2015A-EMS-0190-DHS VOLUME 13 01/13/2016 1 BEFORE …...Jan 13, 2016 · Exhibit AMR-2B Valentine...

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2360

1 INDEX TO EXHIBITS CONTINUED


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


19 Scottsdale Osborn Medical Center


21 2/26/15-10/20/15 Scottsdale Shea

22 Medical Center


24 Scottsdale Thompson Peak

25


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2361




4 Sonoran Health & Emergency Center

5 Exhibit AMR-110 Call Count 2/26/15- 2408 2408

6 10/20/15 all HonorHealth


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2362



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

12

13

14

15

16

17

18

19

20

21

22

23

24

25


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

22 [email protected]

23

24

25


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2364

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

6 [email protected]

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


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2366

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2367

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2368

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2369

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2370

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2371

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2372

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2373

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.


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.


23 MS. FICKBOHM: Okay, good to go.

24 ALJ MIHALSKY: We're good to go.

25 MS. FICKBOHM: You scared me with that


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2374

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:


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2375

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2376

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2377

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2378

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2379

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2380

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 --


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2381

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2382

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2383

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2384

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2385

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2386

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2387

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"?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2388

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2389



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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2390

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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2391

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2392

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2393

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2394

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2395

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2396

1 Q. Thank you.


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2397

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2398

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.



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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2399

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2400

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?


19 Q. But, again, that collects all calls, not just

20 urgent calls?

21 A. Correct.

22 Q. And then within an hour?


24 Q. And two outside of an hour?

25 A. Correct.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2401

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.


6 for the admission of AMR-105.

7 MR. BELANGER: Same objection, Judge.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2402

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2403




4 BY MS. FICKBOHM:


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2404

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?


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.




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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2405

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:


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 &


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2406

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 &


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2407

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?


7 Q. And the percentage for under 60 minutes?

8 A. 100 percent of the time.


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?


21 MS. FICKBOHM: Move for admission, Your

22 Honor.



25 MS. FICKBOHM: Sorry, my mouse is not


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2408

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.





2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2409

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2410

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2411

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?


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?


16 Q. And on scene within 60 minutes?


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2412

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.



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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2413

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2414

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2415

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2416

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2417

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2418

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2419

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2420

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2421

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2422

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2423

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2424

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2425

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2426

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2427

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2428

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2429

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2430

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.


22

23 REDIRECT EXAMINATION

24 BY MS. FICKBOHM:

25 Q. Clear up a couple things, Jim, and sort of


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2431

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2432

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2433

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2434

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2435

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2436

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2437

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,





21

22


24 BY MS. FICKBOHM:

25 Q. Mr. Valentine, what's your position in the


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2438

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2439

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2440

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2441

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2442

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2443

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2444

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2445

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2446

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2447

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.



2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2448

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2449

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2450

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2451

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2452

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2453

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2454

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2455

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2456

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2457

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2458

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2459

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2460

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2461

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2462

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2463

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2464

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2465

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2466

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2467

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2468

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2469

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2470

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2471

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2472

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2473

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2474

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 --


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2475

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2476

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2477

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2478

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2479

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2480

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2481

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2482

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2483

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2484

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2485

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2486

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2487

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2488

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2489

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.


21


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2490

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 --


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2491

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2492

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2493

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2494

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2495

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2496

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2497

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2498

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2499

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2500

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2501

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2502

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2503

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2504

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2505

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2506

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2507

1 that a model that just AMR Maricopa is using, that

2 historically had not been used before?


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2508

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2509

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2510

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2511

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2512

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2513

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?


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2514

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.)


24 And before we resume the examination of

25 Mr. Valentine, it occurred to me that at some point we


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2515

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2516

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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2517

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.


22 MR. BELANGER: Well, are we good to

23 go?

24 ALJ MIHALSKY: I think we are.

25 Yes.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2518

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 --


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2519

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2520


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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2521

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


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2522

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2523

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?


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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2524

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2525

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2526

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?


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2527

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2528

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2529

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2530

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


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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2531

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2532

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2533

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


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.


20

21 GLENN KASPRZYK,






2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2534


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2535

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2536

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2537

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2538

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2539

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2540

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?


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2541

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2542

1 the Arizona EMS Council, 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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2543

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2544

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.




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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2545

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2546

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2547

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2548

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.


15 for admission of AMR Exhibit 100.

16 MR. BELANGER: No objection, Your Honor.


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?


24 Q. And I'm showing you what's been marked as

25 Exhibit 114. You have had an opportunity to review


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2549

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.


9 for admission of AMR Exhibit 114.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2550

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2551

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2552

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2553

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2554

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2555

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2556

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2557

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2558

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2559

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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2560

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2561

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2562

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2563

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2564

1 is something that has to be reported, 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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2565

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2566

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2567

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2568

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2569

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2570

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.


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.)


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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2571

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


23 BY MR. RAY:

24 Q. Under the public necessity rule, it

25 identifies a number of factors that are to be


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2572

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


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2573

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.


25 MR. MCGOLDRICK: Judge, AMR-112 is an


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2574

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2575

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2576

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.


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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2577

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2578

1 MR. MCGOLDRICK: That's all, Your Honor.


3 MS. FICKBOHM: We're done.


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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2579

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2580

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


25 ALJ MIHALSKY: Thank you. Would you


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2581

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


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2582

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2583

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2584

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2585

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2586

1 progression through the company.

2 A. It is an accurate description.

3 MR. ROSENFELD: Your Honor, we offer

4 Rural/Metro 6.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2587

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2588

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?


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?



2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2589

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?


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2590

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2591

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2592

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2593

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.


20 Rural/Metro 156.

21 ALJ MIHALSKY: Exhibit RM-156 is

22 admitted.



25 Q. The exhibit contains all of the individual


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2594

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2595

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2596

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?


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2597

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2598

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2599

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


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2601

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


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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2603

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?


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.


23 Rural/Metro 114.


25 admitted.


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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2605

1 A. Correct.

2 Q. A Section A and a Section B?


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.


19 ALJ MIHALSKY: Exhibit Rural/Metro 115

20 is admitted.



23 Q. Would you then, Marco, take us through

24 Rural/Metro 115 at each of the six fractiles depicted

25 on this exhibit?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2606

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2607

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?


7 Q. And, again, on the required side, the numbers

8 are taken right from the face of the Southwest Maricopa

9 CON, 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.


16 Rural/Metro 116.



19 admitted.



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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2608

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,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2609

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


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?


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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2611

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.


25 ALJ MIHALSKY: Mr. McGoldrick,


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2612

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2613

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2614

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2615

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2616

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2617

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2618

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.


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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2619

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


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,






2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2620


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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2621

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2622

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2623

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.


19


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2624

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2625

1 No questions, Your Honor.


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.


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.)


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.




2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2626

1 (A brief recess was taken.)


3 Go ahead, Mr. -- wait, I haven't sworn

4 this witness in.

5 (Mr. Kevin Stock was duly sworn by the



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.


13 ALJ MIHALSKY: Mr. Rosenfeld, go ahead.

14

15 KEVIN STOCK,





20



23 Q. Good afternoon, Kevin.

24 A. Good afternoon.

25 Q. Where do you work?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2627

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2628

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2629

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.


12 Rural/Metro 9.

13 ALJ MIHALSKY: Rural/Metro Exhibit 9 is

14 admitted.



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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2630

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2631

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2632

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2633

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2634

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2635

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.



7 ALJ MIHALSKY: Exhibit Rural/Metro 153

8 is admitted.



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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2636

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.



21 admitted.



24 Q. I want to talk next, Kevin, about

25 HonorHealth, in addition to the testimony -- or, excuse


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2637

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2638

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.


25 Q. So your principal point of contact, just so


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2639

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2640

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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2641

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2642

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2643

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.


17 I will do so.


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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2644

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2645

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2646

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.


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2647

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2648

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.


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."


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2649

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.



2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2650

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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2651

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?


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2652

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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2653

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.


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


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2654

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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25


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 2655

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

18

19

20

21

22

23 _______________________________________

24 COASH & COASH, INC. Registered Reporting Firm

25 Arizona RRF No. R1036


2015A-EMS-0190-DHS VOLUME 13 01/13/2016 1 BEFORE …...Jan 13, 2016 · Exhibit AMR-2B Valentine...

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Transcript of 2015A-EMS-0190-DHS VOLUME 13 01/13/2016 1 BEFORE …...Jan 13, 2016 · Exhibit AMR-2B Valentine...