BACKGROUND

There wasn’t a whole lot of attention being paid to the Request for Proposals (RFP) Manchester issued for emergency ambulance services, even though the process was initiated because Fire Chief James Burkush refused to exercise the city’s option to extend the current contract with American Medical Response (AMR); a result of significant billing errors that caused the company to refund nearly half a million dollars in over charged fees.

The chief and some aldermen, notably Alderman at Large Dan O’Neil, wanted a new provider, condemning AMR not only for its billing practices, but its high costs and poor response to the city’s concerns.  O’Neil even threatened to bring the matter to New Hampshire’s Attorney General for possible criminal investigation.  O’Neil, himself, claimed to be a victim of the billing practices, noting difficulties resolving bills received after an ambulance call for his wife.

Mayor Ted Gatsas personally intervened, forcing the company to establish a local customer service center that would assist citizens with their bills, rather than have to make sense of a process governed by the company’s billing center in Ohio, which had failed to resolve the complaints.  He demanded that AMR come to terms with Anthem Blue Cross Blue Shield of New Hampshire to resolve issues stemming from AMR’s not being contracted service provider.

It wasn’t until Girard at Large received this June 10, 2013 letter from Harold A. Shaitberger, General President of the International Association of Fire Fighters (IAFF) on June 16, 2013 that anybody started to pay attention to what was happening with the ambulance RFP.  We ran this story in our newscast and started the discussion in this segment.

Shaitberger alleged that this April 30, 2013 letter sent by Falck USA President and CEO Boo Heffner to David Lang, President of the Professional Fire Fighters of New Hampshire, was included with American Ambulance’s (American) bid proposal in an attempt to manipulate the committee evaluating the bids.  As we learned from a source during our first report on June 17th, that the letter from Heffner was not included in American’s bid packet.

So, where did it come from?

THE INVESTIGATION BEGINS

We obtained Heffner’s letter to Lang from a member of the bid review committee and became both curious and confused.  The letter wasn’t included with American’s bid and did not imply IAFF support.  It was introductory and focused on dispelling the notion that Falck was interested in privatizing fire departments.  It stressed cooperation with IAFF personnel in communities in which they work together and provided personal references for Heffner that would attest to the disinterest in managing fire departments and desire to have cooperative relationships.  There was no inference, whatsoever, that the references supported the company or its Manchester proposal.

I called Chief Burkush.  He said there’d been a lot of firehouse chatter about American’s parent company wanting to privatize fire departments.  He’d asked Deputy Chief Nick Campasano to see if he could get some information to clear it up one way or the other.  Heffner’s letter to Lang, he said, was sent by American in response to Campasano’s request.  Burkush said he considered the whole issue irrelevant to the  bid process and put the “in his top drawer.”  He also said he was unaware that Campasano had distributed it to the committee.

In a meeting with Burkush, Campasano and Deputy Chief Dan Goonan the next day, Wednesday the 19th of June, Burkush would have a different version of events, agreeing that Campasano presented Heffner’s letter to the committee, separately from the bids, and explained what it was, how he obtained it and why it was being distributed.  Other committee members confirmed that happened.  Once explained, they said, they thought the issue was done.

Lt. Brian Paquette, a supposed member of the committee (more on that later), didn’t think so.  During the committee’s interview with American, he accused company officials of including the letter with their bid and lying about their references, noting that several had said they didn’t endorse the company or its Manchester application.  Paquette was absent during Campasano’s presentation and the letter had been included in a packet, along with the bids and other hand outs, and given to him at a later date.  Campasano, confirmed by Burkush and Goonan, said he corrected Paquette about whether or not the letter was part of the packet and apologized for any confusion.

Before accusing American of deception, Paquette had notified Lang of the letter’s “inclusion” with the bid packet.  Lang, in an interview with Girard at Large, expressed  anger that the “private letter” sent to him was released to the committee.  He accused Heffner of writing to him so it could be “leaked” for PR purposes.  He admitted he knew it had nothing to do with American’s Manchester ambulance bid.

“So, if it had nothing to do with the Manchester Ambulance bid, why did you bring it to the national’s attention and ask them to intervene” I asked.  He said it was because the references didn’t check out and the letter involved multiple IAFF parties.

“Were the references asked whether or not they supported America’s application, or were they asked if they knew Boo Heffner and could attest to the content of the letter?”  Lang didn’t know, but he emphatically challenged the assertion that Falck USA was disinterested in privatizing fire services, noting a company named Wackenhut, which he wrongly said was owned by Falck, had tried to privatize Dover’s fire department many years ago.  Lang was clear, neither he nor the IAFF at any level wanted American to win the Manchester contract or any contract because of this.

“Why would the national accuse them of including your letter as a reference it when you know they didn’t?”  “Read the letter again,” he said.  “It doesn’t say American did it.  It said it was included.”  He was right.  While worded to lead one to that conclusion, it didn’t say that.

Lang took aim at Campasano’s objectivity, accusing him of giving a reference for American in its Somersworth proposal.  “Are you suggesting that Nick is trying to torpedo his own chief,” I asked.  “Why else would he give a reference for American in Somersworth and recommend them in Manchester?” was the reply.  “I’ve known Nick for a long time, I don’t believe he’d torpedo his own chief.”  “I don’t share that belief,” said Lang, twice.  Lang was also critical of Campasano for distributing news articles that had been critical of AMR, a further indication of bias, he said.

The facts, as you will soon see, were different.

THINGS GET INVOLVED

Heffner said he’d sent the letter to Lang because he’d heard that a letter was going from Local 856 to Burkush endorsing AMR’s bid because of the privatization issue.  He said he “immediately called and emailed Lang” to introduce himself and put to rest any worries that the company was interested in managing fire departments.  He said Lang failed to respond to any of his inquiries.  As a result, he sent the letter of introduction requesting communication, addressing the concerns and providing personal references.

Lang and Burkush, were critical of the references because they allegedly weren’t supportive.  Neither of them could answer what was asked of the references.  Heffner admits he didn’t give the references a “heads up,” but insists it was the right way to approach it.  “If I’d told the people I listed to expect a call,” he said, “they’d say I stacked the deck.”  He didn’t know what questions were asked of the references, but said that many of those  he’d followed up with were being pressured by the national and wanted to stay out of the controversy.  Read the emails disavowing Heffner carefully, just like Shaitberger’s letter.  At least one of the references, Mike Brown, Executive Director of the Washington Fire Chiefs Association, remained supportive.

Heffner strongly disputed statements Burkush made to Girard at Large regarding America’s alleged absence of 911 response and billing experience.  Burkush had said, both publicly and to Girard at Large, that he was “unable” to find sufficient references from chiefs who could attest to their abilities in either activity.  Burkush further stated there was a difference between billing for 911 services and non-emergency transport.

“Did he call our references,” Heffner asked.  At our request, he sent a listing of communities in which subsidiary companies of Falck USA both provide and or bill for 911 ambulance services.  “We’re the third largest ambulance company in the United States,” said Heffner.  “We know how to send bills and we’ve never had any problem with that, unlike AMR who has them all over the country.”  Heffner said if they win Manchester’s bid, they will establish a local customer service office because they like to handle things locally.

When confronted with Heffner’s statements, Burkush clarified that he meant there wasn’t much locally in New England and that Falck was doing business under different ambulance company names and that those companies “aren’t American.”  American, which was acquired by Falck in 2012, is a major Florida based ambulance company, which started in 1964.  American expanded into New England in 2011 with the acquisition of Mercy General/Samaritan Ambulance of Boston , which was a 12 year old 911 provider at the time.  They are currently an official back up 911 responder for Boston and transported eleven victims of the Boston Marathon Bombing.  Falck separately bought Cape Cod Ambulance, a company with more than 30 years in the emergency ambulance business.

NOW THAT YOU KNOW ALL THAT…

…the real controversy begins.

Despite howls of protest, threats to go to the Attorney General’s Office and a refusal to extend the contract over the billing issues, Burkush recommend the city award the new contract to AMR at the June 17 meeting of the Committee on Administration and Information Systems.  O’Neil agreed.  Both said the issues had been resolved, the quality of care was good and the ad hoc committee reviewing the bids failed to reach consensus.  The chief made the case that it was in the best interest of public safety to stay the course.  He didn’t want the city to go through the disruption of a transition if the problems had been solved.

That was a reversal of course that caused people’s brains to warp.

With documents that Girard at Large obtained prior to the committee meeting and posted here and discussed here, Ward 4 Alderman Jim Roy, a retired firefighter and member of the ad hoc ambulance review committee, “went nuclear.”  He pointed out irregularities in the bid process, questioned whether or not AMR’s bid should have been rejected for failing to disclose required information and shared draft minutes that had been “scrubbed” of committee members’ expressed preferences.  He defended American by noting they did not include the letter to Lang with their bid and boiled the issues down to union interference in the process.

He also questioned why Burkush sought and obtained AMR’s agreement to lower the rates it proposed to match those offered by American before making his recommendation to the committee.

In discussion with Girard at Large, Burkush admitted talking with AMR, but said there was nothing improper.  He noted it wasn’t a “bid” per se, but a request for professional services which states that negotiation is allowed.    He’s right about that, but did he speak with all bidders to negotiate improvements in their proposal before making his recommendation to the  committee?

No, and the other companies protested loudly.  Rick Doherty of CarePlus, the often forgotten bidder, reacted to our reporting Burkush’s assertion that his company was disqualified in part because it failed to agree to the non-negotiable “dispatch fee” was wrong.  He sent an email explaining they first wanted justification of the fee to ensure it would comply with “federal anti-kickback laws” and that once satisfied they committed to that fee and sent a letter confirming this commitment, among others.

HERE’S WHERE IT BECOMES DECEPTIVE AND STORIES FALL APART

At the meeting with Goonan and Campasano I asked Burkush why he was willing to disqualify CarePlus for its failure to agree to the dispatch fee in the bid, but not willing to disqualify AMR for its failure to disclose a termination, that it had a “Corporate Integrity Agreement” with the Office of the Inspector General of the federal Department of Health and Human Services and had walked away from contracts in several communities.  The bid required disclosure and threatened rejection of proposals that were “unsatisfactory” in any of the listed categories.  Burkush said he was unconcerned because the termination and walkaways weren’t adversarial, they were mutually agreed to and that the “CIA” was with a New York subsidiary of the company, not the Massachusetts based subsidiary that was bidding on the contract.

“But Chief, the RFP didn’t say anything about disclosing ‘adverse’ situations and it allowed for explanations of anything disclosed.  If it wasn’t going to hurt the company, why not disclose it?”  Burkush was satisfied with the information he’d received, didn’t think any of the bidders met the specs perfectly, and said that I should check with Chris Stawasz of AMR if I wanted further detail.

I did.

Stawasz echoed what Burkush had said, but went further.  He asserted that communities they walked away from in Massachusetts, Newburyport, Salisbury, and West Newbury were the result of failed union negotiations that made it impossible for them to serve those communities.  The towns released them.  (Judge for yourself)  Plymouth, he said, was worried that “they might be next” and didn’t want to renew the contract, which was at the end of its term.  It had nothing to do with their performance in the community, he said.  Because none of it was adverse, he asserted it didn’t need to be disclosed.  When challenged on the wording of the RFP, he said it was “generally understood in the industry” that communities were looking for adverse circumstances.

The Corporate Integrity Agreement, he said, “didn’t apply to AMR of Massachusetts, Inc.” the company bidding on the contract, because “it was specific to the subsidiary in New York,” and therefore it didn’t need to be disclosed.

He also criticized America for complaining about Burkush asking AMR to match their rates.  “They did the same thing to us in Somersworth to win that bid,” he said, accusing them of a double standard and tagged Campasano as a tainted player in the game for recommending  American’s proposal in Somersworth.

After speaking with Plymouth Fire Chief Ed Bradley, Somersworth Fire Chef Keith Hoyle and City Manager Bob Belmore, and the Office of the Inspector General at HHS, it became clear:  None of what Stawasz said proved to be true.  None of it.

Chief Bradley said there’d been eighteen difficult months with AMR leading to their exercising the contract termination clause.  At the time of termination, there was still a full year left on the contract.  The final straw, said Bradley, was the departure of regional manager Brendan McNiff.  “He was the only one holding things together,” said Bradley.  “He did a fantastic job and was very responsive to us.”    Bradley said AMR was losing revenue from their transport business, their service was going down, they had to call in mutual aid more often from other towns, they laid off their area supervisors and customer service staff, and McNiff’s replacement, Todd Walker, was a disaster.

“When McNiff left, every chief in Massachusetts that had AMR’s ambulance service took notice,” said Bradley, who highly praised McNiff; praise he said he shared with Burkush.

Burkush, Stawasz and others had said that McNiff and his staff were the cause of the billing problems in Manchester.  When pressed (well before my interview with Bradley) on how McNiff could be responsible for Manchester’s billing problems given that AMR’s billing problems were nationwide and that it handled billing from a national facility in Ohio, Burkush shifted his critique, saying McNiff “wasn’t responsive.”

The “CIA” applies to AMR and “any and all of its subsidiaries and affiliates,” said multiple people in the OIG .  That includes AMR of Massachusetts, Inc, which clearly identifies itself as an affiliate in its bid proposal.  Girard at Large has learned that every manager within AMR, including the subsidiary bidding on Manchester’s contract, is required to attend mandatory annual training for compliance with the CIA and is issued a certificate like this one annually as proof of successful completion.  For obvious reasons, this source will not be revealed.  However, according to this source, Stawasz knows AMR of MA, Inc. is subject to the CIA and will have a certificate just like this that proves it.

Chief Hoyle and City Manager Belmore say “not true” to the allegation that they asked American to match any of the items in AMR’s bid after their presentations.  They said the presentation given by American reflected its bid and there were no changes to its billing rates.  Charlie Mayman of American said during their presentation, they were asked some about some minor issues, like if they’d allow Somersworth personnel to participate in their trainings, to which they said “yes,” but they agreed they were never asked to alter their proposal to “match” anything offered by AMR.

As was Chief Bradley in Plymouth, Chief Hoyle  was complimentary of McNiff’s performance in Somersworth.  Also like Bradley, he was critical of various AMR “corporate” decisions.  In Somersworth, he said the upper echelon was unhappy with the “low utilization rate” of the emergency response ambulance, so they used it to transport non-emergency patients frequently, resulting in the city having to call in “mutual aid” ambulances from Dover about twice per week.  He said there was nothing they could do about it, though as they were meeting the terms of the contract.  Holye praised American for its professionalism in its presentation and its handling of the transition, which went live last week.  “They hired really good people,” said Hoyle, noting that several of American’s hires came from AMR’s staff.  The transition, he said, went well.

He also debunked the charges leveled by Lang and Stawasz that Campasano had provided a reference for American.  As far as Hoyle was concerned, the reference given was a “professional reference for a member of the management team.  It says so right here,” he said referring to this document.

In addition to the walkaways and terminations admitted to, though not disclosed,  there were multiple others not mentioned.  Stawasz made issue of six of them in 2010 when, as Executive Director of Rockingham Ambulance, he was fighting to retain the city’s contract.  Here’s a news article from the Eagle Tribune on the withdrawal and here are the minutes of the Committee on Administration meeting discussing it (check the highlights of how O’Neil was in favor of the committee’s recommendation, how the EMS Medical Director’s recommendation was pivotal, why the chief, who is now worried about the newcomer’s ability to handle a “mass casualty event” wasn’t worried when union shop AMR was on the way in, and why transition wasn’t a big deal, which it now is, of course).

BTW, here is an additional listing of ALL terminations and walkaways that should have been disclosed under the RFP.  It’s truly shocking how much they left out.  Remember, the RFP didn’t limit disclosure to 911 terminations and walkaways.  It asked for any and all.

THE CONVERSION OF BURKUSH AND O’NEIL TO AMR

Two words:  Union politics.

As said at the beginning of this post, awareness changed with Shaitberger’s letter to Burkush and O’Neil.  Danny O’Neil, ever one to do any union’s bidding sent this email the day he received the letter.  Consider this the frosting on the cake, though.  The impetus that changed everything was this email sent by Local 856 President Jeff Duval on April 20, 2013.  He clearly state their preference for AMR after the news that Somersworth’s city council voted overwhelmingly to change from AMR to American and cite the non-existent ownership of private security and fire service company Wackenhut by American’s parent company Falck as the basis for their support.

It was that email and the uproar it caused that Heffner was responding to in his letter to Lang.

Just one day after receiving Shaitberger’s letter, on June 11th, Burkush spoke to Stawasz and asked AMR to lower its prices to meet American’s.  It was a big difference, as this Vendor Rate Comparison shows.  Our sources say the two met in person, however, both would only admit to a phone conversation.

Following the meeting on June 13, Deputy Campasano circulated draft minutes in an email asking for feedback prior to finalizing them.  This thread of messages is interesting for several reasons.  Health Officer Tim Soucy and Medical Director Tom D’Aprix, both agreed they were an accurate reflection of the meeting.  Burkush, who stated Campasano got it wrong when he wrote there was “MFD personnel in attendance who were not committee members but voiced their support for AMR” didn’t mention that in his email.  He simply indicated the “votes” should be removed as there was no consensus.  Former 856 President Ryan Cashin said he “believed” that the unnamed attendees, Lt. Brian Paquette  and firefighter Paul Brassard, were members and the minutes should reflect that.  Odd thing about this “belief” is that for the dozens of emails and the other documents identifying committee members, not once was there ever a mention of Paquette or Brassard as members or an email sent to the committee that included their names.  Their two “votes” in favor of AMR, along with the chief’s recommendation in their favor made it “a tie” on the committee, therefore there was “no consensus.”

Questions remain as to why Burkush, before all other discussion in the meeting of June 13, stated his preference for AMR and stated that’d he’d secured their agreement to lower their patient pricing before the meeting.  (He told Girard at Large that he’d done so anticipating the aldermen would ask him to do that because of his recommendation.)  In this March 11, 2013 letter to Committee on Administration Chairman Phil Greazzo, Burkush notes he expected the committee to make a formal recommendation.  Yet, he sent this email to the clerk’s office, on June 11 saying the committee would send an “informal” recommendation  and he would send his if it was different; just one day after Shaitberger’s letter.

Not reflected in those minutes, but confirmed by Burkush, Campasano, Goonan, Alderman Roy, and every other member of the committee I spoke to was a statement made by Cashin that he and the union supported AMR’s proposal “in solidarity of with their union brothers” (AFSCME) who worked there.  It’s hard to ignore that everybody in the room supporting AMR’s bid was either a member of Local 856 (Cashin, Brassard, Paquette) a former member of 856 (Goonan, Burkush) or a never questioned supporter of 856 (O’Neil).  Campasano was the only former member of 856 and fire service person to stand with another bidder, which has earned him intense ire.  All the others in the room, to a person, supported AMERICAN’s bid.

The other mystery here is why Burkush wanted to ditch the use of the evaluation sheets.  He said they’d be “too subjective.”  However, in the RFP, the rating system by which the bids were to be evaluated was clearly spelled out, so why the “informal discussion?”  Is it any wonder Mayor Gatsas received a letter from American’s attorneys reminding it of the proper process and a lost law suit over a similar situation with an ambulance contract bid in 1993 which the city lost?

LOST IN THE MIX–QUALITY OF CARE AND CUSTOMER SERVICE

Dr. Tom D’Aprix, the city’s medical director overseeing the ambulance service said something that needs to be addressed.  He noted that the quality of ambulance care in the city has “improved dramatically” since AMR took over from Rockingham Ambulance.  “It’s true,” he said.  “The quality of care is good.  The other half of that statement that some like to quote me as saying is that the management team that improved the quality of care is the management team that left AMR and went to American Ambulance.”  It should be noted that the management team at AMR was the management team at Rockingham, the ambulance company whose service was improved upon and the ambulance company that also got slapped with a Corporate Integrity Agreement in 2008 for overbilling.  They paid nearly $1 million in fines for overcharging Medicare.

CONCLUSION

Clearly, AMR withheld information about contract terminations and walkaways that would have cause the bid to be rejected.  They answered “highly advantageous” in their bid on this question and said they’d had no issues.    They also answered “highly advantageous” regarding regulatory actions and said they had no issues.  When confronted about the information, Stawasz simply lied.

 If the city is to play by the rules it set, if the process is to have integrity, if the public is to have confidence, AMR’s bid must be disqualified.

Several people have expressed their concern, even dismay, at how union issues have driven this process.  Given the incontrovertible proof that AMR’s bid should be disqualified, it’s hard to see how Burkush’s recommendation can be see as anything but a move to keep Local 856 happy.

Given the facts, there doesn’t appear to be any other reasonable conclusion.

Note:  For as long as this article is, there’s more, much more, but even I have time and space limits.

Thanks for tuning in.