PHILADELPHIA -- When Carol White sued the city in 1994 after it took 19 minutes for an ambulance to respond to her dying mother, the city presented a novel argument in its legal defense.
"The plain truth is that Esther Piazzo's friends and family could have sought private medical and ambulance services," a city lawyer wrote in a federal court filing.
But private ambulances licensed in Philadelphia are required to sign a statement acknowledging that the city fire department "is the sole responder to medical emergencies through the 911 emergency system."
"They don't like us running lights and sirens in the city," said Mike Green of Patriot Ambulance, a private company based in Huntingdon Valley, just across the Montgomery County line from Philadelphia. "I've had [Philadelphia] police follow me on a call."
In truth, making emergency runs has long been a legal gray area for the 40 private and nonprofit ambulance companies operating in Philadelphia.
Most transport patients between institutions like nursing homes and hospitals.
But a few provide emergency service to residential subscribers, and as the city's over-burdened ambulance corps faces increasing strain and criticism, some are urging the city to tap non-municipal ambulances for help.
The issue came into focus after the early morning death of Deborah Payne, who died Jan. 1 after waiting more than an hour for a city ambulance.
Rob Berkoff of Northeast Community Ambulance noted that he had an ambulance sitting in his shed only seven blocks away while city medic units were overwhelmed by calls from New Year's Eve revelers.
"The city doesn't have the money or manpower now to handle this," Green said. "If they would incorporate us into the 911 system, it would help."
Bringing non-municipal ambulances into the 911 system would require getting them communications equipment and sorting out legal and quality-control issues.
Short of that, could a private ambulance service sign up citizens who want an alternative to the city's 911 system?
"I would say not," said George Butts, the director of the Philadelphia Regional Emergency Medical Services Council, citing a 1988 executive order by Mayor Wilson Goode giving the fire department responsibility for EMS.
But Butts said it's understood some private and non-profit ambulances do perform emergency runs, and he's willing to consider a greater role for them in the future.
"My personal opinion is that they're a valuable resource," Butts said, noting the city has now brought non-municipals into disaster planning and drills.
Fire commissioner Lloyd Ayers has said increased use of private companies isn't something he rules out for the future.
David Kearney, recording secretary for the city firefighters union and a 15-year paramedic, said city crews are better trained, better screened and better able to handle a range of emergency situations than private ambulances.
"I've raised my hand and taken an oath to serve the citizens of Philadelphia and follow orders," Kearney said. Private companies have different loyalties, he said, and he doubts many crews would be willing to serve all areas of the city as the fire department does.
Joe Schmider, EMS director for the state health department, said the training and certification requirements for private ambulances and their crews are identical to those for city medic crews.
"To the commonwealth, there's no difference between a city ambulance and a private ambulance," Schmider said. "An ambulance is an ambulance."
Schmider said many counties in Pennsylvania use both municipal and non-municipal ambulances to respond to 911 calls.
"Big cities like New York do it," said Tim Hinchcliff, who represents nonprofit companies on the EMS Council and advocates their use for 911 emergencies."Maybe only 10 of the 40 ambulance services here would participate," Hinchliff said, "but we could sit down and work out the details, and it would save the city money and help its citizens."