City commissioner and mayoral candidate Rene Gonzalez lobbed another email across the river to Multnomah County Chair Jessica Vega Pederson, this time to protest slow ambulances run by county contractor American Medical Response.

Last month, Gonzalez wrote Vega Pederson, urging her to stop allocating money for tents, tarps and syringes as the county wrapped up its $4 billion budget. The missive worked. The county agreed to halt purchases in favor of producing more shelter beds.

This time, Gonzalez wrote to the county chair to describe how a Portland Fire & Rescue engine had to transport a patient to the hospital because AMR didn’t make one available for the call, despite having two in the area. The incident, Gonzalez wrote, showed that Multnomah County must follow other counties and staff ambulances with one paramedic and one lesser-trained emergency medical technician, instead of two paramedics, in order to ease a staffing shortage that has hurt ambulance response times.

“I realize your team has a tremendous amount on your plate, but it has been over 4 months since the cities of Gresham and Portland each adopted unanimously resolutions calling for Multnomah County to pilot the 1:1 Model to alleviate the crises,” Gonzalez wrote July 3. “Your office opted not to place on the Multnomah County agenda a matching resolution brought by your colleagues to create space for the County and AMR to resolve their differences.”

During budget negotiations, County Commissioner Sharon Meieran, an emergency room doctor, pressed Vega Pederson to fund a pilot program to test the paramedic-EMT model. Her proposal was rejected after an acrimonious debate between the two that became personal.

In his email, Gonzalez seeks to intervene in negotiations between AMR and the county aimed at fixing response times.

“We had previously understood that the current mediation between Multnomah County and AMR was required by the applicable agreement between the parties,” Gonzalez wrote. “For those reasons, we have been giving the parties space to resolve their differences and hopefully improved the ambulance system, which is in crisis. We learned last week however, that the ‘confidential’ mediation is optional.

“Can we chart a path together on how to bring the right parties to the table?” Gonzalez asks. “We are entering the very dangerous summer season, and going through another quarter without progress on this issue is deeply concerning.”

Until July 1, when the city began its switch to a new form of government, Gonzalez was in charge of Portland Fire & Rescue. Now, like the heads of all other city bureaus, the fire chief reports to the interim city administrator, who in turn reports to the mayor.

Debt-ridden AMR has been under fire for months because of slow response times. AMR is owned by Global Medical Response, a Texas-based company that is in turn owned by Kohlberg Kravis Roberts & Co., a New York investment firm that buys up whole companies using borrowed money. Global Medical Response has $4.5 billion of debt on its balance sheet as a result of the KKR purchase.

In the recent “level zero” incident referred to by Gonzalez, Portland Fire & Rescue responded to a patient who required trauma care, according to an email obtained by WW from Fire Chief Ryan Gillespie to Dr. Jon Jui, medical director at Multnomah County Emergency Medical Services. Level zero means there are no ambulances available to respond to emergencies.

“As a follow-up to our conversation at Commissioner Gonzalez’s office last week, I want to make you aware of an incident that happened this morning,” Gillespie wrote to Jui on July 1. “Engine 21 responded to the call and needed an advanced life support (ALS) ambulance to transport the patient, Gillespie wrote. None was available, he said, but there appear to have been two basic life support, or BLS, ambulances nearby.

“Allegedly there were two BLS ambulances in proximity on low acuity calls, however AMR did not reassign these resources to the trauma system entry,” Gillespie wrote. “Engine 21 was forced to transport the patient because there were no ambulances assigned to the incident. As I have shared multiple times, Multnomah County is responsible for managing ambulance transport service within the City of Portland. The responsiveness and level of service is completely unacceptable to PF&R and to our community. Again, I ask for immediate measures to be taken to positively impact the ambulance service level in the City of Portland. The status quo is endangering our community and our firefighters.”

In a statement, Vega Pederson said she was aware of the emails from Gonzalez and Gillespie.

“BLS ambulances should be utilized for transport in this type of scenario and we have an active protocol to support that approach,” Vega Pederson wrote. “I am very grateful for Portland Fire & Rescue for stepping in to take care of this community member, and I agree with their concern and frustration about AMR’s refusal to reassign a BLS ambulance for transport on this occasion.”

Vega Pederson said she remains committed to the mediation process, despite earlier threats to fine AMR for noncompliance with contractual obligations to respond to 90% of emergency calls within a certain amount of time.

“Our ambulance response and service from AMR continues to miss the mark that I expect and the community deserves,” Vega Pederson wrote. “I continue to work to hold AMR accountable for their contract and to our community, right now through mediation. It is a major focus of my office to resolve this issue.” Confidentiality, she wrote, is “routine and necessary for this type of process.”

On Tuesday, Multhomah County ombudsman Cheryl Taylor is scheduled to brief the board of commissioners, describing a May 3 report she did on tardy ambulance service at the behest of the county auditor. Among her recommendations, according to her presentation, is that the county form a regulatory body called the Emergency Medical Services Advisory Council, which was proposed in 2016 but never created.

Meieran, who has been pressing for changes to the ambulance system for more than a year, says she hope the briefing, combined with pressure from Portland and other cities in Multnomah County, will lead to change.

“There is no excuse for ambulances not arriving when people call 9-1-1,” Meieran said in a statement Sunday. “9-1-1 shouldn’t mean `let’s call for a committee to hire a consultant to plan for a plan.’ 9-1-1 should mean `get me to the ER so I don’t die.’”