Riverside officials' upcoming decision on whether to allow a second ambulance service hinge on how they define public necessity, and whose assessment of it they accept.
Riverside has had a single ambulance company for all medical calls, whether emergency or routine, since at least 1971, according to city records. Corona-based Mission Ambulance hopes to change that with its application to operate nonemergency service in Riverside.
A public hearing on Mission's application is scheduled Tuesday, but the company has requested a one-week postponement.
State law gives counties jurisdiction over who handles 911 ambulance calls, and Riverside County has long had an exclusive contract with American Medical Response, or AMR.
The city of Riverside controls the nonemergency, or "retail" ambulance market through franchise agreements that the council can grant or deny, and so far AMR is the only franchise holder. Officials say Riverside is the only city in the county to operate this way; other cities allow any company that meets the county's criteria to do business there.
The origins of Riverside's franchise rule are murky. Mayor Ron Loveridge was on the council in 1989 when the current version of the rule was adopted, but he said he doesn't recall the rationale.
City records show franchise authority extends back as far as 1980, and the city had agreements with a single company even prior to 1971.
Riverside's ambulance rules say when a company applies for a franchise, the council must consider whether the "public health, safety, welfare, convenience and necessity" indicate a need for the service.
Cities can have a legitimate public purpose in regulating how many ambulances, taxis or trash trucks, for example, can operate, said Michael Jenkins, an attorney for government agencies including the cities of Diamond Bar, Hermosa Beach and West Hollywood. Typical reasons are to coordinate services and make sure companies meet standards such as response times.
Riverside Fire Chief Steve Earley is recommending the council deny Mission a franchise because his investigation did not find any unmet need for ambulance service. A survey by one of Earley's battalion chiefs focused on whether hospitals and care centers are satisfied with AMR's service.
Whether patients aren't getting picked up may not be the only consideration. To help clarify the issue, City Attorney Greg Priamos cited language from a related California Supreme Court case that says public necessity "does not mean indispensable to the public but an urgency less pressing."
Officials from three care centers in the city wrote letters to the city saying they need another ambulance service. With only one, "we are at the mercy of that company for appointment times and costs," wrote Chris Romney, executive director of Alta Vista Healthcare and Wellness Centre.
Officials with ambulance companies and area hospitals said competition affects patient costs.
Corona Regional Medical Center spokeswoman Linda Pearson said the hospital has contracts with Mission and County Rescue Ambulance for nonemergency service, and having a choice provides better response times and leverage in negotiations.
AMR officials could not be reached for comment Friday.
A list of rates ambulance companies provided to Riverside County shows a basic life support call can cost a flat rate of $341, charged by Premier Medical Transportation of Colton, to $1,499, charged by Escondido-based AmeriCare Ambulance.
Additional per-mile charges range from $15 to $39, charged by Premier and AmeriCare, respectively.
AMR's listed rates in Riverside were a $560 flat charge and $33 per mile; Mission's rates for the same services are $866 and $26.
Mission Chief Operating Officer Rick Hartsock said the rates on the county list are a ceiling, but where there's competition the actual charges can be much less.
For example, Mission's competitive rates are $225 for a basic life support call and $7 per mile.
Kaiser Permanente Chief Operating Officer Lesley Wille recently told city officials that AMR's costs can be as much as several hundred dollars more for basic transport and six times more per mile than Kaiser's contract rates with Mission.
Besides considering the need for more ambulance service, Riverside officials are supposed to look at whether granting another franchise would "impair the economic viability" of the existing permit holder.
Priamos said it's a secondary consideration.
Jenkins, the municipal lawyer, cautioned that he doesn't know the specifics of Riverside's rules, but he said the financial impact provision as described to him is "an unusual criterion."
"If ultimately the city never intends to issue a second franchise, it seems kind of pointless to put people through the exercise of applying," he said.