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Riverside (Calif.) Ambulance Rules Dispute Intensifies

RIVERSIDE, Calif. -- Riverside city and county officials are considering how to respond to a state agency's opinion that the city overstepped its authority by limiting ambulance services.

American Medical Response, or AMR, has an exclusive contract for 911 ambulance service in most of Riverside County, including the city of Riverside. Non-emergency medical transportation -- such as trips between a hospital and nursing home -- is an open market in which any company with a permit from the county EMS agency may compete.

Except in the city of Riverside.

For more than 40 years, the city has restricted non-emergency, or "retail," ambulance companies by requiring them to apply for franchise agreements.

To get a franchise agreement, an ambulance provider must have the proper insurance and certifications, and it must convince Riverside officials there is a need for its services and that the competition won't financially harm any existing providers. Several companies have applied in recent years, but the only company to be granted a city permit is AMR.

That has some would-be competitors questioning the city's rules. The issue prompted Corona-based Mission Ambulance, which was denied a city permit in October, to seek an opinion from the state Emergency Medical Services Authority, an agency that oversees county plans for emergency medical service.

In a Jan. 25 letter to Mission, EMSA Director Howard Backer wrote that the state's existing health and safety code sections on ambulance service negated older rules that let cities restrict service if they didn't believe there was a public need.

"The justification for 'need and necessity' cannot be used by the city of Riverside to limit the provision of ambulance services," Backer wrote.

With most of the permit applications Riverside has rejected, the city concluded the applicants failed to show a need for more ambulance service.

Backer also pointed out that Riverside County's state-approved plan for emergency medical services doesn't create exclusive operating areas for non-emergency transports, so "any qualified provider must be allowed to provide ambulance services at that level."

Riverside City Attorney Greg Priamos has previously disagreed with EMSA officials' assessment that the city has no authority to limit ambulance service. Regarding Backer's recent letter, Priamos on Friday would only say the city has received it and is considering its response.

Officials from Mission Ambulance and Symons Ambulance said they think Backer's comments were quite clear that Riverside doesn't have the authority to keep them out. Symons had applied for a city permit under a different name and was rejected.

"This was our argument from the very beginning and (Backer's letter) absolutely supports it," Mission Chief Operating Officer Rick Hartsock said.

Symons Medical Director Jeff Grange agreed, saying, "We believe we could legally go in and (provide service) today," but the threat of litigation from either the city or a much larger company like AMR is a major concern for smaller companies like his.

"Even though you would probably prevail (in court), it would cost you a fortune and potentially put you out of business," Grange said.

AMR is one of the nation's biggest ambulance companies, operating in 38 states. Critics of Riverside's rules have suggested a contract under which AMR pays about $1.4 million a year to fund the city's paramedic program is tantamount to a kickback for remaining the exclusive non-emergency provider, but city officials have maintained the contract has to do with emergency response times and is unconnected to retail ambulance service.

Despite Backer's comments, EMSA is not expected to get involved in the issue because it has no enforcement power. But Backer did recommend that the Riverside County Emergency Medical Services Agency "address the legitimate concerns" raised by Mission Ambulance.

Bruce Barton, director of the Riverside County Emergency Medical Services Agency, said he plans to meet with Mission Ambulance officials. He declined to respond to Backer's letter other than to say, "That's a legal question and that's why we referred the letter to county counsel."

Hartsock said he's waiting to see what happens at the county meeting before determining the next step, but Grange has low expectations that things will change.

If EMSA can't enforce its position and Riverside County officials won't, "What do you do? You can't go pick a fight that the agencies that are supposed to regulate it won't support you," Grange said.



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