Board rejects recommended AMR ambulance contract after hours-long public hearing

The Alameda County Board of Supervisors voted on June 17 to reject Alameda County Health’s recommendation to award a six‑year exclusive-operating-area (EOA) ambulance contract to AMR West, following more than five hours of public testimony and detailed questioning by supervisors. The board’s decision came after an extended presentation from county health staff and consultants and dense testimony from labor leaders, firefighters, paramedics, hospital clinicians, community groups and AMR and Falcon (FALC) representatives.

Alameda County Health presented the procurement that began with an RFP issued in January 2024 and was developed after a multi‑year EMS redesign effort. County staff said the RFP prioritized clinical performance, health equity and system sustainability rather than simple response-time metrics; the proposed contract included nurse navigation, expanded behavioral‑health response teams (CAT teams), and financial penalties tied to equity gaps in prehospital care. The county’s five‑member selection committee recommended AMR West as the highest‑scoring bidder after review of proposals, interviews and a third‑party financial review.

Public testimony was sharply divided. Hundreds of callers and dozens of in‑person speakers told the board of lived experience under long ambulance waits, intermittent station coverage in some parts of the county, and concerns about private equity ownership. Labor unions and frontline EMTs and paramedics said workforce protections were diluted compared with the county’s 2017 procurement and argued the incumbent provider (FALC) had stronger local ties and better labor relations. Union representatives and several fire chiefs urged the board to reject the award or rebid. Hospital physicians and some public‑health advocates, by contrast, backed the EOA model and the innovations in the RFP, arguing a single contracted provider would support systemwide data, common protocols and coordinated programs such as nurse navigation.

The county’s Office of Contract Compliance and Reporting (OCCR) reviewed protests filed during the RFP process (including objections from FALC). OCCR reported it found no material errors in the procurement process: the RFP’s scoring rubric was detailed and impartial; questions from bidders were posted and answered; and procedural protest steps were followed. County counsel told the board that while the procurement complied with the posted process, the board could nevertheless reject the staff recommendation, extend current contracts and direct staff on next steps.

After more than six hours of debate and line‑by‑line questions from supervisors on scoring, workforce protections, the nurse‑navigation model and the practical differences between a contracted EOA and an “open” system, the board voted to reject the AMR award. Supervisors who voted against the recommendation cited concerns about continuity of the workforce, the weighting and transparency of evaluation criteria, and the need to examine alternative system designs including an open model anchored by fire‑department partnerships that could access intergovernmental funding streams.

The board directed county staff to return with options and recommendations for next steps — including the feasibility, timeline and potential costs of an open system and interim steps to ensure continuity of 9‑1‑1 ambulance service. Staff said they would present options and a recommended timetable for the board to consider; supervisors signaled they wanted a thorough review but asked that the item return with meaningful analysis in the coming months so the county can avoid service interruptions while a path forward is chosen.

What’s next: staff will prepare recommendations and an implementation timetable for the board’s consideration; the board also discussed the need for any necessary short-term contract extensions to ensure uninterrupted ambulance service until a durable solution is approved.

(At a later point staff posted the full RFP materials and selection documentation on the county website.)