2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1 BEFORE THE … · 12/16/2016 · 2017A-EMS-0006-DHS VOLUME 5 12/16/20161124 1 ALJ SHEDDEN: All right. Are there any 2 other questions or

2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1117

1 BEFORE THE OFFICE OF ADMINISTRATIVE HEARINGS

2 IN THE MATTER OF: )

3 ) Hellsgate Fire District ) No. 2017A-EMS-0006-DHS

4 dba Rim Country Fire and ) Medical Service, ) (EMS No. 4163)

5 ) Applicant. )

6 ____________________________)

7

8 At: Phoenix, Arizona

9 Date: December 16, 2016

10

11

12

13 REPORTER'S TRANSCRIPT OF PROCEEDINGS

14

15 VOLUME 5 (Pages 1117 through 1273)

16

17

18

19 COASH & COASH, INC.

20 Court Reporting, Video & Videoconferencing 1802 N. 7th Street, Phoenix, AZ 85006

21 602-258-1440 [email protected]

22 Prepared By: JODY L. LENSCHOW, RMR, CRR

23 Certified Reporter Certificate No. 50192

24

25

COASH & COASH, INC. 602-258-1440 www.coashandcoash.com Phoenix, AZ

2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1118

1 INDEX TO EXAMINATIONS

2 WITNESS PAGE

3 JOHN VALENTINE

4 CONTINUED DIRECT EXAMINATION BY MS. FICKBOHM 1124 CROSS-EXAMINATION BY MR. RAY 1166

5 CROSS-EXAMINATION BY MR. MEYERSON 1199 REDIRECT EXAMINATION BY MS. FICKBOHM 1226

6

7 GLENN KASPRZYK

8 DIRECT EXAMINATION BY MS. FICKBOHM 1230 CROSS-EXAMINATION BY MR. RAY 1253

9 CROSS-EXAMINATION BY MR. MEYERSON 1261

10

11 INDEX TO EXHIBITS

12 NO. DESCRIPTION OFFERED ADMITTED

13 Exhibit LLA-5a WP Rocket Holdings 1235 1235 Stipulated Proposed

14 Findings of Fact and Conclusions of Law

15 Exhibit LLA-5b WP Rocket Holdings ALJ 1235 1235

16 Decision 1/8/2016

17 Exhibit LLA-9 Arizona Fire Districts 1236 1236 Tax Rates (2014 & 2015)

18 Exhibit LLA-11 6/5/2016 Arizona Daily 1237 1237

19 Dispatch article re Groom Creek Fire

20 District

21 Exhibit LLA-13c Glenn Kasprzyk Resumé 1233 1233

22 Exhibit LLA-18 Banner Contract 1138 1138 Submittal 07-27-2016

23 Exhibit LLA-24 11/14/2016 letter to 1248 1248

24 ADHS from AMR CON 136 Opposing Hellsgate

25


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1119

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 16th day of December,

6 2016.

7 BEFORE: Administrative Law Judge Thomas Shedden

8

9 For the Applicant:

10 THE MEYERSON LAW FIRM, P.L.C. By Mr. Jeffrey Meyerson

11 2555 E. Camelback Road, Suite 140 Phoenix, Arizona 85016


13

14 For the Intervenor:

15 FLETCHER, STRUSE, FICKBOHM & MARVEL, PLC Ms. Ronna L. Fickbohm

16 6750 N. Oracle Road Tucson, Arizona 85704


18

19 For Arizona Department of Health Services, Bureau of Emergency Medical Services and Trauma System:

20 OFFICE OF THE ATTORNEY GENERAL

21 Education and Health Section Mr. Kevin D. Ray

22 Ms. Molly Bonsall Assistant Attorney General

23 1275 W. Washington Street Phoenix, Arizona 85007-2926


25


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1120

1 ALJ SHEDDEN: All right. Good morning.

2 We are on the record in the matter of Hellsgate Fire

3 District dba Rim Country Fire and Medical Service,

4 applicant. This is Docket No. 2017A-EMS-0006-DHS.

5 Today is December 16, 2016. It's about 8:30 a.m. My

6 name is Administrative Law Judge Thomas Shedden. I've

7 been assigned by the Office of Administrative Hearings

8 to preside over this matter.

9 This is our fifth day of hearing, so,

10 once again, I'll just quickly give some reminders and

11 then I'll turn to the parties and see where we stand

12 going forward and whether they have any issues. For

13 our record, where we left off yesterday, Mr. Valentine

14 was our witness, and he is back in the witness chair,

15 no doubt ready to go forward.

16 Again, I've turned on the recording

17 device. Our court reporter is once again present, so

18 we've got to live up to the niceties that go with those

19 two things. I'll remind you the only food or drink

20 allowed in the hearing room is water. If you could get

21 your devices on mute or vibrate or something like that,

22 that would be good as well.

23 I guess the question I have, as a

24 preliminary issue, is to go to you, Ms. Fickbohm, and

25 just see where Life Line stands in terms of


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1121

1 presentation of its evidence, number of additional

2 witnesses, and how long you think it's going to take us

3 to finish up with those witnesses.

4 MS. FICKBOHM: I'm going to call --

5 finish with Mr. Valentine, and then I'm going to call

6 Mr. Kasprzyk. I don't intend to be very long with

7 Mr. Kasprzyk. So I probably have another, probably, no

8 more than an hour with Mr. Valentine, probably less.

9 He looks at me like -- that's sort of a sad look.

10 So I think that there's no reason that

11 we shouldn't be able to finish our part of the case

12 well before lunch, unless counsel for Hellsgate has a

13 lot of questions.

14 ALJ SHEDDEN: All right. And I'll leave

15 it to you to hear from them before any decision or

16 thoughts on any additional evidence from both Hellsgate

17 and the Department as well.

18 With that then, let me ask are there any

19 preliminary issues or anyone with you today that you

20 would like to introduce, all of you, that haven't or

21 hasn't been previously introduced?

22 MS. FICKBOHM: No one to introduce, Your

23 Honor; but if the information is at your fingertips or

24 in your notes in front of you, I would appreciate

25 confirmation of what exhibits were listed yesterday,


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1122

1 because I couldn't confirm that this morning, unless

2 there's a way we can re -- I don't know if you have had

3 time to input that yet.

4 ALJ SHEDDEN: No, I --

5 MS. FICKBOHM: I assumed you hadn't.

6 ALJ SHEDDEN: No, I didn't get that

7 done. What I'll do is, what I can do is just go down

8 my list here and I'll call them out.

9 MS. FICKBOHM: The ones from yesterday

10 is the ones I'm concerned about. You have all the

11 others in, and I already checked all of those; but

12 I just wanted to -- since we're going to finish

13 today, I just wanted to make sure I hadn't missed

14 anything.

15 ALJ SHEDDEN: So looking, at least

16 initially these are all Life Line exhibits. I'm

17 showing 3aa, 3cc, 3dd. Let's see. 3ee, 3ff, 3gg, then

18 3a, 3j, 3k, 3l, 3n, as in Nancy, 3p, 3r, 3u, 3w, as in

19 Wendy, 3x, 3y, 3z, 5c, 13a, 13b, 13e, 13g, 13h, 13k, 20

20 and 27.

21 MS. FICKBOHM: Thank you, Your Honor.

22 I'll check that against my notes at the break and see

23 if there's anything else that I want to ask to be

24 admitted from yesterday.

25 ALJ SHEDDEN: And I'm thinking there


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1123

1 were no Hellsgate yesterday, but let me just verify

2 that.

3 Right, I'm not showing any. And, again,

4 hopefully quickly, on the docket, the electronic docket

5 on the internet, the entire list will be filled in with

6 the dates that any have been admitted or not admitted,

7 not offered or withdrawn, as you can see on the screen

8 there. And what I would suggest is, once that happens,

9 the parties should take a look at that, and if you see

10 any discrepancies or concerns that I haven't gotten it

11 correct, go ahead and file something, a request or

12 stipulation that I got it wrong, whatever the case may

13 be, so...

14 MS. FICKBOHM: Clarifying.

15 ALJ SHEDDEN: No, that's all right.

16 MR. RAY: Just checking one of the --

17 MS. FICKBOHM: Exhibits.

18 MR. RAY: -- exhibits.

19 ALJ SHEDDEN: And does that match with

20 what you had --

21 MS. FICKBOHM: What Mr. Ray's question,

22 I was able to answer for, he was concerned that all the

23 CPR World Challenge results got into evidence, and they

24 were all summarized in the 2016, so I didn't need to do

25 the 2015, 2014, 2013. So we're good.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1124

1 ALJ SHEDDEN: All right. Are there any

2 other questions or issues this morning?

3 No. All right.

4 Correct me if I'm wrong, Mr. Valentine,

5 but you were put under oath or affirmation yesterday?

6 THE WITNESS: I was, sir.

7 ALJ SHEDDEN: Okay. And you understand

8 then you're still under oath or affirmation today?

9 THE WITNESS: I do, sir.

10 ALJ SHEDDEN: All right. Whenever

11 you're ready, go ahead.

12

13 CONTINUED DIRECT EXAMINATION

14 BY MS. FICKBOHM:

15 Q. Good morning, Mr. Valentine.

16 A. Good morning, Ms. Fickbohm.

17 Q. When we broke yesterday, I think that we were

18 talking about how CON 58 has been resourced or how the

19 resourcing might have changed since AMR took -- was

20 able to obtain full control of the CON via the

21 transfer. So just giving you a place mark of where we

22 were.

23 A. Yes.

24 Q. We discussed -- you discussed the addition of

25 an ambulance -- two new ambulances, correct?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1125

1 A. Correct.

2 Q. We already talked about that.

3 So what I want to ask you is -- and I

4 apologize if we went over this. My notes aren't very

5 good at the very end of the day.

6 Did you also eventually add any unit hours?

7 A. We did. We added 40 unit hours to peak times

8 of the week; Tuesday, Wednesday, Thursday, Friday.

9 Q. And how did you figure out what the peak

10 usage of ambulance transport resources was?

11 A. So Mr. Jones, Doug Jones, spoke earlier. We

12 don't throw darts at a dartboard anymore. We use

13 technology to figure out peak times of days of the

14 week, time of day, days of week.

15 So what we did is I had him do an in-depth

16 analysis of Payson's demand over a period of time, you

17 know, once we could get in and get the records. And we

18 saw very clearly, as has been testified to, that there

19 was a number of interfacility transports that were

20 coming out of -- being taken by units out of the

21 valley, out of Maricopa.

22 So we very rapidly, as rapidly as you can,

23 add unit hours. There's a process to go through that.

24 We had to hire for those -- for that position and staff

25 that and get the piece of apparatus in place.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1126

1 Q. And approximately when did all of that come

2 together?

3 A. October 29th.

4 Q. Did you, when you got in and started looking

5 at what was happening in the area as far as resourcing,

6 ever consider adding one or more other suboperation

7 stations?

8 A. We looked at -- to the best of my knowledge,

9 and after talking to Jeff Baker, my operations manager,

10 they've been a one-operation -- or one-station kind of

11 operation for a long time.

12 We wanted to do an evaluation if an

13 additional station in the Payson area would be helpful.

14 Didn't really get to running that deployment model.

15 After seeing what was going on, the fact that we had

16 kind of a frosty environment up there with some of the

17 Districts, we were in the midst of a CON hearing, we

18 didn't think it would look good to go out and get

19 another station.

20 And from another aspect, you know, there's a

21 tremendous amount of resources that's involved in that,

22 in finding the right location, making sure it's zoned

23 correctly to put apparatus there. And there's a

24 financial, sometimes long-term, financial commitment

25 from a lease.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1127

1 So, you know, I'm hoping that once this

2 hearing is over and we're still in that market, working

3 in that market, that we can come back to the table and

4 possibly research another location, another

5 suboperation station, or work with one of the other

6 current providers, one of the current Fire-based

7 providers that have a station, for subleasing

8 opportunities.

9 Q. But would the first step in that involve

10 Mr. Jones' analysis?

11 A. The first step would be Mr. Jones' analysis,

12 yes.

13 Q. Yesterday there was a lot of discussion about

14 interfacility transports coming out of the Banner

15 Payson Hospital, correct?

16 A. Yes, ma'am.

17 Q. Or I say yesterday. The whole week, correct?

18 A. Correct.

19 Q. What did you see once you got into the system

20 and looked at the interfacility transport resourcing

21 for Banner?

22 A. So one of the things that was interesting,

23 we -- through some contracting, we've embedded an AMR

24 employee actually in the Banner transport facility. So

25 that employee actually sits in the transfer facility


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1128

1 and helps facilitate the movement of the Banner

2 patients throughout the global Banner system, so...

3 Q. And when was that employee embedded in the

4 Banner -- and I assume that means they're physically

5 located at the Banner Hospital?

6 A. That's correct. They're in the Banner

7 Transfer Center in the Banner Hospital here in the

8 valley.

9 Q. Oh, I'm sorry. So they're in a -- so the

10 Banner runs its transfers out of a physical location in

11 Phoenix?

12 A. That's correct.

13 Q. And that includes its transfers in the Payson

14 area?


16 Q. And so you have an employee that's there in

17 Phoenix?


19 Q. And when did that change in resourcing take

20 place?

21 A. About six months ago.

22 Q. Okay. And how does that help? How does that

23 work?

24 A. So what that Transfer Center is supposed to

25 do is help coordinate movement of patients amongst the


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1129

1 Banner facilities. A hospital, one of the Banner

2 facilities, would call and say we have to move a

3 patient from XYZ Hospital to XYZ Hospital. It could be

4 from one of the floors. It could be a wait and return.

5 It could be any number of interfacility transports.

6 That comes up on a transfer board in front of

7 a transfer person that's sitting in the Transfer

8 Center. They coordinate that transport. They

9 coordinate the bed assignment. They're able to

10 facilitate that. Instead of a nurse at a receiving

11 facility or a tech doing that, this person does nothing

12 but coordinate that transport.

13 With us being embedded in there, we can see

14 the calls coming up sometimes hours before they're

15 actually ready to be transported, and in some cases

16 days. They have a procedure that's going to be taking

17 place in the valley that's a scheduled assignment.

18 That comes up on the board as an interfacility

19 transport. We can schedule those transports, and

20 scheduled transports for an ambulance company are much

21 easier to take care of, instead of a demand, like they

22 just pick up the phone and call you and say, "We need a

23 transport."

24 Q. So the 368 Phoenix area provider transports

25 that have been being discussed in this hearing, I want


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1130

1 to ask you a few questions about that.

2 Were 100 percent -- do you know whether it's

3 reasonable to suggest that 100 percent of those were

4 for interfacility transports?

5 A. I can't say whether they were a

6 hundred percent interfacility.

7 Q. Would you agree or disagree that the majority

8 would have been for interfacility transports?

9 A. I would agree with that.

10 Q. What other possible usage could that have

11 been for?

12 A. There could have been 911 calls related to

13 that. There could have been a STEMI, stroke or trauma

14 that our local Payson unit took, and we moved a unit up

15 into the Payson area and they got punched out on a 911

16 call. They could have been calls in the very edge of

17 the CON 136 area that Mr. Roeder talked about. So it

18 could have been a 911 call to one of those areas.

19 Q. Along Highway 87?

20 A. Along Highway 87.

21 Q. Would you use an ambulance that's located in

22 Phoenix to respond to a 911 call in Payson from

23 Phoenix?

24 A. I guess you could. I would -- I would use --

25 if all the local resources were completely out in


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1131

1 Payson, I guess you could.

2 Q. What would you do before you did that,

3 though?

4 A. We have a progressive move-up policy or SSM

5 policy. If we get down below two units, then they

6 start a unit from the valley. It's a good jaunt up the

7 hill there, an hour and 30 minutes, so you want to make

8 sure that you move a unit up to cover the area.

9 Q. So if only two ambulances remain not on task

10 in the Payson area, you mentioned your SSM. What's SSM

11 stand for?

12 A. Our system status management plan.

13 Q. And that calls for, at that point in time, if

14 only two ambulances are ready to undertake a task, you

15 do what?

16 A. We move a -- we start an ALS unit from the

17 valley, from Maricopa.

18 Q. Okay. And then that unit, if needed, could

19 respond from wherever it is en route?

20 A. Where it is en route.

21 Q. Okay. Have you been tracking the use of

22 Phoenix area resources over time?

23 A. We have.

24 Q. And have you seen any changes since you put

25 the new resources in the system at the end of October?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1132

1 A. We did. We've seen a marked drop in the

2 number of interfacility transports and usage of the

3 ambulances coming out of Maricopa County.

4 Q. And can you tell us what your November

5 numbers were?

6 A. We used it -- we used Maricopa units eight

7 times in November.

8 Q. There was some suggestion in the presentation

9 of applicant's case-in-chief that it's problematic to

10 use Phoenix resources for interfacility transports

11 because some of them are very time-sensitive. So let's

12 talk about that for a minute.

13 Banner has a time-sensitive -- let's say

14 they've got a STEMI or stroke patient that needs to get

15 out of Banner. They've been stabilized. They need to

16 get out. How is CON 58 going to staff that call?

17 A. Well, first of all, we work with whoever the

18 local medical director is, under his protocols and how

19 that works. The ER physician has the ultimate choice

20 on how that patient's going to be moved. If they're

21 calling for us, we would use our local resource, one of

22 the Payson units, to take a STEMI, stroke or trauma

23 from the Banner Payson facility.

24 Unfortunately, a lot of those patients are

25 moved by helicopter, not unlike all over the state of


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1133

1 Arizona. Lake Havasu City, Prescott, a lot of those

2 patients, those more critical patients or

3 time-sensitive patients, are moved by rotor wing down

4 to the valley.

5 Q. So if you've got a patient in Kingman who's

6 STEMI/time-sensitive, are they going to go via

7 ambulance to Flagstaff, or are they going to get

8 rotor-winged?

9 A. More than likely they'll be rotor-winged into

10 a cath lab. We're pretty lucky. Lake Havasu has a

11 cath lab, so we can urgently transport that patient

12 there. But Prescott, for example, that patient would

13 be flown down to the valley for a time-sensitive, head

14 bleed. There's a number of scenarios why the patient

15 would be moved.

16 Q. If you have information ahead of time that a

17 patient that requires a critical care ambulance needs

18 to be moved into the Phoenix area, how are you going to

19 resource that?

20 A. Well, unfortunately, you know, critical care

21 units with critical care trained nurses are a very

22 expensive process to have in place. We have eight that

23 usually -- we have eight that are deployed, peak

24 deployment, throughout the valley during the day.

25 Those units would have to be pulled from the valley to


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1134

1 come up there.

2 If it was a scheduled event or we got an

3 alert from the facility that, you know, maybe they were

4 under a weather delay, snow -- Payson does get some

5 weather. -- we could strategically relocate a nurse

6 unit at the hospital in the case that they did need to

7 move a critical patient. There are occasions where

8 we've transported patients, critical patients, with the

9 flight crew when their helicopter was unable to fly.

10 Q. Because of weather?

11 A. Because of weather, or any other reason,

12 mechanical issues or -- yeah.

13 Q. During his direct examination, Chief Bathke

14 suggested that the critical care unit availability

15 isn't really that big a deal for him, because he has a

16 paramedic who can perform the same duties.

17 Is that consistent with your knowledge of the

18 requirements for a critical care -- the tasks a

19 critical care nurse can provide?

20 A. So, first of all, in the state of Arizona

21 critical care paramedics are not recognized as a skill

22 greater than a normally certified paramedic. There are

23 some special skills that a paramedic can be trained to,

24 but there is no such thing as a critical care paramedic

25 in the state of Arizona that gives any higher level of


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1135

1 care.

2 Through rule, there is some allowances for

3 special skills; RSI, which is rapid sequence induction,

4 where we intubate a patient using paralytics; a tox

5 medic, which is a toxicology medic, usually held by the

6 Fire Departments to do hazardous materials. There's

7 some other special skills. I believe they can assist

8 with -- they can't do chest tubes. They can assist

9 with chest tubes.

10 Those procedures, a true critical care unit

11 uses or utilizes a nurse. A nurse has a much more

12 broad spectrum of what they can carry, what they can

13 take. Even here in Phoenix, we're challenged

14 sometimes by the fact that we can't take every

15 medication. I think Cardene is a big one that is being

16 used locally that medics are just not capable of using

17 yet.

18 The state, our state, has a very regimented

19 rule on the medications that we can carry. It does not

20 allow a medical director to just say, "Hey, Paramedic

21 X, you can carry this medication because I say so." In

22 some states they do allow that. The medical director

23 can give permission, through special training and

24 special skills, to carry those things. Not in the

25 state of Arizona.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1136

1 And there's a little bit of misconception. I

2 flew with PHI on the helicopter for about two and a

3 half years.

4 Q. PHI?

5 A. PHI, Petroleum Helicopters, Incorporated,

6 better known as Air Evac, the big yellow birds.

7 And it's a very fine line we walk as a

8 paramedic, because we do not have an expanded scope of

9 practice. So we have to work within our guidelines.

10 So long answer to your question, but...

11 Q. Going back to working with Banner on

12 resourcing, in addition to having an AMR employee now

13 embedded in the Phoenix transfer facility, what have

14 you -- what other steps have you taken to make sure

15 that what Banner needs Banner gets?

16 A. So we've done a contract with Banner that

17 talks about response time parameters. The more rural

18 hospitals are obviously a challenge, but we have

19 stipulated that we will respond within timelines on

20 urgent and nonurgent patients.

21 The urgent patients, the most -- more

22 critical of those patients, within 60 minutes; and the

23 more or less life-threatening, within 90 minutes.

24 Q. And has that contract been approved by the

25 Department of Health Services yet?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1137

1 A. I don't believe that contract's been approved

2 by the Bureau at this time.

3 Q. And so is the contract in effect prior to

4 approval by the Department of Health Services?

5 A. Yes, ma'am, it is.

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

7 LLA-18. Is this the contract or is this a -- is this

8 the submission by -- sorry. I want to get down to the

9 second page of it so that you can see what we're

10 talking about.

11 A. Yes, ma'am, it is.

12 Q. I'm just going to run through it real quick

13 for you.

14 Well, you've looked at this ahead of time.

15 A. I've looked at it, yes, ma'am.

16 Q. Okay. So this is the contract you're talking

17 about?

18 A. Yes, ma'am. I believe even in there it

19 stipulates; you can see the response times for Payson

20 several pages back.

21 This put us in line with what AMR Maricopa,

22 our parent -- one of our sister companies, achieved

23 when we went through our initial CON of instituting

24 arrival times for interfacilities. We felt that it was

25 super-important to have that.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1138

1 It gets a little bit more challenging in a

2 rural area, but we definitely wanted to build it into

3 those facilities, because it's just as important.

4 Q. And the first page of this exhibit, is

5 that -- what's that?

6 A. It looks like a letter from Mr. Jaramillo --

7 to Mr. Jaramillo from Ed -- to Mr. Jaramillo from

8 Edward Armijo in regards to the contract.

9 Q. And so this is the submission to DHS for

10 approval?


12 Q. So prior to DHS giving you the green light,

13 when you say it's in effect, are you honoring those

14 response time criteria?

15 A. We are.

16 Q. Even though it hasn't been signed yet?

17 A. Yes, ma'am.

18 MS. FICKBOHM: I would move for

19 admission of LLA-18.

20 MR. MEYERSON: No objection.

21 ALJ SHEDDEN: All right. Life Line 18

22 is admitted.

23 BY MS. FICKBOHM:

24 Q. You spoke about needing to hire someone for

25 this additional 40 unit hours you were going to put


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1139

1 into the system that became effective October 29th, and

2 yesterday you just talked generally about the type of

3 employees that you're able to attract to Payson.

4 Could you tell us what the experience and

5 training level of the employees that CON has in --

6 CON 58 has in place is?

7 A. Sure.

8 And, once again, I've been there for a very

9 short time with the folks, with my ops manager, Jeff

10 Baker, and the local supervisor. Local supervisor's

11 been there for years.

12 The staff there is made up of a group of

13 local people, majority of which live there. They have

14 a longstanding history in Payson. Some of them are

15 retired firefighters from either Payson or surrounding

16 Districts. I have people that have relocated there

17 from the valley that have worked for long periods of

18 time in high-speed 911 systems here in the valley, like

19 Glendale and Mesa, providing, you know, high levels of

20 care, running lots of calls. As they've gotten a

21 little longer in their career, looking for a little

22 slower pace, but do love the medicine that a rural area

23 brings.

24 There is a certain nuance to running medicine

25 and the practice of medicine in a rural area. You rely


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1140

1 a lot on your partner and your fire partners, with some

2 limited resources. So it does draw a certain breed of

3 paramedic to those areas to work, and we have a high --

4 we have a good group of folks up there that have a lot

5 of experience.

6 Q. And is the local folks' familiarity with

7 roads, mapping of the area, does that enter into

8 decisions about who's going to be used to do

9 interfacility transports versus 911 if you want to

10 bring additional resources into the system?

11 A. You would always like to use the local

12 resources, I mean especially when you get in these

13 rural areas. You know, Google Maps is a great thing

14 and all of this technology is a great thing, but it's

15 all based on, you know, your GIS systems that one of

16 the folks testified to. They get a little harder as

17 they get in these rural areas, and the systems don't

18 get updated as much.

19 So the local folks that work there every day

20 and know the roads, and not only know the roads, but

21 know the community and the patients that we run on

22 frequently, it's super-important. So we utilize the

23 local resources as much as we possibly can to do that,

24 and we use the units that come out of Maricopa, if they

25 come up, to go to the hospital and do interfacilities,


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1141

1 if that takes place. Not to say it always does, but

2 that's our goal.

3 Q. And there was some suggestion that

4 interfacility responses involving Maricopa County

5 resources are always coming from Maricopa County, such

6 that there's going to be an extremely long response

7 time. Is that necessarily true?

8 A. No. If we know that we have a series of

9 prescheduled appointments throughout the day or we're

10 going to have a group of interfacility transports, lots

11 of times we'll get clusters of interfacility

12 transports. The local 911 system had a bad auto

13 accident or there's, you know, any number of reasons,

14 and we get a group of interfacility transports that

15 come out. They cluster. So we'll deploy units up

16 there to stand by at the hospital throughout the day to

17 move them. So lots of times there could be zero wait

18 for a unit to pick up a patient out of the hospital.

19 Q. Is it reasonably possible to staff an

20 ambulance transport operation for all eventualities

21 that might occur and still have a sustainable

22 operation?

23 A. Well, I'll go one step farther. It's not

24 feasible to staff an EMS system, including fire,

25 helicopters, ambulance, 100 percent of the time for


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1142

1 every occurrence. It's the reason we have mutual aid,

2 auto-aid. It's the reason we have FEMA. You can't

3 staff for every possible thing that comes up. And the

4 more rural you get, the harder it is to do feasibly and

5 from finances.

6 Q. So you're not talking about this being unique

7 to the CON 58 area?

8 A. I worked for a small Fire District that was

9 pretty much an island for several years. We couldn't

10 staff for every incident that came up. We utilized our

11 mutual aid partners for the big ones. That's what we

12 do.

13 Q. If Hellsgate Fire District gets a CON and

14 does become the only provider in the area, do you

15 believe they're going to be able to fulfill all the

16 needs of the area without using mutual aid or outside

17 resources?

18 A. Based on the model that they put out, no, I

19 don't think they would. They're not unique or have

20 anything that any other agency would have. They would

21 have days where there was needs, especially if they

22 were doing interfacility transports. The time on task

23 that's put on an interfacility is much greater than a

24 911 call.

25 Q. Mr. Jones spoke yesterday about running an


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1143

1 analysis and having the opinion that, in fact, there

2 are more resources in the Payson area than are needed.

3 And he said this is just information, we provide data,

4 and then it's up to local management and operations to

5 determine what to do with that.

6 What have you done with that information?

7 A. His division is just that. They do data, and

8 they run data based on that. You can't factor in all

9 of the nuances of any area. There are some pieces when

10 it gets -- pieces and parts to that, when you get into

11 a rural area, where it just doesn't factor.

12 We have not taken the 60 unit hours out. We

13 actually added the 40 hours in. But based on his data,

14 that's the way it appears. We have to rely on our

15 local eyes and ears to see what's going on, and that's

16 why his team recommends. We have long discussions

17 about his recommendations. We interject our local

18 knowledge that we get, and we come up with a deployment

19 model.

20 It makes it a little easier in a metro

21 setting or a very -- a large dense setting and it's a

22 little bit more accurate. Bless you, Your Honor. But

23 after his analysis, I sat down with my ops manager and

24 Mr. Kasprzyk, and we agreed to add the unit hours and

25 went on about our days.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1144

1 And so far it appears to be working. We will

2 consistently and continue to reevaluate the needs of

3 Payson, of Prescott, Arizona, of Lake Havasu, of all of

4 these. They grow. Things change. They have weekend

5 swells. We have to be able to adapt to all those as

6 the communities grow.

7 Q. So let's talk about mutual aid for a few

8 minutes.

9 Tell me, when you got into the area, what did

10 you determine the mutual aid setup consisted of? How

11 was it -- written contracts, oral agreements,

12 handshakes; like what was -- how was it working?

13 A. I spoke with Mr. Roeder, who had some

14 historical knowledge, and I spoke with Jeff Baker, my

15 ops manager, and it was -- who spoke with the local

16 supervisor; and it was very apparent that there was a

17 longstanding verbal agreement between the CON holders

18 in that area that there was mutual aid that was done.

19 I didn't see anything formally written down,

20 unfortunately. I think it was a very tight-knit group

21 and probably still remains that to this day.

22 Q. Who is the tight-knit group?

23 A. All the agencies up there that respond. In

24 the rural areas, look, you all rely on each other. And

25 I think for a long time there was a lot of handshake


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1145

1 agreements that took place, a lot of verbal, "You cover

2 me, I'll cover you." And I think that still happens to

3 this day.

4 Look, at the end of the day, we're sitting

5 across the table from each other, but when the 911 call

6 goes down, we do what we need to do to take care of the

7 patient. So we mutual aid into Pine-Strawberry, and

8 we'll mutual aid into other areas as needed.

9 Q. And do you also provide mutual aid to your

10 Fire partners, such as Payson?

11 A. We do.

12 Q. So is the setup with oral agreements ideal?

13 A. It's not.

14 Q. So what's your preference?

15 A. My preference is a written mutual aid

16 agreement. It just spells out for both sides.

17 Q. And so do you have any of those in place?

18 A. We do not. We do not.

19 Q. And why not?

20 A. Well, as I've spoken in earlier testimony,

21 once we kind of got in and saw the landscape and

22 understand it, understood that there was some -- we'll

23 call it some frosty conditions going on amongst the

24 Districts and the local ambulance company, we were not

25 in a position to start sending out mutual aid


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1146

1 agreements to be signed.

2 So that's where we -- we kind of figured if

3 we could get through this process and we could get to a

4 better place, that we would readdress that at a later

5 date.

6 Q. When you say "this process," what do you

7 mean?

8 A. Get through the CON process.

9 Q. This hearing?

10 A. This hearing. I'm sorry.

11 Q. And when you talk about frosty, are you

12 referring to the environment related to Hellsgate

13 pursuing a certificate of necessity?

14 A. Yes. It was very apparent that there was --

15 there was talks amongst all the Districts up there to

16 form some kind of a consortium to pretty much take our

17 business, and I didn't feel that was a really good

18 environment for us to go out and ask for mutual aid

19 agreements with.

20 Q. Have you committed to -- has AMR committed to

21 the Department of Health Service that it will, in fact,

22 pursue written mutual aid agreements?

23 A. Yes, we did.

24 Q. And do you take that commitment seriously?

25 A. We do take the commitment seriously. It's a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1147

1 very important part of what we do. I mean when I was

2 with the Fire Department, we spent a year signing all

3 of our County partners up in a mutual aid agreement

4 process. It's an important process of how we do

5 emergency services every day.

6 Q. So in addition to having access to critical

7 care units located in Phoenix, I want to talk to you

8 about other specialty resources that CON 58 has access

9 to.

10 First of all, the Chief said that they have a

11 bariatric cot, which I understand to be gurney. Same

12 thing, cot and gurney, interchangeable?

13 A. Yes, ma'am.

14 Q. Okay. Does CON 58 have a bariatric gurney?

15 A. We do.

16 Q. And for purposes of the record, what does

17 bariatric refer to?

18 A. It's a large -- it's a larger person, usually

19 greater than 350 pounds, and can weigh up to as much as

20 1,500 pounds.

21 Q. And is that purely for patient safety and

22 comfort?

23 A. It's strictly patient safety and comfort.

24 Q. What about the employees?

25 A. It helps greatly with the employees as well.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1148

1 Q. Does CON 58 have access to a bariatric

2 ambulance?

3 A. There's not one in Payson, but they have

4 access to our Phoenix-based bariatric unit, which is

5 equipped with not only the bariatric stretcher, it has

6 a series of ramps, a winch system that we can lower the

7 cot to the lowest point and actually winch the patient.

8 Usually those patients are greater than 750 pounds and

9 with a girth greater than 65 inches.

10 Q. And is that a person that can fit in a

11 regular ambulance?

12 A. No. I guess they could, but not safely.

13 Q. And if you did get them in, would it be safe

14 for an attendant in the back to be working on them?

15 A. No.

16 Q. Tell me what other operation -- Doug Jones

17 talked about technological resources. Dr. Racht talked

18 about clinical resources. Any other operational

19 resources you want to speak to that are available

20 through the American Medical Response organization?

21 A. So I spoke earlier about our MEDS platform.

22 Once we get some data gathered in that, we'll be able

23 to start to share that back with our employees and

24 benchmark them, not only against themselves, but

25 against other like-like operations. We'll be able to


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1149

1 get our information -- our information is downloading

2 into CARES as we speak, but also into the Bureau.

3 It's going to be imperative that some of

4 these processes that we've been talking about, the CPR

5 Challenge, for example, that we engage with our Payson

6 staff and hopefully some of our Fire partners, that

7 we've done here in the valley and around the state.

8 We've partnered with our partners to help get the

9 message out about CPR.

10 We -- you know, through Doug Jones and his

11 group, with the OPAP platform, it allows not only Jeff

12 Baker and the local supervisor the opportunity to see

13 day of the week, time of day literally in 5-minute

14 intervals how they're performing, where they're at,

15 where their call volume is. It gives us, us at a much

16 higher level, 80,000-foot view, the operation over days

17 of the week, 20-week periods, to see where we can trend

18 in volume; do we need to add units, where are potential

19 areas that need improvement.

20 I'm very excited about working with our --

21 you know, our local medical director, who has been

22 extremely busy through this acquisition process,

23 getting out and visiting all of the local operations

24 around and River Medical, Lake Havasu, and in

25 Prescott.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1150

1 Our hope is to get our local medical

2 director, Dr. Stites, up to meet with the medical

3 director in Payson and start to work through some of

4 the pieces that Dr. Racht talked about, some of the

5 clinical things that are available and share those with

6 not only our Payson staff, but the staff in the Fire

7 agencies that are up there.

8 Q. Was it possible for CON 58 to participate in

9 the AMR's CPR World Challenge that took place in May of

10 2016?

11 A. I don't believe so.

12 Q. Is that a -- go ahead. Do you have anything

13 else you want to say?

14 A. No, I don't believe it was. We just weren't

15 in a position to start. It's a very time-consuming

16 process. There's a lot of material that goes out. You

17 don't want to get that -- you don't want to put the

18 material out wrong. So it just wasn't time to roll

19 that process out.

20 Q. And I want to back up just for -- well, no,

21 I'll finish this topic and then I'll back up in a

22 minute.

23 What about 2017, will CON 58 be

24 participating?

25 A. Yeah, that's our hope. Not only CON 58 and


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1151

1 its employees, but we hope that we can get some help

2 from some of our Fire partners up there to get it. I

3 think we all have the same common goal here. It's

4 about patient care.

5 Q. When you were speaking a few minutes earlier

6 about benchmarking against other AMR organizations, are

7 you talking just clinical benchmarking, or are you

8 talking about operational benchmarking also?

9 A. We have the opportunity to benchmark

10 ourselves operationally against other like-like

11 operations. When you're in 42 states, and I forget how

12 many different operations, thousands of operations,

13 there are like-like. I'm not saying they're exactly

14 the same, but they do give us an opportunity to look at

15 what we're doing operationally.

16 And then from a clinical standpoint, we

17 definitely can look across the country how we're doing,

18 and even drill it down as what -- how are we doing in

19 Arizona, based on protocols and certain things.

20 Q. The CARES data that Dr. Racht spoke about,

21 was the software installed at -- was the software in

22 place that would have allowed CON 58 to do this in

23 2016?

24 A. I don't believe so, but I didn't run the

25 operation then, so I would -- I can't really speak --


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1152

1 Q. I'm sorry, 2016.

2 Do you know when the software got installed?

3 A. I don't. It would have come when we did our

4 MEDS. We've been on our MEDS platform, our ePCR

5 platform, for the last two months.

6 Q. And you used that word "MEDS platform"

7 earlier. Just real quickly, what does that -- what is

8 that?

9 A. That's our brand of ePCR. There's

10 ImageTrend. There's MEDS. There's a number of

11 different platforms that provide an electronic patient

12 charting.

13 Q. A way to track clinical data?

14 A. A way to track clinical data and a way to do

15 billing. There's a number of things that come from

16 that.

17 Q. Are you able to access the CARES data now and

18 input it now on that CON 58?

19 A. Yes.

20 Q. And is it your intent to have all of 2017

21 included, as an annual figure to compare?

22 A. Yes. It's very important to Dr. Racht and

23 our organization to make sure that we're sending that

24 data up. It's important to our organization and it's

25 important to our practice, not only, you know, our


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1153

1 paramedics, but fire paramedics around the country.

2 Q. The sort of lag time in getting CON 58 up and

3 running with the CARES data, is that unique to CON 58,

4 or was that experienced at other CONs that were

5 transferred from Rural/Metro to AMR?

6 A. Yeah, that's -- that's exactly correct. It

7 was part of the transition and part of the acquisition

8 when we moved everybody over to our platform.

9 Q. The issue of mobile integrated healthcare was

10 brought up. Have there been any mobile integrated

11 healthcare discussions relating to CON 58's service

12 area?

13 A. No, not directly. We're hoping, through one

14 of our pilot programs with one of the other Banner

15 facilities, that if it becomes successful and

16 sustainable, that it would be a model that we could

17 move over to other operations.

18 Mobile integrated health is a beast. There's

19 a lot of pieces to it, a lot of parts to the spoke. I

20 believe Dr. Racht spoke about it. Community paramedic

21 or paramedics in general are only one piece of a very

22 complicated health system that we don't take lightly.

23 It's going to take some time to get that. We're hoping

24 through our pilot with Banner, it will be something we

25 can share with Banner Payson.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1154

1 Q. I asked the Payson Fire Chief about an

2 incident occurring in early November of this year, an

3 apartment complex, multiunit explosion and fire, and

4 AMR and CON 58's assistance in responding to that.

5 Can you just give us a thumbnail about how

6 fast AMR jumped in to help out on this and what kind of

7 resources were provided?

8 A. I can. I have a document in front of me that

9 kind of just lays it out. But on that date our alarm

10 room, which is our dispatch center, received a call

11 from Payson, their alarm room, stating that they had a

12 large explosion from an apartment complex and pretty

13 much send all the resources you have.

14 Now, I wasn't in the alarm room, so I don't

15 know, but that was the way we got the call. So very

16 rapidly our operations supervisor started gathering our

17 resources and putting together a response to Payson

18 within -- that was within minutes. The on-duty or

19 administrator on call for that day was Jeff Baker.

20 Q. And Jeff lives where?

21 A. Jeff lives down here in Mesa.

22 Q. Okay.

23 A. Jeff was notified. Jeff notified me very

24 rapidly. Jeff went in his personal car and made sure

25 that he gathered all the appropriate resources and was


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1155

1 in communication with our supervisor that was

2 responding to the scene and facilitated moving, I

3 believe, almost 24 pieces of resources and --

4 Q. When you say "pieces of resources" --

5 A. Ambulances. I'm sorry. Ambulances to the

6 Greater Payson area.

7 So along with that was -- there was, I

8 believe, four, four command staff, which would be line

9 supervisors, and then Jeff Baker himself.

10 Q. Was Mr. Kasprzyk notified?

11 A. He was.

12 Q. And why is that?

13 A. Anytime we have an incident of this size and

14 scope, we want to make sure that our local leadership

15 is advised. I won't speak for Mr. Kasprzyk, but the

16 majority of times he'll notify our regional chief

17 operating officer, in case other resources are needed.

18 It's just a part of our alerting system.

19 Q. And after the dust cleared and -- well, so

20 how did you support Banner's needs in connection with

21 this incident?

22 A. So let's back up a little bit. It became

23 more apparent, as they got an incident commander on the

24 scene, that all the resources weren't needed that were

25 being requested. I spoke with the Payson Fire Chief


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1156

1 that night personally. I believe he was the incident

2 commander initially. He said that the resources

3 weren't needed and the balance of that alarm was being

4 canceled or a lot of those resources were being

5 canceled.

6 We did know that there were several patients

7 that were transported to the local facility. I believe

8 there were six or eight folks transported to the local

9 facility. So Jeff made the decision, Jeff Baker made

10 the decision to continue at least seven resources --

11 Q. Seven ambulances?

12 A. -- seven ambulances into the Banner facility.


14 A. More than likely, those patients are going to

15 be moved if they're smoke inhalation, if they're burns,

16 if there were any number of issues. If there was an

17 explosion, there's, you know, trauma involved in those.

18 So we just moved those -- we moved those

19 resources in there to let Banner know that if they

20 needed to move patients rapidly, that they'd be ready.

21 And a lot of the local resources had already been

22 tapped from this incident. It was a large incident for

23 Payson. I believe Hellsgate Fire was there, some of

24 the other Fire agencies were there, I believe,

25 providing support to Payson.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1157

1 So we continued those resources in. We had

2 members of our interfacility team meet with the nursing

3 staff there, make sure that anything they needed.

4 Sometimes in some of these small rural communities, the

5 EMTs and paramedics will go in and assist with moving

6 patients in the ER or help triaging, any number of

7 things, so...

8 Q. And can you tell us, John, what time of day

9 this is all occurring?

10 A. It's all occurring at night, in the evening

11 time, 8:00, 8:00 at night, 8:15, 9:15, 9:17, 9:30.

12 2200 we cleared units out of there. We also sent fire

13 resources up there, as far as fire rescues. Our

14 rescues have --

15 Q. And what's the purpose of that?

16 A. They were -- well, they were close as well.

17 Those fire rescues have a different capability than a

18 medic unit, so they're certified or sworn firefighters,

19 both EMTs and paramedics. So those came out of our

20 Fountain Hills operation.

21 Q. So they could have provided additional

22 firefighting resources?

23 A. They could have.

24 Q. And then when you say "fire rescue," what

25 does that mean?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1158

1 A. That's just an ambulance with a different

2 terminology. A rescue means that they have sworn -- in

3 the metroplex here a rescue is an ambulance with two

4 sworn fire personnel on it, both an EMT and a

5 paramedic. And that piece of -- that resource could be

6 used in different -- differently than an ambulance

7 could be used. Their personnel could be used for part

8 of a fire crew. They could be used for a number of

9 different things.

10 Q. Did you leave any of the fire rescue or

11 ambulance units on the scene of the incident itself

12 after the victims were moved to Banner?

13 A. I believe we dispatched a unit to stand by at

14 the fire to relieve, I believe, one of the fire units.

15 And I'm a little bit speculating here. I believe it

16 was Pine-Strawberry or one of the agencies, or it could

17 have even been Payson's rescue was there doing rehab or

18 standing by, and I think we offered to relieve them so

19 they could help with more fire resources. I'm not sure

20 that that happened or not. I wasn't at the scene.

21 Q. Switching topics, Chief Bathke testified

22 about his first responder units arriving before

23 ambulances at emergency medical scenes. Is that

24 uncommon?

25 A. No.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1159

1 Q. Does Life Line Ambulance ever arrive on scene

2 in CON 58 at large, meaning not just the Hellsgate

3 area, but Payson and outside areas, before the first

4 responders?

5 A. I'm sure they do. That's not uncommon in

6 areas.

7 Q. The issue of joint training with local EMS

8 partners was brought up in the applicant's

9 case-in-chief. Is that something that you're for or

10 against?

11 A. Well, I'm always for training together.


13 A. Look, when you train together, you work

14 together, you know, we always say, you know, you train

15 like you do it real life.

16 Q. And what's been done since you've gotten

17 involved in CON 58 to put any joint training operations

18 together?

19 A. You know, as I testified earlier, we haven't

20 done, really, anything to do any joint training, other

21 than what we do, tape and charts with the local

22 hospital and medical direction.

23 Q. So let me just back you up on that for a

24 minute. When you say "tape and charts," is this the

25 quality review that the Chief talked about?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1160

1 A. Yes.

2 Q. And CON 58 participates in that as well?

3 A. Correct. And, you know, there may be some

4 other continuing education that the hospital puts on

5 that we jointly work with or a paramedic refresher. I

6 don't have knowledge of that.

7 But as far as going out and setting up joint

8 training with the Fire Departments, I haven't -- we

9 haven't pushed for that currently because of the kind

10 of frosty attitude that's going on.

11 Q. What do you want to do; what's ideal and

12 what's your intention?

13 A. Well, my intention is that we're successful

14 in this hearing, we maintain as the primary provider of

15 transportation of sick and injured in CON 58; that we

16 work collaboratively with our Fire partners to continue

17 making the system of Payson stronger and do joint

18 training, disaster training, to truly work as an EMS

19 system in a rural area.

20 Q. Now, you've worked with rural Fire Districts

21 before in a -- before you became in a supervisory

22 capacity for AMR, correct?

23 A. I worked for two very rural Districts.

24 Q. So I would like you to speak -- and you

25 worked for them in a, like, mid-level management


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1161

1 position?

2 A. I worked from a mid-level management position

3 to a division chief position.

4 Q. I would like you to spend a couple minutes

5 talking about the Hellsgate Fire District's proposed

6 operations model. First of all, do you understand what

7 it is?

8 A. I don't.

9 Q. One possible version that I believe the Chief

10 discussed was having a paramedic -- one paramedic on an

11 ambulance, having the fire truck respond as the first

12 responder with at least two employees on it, maybe just

13 two; and then if -- switching resources back and forth

14 between those as needed.

15 Do you think that that's a good operations

16 model?

17 A. I don't. And I believe --

18 Q. And can you tell us -- I'm sorry.

19 A. Let me back up.

20 I believe he stated an EMT or a driver of an

21 apparatus, of the ambulance, and one, two or three

22 personnel on an engine responding to the scene.

23 Q. So what's the problem?

24 A. Well, there's a number of problems with that.

25 One is, there's one person on the ambulance. I'm not


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1162

1 saying you couldn't do that. The problem is, if the --

2 let's say the engine that's responding to that scene

3 gets in an accident and never arrives to meet the

4 ambulance. Now you have an ambulance on scene with an

5 EMT, or maybe a medic, that can do what he or she can

6 do, but definitely not transport a person.

7 The other issue in some of these smaller

8 Districts is, they don't have a ton of resources

9 available to them, even and their mutual aid partners

10 are some distance away.

11 If, in response to this EMS assignment, they

12 get punched out for a structure fire or a car accident,

13 they may have a duty to respond to that. They are a

14 Fire Department. Now, could they rely on their mutual

15 aid partners to handle that call? But more than likely

16 it would limit their response to the initial call. I'm

17 not saying they wouldn't respond. I'm just saying

18 that's one of the scenarios.

19 Q. In the fire prevention and control world,

20 what does the phrase "two in/two out" mean?

21 A. So NFPA came up with a standard.

22 Q. NFPA is?

23 A. National Fire Protection Association came up

24 with standards governing firefighters and Fire

25 Departments, and it is a standard. It is not a law.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1163

1 That anytime we send two firefighters or two personnel

2 into a hazardous environment, that we should have two

3 people on the outside as a rescue, as a rescue measure.

4 Doesn't mean you cannot send two people into a hazard

5 environment if there's a life safety issue. If we saw

6 that there was a -- we knew for a fact that there was a

7 person trapped in that facility, we could send them in

8 without having two in/two out.

9 Q. And when you say "in," you mean into a

10 structure fire?

11 A. Into a structure fire, into a hazardous

12 environment. There are times when you can, can and

13 probably should break that rule. It's the reason we

14 staff fire engines with four people. It's to meet

15 two in/two out. It's to put the right number of

16 resources onto a structure fire.

17 Q. And the two out are for what purpose?

18 A. To rescue the two that go in.

19 Q. Switching topics, CON 136, AMR Maricopa --

20 A. Yes, ma'am.

21 Q. -- overlaps with CON 58 in the northeast

22 corner of Maricopa County that's been excluded by the

23 applicant from their proposed service area, correct?

24 A. Yes, ma'am.

25 Q. Okay. Can you address why that fact doesn't


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1164

1 take care of the concern that if Hellsgate were to

2 replace Life Line, shove it out of the area, basically,

3 about resourcing that area?

4 A. It would be much harder to get to from 136,

5 AMR's CON 136, than it would be their Payson operation.

6 Q. Longer response times?

7 A. Longer response times.

8 Q. John, when -- you've been sitting here

9 addressing Chief Bathke's testimony and Hellsgate's

10 proposed operations. Is it your intent to communicate

11 to the Judge or to the Department of Health Services or

12 anybody else that you think Hellsgate Fire District is

13 a bad Fire District or the Chief's doing a bad job

14 running its Fire District necessary services?

15 A. No, I don't think the Chief's doing a bad

16 job. I think he is doing the best job he can in a Fire

17 District that's small, it's rural. He has done, I

18 think, a good job of maintaining the status quo. I

19 think that the District has done a good job of building

20 up their reserves, which takes, in small Districts,

21 sometimes years to do.

22 I think that the focus of the District needs

23 to stay with the focus of what their intent and

24 probably some of their missions are, is to do the fire

25 service portion of it, and rely on their community


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1165

1 partners from CON 58, Life Line, to provide the

2 transport department of it.

3 I hate to see a small District -- and I've

4 seen it in others, where small Districts try to venture

5 into the ambulance world and provide transport, one,

6 when it's not -- there's no need, and, two, when the

7 current provider's doing what they need to, and then

8 losing money or losing the ability to focus on what,

9 really, their mission is. Their mission is to provide

10 fire service and help support EMS to their community.

11 Q. And do you think that CON 58 is doing its

12 part in the system?

13 A. I think CON is doing its part. I think CON

14 needs to continue to evaluate what it's doing as a good

15 partner, both to Hellsgate and the other Fire Districts

16 and Fire Departments that are there.

17 But there's been nothing put into the record

18 that we haven't done what has been set forth by the

19 Bureau. We've met our response times. We continue to

20 do that. We continue to send data to the Bureau as we

21 are required to. We continue to be a good partner with

22 our hospital that runs our medical direction.

23 We've done the requirements that we need to

24 do as a certificated holder. The only thing that I can

25 see is we're a private provider, and the local entities


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1166

1 are looking to push that private provider out so that

2 they can have control of their Fire-based EMS system.

3 And there isn't a White Sheet out there or a document

4 or any testimony that I've seen today that says

5 Fire-based EMS is better than private sector EMS.

6 Q. Thank you, Mr. Valentine.

7 MS. FICKBOHM: I don't have any other

8 questions at this time.

9 ALJ SHEDDEN: All right. Mr. Ray, any

10 questions from the Bureau?

11 MR. RAY: Yes, Judge. Thank you.

12

13 CROSS-EXAMINATION

14 BY MR. RAY:

15 Q. Good morning John.

16 A. Good morning, Mr. Ray.

17 Q. And I'm afraid some of what I'm going to ask

18 you Ms. Fickbohm has covered, but my inability to keep

19 up in note-taking will prove my downfall.

20 So what I want to focus on, John, is backing

21 up into the operation of CON 58 when AMR first got

22 involved or bought a -- entered into the stock purchase

23 agreement with Rural/Metro, okay?

24 A. Okay.

25 Q. And really what I want to do is try to


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1167

1 provide a timeline in a chronological order that will

2 be easier to refer to in the record, okay?

3 A. Okay.

4 Q. So I think your testimony is that AMR's stock

5 purchase agreement took place in October of 2015?

6 A. Correct.

7 Q. Prior to that time, Rural/Metro controlled

8 CON 58; is that correct?

9 A. That is correct.

10 Q. And I think your testimony is, that until the

11 Department or the Director approved the transfer of the

12 CON from Rural/Metro to AMR, it was a situation where

13 you had AMR personnel, management personnel, in CON 58,

14 but your focus was maintaining status quo until the

15 Department issued a decision?


17 Q. Okay. And that decision occurred in late

18 January 2016?

19 A. I believe January 26th, correct.

20 Q. Okay. So when AMR executed the stock

21 purchase agreement and arrived on the scene in CON 58

22 in October of 2015, what was the ambulance resource and

23 staffing availability at that time that Rural/Metro had

24 in place?

25 A. So I didn't really get on the ground, because


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1168

1 we were in this very unique period of time where it was

2 status quo. So there was really no local AMR

3 management embedded in Payson. Those were still all

4 Rural/Metro folks.

5 But when we arrived on scene, it is no

6 surprise that Rural/Metro was a distressed company that

7 had come out of bankruptcy, but was a distressed

8 company. They had -- their staffing and their

9 leadership had done the very best they could to

10 maintain good working relationships and good equipment

11 and all of those pieces.

12 I was happy to find that they had maintained

13 response times and had done the things needed to meet

14 the Bureau's requirements and the requirements of

15 CON 58.

16 Q. Okay. So I think there has been testimony in

17 the applicant's case-in-chief about three ambulances

18 being available in the Payson CON 58 service area, and

19 one of the advantages that Hellsgate's application

20 brought was an additional ambulance. You've sat

21 through the hearing. Do you recall that testimony?

22 A. I do.

23 Q. Okay. So how many ambulances were in place

24 in October of 2015?

25 A. They had staffed -- the schedule was staffed


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1169

1 for three units 24 hours a day, 7 days a week.

2 Q. Okay. So they had three 24-hour units

3 available?

4 A. I will not tell you that they 100 percent of

5 the time staffed all those. I wasn't -- I don't have

6 knowledge of that going backwards.

7 Q. Okay.

8 A. That's what they -- that's what the

9 schedule -- the schedule that was presented to me was

10 three 24-hour units, and I know that those were staffed

11 paramedic level. I know that there was times where

12 there was intermediates that ran on those units, so

13 there may have been two paramedic units and an

14 intermediate unit. That was my understanding, but I

15 wasn't there.

16 Q. Fair enough.

17 And that's the status of the Rural/Metro

18 resources in that area when you or AMR became

19 affiliated with Rural/Metro in October of 2015?

20 A. Yes, sir.

21 Q. Okay. So moving forward from that point in

22 time, what additional -- give me some time frames and

23 when AMR increased the number of ambulances and

24 personnel. Because I think at one point you testified

25 that currently there's sometimes between five and seven


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1170

1 ambulances in the CON 58 area that are affiliated to

2 Payson?

3 A. That's correct. Those are physical

4 ambulances.

5 Q. Okay.

6 A. Those aren't staffed.

7 Q. So --

8 A. We don't have five to seven ambulances

9 staffed in Payson.

10 Q. Okay. So beginning in October of 2015, bring

11 us current on from a timeline and an explanation

12 perspective --

13 A. Sure.

14 Q. -- additional ambulances, staffing,

15 et cetera.

16 A. So as I spoke of earlier, there was the three

17 24-hour units. They were most of the time staffed

18 paramedic level, at least two of those, and there might

19 have been times, either through sick calls or any other

20 reason, that there was a unit that was an intermediate

21 level. Still an ALS unit, but not a paramedic unit.

22 I recognized very quickly that the current

23 manager over that operation in March was not the right

24 person to be managing the 911 service. Mr. Wayne

25 Clonts works in our IFT division. He is a registered


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1171

1 nurse and has a tremendous amount of knowledge about

2 the nursing industry and critical care and runs our

3 interfacility side. I very rapidly removed Mr. Clonts

4 from that operation and embedded Mr. Baker.

5 Mr. Baker has a history, a long history, of

6 working in 911 systems here in the valley, in

7 high-speed 911 systems. He's a certified paramedic and

8 works alongside several of my fire partners here in the

9 valley on our contracts. So we very quickly did that.

10 I tasked -- go ahead.

11 Q. Okay. And that's a lot of good information.

12 So Wayne Clonts was the Rural/Metro manager

13 on scene?

14 A. Correct.

15 Q. In Payson?

16 A. He wasn't in -- physically in Payson. He was

17 actually located here in the valley.

18 Q. Okay.

19 A. In Phoenix. And Jeff is located here.

20 Q. Sure.

21 A. Our local management team that is there has

22 been Danny Brumbaugh. He has been in that market for a

23 great number of years. I don't know exactly the number

24 of years. He worked alongside Charlie Smith and ran

25 the operation or worked with Charlie for many years in


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1172

1 that operation, has a great deal of local knowledge in

2 that area. But we felt that he needed support from a

3 different leader that had a more vast knowledge of the

4 911 systems.

5 Q. Okay. So what that suggests to me is there

6 were some difficulties in the 911 -- in Rural/Metro's

7 former 911 capabilities that were in existence; is that

8 fair?

9 A. I wouldn't say there was difficulties in 911.

10 I think there was difficulties in the leadership that

11 was overseeing that 911 operation.

12 Understanding that the interfacility market

13 here in Maricopa is a very busy and time-consuming one,

14 that the necessary time that was needed to give to the

15 Payson supervisor and its staff needed to come from

16 somebody that had more 911 knowledge.

17 Q. Okay. What was -- was there a triggering

18 event that led you to make that decision in March?

19 A. There wasn't a triggering event. I just -- I

20 very quickly noticed that that current leader was not a

21 person that had that kind of rural knowledge.

22 Mr. Baker comes from a rural area in Texas

23 and has worked in that kind of environment and just

24 felt it was -- they just -- they needed a change.

25 Q. Okay. So -- okay, what kind of oversight or


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1173

1 review or evaluation process was put in place in late

2 January of 2016 once the transfer was approved? What

3 did AMR do with respect to review, evaluation, and

4 oversight of the CON 58 market?

5 A. So I tasked Mr. Baker with doing a complete

6 review of deployment, staffing, scheduling, business

7 development needs. I reached out to our business

8 development, our marketing team, Paul Cloward and his

9 team, to work with the Banner facility to start to find

10 out some of the -- mainly the jinx in the armor that

11 would happen, what was happening there, as one of our

12 partners.

13 We tried to reach out to some of our fire

14 partners, both myself and Glenn Kasprzyk. That didn't

15 go so well, little of it. We got some input from

16 Mr. Staub in Payson. But it was Jeff's task to really

17 dig into where we were at in Payson, bring me back a

18 report on what's going on.

19 Q. Okay. Did that occur in late January, in

20 February, or in March?

21 A. Didn't really start happening until March.

22 Q. Okay.

23 A. Although we took ownership in January,

24 remember we took ownership of 13 CONs. Arizona is a

25 huge market, a lot of work to do. So we started


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1174

1 working our way through the process, and it took some

2 time.

3 Q. Okay. So let's back up and talk about the

4 three 24-hour units that Rural/Metro had in place in

5 October.

6 How were interfacility runs being handled

7 between October and March of 2016?

8 A. It's my understanding that there was some

9 staffing challenges in the Payson market. It's my

10 understanding that those interfacilities were being

11 handled by local resources to the point where they

12 could get -- if they dropped below the three units, so

13 if they had only two units available, they would save

14 those two units to run 911 calls, unless there was an

15 emergent and immediate interfacility need, STEMI,

16 stroke or trauma, and then they would dispatch units

17 from the valley to come up, usually one a day, to kind

18 of stand by and run interfacility transports down to

19 the valley.

20 Q. Okay. So we have three Rural/Metro

21 ambulances in October of 2015 when the stock purchase

22 agreement goes through. From that point until March,

23 when you began to actively manage the Payson area, your

24 understanding is those three units -- of those three

25 units in Payson, one would be utilized for


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1175

1 interfacility calls if those needs -- if those calls

2 came in. But once that one of three cars was utilized

3 for interfacility, CON 58 would rely on other ambulance

4 units moving up from the valley to take other

5 interfacility calls?

6 A. Yes. And they could have already been moved

7 up. There may have been prescheduled interfacilities.

8 There could have been any number. They could have

9 already moved a unit up for the day. If there was a

10 staffing shortage for the day, they would have moved a

11 unit up to already be placed in the Payson market to

12 respond to calls.

13 Q. Okay. Was there an additional reserve

14 ambulance during the time between October of 2015 and

15 March 2016, when AMR began actively managing that area;

16 was there a reserve ambulance in place in Payson in

17 case one of those three units went down?

18 A. They do have reserve units there in case one

19 of the units go down. I believe they have two or

20 three, depending on time of day and day of week, if,

21 like I said earlier, as I testified about units going

22 down for routine or longer, but they always have two or

23 three units in the market to -- look, even brand-new

24 units break down, unfortunately. So you have to always

25 have backup and reserve units.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1176

1 Q. So --

2 A. They also -- I'm sorry.

3 Q. So you did have?

4 A. Yes. Yes.

5 They also -- once again, pretty tight-knit

6 group up there. Even the night of, you know, the

7 Payson apartment fire, we had employees that came back

8 to the station and called in folks to staff another

9 unit. That -- I don't want to say that happens

10 commonly, but it does happen. So there is reserve

11 units there.

12 Q. But the fire you're talking about was a year

13 later, in November of '16.

14 A. Correct.

15 Q. Okay. So my question was really focused on

16 October '15 through March of '16. You've testified

17 there were three full-time ambulances staffed that were

18 available. And am I correct that you're also saying

19 there was at least one, and maybe more, reserve

20 ambulances in the Payson area that could be utilized if

21 one of those three mainline ambulances went down?

22 A. Yes.

23 Q. Okay. So let's move forward to March again.

24 So Mr. Baker, you've tapped Mr. Baker to come in and

25 analyze the needs and report back. Pick up there,


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1177

1 John, and move forward.

2 A. Okay.

3 Q. Tell me what the conclusions were, when those

4 conclusions were reached, and when additional staffing

5 and resources were entered, were introduced into the

6 Payson market.

7 A. So in March Jeff started to do the deep dive

8 into the operations of Payson. He very rapidly deduced

9 that we had a staffing shortage, that we needed to hire

10 staffing. I will tell you that's nothing unique across

11 the country. So we were already in an active position

12 of starting to staff up the Rural/Metro agencies across

13 Arizona.

14 So we started to look at staffing probably

15 the first part of April and started actively recruiting

16 for additional staff in Payson. We wanted to make sure

17 that by -- you know, as quickly as we possibly could,

18 that we could staff all three units with paramedics.

19 It's very important in a rural area. That we utilize

20 the intermediates as drivers, is the best way to do

21 that. That was probably March, April.

22 I would say by the time we got them through

23 training and up to date, March, April -- probably late

24 May, June we became fully staffed. I don't know the

25 exact times, but in June those three units were fully


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1178

1 staffed paramedic level.

2 We knew very rapidly they needed a refresh --

3 as soon as March, they needed a refresh on some of

4 their ambulances. So I made sure that that was put on

5 the list for the Arizona 100. Commonly what we call

6 the Arizona 100 is that the 100 ambulances that we

7 committed in our hearing in Maricopa to refresh the

8 Rural/Metro fleet. Not just here in Maricopa. We've

9 refreshed across the Arizona market. So they were put

10 on the list for those very quickly in March.

11 Some of the other equipment needs we saw

12 very quickly were their cardiac monitors, their

13 Lifepaks, were very old and needed some refreshing. We

14 did not build that into the capital needs for that

15 year, but we were able to, through the strength and

16 size of the company, get cardiac devices from another

17 operation that are refurbished and were almost

18 brand-new. So we moved in brand-new cardiac devices

19 probably around the same time, June, July, August, in

20 that time frame.

21 During that period I realized pretty quickly

22 that the deployment model that was currently in place

23 of, you know, moving these Maricopa units up needed to

24 be looked at and we needed to look at going forward

25 with hiring additional staff in Payson.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1179

1 In the midst of all of that, we went through

2 a labor organization, so they were unionized. So that

3 makes things a little bit more complicated and a little

4 bit more drawn out to do staffing models and how we do

5 that, so we have to negotiate with the union. So that

6 didn't get in place until October 29th. After hiring,

7 training, running them through all their preceptorship,

8 that went into place on October 29.

9 And then it's been just a constant evaluation

10 from there going forward. Part of it -- part of it's

11 been a rebranding of the operation. We haven't

12 completed the complete rebranding of the operation,

13 which includes uniforms. And the reason for that is,

14 once again, uniforms are a negotiable item through our

15 labor, our labor group. So we've had to meet and

16 confer over uniforms, types, styles, colors and those

17 things. So that's been a little bit of a challenge,

18 but they are in new uniforms as we speak. There may

19 still be a couple of outliers out there, but they're in

20 the new branded uniforms.

21 And we also noticed in March, and it

22 took us March, April, May, June, July -- in September

23 we, from a national perspective, rolled the Rural/Metro

24 Corporation over into our TeleStaff, which is our

25 scheduling platform, and it took us a -- that takes a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1180

1 little bit more time to do that.

2 And then the last is the MEDS platform

3 or our ePCR platform a couple of months ago. We

4 understand -- we understood very quickly in March that

5 they had challenges from a charting perspective. We

6 believed that they were doing a good job on what they

7 had, but we felt there was some room for improvements

8 on their charting platform.

9 Q. So when did you put a -- put the peak time

10 ambulance in play?

11 A. October 29th of this year.

12 Q. Okay. So you increased the three 24-hour

13 ambulances by adding a fourth part-time unit; is that a

14 fair way to say it?

15 A. It is a fourth full-time/40-hour-a-week unit,

16 what we call a peak time car. 40 hours a week is a

17 full-time schedule for an ambulance employee. So it's

18 not a 24-hour-a-day/7-day-a-week, but what we consider

19 a full-time peak-hour car.

20 Q. Okay. So what are the hours that that fourth

21 car is operating?

22 A. That unit is up from 10:00 in the morning

23 until 10:00 at night Tuesday, Wednesday, Thursday,

24 Friday, to handle peak time calls. I believe some of

25 the testimony with Mr. Jones is what's the peak time


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1181

1 for 911. Well, there isn't very many 911 systems out

2 there that doesn't have a peak deployment between 10:00

3 in the morning and, 11:00, 12:00 at night.

4 Q. And I did hear that testimony. What about

5 the Chief's testimony that Payson is a weekend and

6 seasonal draw as well? So you have folks from the

7 valley going up on the weekends to get out of the heat,

8 expanding the population during the summer. How does

9 that schedule for your fourth ambulance address those

10 needs?

11 A. It doesn't address those needs. But what

12 does address those needs is we have the ability to flex

13 a unit up for special events, such as the large rodeo

14 that takes place. If there is a need that the

15 operations manager feels is important, there's a

16 special event or a certain surge in population, then he

17 has the ability to either staff up units from one of

18 our reserve units. We'll call employees back as

19 reserves. They can come back and work shifts. We

20 utilize our part-time people to increase our staffing

21 model if it's needed on the weekends.

22 We manage -- we monitor that traffic. You

23 know, I work and have worked in a very large

24 recreational area for a long period of time on the

25 Colorado River in Lake Havasu. Although we see a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1182

1 swell, a large swell in population, we don't --

2 unless it's an absolutely huge, crazy weekend,

3 4th of July or Memorial Day, don't see a tremendous

4 growth in the number of 911 calls we receive. You

5 may get a little on those larger weekends, obviously,

6 from the crowd. But the normal day-to-day weekends

7 that take place, we don't see a huge swell from call

8 volume.

9 Q. Okay. Fair enough. I want to talk for a

10 minute about --

11 ALJ SHEDDEN: Well, let me jump in,

12 Mr. Ray. We're at about an hour and a half. Is this a

13 good opportunity for a break --

14 MR. RAY: Sure.

15 ALJ SHEDDEN: -- or do you think you'll

16 wrap up shortly?

17 MR. RAY: I've probably got 10 or 15

18 minutes, so...

19 ALJ SHEDDEN: All right. Why don't we

20 take a break then. We're at 10:01. We'll meet back up

21 at about 10:16, in 15 minutes.

22 (A recess was taken.)

23 ALJ SHEDDEN: All right. We're back,

24 ready whenever you are, Mr. Ray.

25 MR. RAY: Thank you, Judge.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1183

1 BY MR. RAY:

2 Q. All right, John, I wanted to talk a little

3 bit about the term you've described as a frosty

4 relationship with the Chiefs.

5 Was that evident as far back as October of

6 2015?

7 A. I didn't have knowledge of it, really, then.

8 Q. When did you first gain awareness of that?

9 A. Let me back up. I guess I had some knowledge

10 from the local operation that there was concerns about

11 CON talks and CONs being submitted. And I don't

12 remember the date, but myself and Mr. Kasprzyk had a

13 meeting with Chief Staub. John Karolzak, one of our

14 other regional directors was there. Kind of really to

15 introduce me to Chief Staub. And he -- by then we had

16 had word that there was almost a collaboration or

17 consolidation of some of the Districts going on at that

18 point. So from that point forward. And I don't know

19 the exact date. I could go back through my calendar.

20 In October, November or somewhere in there, maybe even

21 December.

22 Q. Okay. Let me see if we can put some meat on

23 that.

24 A. Sorry.

25 Q. No, no, you're fine.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1184

1 So we know the application was filed in late

2 December two thousand --

3 A. December 23rd.

4 Q. Yes, December 23rd, 2015, correct?

5 A. Yes. Correct.

6 Q. Okay. Would your meeting that you're talking

7 about have occurred before that date?

8 A. After that date.

9 Q. Okay. It would have been after

10 December 23rd, 2015?

11 A. Yes.

12 Q. Okay. Did you or any of your employees that

13 you supervised reach out to the Fire Chiefs -- and I'm

14 using that term collectively. -- in the area between

15 the October stock purchase date and the first time you

16 met with Chief Staub?

17 A. Not to my knowledge. I know that there was

18 ongoing dialogue either at the Chiefs meeting that we

19 go to monthly -- there's a monthly Chiefs meeting that

20 our local supervisor goes to, Danny Brumbaugh and some

21 of the Chiefs. He quickly relayed that, to me, had

22 become a little contentious at times, for a number of

23 reasons.

24 Q. Okay. And when would -- when did that

25 communication about a contentious --


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1185

1 A. I probably was notified of that around March,

2 somewhere in that area, when we really started digging

3 into what was going on up there.

4 Q. Okay. So if we back up and look at the

5 filing date of the application being December 23rd,

6 2015, you're not aware of any communications from your

7 level, management level or above, between AMR and any

8 of the Fire Chiefs in the region about a frosty

9 relationship?

10 A. Not to my knowledge, no.

11 Q. So if we use, again, the December 23rd, 2015

12 time frame, when did AMR first hear about the filed CON

13 application?

14 A. I've got to tell you, I really don't remember

15 exactly when we heard about it. I just -- off the top

16 of my head, I can't.

17 Q. Okay. Would you assume it was relatively

18 soon after that?

19 A. Not necessarily. They probably didn't go

20 public with it. And after hearing some of the

21 testimony that went on here, that there was several

22 members of the Districts involved, basically the whole

23 Payson Fire group, I'm not sure that they went public

24 with that information right off the bat. I don't know,

25 though.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1186

1 Q. Okay. Fair enough.

2 So if we use the December 23rd time frame and

3 move it forward to March, when -- when -- so if we --

4 So in the time frame between December 23rd

5 and March, you and Mr. Kasprzyk and Mr. -- who?

6 A. Karolzak.

7 Q. Karolzak, thank you.

8 A. Yes.

9 Q. -- met with Chief Staub, can you give me a

10 time frame in that three-month period of time?

11 A. I really can't. I --

12 Q. Okay. Do you think it -- okay.

13 You don't know whether that occurred prior to

14 you getting Mr. Baker involved in kind of a deep dive

15 into the CON 58 operations?

16 A. The intention of the meeting -- so let me

17 tell you what the intention of the meeting was; is to,

18 one, introduce myself to Chief Staub. I had met him

19 before at some other events, but really wanted to

20 introduce him as the new leader and kind of talk him

21 through some of the new changes that were coming up

22 with the integration, the purchase, the branding,

23 because there had been some talk about what that was

24 going to look like, and then a little bit of our

25 organizational structure.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1187

1 And then, really, I wanted to glean from

2 Mr. Staub -- because it was apparent to me that

3 Mr. Staub has a great deal of knowledge of the area, so

4 I could glean some information on where, maybe, some of

5 our issues were as my analysis of the area.

6 I know it was a nice day, it was summer-ish,

7 so probably sometime after March, in that time, April.

8 Q. And I'm sorry if I've asked this already, but

9 to your knowledge, are you aware of any attempts to

10 reach out to any of those Rim Country Fire Chiefs in

11 January or February by AMR?

12 A. I'm not sure of the exact date. I believe

13 Mr. Kasprzyk will testify to some correspondence he

14 attempted and we attempted to have with the Fire Chief

15 from Hellsgate, but I don't have that date in front of

16 me.

17 Q. Okay.

18 A. And other than -- and other than Mr. Bathke

19 and Chief Staub, those were the only two Fire Chiefs

20 that we attempted to have any correspondence with.

21 Q. Okay. So do you have a general time frame of

22 when you or Mr. Kasprzyk reached out to Chief Bathke;

23 and was it one time, multiple times?

24 A. So I'm going to say September. It's a

25 complete guess. I believe Mr. Kasprzyk has the exact


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1188

1 dates, an e-mail chain that took place. There was a

2 phone call made. We set up a meeting. I believe the

3 meeting was canceled and rescheduled. I don't have all

4 of the details. I would really rather refer to

5 Mr. Kasprzyk with more specific timeline of it and the

6 correspondence that took place.

7 Q. Okay. And do you have any knowledge of

8 whether Mr. Baker ever reached out to either Chief

9 Staub or Chief Bathke for -- to discuss the

10 relationship issue?

11 A. I don't believe so. Mr. Baker started going

12 to and attending the Chiefs meetings that are held up

13 there once a month. I'm not sure that he made every

14 one of them, but I know that he started to go to those

15 meetings, along with our local supervision, to try to

16 get a feeling and a temperature of what was going on.

17 Q. Okay. Were you contacted by any of the Fire

18 Chiefs directly to talk about any deterioration in the

19 relationships up there?

20 A. No. I think all of the correspondence came

21 from us initiating those conversations. I'm not sure

22 if there was correspondence. I think there was some

23 testimony by Mr. Staub that he reached out to one of

24 our operations folks to try to arrange a meeting, but

25 that was well before AMR was involved with the


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1189

1 marketplace.

2 Q. Okay. All right. One more question on this

3 topic. I've written down that your testimony was that

4 you hadn't pushed and you didn't push for joint

5 training with your fire partners until, and just -- A,

6 due to the frosty relationship and, B, until this CON

7 hearing process is resolved. Is that accurate?

8 A. That's an accurate statement. We --

9 Q. Okay. Have --

10 A. Could I elaborate just a little bit?

11 Q. Sure.

12 A. I wouldn't not allow or help participate in

13 something that came up.

14 Q. Yes. So, and that was probably a poor

15 question.

16 Did you or any of your other managers

17 initiate any overtures to the fire partners, the Fire

18 Chief group, to participate in joint training outside

19 of what you've already testified to?

20 A. Not to my knowledge, no.

21 Q. Do you -- are you aware of any communication

22 from the Fire Chief group to AMR requesting the

23 participation in joint training activities outside of

24 the tape and chart or hospital-run education

25 opportunities?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1190

1 A. I'm not. I'm not aware of that. I asked

2 Mr. Baker last night about that exact question, and he

3 wasn't aware of any joint training that we've been

4 requested to be present at outside of the normal tape

5 and charts.

6 Q. Okay.

7 ALJ SHEDDEN: That's it?

8 MR. RAY: No.

9 ALJ SHEDDEN: No. Sorry.

10 MR. RAY: No. Judge, every time I try

11 to estimate whether my -- my time frame, I'm always

12 underestimating. So maybe I ought to stop doing that.

13 So my 10 to 15 minutes is, I apologize, a little longer

14 than that.

15 BY MR. RAY:

16 Q. John, I want to ask you one question relating

17 to -- or the next topic of questions relating to

18 Rural/Metro's relationship with the Banner Payson

19 facility when you -- when the stock purchase

20 transaction occurred in October. And I want you to

21 take that, and what I want to talk about is, if we

22 start at that period of time and move to the present

23 time, I want to explore that relationship.

24 So starting in October of 2015, were you

25 aware of any relationship issues between the Banner


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1191

1 Hospital facility in Payson and the CON 58 operation?

2 A. I was not aware of any.

3 Q. Okay. Have you been made aware of any

4 relationship issues between Banner Payson and AMR from

5 the period of time in January through present?

6 A. So let me back up a little bit. In March

7 part of the evaluation process that I testified to was

8 to have our business development group research that

9 exact piece. I think there was some challenges from

10 the Rural/Metro organization on their interaction with

11 the Banner Payson facility.

12 In understanding that, once we got into

13 the -- one, the Banner Transfer Center and then started

14 interacting with the Banner -- local Banner staff, we

15 have a monthly business development call with Mike

16 Ward, who is their -- I believe he runs the emergency

17 room. He's a nurse director there that runs the

18 emergency room. Mr. Baker, I have been on those calls.

19 Our business development folks worked very closely on

20 that.

21 There were some challenges, no doubt about

22 it; and we have worked very hard over the course of the

23 last several months, specifically from March forward,

24 to mend those relationships. One of those being, you

25 know, interacting these response time guidelines and


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1192

1 arrival times. I don't want to call them response

2 times, but arrival times. And then continuing every

3 month to manage anything that comes up.

4 Look, we're in the emergency world. Kind of

5 things and challenges do come up, and we do respond to

6 those very rapidly, and we have good dialogue with the

7 hospital. It's my understanding currently that we have

8 a very good relationship, a very strong relationship

9 with the Banner Payson Hospital, and we are continuing

10 to move forward with that.

11 Q. Okay. Can you give some details about what

12 you learned in March relating to the Rural/Metro issues

13 with Banner Payson?

14 A. I believe they had some staffing challenges.

15 And when you run a blended market -- and when I mean

16 blended market, you run a 911 and interfacility market

17 as a single joint operation and operation deployment

18 plan. -- that you constantly are tugged to provide

19 services both directions. You want to make sure you

20 take care of your 911 partners and respond to calls

21 appropriately and meet your response times, but you

22 also have an obligation to provide service to the

23 hospital.

24 And with a distressed company that was having

25 staffing challenges, I believe that there was some


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1193

1 delays that the hospital faced and some -- probably

2 some big concerns for that hospital.

3 Q. And the delays would have been waiting times

4 to move interfacility patients down to Phoenix?


6 Q. Okay. Were there any issues related to 911?

7 A. Not -- Chief Staub relayed to me that there

8 was some concerns, prior to AMR taking ownership of

9 that operation, that staffing was a challenge; that

10 they had on occasion had to use their own rescue unit

11 to respond to calls. He didn't elaborate on whether

12 they transported or not. He did say that they had

13 responded to it and there was some challenges.

14 And from what Mr. Staub relayed to us, that

15 there was some challenges or some thoughts that -- on

16 the staffing model not always having a paramedic on

17 every ambulance. The use of the intermediate provider,

18 better known as an IEMT, intermediate emergency medical

19 technician, was a little concerning. But that was my

20 understanding at the time.

21 Q. Okay. And I think your counsel introduced

22 the un -- well, the contract, I think it's --

23 MS. FICKBOHM: It's up in front of us.

24 BY MR. RAY:

25 Q. This one right here.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1194

1 A. LLA.

2 Q. It is Life Line 18 for nonemergency

3 transports.

4 A. Yes, sir.

5 Q. We're talking about -- are we talking about

6 response times when we're talking about interfacility

7 transports?

8 A. We're talking about arrival times.


10 A. Response times are usually to the scene, to a

11 person. Very difficult to get a response time to a

12 facility. They could be multistory. They could be --

13 you could take 15 or 20 minutes to get to a patient's

14 bedside once you get to the facility.

15 Now, Banner Payson isn't as large as some of

16 the metropolitan hospitals, but I think the focus there

17 is that we get to the facility in that time and then

18 help facilitate a better turnaround on patients being

19 moved.

20 Q. And CON 136 has certificated arrival times,

21 correct?


23 Q. Okay. And the reason for using the

24 terminology "arrival times" is to not confuse the

25 concept of response times, which are triggered by rule


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1195

1 as being generated from a tone-out on an emergency

2 dispatch; is that correct?


4 Q. And was the agreement submitted to the Bureau

5 back in July of 2016, was this to address some of the

6 concerns of Banner Payson that there had been longer

7 wait times for ambulances to take patients to Phoenix

8 in the past than they were happy with?

9 A. I believe that's one of the pieces. This was

10 a statewide contract with Banner, and we wanted to make

11 sure that we could meet the needs of all of the

12 facilities that we currently hold certificates in. So

13 the goal here was to, as you spoke, or as you said,

14 meet the needs of the Banner Payson in these arrival

15 times.

16 Q. Okay. So my last area of questioning deals

17 with mutual aid.

18 A. Okay.

19 Q. Okay. Is a written mutual aid agreement the

20 same thing as a backup -- a written backup agreement?

21 A. It depends on where you're at, I guess. And

22 I hate to use the word "depends," but depends on where

23 you're at.

24 Q. So let me ask you a different question.

25 Is a mutual aid concept utilized both by fire


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1196

1 and ambulance organizations?

2 A. Yes.

3 Q. That's a common term that is used

4 interchangeably by both disciplines?


6 Q. Do you know if the term "mutual aid" or

7 "mutual aid agreement" is defined in the statutes and

8 rules governing ambulance services?

9 A. I believe it is.

10 Well, let me -- can I take a step back with

11 that?

12 Q. Sure.

13 A. I don't believe it's governed in rules. I

14 know that the Bureau speaks of obtaining and managing

15 and maintaining mutual aid agreements with partners.

16 I'm not sure if that's actually a rule.

17 Q. Okay. And if I tell you that the Department

18 has a rule for a backup agreement, but not for a mutual

19 aid agreement, would that surprise you?

20 A. If you told me, it's got to be true.

21 Q. Well, let me, for the matter of the record,

22 read you the definition; and tell me if, upon listening

23 to the definition, whether you believe the term "backup

24 agreement" is synonymous with what you termed "a

25 written mutual aid agreement" when speaking about


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1197

1 ambulance services.

2 A. Fair enough.

3 Q. Okay. So under R9-25-901, Subsection 5,

4 backup agreement is defined as a written arrangement

5 between a certificate holder and a neighboring

6 certificate holder for temporary coverage during

7 limited times when the neighboring certificate holder's

8 ambulances are not available for service in its service

9 area.

10 So that is the definition in the ambulance

11 regulations for a backup agreement. Is that synonymous

12 with what you understand the terminology being a mutual

13 aid agreement for ambulance services?

14 A. Yes.

15 Q. John, one last question on mutual aid, and

16 here I am contributing to the confusion or

17 interchangeability of those terms.

18 You testified that when you met with Chief

19 Staub in March, or thereabouts, you were aware that

20 there had been or that there were verbal agreements in

21 place amongst the CON holders to respond, if requested.

22 A. I don't know if we discussed mutual aid

23 agreements at that time. I think it's probably an

24 assumption on my part, due to the fact that we had -- I

25 had seen documents where Pine-Strawberry had responded


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1198

1 into CON 58's area; and I was present at a meeting,

2 one of the Chiefs meetings, where the Chief,

3 Mr. Morris, Chief Morris, had thanked Danny

4 Brumbaugh for responding to a call in Pine-Strawberry.

5 It was an assumption for me that that was what was

6 going on.

7 Q. Okay. Since you've been actively on the

8 scene in March, has there been a request for mutual aid

9 or backup from any of the Fire-based CON holders to

10 CON 58?

11 A. I'm sure there probably has been. I don't

12 have the data in front of me. I believe there was

13 testimony here by one of the witnesses that as of

14 Thursday of last week, there was a request. I'm not

15 sure if that resulted in a transport or what the

16 specific circumstances were about that request.

17 Q. All right. And beginning in March of 2016,

18 has CON 58 requested any mutual aid of any of the fire

19 service CON holders?

20 A. I think I -- unless I'm not understanding

21 your question, I think I just testified to the fact

22 that I believe that that is still happening. As of

23 last week, there was a request for mutual aid for a

24 call, for a 911 call in the system.

25 Q. Okay. Let me make sure the record's clear.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1199

1 I thought my first question was, are you aware if any

2 of the Fire-based CON services had requested mutual aid

3 of CON 58?

4 A. Oh, I'm sorry. My apology.

5 I don't have the data in front of me, but I

6 know that we have responded into Pine-Strawberry I

7 think somewhere in the neighborhood of 8 to 10 times

8 this year for various reasons.

9 Q. Okay.

10 A. And I can't testify that those resulted in a

11 transport or anything else. They were a request for

12 service.

13 Q. Okay. The flip-side question is, do you know

14 if CON 58 has requested mutual aid from any of the

15 Fire-based CON services in that area from March to the

16 present time?

17 A. Yeah. Yes. I'm sure we have. That was

18 testified here earlier.

19 Q. All right.

20 A. So sorry about the confusion.

21 Q. That's quite all right. Thank you very much.

22 A. Thank you.

23 MR. RAY: Judge, I don't have any

24 further questions at this point.

25 ALJ SHEDDEN: All right. Mr. Meyerson.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1200

1 CROSS-EXAMINATION

2 BY MR. MEYERSON:

3 Q. How long have you been in charge or have had

4 oversight of CON 58?

5 A. Since, we'll say, March.

6 Q. And so you testified -- and Mr. Ray ran us

7 through the timeline. You testified that the purchase

8 was in October 2015, the transfer occurred at the end

9 of January 2016, but, really, AMR generally had no

10 operational control until March 2016, correct?

11 A. That's a fair statement.

12 Q. Were you here for Mr. Bartus' testimony?

13 A. I was.

14 Q. Do you recall him using the word "we" and AMR

15 and referring to our operational results in 2015?

16 A. I do remember him testifying to that.

17 Q. If you had no operational control of the CON

18 prior to March 2016, you would have to agree that AMR

19 had no impact on the 2015 operational results, correct?

20 A. I wouldn't agree with that. What happened

21 from the finance side and above my level operationally,

22 I don't have any knowledge of that.

23 Q. But billing stayed the same, correct?

24 A. It could have, yeah.

25 Q. Well, you testified yesterday that billing


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1201

1 stayed the same.

2 A. Okay.

3 Q. And the personnel would be the same. I --

4 So it would be near impossible, as Mr. Bartus

5 tried to sidestep, to know whether the revenue for

6 CON 58 was maximized or expenses minimized for 2015;

7 isn't that right?

8 MS. FICKBOHM: I'm going to object to

9 the form of the question. A, it's argumentative.

10 ALJ SHEDDEN: Well, I would say it was,

11 with the comment about sidestepping. So why don't you

12 just reask your question.

13 BY MR. MEYERSON:

14 Q. Okay. Would it be near impossible for you or

15 Mr. Bartus to know whether revenue was maximized or

16 expenses minimized?

17 A. That would be a question for Mr. Bartus. I

18 don't -- I don't oversee the finances.

19 Q. And you mentioned Lake Mohave Ranchos as one

20 of the Fire Districts as a comparison to Hellsgate or

21 at least saying here's all of the Fire Districts that

22 we're currently assisting with.

23 You mentioned that they had filed bankruptcy

24 due to difficulty through the recession. Do you

25 remember that?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1202

1 A. I do remember saying that.

2 Q. And in the Payson Town Council meeting, do

3 you recall saying to the Council that the Hellsgate tax

4 base has been decreased by over $700,000 after the

5 recession?

6 A. I remember that.

7 Q. And you would expect such a cut in their tax

8 base to have a significant financial impact on their

9 financial position; would you agree?

10 A. I believe it did.

11 Q. But the Chief testified, and would you agree,

12 that they didn't dip into their line of credit; they

13 didn't raise the tax rates; in fact, the tax rate went

14 down; and they didn't access a material portion of

15 their capital reserves; would you agree with that?

16 A. Their tax rate remained at the max, 3.25.

17 And I don't know whether they dipped into their

18 reserves or not. And the capital acquisition fund or

19 the capital fund that you're speaking of is designed to

20 pay for large capital purchases, so I don't know if

21 they dipped into it or not.

22 Q. Bullhead City was another District that you

23 testified about, and you testified that your -- AMR --

24 River Medical, is that the AMR entity that's covering

25 for Bullhead City?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1203

1 A. CON 94, that's correct.

2 Q. River Medical?

3 You testified that Bullhead City determined

4 that it would not do interfacility transports after a

5 certain hour; is that correct?


7 Q. You didn't say that that change was a result

8 of financial difficulties, though, did you?

9 A. No, I did not.

10 Q. And didn't one of Life Line's witnesses

11 earlier testify that almost all interfacility

12 transports are not urgent?

13 A. I believe somebody testified to that.

14 Q. So doing an interfacility transport at -- do

15 you know what hour it was that they said they would

16 stop?

17 A. I believe it was 5:00 or 6:00 in the evening,

18 and it came to they said it was due to fatigue. They

19 didn't want their firefighters taking transports after

20 a certain time of night.

21 Q. Where do most -- where do most Bullhead City

22 interfacility transports go?

23 A. Las Vegas.

24 Q. And how far away is that?

25 A. It's roughly an hour and 45 minutes, two


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1204

1 hours, depending on the hospital and traffic.

2 Q. And so roundtrip would be roughly --

3 A. Four to five hours, four and a half hours.

4 Q. Four to five?

5 And what about to Maricopa County? Because

6 you mentioned some would also have to go to Maricopa

7 County?

8 A. Yes. Probably six hours roundtrip, maybe a

9 little longer.

10 Q. So late night transports then, based on the

11 fact that most interfacility transports aren't going to

12 make up a large number of those transports per year,

13 correct?

14 A. No, not correct. And I disagree with the

15 fact that those patients still don't have a need to be

16 moved. The hospital, especially the more rural,

17 critical access hospitals, need bed space. And

18 there's no reason for a patient to sit on a bed space

19 or take up a bed space that another emergency patient

20 may need.

21 So we feel at our company that those patients

22 have every right to be moved in a timely manner, and I

23 believe some of your witnesses testified to the fact

24 that, you know, interfacilities need to be moved when

25 there's a call for them.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1205

1 Q. Has Hellsgate indicated that it would not

2 provide interfacility transports after 5:00 or 6:00?

3 A. It has not.

4 Q. Does River Medical provide services to CON 58

5 or impact Hellsgate's financial health?

6 A. Does -- I'm sorry, rephrase.

7 Q. Does River Medical provide services into the

8 CON 58 boundaries currently?

9 A. No, it does not.

10 Q. I want to pull up Exhibit 20, and this was an

11 exhibit from the International Association of EMTs and

12 Paramedics, and this is Life Line Exhibit 20.

13 What is your understanding about what a union

14 does?

15 A. A labor union is there to work with

16 management and labor to provide what the employees feel

17 they need representation on.

18 Q. So it wouldn't be surprising to you that they

19 would write a letter, when it's their job as a union to

20 protect the employees that are part of that union?

21 A. It's -- I think this goes to the passion of

22 the staff that are there trying to protect their jobs,

23 and they probably worked with their local union to help

24 facilitate this letter.

25 Q. But to answer my question, the Association


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1206

1 that wrote this letter, it really is their job to write

2 this letter?

3 A. It's their job to protect their employees and

4 their jobs.

5 Q. Do you remember earlier when Doug Jones

6 testified that he felt that CON 58 was significantly

7 overstaffed?

8 MS. FICKBOHM: And I'm going to object

9 to the form of the question. That wasn't his

10 testimony.

11 ALJ SHEDDEN: All right. And let me

12 ask, Mr. Meyerson, do you agree, or do you want to

13 rephrase your question in any way?

14 MR. MEYERSON: No, I disagree with --

15 that is what he testified. He said --

16 ALJ SHEDDEN: Well, I'm not going to get

17 into whether he did or not.

18 MR. MEYERSON: Yeah, okay. Okay.

19 ALJ SHEDDEN: So I'll just ask you to

20 rephrase your question, or I'll ask it.

21 MR. MEYERSON: Okay.

22 ALJ SHEDDEN: Did you hear Mr. Jones

23 testify that CON 58 was significantly overstaffed?

24 THE WITNESS: I don't remember hearing

25 the word "significantly." He said overstaffed.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1207

1 BY MR. MEYERSON:

2 Q. And would you agree that your testimony and

3 his testimony are a little bit at odds with one

4 another; would you agree with that?

5 A. I would agree with that.

6 Q. So you testified when you started to dive

7 into and just -- would you agree that when you started

8 to dive into CON 58 operations in March of 2016, that

9 you noticed that it was understaffed, and you had Jeff

10 Baker immediately begin hiring in March and April of

11 2016, and even added a fourth ambulance a month and a

12 half ago; is that correct?

13 A. Correct.

14 Q. Can you tell us, I mean other than the fact

15 that we have -- that Doug Jones has data available to

16 help you with local decision-making, what we are to

17 take from his testimony about the resources being

18 overstaffed as it relates to the interfacility

19 transports?

20 A. Doug and his team's job is to look at data.

21 I think Doug testified that his team recommends to the

22 local operation, and then it's a collaboration between

23 his team and our local knowledge and the local

24 knowledge of the folks that are there and historical

25 knowledge to figure out the deployment.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1208

1 It's not a perfect science, nor is drawing

2 circles with response times as your response time

3 person testified. It's not a perfect science. You

4 have to take all of the factors that you have available

5 to you, historical knowledge, local resources, the

6 operational plan and deployment from the software, and

7 build your model.

8 Q. Would you agree that his testimony stating

9 that the 368 interfacility transports -- he was

10 suggesting that the 368 interfacility transports had

11 nothing to do with staffing of the ambulance?

12 A. I don't really understand your question. I'm

13 sorry.

14 Q. I'm asking what you thought he was suggesting

15 when he said that -- when he started relating the

16 overstaffing to the 368 interfacility transports.

17 In my mind, I thought he was suggesting that

18 those transports had nothing -- that were done by the

19 Maricopa County ambulances had nothing to do with

20 understaffing.

21 And I'm just asking you what you thought he

22 was suggesting when he related the 368 interfacility

23 transports to his comment that it was overstaffed?

24 MS. FICKBOHM: Excuse me, Counsel. I'm

25 going to object to the form of the question.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1209

1 Mr. Valentine's understanding of another -- of Doug

2 Jones' testimony isn't really relevant here, Your

3 Honor. It's your understanding. It's the Director's

4 understanding. It's not counsel's understanding. It's

5 not Mr. Valentine's understanding. It was what it was.

6 I mean if he wants to ask him if he

7 agrees with X, Y, Z, if he believes X Y Z; but the

8 litany of what did you understand this meant, what did

9 you understand that meant, I don't see the relevance of

10 that kind of questioning.

11 ALJ SHEDDEN: All right. The

12 objection's overruled.

13 You can answer.

14 THE WITNESS: Well, I would hate to

15 speculate on what Mr. Jones did or did not want to mean

16 by that, so I don't want to speculate on that thought.

17 BY MR. MEYERSON:

18 Q. Okay. But given when you came in and you saw

19 368 interfacility transports conducted -- or I guess we

20 should say 214, because you probably only had the 2015

21 data available to you.

22 When you saw that in 2015, that there was 214

23 interfacility transports and then that trend had maybe

24 increased slightly in the first few months of 2016, you

25 saw that as an issue and began to staff immediately; is


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1210

1 that correct?

2 A. It was one of the factors that we worked to

3 remedy very quickly. We wanted to utilize Payson-based

4 units to take interfacilities as much as we possibly

5 could. That was one of the factors in some of the

6 things I testified with Mr. Ray; that we moved

7 additional resources in to take not only

8 interfacilities, but other calls.

9 Q. But from March to August -- and I can pull up

10 that exhibit, pull up Exhibit -- it's Hellsgate

11 Exhibit 15, the second 2016 monthly recap report. You

12 took over in March, which I'm assuming it wasn't

13 necessarily March 1. But if we look at April, May,

14 June, July, August, it goes -- it says 40, 12, 28, 47,

15 37.

16 When did you start moving those interfacility

17 transports or attempting to move those interfacility

18 transports from Maricopa County ambulances to CON 58

19 ambulances?

20 A. So, first of all, you can't hire overnight.

21 So it takes time to staff, to adequately run those

22 folks through what we call our new hire orientation

23 process, get staffing up.

24 I will tell you after October, of adding the

25 new unit, and I think I testified to it, so far -- and


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1211

1 this is only very short-term data. As of November,

2 there was only 8 transports that were taken out of the

3 Maricopa County market. So by adding that 40-hour

4 resource, we've dramatically, if not completely, met

5 the need of those -- of the hospital.

6 Q. But we don't have any documentation; we're

7 just --

8 A. You don't.

9 Q. Are there a significant number of transports

10 that go from a Maricopa County hospital to a Gila

11 County hospital?

12 A. Not to my knowledge.

13 Q. So the proposition that a Maricopa County

14 ambulance happens to be in Payson after it did an

15 interfacility transport, and so it grabbed a Northern

16 Gila County resident from Banner Payson and took it

17 back, that's not a very likely scenario?

18 A. That could happen. The more likely scenario

19 is the unit was moved up for a prescheduled

20 interfacility or a special request for either a

21 critical care unit, a bariatric unit, some specialty

22 type call, so that would be...

23 Q. So on that -- pardon me. Jumping around a

24 little bit. I'm trying to keep it as organized as I

25 can for us.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1212

1 So you stated that there's now an employee in

2 the Banner Transfer Center in Phoenix that coordinates

3 interfacility transports throughout the Banner system,

4 correct?

5 A. That employee assists with the ground

6 ambulance piece of -- or air, if the patient needs to

7 be, you know, relocated out of the state.

8 Q. And so that's some of the ability to kind of

9 do the prescheduled, move an ambulance up from Maricopa

10 County.

11 One question. When you have a scheduled

12 transport -- and remind me, how many ambulances did you

13 say you had in the system?

14 A. In which system?

15 Q. CON 58.

16 A. Three and a half units --

17 Q. Three and a half?

18 A. -- on those days Tuesday, Wednesday,

19 Thursday, Friday.

20 Q. And then can you describe for me the reserve

21 unit idea.

22 A. So they have reserve ambulances there. There

23 are times where if there was either a large incident or

24 they wanted to call back folks, they would call back

25 staff in that area.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1213

1 Q. And you stated that you could see those

2 transports sometimes hours, sometimes days in advance.

3 Couldn't Life Line have staffed then a CON 58

4 ambulance, if it had a reserve going back to March of

5 2016, to conduct that interfacility transport?

6 A. I think that's definitely a plan going

7 forward. I think through the issue of the staffing

8 shortage that they were in, I don't think that was as

9 realistic. You know, the staff up there, they work

10 long and hard, like the Fire Service does. They work

11 part-time jobs. They don't always want to come back

12 and do those duties. But it is definitely something to

13 look for, as now that our staffing has become full,

14 that callback is a possibility.

15 Q. Can you describe to the Judge what level zero

16 means?

17 A. Level zero is a term that's been used both on

18 the fire side and on the EMS side, where there's no

19 ambulances available for a call.

20 Q. Do you personally get notifications when the

21 system goes to level zero?

22 A. I do not.

23 Q. Who would get those notifications?

24 A. Probably Mr. Baker and the ops, other ops,

25 operations managers.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1214

1 The only misconception with level zero is no

2 one ever quantifies a time. So a page could go out for

3 a level zero, and 30 seconds later three ambulances

4 could come available. And it's very common in any

5 large system where they say level zero, but it could be

6 minutes, it could be 10 minutes.

7 Q. You testified earlier that Life Line was

8 reviewing adding a new station in the Payson area; is

9 that correct?


11 Q. And would you agree with me that adding a

12 station would improve your response times to other

13 parts of the area, versus the one station that it

14 currently has?

15 A. I don't know yet, because we haven't

16 evaluated it. One of the things that we've been very

17 active with here in Maricopa County is partnering with

18 local jurisdictions, Fire Districts, Fire Departments,

19 municipalities, and housing ambulances within those

20 jurisdictions that are strategically located. So we

21 haven't done the research on that yet.

22 Q. But through, I guess, common sense, would you

23 expect it to improve response times to other parts?

24 A. Maybe to that one geographic location where

25 that ambulance is located, if that ambulance is


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1215

1 actually located there when the call comes in.

2 Q. Ms. Fickbohm stated what else are you doing

3 to make sure that what Banner needs Banner gets.

4 Would you agree with me that the CEO of

5 Banner Payson asking Gary Morris to amend his CON to

6 include interfacility transports means, at least in

7 part, that Banner was not getting what Banner needed?

8 MS. FICKBOHM: And, Your Honor, I'm

9 going to object to the question as misstating the

10 facts, because counsel is directing that to the time

11 frame when Mr. Valentine has been involved; and

12 Mr. Morris, Chief Morris, was pretty clear that that

13 was a 2015 issue, not a 2016 issue.

14 ALJ SHEDDEN: All right. Well, I don't

15 know that it does misstate the facts, although

16 understanding you've added some supplemental facts.

17 Do you want to respond, Mr. Meyerson, to

18 Ms. Fickbohm's objection?

19 MR. MEYERSON: Well, there's been no

20 indication, and from Chief Morris' testimony, when

21 asked what they would do if Hellsgate is not awarded

22 the CON, he stated that he would very likely amend his

23 CON to include interfacility transports.

24 ALJ SHEDDEN: Well, he can't amend his

25 CON, can he? I mean he's got to apply and go through a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1216

1 hearing.

2 MR. MEYERSON: Well, apply, yes. But

3 would submit for the amendment, is what I meant; not

4 that he would just amend it in that fashion. But he

5 did indicate that they would look to amend their CON.

6 ALJ SHEDDEN: All right. I'm going to

7 overrule the objection.

8 You can go ahead and answer.

9 THE WITNESS: So, first of all, I saw no

10 evidence put before us, Counsel, the Bureau, or the

11 Judge of any written documentation that took place

12 between Mr. Morris and the CEO. There is a verbal --

13 there was obviously some verbal conversations that took

14 place. I'm not privy to that, and I don't want to

15 speculate to what the relationship was with the Banner

16 Hospital system and CON 58, or Mr. Morris, for that

17 matter.

18 BY MR. MEYERSON:

19 Q. So I'm assuming you're not saying that Chief

20 Morris was lying on the stand, but it wasn't really my

21 question. The question that you answered wasn't my

22 question.

23 My question was whether the testimony from

24 Mr. Morris supported the idea that Banner was getting

25 what Banner needed?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1217

1 A. Once again, I would be speculating.

2 Q. Well, I suppose I'm asking you somewhat to

3 speculate in the answer. I'm asking you, if Chief

4 Morris testified that he had a conversation with the

5 CEO of Banner Payson asking him to amend his CON to

6 include interfacility transports, if that would

7 indicate that Banner was not happy?

8 A. And I apologize. I wasn't privy to the

9 conversation. I heard the testimony. I cannot attest

10 to whether it took place or not. So I don't want to

11 speculate to what the conversation or the relationship

12 at the time with Banner, the CEO, and Chief Morris. I

13 don't think he lied on the stand. I don't know exactly

14 the conversation that took place.

15 Q. You mentioned the new Banner contract that is

16 in front of DHS currently, and then you also mentioned

17 that Life Line has already started adhering to that

18 contract, even though it has not been approved.

19 About when did it start following the terms

20 of the contract?

21 A. I'll have to think. Let's see.

22 I would say shortly around late September,

23 early October we knew we were going to, in October,

24 place a new unit in there to meet the peak demands. I

25 don't know exactly the time, but probably right around


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1218

1 October. And I haven't seen the data from that yet.

2 Q. So when you said that you haven't seen the

3 data yet, you've said you've been in compliance with

4 the response time requirements. So, really, you don't

5 know if you've been fully compliant with the response

6 times?

7 A. So let's back up for a second. They're not

8 response times. They're arrival times.

9 Q. Okay.

10 A. If -- there isn't a great deal of -- there

11 isn't a great number of interfacility transports there,

12 so we have to take some time to build the data. There

13 are some percentages built into that. It's not a

14 hundred percent of the time, if I'm correct. I believe

15 it's on a 90 percentile. So it's going to take some

16 time to build some data. And I haven't reviewed it.

17 Honestly, I haven't reviewed that data yet.

18 Q. So the answer is, you don't know; is that

19 correct?

20 A. The answer is, I don't know. That's a

21 fair...

22 Q. I want to talk a little bit about the frosty

23 relationship. What steps did you take -- other than I

24 think you mentioned you reached out to Chief Staub in

25 March, what other steps did you take to try to heal


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1219

1 that frosty relationship?

2 A. Other than reaching out to Chief Staub and

3 trying to get a better understanding, I really tried to

4 seek to understand what had happened prior to the

5 acquisition, and then trying to reach out at one point

6 to Chief Bathke and Hellsgate, once we got a better

7 understanding of -- or what we thought was a better

8 understanding of Hellsgate applying for a CON, nothing,

9 other than we -- Mr. Baker and Mr. Brumbaugh continued

10 to go to the Chiefs meetings and tried to stay engaged

11 with local operations. Nothing.

12 Q. And you mentioned earlier that you weren't

13 aware of when AMR knew that the Hellsgate Fire District

14 had submitted its CON application. But isn't the

15 filing of the CON application a matter of public

16 record?

17 A. It is.

18 Q. And would you expect that AMR would have been

19 aware of the press release that was submitted and

20 printed by the Payson Roundup in November of 2015 about

21 a pending application being filed?

22 A. I would imagine it would.

23 Q. So they would have had knowledge of the CON

24 application very soon, if not the same day it was

25 filed; that would be reasonable to expect, correct?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1220

1 MS. FICKBOHM: Excuse me a second. I'm

2 going to object, Your Honor. This "they," I'm not sure

3 who counsel is intending to include in "they." So I

4 would object to the form of the question.

5 ALJ SHEDDEN: All right. Let me ask,

6 Mr. Meyerson, do you mean everyone in AMR, anyone in

7 AMR?

8 BY MR. MEYERSON:

9 Q. No, I mean leadership in AMR, Life Line in

10 the Payson area.

11 A. I'm sure that we would have been made aware

12 of it. We were in a period of time going through a

13 very large acquisition. Payson was one part of it.

14 There's literally thousands of moving parts in an

15 acquisition. I'm sure somebody was aware of that.

16 Q. What were you personally doing during the

17 acquisition period?

18 A. So I was part of the team that was running

19 the AMR Maricopa market. Myself and Glenn Kasprzyk

20 were the architect of that CON application and worked

21 through that. We spent a great deal of our time

22 working with local fire partners, rebuilding

23 relationships in the market here in Maricopa, and as

24 well as that running my operation on the river and in

25 Prescott.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1221

1 Q. And when were you made aware of the frosty

2 relationship?

3 A. I mean shortly after March, when I took over,

4 it was kind of brought to my attention.

5 Q. And you stated that Mr. Kasprzyk attempted to

6 contact Chief Bathke; but that wasn't until

7 approximately September of 2016, correct?

8 A. Yeah, Mr. Kasprzyk will have to really attest

9 to the dates and times. He has the e-mails.

10 Q. And you also mentioned that you were aware

11 that Chief Bathke had attempted to contact, I guess,

12 the prior leadership before the merger was all

13 finalized.

14 Once you saw the CON application, would you

15 agree with me that to repair the frosty relationship,

16 it may have been a good idea to reach out or have

17 somebody reach out to Chief Bathke and follow up on

18 that attempted contact?

19 A. We did attempt to reach out to Chief Bathke,

20 myself and Mr. Kasprzyk, without a response. We

21 reached out to who I felt was the -- possibly a less

22 biased Fire Chief, who has what I feel is a great deal

23 of oversight of many of the Districts in that area,

24 Chief Staub, to try to get an understanding of what was

25 going on.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1222

1 Q. So there was an issue, and you decided to go

2 through Chief Staub; and when that didn't work, in

3 September of 2016, that's when the two of you tried to

4 reach out to Chief Bathke; is that a good summary?


6 to the form of the question. The witness has already

7 answered that Mr. Kasprzyk has the dates.

8 ALJ SHEDDEN: All right. I'll overrule

9 the objection.

10 You can answer.

11 THE WITNESS: Like I said, I don't have

12 the exact dates.

13 BY MR. MEYERSON:

14 Q. Were you made aware by an operations

15 supervisor in August of 2016 that your ambulance

16 personnel were deliberately not calling for HALO 211

17 because it was affiliated with Hellsgate?

18 A. I have no knowledge of that.

19 Q. You have mentioned a lot of action items that

20 will be taken in the rest of 2016 and 2017 to address,

21 presumably, all of the issues that we've brought up

22 here in this hearing. Do you have any detailed

23 exhibits to show us to outline, you know, concrete

24 steps that are going to be taken?

25 A. No. I don't believe it's our job to bring


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1223

1 exhibits to this hearing; and, no, I don't have

2 exhibits. You're just going to have to take my word

3 for it.

4 Q. The explosion situation in Payson, your

5 testimony was that you sent 24 ambulances up the hill

6 at the request of Payson; is that correct?

7 A. It was on the request of whoever called our

8 alarm room. I would assume that was the Payson PSAP.

9 Q. Okay. I was just curious. Chief Staub --

10 were you here for Chief Staub's --

11 A. I was.

12 Q. -- testimony?

13 A. I was.

14 Q. And so you remember him saying that he did

15 not request those resources; that they self-deployed?

16 Do you recall that?

17 A. I don't remember that exact testimony. I

18 remember him saying that -- something to the effect

19 that they weren't needed.

20 Q. And then you -- Ms. Fickbohm asked you about

21 an alternative model that isn't reflected in the

22 applicant's ARCR that's come up a couple of times

23 during the hearing. Would you agree, though, that a

24 fully staffed model, that the fire unit would be

25 separate from the ambulance unit, and then in that case


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1224

1 a fire call would not impact the ability of the

2 ambulance to respond?

3 A. I think that would be very similar to the

4 model that you have right now.

5 Q. The southwest corner of CON 58, we'll call it

6 the exclusion piece. There are two, the one a little

7 farther north; but that southwest corner with the

8 Beeline Highway. Do you remember Chief Bathke saying

9 that they would respond, Hellsgate would respond, to

10 that area and even move to amend the CON to include

11 that area if Life Line was to stop providing service

12 there?

13 A. I did hear that testimony.

14 Q. You also stated that Chief Bathke has done a

15 good job primarily maintaining the status quo, correct?

16 A. I don't know if that was my exact

17 terminology, but I think he's done a good job.

18 Q. Would you -- and I do believe it was in

19 testimony that he's maintaining the status quo.

20 A. Okay.

21 Q. Would you consider a public/private HALO

22 partnership the status quo?

23 A. I really don't understand your question.

24 Q. Would you consider the establishment of a

25 public/private HALO partnership by Chief Bathke the


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1225

1 status quo?

2 A. You would have to give me more details to the

3 specifics of what the HALO project that he currently

4 has going with PHI entails; if it's fiscally

5 responsible for him to do that, he has a good return on

6 covering costs, if it makes sense for his District.

7 There would be a number of things I would need to know

8 before you -- I answer that correctly.

9 Q. Well, I don't think the status quo has

10 anything to do with whether something is successful or

11 not.


13 to counsel arguing with the witness, Your Honor.

14 ALJ SHEDDEN: All right. Mr. Meyerson,

15 just go ahead and move to a question, please.

16 BY MR. MEYERSON:

17 Q. Okay. Give me one second.

18 Would you agree that financial results aside,

19 that the establishment of a public/private HALO

20 partnership is more than maintaining the status quo?

21 A. Once again, the HALO project that he is

22 undertaking with PHI, if it works for his organization,

23 that's great. I don't know if it's -- I -- I don't

24 know where to go with that question. I'm sorry.

25 Q. Okay. Would you consider moving to


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1226

1 electronic patient reporting the status quo?

2 A. I would say moving to electronic patient

3 charting is a standard of care that every agency in the

4 state, if not on it already, should be moving towards

5 it. So, no, I wouldn't say that that's out of the

6 norm.

7 Q. Would you consider Hellsgate becoming a

8 DHS-approved ALS training center the status quo?

9 A. There are several organizations. I applaud

10 Hellsgate for doing that. We're a DHS-approved

11 training center. Lots of especially more rural

12 agencies become training centers. So I don't think

13 that's outside the norm of many Fire Districts around

14 the state.

15 MR. MEYERSON: Okay. That's all I have.

16 Thanks, Mr. Valentine.

17 THE WITNESS: Thank you.

18 ALJ SHEDDEN: All right. Ms. Fickbohm,

19 any follow-up questions?

20

21 REDIRECT EXAMINATION

22 BY MS. FICKBOHM:

23 Q. Mr. Valentine, did you want to correct the

24 hours your peak usage unit is in service?

25 A. Yes. It's not 10:00 in the morning till


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1227

1 10:00 at night. That would be a 12-hour day, which

2 would be much longer than 40 hours a week. It's 10:00

3 in the morning till 8:00 at night.

4 Q. And you talked about sort of general

5 knowledge of peak hours of usage in other systems. Is

6 there anything unique about the Payson area that makes

7 an earlier end to that peak usage applicable?

8 A. It was a good launching point for us.

9 There's nothing -- I haven't seen anything in data that

10 would say that. We have enough resources on currently

11 to take care of our peak -- what we feel is a peak 911

12 deployment time. We started a unit at 10:00, and we

13 thought that was a good launching point, and then build

14 our data from there as we go forward.

15 So there's nothing so far that I've seen in

16 any of the data, the very limited data that we've

17 looked at, that would suggest any different.

18 Q. Do things close down early in Payson?

19 A. You know, I don't live there, but I would

20 imagine it would kind of roll up early.

21 MS. FICKBOHM: I don't have any other

22 questions, Your Honor.

23 ALJ SHEDDEN: All right. Mr. Ray,

24 anything?

25 MR. RAY: Nothing further, Judge. Thank


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1228

1 you.

2 ALJ SHEDDEN: Mr. Meyerson?

3 MR. MEYERSON: No. That's all, Judge.

4 ALJ SHEDDEN: All right. Thank you.

5 THE WITNESS: Thank you, Your Honor.

6 ALJ SHEDDEN: All right. Who's next

7 then?

8 MS. FICKBOHM: Mr. Kasprzyk.

9 ALJ SHEDDEN: All right. Come on up.

10 Well, let me ask you, Ms. Fickbohm. I

11 know earlier you said you didn't have a lot of

12 questions for him. It's at 11:25. Would you prefer to

13 take the lunch break now or launch into your questions

14 for him?

15 MS. FICKBOHM: Unless Mr. Meyerson were

16 to say that they weren't going to put on a rebuttal

17 case, in which case we could do Mr. Kasprzyk and go to

18 lunch a little later and get out of here; but I assume

19 he's going to do some rebuttal, and so in that case, I

20 think it would be better to take lunch now.

21 MR. MEYERSON: At this time we don't

22 have a rebuttal witness planned.

23 ALJ SHEDDEN: All right. So it does

24 make sense to take his testimony now, is what we're

25 saying?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1229

1 MS. FICKBOHM: Well, because maybe we

2 could, you know, work till 12:30 and be done. But I

3 don't want to get in your way of anything you have

4 planned at lunch; or, Jody, I don't want to make you

5 comfortable.

6 ALJ SHEDDEN: So I'll tell you what, why

7 don't we take a 10-minute break now and then we'll pick

8 it up and see where we get about 12:30 and evaluate at

9 that time.

10 MS. FICKBOHM: I'm for it, I'm for it.

11 (A recess was taken.)

12 ALJ SHEDDEN: All right. We're back on

13 the record. Mr. Kasprzyk is in the witness chair.

14 Before I get him sworn, let me just make

15 sure. I thought, when the idea came up just before the

16 short break there that we would plow on, everyone was

17 in agreement that's the best way to go. But I want to

18 make sure that we are all in agreement for that.

19 And, again, a lot of folks shaking their

20 head yes.

21 MS. FICKBOHM: I see a lot of head nods,

22 a lot of nods.

23 ALJ SHEDDEN: Yeah, not hearing any

24 no's.

25 With that, let me get you sworn in.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1230

1 GLENN KASPRZYK,

2 called as a witness on behalf of the Intervenor herein,

3 having been first duly sworn by the Administrative Law

4 Judge to speak the truth and nothing but the truth, was

5 examined and testified as follows:

6

7 ALJ SHEDDEN: All right. Please state

8 and spell your name for our record.

9 THE WITNESS: Glenn Kasprzyk, G-L-E-N-N,

10 last name K-A-S-P-R-Z-Y-K.

11

12 DIRECT EXAMINATION

13 BY MS. FICKBOHM:

14 Q. Good morning, Mr. Kasprzyk.

15 A. Good morning.

16 Q. It is still morning.

17 Can you tell the Judge how it is you came to

18 emergency medical services?

19 A. Yes. So in high school back in -- outside of

20 Buffalo, New York, our high school had a first

21 responder program certified by the State. So there was

22 multiple levels in New York and it was kind of the

23 entry level before EMT. So I took an elective, and

24 from that point forward I kind of caught the bug. I

25 joined the local Volunteer Fire Department at 16 as a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1231

1 junior firefighter, pursued EMT and then paramedic

2 subsequently. Began working for the private ambulance

3 company in that area in 1994, and have been in the

4 industry ever since then. Worked in Buffalo, New York

5 for LaSalle Ambulance and Town's, both which were

6 acquired by the Rural/Metro Corporation in 1995, if

7 memory serves me correct.

8 Stayed in Buffalo until 2002, and under the

9 changes in leadership, our regional director or general

10 manager was also overseeing the Orlando, Florida

11 market. So if you're familiar with New York State,

12 it's snowy and it was tough to shovel sunshine, so I

13 said I'm going to Orlando to work for Rural/Metro. I

14 thought it was a great opportunity to advance my

15 career. And even in working for the operations in

16 Buffalo, I kind of withdrew myself from the field and

17 began to work in the communications center and starting

18 to get an understanding of the EMS industry as a whole.

19 So it was a natural fit to go to Orlando in 2002.

20 Q. And what did you do in Orlando? What was

21 your position there?

22 A. Originally went down as the communications

23 center manager, and then shortly thereafter

24 transitioned into the operations manager role. The OM

25 there had retired. Certainly a large market in


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1232

1 Orlando.

2 Q. How big was that?

3 A. It served the Metro Orlando area and parts of

4 Orange County. I don't recall the overall specifics,

5 but I believed it to be around a hundred thousand

6 transport operation a year.

7 Q. More urban?

8 A. More urban, for sure.

9 And then in 2006 had an opportunity to look

10 at an operation here in Arizona through a mutual

11 friend, who said they were looking for a communications

12 manager. I had been in operations and wanted to go

13 back to communications and it was time to make a

14 change.

15 So I met with the owner, Cheryl Smith. We

16 hit it off well, and I liked the area, liked the state,

17 and came out and worked for Life Line Ambulance in

18 Prescott, Arizona.

19 And then in 2014, '13, '14, we began the

20 process of being acquired by American Medical Response.

21 I had time to think about what I wanted to do at that

22 particular point. Ted Van Horne was the regional CEO

23 at the time. Ted and I actually went to paramedic

24 school back in Buffalo, New York, and I knew Ted as an

25 instrumental leader in the industry, and I felt that I


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1233

1 wanted to stay.

2 So I stayed on with AMR, and then certainly

3 we've grown here in Arizona with CON 136 coming to

4 fruition, AMR of Maricopa, and then the acquisition of

5 the Rural/Metro family, which also gave me additional

6 opportunity to grow my career and then assume the role

7 of regional chief operations officer.

8 Q. And is there additional detail behind what

9 you just testified to in Exhibit 13c?

10 A. There is.

11 MS. FICKBOHM: At this point I would

12 move for admission of Life Line 13c.


14 ALJ SHEDDEN: All right. 13c is

15 admitted.

16 BY MS. FICKBOHM:

17 Q. So tell us what your responsibilities as

18 regional chief operations officer for Arizona American

19 Medical Response involve.

20 A. So Arizona, with the acquisition of

21 Rural/Metro, Arizona is one of the largest overall

22 markets within the organization. New York State,

23 California, Texas, there's certain areas that have a

24 large footprint. So in order to put a level in at

25 between the region level and the local level with the


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1234

1 regional directors, John Valentine, John Karolzak, Todd

2 Jaramillo, is the regional COO.

3 So my responsibility is working with those

4 regional directors as they manage their business units,

5 both on the operational side, the clinical side, the

6 financial side. And then I have direct accountability

7 to Jeff McCollom, our regional CEO. And that rolls up

8 into the whole entire global Arizona operation as far

9 as all the accountability and reporting go. So I work

10 directly with Jeff and then in turn pass that down

11 through the regional director level.

12 Q. And Jeff McCollom, other than today, has been

13 here all week?

14 A. Yes.

15 Q. So let's -- I just want to clean up the

16 record a little bit. We're getting some exhibits into

17 evidence to flesh out ones that are already admitted.

18 The Director's final decision in the

19 Rural/Metro Arizona transfer, CON transfer, was

20 admitted as Life Line 5c, but it incorporates a couple

21 other documents that you really need to see the thing

22 as a whole.

23 So I'm going to ask you if you recognize Life

24 Line 5a as the stipulated proposed findings of fact and

25 conclusions of law submitted with the Department -- or


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1235

1 I'm sorry, with the Bureau?


3 Q. And then -- in connection with that transfer.

4 A. Yes.

5 Q. And then 5b, The Administrative Law Judge's

6 decision in that matter?

7 A. Yes.

8 MS. FICKBOHM: And I would move for --

9 even though they're public records, just to make things

10 easier, I would move for admission of Life Line 5a and

11 5b.


13 ALJ SHEDDEN: All right. 5a and 5b are

14 admitted.

15 BY MS. FICKBOHM:

16 Q. Next, Mr. Kasprzyk, Mr. McIntyre [sic]

17 referred to a document identifying the Arizona Fire

18 District tax rates, identification through the color

19 coding as to Districts that provide ambulance service.

20 And who put this document together?

21 A. So I put that document together. The Arizona

22 Tax Research Association on an annual basis has a book

23 that outlines all of the special district, political

24 subdivision tax rates; includes Fire Districts, School

25 Districts, et cetera. So I went through and compiled


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1236

1 all of the Fire Districts' tax information based on

2 that publication between 2014 and 2015.

3 MS. FICKBOHM: Move for admission Life

4 Line No. 9.


6 ALJ SHEDDEN: All right. Life Line

7 No. 9 is admitted.

8 BY MS. FICKBOHM:

9 Q. I'm showing you what's been marked as Life

10 Line No. 11, and can you tell us what this is?

11 A. So that is -- I subscribe to a local,

12 statewide, it's called the Arizona Daily Dispatch. So

13 it just provides information regarding fire service,

14 fire activities in Arizona.

15 That particular day, the article there,

16 "Groom Creek Fire District gets loan, will stay in

17 business" from the Daily Courier caught my eye. I have

18 a residence in Prescott, Arizona. Groom Creek is near

19 Prescott.

20 Just, you know, I think as previous

21 testimony by the consultant indicated some of the

22 issues with Fire Districts, and that, you know, was an

23 article that illustrates this local Fire District was

24 struggling and needed some infusion to be able to

25 continue to operate.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1237

1 MS. FICKBOHM: Offer Life Line No. 11

2 into evidence.



5 is admitted.

6 BY MS. FICKBOHM:

7 Q. Mr. Kasprzyk, I want to go sort of general to

8 specific.

9 Could you speak to the American Medical

10 Response Company's Arizona commitment to supporting

11 services in rural and wilderness communities?

12 A. Yes. So, you know, it even goes back to when

13 CON 136, when we had applied. At the point of AMR

14 assuming Life Line's operation in '13, '14, they had

15 the River Medical operation in 2008. And certainly a

16 lot of our state is vast rural area. We sometimes hear

17 "the state of Maricopa." No disrespect to that, but I

18 mean there's a lot of other parts of Arizona that come

19 into play, and I know the Bureau is very concerned, as

20 well as anybody, in those areas that there's a

21 commitment to have services available.

22 So AMR has, in previous testimony through

23 other hearings, asserted that commitment to maintaining

24 rural service, being a partner and a provider in those

25 areas; not only just from the basis of providing


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1238

1 ambulance service, but all of the infrastructure that

2 goes around those particular areas, to ensure that the

3 same standards of care, the levels of equipment are

4 available to those as they would be in Metro Phoenix or

5 Tucson. You can't delineate urban and rural. It's all

6 one and the same as it relates to the standards of care

7 and providing equipment and resources.

8 Q. Mr. Kasprzyk, in connection with this

9 hearing, did you check the growth, or lack thereof, of

10 population in Gila County as between the last two U.S.

11 Census figures?

12 A. I've reviewed that information.

13 Q. And in 2010, what was the population of Gila

14 County?

15 A. I believe 53,597 in --

16 Q. And then in 2015, it was?

17 A. I think 53,160-something, around those. It's

18 off a little bit, but it's close to that.

19 Q. So by looking at the U.S. Census data, do you

20 see growth in Gila County?

21 A. There was -- no. There was a delta, I think,

22 of 438 there, negative .8 percent. So I would say the

23 growth was flat and lost, certainly, a little bit of

24 population between '10 and '15.

25 Q. Referring to the Banner contract that's been


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1239

1 the subject of discussion here, just briefly, already

2 admitted as Life Line Exhibit No. 18, and understanding

3 that that contract has not yet been approved by the

4 Department. Assuming that it is approved or as

5 written, does that require CON 58 to use resources only

6 from CON 58 in order to satisfy the timelines for

7 arrival that Banner wants to see in Payson?

8 A. There's nothing specific in that contract,

9 whether it's CON 58, 71, 86, that says those assets

10 where a particular facility is are required to respond

11 with those unique assets from that CON.

12 Q. Mr. Ray spent some time exploring that rather

13 unique period of time starting in October of 2015, when

14 AMR signed the contract to purchase the stock of

15 Rural/Metro, between then and when the transfer of the

16 CONs from Rural/Metro-held entities to AMR actually was

17 approved by the Director.

18 Tell us when in October that the stock

19 purchase agreement was executed.

20 A. If memory serves me correct, October 28th,

21 plus or minus a day.

22 Q. And so just -- I'm just going to talk in

23 round figures. So in November and December of 2015 and

24 January -- and then we already have in the record that

25 the Director's decision in approving the transfers


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1240

1 occurred, I believe it was, on January 26 or 27th, very

2 end of the month, 2016.

3 So during October -- I'm sorry, November

4 2015, December 2015, January 2016, what was AMR's

5 ability to manage and control operations in those CONs?

6 A. So the ability was extremely limited. So

7 what -- let me back up.

8 So in Arizona, the way the CON statutes and

9 rules are written, it's very specific on how and who

10 operates. So albeit the corporate level transaction

11 occurred in October, which -- end of October, you had

12 an entity called AMR Holdco, which now was the new

13 parent to the organization. So we had to work with the

14 Bureau to get an authority to -- in essence, because of

15 that transfer of ownership, in order to keep the

16 certificate, in essence, operating by law, we had to

17 get a temporary authority, in essence, while we were

18 working through the application and transfer process.

19 So very specifically, at the top parent

20 level, yes, AMR Holdco, in essence, owned the

21 certificate at that point. We could not operate from

22 the front-line management level in Arizona because the

23 transfer in the management, as required to be

24 submitted, had not. So we, in essence, were operating

25 to some degree as AMR and Rural/Metro in Arizona


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1241

1 because the way the laws were.

2 So we had very limited interaction with their

3 management that was there. There was some sharing of

4 information, but specifically because that transfer

5 hadn't been completed and the way the law was, we were

6 just not able to assume direct control.

7 So they were continuing to operate as

8 business as usual. The same managers were there. They

9 were doing the same things that they had been doing.

10 And until that transfer was completed at the end of

11 January, then we were able -- because the management

12 change was now part of the certificate in the

13 application, then we were able to begin managing it

14 more at the local level.

15 Q. So when the Director approved the transfer on

16 January 27th, can you explain to the Judge and the

17 Director why it is that AMR didn't dive into Prescott

18 the next day on January 28th and immediately start

19 shaking things up?

20 A. Payson, I think you --

21 Q. Payson, Payson, Payson. Thank you.

22 A. So when AMR finalized everything here, we now

23 were responsible for an additional 13 certificates of

24 necessity in various areas throughout the state. We

25 started to then interact. We had a timeline.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1242

1 There were issues that were well-known, that

2 were ongoing previously with Rural/Metro. The

3 condition of the organization, some of the

4 relationships had been strained, and some more so in

5 other areas than others. So we began to systematically

6 outline our plan under my leadership and, at that

7 point, Leslie Mueller, our regional CEO at that

8 particular point in time, and Ted Van Horne.

9 So 30, 45 days to get that aligned and then

10 get into Payson, with the size and scope of the

11 operation, wouldn't be anything that would be out of

12 the ordinary. We had to prioritize issues. Certainly

13 Payson was on the list. We knew that -- I was aware of

14 the Hellsgate CON activity, certainly, as well as other

15 CON activity around the state prior to the Rural/Metro

16 bankruptcy.

17 So I needed to get a better internal

18 understanding from the leadership that was in place

19 with Rural/Metro what the dynamics were and the

20 environment in that particular theater of operation,

21 per se, and then, you know, work with John Valentine

22 and begin to go start working on relationships and

23 meeting and introducing ourselves.

24 Q. So the fact that Mr. Valentine didn't really

25 start digging into CON 58 in the Payson area until


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1243

1 March, does that mean that AMR had no ownership control

2 of CON 58 in the meantime?

3 A. None whatsoever. The same management team

4 that was operating that during the transfer window

5 period of temporary authority was still in place. So

6 there was dialogue. Mr. Valentine, Mr. Karolzak were

7 communicating with the local leaders there. At that

8 point I believe it was Wayne Clonts and Danny

9 Brumbaugh.

10 So there was interaction. It just -- it

11 takes time to get to every place in Arizona. And,

12 quite frankly, you know, having a good structured plan

13 is important. That's my leadership style, is to make

14 sure we know the facts, we kind of understand, and then

15 work to go in and start to figure out what we need to

16 make changes.

17 John was actively doing those things. Even

18 during that period of time, he had been tasked with

19 certain specific operating areas that were delegated to

20 him, and he was analyzing those, and then we were

21 communicating that up at our internal meetings.

22 Q. So effective with the Director's decision at

23 the very end of January through to Mr. Valentine diving

24 in in March, who was operating and controlling -- who

25 was in operational -- operating and controlling the


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1244

1 CON 58? Was it Rural/Metro or was it now AMR?

2 A. After the transfer it was now AMR, with the

3 leadership -- the existing leadership that was there.

4 So there was never a gap that people were pulled out

5 and it was left to hang. It just had to work through

6 the transfer process.

7 Q. But there was a new management at the top

8 level?


10 Q. So let's talk about your meeting with -- or

11 your attempts to meet with Chief Bathke.

12 MR. MEYERSON: I'm going to object. I

13 think the testimony is an attempt, not attempts.

14 ALJ SHEDDEN: Well, we'll -- I'll

15 overrule the objection, and we'll see what the

16 questions are, I guess.

17 MS. FICKBOHM: And I didn't mean to say

18 attempts. I did -- well, it will be what it is.

19 BY MS. FICKBOHM:

20 Q. Mr. Valentine said that you had the most

21 precise information on that and the time frame, so

22 since he was unable to answer counsel's questions,

23 could you provide that meeting with as much precision

24 regarding timeline as you have?

25 A. Sure.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1245

1 So one of the things that was important to me

2 was to reach out to the areas where after, you know, I

3 had a good understanding that there was some struggles

4 or some relationship challenges. So on April 5th I

5 sent an e-mail to Chief Bathke requesting a meeting

6 with him, I believe on April 13th. We had a planned

7 trip to go to Payson to meet the employees and then

8 meet with other folks as well, the hospital, Chief

9 Staub of Payson as well.

10 I had then asked Renee Sandberg, my

11 administrative assistant, to attempt a phone call. I

12 was traveling and wanted to get that meeting set up.

13 She had made two attempts over to the District to --

14 Q. You mean Hellsgate Fire District?

15 A. Hellsgate Fire District, as well as some

16 other, Chief Staub's office as well and Banner as well,

17 to get some meetings set up.

18 We got meetings established with Banner, got

19 a response from Banner. Chief Staub responded. He was

20 unavailable to meet on the 13th of April, so we

21 subsequently set up a meeting then on May 4th with

22 Chief Staub.

23 And we did not meet with Hellsgate. I didn't

24 get a response, whether by phone or by e-mail, to my

25 request to meet with Chief Bathke.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1246

1 Q. And was there any additional follow-up after

2 that, by you or your staff?

3 A. So when we met with Chief Staub on May 4th, I

4 had -- you know, subtly had asked that, you know, we

5 had reached out to Chief Bathke, and if he could help

6 facilitate a meeting. You know, I don't know if Chief

7 Staub did or didn't. I just asked.

8 I never heard back. So either the assumption

9 was he maybe forgot, he didn't, or he did and there was

10 no desire to meet. I don't know. But at that

11 particular point, since about a month had passed from

12 my original inquiry, it was apparent to me that there

13 was no desire. So we were going to continue then to

14 utilize our local leadership to manage those day-to-day

15 relationships.

16 Q. Mr. Valentine testified about the AMR

17 Maricopa resource response to the apartment complex

18 fire in early November of 2016. Can you detail from

19 your end your information about that and your role in

20 that?

21 A. Regarding the -- when Mr. Valentine contacted

22 me regarding that?

23 Q. Yes.

24 A. So within our organization, you know,

25 certainly when things occur, we want to know. And in


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1247

1 today's day and age, I think there's a big

2 hypersensitivity to large-scale incidents that are out

3 there.

4 So Mr. Valentine's team certainly got alerted

5 to that incident. He had contacted me that evening to

6 advise me of the situation, that there was an explosion

7 in a rural community, which certainly, in my mind,

8 living in Prescott for many years, when those large

9 incidents occur, resources just aren't there in

10 minutes. If you have to go outside your area, it takes

11 some time.

12 Based on the initial information, he felt

13 enough cause for concern to alert me. I alerted Jeff

14 McCollom and Ted Van Horne as well via text that

15 evening, to let them know that there was a potential

16 mass casualty situation in Arizona. They also like to

17 be apprised. And, you know, explained to John if there

18 was any regional resources that may have been needed,

19 that I was committed to helping him and facilitate that

20 from my level.

21 Q. I'm showing you what's been marked as Life

22 Line No. 24. Is that your signature?

23 A. Yes, that is.

24 Q. And this is a letter you wrote to the

25 Director of the Department of Health Services?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1248


2 Q. And who was this letter written on behalf of?

3 A. AMR of Maricopa CON 136.

4 Q. And this is stating that CON holder's

5 opposition to Hellsgate's CON?

6 A. That is correct.

7 MS. FICKBOHM: I would move for

8 admission of Life Line 24.



11 is admitted.

12 BY MS. FICKBOHM:

13 Q. What is the unique issue from AMR Maricopa's

14 perspective with regard to Hellsgate's application?

15 A. So the unique piece there is the one rural

16 area that 136, in essence, overlaps today with 58.

17 Should CON 58 all of a sudden not be able to operate

18 because of a shift in the market environment, you would

19 have an area that, in essence, now is one certificated

20 provider covering a very remote rural area with very

21 few calls.

22 So having the synergy of the overlapping

23 certificates as outlined gives the ability to have

24 resources, whether that be from 136 or 58, whoever

25 might be closer to respond to that. With, in essence,


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1249

1 a provider leaving and another provider not

2 overlapping, now solely relies on a small rural area to

3 have coverage from 136.

4 It wouldn't be a sustainable model to put a

5 resource in that area for such a small number of calls.

6 You rely on all your system resources. That's what

7 that situation creates.

8 Q. Hellsgate is saying now that it's willing to

9 go into that area. So doesn't that fix the problem?

10 A. So verbally you could say that we would be

11 committed to doing that; but if your certificate

12 doesn't necessarily provide that, you would have no

13 realistic obligation to go do that under your

14 certificate. You would do it as mutual aid then to

15 come in; and if you turned that down, you would have no

16 responsibility to respond to that because it's not

17 within your provider area.

18 Q. And did Hellsgate -- Hellsgate's initial

19 application include that area?

20 A. I believe it did.

21 Q. And did they deliberately carve it out?

22 A. It was amended to eliminate that area.

23 Q. Can you just summarize for us why you believe

24 that Hellsgate's application is not in the public's

25 best interest?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1250

1 A. So as many people in this room have been

2 through these hearings, some of them very lengthy, you

3 have a lot of time to reflect on testimony, things you

4 hear, reflect on the application, reflect on things in

5 general.

6 Why I believe that it's not in the public's

7 best interest is, one, AMR is part of Envision

8 Healthcare. We're an S & P 500 company with a

9 $7.7 billion market cap. We have the strength and

10 resources, not only locally, but nationwide to support

11 our operations.

12 When you look at what we've done in this

13 marketplace, around the country, from our clinical

14 practices to our capital investment to our commitment

15 to the leadership, it's very important to have that

16 strength behind you.

17 When you look at -- and no disrespect to the

18 Fire District. I agree with Mr. Valentine. They do a

19 good job doing what they do. But from my perspective,

20 taking on an endeavor that could potentially impact the

21 future state of your organization, potentially could be

22 detrimental to that community. And in every area --

23 and it's been stated before. If you've seen one

24 ambulance operation, you've seen one ambulance

25 operation. But it extends beyond that, from the point


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1251

1 of it's the system working together. And the system

2 that's in place in the greater Payson area is a good

3 system. Bringing in another provider to take calls or

4 do things is just not a sustainable operating

5 environment in a rural area.

6 I think albeit not necessarily well-outlined,

7 I think some of the things I've heard about some of

8 their operational models, potentially, as it relates to

9 resourcing ambulances with one personnel and leveraging

10 personnel off a fire resource, if I was a resident and

11 that was happening in my community, I would question

12 that, is what is the advantage of that, because if the

13 resource isn't available to make two people on an

14 ambulance, in essence, the ambulance from a

15 transport standpoint is ineffective. You can have a

16 provider that can maintain care, but you still need a

17 resource.

18 My opinion is that this will have a

19 significant impact on our organization. It will have

20 a significant impact on the community. I think it

21 would have a question on overall reliability of

22 resources, because there's a lot of variables that

23 having Hellsgate operate in that environment, I'm just

24 not so sure that they could sustain that for the

25 long-term.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1252

1 Our organization has committed to that area.

2 In Mr. Valentine's testimony, he outlined the capital

3 infrastructure. The things that we have changed in

4 that area are ongoing potential changes in that area.

5 And not only through that testimony today,

6 but in all of the previous testimony that I've provided

7 in any of the transactions related to the Rural/Metro

8 AMR acquisition, to me, is our organization's

9 commitment to be here, to be here in Arizona, whether

10 it's urban or rural.

11 You know, my goal is to work with communities

12 to provide the best level of service. If there's

13 opportunities for partnerships or changes in how things

14 are operating, in my opinion, we do that. We do that

15 every day.

16 And, more so, I think the other piece is we

17 have a very uncertain healthcare climate right now. We

18 just came out of an election. I think there's a lot of

19 uncertainty what will happen to national healthcare,

20 a.k.a. ObamaCare, how that will impact reimbursement

21 levels, how that will impact individuals in what type

22 of insurance coverage they have.

23 From everything that I've read, I do not

24 believe there will be a shift away from high-deductible

25 plans. I think we're going to continue to see those


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1253

1 potentially grow, which puts more of a financial burden

2 on an individual to pay for those services.

3 That's what AMR has, is that depth; and I'm

4 just not sure that Fire-based EMS, by definition, is

5 the same as Fire-based ambulance. And when you take it

6 down to the small scale in today's healthcare

7 environment, that whether it's Hellsgate or anybody,

8 that they have the depth and resources to manage that.

9 I don't believe that it's in the public's

10 best interest. I believe AMR, in my heart, is doing a

11 good job with CON 58, as well as the others, and we're

12 committed to maintaining that well into the future.

13 MS. FICKBOHM: Thank you, Mr. Kasprzyk.

14 I don't have any other questions.

15 ALJ SHEDDEN: Mr. Ray, do you have any

16 questions?

17 MR. RAY: Yes, I do.

18


20 BY MR. RAY:

21 Q. So, Glenn, the applicant has indicated they

22 will have four full-time ambulances to serve the CON

23 area, correct?

24 A. Correct.

25 Q. In your opinion, are those four full-time


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1254

1 ambulances sufficient to do all of the 911 calls and

2 interfacility calls that currently come out of the

3 proposed service area?

4 A. In a perfect world, if you could know every

5 call at every time and plan, you may be able to service

6 that area straight out with that number of ambulances.

7 But you can't. You will have situations that

8 will tax resources. You have to adjust for employee

9 issue. You may not have vehicles staffed. The reality

10 is, is you will always have a base demand that you

11 believe will service an area and a certain universe of

12 calls and a certain number of resources to meet that;

13 but that is not all-inclusive. Whether it would be

14 Hellsgate, Payson, AMR, Pine-Strawberry, you have a

15 base.

16 What we bring is the ability to flex, when

17 needed, to either ramp those resources up, preplan

18 deployment. And what that does is it allows the system

19 to be more efficient. It allows for fluidity in the

20 system. And it allows to be able to manage those ebbs

21 and flows when volume changes because of the

22 unpredictable environment of emergency services. To

23 say that a particular number would 100 percent of the

24 time service an area adequately, no one could say that

25 with full certainty.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1255

1 Q. So as a follow-up to your answer, you would

2 expect that, if granted the CON and if Hellsgate had to

3 make and meet all of the necessary calls and

4 transports, you would expect them to utilize mutual aid

5 or backup with other certificated providers?

6 A. Similarly as any agency would. You need

7 those resources available.

8 Q. Okay. What --

9 A. And if I could -- could I just expand one

10 second too on that?

11 Q. Sure, sure.

12 A. I think the important thing to realize is, no

13 matter how many providers you have in a particular

14 area, there's a certain universe of calls that exist.

15 By having more providers doesn't add more calls to the

16 system. Having more providers potentially adds more

17 cost to the system, with less number of calls available

18 to each provider.

19 So one of two things happens. Either both

20 scale to a level that it works. But it wouldn't be

21 financially efficient that way, because when you reduce

22 number of calls and reduce number of resources, it

23 doesn't proportionally change your expense, because you

24 have loaded expense in order to be able to have those

25 resources available. So either one would go and one


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1256

1 would stay and then one would have to change. But you

2 do have to rely on your partners.

3 Q. Okay. So, conversely, you currently have

4 three 24-hour ambulances in Payson operating for

5 CON 58, and you have a less -- you have an extra fourth

6 peak demand ambulance that's been added to the system,

7 correct?

8 A. Uh-huh. That's correct.

9 Q. Do those four ambulances that service CON 58,

10 are those enough ambulance resources to handle all of

11 the calls, 911 and interfacility?

12 A. At times, absolutely, because you have one

13 call, one ambulance. The reason why you have a change

14 in resource deployment is because change in call

15 volume, so you're managing your system efficiently.

16 Theoretically, if all the resources are there and

17 there's no calls, then, yes, you have enough resources.

18 Conversely, you may have more resources for that

19 particular moment of time.

20 You're basing your demand and operational

21 perspective on that universe of calls with the best

22 historical trends, to predict when volume will be

23 there, in order to meet the demand with the number of

24 resources you have deployed.

25 Q. Okay. I think Mr. Valentine testified that


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1257

1 when AMR took a deep dive into CON 58, that they

2 concluded it was understaffed, and they've added the

3 peak ambulance, the fourth -- I'm sorry, the fourth

4 peak ambulance and additional paramedic staffing and

5 overall staffing to meet the needs of that service

6 area.

7 I believe Mr. Valentine also testified that

8 they wanted to reduce the need for utilizing

9 valley-based ambulances for the number of interfacility

10 calls that were being taken from the Payson Hospital.

11 Is that fair?

12 A. That's fair.

13 Q. Okay. Does that fourth -- does the addition

14 of that fourth peak-hour ambulance accomplish that, or

15 is that going to be accomplished by the ambulance

16 contract that's currently pending before the Department

17 for approval?

18 A. Kevin, could you clarify that a little bit

19 for me, please?

20 Q. Sure.

21 So one of the stated goals of AMR in CON 58

22 was to reduce the utilization of valley-based

23 ambulances coming into Payson to run interfacility

24 calls. Agreed?

25 A. Agreed.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1258

1 Q. Is the addition of that fourth peak-time

2 ambulance enough to accomplish that?

3 A. No, because, again, there will be times when

4 the demand or interfacilities will go out, that you'll

5 require additional resources.

6 Q. Okay.

7 A. A majority of the operational time throughout

8 a year's period, yes, that will; but there will be

9 times that you will need more resources than what you

10 have there, for sure.

11 Q. Okay. And then as a follow-up to that, is

12 the need for those times when you have to have

13 additional resources in the system, is that going to be

14 met by the contract? And I believe it's the Life Line

15 18 --

16 MS. FICKBOHM: 18.

17 BY MR. RAY:

18 Q. -- contract that's been submitted. Is that

19 need going to be met by the pool of ambulances that are

20 committed to that contract?

21 A. Yes. So it's a global contract. So the

22 advantage that we have, I think, with this agreement

23 that's been testified to is having resources in the

24 Transfer Center in preplanning for future calls that

25 are going to come out.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1259

1 So one of the desires when we met with Banner

2 was to be able to, one, have visibility and preplan;

3 and then, two, on our side, to be able to match and

4 preplan for that demand.

5 So by virtue of the pending finalization with

6 the Bureau, it creates a relationship that better

7 serves the patient. And I think as we even testified

8 in the AMR of Maricopa hearing with our arrival times,

9 is we recognize the fact that -- and that's why there's

10 different levels, is, A, you will have an immediate

11 need sometimes to move a patient because of strokes,

12 STEMI, trauma. They may go by ground. They may go by

13 helicopter. Then you have windows to meet patient

14 movement. A lot of that timing also has to do with

15 throughput and process on the hospital side as well.

16 Q. Okay. As part of the discussions with Banner

17 and the planning for that contract, were you able to

18 estimate the number of times you would need the

19 valley-based ambulances to come into Payson to do these

20 overflow runs?

21 A. So one of the advantages when you have a

22 partnership at the hospital level like that is we're

23 now able to share data. So we're able to reconcile

24 what we were seeing as historical data from that

25 facility and what Banner was showing as historical data


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1260

1 from the transfer side.

2 It gives us the ability to better preplan

3 through routine meetings with the facility, individual

4 facilities and the organization Banner as itself as a

5 whole.

6 We took a lot of things into consideration,

7 when we established times and demand and locations, to

8 be able to account for that. So, yes, there were

9 certain factors that were put into our operational

10 implementation and discussion with Banner that we knew

11 now we could quantify, because we had two sets of data

12 to look at.

13 So, yeah, there is some factor that on a

14 preplan basis, if you're getting an hour and a half

15 advance notice of a transfer coming out, the dispatcher

16 in the Banner transfer facility can look at the

17 AMR-Rural/Metro TriTech CAD system and say, wow, it

18 looks pretty busy, and in Payson with 911 calls,

19 they're down to a certain level. We are now going to

20 move a resource into that to be able to maintain the

21 criteria that were established in that contract.

22 Q. Okay. And as part of that planning process,

23 I assume you've done some preliminary projections. Do

24 you know or have you projected how many times a month

25 you would anticipate that the overflow needing a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1261

1 Phoenix-based ambulance being sent up to the Payson

2 facility?

3 A. No. But I think Mr. Valentine testified that

4 that number has diminished significantly recently, with

5 the addition of the additional resource. That will

6 change from time to time, so there's -- with no

7 certainty to say at this particular date and time that

8 could occur.

9 I think the advantage is, is when you have a

10 partnership at the level that we have with Banner and

11 visibility into their whole system, allows us more time

12 to adapt to changing demand conditions, whether that's

13 in Payson, Metro Phoenix, Casa Grande, Tucson.

14 MR. RAY: All right. Thank you. I

15 don't have any further questions.

16 THE WITNESS: Thank you.

17 ALJ SHEDDEN: All right. Mr. Meyerson?

18 MR. MEYERSON: Yeah, just a few, Your

19 Honor.

20


22 BY MR. MEYERSON:

23 Q. I guess I'm going to cover a few things of

24 what -- you said a lot about what AMR does. I want to

25 make sure that you're not suggesting some things on the


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1262

1 flip side.

2 A. Sure.

3 Q. So you aren't saying that Hellsgate couldn't

4 flex or rely on its partners to address ebbs and flows

5 in volume, correct?

6 A. Not saying that.

7 Q. Okay. And you aren't saying that Hellsgate's

8 going to be rigid in their staffing model, correct?

9 A. No, no.

10 Q. On the population I just wanted to cover one

11 thing. Ms. Fickbohm went over the census data from

12 2010 and 2015, correct?

13 A. Correct.

14 Q. And I think you were -- you said there was a

15 decrease of approximately .8 percent in population?

16 A. If my math is correct. It was 438-ish, so

17 not quite a percent. I mean it's de minimis.

18 Q. Would you agree that the coming college and

19 associated businesses could increase population in the

20 near future?

21 A. Sure, potentially.

22 Q. You also mentioned the southwest corner of

23 CON 58, the area that has been excluded from the

24 proposed CON area, and you heard -- you mentioned you

25 heard Bathke, Chief Bathke, testify that they would


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1263

1 respond into that area, correct?

2 A. Correct.

3 Q. And you mentioned that there was no

4 obligation to cover, and that's a little bit of a

5 concern, correct?

6 A. Yeah.

7 Q. That is a -- that's one of the concerns?

8 A. Sure. I mean if you don't have an area in

9 your certificated area, you don't have an obligation to

10 necessarily respond to that. I mean that's not, you

11 know, your area that you would define as responsible

12 for.

13 Q. And you would agree that that's the same way

14 that the current provider doesn't have the obligation

15 to respond to the calls to the east of CON 58, as

16 admitted in evidence here?

17 A. Can you expand on that area?

18 Q. Yeah, I can pull up --

19 A. Show me your map?

20 Q. Yeah, absolutely. Let me --

21 A. Yeah, just so I can see that. Thanks.

22 Q. Yeah, let me pull up the -- and I don't

23 recall which Life Line exhibit that is.

24 MS. FICKBOHM: 17 --

25 MR. MEYERSON: 17? Thank you.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1264

1 MS. FICKBOHM: -- b, b.

2 MR. MEYERSON: b?

3 BY MR. MEYERSON:

4 Q. This lists the number of calls that CON 58

5 provider has responded to in a noncertificated area.

6 So the no obligation to cover is much the

7 same way as CON 58 has no obligation to cover in this

8 area as well, correct?

9 A. Absolutely.

10 And I think, you know, if I can just caveat

11 that, is I think there's a moral obligation, right, if

12 a resource is available, to go help somebody in need.

13 But in the purest form, to the letter of the

14 law in your metes and bounds, one would say if you got

15 a call and you have a specific certificated area, I

16 need you to come to Camp Verde to take a call, you

17 could, but you would have no obligation to necessarily

18 respond.

19 Q. Agreed.

20 A. Yeah.

21 Q. You're not, also, saying that small Fire

22 Districts can't operate successful ambulance services

23 in rural areas?

24 A. I think when you look at the ARCRs, I think

25 small Fire Districts -- I think Fire Districts in


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1265

1 general struggle with an ability to not have ambulance

2 operations supported by, in essence, the Fire general

3 fund per se.

4 Do they struggle in the purest form

5 operationally? They may; they may not. From the

6 financial and fiscal health side of it, I think it's

7 pretty well-documented that most of them operate at a

8 loss and require other support to do that, financial.

9 Q. But there are examples in Arizona of Fire

10 Districts in rural areas operating profitable and

11 successful ambulance services?

12 A. If memory serves me correct, I believe there

13 were only two Fire Districts, Rio Rico and Golden

14 Ranch, that showed a positive bottom line on their

15 ARCRs.

16 Most of them operated at a deficit. But,

17 again, operationally, that doesn't necessarily say that

18 they don't know what they're doing. They just require

19 other financial support to maintain the ambulance

20 service.

21 Q. Okay. Thank you.

22 MR. MEYERSON: That's all I have.

23 Sorry. That's all I have.

24 ALJ SHEDDEN: That's it?

25 MR. MEYERSON: Yeah. Thank you.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1266

1 ALJ SHEDDEN: All right. Ms. Fickbohm?

2 MS. FICKBOHM: Nothing more.

3 ALJ SHEDDEN: Nothing more?

4 Mr. Ray? No?

5 All right. Thank you, sir.

6 MS. FICKBOHM: That's the conclusion of

7 our case, Your Honor.

8 ALJ SHEDDEN: All right. Let me just

9 ask both DHS and Hellsgate at this time, or each of

10 you, is there anything else, evidence from either

11 party?

12 MR. MEYERSON: Not for us, Your Honor.

13 MR. RAY: Not from the Bureau either,

14 Judge.

15 ALJ SHEDDEN: All right. Then let's, I

16 guess, see where we're going to go from here.

17 MS. FICKBOHM: Shall we go off the

18 record, or no?

19 ALJ SHEDDEN: Well, maybe when we get to

20 some specific scheduling; but I'm assuming just the

21 conversation we had before not taking lunch, that there

22 is some sort of agreement to submit written closings?

23 MS. FICKBOHM: Yes.

24 ALJ SHEDDEN: Okay. And do you have

25 dates worked out for that, or not?


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1267

1 MS. FICKBOHM: I think we do.

2 MR. MEYERSON: Yeah, I would agree.

3 ALJ SHEDDEN: All right. Do you want to

4 give those? Do you want to go off the record and talk

5 about it and then give them?

6 MS. FICKBOHM: Can we go off the record

7 for just a second?

8 ALJ SHEDDEN: All right. Why don't we

9 do that.

10 (An off-the-record discussion ensued.)

11 ALJ SHEDDEN: All right. We're back.

12 Go ahead.

13 MS. FICKBOHM: We're in agreement to do

14 simultaneous submission of closing statements and

15 proposed findings of fact and conclusions of law on

16 Tuesday, February 14th; and then just a responsive

17 briefing, not another round of findings of fact and

18 conclusions of law, just responsive briefing on

19 March 7, which is also a Tuesday.

20 ALJ SHEDDEN: All right. And that

21 certainly works for me. The thing I'll let folks know

22 is that from my perspective, you know, submit whatever

23 you want, and there's no obligation for any of you to

24 do so, and perhaps particularly from the response

25 perspective.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1268

1 And then if I'm not mistaken, some of

2 this is predicated on January 9 the transcript being

3 ready, correct?

4 MS. FICKBOHM: Correct.

5 ALJ SHEDDEN: All right. And let me --

6 well, let me just see, is there anything else from your

7 perspectives about that scheduling that I should know?

8 MS. FICKBOHM: I don't think so.

9 ALJ SHEDDEN: No. All right, I'll get

10 an order posted covering that.

11 The things from my perspective, I guess,

12 would be that, one, just getting the transcript posted

13 up to the internet is the only obligation that you

14 have. And I want to be crystal clear about that. It's

15 always nice if I can get a paper copy with the four up.

16 It's a little easier to work with. And to be crystal

17 clear, nice; not required. And I understand that that

18 kind of stuff costs money. So I'll just leave it at

19 that.

20 The other thing that I would request

21 from you is that in addition to posting to the internet

22 your proposal, your findings, your arguments, if you

23 could file electronic versions in Word. I don't

24 often -- you know, sometimes it's good just to be able

25 to cut and paste and work that way. But, again, not a


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1269

1 requirement; but it can be helpful, particularly, I'll

2 let the Department know, when you have long

3 descriptions, for example, of the service area or

4 whatever, given my speed at typing, and there's an

5 accuracy issue, certainly, on those kind of things.

6 But, again, definitely not required.

7 Finally, the uncertainty comes in as

8 well as, you know, how quickly I'll be able to go

9 through all this. And, you know, always I start with

10 the intention that, boy, when those first ones get

11 here, I'll jump right on that. And, unfortunately, you

12 know, either other stuff gets in the way or I just

13 don't live up to it.

14 So what I'll be doing is not setting a

15 conclusion of the hearing date, would be the technical

16 requirement from the Revised Statutes and/or our rules,

17 and will try and keep you posted. But I would expect

18 that, you know, we would be looking at some time out

19 after those last dates to really get my decision done.

20 I know in the past when I've lagged on

21 this, you know, little reminders come via either, you

22 know, a filing or phone call or posting on the

23 internet. And I understand your clients are spending a

24 lot of money and want to get results, and so if you

25 feel I've lagged too long, you know, it won't hurt my


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1270

1 feelings. And if you do, I'll get over it, rest

2 assured.

3 So any thoughts or questions about that

4 or concerns?

5 MS. FICKBOHM: And -- no. We can talk

6 about the paper copy after.

7 ALJ SHEDDEN: All right.

8 MR. RAY: So, Judge, as I understand

9 what you've just said, you are not going to officially

10 close the record on March 8th.

11 ALJ SHEDDEN: Right.

12 MR. RAY: Okay.

13 ALJ SHEDDEN: Right. And I've switched

14 my terminology on this because, really, you know, what

15 the statute calls for is, conclusion of the hearing,

16 20-day time frame starts to run. The statutes don't

17 say when the hearing concludes, but the rules, our

18 rules, talk about when it concludes, and there's a

19 number of opportunities in there, including whenever

20 the ALJ says it does. And, of course, you know, I --

21 without knowing what's going to be filed, and there's

22 always that risk. And, you know, I favor the thorough

23 approach, rather than fast, is sort of my personality,

24 but -- so that answers your question?

25 MR. RAY: That's fine. Yes. Thank you.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1271

1 ALJ SHEDDEN: All right. And I know

2 from what Ms. Fickbohm said about the paper copy,

3 again, you know, trust me, I mean I can print up paper

4 copies. I can print what comes in. You know,

5 sometimes they come with the different versions as

6 well.

7 But the other thing I'll let you know

8 is, I'll be working to make sure our staff gets on the

9 internet our exhibit list fully posted showing a final

10 version of what's been admitted, what has not been

11 admitted. Again, if you see what you perceive to be

12 errors in there, let me know in some way or hash it out

13 among yourselves and let me know, and we can get that

14 corrected.

15 Finally, I believe all four days that

16 we've had already, perhaps not the fourth day, the

17 audio will already have been posted up there. I've

18 requested that, and I will request the fifth day and

19 the fourth, if not, to be done before I leave today as

20 well.

21 So in theory, sometime Monday that

22 should be available via the internet with a link. And

23 if you don't know, you need a little plug and play

24 Olympus thing to get those to play anywhere, but that

25 can be downloaded from our website.


2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1272

1 So let me ask, are there any other

2 questions, comments or concerns that we should address?

3 All right. I'll remind everyone again

4 about the evaluations. Strictly voluntary, but our

5 Director does appreciate your comments, questions or

6 concerns, good, bad or ugly, I guess, that -- you know,

7 and the best use of that is if there are deficiencies

8 in our process that he can be aware of to try and fix.

9 So with that, I'll thank you all for your time.

10 (The hearing concluded at 12:41 p.m.)

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2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1273

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 3rd day of January, 2017.

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


Documents

2017A-EMS-0006-DHS VOLUME 5 12/16/2016 1 BEFORE THE … · 12/16/2016 · 2017A-EMS-0006-DHS VOLUME 5 12/16/20161124 1 ALJ SHEDDEN: All right. Are there any 2 other questions or