Cities Try to Figure Out Next Step on Ambulances

Attorneys for several Orange County cities and an agency representing 19 others are scrambling to respond to a recent landmark state Supreme Court ruling limiting the right of cities to provide public ambulance service.

The state’s high court ruled June 30 in a case originally involving San Bernardino County that if a city did not already provide ambulance service before June 1980, it could not get into the business without county approval.

The court also ruled that counties, not cities, control the emergency management system and that ambulance-service contracts awarded for exclusive operating areas existing after 1981 must be competitively bid.

Since the court decision, city and county attorneys have been studying the 80-page ruling. County officials have contacted city officials in Orange, Huntington Beach, La Habra and Newport Beach to tell them to continue providing city ambulance service until further notice.

City ambulance service also hasn’t changed in San Clemente, Westminster or Santa Ana, where city service predates 1980.

“It’s very complicated,” conceded Capt. Scott Brown of the Orange County Fire Authority, the entity given responsibility by the county for emergency planning when it was formed in 1995. “We’re still reviewing what it means.”

The Fire Authority is proposing to take over ambulance transport from private companies serving its 19 cities and the county’s unincorporated area.

The authority was preparing to vote this month or next to authorize the takeover, which it said would result in a 10% drop in the patient transport charge--from $300 per trip by private companies to $270 for firefighter paramedics.

Due in large part to the court ruling, the authority’s budget and finance committee recently voted against recommending a takeover. The committee instead proposed charging existing private ambulance companies for the cost of providing firefighter paramedic services. And that would hit consumers hard.

Under the new proposal, which must be reviewed by the full 21-member authority board, patients transported to hospitals would be charged $450--the $300 fee plus another $150 to recoup public paramedic costs.

In Orange, Assistant City Atty. Wayne Withers told council members in a recent memo that he feels confident that the city’s takeover of ambulance service in 1995 was proper. The city got permission from the county before taking the action.

However, the city still faces a lawsuit from Medix Ambulance Service, which shared responsibility for city transport with CareLine of California. Medix argued that the Orange Fire Department should have had to compete for the contract with private companies. The city contended it didn’t have to bid on the contract because ambulance service in Orange County has been a municipal responsibility since before 1980.

Huntington Beach Fire Chief Michael P. Dolder said his city also obtained written permission from the county to take over ambulance service from Seals Ambulance Co. in 1993. So did Newport Beach and La Habra before they took action.

Even the Ambulance Assn. of Orange County isn’t sure yet how the court case will affect the future of ambulance service across the county. The association is in the midst of a city-by-city review, said Jim Karras, association president and regional manager of Schaefer Ambulance Service of Santa Ana.

“All I can say now is that, philosophically, we’re always opposed to a takeover without a competitive process,” Karras said. “We have some questions about how a private company can compete with a municipality [for a contract] if they design the process and award the contract.”

San Diego attorney Michael Scarano, who sided with San Bernardino County on behalf of several health-care groups before the state Supreme Court, said the impetus for a county-based emergency care system came out of a desire in the early 1980s to end a patchwork of service that resulted in some areas being well-covered and other, often rural, areas being underserved.

In some instances, the fragmented system resulted in patient deaths, he said.

“If you had cities setting up their own systems, you’d have like Los Angeles County where you have 60 different providers covering their own little areas,” he said. “There might be an ambulance two miles away but because of where you are, you might get a response from an ambulance 10 miles away.”

Dolder of Huntington Beach said that scenario wouldn’t happen in Orange County regardless of whether ambulances respond from private companies or city fire departments. Since the early 1970s, the county has required all ambulance providers to respond as needed even outside city boundaries.

“The real question is how do you maintain a seamless emergency care system,” Dolder said, “and we do that now.”