Council discusses short-term interlocal with Bexar County ESD 4 for ambulance transport; members press for response standards and billing clarity

Fair Oaks Ranch city officials held a workshop discussion on Feb. 6 to review a draft interlocal agreement (ILA) under which Bexar County Emergency Services District 4 (ESD 4) would assume ambulance transport duties on an interim basis after Acadian Ambulance informed the city it would not renew its transport contract.

Assistant City Manager Scott told the council Acadian’s contract expires April 30 and the city received formal notice of termination in late January. Scott said staff negotiated a draft ILA with ESD 4 that could begin as soon as March 1 and would run through Sept. 30 to align with the city's existing fire/first-response agreement; the ILA would provide continuous 24/7 transport coverage if finalized. "This approach would provide the continuity of care in that interim period while the city evaluates its long term options for both ambulance transport as well as fire and first response," Scott said.

Council members raised several concerns and asked staff to use the full remaining term of the Acadian contract to fully vet a transport agreement rather than rush to a March 1 start. Council Member Laura said the financial and service model for an ILA differs from the city’s fire-first-response ILA and recommended the agreement be modeled on the city’s prior medical transport contract instead of relying primarily on the ESD’s template. She asked for clarity on resident billing and rates, noting that ambulance transport charges are typically billed to the patient or the patient's insurer.

Council members also pressed for clear operational standards in the ILA, including response-time expectations comparable to the city's historical benchmarks. Scott and other council members referenced the city's EMS study showing an Acadian 70th-percentile response time of about 11 minutes as an appropriate benchmark to incorporate. Members asked the draft ILA to specify minimum ambulance staffing and equipment standards (for example, designation and staffing consistent with Texas DSHS mobile intensive care unit standards) and to make the contract's service and equipment expectations explicit.

Division Chief Michelle Brown of ESD 4 explained the district had recently started its own ambulance transport capability on Jan. 1 and said ESD 4 has been increasing staffing and planning to add ambulances. "We're going to continue to add as much as we can on the ambulance side," Brown said, noting ESD 4 was already discussing adding ambulances to increase response capacity.

Council also asked staff to review the liability and insurance limits in the draft agreement; one council member said the $1 million insurance requirement in older contracts may be inadequate in current circumstances and requested staff evaluate raising coverage limits. Members agreed they expected the city's first-responder ILA with ESD 4 to continue and that the transport ILA should be explicit that transport is a separate service, not a consolidation of first response and transport.

Scott said staff will continue negotiations with ESD 4, meet with the district's leadership next week, and expected to return to council for formal approval after the ESD board reviews the draft (the ESD board is scheduled to consider the item Feb. 17). Council indicated a preference to use the remaining Acadian contract term to ensure the transport agreement is properly vetted rather than rush to a March 1 start date.