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California City Considers Ambulance Policy Changes

Long-awaited new rules for ambulance companies in Riverside would overhaul the city's permit system for non-emergency medical transport, but they came with an unexpected twist: They also would apply to 911 ambulance response within its boundaries.

Any move by Riverside to give permits for 911 service would be at odds with a state-approved plan that gives Riverside County oversight of emergency ambulance service. The county has a near-exclusive contract with American Medical Response.

Riverside Fire Chief Steve Earley recommended the changes, which the council will discuss Tuesday, Sept. 24. Officials said the proposal is not intended to change existing 911 ambulance service, but rather to spell out rights the city believes it has always had.

Earley said the recommendations are intended to ensure the best possible medical transportation for people in Riverside.

"We're trying to make it easier for the (franchise) applicants and the council," he said.

But one ambulance company hoping to get into Riverside's non-emergency market has already questioned whether the proposed new rules could make it even harder to get an application approved.

There are two kinds of ambulance service: emergency, which is triggered by 911 calls, and non-emergency, also called retail or interfacility transport. Non-emergency service might take patients from a nursing home to a doctor's office, or from a hospital to a long-term care center. Providing non-emergency service is more lucrative than providing 911 service because it's more likely to be covered by insurance.

For nearly two years, some Riverside officials have acknowledged the need to change their franchise permit system for non-emergency ambulances, which has created a de facto monopoly for the one company with a permit, AMR.

Other providers have applied for permits, but the council has rejected them all, saying they didn't meet the city's criteria.

NEW RECOMMENDATIONS

Riverside is the only city in the county where retail ambulance service providers need a permit the city refers to as a franchise.

Everywhere else, companies only need a permit from the county to sign contracts with medical providers and otherwise compete for business.

Among Earley's recommendations are:

Creating a new franchise fee.

Requiring that franchise holders be accredited by an independent industry group, the Commission on Accreditation of Ambulance Services.

Setting up a city inspection process.

Taking out a provision that says the council should consider whether granting any new permit would "threaten the economic viability" of current permit holders.

Existing state and county rules require ambulances to be inspected by the California Highway Patrol and Riverside County.

"We give them a very thorough look from top to bottom" when a company first applies for a county permit, said Bruce Barton, director of the Riverside County Emergency Medical Services Agency.

As to why an additional city inspection might be needed, Earley said, "I'm not sure how detailed (the county's) inspection is. … When they're operating in the city we want to make sure they're a certain condition for the safety of our residents."

Rick Hartsock, of Mission Ambulance, which was turned down for a Riverside permit in 2011, worried that the suggested accrediting commission is "a private club" and said he doesn't know of other local governments that require it. He questioned whether the commission would be biased because its executive director is married to an AMR executive.

Earley's proposal is "absolutely my worst fear, which was suggested to strengthen the monopoly that they already have," Hartsock said.

Earley said he doesn't think the accreditation process could be manipulated by any one person.

Barton said the county is in the midst of a thorough study of its entire emergency medical service system and he's considering an accreditation requirement as part of that.

June Iljana, executive director of the California Ambulance Association, said accreditation by CAAS is not uncommon and follows a stringent process.

EMERGENCY SERVICE

If the council agrees to the changes, it would be the first time the city has had two types of franchises, one for 911 service and one for non-emergency service.

Earley said the city already has its own contract with AMR and he thinks the company does a good job, adding that he's not recommending that the council seek bids for emergency ambulance service.

City spokesman Phil Pitchford said Monday that there's "currently no effort to change the existing arrangement for emergency service."

Pitchford said the proposal regarding 911 service aims to make clear that the city has always had the authority to govern all ambulance service in its territory.

But the state Emergency Medical Services Authority, which reviews and approves county plans for emergency services, appears to disagree.

"Under Riverside County's existing plan there is not a condition for anybody other than the county to be handling the exclusivity or the operations of the EMS system," said Tom McGinnis, chief of the agency's EMS systems division.

Barton said he's not ready to weigh in on whether Riverside has the authority to create its own contract for 911 ambulance service independent of the county agreement. "I want to hear what they have to say and figure out what the actual intent (of the changes) is before I comment," he said.

Pitchford said Tuesday's workshop will largely focus on the non-emergency provisions.



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