Re: Re: City Ordinances

January 29, 2006

Politics is politics anywhere, not just in Texas. Unfortunately, too many

believers in " free enterprise " are all for the government intervening when it

could help them. However, when regulation might impact them, you hear the

howls of " free enterprise. "

-Wes

In a message dated 1/29/2006 10:14:19 PM Central Standard Time,

scapuchino@... writes:

This is Texas and unfortunately politics will always

play a roll.

Salvador Capuchino

EMTP

--- Kim wrote:

> I agree that regulation is needed.

>

> But...

>

> It's just unfortunate though that the ones who are

> doing the " regulating " of

> ambulance services in many cities (in other words,

> granting or denying

> franchises) are *not* the ones who are actually in

> the trenches of patient

> care. It's not the hospital physicians, nurses, or

> nursing home staff who

> are allowed to decide which competent and licensed

> ambulance service may

> assume care of their patients... it's a city

> governmental and administrative

> body who does. And as such, the hospital cannot

> call the transfer service

> they *want* to use for the best patient care when

> the choice is severely

> limited to a single service because of long-standing

> city ordinance and

> franchise protections.

>

> I've recently learned a hard lesson that politics

> will always play a factor

> in local government, no matter how good or honorable

> your intentions and

> labours. If regulation and permission to operate

> was granted by a medical

> body of the city, I would be more optimistic of the

> whole situation. I see

> it as a cold day in Hades before a city will ever

> relinquish that control

> willingly, and so the patient may never experience

> " the best care " . The

> patient will only receive " the available care " per

> ordinance, as the only

> service in town has little reason to improve beyond

> the lowest standard when

> protected by the city.

>

> > It amazes me that these actions in South Texas are

> met with such surprise

> > and indignation when they have been a part of the

> EMS landscape for over

> > 20

> > years, While the free-market should prevail, all

> one has to do is look at

> > the medical helicopter industry and see that EMS,

> in whatever form, never

> > can manage itself and government must step in.

>

January 29, 2006

Politics is politics anywhere, not just in Texas. Unfortunately, too many

believers in " free enterprise " are all for the government intervening when it

could help them. However, when regulation might impact them, you hear the

howls of " free enterprise. "

-Wes

In a message dated 1/29/2006 10:14:19 PM Central Standard Time,

scapuchino@... writes:

This is Texas and unfortunately politics will always

play a roll.

Salvador Capuchino

EMTP

--- Kim wrote:

> I agree that regulation is needed.

>

> But...

>

> It's just unfortunate though that the ones who are

> doing the " regulating " of

> ambulance services in many cities (in other words,

> granting or denying

> franchises) are *not* the ones who are actually in

> the trenches of patient

> care. It's not the hospital physicians, nurses, or

> nursing home staff who

> are allowed to decide which competent and licensed

> ambulance service may

> assume care of their patients... it's a city

> governmental and administrative

> body who does. And as such, the hospital cannot

> call the transfer service

> they *want* to use for the best patient care when

> the choice is severely

> limited to a single service because of long-standing

> city ordinance and

> franchise protections.

>

> I've recently learned a hard lesson that politics

> will always play a factor

> in local government, no matter how good or honorable

> your intentions and

> labours. If regulation and permission to operate

> was granted by a medical

> body of the city, I would be more optimistic of the

> whole situation. I see

> it as a cold day in Hades before a city will ever

> relinquish that control

> willingly, and so the patient may never experience

> " the best care " . The

> patient will only receive " the available care " per

> ordinance, as the only

> service in town has little reason to improve beyond

> the lowest standard when

> protected by the city.

>

> > It amazes me that these actions in South Texas are

> met with such surprise

> > and indignation when they have been a part of the

> EMS landscape for over

> > 20

> > years, While the free-market should prevail, all

> one has to do is look at

> > the medical helicopter industry and see that EMS,

> in whatever form, never

> > can manage itself and government must step in.

>

January 30, 2006

In a message dated 30-Jan-06 11:27:21 Central Standard Time,

bbledsoe@... writes:

Wes or Gene should probably answer this, but I think a municipal ordinance

trumps TDSHS " rules " since the former is actually a law and the latter a

rule or guideline.

You may be surprised there, ...in most states, executive rules and

guidelines promoted by divisions and bureaus created and funded by the

legislature, have the effective force of state law, just like CMS regulations

have the

effective force of Federal Law.

and it's a generally held guideline that local ordinances can be more strict

than state laws (unless there is a state preemption), and state laws may be

more strict than federal laws, but no lower level division can make a

particular law *less* strict...this is where the Pot Legalization efforts in

California and Oregon are falling afoul of the courts...

ck

S. Krin, DO FAAFP

January 30, 2006

In a message dated 30-Jan-06 11:27:21 Central Standard Time,

bbledsoe@... writes:

Wes or Gene should probably answer this, but I think a municipal ordinance

trumps TDSHS " rules " since the former is actually a law and the latter a

rule or guideline.

You may be surprised there, ...in most states, executive rules and

guidelines promoted by divisions and bureaus created and funded by the

legislature, have the effective force of state law, just like CMS regulations

have the

effective force of Federal Law.

and it's a generally held guideline that local ordinances can be more strict

than state laws (unless there is a state preemption), and state laws may be

more strict than federal laws, but no lower level division can make a

particular law *less* strict...this is where the Pot Legalization efforts in

California and Oregon are falling afoul of the courts...

ck

S. Krin, DO FAAFP

January 30, 2006

In a message dated 30-Jan-06 11:27:21 Central Standard Time,

bbledsoe@... writes:

Wes or Gene should probably answer this, but I think a municipal ordinance

trumps TDSHS " rules " since the former is actually a law and the latter a

rule or guideline.

You may be surprised there, ...in most states, executive rules and

guidelines promoted by divisions and bureaus created and funded by the

legislature, have the effective force of state law, just like CMS regulations

have the

effective force of Federal Law.

and it's a generally held guideline that local ordinances can be more strict

than state laws (unless there is a state preemption), and state laws may be

more strict than federal laws, but no lower level division can make a

particular law *less* strict...this is where the Pot Legalization efforts in

California and Oregon are falling afoul of the courts...

ck

S. Krin, DO FAAFP

January 30, 2006

In a message dated 30-Jan-06 11:53:38 Central Standard Time,

ExLngHrn@... writes:

Pretty good for a brief lesson in administrative law and in the authority of

local governments. I'll write you a letter of recommendation for law school

in the event that you don't play enough golf as a physician. <tongue firmly

in cheek>

-Wes Ogilvie

What I'm planning to check out when we move to MO is if they still allow

challenges to the Bar....and if they do, I'll find me a nice friendly judge to

clerk and investigate for in my 'spare time'...a couple of years of 'reading

the Law' like that, and I'll bet that I can beat the Bar exam without more

than a basic 'Kaplan board course' under my belt.

ck

S. Krin, DO FAAFP

January 30, 2006

In a message dated 30-Jan-06 14:09:30 Central Standard Time,

ExLngHrn@... writes:

My advice is to check out BarBri when you decide you want to challenge/take

the Bar exam.

thanks... is a good outfit.

ck

S. Krin, DO FAAFP

January 30, 2006

Re: Re: City Ordinances

>

> Politics is politics anywhere, not just in Texas. Unfortunately, too

> many

> believers in " free enterprise " are all for the government intervening when

> it

> could help them. However, when regulation might impact them, you hear

> the

> howls of " free enterprise. "

>

> -Wes

>

Yes, that's true Wes... and you know I have a lot of respect towards your

opinions. But that doesn't mean one should drop the idea or efforts to

create a more balanced system, one that incorporates the optimal amount of

regulation by a more *unbiased* and medically-educated party (obviously,

avoiding bias completely is impossible when dealing with human nature) and

still allowing enough free enterprise to give the patients a chance at

better care. Why are the same people who decide on zoning ordinances, water

rights, city budgets, and sewer line rerouting the same people who decide

what's best for the patient in a non-emergency transfer situation? Because

they were elected to do so. But are they physicians or RNs?

When a hospital nurse has NO choice but to call a particular existing

ambulance service because a city ordinance says they can use no other,

regulation has gone too far. Especially when the patient's condition would

benefit significantly from onboard critical care equipment and skilled crews

with another service, and the helicopter option is simply unavailable due to

weather. That patient does not benefit from a lower level of care,

especially if the granting of franchises in that city was primarily based on

" call volume " numbers. The patients have been cheated.

I'm 100% in support of franchises or permits when the city feels that a

standard is required beyond the extensive TDSHS licensing process. I'm 100%

for franchises to maintain a fluid, sound 9-1-1 system that does not allow

rouge services to steal away calls. But what about non-emergency transfers

by TDSHS licensed services who offer a higher level of competancy? Why not

allow them to obtain a permit from the city based on that competancy, and

not a vote by elected officials?

I'm sure many of us agree that quite a few ambulance services leave much to

be desired, and need to adhere to higher expectations. This should be the

goal of franchising or permitting; it seems obvious since the local

ordinances I've read list staffing, basic equipment, insurance, and vehicle

safety requirements for the application process. But I never specifically

read that the franchising process should protect the financial future of the

existing transfer service. But obviously, I've learned that it does.

In support of Dr. Bledsoe's observations with air services, I've personally

accepted care of patients from particular air services that leaves me

wondering just how many rivets still remained on the bird before takeoff.

Yes, regulation is needed for both air and ground, but based on medical

competancy and good service. I am not for the idea of franchises when

" protecting the existing business concern " is the prevailing factor instead.

If as a franchise-holder, I have to compete head-to-head with a " big

service " because of lack of business protections, then I say bring it on!

The best service will care about their crews, their patients, and their

equipment first, and it will show.

(And with that lecture, let's see if this email program is going to behave

itself better today, unlike yesterday. ;-) )

January 30, 2006

No arguments there. Just saying that sometimes, the city officials who know

nothing about EMS may get " guidance " from friendly folks from the local transfer

services who want to protect their turf. They like that kind of government

interference. Now, if you get the city officials mandating certain standards,

those same friendly folks become very unfriendly, claiming that the city

shouldn't regulating private business.

Pardon my cynicism. It's Monday morning.