responsibility for those services. On August 14, 2023, the County and SDCFPD completed an agreement to memorialize the Board of Supervisors and SDCFPD Board of Directors actions. Under the terms of this agreement, when an existing contract for ambulance transportation services expires, responsibility shifts to the SDCFPD to manage and/provide services on behalf of the County.
Ambulance Deployment Study
On June 18, 2026, County Fire entered into an agreement with the Center for Public Safety Management (CPSM) to perform ambulance deployment studies in the SDCFPD Ground Ambulance Service Area and County Service Area (CSA) 17-which includes the communities of Rancho Santa Fe, Del Mar, Solana Beach, and Encinitas. The consultant will be tasked with evaluating each ambulance service area to ensure County resources are being efficiently utilized to maximize patient outcomes. This work includes determining the number and type of ambulances, scheduling, locations, response times, and billing practices to support County resources.
If the Board takes action as proposed today, the consultant will also study the Grossmont AOA, which has operated in a similar manner and scope since 1979 which may not reflect population growth, patient needs, and emergency medical service priorities. Recommendations from the deployment study could be incorporated into the contract with the current ambulance operator and then included in a future competitive solicitation for ambulance service.
Enhancing Patient Outcomes and Community Investments
In 2025, the Grossmont AOA had 23,978 dispatches for emergency medical services calls and 15,798 ambulance transports. County Fire is proposing that a new ambulance contract include specific patient protections. These could include a requirement for a quality assurance Registered Nurse to review medical outcomes and recommend procedural changes, a dedicated EMS trainer for the ambulance operator and fire department staff in the Grossmont AOA and SDCFPD, and the establishment of penalties should the ambulance operator be unable to meet contractual requirements such as response times or patient outcomes. County Fire will establish a quarterly working group that includes impacted stakeholders to maintain open communication. Further, County Fire staff will work with system stakeholders to determine if innovative healthcare initiatives, such as telehealth, community paramedicine, and alternative transport destinations are viable in this area and improve patient outcomes.
A cost recovery fee, through a revenue agreement, will be established to support contract management, quality assurance review, system oversight, and community reinvestment. In addition, the contracted provider will be required to perform community outreach in Grossmont AOA communities, which could include teaching critical lifesaving skills in partnership with schools and fire departments, and providing funding for a County-recognized job training program(s) for young adults from traditionally under-resourced communities to gain full-time employment in the fire and EMS systems.
Grossmont AOA Stakeholder Feedback
As part of County Fire’s stakeholder outreach in advance of today’s recommended actions, County Fire staff engaged with representatives from Heartland Fire and Rescue (HFR), which serves the cities of La Mesa and Lemon Grove, San Miguel Fire and Rescue (SMFR), Grossmont Hospital Corporation (Sharp Grossmont and the Grossmont Healthcare District), and University of California San Diego (UCSD) East Hospital to seek their input on immediate changes for the private ambulance service in the Grossmont AOA. Multiple in-depth discussions have taken place with the Fire Chiefs from HFR and SMFR, and their written feedback includes:
• Request for no changes to be made to the Fire Responder Fee that the private operator charges to self-pay patients and medical insurance plans and transfers to the fire agencies to support Advanced Life Support service on fire engines
• Change the 911 dispatching of ambulances from the private operator to Heartland Communication Facilities Authority (HCFA) for seamless service delivery and additional oversight
• HFR supports County Fire’s interest in establishing a Quality Assurance Registered Nurse (RN) to ensure positive medical outcomes and to assign a dedicated Clinical Educator for training to all first responders and ambulance staff in the Grossmont AOA
• Funding from the contract to support QA/QI and community engagement should only be used for functions related to the Grossmont AOA
• SMFR has requested to stand up an agreed-upon number of ambulances as part of an interim solution, and stated that County Fire’s proposed system enhancements require greater consideration, study, and public input
• Both fire agencies have requested that the private ambulance operator increase community engagement
County Fire sees its role as limited to managing the Grossmont AOA, and would not recommend modifying ambulance rates or impact outside First Responder Agreements during the interim period. The interim period would provide time for the current system to be analyzed and an RFP issued. County Fire supports changing the 911 dispatching to HCFA and modifying the current contract to bolster QA/QI, community engagement and contract oversight. Any funds from a revenue agreement with the current ambulance provider for administrative oversight, service enhancements, community investment and collection of non-compliance penalties would be restricted for use within the Grossmont AOA, and there would be no fiscal impact to patients or first responder agencies.
Competitive Solicitation and Waiver of Board Policy A-87
To maintain exclusivity in the Grossmont AOA, under State law, a competitive solicitation will be prepared by the EMS Office, a division of County Fire, and the Board-designated Local EMS Agency. Once a draft solicitation is completed for the SDCFPD, the EMS Office will submit those documents to the State’s Emergency Medical Services Authority (EMSA) who will certify the process meets State standards. The Department of Purchasing and Contracting will then complete the competitive solicitation to ensure impartiality in selecting a new ambulance operator. In preparation for a new competitive solicitation for the Grossmont AOA, staff will engage in robust community outreach so that input from residents, fire agencies, hospitals and other stakeholders is fully considered. With the goal of a patient centered ambulance operating area, County Fire would seek input on the level of service, oversight, innovation, and the fees being charged. The Grossmont AOA currently has some of the highest rates in the region, far exceeding the County Fire’s rates and the regional average.
If the Board of Supervisors approves the mutual termination with the Grossmont Hospital Corporation, the existing contract between the Grossmont Hospital Corporation and private operator would be transferred to the SDCFPD. In addition, the SDCFPD Board of Directors is being asked to waive Board Policy A-87 and authorize the Executive Director, or designee, to accept ownership of the ambulance transportation contract and make all necessary amendments to enhance service delivery by addressing patient outcomes and service needs and include the County of San Diego’s standard terms and conditions. As currently structured the Grossmont AOA’s exclusivity is non-competitive exclusivity under Health and Safety Code section 1797.224 that allows providers to continue service in the same manner and scope as what was provided without interruption prior to 1981. Adding additional providers or changes to the providers prior to the Local EMS Agency running a competitive process would extinguish those exclusivity rights. Transferring ownership of the existing contract from the Grossmont Hospital Corporation to SDCFPD will ensure uninterrupted exclusive ambulance service within the Grossmont AOA. In addition, if approved by the SDCFPD Board of Directors, a competitive process would be completed for the Grossmont AOA to optimize the service model while enhancing patient outcomes, accountability, and quality assurance oversight. Should the system operator be unable to meet system requirements, and revenue is available for the SDCFPD to do direct billing without an impact to the County’s General Fund, that option will be included in the competitive solicitation. Staff will also determine the most appropriate method to ensure County staff time and community investments cost recovery do not impact General Purpose Revenue which may include, but not limited to, establishing a performance bond or escrow account. In addition, today’s actions include a request for the Board of Directors to establish and maintain a revenue agreement with the exclusive ambulance transportation provider(s) in the Grossmont AOA to provide system oversight, service enhancements, and community investment and collect penalties should the contractor be unable to meet response times and patient outcomes.
Linkage To The County Of San Diego Strategic Plan
Today’s recommendations support the Community and Equity Initiatives of the County of San Diego’s 2026-2031 Strategic Plan by engaging with the public and emergency medical services stakeholders in advance of a new ambulance transportation contract in the Grossmont Exclusive Operating while also focusing on patient outcomes to reduce health disparities in some of our most underserved communities.
Respectfully submitted,
Ebony N. Shelton
Chief Administrative Officer
Attachment(s)
Attachment A - Agreement Between County of San Diego and San Diego County Fire Protection District for Emergency Ambulance Services Administration
Attachment B - Correspondence Received