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Receive a presentation on the Solano Emergency Medical Services Cooperative (SEMSC) Joint Powers Agency (JPA) and consider providing direction to staff on the next steps regarding the SEMSC JPA and County Governance of Emergency Medical Services and designation as the Local Emergency Medical Services Agency (LEMSA)
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Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
The County Administrator recommends that the Board of Supervisors receive a presentation on the Solano Emergency Medical Services Cooperative (SEMSC) Joint Powers Agency (JPA) and consider providing direction to staff on the next steps regarding the SEMSC JPA and County Governance of Emergency Medical Services and designation as the Local Emergency Medical Services Agency (LEMSA).
SUMMARY:
The Solano County Emergency Medical Services Cooperative (SEMSC) Joint Powers Authority (JPA) was originally formed in 1996 and later amended in 2003. Members included the County, all the cities within the County with the exception of Vacaville, the city of Isleton, and the fire districts in the unincorporated areas. Its purpose was a creative long-range solution for emergency ambulance service throughout the county by collaborating with JPA members. This Board also formally designated the JPA as the local Emergency Medical Service (EMS) Agency pursuant to Health & Safety Code §1797.200, thereby, sharing the authority and responsibility of the Agency with the JPA members. The SEMSC Joint Powers Agreement was amended in 2003 to address certain technical issues as well as to remove the City of Vacaville and the Dixon Fire Protection District (FPD) since Vacaville’s ambulance service had been given authority to continue operating under Health & Safety Code §1797.201 and Dixon FPD operated under a contract with the City of Dixon.
In October 2024, SEMSC adopted Policy 1900 establishing contracting procedures for ambulance providers and requested that this Board affirm the Policy to ensure compliance with Health & Safety Code §1797.230(c) which this Board did on February 4, 2025. SEMSC is currently conducting a Request for Proposals (RFP) process for a new exclusive ambulance services contract, and proposals were due October 10, 2025.
The City of Fairfield was one of two agencies that submitted a proposal to be awarded the exclusive ambulance services contract and has negotiated a Joint Exercise of Powers Agreement with the cities of Benicia, Dixon, Rio Vista and Suisun City to allow those agencies to potentially receive additional revenue. Negotiations are still underway with the City of Vallejo with respect to that agreement.
Because SEMSC’s Board includes both a city manager and a fire chief, individuals whose agencies may directly benefit from Fairfield’s bid, the process raises possible concerns about perceived conflicts of interest and the perception of bias. While it has been determined that there is no legal conflict, if a governing member of SEMSC is affiliated with an agency seeking the contract, it potentially undermines confidence in the fairness and impartiality of the RFP process and whether these dual roles create a possible appearance of impropriety, even if no legal conflict exists.
For this reason, it appears to be the opportune time for this Board to consider whether to maintain participation in SEMSC. Options include maintaining the status quo, terminating the County’s participation in SEMSC, and/or revoking SEMSC’s designation as the LEMSA and returning direct governance of the LEMSA to the County, ensuring that ambulance contracting and oversight are managed independently from potential provider interests.
FINANCIAL IMPACT:
The cost for preparation of this staff report is nominal and included in the Department’s FY2025/26 Working Budget.
DISCUSSION:
Background
In 1980 the Legislature enacted a comprehensive statutory scheme, the Emergency Medical Services System and the Prehospital Emergency Medical Care Personnel Act (Health & Safety Code §§ 1797-1799.207; “Act”) to establish a statewide system for providing emergency medical services to those in need thereof. The Act is administered by the Emergency Medical Services Authority (“Authority”) at the state level (HSC § 1797.1) and by an emergency medical service agency (“EMS agency”) at the local county level (HSC § 1797.200).
Specifically, Section 1797.200 provides: “Each county may develop an emergency medical services program. Each county developing such a program shall designate a local EMS agency which shall be the county health department, an agency established and operated by the county, an entity with which the county contracts for the purposes of local emergency medical services administration, or a joint powers agency created for the administration of emergency medical services by agreement between counties or cities and counties pursuant to the provisions of Chapter 5 (commencing with Section 6500) of Division 7 of Title 1 of the Government Code.”
Local Emergency Medical Services Agency
The concept for the Solano Emergency Medical Services Cooperative (SEMSC) was born out of an effort to develop a collaborative structure to coordinate pre-hospital emergency medical services across cities, fire districts, and the County with input from medical stakeholders. Beginning back in 1994, this Board formed an “Ambulance Services Facilitating Team” whose charge was to develop a comprehensive Prehospital Care plan for the Board’s consideration consistent with the Act with the goal of reducing or keeping the cost of ambulance services down, while at the same time, enhancing and improving prehospital care service countywide.
The County supported cooperative ambulance service planning in 1995 which led to the creation of the SEMSC JPA in 1996 (see Attachment link to 1996 Agenda Item). The JPA was amended in 2003 to address certain technical issues as well as to remove the City of Vacaville and the Dixon Fire Protection District (FPD) since Vacaville’s ambulance service had been given authority to continue operating under Health & Safety Code §1797.201 and Dixon FPD operated under a contract with the City of Dixon (see Attachment link to 2003 Agenda Item).
Current Status of Request for Proposal (RFP)
The County’s Public Health Division is currently administering a procurement process for a new 5-year ambulance agreement, with possible extensions. This RFP is being administered by Public Health EMS staff in accordance with the SEMSC Exclusive Operating Area Emergency Ambulance Services Provider Contracting Process Policy (RFP Policy).
The RFP covers three service types: emergency ambulance services, i.e., all calls originating through the 911 system or a Public Safety Answering Point (PSAP), all calls made directly to the ambulance provider with an emergency room destination, all emergency transports between facilities, and all standby services; Advanced Life Support (ALS) services as defined in Health and Safety Code §1797.52, including non-emergency ALS interfacility transports; and Critical Care Transport (CCT) services as generally defined as “specialty care transport” in U.S. Code of Federal Regulations, Title 42 §414.605.
The Exclusive Operating Area (EOA) for emergency ambulance services covered by the anticipated RFP is “Zone B,” which includes all of the County of Solano except for the territorial limits of the City of Vacaville, certain immediately contiguous areas surrounding the City of Vacaville (both serviced by the City of Vacaville as “Zones A and C”), and the territorial limits of Travis Air Force Base. The EOA for emergency ambulance services also includes portions of Sacramento County under the River Delta Fire District and Delta Fire Protection District, as well as the City of Isleton. For ALS interfacility transports and CCT, the EOA includes all transports originating from anywhere in Solano County.
In accordance with the statutory language of §1797.230, the RFP Policy requires that the contract resulting from the RFP shall include:
• Payment of comparable wages and benefits to all ambulance service employees consistent with compensation in the same geographic region.
• Comparable staffing levels to the previous contract.
• Coverage for the complete territory encompassed by EOA Zone B, which may occur by subcontract.
• Coordination with local fire agencies, including with ALS first responders to extend ambulance response times.
• Coverage for all service types and levels of care.
• Requirement to meet response time standards and clinical care standards, with an active continuous quality improvement (CQI) plan.
• Provision of an emergency medical dispatch (EMD) center for ambulance dispatch.
• Requirement to meet radio/telecommunication standards, vehicle and equipment requirements, and data collection and evaluation requirements.
• Requirement to meet all financial requirements, including sufficient capacity to commence and maintain services for at least five (5) years.
The current ambulance provider, Medic Ambulance, stated as part of public comment that they would not apply for a new contract until they believed the language of §1797.230 had been satisfied, as a failed bid may become public record in the event of a legal dispute and damage their ability to make a future competitive proposal. As a result, the SEMSC Board voted to ask the Board of Supervisors to approve the RFP Policy in parallel to satisfy alternate interpretations of the statute in question. In response to that request, this Board took action on February 4, 2025 to endorse SEMSC Policy 1900.
Current Composition of SESMC Board
The membership of the SEMSC Board is established in the JPA to include the following seven members:
• The Solano County Administrator who serves as the Chair;
• One City Manager selected by the Solano County City Managers;
• One fire chief selected by the Solano-Napa Counties Fire Chiefs organization;
• Two medical professionals (i.e. physician, registered nurse, paramedic, hospital administrator, etc.) selected by the Solano County hospitals with emergency rooms;
• One emergency room physician selected by the Physician’s Forum; and
• One health care consumer selected by the six other members of the Board.
Currently, the Rio Vista City Manager and the Benicia Fire Chief are the designated city representatives.
Current Status of SEMSC
For decades, this arrangement provided stability and collaboration. However, because SEMSC Board members represent entities that are also system participants, the structure has always carried a risk of perceived conflicts. That risk is now heightened because, as mentioned above, SEMSC is in the middle of an RFP to award a high-value, multi-year exclusive ambulance contract.
The City of Fairfield is one of two agencies that submitted proposals for that contract and has formed a Joint Exercise of Powers Agreement (JEPA) with Dixon, Benicia, Rio Vista, and Suisun City. Vallejo has not yet signed the JEPA, nor has this Board, sitting as the Fire District Board for the East Vallejo, Montezuma, Suisun, or Vacaville Fire Protection Districts, approved participation in the JEPA. None of the County’s fire districts have agreed to participate. Although the Fair Political Practices Commission (FPPC) has determined there is no legal conflict of interest disqualifying the Rio Vista City Manager and Benicia Fire Chief from participating in the upcoming award of the ambulance contract, a practical concern remains. These officials represent agencies that have signed Fairfield’s JEPA, meaning their jurisdictions stand to benefit financially if Fairfield is awarded the contract. Thus, their dual role in serving both as SEMSC Board members participating in the RFP process and as representatives of jurisdictions with a direct financial interest, may create an possible appearance of bias. Even absent a legal violation, the optics of a potential conflict of interest could be troubling to observers.
Approximately thirty years ago, the County delegated EMS governance to SEMSC. Under Health & Safety Code §1797.200, however, the Board retains the authority to redesignate the Local EMS Agency (LEMSA) at any time. This authority exists independently of SEMSC’s Joint Powers Agreement (JPA), which requires one year’s notice only if the County withdraws from the JPA entirely. As such, the Board could designate another entity - for example, the County Health and Social Services Department, a special EMS district, or another JPA - as the LEMSA, while SEMSC could continue to function in an advisory or coordinating capacity.
When SEMSC was created, the intent was to provide a regional governance structure that included cities and hospitals in decision-making and reduced concerns about centralized County control. Over the years, this structure has supported collaboration among agencies and helped manage political sensitivities related to ambulance contracting. Stakeholders may have concerns that altering SEMSC’s governing role could affect these long-standing relationships, and that making changes during an RFP process could create uncertainty.
At the same time, there are several factors for the Board to consider. The statutory framework has evolved since SEMSC’s creation. For example, Health & Safety Code §1797.230(c) requires counties to adopt ambulance contracting policies, underscoring the Board’s ultimate accountability to the public for EMS system decisions.
In addition, SEMSC’s structure means that some entities serving on its Board are also participants in the EMS system and may have interests in the outcome of ambulance contracting. While this arrangement has supported collaboration, it may also create the perception of conflicts of interest. Public confidence in the fairness and integrity of the contracting process is critical to system stability.
Redesignating the LEMSA would not require eliminating SEMSC. The County could continue to rely on SEMSC as an advisory body, consistent with Health & Safety Code §1797.270, which authorizes the establishment of an emergency medical care committee. This approach would preserve regional collaboration while ensuring that final decision-making authority rests with a structure directly accountable to the Board.
Finally, the timing of SEMSC’s ambulance RFP presents a natural decision point. The resulting contract will establish ambulance service delivery for many years. Addressing governance questions before the award is finalized would provide clarity and help ensure that the process is conducted under the framework the Board determines most appropriate.
Staff is seeking direction from this Board as to the next steps. Options include but are not limited to the following:
1. Take no action and maintain the existing SEMSC JPA and its delegation as the LEMSA under HSC §1797.200.
2. Direct staff to take the necessary steps to revoke the LEMSA designation including drafting an ordinance to amend Solano County Code sections 7.1-12 and 7.1-13 which currently reference SEMSC as the designated LEMSA. This option could also maintain the County’s participation in SEMSC in its refined role as an advisory forum whose focus is on consumer-oriented prehospital and in hospital services throughout Solano County, but without the statutory LEMSA authority.
3. The Board could also determine that SEMSC has outlived its useful life and provide notice of termination and direct staff to explore the creation of a new advisory committee as authorized under HSC §1797.270.
Should the Board decide to provide direction to revoke the LEMSA designation, since the Board endorsed the RFP Policy as required under §1797.230, the Board could direct staff to continue with the evaluation and scoring of the RFPs and bring the negotiated contract with best apparent bidder back to the Board for final contract award.
ALTERNATIVES:
The Board could choose not to receive this presentation and/or take no action. This would maintain the status quo of the JPA and the continuance of the RFP process. Alternatively, the Board could direct staff to return with the necessary actions to formally terminate the County’s participation in the SESMC JPA and/or the designation of the County as the LEMSA. If the Board desires to designate the County health department as the LEMSA, the Board could still direct SEMSC staff to continue with the current ambulance RFP and the resulting contract be brought to the County Board for final approval.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION