If private-ambulance workers take a break from work, even for 10 minutes, it can mean the difference between life and death.
So, they routinely accept emergency calls during their meal and rest breaks — just as firefighters, policemen and other public emergency workers do.
But labor laws guarantee most California workers uninterrupted breaks, and multiple lawsuits are challenging whether private ambulance companies have the right to interrupt their employees’ breaks.
In November, voters will resolve the issue. Proposition 11 — a measure backed and funded by American Medical Response (AMR), California’s largest private ambulance company — would require private-ambulance employees to remain on call during their breaks.
“If a dispatcher calls and the closest ambulance is only a few blocks away, they’ll be reachable and ready to respond,” said Marie Brichetto, spokeswoman for the campaign advocating the ballot measure. “In times of emergency, seconds will make a difference.”
Proposition 11 also would require private ambulance companies to provide their employees with mental health coverage and training to respond to natural disasters, mass shootings and other emergencies.
The ballot measure would apply to the state’s estimated 17,000 private ambulance employees, including dispatchers, emergency medical technicians (EMTs) and paramedics, who answer about three-quarters of the state’s emergency calls, according to a report by the state Legislative Analyst’s Office. The initiative doesn’t affect public ambulance workers because the labor codes governing rest and meal breaks apply only to private-sector workers.
Opponents of the measure, including a California lawmaker who works part time as an EMT, call it a “misleading” effort by the industry to save money on staffing — and get out of potentially bank-breaking lawsuits.
The initiative isn’t about public safety, but rather “trying to extract machine-level work from human beings,” said Mike Diaz, an AMR employee in Antelope Valley and president of the International Association of EMTs and Paramedics Local 77.
For AMR, “the most efficient ambulance crew is one that is on a call for every hour of your 24-hour shift,” he said. “We’re not machines. We need rest.”
The initiative grew out of a 2016 state Supreme Court ruling in Augustus v. ABM Security, which found that a California security company had failed to meet its legal obligation to provide breaks because its workers had to remain on call.
Given the similarities between the private security and ambulance industries, the case is likely to be applied to private EMTs and paramedics, the analyst’s report concluded.
AMR is already facing at least two lawsuits from employees who say they were denied breaks.
If the ambulance companies lose in court, they can no longer assume their employees are available during their breaks and would have to increase staffing — which could cost the industry around $100 million a year, the report said.
Proposition 11 is the industry’s effort to avoid that. The ballot measure also includes a provision that would effectively nullify the pending lawsuits.
So far, AMR is the only donor on either side of the measure. The company has poured about $3.6 million into a committee to support the measure, and the committee has used about $3 million of that, mostly to get the measure on the ballot. AMR declined to comment for this article and referred inquiries to Brichetto, the Proposition 11 campaign spokeswoman.
Some ambulance companies have offered muted support for the measure, while others have remained silent.
Edward Guzman, CEO and general manager of the nonprofit Sierra Ambulance Company in eastern Madera County, said he supports Proposition 11. But he acknowledged there are some private companies that overwork their employees.
“Some of the urban providers … were running their people into the ground and not providing adequate rest or breaks,” he said. “There are players that will continue to do that because they don’t want to add extra units into the mix.”
This summer, Sierra added an additional ambulance and paramedics to its daytime rotation to respond to higher demand, and employees have a strong collective bargaining agreement that protects them from overwork or abuse, Guzman said.
Still, he fears that his smaller company could get slammed with lawsuits if Proposition 11 doesn’t pass. The measure protects Sierra “from unnecessary and expensive litigation,” he said.
County officials across the state cannot take political positions, but some worry that if the measure fails and lawsuits against the companies succeed, the cost of hiring more ambulance workers could be passed on to them. Some counties hire private ambulance companies to supplement local fire departments and public ambulances.
“Somebody’s gonna have to pay for that,” said Cathy Chidester, director of Emergency Medical Services for Los Angeles County. “That [cost is] going to go back to the general public.”
Opposition to the ballot measure is largely unorganized but includes some unionized emergency response workers and lawyers representing the plaintiffs who are suing AMR. They argue that the proposition won’t change how private-ambulance employees operate, because their first instinct is to help people in distress.
“If I see something happen in front of me while I’m having my meal or rest break, I’m gonna respond. That’s our duty. That’s our calling,” said state Assemblyman Freddie Rodriguez (D-Pomona), who works part time as an EMT. “We’re not gonna sit there and watch somebody die just because we’re eating.”
Rodriguez and other opponents say the Proposition 11 campaign’s emphasis on public safety masks its true intentions: to maximize private companies’ profit margins.
“It’s a little misleading,” Diaz said.
EMT and paramedic workloads vary greatly depending on the county and employers. Diaz, who works in the Antelope Valley region of Los Angeles County, said his area is chronically understaffed. But Dandy Mendoza and Esther Nungaray, who work for American Ambulance in Fresno County, said they take an average of six to seven calls during a 12-hour shift — a number they consider reasonable.
“I don’t really have a strong opinion because I really like my job. I show up to take care of people,” Mendoza said. “I try to stay out of politics.”
This story was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.