Ambulance N.B. asks Medavie to renegotiate contract over response times

Ambulance New Brunswick says it aims to reopen its contract with its private-sector service provider to address response times in rural areasthat chronically fall short of provincial targets.

Officials told the legislature's public accounts committee that they are talking to Medavie Health Services New Brunswick Inc. about exemptions to the response-time targets and the formula that determines if ambulances are "on time."

"We've initiated those discussions with Medavie for the purpose of negotiating the contract," said Ian Watson, chair of the board at Extra Mural/Ambulance New BrunswickInc., the provincial entity that contracts with Medavie for ambulance services and extra-mural care.

Last year officials told the same committee that there had been no moves to renegotiate the contract, which was the subject of a scathing report by the province's auditor general in 2020.

That report found that low on-time response rates in rural areas do not count against payments to Medavie because those calls are averaged into broader regional numbers that included a far greater number of on-time responses in urban areas.

That produces an overall number that looks good on the surface.

"The issue arises when there are bonus payments being paid out for meeting contractual obligations," Moncton Centre Liberal MLA Rob McKee told the Ambulance N.B. officials Wednesday.

"But when you do look community by community, some of those communities aren't meeting the targets or getting the service they should be getting."

Under the contract, Medavie, a private company that operates the ambulances, must be on time for calls 90 per cent of the time.

"On time" is defined in the contract as within nine minutes in urban areas and 22 minutes in rural areas.

Low on-time response rates

Figures for 2022 show Ambulance N.B.hit its on-time targets 93.5 per cent of the time in urban areas and 88.5 per cent of the time in rural areas.

But the figures on its website show individual communities with a range of on-time response rates, many of them very low:

• Belledune's calls did not hit the target of 90 per cent on-time response in any month of 2022, and its rate was a mere 29.2 per cent in December.

• Port Elgin's on-time response rate ranged from 55.6 per cent in July to 15.8 per cent in September.

• Blackville had an on-time rate higher than 90 per cent only once, in April, when it was 90.2 per cent. Its lowest rate was 58 per cent in July.

• Fords Mills, in Kent County, was at 57.1 per cent in May of last year, its best result, while its worst month was August at 23.1 per cent.

• In Caraquet, Ambulance N.B.achieved the target response time 88.3 per cent of the time in October 2022, but only 65.6 per cent of the time in December of that year.

"There are communities, if you look at the data, that are not performing as well as other communities," Craig Dalton, CEO of Extra Mural/Ambulance N.B.,told the committee.

The contract includes exemptions for circumstances beyond Medavie's control. In those cases, late responses don't count against the targets or its bonus payments.

Watson, who is also the assistant deputy minister in the provincial health department, said those exemptions will be part of the negotiations that he hopes will be underway before Christmas.

"Both parties know that and are willing to have that conversation," he said.

Medavie Health Services N.B.did not respond immediately to a request for a comment on the potential for changing the contract.

The 2020 audit said the exemptions mean there's less incentive for Ambulance N.B.to improve its numbers.

"[Medavie] is given the opportunity to focus resources on urban areas, while having decreased performance in outlying communities and without impacting its performance-based payments," Auditor General Kim Adair-MacPherson wrote then.

Asked what steps Ambulance N.B. has taken to address the issues raised in the audit, Dalton pointed out that the organization now posts individual community response times on its web site.

And he said the provincial entity has approached Medavie to reopen the contract, which expires in 2027.

"We've expressed our desire to participate in that contract review process and specifically lookat these targets," he said.

He said what he called "systemic issues" beyond Ambulance N.B.'s control have affected response times.

These includean increase in delays offloading patients at hospitals in 2022 and a 10-per-cent increase in ambulance calls overall.

The CEO refused to tell Memramcook-Tantramar Green MLA Megan Mitton how much was paid to Medavie in performance bonuses in 2022, saying he might not be allowed to disclose it under the contract.

"I'm not certain we can divulge the amount today," he said.

Mitton pointed out however that Ambulance N.B. revealed in a previous committee appearance that there were $2.7 million in bonuses paid out in the 2020-21 fiscal year.